Atopic dermatitis (eczema)

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Periocular dermatitis: a report of 401 patients.

J Eur Acad Dermatol Venereol. 2009 Feb;23(2):124-8

Authors: Temesvári E, Pónyai G, Németh I, Hidvégi B, Sas A, Kárpáti S

BACKGROUND: Periocular contact dermatitis may appear as contact conjunctivitis, contact allergic and/or irritative eyelid and periorbital dermatitis, or a combination of these symptoms. The clinical symptoms may be induced by several environmental and therapeutic contact allergens. OBJECTIVES: The aim of the present study was to map the eliciting contact allergens in 401 patients with periocular dermatitis (PD) by patch testing with environmental and ophthalmic contact allergens. METHODS: Following the methodics of international requirements, 401 patients were tested with contact allergens of the standard environmental series, 133 of 401 patients with the Brial ophthalmic basic and supplementary series as well. RESULTS: Contact hypersensitivity was detected in 34.4% of the patients. Highest prevalence was seen in cases of PD without other symptoms (51.18%), in patients of PD associated with ophthalmic complaints (OC; 30.4%), and PD associated with atopic dermatitis (AD; 27.9%). In the subgroup of PD associated with seborrhoea (S) and rosacea (R), contact hypersensitivity was confirmed in 17.6%. Most frequent sensitisers were nickel sulphate (in 8.9% of the tested 401 patients), fragrance mix I (4.5%), balsam of Peru (4.0%), paraphenylendiamine (PPD) (3.7%), and thiomersal (3.5%). By testing ophthalmic allergens, contact hypersensitivity was observed in nine patients (6.7% of the tested 133 patients). The most common confirmed ophthalmic allergens were cocamidopropyl betaine, idoxuridine, phenylephrine hydrochloride, Na chromoglycinate, and papaine. LIMITATIONS: Patients with symptoms of PD were tested from 1996 to 2006. CONCLUSIONS: The occurence of contact hypersensitivity in PD patients was in present study 34.4%. A relatively high occurrence was seen in cases of PD without other symptoms, in PD + OC and in PD + AD patients. The predominance of environmental contact allergens was remarkable: most frequent sensitizers were nickel sulphate, fragrance mix I, balsam of Peru, thiomersal, and PPD. The prevalence of contact hypersensitivity to ophthalmic allergens did not exceed l.5%.

PMID: 18761544 [PubMed - indexed for MEDLINE]

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Contact dermatitis in car repair workers.

J Eur Acad Dermatol Venereol. 2009 Feb;23(2):138-45

Authors: Attwa E, el-Laithy N

BACKGROUND: Occupational contact dermatitis (OCD) is a common skin disorder with a poor prognosis. OBJECTIVES: The objectives of this study were to (1) estimate the prevalence of CD among car repair workers, (2) study some risk factors associated with CD, and (3) conduct an intervention skin care education program. SUBJECTS AND METHODS: A cross-sectional study was conducted in 87 car repair workers with regular and direct exposure to chemicals at the industrial zone in Zagazig City, Egypt and 76 unexposed assembly booksellers. All workers were subjected to a questionnaire and clinical examination, and those who were diagnosed clinically as CD were patch tested. Intervention study with a skin care education program was carried out on 47 car repair workers. Re-evaluation of the intervention group after 5 months was done. RESULTS: The total prevalence of CD among car repair workers (18.4%) was significantly higher compared with their controls (3.9%), with the highest prevalence among car mechanics (24.1%) and painters (20.7%); 16.1% of them reported recurrent dermatitis in the last 12 months. Nickel accounted for most positive patch test reactions (33.3%). A significant association was noticed between the prevalence of CD and age, smoking, atopic background and duration of work. After the intervention study, a significantly higher knowledge level about CD was reported. CONCLUSION: The most important risk factors for OCD among the car repair workers are atopic background and long duration of work. Skin care education program is an important tool for prevention of CD and control of exposure to substances hazardous to the skin.

PMID: 18705631 [PubMed - indexed for MEDLINE]

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Atopic dermatitis and risk factors in poor children from Great Buenos Aires, Argentina.

Clin Exp Dermatol. 2009 Apr;34(3):299-303

Authors: Dei-Cas I, Dei-Cas P, Acuña K

BACKGROUND: In recent decades, the prevalence of atopic dermatitis (AD) has risen steadily, and risk factors for AD are currently being investigated worldwide. In Argentina, there are no available data on risk factors of AD. AIM: To determine the prevalence of and any gender predilection for AD, and to identify familial and environmental factors that are associated with increased AD risk. METHODS: In this case-control cross sectional study, 603 children aged 12-60 months old from a poor urban community in Buenos Aires were recruited. AD was defined following UK Working Party Diagnostic Criteria. We evaluated the relationship between AD and the presence of family history of atopy, > 5 family members, wearing synthetic clothes, having a carpeted room, eating > or = 3 eggs/week, tobacco smoking indoors by family members, and living< 300 m from a main road, polluted stream or industry. RESULTS: The prevalence of AD was 41.1% (95% CI 37.2-45.2%). Logistic regression analysis showed that AD was significantly associated only with a family history of atopy (OR = 5.7; 95% CI 3.7-8.8%; P = 0.0000), wearing synthetic clothes (OR = 2.2; 95% CI 1.4-3.5; P = 0.0009), having a carpeted room OR = 1.9; 95% CI 1.2-3.0%; P = 0.009) and living < 300 m from an industry (OR = 1.93; 95% CI 1.2-3.1%; P = 0.0051). CONCLUSION: We found a high prevalence of AD in our study population. Not all the investigated risk factors for AD had a significant association with the disease.

PMID: 19018789 [PubMed - indexed for MEDLINE]

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Cercarial dermatitis in the UK.

Clin Exp Dermatol. 2009 Apr;34(3):344-6

Authors: Fraser SJ, Allan SJ, Roworth M, Smith HV, Holme SA

‘Swimmer’s itch’ or cercarial dermatitis (CD) results from an immunological reaction to free-swimming non-human schistosome parasites released from aquatic snails. Affected bathers develop a self-limiting, pruritic, macular or papular eruption shortly after leaving the water. The condition is well-recognized in continental Europe, Asia and America, but has not to date been recorded in the UK.

PMID: 18699837 [PubMed - indexed for MEDLINE]

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Medium-dose ultraviolet (UV) A1 vs. narrowband UVB phototherapy in atopic eczema: a randomized crossover study.

Br J Dermatol. 2009 Mar;160(3):652-8

Authors: Gambichler T, Othlinghaus N, Tomi NS, Holland-Letz T, Boms S, Skrygan M, Altmeyer P, Kreuter A

BACKGROUND: Ultraviolet (UV) A1 and narrowband (NB)-UVB have been reported to be effective treatments for atopic eczema (AE). OBJECTIVES: We aimed to compare the efficacy of medium-dose UVA1 and NB-UVB mono-phototherapy in patients with AE. METHODS: A randomized double-blind controlled crossover trial (ClinicalTrials.gov Identifier: NCT00419406) was conducted in which patients with AE received a 6-week course of both medium-dose UVA1 and NB-UVB. Clinical efficacy was assessed using the Six Area, Six Sign, Atopic Dermatitis (SASSAD) score and a visual analogue scale for pruritus. Assessment of health-related quality of life was performed using the Skindex-29. Total immunoglobulin E (IgE) and eosinophilic cationic protein (ECP) were evaluated at baseline and after each phototherapy course. RESULTS: Twenty-eight patients who completed both UVA1 and NB-UVB phototherapy courses on an intention-to-treat basis were analysed according to the crossover design. Both interventions were associated with significant clinical improvement but there was no significant difference between treatments with respect to the mean +/- SD relative reduction (RR) of the clinical scores (SASSAD, 43.7 +/- 31.4% vs. 39.4 +/- 24.1%, P = 0.5; pruritus score, 16 +/- 61.8% vs. 25.2 +/- 30.5%, P = 0.5, respectively). There was no significant difference in the mean +/- SD RR of the Skindex-29 after UVA1 and NB-UVB phototherapy (12.7 +/- 18.8% vs. 16.5 +/- 17.6%, P = 0.1). Changes in the total IgE and ECP levels following UVA1 and NB-UVB did not differ significantly (P = 0.3 and P = 0.9, respectively). CONCLUSIONS: A 6-week course of NB-UVB and UVA1 phototherapy of AE resulted in significant clinical improvement. With regard to efficacy and tolerability, both phototherapeutic modalities may be considered comparably good.

PMID: 19120333 [PubMed - indexed for MEDLINE]

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First experience with enteric-coated mycophenolate sodium (Myfortic) in severe recalcitrant adult atopic dermatitis: an open label study.

Br J Dermatol. 2009 Mar;160(3):687-91

Authors: van Velsen SG, Haeck IM, Bruijnzeel-Koomen CA, de Bruin-Weller MS

BACKGROUND: Severe atopic dermatitis (AD) is often treated successfully with oral immunosuppressive drugs such as cyclosporin (CsA) or oral corticosteroids. However, some patients develop adverse effects or are unresponsive to these first-choice oral immunosuppressive drugs. OBJECTIVES: To evaluate whether enteric-coated mycophenolate sodium (EC-MPS) is an effective treatment in patients with severe, recalcitrant AD. METHODS: Ten patients with severe, recalcitrant AD were treated with EC-MPS 720 mg twice daily for 6 months. All patients had to discontinue other oral immunosuppressive drugs due to adverse effects (n = or nonresponsiveness (n = 2). Disease activity was monitored using the Severity Scoring of Atopic Dermatitis (modified SCORAD) index and the Leicester Sign Score (LSS). Additionally, the level of serum thymus and activation-regulated cytokine (TARC) was measured. During treatment, safety laboratory examination was performed. Total serum immunoglobulin E (IgE) was followed during treatment. Use of topical corticosteroids was recorded before and during treatment. RESULTS: Compared with baseline, the mean scores for disease activity significantly decreased during treatment with EC-MPS [modified SCORAD (P = 0.04), LSS severity (P = 0.01), LSS extent (P = 0.01)]. In addition, serum TARC levels and total serum IgE levels significantly decreased after treatment compared with before (P = 0.03; P = 0.05). Disease activity decreased after approximately 2 months of treatment and stabilized during the 6-month treatment period. No differences in the amount of topical corticosteroids used in the 6 months prior to treatment compared with the 6-month treatment period were found (P = 0.4). None of the patients discontinued use of EC-MPS and only mild adverse effects were seen. CONCLUSIONS: In this study EC-MPS at a dose of 720 mg twice daily for 6 months has proven to be an effective and well-tolerated treatment for patients with severe, recalcitrant AD.

PMID: 19120337 [PubMed - indexed for MEDLINE]

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Skin and systemic pharmacokinetics of tacrolimus following topical application of tacrolimus ointment in adults with moderate to severe atopic dermatitis.

Br J Dermatol. 2009 Mar;160(3):665-9

Authors: Undre NA, Moloney FJ, Ahmadi S, Stevenson P, Murphy GM

BACKGROUND: Systemic exposure to tacrolimus following topical application of tacrolimus ointment is minimal. There are, however, no data on the distribution of tacrolimus in the skin. OBJECTIVES: To assess the distribution of tacrolimus in the skin and the systemic pharmacokinetics of tacrolimus in adults with moderate to severe atopic dermatitis after first and repeated application of tacrolimus ointment. METHODS: We investigated skin distribution of topically applied tacrolimus and systemic pharmacokinetics of percutaneously absorbed tacrolimus in adults with atopic dermatitis after topical application of tacrolimus 0.1% ointment twice daily for 2 weeks. Tacrolimus concentrations were assessed in full-thickness skin biopsies and blood samples. RESULTS: Of 14 patients, 11 completed treatment and were analysed. Mean +/- SD tacrolimus concentrations in the skin at 24 h after first and last ointment applications were 94 +/- 20 and 595 +/- 98 ng cm(-3), respectively. At 168 h after stopping treatment, values were 97% lower than at 24 h after last application. Tacrolimus concentration decreased with increasing skin depth. Systemic tacrolimus exposure after ointment application was low and highly variable, with 31% of samples below the limit of quantification (0.025 ng mL(-1)) and 94% below 1 ng mL(-1). Blood concentrations at 24 h after the first and last ointment applications were 750 and 1800 times lower, respectively, than those in skin. Physicians’ assessments showed that tacrolimus ointment was effective and well tolerated. CONCLUSIONS: Tacrolimus was primarily partitioned in the skin, with minimal systemic absorption after topical application, in patients with atopic dermatitis.

PMID: 19076975 [PubMed - indexed for MEDLINE]

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Nurses’ perceptions of the benefits and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group.

Br J Dermatol. 2009 Mar;160(3):565-72

Authors: Stutz N, Becker D, Jappe U, John SM, Ladwig A, Spornraft-Ragaller P, Uter W, Löffler H

BACKGROUND: Nurses have a high risk of developing hand eczema due to hand disinfection procedures. OBJECTIVES: To investigate the perception of nurses regarding the adverse effects of hand washing (HW) and alcoholic disinfection (ADI), and to obtain data on the prevalence of hand dermatitis and sensitization to alcohols and alcohol-based hand rubs (ABHRs). METHODS: A self-administered questionnaire survey, carried out as a pilot study (PS), followed by a modified multicentre study (MC) in five hospitals. Patch tests to ethanol (80%), 1-propanol (60%), 2-propanol (70%) and ABHRs were performed in a subsample. RESULTS: The majority (PS 60.1%; MC 69.5%) of nurses considered ADI to be more damaging than HW. Mostly, ADI and HW were suspected to have irritant effects (ADI 79.2%/52.1%; HW 65.5%/36.2%) compared with an allergenic potential (ADI 10.4%/5.8%; HW 7.8%/3.9%). The prevalence of hand dermatitis in the MC was 13.4% by self-diagnosis and 22.4% by symptom-based questions. In 50 tested individuals no sensitization and only two irritant reactions to alcohols and three single-positive reactions to ABHRs were observed, none of the latter related to alcohols. CONCLUSIONS: Although ADI is known to cause less skin irritation than HW, nurses perceive ADI as more damaging, resulting in: (i) a low compliance with ADI and (ii) a higher prevalence of hand dermatitis because the more deleterious HW is preferred. This may result in an increase in occupational disease and nosocomial infections. Educational programmes should promote ADI as a procedure with good efficiency and skin tolerability to reduce the prevalence of hand eczema in nurses and to enhance compliance with hand hygiene standards.

PMID: 19067700 [PubMed - indexed for MEDLINE]

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Itch characteristics in atopic dermatitis: results of a web-based questionnaire.

Br J Dermatol. 2009 Mar;160(3):642-4

Authors: Dawn A, Papoiu AD, Chan YH, Rapp SR, Rassette N, Yosipovitch G

BACKGROUND: Itch significantly impairs the quality of life of patients with atopic dermatitis. However, only a few previous studies have examined the specific characteristics of itch in atopic dermatitis. OBJECTIVE: To examine the frequency, intensity and perceived characteristics of pruritus among individuals with atopic dermatitis. METHODS: Questionnaire reliability and validity were established in pilot testing. Survey participants completed the comprehensive, web-based ‘Characteristics of itch’ questionnaire. Participants provided anonymous demographic information and answered questions regarding itch intensity, frequency, timing, duration, location, associated symptoms and itch descriptors. RESULTS: A total of 304 individuals with atopic dermatitis completed the web-based questionnaire. Itch occurred at least once daily in 91% of the individuals surveyed. Of the 32 itch descriptors rated by survey participants, 31 demonstrated a statistically significant positive correlation with the participants’ ratings of itch intensity (P < 0.001). More than half the survey participants reported pain (59%) and heat sensation (53%) associated with itch. CONCLUSION: The questionnaire was found to be a useful tool in characterization of itch. Pain appears to be an important component of atopic dermatitis. The strong correlation between itch descriptors and itch intensity suggests that such descriptors serve as strong indicators of the symptomatology in atopic dermatitis.

PMID: 19067703 [PubMed - indexed for MEDLINE]

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Does tobacco smoking influence the occurrence of hand eczema?

Br J Dermatol. 2009 Mar;160(3):514-8

Authors: Meding B, Alderling M, Albin M, Brisman J, Wrangsjö K

BACKGROUND: Tobacco smoking is known to influence various inflammatory skin diseases and an association between tobacco smoking and hand eczema has been proposed in some studies. OBJECTIVES: To examine a possible association between reported current tobacco smoking and the occurrence of hand eczema. SUBJECTS AND METHODS: Previously collected questionnaire data on the occurrence of hand eczema in three occupational cohorts and corresponding controls from the general population were studied. The questionnaires used included questions on 1-year prevalence of hand eczema and questions on smoking habits. For one occupational group, hairdressers and their controls, information on amount of smoking was obtained. Information on age, sex and history of atopy was also available. RESULTS: In total, answers regarding smoking and hand eczema were obtained from 13,452 individuals. Out of 3493 smokers, 437 (12.5%) reported hand eczema compared with 1294 out of 9959 nonsmokers (13.0%) (P = 0.51). With regard to the number of cigarettes smoked, 22.6% of the hairdressers smoking more than 10 cigarettes per day reported hand eczema compared with 17.4% of those smoking 0-10 cigarettes per day (P = 0.01). Corresponding figures for the controls were 14.5% and 11.7%, respectively (P = 0.06). CONCLUSIONS: No clear association was found between 1-year prevalence of hand eczema and smoking. Heavy smoking, more than 10 cigarettes per day, may give a slightly increased risk of hand eczema. Further studies with information on the amount of tobacco consumption and on possible confounders are needed to evaluate smoking as a risk factor for hand eczema.

PMID: 19067707 [PubMed - indexed for MEDLINE]

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