Atopic dermatitis (eczema)

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Superimposed segmental dermatitis with chronic prurigo.

Eur J Dermatol. 2009 May 25;

Authors: Kawachi Y, Taguchi S, Fujisawa Y, Furuta J, Nakamura Y, Ishii Y, Otsuka F

Common acquired skin diseases with a polygenic background, such as lichen planus, may show linear or segmental manifestations of underlying systemic skin disease. The linear arrangement in such cases is usually consistent with the lines of Blaschko. Happle summarized the various types of segmental arrangement of common polygenic diseases and proposed a novel designation of superimposed segmental dermatosis. Here, we report a unilateral linear dermatitis distributed along the lines of Blaschko on the leg, which was not self-healing and persisted for at least 6 years without complete remission, and was accompanied by preceding chronic prurigo on the extremities. Histological examination showed subacute spongiotic dermatitis and epidermal infiltration of CD4-positive cells. This case report presents a superimposed segmental dermatitis that arose based on systemic eczematous conditions, such as chronic prurigo.

PMID: 19467959 [PubMed - as supplied by publisher]

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Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study.

J Eur Acad Dermatol Venereol. 2009 Mar 16;

Authors: Malekzad F, Arbabi M, Mohtasham N, Toosi P, Jaberian M, Mohajer M, Mohammadi MR, Roodsari MR, Nasiri S

Abstract Aim The intent of our study was to determine the efficacy of oral naltrexone, an opiod antagonist, in the treatment of pruritus in patients with chronic eczema. Methods This double-blind, placebo-controlled study recruited 38 patients with eczema complaining from pruritus. Pruritus scores were evaluated. Patients were given placebo (n = 20) or naltrexone 50 mg (n = 18) for 2 weeks period. During the study, pruritus scores based on visual analogue scale system (VAS) were assessed three times: at the start of study, after 1 week, and after 2 weeks. Results In both groups, decreased VAS scores were observed, but naltrexone showed to be significantly more effective than placebo in decreasing VAS score after 1 week (P < 0.005) and 2 weeks (P < 0.001). Conclusion Naltrexone is more effective than placebo in the treatment of pruritus in patient with eczema. Naltrexone might be considered as an adjunct treatment in the treatment of pruritus. However, further studies in this aspect are highly fostered. Conflicts of interest This study and the authors were not supported by any company with a vested interest in the product being studied and the project was funded by Skin Research Center.

PMID: 19453814 [PubMed - as supplied by publisher]

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Allergic and irritant contact dermatitis.

Eur J Dermatol. 2009 May 14;

Authors: Nosbaum A, Vocanson M, Rozieres A, Hennino A, Nicolas JF

Irritant and allergic contact dermatitis are common inflammatory skin diseases induced by repeated skin contact with low molecular weight chemicals, called xenobiotics or haptens. Although both diseases may have similar clinical presentations, they can be differentiated on pathophysiological grounds. Irritant contact dermatitis (ICD) is a non-specific inflammatory dermatitis brought about by activation of the innate immune system by the pro-inflammatory properties of chemicals. Allergic contact dermatitis (ACD) corresponds to a delayed-type hypersensitivity response with a skin inflammation mediated by hapten-specific T cells. Recent progress in the pathophysiology of chemical-induced skin inflammation has shown that ICD and ACD are closely associated and that the best way to prevent ACD is to develop strategies to avoid ICD. The immunological diagnosis of ICD or ACD requires investigation of the presence (ACD) or absence (ICD) of antigen-specific T cells. The detection of T cells can be performed in the skin (collected from ACD lesions or positive patch tests) and/or in the blood, particularly by using the enzyme-linked immunospot assay (ELISPOT). This method, recently developed in ACD to metals, offers a new biological tool enabling the immunobiological diagnosis of ACD.

PMID: 19447733 [PubMed - as supplied by publisher]

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Development and validation of a questionnaire measuring quality of life in primary caregivers of children with atopic dermatitis (QPCAD).

Br J Dermatol. 2009 Apr 29;

Authors: Kondo-Endo K, Ohashi Y, Nakagawa H, Katsunuma T, Ohya Y, Kamibeppu K, Masuko I

Background Disease-specific health-related quality of life (HRQoL) instruments for primary caregivers of children with atopic dermatitis are useful in evaluating the efficacy of treatment in clinical practice and study. However, no such scale has been available in Japan. Objectives To develop and validate a self-administered instrument specifically designed to measure quality of life in primary caregivers of children with atopic dermatitis (QPCAD). Methods This study consisted of three successive phases: the item generation phase, pilot test phase and validation phase. In the item generation phase, questionnaire items were derived from 33 qualitative interviews with primary caregivers. In the pilot test phase, the face and content validity of the preliminary scale were assessed (n = 33). In the validation phase, the questionnaire was finalized and assessed in terms of statistical performance (n = 416). Results The QPCAD included 19 items in the following categories: ‘exhaustion’, ‘worry about atopic dermatitis’, ‘family cooperation’ and ‘achievement’. The reliability of internal consistency was fair (Cronbach’s alpha coefficients 0.66-0.87). The QPCAD subscales and total score were significantly correlated with psychological health, physical health, anxiety, depression and severity score, with mild to moderate correlation coefficients. Test-retest reliability and responsiveness to change in severity were also satisfactory. Conclusions The QPCAD is an appropriate tool for assessing HRQoL of primary caregivers of children with atopic dermatitis in clinical practice and clinical trials.

PMID: 19438436 [PubMed - as supplied by publisher]

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The cystatin M / E-controlled pathway of skin barrier formation: expression of its key components in psoriasis and atopic dermatitis.

Br J Dermatol. 2009 Apr 24;

Authors: Cheng T, Tjabringa GS, van Vlijmen-Willems IM, Hitomi K, van Erp PE, Schalkwijk J, Zeeuwen PL

Background The antiprotease activity of cystatin M/E regulates skin barrier formation, as it inhibits the activity of cathepsin V, cathepsin L and legumain, thereby controlling the processing of transglutaminase 3. Misregulation of this pathway by unrestrained protease activity, as seen in cystatin M/E-deficient mice, leads to abnormal stratum corneum and hair follicle formation, and severe disturbance of skin barrier function. Objectives Our major aim was to make a quantitative analysis of the expression of all players of this pathway in the epidermis of patients with inflammatory skin diseases. A second aim was to determine if reconstructed human skin could be used as an in vitro model system to investigate this pathway. Methods Autopsy material from normal human tissues, biopsies from normal skin of healthy volunteers, and lesional skin from patients with atopic dermatitis and psoriasis were used to study the expression of the above-mentioned molecules at the mRNA level by quantitative real-time polymerase chain reaction. Localization of the protein was performed by immunofluorescence microscopy, and expression was quantitated by image analysis. Results In skin, cystatin M/E is expressed at relatively higher levels than its target proteases, when compared with other tissues, which emphasizes its prominent role in cutaneous biology. We found decreased expression of cystatin M/E and cathepsin V in lesional atopic dermatitis and psoriasis epidermis at the mRNA level as well as the protein level. Cathepsin L and transglutaminase 3 were increased at the transcriptional level; however, this was not reflected by higher protein levels. Interestingly, the expression of all these molecules in reconstructed skin was qualitatively and quantitatively similar to the in vivo situation. Conclusions Disturbance of the cystatin M/E - cathepsin pathway could contribute to the dysregulated skin barrier function observed in inflammatory dermatoses. Human reconstructed skin appears to be a valuable model to study this novel biochemical pathway in vitro.

PMID: 19438477 [PubMed - as supplied by publisher]

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Effect of a Mycobacterium vaccae derivative on paediatric atopic dermatitis: a randomized, controlled trial.

Clin Exp Dermatol. 2009 Apr 27;

Authors: Brothers S, Asher MI, Jaksic M, Stewart AW

Summary Background. The prevalence of atopic diseases in the Western world is rising while infectious diseases decline. The ‘hygiene hypothesis’ suggests that reduced exposure to microbes such as mycobacteria in early life is associated with increased atopic disease. Recent research showed that Mycobacterium vaccae reduced the severity of atopic dermatitis (AD) in children. Objective. To evaluate the efficacy of a derivative of heat-killed M. vaccae in children with AD. Methods. In total, 129 children, aged 5-16 years old with moderate to severe AD participated in this randomized, double-blind, placebo-controlled trial. Participants received an intradermal injection of either M. vaccae or placebo three times at 2-weekly intervals. The two groups were compared for changes in severity and extent of AD from baseline to 3 and 6 months after treatment. Results. There was no significant difference between the two groups for change in severity of AD at 3 and 6 months (P = 0.77 and P = 0.70, respectively) or in extent of disease at 3 months (P = 1.0). Local injection-site reactions occurred in 47% of participants, of whom 75% received M. vaccae. Conclusion. In this study, M. vaccae did not improve AD significantly in children with moderate to severe disease.

PMID: 19438539 [PubMed - as supplied by publisher]

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Localized acquired cutis laxa secondary to interstitial granulomatous dermatitis.

Clin Exp Dermatol. 2009 May 5;

Authors: Lucas A, Bañuls J, Mataix J, Pérez-Crespo M, Jiménez MJ, Botella R, Betlloch I

Summary We report the case of a 68-year-old woman who had interstitial granulomatous dermatitis associated with seronegative polyarthritis. Two years later, this had evolved to become localized acquired cutis laxa.

PMID: 19438565 [PubMed - as supplied by publisher]

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Risk factors for severe impetiginized atopic dermatitis in Japan and assessment of its microbiological features.

Clin Exp Dermatol. 2009 May 5;

Authors: Hayakawa K, Hirahara K, Fukuda T, Okazaki M, Shiohara T

Summary Patients with atopic dermatitis (AD) are susceptible to cutaneous bacterial infection. When such patients develop infection, some have extensive impetiginized dermatitis with high fever. To clarify the risk factors for severe impetiginized AD and its microbiological features, we reviewed clinical and microbiological data of 14 patients with impetiginized AD who were admitted to our hospital between the years 1999 and 2006. All patients had poorly controlled AD with eczematous lesions on the extensive body surface. The mean age was 28.2 years (range 18-35). Cultures of the lesional skin yielded both Streptococcus pyogenes and Staphylococcus aureus in 12 patients. S. pyogenes alone was isolated in two cases. These observations suggest that poorly controlled AD in adults is a risk factor for severe impetiginized AD and that S. pyogenes might play an important role in the development of severe clinical symptoms.

PMID: 19438578 [PubMed - as supplied by publisher]

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Isolation of alpha-toxin-producing Staphylococcus aureus from the skin of highly sensitized adult patients with severe atopic dermatitis.

Br J Dermatol. 2009 May 12;

Authors: Wichmann K, Uter W, Weiss J, Breuer K, Heratizadeh A, Mai U, Werfel T

Background Staphylococcus aureus is a well-known trigger factor of atopic dermatitis (AD). Besides staphylococcal superantigens, alpha-toxin may influence cutaneous inflammation via induction of T-cell proliferation and cytokine secretion. Objectives To investigate the association between sensitization to inhalant allergens and skin colonization with alpha-toxin-producing S. aureus in AD. Patients and methods We investigated 127 patients with AD, aged 14-65 years, who were on standard anti-inflammatory and antiseptic treatment before investigation. We evaluated skin colonization, medical history, severity of AD and sensitization to inhalant allergens. Results Forty-eight of 127 patients were colonized with S. aureus, suffered from more severe AD, had asthma more often and showed higher sensitization levels to inhalant allergens. Thirty of 48 patients with S. aureus skin-colonizing strains produced alpha-toxin and had higher total IgE and specific IgE to birch pollen and timothy grass pollen. Conclusions Under topical treatment with antiseptic and anti-inflammatory agents the colonization of lesional skin with S. aureus was clearly lower than commonly found in untreated patients with AD. Colonization with S. aureus was associated with a higher severity of AD, higher degree of sensitization, and a higher frequency of asthma. The proportion of patients whose skin was colonized with alpha-toxin-producing S. aureus was higher than expected from a former study. Cutaneous colonization with alpha-toxin-producing S. aureus was associated with a higher sensitization level to birch pollen allergen in AD. This may point to a higher susceptibility of patients with higher T-helper 2 polarization towards alpha-toxin-producing S. aureus.

PMID: 19438853 [PubMed - as supplied by publisher]

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The prevalence, characteristics of and risk factors for eczema in Belgian schoolchildren.

Pediatr Dermatol. 2009 Mar-Apr;26(2):129-38

Authors: Govaere E, Van Gysel D, Verhamme KM, Doli E, Oranje AP, De Baets F

Childhood eczema is common in infants, but its nature and extent during later childhood remains unclear. In this cross-sectional study we examined the prevalence and characteristics of eczema in an unbiased community population of 2,021 Belgian schoolchildren, aged 3.4 to 14.8 years with skin prick testing and parental questionnaires. Our study identified an eczema prevalence of 23.3% and a considerable allergic comorbidity, mainly in sensitized children. The reported prevalence of eczema in infancy was 18.5% and for current eczema 11.6%. The overall sensitization rate (33.2%) as well as sensitization rates for the individual allergens were significantly higher in children with “eczema ever.” Sensitization to Dermatophagoides pteronyssinus (19.6%), mixed grass pollen (15.1%), and cat (9.1%) were most common. Until the age of 6 years, boys with eczema were significantly more sensitized than girls (p = 0.007). Children with both eczema in infancy and current eczema show a tendency to be more sensitized than children with eczema in infancy only or current eczema only, but significance was only noted for a few individual allergens. Analysis of factors associated with eczema revealed a predominantly atopic profile characterized by family or personal history of allergy. Breastfeeding and environmental factors seemed to assume little relevance except for a protective effect of prematurity and having a dog at birth.

PMID: 19425274 [PubMed - in process]

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