Atopic dermatitis (eczema)

Filaggrin mutations may confer susceptibility to chronic hand eczema characterized by combined allergic and irritant contact dermatitis.

Br J Dermatol. 2009 Apr 22;

Authors: Molin S, Vollmer S, Weiss EH, Ruzicka T, Prinz JC

Background The pathogenesis of chronic hand eczema (CHE) is multifactorial and involves both endogenous predisposition and environmental triggers. Objectives Filaggrin is a structural protein of the cornified envelope and important for the formation of the epidermal skin barrier. The aim of this investigation was to evaluate the role of mutations in the filaggrin gene (FLG) in the development of CHE. Methods In total, 122 German patients with clearly defined CHE subtypes were screened for the FLG variants R501X and 2282del4 by polymerase chain reaction and restriction enzyme digest analysis. The prevalence of these variants in CHE patients was compared with that in 95 healthy individuals. Results Overall, allele frequency and the number of mutation carriers were similar in both the CHE and control groups. When classified according to clearly defined CHE subtypes, however, the nonfunctional FLG variants showed an association with CHE involving an aetiological combination of contact allergy and irritant factors [P = 0.04; P (exact test) = 0.06; P (difference in rates) = 0.09; 95% confidence interval (CI) 0-56.8)], or with excessive daily exposure to water and irritants [P = 0.003; P (difference in rates) < 0.001; 95% CI 29.3-67.9]. Conclusion Heterozygosity for nonfunctional mutations in the FLG gene may contribute to the manifestation and maintenance of a particular CHE subtype that is characterized by the combination of allergic and irritant contact dermatitis.

PMID: 19538184 [PubMed - as supplied by publisher]

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Dermatological future of european patients with atopic dermatitis.

J Eur Acad Dermatol Venereol. 2009 Jun 1;

Authors: Misery L, Boussetta S, Shooneman P, Taieb C

Abstract Background The dermatological becoming of children presenting with atopic dermatitis (AD) is not well known. Objective We performed a study on the presence of AD and other dermatological diseases in subjects with a previous history of AD. Methods An opinion poll was conducted in eight countries through a telephone interview: Belgium, France, Germany, Greece, Italy, Portugal, Spain and Switzerland. Results Among 4369 interviewees, 12.25% declared a history of AD in infancy and 12.4% declared to suffer from a dermatological disease (27% of patients had a history of AD and 10.3% did not have it). Current declared cases of atopic eczema or contact eczema were more frequent in patients with previous history of AD (39.3% vs. 21.5%), whereas these patients appeared less affected by rosacea (2.9% vs. 7.9%). Some differences were observed between different countries. Conclusion The main interests of this study are the large number of subjects, originating from eight different countries, and its focus on the dermatological future of patients with AD, which is not limited to AD itself. Conflicts of interest Sami Boussetta, Pierre Shoonemann and Charles Taieb are employees of the Pierre Fabre Group. Laurent Misery is consultant for Abbott, Astellas, Cogniz, Galderma, Johnson & Johnson, Leo, Pierre Fabre, Schering-Plough, Stiefel, UCB, Wyeth.

PMID: 19522708 [PubMed - as supplied by publisher]

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Brain-derived neurotrophic factor gene polymorphisms and serum levels in Chinese atopic dermatitis patients.

J Eur Acad Dermatol Venereol. 2009 Jun 1;

Authors: Ma L, Gao XH, Zhao LP, Di ZH, McHepange UO, Zhang L, Chen HD, Wei HC

Abstract Background Brain-derived neurotrophic factor (BDNF) plays an important role in the pathogenesis of atopic dermatitis (AD). Whether BDNF gene polymorphisms are associated with Chinese AD remains totally unknown. Objective The aim is to determine if BDNF gene C270T and G196A polymorphisms are associated with Chinese AD, and analyse the clinical relevance of BDNF gene polymorphisms and BDNF serum levels. Methods We conducted a case-control association analysis (160 patients and 169 controls) in Northern Chinese subjects. Genotyping was performed by restriction fragment length polymorphism, and serum levels of BDNF were measured using enzyme-linked immunosorbent assay. Results For C270T, there were significant differences in C/T genotype distribution (P = 0.003) and T allele frequencies (P = 0.004) between AD patients and controls in the whole dataset. Higher C/T genotype frequencies were found in male AD (10.6% vs. 1.1%, P = 0.018) and in intrinsic AD (IAD; 15.79% vs. 2.91%, P = 0.008). No association between G196A polymorphism and AD was observed in the whole cohort, while A allele was much more frequent in AD patients with atopy in first-degree relatives (65.8% vs. 34.2%, P = 0.038). Serum BDNF levels were correlated with IAD severity as measured by Scoring Atopic Dermatitis index (r = 0.576, P < 0.001). Conclusion T allele in C270T may be a risk factor for AD, especially in IAD and male AD. A allele in G196A may be a risk factor in AD patients with atopy in first-degree relatives. Serum BDNF levels were correlated with the severity of IAD. Conflicts of interest None declared.

PMID: 19522715 [PubMed - as supplied by publisher]

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Serine protease inhibitor lymphoepithelial Kazal type-related inhibitor tends to be decreased in atopic dermatitis.

J Eur Acad Dermatol Venereol. 2009 Jun 1;

Authors: Roedl D, Traidl-Hoffmann C, Ring J, Behrendt H, Braun-Falco M

Abstract Background A pathogenic role of serine protease inhibitor lymphoepithelial Kazal type-related inhibitor (LEKTI) in atopic dermatitis (AD) is currently in intense debate. Analyses of an association between genetic polymorphisms of SPINK5 and atopic diseases revealed contradictory results. Herein, we assessed the role of LEKTI in AD at an expressional and functional level. Methods The expression of LEKTI and its inhibitory capacity was measured by real-time polymerase chain reaction and hydrolytic activity assay, respectively, in keratinocyte cell cultures of three AD patients in comparison to cultures of healthy individuals (5x) and Netherton (NS) patients (3x). Results Expression of LEKTI was significantly decreased in AD vs. healthy volunteers. Due to reduced protease inhibition, trypsin-like hydrolytic activity in AD was slightly increased, although not significantly. Conclusions Even though the number of investigated subjects was small and hydrolytic activity was only slightly increased, the results denote that LEKTI might be diminished in AD. The study also disclosed the necessity of functional analyses in addition to genetic investigations to gain further and more detailed insights into the role of LEKTI in AD. Conflicts of interest None declared.

PMID: 19522716 [PubMed - as supplied by publisher]

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Canine Models of Atopic Dermatitis: A Useful Tool with Untapped Potential.

J Invest Dermatol. 2009 Jun 11;

Authors: Marsella R, Girolomoni G

Animal models have contributed greatly to the expansion of knowledge in the field of atopic dermatitis (AD). Some species, such as the dog, naturally and commonly develop a pruritic dermatitis that is clinically and immunologically extremely similar to human AD. Recently, canine models of AD have been validated. In one of these models (Beagles), AD can be reliably reproduced upon allergen challenge, providing a tool with which to study effectively how AD is affected by allergen exposure. Interestingly, decreased epidermal filaggrin expression and disturbed extrusion of lamellar bodies by keratinocytes are present in these dogs, as well as increased transepidermal water loss, particularly in sites characteristically affected by AD. Owing to the remarkable similarity with the human disease, these dog models not only can help answer questions relative to the pathogenesis of the disease but also can be used as tools for rapid screening of drugs with potential clinical application, including those aimed at restoring epidermal barrier dysfunction.Journal of Investigative Dermatology advance online publication, 11 June 2009; doi:10.1038/jid.2009.98.

PMID: 19516261 [PubMed - as supplied by publisher]

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Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial.

J Eur Acad Dermatol Venereol. 2009 Jun 8;

Authors: Wirén K, Nohlgård C, Nyberg F, Holm L, Svensson M, Johannesson A, Wallberg P, Berne B, Edlund F, Lodén M

Background Standard treatment of atopic dermatitis (AD) is based on topical glucocorticosteroids or calcineurin inhibitors to treat flares combined with moisturizer treatment to alleviate dry skin symptoms. Patients with AD have an abnormal skin barrier function, and strategies for reducing the risks for eczema would be to repair the barrier or prevent barrier dysfunction. Objectives The objective of this study was to explore the time to relapse of eczema during a 26-week maintenance treatment with a urea containing moisturizer compared to no treatment (neither medical nor non-medicated preparations) after successful clearing of atopic lesions. The moisturizer has previously been shown to improve skin barrier function. Methods Patients applied betamethasone valerate (0.1%) on eczematous lesions during a 3-week period. Those with cleared eczema entered a 26-week maintenance phase, applying the moisturizer or left the previously affected area untreated. Upon eczema relapse, patients were instructed to contact the clinic and to have the relapse confirmed by the investigator. Results Fifty-five patients entered the study and 44 patients were included in the maintenance phase (22 using moisturizer twice daily and 22 using no treatment). Median time to relapse for patients treated with moisturizer was > 180 days (duration of the study) compared with 30 days for the no-treatment group. Sixty-eight per cent of the patients treated with the moisturizer and 32% of the untreated patients remained free from eczema during the observation period. Conclusions Maintenance treatment with a barrier-improving urea moisturizer on previous eczematous areas reduced the risk of relapse to approximately one third of that of no treatment.

PMID: 19508310 [PubMed - as supplied by publisher]

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Measurement of nitric oxide and 8-isoprostane in exhaled breath of children with atopic eczema.

Clin Exp Dermatol. 2009 Jul;34(5):607-12

Authors: Zinelli C, Caffarelli C, Strid J, Jaffe A, Atherton DJ

BACKGROUND: Children with atopic eczema (AE) are at risk of developing asthma. Airway inflammation has been shown to be present before the onset of clinical asthma. Increased exhalation (forced expiration; FE) of nitric oxide (FE(NO)) and 8-isoprostane seems to be a feature of bronchial inflammation in people with asthma. AIM: To determine whether the exhalation of these two molecules is increased in children with eczema, even in the absence of overt asthma. METHODS: In total, 21 children with AE were recruited and compared with healthy controls. A questionnaire was completed to identify respiratory symptoms compatible with asthma. The severity of AE was graded clinically. Spirometry, FE(NO) measurements and exhaled breath condensate collection for 8-isoprostane were performed. RESULTS: The mean level of 8-isoprostane was similar for children with AE (2.33 +/- 4.76 pg/mL) and controls (3.37 +/- 3.43). FE(NO) was increased in children with AE (mean 64.97 parts per billion) compared with the normal range, even in the absence of respiratory symptoms and in the presence of normal lung function. CONCLUSIONS: FE(NO) but not 8-isoprostane levels in exhaled breath condensate are higher in children with AE without asthma. Our finding may indicate a predictive role for FE(NO) for the development of asthma.

PMID: 19508477 [PubMed - in process]

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Estimating emollient usage in patients with eczema.

Clin Exp Dermatol. 2009 Jun 1;

Authors: Hon KL, Ching GK, Leung TF, Choi CY, Lee KK, Ng PC

Background. Atopic eczema (AE) is characterized by reduced skin hydration (SH) and impaired integrity of the skin. Proper emollient usage is an important facet of AE management and patients are encouraged to use emollients liberally. Aim. To evaluate whether the amount of emollient and skin cleanser used correlates with eczema severity, SH or transepidermal water loss (TEWL), and whether liberal usage alters disease severity, SH and TEWL. Methods. We studied SH and TEWL at three common measurement sites on the forearm (antecubital flexure, 20 mm below the antecubital flexure, mid-forearm) and determined the SCORing Atopic Dermatitis (SCORAD) score, Nottingham Eczema Severity Score (NESS), Children’s Dermatology Life Quality Index (CDLQI) and the amount of emollient and cleanser usage over a 2-week period in consecutive new patients seen at the paediatric skin clinic of a teaching hospital. Results. In total, 48 subjects and 19 controls were recruited. Patients with AE had significantly higher TEWL and lower SH in the studied sites. Emollient and cleanser usage was significantly higher (P = 0.001 and P = 0.041, respectively) in patients with AE than in controls. The amount of emollient usage was correlated with NESS, SCORAD, CDLQI, TEWL and mid-forearm SH. No such correlation was found with cleanser usage. Regardless of SCORAD, prescribing 130 g/m(2)/week of emollient met the requirement of 95.8% of patients, and 73 g/m(2)/week met that of 85.4%; for the cleanser, prescribing 136 g/m(2)/week met the requirement of 91.7% of patients. Although skin dryness and SH were improved, there was no significant improvement in SCORAD or TEWL after 2 weeks. In terms of global acceptability of treatment, three-quarters of patients with AE and controls rated the combination of cream and cleanser as ‘good’ or ‘very good’. Conclusions. Adequate amounts of emollient and bathing cleanser should be prescribed to patients with AE. These amounts can be conveniently estimated based on body surface area instead of the less readily available tools for disease severity, degree of SH or skin integrity. However, liberal usage of emollients and bathing cleanser alone does not seem to alter disease severity or TEWL within 2 weeks, implying that additional treatments are necessary to manage AE.

PMID: 19489850 [PubMed - as supplied by publisher]

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Dermatitis papulosa adultorum.

Clin Exp Dermatol. 2009 Jun 1;

Authors: Kraigher O, Brenner S

Dermatitis papulosa juvenilis, also referred to as frictional lichenoid eruption, summertime lichenoid dermatitis of the elbows, Sutton’s summer prurigo, recurrent papular eruption of childhood, and sandbox dermatitis, has been reported previously only in children. We describe three cases of DPJ in adults, which were confirmed by clinical and histology investigations. The term ‘dermatitis papulosa adultorum’ is suggested for this condition in adults.

PMID: 19489852 [PubMed - as supplied by publisher]

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Epidermal Barrier Dysfunction in Atopic Dermatitis.

J Invest Dermatol. 2009 Jun 4;

Authors: Cork MJ, Danby SG, Vasilopoulos Y, Hadgraft J, Lane ME, Moustafa M, Guy RH, Macgowan AL, Tazi-Ahnini R, Ward SJ

Atopic dermatitis (AD) is a multifactorial, heterogenous disease that arises as a result of the interaction between both environmental and genetic factors. Changes in at least three groups of genes encoding structural proteins, epidermal proteases, and protease inhibitors predispose to a defective epidermal barrier and increase the risk of developing AD. Loss-of-function mutations found within the FLG gene encoding the structural protein, filaggrin, represent the most significant genetic factor predisposing to AD identified to date. Enhanced protease activity and decreased synthesis of the lipid lamellae lead to exacerbated breakdown of the epidermal barrier. Environmental factors, including the use of soap and detergents, exacerbate epidermal barrier breakdown, attributed to the elevation of stratum corneum pH. A sustained increase in pH enhances the activity of degradatory proteases and decreases the activity of the lipid synthesis enzymes. The strong association between both genetic barrier defects and environmental insults to the barrier with AD suggests that epidermal barrier dysfunction is a primary event in the development of this disease. Our understanding of gene-environment interactions should lead to a better use of some topical products, avoidance of others, and the increased use and development of products that can repair the skin barrier.Journal of Investigative Dermatology advance online publication, 4 June 2009; doi:10.1038/jid.2009.133.

PMID: 19494826 [PubMed - as supplied by publisher]

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