Atopic dermatitis (eczema)

Psychiatric comorbidity in adult eczema.

Br J Dermatol. 2009 Jul 14;

Authors: Schmitt J, Romanos M, Pfennig A, Leopold K, Meurer M

Summary Background Atopic eczema (AE) is a common dermatological condition that causes significant problems in everyday life and high levels of illness-related stress in substantial proportions of patients. The extent to which adult AE is associated with clinically relevant psychiatric morbidity is unclear. Objectives To investigate the association between adult AE and major psychiatric/psychosomatic disorders. Methods Case-control study utilizing the GKV database Saxony, an interdisciplinary administrative outpatient database from Germany. All patients documented as having AE at least twice within the study period (2003-2004) (n = 3769, mean age 44 years) were individually matched by age and sex to 3769 controls without AE. Logistic regression models were fitted to investigate the relationship of AE with affective, stress-related, behaviour and schizophrenic disorders, considering sociodemographic characteristics, consulting behaviour and allergic comorbidities as potential confounding factors. Results Eczema was independently associated with affective [adjusted odds ratio (OR) 1.42, 95% confidence interval (CI) 1.13-1.79], stress-related (OR 1.55, 95% CI 1.35-1.77), behaviour (OR 1.52, 95% CI 1.03-2.23) and schizophrenic disorders (OR 2.12, 95% CI 1.22-3.71). For each psychiatric condition the likelihood of being affected significantly increased with each physician visit due to AE, suggesting that the risk of psychiatric comorbidity increases with the severity of AE. Conclusions This study indicates psychiatric comorbidity of adults with AE. Collaboration between dermatologists and mental health specialists may optimize medical care for a significant subgroup of patients with AE.

PMID: 19624545 [PubMed - as supplied by publisher]

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Prevalence of adult atopic dermatitis among nursing staff in a Taiwanese medical center: A pilot study on validation of diagnostic questionnaires.

J Am Acad Dermatol. 2009 Jul 10;

Authors: Lan CC, Lee CH, Lu YW, Lin CL, Chiu HH, Chou TC, Hu SC, Wu CY, Kim YY, Yang HJ, Chen YC, Wu CS, Hsu HY, Shieh SL, Yu HS, Ko YC, Chen GS

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing dermatosis. Previous studies have focused mostly on pediatric patients, and investigations emphasizing adult AD have been limited. OBJECTIVE: We set out to determine the 1-year prevalence and evaluate the validity of the International Study of Asthma and Allergies in Childhood (ISAAC) and United Kingdom Working Party (UKWP) AD questionnaires of adult AD in Taiwan. METHODS: We conducted a cross-sectional study among nursing staff at a university hospital. The 1-year prevalence of AD was assessed by ISAAC and UKWP questionnaires. Subsequently, the dermatologists’ diagnosis based on Hanifin and Rajka criteria was used as a reference for validation. RESULTS: The overall response rate was 92.9%, equivalent to 1131 complete questionnaires. Ninety adult patients with AD (8%) were identified by dermatologists’ diagnosis whereas ISAAC identified 107 (9.5%); sensitivity and specificity were 36.7% and 92.9%, respectively. UKWP identified 42 (3.7%) patients with AD; sensitivity and specificity were 42.2% and 99.6%, respectively. Using the receiver operating characteristic curve analysis, the UKWP criteria performed significantly better than its ISAAC counterpart. Further analysis indicated that modification of these criteria resulted in significant improvement in their diagnostic efficacy. More specifically, modified ISAAC showed 90.0% and 55.2% sensitivity and specificity, respectively, whereas modified UKWP demonstrated 82.2% and 94.2% sensitivity and specificity, respectively. LIMITATION: Most of the study subjects were female with a high educational background. CONCLUSION: Currently available questionnaire instruments do not perform well in the identification of adult patients with AD. Modification of the original questionnaires may allow for future large-scale epidemiologic studies.

PMID: 19595479 [PubMed - as supplied by publisher]

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Future perspectives in the treatment of atopic dermatitis.

J Dermatol. 2009 Jul;36(7):367-76

Authors: Katoh N

Atopic dermatitis is a chronically relapsing inflammatory skin disease with an increasing prevalence. The guidelines for the treatment of atopic dermatitis enable us to manage many patients with atopic dermatitis under a global consensus, which also contributes to improving their quality of life. However, there remain some patients with atopic dermatitis whose symptoms cannot be satisfactorily controlled using the therapeutic management recommended by the guidelines. Recent genetic, immunological and physiological insights into the pathomechanisms of atopic dermatitis are expected to overcome the limitations of the currently available treatment. Advances in pharmacology and biotechnology will also provide more efficient and safer medications. In this review, the limitations of the currently available therapies and the advantages and disadvantages of new approaches for the treatment of atopic dermatitis including topical and systemic immunosuppressants as well as biologics and anti-pruritic agents are discussed. Potential new cellular targets for the treatment of atopic dermatitis are also illustrated.

PMID: 19583684 [PubMed - in process]

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Staphylococcus aureus and hand eczema severity.

Br J Dermatol. 2009 Jul 3;

Authors: Haslund P, Bangsgaard N, Jarløv JO, Skov L, Skov R, Agner T

Background The role of bacterial infections in hand eczema (HE) remains to be assessed. Objectives To determine the prevalence of Staphylococcus aureus in patients with HE compared with controls, and to relate presence of S. aureus, subtypes and toxin production to severity of HE. Methods Bacterial swabs were taken at three different visits from the hand and nose in 50 patients with HE and 50 controls. Staphylococcus aureus was subtyped by spa typing and assigned to clonal complexes (CCs), and isolates were tested for exotoxin-producing S. aureus strains. The Hand Eczema Severity Index was used for severity assessment. Results Staphylococcus aureus was found on the hands in 24 patients with HE and four controls (P < 0.001), and presence of S. aureus was found to be related to increased severity of the eczema (P < 0.001). Patients carried identical S. aureus types on the hands and in the nose in all cases, and between visits in 90% of cases. Ten different CC types were identified, no association with severity was found, and toxin-producing strains were not found more frequently in patients with HE than in controls. Conclusions Staphylococcus aureus was present on hands in almost half of all patients with HE, and was significantly related to severity of the disease. This association indicates that S. aureus could be an important cofactor for persistence of HE.

PMID: 19575755 [PubMed - as supplied by publisher]

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Topical treatment of perianal eczema with tacrolimus 0.1%

Br J Dermatol. 2009 Jul 3;

Authors: Schauber J, Weisenseel P, Ruzicka T

Background Perianal eczema is an inflammatory skin disease with a high prevalence in most industrialized countries. As general practitioners and dermatologists frequently see patients with perianal eczema the need for efficient, fast and safe therapies is high. Topical calcineurin inhibitors such as tacrolimus (FK506) ameliorate cutaneous inflammation and associated pruritus in an array of inflammatory dermatoses. Objectives To investigate the effect of topical tacrolimus in perianal eczema. Methods Twenty-four patients with perianal eczema were treated with tacrolimus 0.1% ointment twice daily on the affected skin area for 2 weeks. Results All returning patients showed clinical improvement as assessed by macroscopic appearance and clinical score (modified SCORAD index). Conclusions In this short-term trial we demonstrate that topical tacrolimus 0.1% is safe, efficient and well tolerated in patients with perianal eczema irrespective of the underlying cause.

PMID: 19575757 [PubMed - as supplied by publisher]

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Palisaded neutrophilic granulomatous dermatitis associated with systemic lupus erythematosus presenting with the burning rope sign.

J Am Acad Dermatol. 2009 Jul 2;

Authors: Gulati A, Paige D, Yaqoob M, Proby CM, Cerio R, Harwood CA

Palisaded neutrophilic granulomatous dermatitis is a rare but increasingly recognized cutaneous manifestation of connective tissue disorders. It is reported most commonly with rheumatoid arthritis but also occasionally in association with systemic lupus erythematosus, inflammatory bowel disease, lymphoproliferative disorders, and systemic vasculitides. The clinicopathological presentation is highly variable, which has led to suggestions that it encompasses a number of distinct diseases. Most previous cases have reported only a single clinical and histologic manifestation of the condition within an individual. Here, we present a case of systemic lupus erythematosus-associated palisaded neutrophilic granulomatous dermatitis in which a striking evolution of both clinical and histologic features was observed during the course of 7 years, providing compelling evidence for the proposal that palisaded neutrophilic granulomatous dermatitis represents a disease spectrum rather than separate disease entities.

PMID: 19577332 [PubMed - as supplied by publisher]

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Human T-cell lymphotropic virus type 1 infective dermatitis emerging in adulthood.

Int J Dermatol. 2009 Jul;48(7):723-30

Authors: Maragno L, Casseb J, Fukumori LM, Sotto MN, Duarte AJ, Festa-Neto C, Sanches JA

BACKGROUND: Infective dermatitis (ID) is a rare dermatologic condition of childhood that has been linked to human T-cell lymphotropic virus type 1 (HTLV-1). OBJECTIVE: To analyze the clinical and laboratory features associated with adult-onset ID linked to HTLV-1. METHODS: From December 1995 to December 2007, four patients with ID were followed in the dermatology outpatient clinic of the “Hospital das Clínicas” of the University of São Paulo Medical School, São Paulo, Brazil. Epidemiologic data were collected and dermatologic examination was performed. Patients were submitted to histopathologic, hematologic, virologic, and immunologic investigations. RESULTS: All patients had a diagnosis of ID according to previously established criteria, despite being adults. HTLV-1 infection was demonstrated by enzyme-linked immunosorbent assay, Western blotting assays, and polymerase chain reaction. The male to female ratio was 1 : 3 and the median age at diagnosis was 42 years. The cutaneous manifestations were erythematous, scaly, and crusted lesions in all patients, and ichthyosis in three of the four cases. Histopathologic study showed lymphocytic epidermotropism in two cases. The median proviral load was 281 copies/10,000 peripheral blood mononuclear cells. Immunodeficiency was not observed in any case. The therapies used were antimicrobials, corticosteroids, and phototherapy. CONCLUSIONS: Although many authors have considered ID to be a form of childhood dermatitis, we have described four cases that fulfilled the major criteria for ID, except for onset in adulthood.

PMID: 19570078 [PubMed - in process]

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Calcitonin gene-related peptide modulates interleukin-13 in circulating cutaneous lymphocyte-associated antigen-positive T cells in patients with atopic dermatitis.

Br J Dermatol. 2009 Jun 29;

Authors: Antúnez C, Torres MJ, López S, Rodriguez-Pena R, Blanca M, Mayorga C, Santamaría-Babi LF

Background Neuropeptides (NPs) may play an important role in the pathogenesis of atopic dermatitis (AD) by regulating immune responses and contributing to the cross-talk between the immune and nervous systems. Objectives To assess the ability of NPs to influence interleukin (IL)-13 and interferon (IFN)-gamma production and the expression of the activation marker HLA-DR in skin memory T cells [cutaneous lymphocyte-associated antigen (CLA)+ T cells] from patients with AD with severe, chronic lesions and intense pruritus, and from nonatopic controls. Methods Cells were cultured in the presence and absence of different NPs, calcitonin gene-related peptide (CGRP), somatostatin (SOM) and substance P (SP). IL-13 and IFN-gamma production and HLA-DR expression were measured in both CLA+ and CLA- T-cell subsets by flow cytometry. Results CGRP increased IL-13 production in peripheral blood mononuclear cells from patients with AD (P < 0.05), with no changes detected in the presence of SOM or SP. These patients with AD had a lower expression of CGRP receptor compared with controls (P < 0.05). Memory T cells incubated with CGRP also showed an increase in IL-13 (P < 0.05) and HLA-DR (P < 0.05) in CLA+ T cells from patients with AD compared with controls, but not in CLA- T cells. Patients with a higher production of IL-13 were those with higher total IgE and percentage of skin area involved. Furthermore, the IL-13/IFN-gamma ratio was increased in patients with AD after cells were cultured with CGRP (P < 0.05). Conclusions Our results suggest an immunomodulatory role of CGRP towards a Th2 pattern in CLA+ T cells, which may contribute to exacerbating clinical symptoms in patients with AD.

PMID: 19566660 [PubMed - as supplied by publisher]

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Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults.

J Eur Acad Dermatol Venereol. 2009 Jun 22;

Authors: Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H

Background Atopic dermatitis (AD) is a common inflammatory skin disease. Methotrexate (MTX) was suggested as an effective treatment option in cases of moderate-to-severe atopic dermatitis. This study assessed the efficacy and safety of treatment with low weekly doses of methotrexate for moderate-to-severe AD in adults. Methods Twenty adult patients with moderate-to-severe AD were included in this retrospective study. Those patients were unresponsive to topical treatments, antihistamines and at least one of the second-line treatments. MTX in low weekly doses of 10-25 mg was administered orally or intramuscularly with folic acid supplementation 5 mg per week for at least 8-12 weeks. The response to treatment was evaluated by change in SCORAD (SCORing Atopic Dermatitis), DLQI (Dermatology Quality of Life Index) and the global assessment of the clinical response score. Results After 8-12 weeks of treatment, we observed an objective response in most patients. There were 16 responders and 4 non-responders. The mean SCORAD and DLQI decreased by 28.65 units (44.3%) and 10.15 units (43.5%), respectively. The first improvement was observed after a period ranging from 2 weeks to 3 months (mean 9.95 w +/- 3.17). Treatment was more effective in adult onset AD than in childhood onset. Tolerance of treatment was good. However, nausea and an increase of liver enzymes were observed in 5 patients and 3 of them required a transient discontinuation of MTX. One patient developed peripheral neuropathy, which was resolved several weeks after the discontinuation of MTX. Conclusion MTX seems to be an effective and safe second-line treatment for patients with moderate-to-severe atopic dermatitis. A randomized, controlled study is warranted. Conflicts of interest None declared.

PMID: 19552716 [PubMed - as supplied by publisher]

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