Atopic dermatitis (eczema)

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Patch test reaction on Ethiopian subjects with eczema.

Int J Dermatol. 2009 Sep;48(9):979-83

Authors: Bilcha KD, Shibeshi D, Grangsjo A, Hiletework M

BACKGROUND: Allergic contact dermatitis is a common condition with an incidence of 1-10% in the general population. An increasing number of allergens in the environment are responsible for the condition. These allergens can be identified using patch testing. Many countries have a standard series of common allergens used for patch testing. There is no standard series of allergens in Ethiopia, and our objective was to obtain baseline data for common allergens for future standardization. METHODS: One hundred and eighty-one subjects with eczema were patch tested using 17 selected allergens from Chemotechnique Diagnostics AB employing a standard procedure. RESULTS: Positive patch test reactions were detected in more than 60% of subjects, the most common allergen being nickel, followed by fragrance mix and butylphenolformaldehyde. A higher incidence of positive reactions was seen in females. CONCLUSIONS: A high incidence of positive patch test reactions was identified in the study population, and the introduction of patch testing in Ethiopia is essential for the management of allergic contact dermatitis.

PMID: 19702984 [PubMed - in process]

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Dermatitis artefacta of the breast: a retrospective analysis of 27 patients (1976-2006).

J Eur Acad Dermatol Venereol. 2009 Aug 20;

Authors: Rodríguez-Pichardo A, Hoffner MV, García-Bravo B, Camacho FM

Abstract Background Dermatitis artefacta (DA) is defined as all dermatological, self-inflicted skin lesions, where the patient denies having produced the lesions. Objectives The purpose of this study is to make a single-centre retrospective clinical review of patients diagnosed as DA of the breast. Materials and methods During a 30-year period (1976-2006), patients diagnosed as DA of the breast, seen in the Department of Dermatology of the Virgen Macarena Hospital in Seville, were recorded. Clinical and epidemiological features are described. Results A total of 27 women with a mean age of 34.33 years were selected representing 13.43% of the total of DA patients recorded (n = 201) in this period. The most frequent clinical forms were: excoriations (nine patients, 33.33%) and ulcers (nine patients, 33.33%), followed by burns (six patients, 22.22%), blisters (one patient, 3.70%), contact dermatitis (one patient, 3.70%) and haematomas (one patient, 3.70%). Ten of the cases were located exclusively on the breasts, whereas 17 had also other locations such as face in seven cases, arms in five cases, abdomen in five cases and the entire body in two cases. Cutaneous lesions were treated with occlusive bandages using zinc paste or plaster splint when necessary. Conclusion To our knowledge, this is the major series of DA of the breast studied. This complicated psychodermatological condition requires a correct diagnosis, appropriate management and psychiatric assessment.

PMID: 19694893 [PubMed - as supplied by publisher]

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Dental infection associated with nummular eczema as an overlooked focal infection.

J Dermatol. 2009 Aug;36(8):462-5

Authors: Tanaka T, Satoh T, Yokozeki H

Nummular eczema is a common skin disease, but the pathoetiology has yet to be elucidated. We report here a case of severe nummular eczema. Although the skin lesions were resistant to topical corticosteroids, the patient became responsive to treatment and no recurrence was noted after the eradication of dental infections. We have experienced 13 similar cases of nummular eczema with widely-distributed skin lesions. The cases had moderate to severe odontogenic infections, which were detected by panorama X-ray screening test. In 11 patients, skin lesions partially or completely improved after the dental treatment. Latent odontogenic infection may thus be an aggravating factor in treatment-resistant nummular eczema.

PMID: 19691752 [PubMed - in process]

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Filaggrin haploinsufficiency is highly penetrant and is associated with increased severity of eczema: further delineation of the skin phenotype in a prospective epidemiological study of 792 school children.

Br J Dermatol. 2009 Jun 11;

Authors: Brown SJ, Relton CL, Liao H, Zhao Y, Sandilands A, McLean WH, Cordell HJ, Reynolds NJ

Summary Background Null mutations within the filaggrin gene (FLG) cause ichthyosis vulgaris and are associated with atopic eczema. However, the dermatological features of filaggrin haploinsufficiency have not been clearly defined. Objectives This study investigated the genotype-phenotype association between detailed skin phenotype and FLG genotype data in a population-based cohort of children. Methods Children (n = 792) aged 7-9 years were examined by a dermatologist. Features of ichthyosis vulgaris, atopic eczema and xerosis were recorded and eczema severity graded using the Three Item Severity score. Each child was genotyped for the six most prevalent FLG null mutations (R501X, 2282del4, R2447X, S3247X, 3702delG, 3673delC). Fisher’s exact test was used to compare genotype frequencies in phenotype groups; logistic regression analysis was used to estimate odds ratios and penetrance of the FLG null genotype and a permutation test performed to investigate eczema severity in different genotype groups. Results Ten children in this cohort had ichthyosis vulgaris, of whom five had mild-moderate eczema. The penetrance of FLG null mutations with respect to flexural eczema was 55.6% in individuals with two mutations, 16.3% in individuals with one mutation and 14.2% in wild-type individuals. Summating skin features known to be associated with FLG null mutations (ichthyosis, keratosis pilaris, palmar hyperlinearity and flexural eczema) showed a penetrance of 100% in children with two FLG mutations, 87.8% in children with one FLG mutation and 46.5% in wild-type individuals (P < 0.0001, Fisher exact test). FLG null mutations were associated with more severe eczema (P = 0.0042) but the mean difference was only 1-2 points in severity score. Three distinct patterns of palmar hyperlinearity were observed and these are reported for the first time. Conclusions Filaggrin haploinsufficiency appears to be highly penetrant when all relevant skin features are included in the analysis. FLG null mutations are associated with more severe eczema, but the effect size is small in a population setting.

PMID: 19681860 [PubMed - as supplied by publisher]

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Delay in medical attention to hand eczema: a follow-up study.

Br J Dermatol. 2009 Jul 7;

Authors: Hald M, Agner T, Blands J, Johansen JD,

Background Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis. Objectives To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis. Methods Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6-month follow up using a self-administered photographic guide. Additional information was obtained by self-administered questionnaires. Results Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1.5-8.0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1-8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1.11 [95% confidence interval (CI) 1.02-1.21] per month of patient delay and by 1.05 (95% CI 1.00-1.10) per month of healthcare delay. Conclusions A poorer prognosis of hand eczema was associated with longer delay before medical attention.

PMID: 19681880 [PubMed - as supplied by publisher]

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Predictive Factors of Eczema-Like Eruptions among Patients without Cutaneous Psoriasis Receiving Infliximab: A Cohort Study of 92 Patients.

Dermatology. 2009 Aug 13;

Authors: Esmailzadeh A, Yousefi P, Farhi D, Bachmeyer C, Cosnes J, Berenbaum F, Duriez P, Aractingi S, Khosrotehrani K

Background: Anti-tumor-necrosis-factor-alpha agents are limited by their side effects. Eczema is one of the most frequent adverse reactions affecting quality of life. Objective: To assess potential predictive risk factors for eczema in patients receiving infliximab. Methods: We conducted a prospective cohort study including patients treated with infliximab for a variety of disorders with the exception of cutaneous psoriasis. Clinical features were compared among patients with and without eczema under therapy. Results: 92 consecutive patients were included; 15 developed eczema after the initiation of infliximab. In univariate analyses, a personal history of atopic symptoms was the only predictive factor for the occurrence of eczema (odds ratio = 3.6). Sex, age, principal diagnosis, dose and duration of infliximab and concomitant use of other immunosuppressors had no influence on the occurrence of eczema. Conclusions: A personal history of atopic symptoms is predictive of eczema under infliximab. Specific information should be provided to atopic patients starting such a treatment.

PMID: 19684381 [PubMed - as supplied by publisher]

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Low bone mineral density in adult patients with moderate to severe atopic dermatitis.

Br J Dermatol. 2009 Jun 4;

Authors: Haeck IM, Hamdy NA, Timmer-de Mik L, Lentjes EG, Verhaar HJ, Knol MJ, de Bruin-Weller MS, Bruijnzeel-Koomen CA

Summary Background Atopic dermatitis (AD) is a chronic inflammatory skin disease commonly treated with topical corticosteroids. The inflammatory nature of this disorder and the use of topical corticosteroids represent potential risk factors for bone loss. Objectives The aim was to assess the prevalence of osteoporosis and osteopenia in adult patients with moderate to severe AD. In addition, the associations between topical/oral corticosteroid use and bone mineral density (BMD) and between disease activity and BMD were studied. Patients and methods We studied 125 adult patients with moderate to severe AD. Using dual-energy X-ray absorptiometry, BMD was measured at lumbar spine and hips. The cumulative dose of topical and oral corticosteroids was calculated from pharmacy prescription records. Lifestyle parameters were collected by a questionnaire. Biochemical parameters of bone metabolism and disease activity [serum concentration of thymus and activation-regulated chemokine (TARC) levels] were also measured. Results Osteoporosis was documented in six patients (4.8%) and osteopenia in 41 patients (32.8%); 30.4% of the patients had a Z-score

PMID: 19673879 [PubMed - as supplied by publisher]

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Inflammatory epidermolysis bullosa acquisita mimicking toxic epidermal necrolysis and dermatitis herpetiformis.

Clin Exp Dermatol. 2009 Jul 29;

Authors: Madan V, Jamieson LA, Bhogal BS, Wong CS

Summary We report a patient with a spectrum of clinical features simulating toxic epidermal necrolysis, bullous erythema multiforme and later, dermatitis herpetiformis (DH). The histological features were suggestive of DH, bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA). Direct immunofluorescence results suggested BP or EBA. Indirect immunofluorescence on salt-split skin and immunoblotting analysis on normal human dermal extracts gave results that were diagnostic for EBA.

PMID: 19663858 [PubMed - as supplied by publisher]

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Distinct patterns of brain activity evoked by histamine-induced itch reveal an association with itch intensity and disease severity in atopic dermatitis.

Br J Dermatol. 2009 May 15;

Authors: Ishiuji Y, Coghill RC, Patel TS, Oshiro Y, Kraft RA, Yosipovitch G

Background Little is known about brain mechanisms supporting the experience of chronic puritus in disease states. Objectives To examine the difference in brain processing of histamine-induced itch in patients with active atopic dermatitis (AD) vs. healthy controls with the emerging technique of functional magnetic resonance imaging (fMRI) using arterial spin labelling (ASL). Methods Itch was induced with histamine iontophoresis in eight patients with AD and seven healthy subjects. Results We found significant differences in brain processing of histamine-induced itch between patients with AD and healthy subjects. Patients with AD exhibited bilateral activation of the anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), retrosplenial cingulate cortex and dorsolateral prefrontal cortex (DLPFC) as well as contralateral activation of the caudate nucleus and putamen. In contrast, healthy subjects activated the primary motor cortex, primary somatosensory cortex and superior parietal lobe. The PCC and precuneus exhibited significantly greater activity in patients vs. healthy subjects. A significant correlation between percentage changes of brain activation was noted in the activation of the ACC and contralateral insula and histamine-induced itch intensity as well as disease severity in patients with AD. In addition, an association was noted between DLPFC activity and disease severity. Conclusions Our results demonstrate that ASL fMRI is a promising technique to assess brain activity in chronic itch. Brain activity of acute itch in AD seems to differ from that in healthy subjects. Moreover, the activity in cortical areas involved in affect and emotion correlated to measures of disease severity.

PMID: 19663870 [PubMed - as supplied by publisher]

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Sites of dermatitis in a patch test population: hand dermatitis is associated with polysensitization.

Br J Dermatol. 2009 May 5;

Authors: Carlsen BC, Andersen KE, Menné T, Johansen JD

Background Sites of dermatitis in larger series of contact allergic patients are rarely reported. Increased risk of polysensitization has been linked only to stasis dermatitis and leg ulcers. However, a large proportion of polysensitized individuals may have dermatitis in other skin areas. Objectives To examine the site of dermatitis at time of first appearance in contact allergic individuals with special focus on the distribution of dermatitis in polysensitized individuals and to examine if widespread dermatitis is more frequent in polysensitized than in single/double-sensitized patients. Methods A matched case-control study was carried out including 394 polysensitized and 726 single/double-sensitized patients who responded to a postal questionnaire. All subjects were recruited from a hospital patch test population. Results The hands were the most frequent and the anogenital region was the least frequent skin area affected with dermatitis. Dermatitis on the hands/wrists [odds ratio (OR) 1.58], in the armpits (OR 1.56) and on the back (OR 1.91) was positively associated with polysensitization. The hands were the only skin area with dermatitis which maintained the association to polysensitization in two subpopulations consisting of, respectively, individuals with and without atopic eczema. Dermatitis on the scalp was negatively associated with polysensitization (OR 0.66) primarily for individuals without atopic eczema. The dermatitis did not seem to be more widespread in polysensitized compared with single/double-sensitized patients. Conclusions Special awareness in patients with hand dermatitis seems justified either to prevent development of multiple contact allergies or to document polysensitization as an aetiological factor.

PMID: 19663872 [PubMed - as supplied by publisher]

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