Atopic dermatitis (eczema)

A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist.

Br J Dermatol. 2009 Sep 8;

Authors: Schuttelaar ML, Vermeulen KM, Drukker N, Coenraads PJ

Summary Background We hypothesized that a nurse practitioner would improve the quality of life of a child with eczema more than a dermatologist because of a structured intervention and more consultation time. Objectives To compare the level of care by nurse practitioners with that by dermatologists in children with eczema. Methods New referrals aged

PMID: 19849695 [PubMed - as supplied by publisher]

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Late-onset of IgE sensitization to microbial allergens in young children with atopic dermatitis.

Br J Dermatol. 2009 Sep 8;

Authors: Ong PY, Ferdman RM, Church JA

Summary Background A significant proportion of young children with atopic dermatitis (AD) is sensitized to microbial allergens, which play a potential role in the pathogenesis of AD inflammation. Objective To study the timing of IgE sensitization to microbial allergens including staphylococcal superantigens, Malassezia species and Candida albicans in young children with AD. Method Specific IgE antibodies to staphylococcal superantigens, Malassezia species, C. albicans and control inhalant/food allergens were measured in 53 young children with mild to moderate AD. The presence of IgE sensitization relative to age (>/= 3 years vs. < 3 years) was analysed by logistic regressions. Results IgE sensitization to the staphylococcal superantigen group, Malassezia species and C. albicans was significantly associated with older age in children with AD [P = 0.02, odds ratio (OR) 4.9; P = 0.02, OR 4.7; and P = 0.05, OR 4.0, respectively]. Conclusion IgE sensitization to microbial allergens is associated with an older age group in young children with mild to moderate AD.

PMID: 19849698 [PubMed - as supplied by publisher]

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A randomized double-blind controlled trial to compare a triclosan-containing emollient with vehicle for the treatment of atopic dermatitis.

Clin Exp Dermatol. 2009 Oct 19;

Authors: Tan WP, Suresh S, Tey HL, Chiam LY, Goon AT

Summary The use of topical antiseptics in the treatment of atopic dermatitis (AD) has previously been explored. However, no triclosan-containing leave-on emollient has been evaluated previously, to our knowledge. The aims of this study were to assess the safety and efficacy of an emollient containing triclosan compared with the emollient alone (vehicle) for the treatment of AD. Eligible patients with mild to moderate AD were randomized to receive either the study cream or vehicle. All patients also received a low-potency corticosteroid cream to use during the treatment phase of the study if necessary. Patients were assessed for severity according to the SCORing Atopic Dermatitis (SCORAD) Index, amount of corticosteroid used, patient assessment of cream, and adverse events (AEs). In total, 60 patients received either the study cream or vehicle, and an intention-to-treat analysis was performed. At day 14, there was a significant decrease in SCORAD from baseline for the study cream compared with vehicle (P < 0.05). At day 27, although there was an improved mean reduction from baseline, this was no longer significant (P > 0.05). Only four patients had mild treatment-related AEs. The mean total amount of topical steroid applied by the patients using the study was significantly lower than that used by controls (P = 0.40). Triclosan-containing leave-on emollient was safe and highly acceptable to patients. However, the overall benefit on day 27 was not significant. Nevertheless, the amount of topical steroid used by patients was significantly less with the study cream than with the vehicle, thus further studies are needed to confirm its steroid-sparing effect.

PMID: 19843084 [PubMed - as supplied by publisher]

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Corticosteroids’ effect on the height of atopic dermatitis patients: a controlled questionnaire study.

Pediatr Dermatol. 2009 Sep-Oct;26(5):524-8

Authors: Thomas MW, Panter AT, Morrell DS

To investigate if children treated with topical corticosteroids have a significantly shorter height than the height of children not treated with corticosteroids and to see if corticosteroids affect the ability for treated children to meet growth potential defined as midparental height. Parents of patients attending the UNC’s Dermatology clinic completed the survey. The patient’s height and siblings’ heights were measured by staff. Parents’ heights were self reported as were the child’s diagnosis of atopic dermatitis, and duration of use of corticosteroids. The patient’s height was standardized using CDC charts. Additionally, the midparental height was calculated and standardized. The difference between present and predicted standardized heights was calculated; 151 surveys yielded data on 83 girls and 63 boys (ages 2-21 yrs). The standing height and the difference in standing height and midparental scores were not significantly different among: (i) children with and without atopic dermatitis; and (ii) children treated and not treated with corticosteroids. The overall height of children examined in this survey who were treated with topical corticosteroids appears to be unaffected.

PMID: 19840305 [PubMed - in process]

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Twice-daily versus Once-daily Applications of Pimecrolimus Cream 1% for the Prevention of Disease Relapse in Pediatric Patients with Atopic Dermatitis.

Pediatr Dermatol. 2009 Sep-Oct;26(5):551-8

Authors: Ruer-Mulard M, Aberer W, Gunstone A, Kekki OM, Estebaranz JL, Vertruyen A, Guettner A, Hultsch T

The aim of this study is to compare twice-daily and once-daily applications of pimecrolimus cream 1% for prevention of atopic dermatitis relapses in pediatric patients. This multicenter trial enrolled 300 outpatients aged 2 to 17 years, with mild-to-severe atopic dermatitis. The patients were initially treated with twice-daily topical pimecrolimus until complete clearance or for up to 6 weeks (open-label period). Those who achieved a decrease of at least 1 point in the Investigator’s Global Assessment score were then randomized to double-blind treatment with pimecrolimus cream 1% either twice daily or once daily for up to 16 weeks. Study medication was discontinued during periods of disease remission (Investigator’s Global Assessment = 0). The primary efficacy end point of the double-blind phase was disease relapse (worsening requiring topical corticosteroids or additional/alternative therapy and confirmed by Investigator’s Global Assessment score >/= 3 and pruritus score >/= 2). Of the 300 patients enrolled in the study, 268 were randomized to treatment with pimecrolimus cream 1% either twice daily or once daily (n = 134 in each group). The relapse rate was lower in the twice-daily dose group (9.9%) than that in the once-daily dose group (14.7%), but analysis of the time to disease relapse, using a Cox proportional model to adjust for confounding variables, did not show a statistically significant difference between treatment arms (hazard ratio: 0.64; 95% CI: 0.31-1.30). Treatment of active atopic dermatitis lesions with pimecrolimus cream 1% twice daily, followed by the once-daily dosing regimen, was sufficient to prevent subsequent atopic dermatitis relapses over 16 weeks in pediatric patients.

PMID: 19840309 [PubMed - in process]

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Lyme disease as a cause of acropapular dermatitis of childhood.

Pediatr Dermatol. 2009 Sep-Oct;26(5):635-6

Authors: Kennedy CE, Azfar RS, Honig PJ

Acropapular dermatitis of childhood is a symmetric self-limited papulovesicular exanthem that classically occurs on the cheeks, extensor extremities, and buttocks in young children. The eruption of acropapular dermatitis of childhood represents a reaction to a variety of infections usually of viral origin. We present a child with typical findings of acropapular dermatitis of childhood whose serologic workup revealed an acute Lyme infection.

PMID: 19840337 [PubMed - in process]

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Protein losing enteropathy in severe atopic dermatitis in an exclusively breast-fed infant.

Pediatr Dermatol. 2009 Sep-Oct;26(5):638-9

Authors: Hwang JB, Kang YN, Won KS

We first report a case of protein losing enteropathy in severe atopic dermatitis in an exclusively breast-fed 5-month-old infant. Protein losing enteropathy was confirmed by fecal alpha(1)-antitrypsin clearance test and imaged successfully by (99m)Tc-human serum albumin scintigraphy. The present case highlights that protein losing enteropathy in severe infantile atopic dermatitis is being a topic of concern and also an issue even in exclusive breast feeding patients.

PMID: 19840339 [PubMed - in process]

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Homoeopathic versus Conventional Therapy for Atopic Eczema in Children: Medical and Economic Results.

Dermatology. 2009 Oct 13;

Authors: Witt CM, Brinkhaus B, Pach D, Reinhold T, Wruck K, Roll S, Jäckel T, Staab D, Wegscheider K, Willich SN

Background: One of five children visiting a homoeopathic physician is suffering from atopic eczema. Objective: To examine the effectiveness, safety and costs of homoeopathic versus conventional treatment in usual care. Methods: In a prospective multicentre comparative observational non-randomised study, 135 children (homoeopathy n = 48 vs. conventional n = 87) with mild to moderate atopic eczema were included. The primary outcome was the SCORAD (Scoring Atopic Dermatitis) at 6 months. Further outcomes at 6 and 12 months also included quality of life of parents and children, use of conventional medicine, treatment safety and disease-related costs. Results: The adjusted SCORAD showed no significant differences between the groups at both 6 months (homoeopathy 22.49 +/- 3.02 [mean +/- SE] vs. conventional 18.20 +/- 2.31, p = 0.290) and 12 months (17.41 +/- 3.01 vs. 17.29 +/- 2.31, p = 0.974). Adjusted costs were higher in the homoeopathic than in the conventional group: for the first 6 months EUR 935.02 vs. EUR 514.44, p = 0.026, and for 12 months EUR 1,524.23 vs. EUR 721.21, p = 0.001. Quality of life was not significantly different between both groups. Conclusion: Taking patient preferences into account, homoeopathic treatment was not superior to conventional treatment for children with mild to moderate atopic eczema.

PMID: 19828937 [PubMed - as supplied by publisher]

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Allergic contact dermatitis to inhalation corticosteroids.

Eur J Dermatol. 2009 Oct 13;

Authors: Baeck M, Pilette C, Drieghe J, Goossens A

Inhaled and intranasal corticosteroids (CS) are used to treat various inflammatory or allergic diseases of the upper and lower respiratory tract. Despite their wide use, only a few reports about their sensitization potential have been published. We determined the frequency, clinical signs and molecules responsible for skin allergic reactions following inhalation of corticosteroids amongst patients with identified and investigated “contact allergy” to corticosteroids. We reviewed clinical data, patch test results and sensitization sources in patients who reacted positively to corticosteroids tested in the K.U.Leuven Dermatology department during an 18-year period. 12 subjects (out of 315 with contact allergy to CS) presented with allergic manifestations due to nasal or orally inhaled corticosteroids, 11 of which were due to budesonide and one to tixocortol pivalate. Amongst patients with “contact allergy” to corticosteroids, very few were found with allergic manifestations due to inhaled corticosteroids. Budesonide was the major allergen found. Other inhalation corticosteroids such as beclomethasone, mometasone and fluticasone derivatives may, in most cases, still be used, since they do not cross react with budesonide.

PMID: 19825528 [PubMed - as supplied by publisher]

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Molecular Diagnostics of Psoriasis, Atopic Dermatitis, Allergic Contact Dermatitis and Irritant Contact Dermatitis.

Br J Dermatol. 2009 Oct 10;

Authors: Kamsteeg M, Jansen PA, van Vlijmen-Willems IM, van Erp PE, Rodijk-Olthuis D, van der Valk PG, Feuth T, Zeeuwen PL, Schalkwijk J

ABSTRACT Background: Microarray studies on the epidermal transcriptome in psoriasis and atopic dermatitis have revealed genes with disease-specific expression in keratinocytes of lesional epidermis. These genes are possible candidates for disease-specific pathogenetic changes, but could also provide a tool for molecular diagnostics of inflammatory skin conditions in general. Objectives: To analyze if gene expression signatures as found in purified epidermal cells from atopic dermatitis are also present in other eczematous conditions such as allergic and irritant contact dermatitis. Methods: We used real-time quantitative PCR, immunohistochemistry and bioinformatics to investigate gene expression in different forms of eczema. Normal epidermis and psoriatic epidermis were analyzed for comparison. Results: Carbonic anhydrase II was highly induced in epidermis from all forms of eczema but not in psoriasis. Remarkably, the presumed neuron-specific Nel-like protein 2 showed a strong induction only in atopic dermatitis epidermis. Interleukin-1F9, elafin, beta-defensin-2 and vanin-3 were strongly induced in psoriasis, but not in any type of eczema. High levels of the chemokines CCL17 and CXCL10 were predominantly found in epidermis of allergic contact dermatitis. The chemokine CXCL8 was highly expressed in psoriasis, atopic dermatitis, and allergic contact dermatitis but not in irritant contact dermatitis. Cluster analysis or multinomial logistic regression indicated that expression levels of a set of seven genes are a strong predictor of the type of inflammatory response. Conclusions: These observations contribute to molecular diagnostic criteria for inflammatory skin conditions.

PMID: 19818069 [PubMed - as supplied by publisher]

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