Atopic dermatitis (eczema)

Initial presentation of stasis dermatitis mimicking solitary lesions: A previously unrecognized clinical scenario.

J Am Acad Dermatol. 2009 Dec;61(6):1028-1032

Authors: Weaver J, Billings SD

BACKGROUND: Stasis dermatitis is a common skin condition secondary to chronic venous insufficiency. Characteristic dermatologic changes in well-developed disease include bilateral erythematous, scaly, and slightly discolored papules and plaques on the lower legs. Earlier signs, such as prominent superficial veins and pitting ankle edema, are well known. Early recognition of signs and appropriate diagnosis can lead to timely treatment that can prevent painful complications, such as leg ulcers which are at risk for development of squamous cell carcinoma. OBJECTIVE: Herein we describe a yet unrecognized early sign of venous dermatitis-a solitary lesion, some mimicking neoplastic processes. METHODS: Thirty-seven cases of stasis dermatitis submitted with the clinical diagnosis of a solitary lesion were identified. Thirty-three had no clinical history of venous insufficiency. All cases of stasis dermatitis presenting for the first time as a solitary lesion were reviewed retrospectively both clinically and pathologically. RESULTS: Squamous cell carcinoma was most commonly suspected (33%), followed by basal cell carcinoma (24%), and a variety of other solitary lesions. The histopathology was characteristic of stasis dermatitis in all cases with absent or mild spongiosis (82%), variable acanthosis and dermal fibrosis, and proliferation of papillary dermal thick-walled vessels were prominent (2-3+) in nearly all cases (>/=90%) along with hemosiderin-laden macrophages and extravasated red blood cells (>/=95%). LIMITATIONS: The study is limited by its retrospective nature and absence of clinical images on all cases. CONCLUSION: Stasis dermatitis may present as a solitary lesion mimicking a neoplasm. Early recognition of stasis dermatitis can lead to appropriate treatment and possibly prevent further morbidity.

PMID: 19925928 [PubMed - as supplied by publisher]

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The effect of tobacco smoking and alcohol consumption on the prevalence of self-reported hand eczema: a cross-sectional population-based study.

Br J Dermatol. 2009 Jun 30;

Authors: Thyssen JP, Linneberg A, Menné T, Nielsen NH, Johansen JD

Background Hand eczema is a prevalent disorder that leads to high health care costs as well as a decreased quality of life. Important risk factors include atopic dermatitis, contact allergy and wet work whereas the role of null mutations in the filaggrin gene complex remains to be clarified. It has been debated whether life-style factors such as tobacco smoking and alcohol consumption are associated with hand eczema. Objectives The current study aimed to investigate whether self-reported hand eczema was associated with smoking and alcohol consumption in the general population. Methods Between June 2006 and May 2008, a cross-sectional study was performed in the general population in Copenhagen, the capital of Denmark. A random sample of 7931 subjects aged 18-69 years old was invited to participate in a general health examination including a questionnaire; 3471 (44%) participated. Data were analysed with logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CI). Results The prevalence of hand eczema was higher among previous smokers (OR = 1.13; CI = 0.90-1.40), current light smokers (OR = 1.51; CI = 1.14-2.02) and current heavy smokers (OR = 1.38; CI = 0.99-1.92) compared with never-smokers. Conclusions Tobacco smoking was positively associated with hand eczema among adults from the general population in Denmark. Apparently, current light smokers (< 15 g daily) had a higher prevalence of hand eczema than current heavy smokers (> 15 g daily) but this needs to be reconfirmed. Alcohol consumption was not associated with hand eczema.

PMID: 19919628 [PubMed - as supplied by publisher]

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Granulomatous dermatitis with pseudoxanthoma elasticum-like changes: report of a case in a patient with cystic fibrosis.

Arch Dermatol. 2009 Nov;145(11):1292-5

Authors: Tiger JB, McKenzie J, Tran DT, Olerud JE, George E

BACKGROUND: There is scant literature that documents pseudoxanthoma elasticum (PXE)-like histologic changes in the setting of inflammatory skin diseases. This article documents granulomatous dermatitis with PXE-like changes in a patient with cystic fibrosis. This is the first report of its kind, to our knowledge. OBSERVATIONS: A 33-year-old woman with cystic fibrosis developed a papular eruption on the flexural surfaces of the upper and lower extremities, which was initially treated with prednisone. A punch biopsy showed granulomatous inflammation and associated PXE-like changes. The combined histologic and clinical findings were most consistent with granuloma annulare. There was no family history of PXE or clinical manifestations of PXE. The rash gradually resolved itself over the next several months. CONCLUSIONS: There are few publications that document PXE-like changes in association with various inflammatory skin conditions. Thus, the clinical significance of this finding remains uncertain. This case and previous reports are discussed in the context of current molecular and genetic knowledge. It is hoped that greater awareness of this phenomenon will promote further investigation and elucidation of the clinical and biologic significance of PXE-like changes observed in biopsies of inflammatory skin disorders.

PMID: 19917959 [PubMed - in process]

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An investigator-blind, randomized, 4-week, parallel-group, multicenter pilot study to compare the safety and efficacy of a nonsteroidal cream (Promiseb Topical Cream) and desonide cream 0.05% in the twice-daily treatment of mild to moderate seborrheic dermatitis of the face.

Clin Dermatol. 2009 Nov-Dec;27(6 Suppl):S48-53

Authors: Elewski B

The treatment of seborrheic dermatitis includes topical antifungal agents to eradicate Malassezia spp, corticosteroids, which treat the inflammatory component of the disease and keratolytics which remove scale and crust. This study compared the efficacy of a nonsteroidal topical cream and a low-potency topical corticosteroid for the treatment of mild to moderate seborrheic dermatitis of the face in 77 volunteers randomized to twice-daily treatment with nonsteroidal cream or corticosteroid cream for up to 28 days. If the individual was rated clear by day 14, the study drug was collected and the participant was told not to use any topical products on the previously treated areas until after the 28-day follow-up visit. Both treatments were similarly effective in reducing disease severity, with approximately 90% of participants clearing or almost clear during the study. Both treatments demonstrated significant reductions in erythema, scaling, and pruritus (P < .0001). Safety in both groups was rated as excellent in more than 90%. Those using the nonsteroidal cream who cleared after 14 days of treatment were more likely to remain clear than were participants using the corticosteroid cream (P = .0173). Investigator global assessments of improvement found both study agents were essentially the same, and participants in both groups achieved clinically important improvement.

PMID: 19878781 [PubMed - in process]

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Successful retreatment with alitretinoin in relapsed chronic hand eczema patients.

Br J Dermatol. 2009 Nov 10;

Authors: Bissonette R, Worm M, Gerlach B, Guenther L, Cambazard F, Ruzicka T, Maares J, Brown TC

Abstract BACKGROUND: Patients with severe chronic hand eczema (CHE) often respond to therapy with oral alitretinoin (9-cis-retinoic acid). However, the efficacy of alitretinoin after disease relapse has not been demonstrated. OBJECTIVES: To assess the efficacy and safety of a second course of oral alitretinoin in patients with severe CHE who relapsed after achieving ‘clear’ or ‘almost clear’ hands following a previous course of alitretinoin. METHODS: Double-blind study in 117 CHE patients who had responded to therapy in an earlier clinical trial and subsequently relapsed. Patients were randomized to receive their previous treatment or placebo. Treatment was alitretinoin 30mg or 10mg or placebo given once daily for 12 to 24 weeks. Response was defined as an overall Physician’s Global Assessment rating of ‘clear’ or ‘almost clear’ hands at the end of therapy. RESULTS: Response rates were 79.6% in patients retreated with 30mg alitretinoin compared with 8.3% for placebo [P<0.001]. In patients re-treated with 10mg alitretinoin response rates were 47.6%, compared with 10.0% in the placebo group. Alitretinoin was well tolerated. Adverse reactions comprised typical retinoid class effects, and no late arising side-effects were observed during this second course of treatment. CONCLUSIONS: The majority of patients with CHE who previously achieved ‘clear’ or ‘almost clear’ hands following treatment with alitretinoin 30mg per day also responded to a second course of treatment. Retreatment was well tolerated. Intermittent treatment with alitretinoin is suitable for the long-term management of CHE.

PMID: 19906075 [PubMed - as supplied by publisher]

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Increased expression of glucocorticoid receptor beta in lymphocytes of patients with severe atopic dermatitis unresponsive to topical corticosteroid.

Br J Dermatol. 2009 Nov 9;

Authors: Hägg PM, Hurskainen T, Palatsi R, Ilves M, Oikarinen A

Summary Background Variable response to topical glucocorticoid therapy occurs in the treatment of severe atopic dermatitis (AD). Glucocorticoid receptor (GR)-beta does not bind glucocorticoids but antagonizes the activity of the classic GRalpha, and could thus account for glucocorticoid insensitivity. Objectives To investigate GRalpha and GRbeta mRNA and protein expression in lymphocytes of patients with AD before and after treatment with topical corticosteroids. Methods Blood was collected from 11 healthy donors, 10 patients with mild AD and 13 patients with severe AD. mRNA was isolated from peripheral blood mononuclear cells. Expression of GRalpha and GRbeta mRNA was determined by reverse transcriptase-polymerase chain reaction and quantitated. Expression of the GRs was confirmed by Western blot analysis. Result The expression of GRalpha mRNA was detected in all subjects. GRbeta mRNA was detected in four out of 11 healthy volunteers, five out of 10 patients with mild AD and 11 out of 13 patients with severe AD. The incidence of GRbeta mRNA expression was higher in patients with severe AD (85%) than in patients with mild AD (50%), and significantly higher than in healthy volunteers (36%, P = 0.033). Four of the 13 patients with severe AD showed a 3.3-13.2-fold increase in the expression of GRbeta mRNA during a 2-week treatment with topical corticosteroids. In these patients the response to topical corticosteroids was poor. Conclusions Expression of GRbeta is increased during topical corticosteroid treatment in the lymphocytes of patients with AD and, in particular, glucocorticoid-insensitive AD is associated with increased expression of GRbeta.

PMID: 19903176 [PubMed - as supplied by publisher]

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Interstitial granulomatous dermatitis with arthritis.

Dermatol Online J. 2009;15(8):22

Authors: Jabbari A, Cheung W, Kamino H, Soter NA

A 54-year-old woman with a history of arthritis presented for a long-standing history of symmetric, indurated plaques on her thighs and lateral aspects of the trunk. Histopathologic examination of skin biopsy specimens was consistent with interstitial granulomatous dermatitis, and a diagnosis of interstitial granulomatous dermatitis with arthritis was made. Administration of topical potent glucocorticoids, intralesional glucocorticoids, and narrow-band ultraviolet B phototherapy, in addition to continuation of systemic glucocorticoids and methotrexate, resulted in improvement of her cutaneous and musculoskeletal disease.

PMID: 19891930 [PubMed - in process]

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Health behaviour models: a framework for studying adherence in children with atopic dermatitis.

Clin Exp Dermatol. 2009 Nov 3;

Authors: Chisolm SS, Taylor SL, Gryzwacz JG, O’Neill JL, Balkrishnan RR, Feldman SR

Summary Atopic dermatitis (AD) is a common problem of childhood causing considerable distress. Effective topical treatments exist, yet poor adherence often results in poor outcomes. A framework is needed to better understand adherence behaviour. To provide a basis for this framework, we reviewed established models used to describe health behaviour. Structural elements of these models informed the development of an adherence model for AD that can be used to complement empirical AD treatment trials. Health behaviour models provide a means to describe factors that affect adherence and that can mediate the effects of different adherence interventions. Models of adherence behaviour are important for promoting better treatment outcomes for children with AD and their families. These models provide a means to identify new targets to improve adherence and a guide for refining adherence interventions.

PMID: 19886956 [PubMed - as supplied by publisher]

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Seborrhoeic dermatitis among Oxford renal transplant recipients.

J Eur Acad Dermatol Venereol. 2009 Nov 2;

Authors: Lally A, Casabonne D, Newton R, Wojnarowska F

Abstract Background Seborrhoeic dermatitis is an inflammatory dermatosis with a prevalence of 1-3% in the general population. It is recognized more commonly in those infected by human immunodeficiency virus (HIV). No studies have looked at seborrhoeic dermatitis in the context of immunosuppression secondary to organ transplantation. Therefore, we investigated the prevalence of seborrhoeic dermatitis in a renal transplant population and characteristics of those affected. Methods A prospective study of 308 renal transplant recipients (RTRs) was carried out. All participants were examined for seborrhoeic dermatitis. Descriptive statistics were employed and associations with seborrhoeic dermatitis were examined using Fisher’s exact test to calculate P-exact values, and Student’s t-test was used to compare mean ages and time since transplantation. Statistical analysis was carried out using spss version 14.0 for Windows. Results Seborrhoeic dermatitis was identified in 29/308 (9.5%) patients and was more common in males (P-exact = 0.004) and in those who had been transplanted for longer (P = 0.02). The disease was mild-moderate severity in the majority but an unusual flexural appearance was recorded in 7/29 patients. Seborrhoeic dermatitis was less likely in those taking prednisolone (P-exact = 0.006) or tacrolimus (P-exact = 0.008). Seborrhoeic dermatitis was significantly associated with cutaneous malignancy, in particular squamous cell carcinoma (P-exact < 0.0001). Discussion Seborrhoeic dermatitis is more common than other inflammatory dermatoses in immunosuppressed RTRs, but is not as frequent as in those immunosuppressed secondary to HIV. Degree and duration of exposure to immunosuppression and increased colonization with Malassezia yeast genus are likely be important in the aetiology of seborrhoeic dermatitis in RTRs. Further studies are required to clarify this.

PMID: 19888944 [PubMed - as supplied by publisher]

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Related Articles

Perinatal exposure to endotoxin and the development of eczema during the first 6 years of life.

Clin Exp Dermatol. 2009 Oct 23;

Authors: Chen CM, Sausenthaler S, Bischof W, Herbarth O, Borte M, Behrendt H, Krämer U, Williams HC, Wichmann HE, Heinrich J,

Summary Background. Previous studies have reported a protective association between high levels of exposure to endotoxin during infancy and the development of subsequent eczema within the first 6 months of life. Aim. To investigate the association between exposure in infancy to endotoxin from mattress dust and the development of eczema up to age of 6 years in 2166 children participating in the German Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood (LISA) study, an ongoing population-based birth-cohort study. Methods. Endotoxin levels in house dust samples collected at 3 months after birth were quantified using the kinetic Limulus amebocyte lysate assay. Specific IgE antibodies to common food and aeroallergens were measured using radioallergosorbent test, fluorenzyme immunoassay (Pharmacia CAP system) when children were 2 and 6 years old. Information on eczema symptoms and physician-diagnosed eczema were collected at each follow-up using a questionnaire. Results. No association was found between endotoxin exposure from mattresses (the mattresses of each child and their parents were examined) during infancy and the development of eczema symptoms or doctor-diagnosed eczema by 6 years of age (OR = 1.1, 95% CI 0.5-2.3, and OR = 1.1, 95% CI 0.4-3.3, respectively). No association was found when children with only atopic eczema. Conclusion. Endotoxin exposure during infancy is unlikely to have a large long-term effect on the development of eczema, especially the atopic form.

PMID: 19874326 [PubMed - as supplied by publisher]

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