Atopic dermatitis (eczema)

Efficacy of a 5-HT receptor agonist in atopic dermatitis.

Clin Exp Dermatol. 2010 Jan 18;

Authors: Kawana S, Kato Y, Omi T

Summary Background. Atopic dermatitis (AD) can be aggravated by mental stress. We recently showed that pretreatment with tandospirone citrate (TC), a serotonin (5-HT) agonist for the 5-HT(1A) receptor subtype, significantly inhibits stress-induced degranulation of mouse dermal mast cells. Aims. To evaluate the efficacy of TC in treatment of AD. Methods. Changes in anxiety levels, depression symptoms and the clinical severity of AD after administration of TC were examined. Data were collected for 20 patients with AD who received TC 30 mg/day for 4 weeks and 17 patients with AD who did not receive the drug. Profile of Mood States (POMS) scores were used to meaure several types of mental stress. Severity of AD was evaluated using the SCORAD Index, and the patients’ level of stress and sleeping status were evaluated using visual analogue scales. Results. Before TC administration, all scores were markedly different in the 37 patients compared with 37 normal healthy controls matched for age and gender. POMS scores for tension-anxiety (T-A) and the SCORAD Index decreased signficantly in patients who received TC, but did not change significantly in the untreated patients. The two groups had significantly different treatment responses based on changes in T-A scores. There was a significant correlation between changes in the T-A score and SCORAD Index. Conclusion. These data suggest that anxiolytic drugs such as 5-HT(1A) agonists are useful in the clinical management of stress-associated aggravation of AD. Inhibition of stress-induced mast cell degranulation may be one of the mechanisms underlying the clinical efficacy.

PMID: 20089082 [PubMed - as supplied by publisher]

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Breastfeeding and atopic dermatitis: protective or harmful? facts and controversies.

Clin Dermatol. 2010 Jan;28(1):34-37

Authors: Dattner AM

Conventional wisdom posits that breastfeeding during the first 4 months of life generally reduces the incidence of atopic dermatitis in the child. Recent studies question this truism, especially in cases when the mother herself is allergic. Studies about maternal dietary allergens in breast milk and their influence on atopic dermatitis have been questioned as well. There is evidence that probiotic and essential fatty acid supplementation, along with an allergen-avoidance diet, may reduce the chance of maternal dietary allergens provoking atopic dermatitis in the infant. Evidence on both sides of the controversy is presented in an effort to produce meaningful guidelines for breastfeeding infants at risk for atopic dermatitis.

PMID: 20082948 [PubMed - as supplied by publisher]

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The diagnostic value of atopy patch testing and prick testing in atopic dermatitis: facts and controversies.

Clin Dermatol. 2010 Jan;28(1):38-44

Authors: Lipozenčić J, Wolf R

We conducted a systematic Medline search of the literature (1998-2008) on the criteria for performing the skin prick test and atopy patch testing (APT) to determine their utility in atopic dermatitis (AD). The skin prick, scratch, and skin patch tests are performed to identify which allergen is causing eczematous skin symptoms in patients with AD, or sneezing, nasal congestion, itchy eyes, wheezing, skin rash, and swelling. Many allergens in foods, drugs, and environmental substances (eg, ragweed and fungus), as well as contact allergens, can elicit eczematous skin reactions after epicutaneous application. Because no gold standard exists for aeroallergen provocation in AD, the APT is currently used to evaluate allergen without comparison with another accurate and reliable method. The APT is presumed to reflect delayed-phase clinical reactions. Even with delayed onset of symptoms (more than 2 hours after food ingestion), APT findings were not consistent among AD children. The APT could be used in children with gastrointestinal reactions to foods as well as AD. After standardization, the APT may provide further diagnostic information in addition to the skin prick test and serum immunoglobulin E values and may be able to evaluate the actual clinical relevance of immunoglobulin E-mediated sensitizations for eczematous lesions. The European APT model used with standardization of allergen concentration and vehicle may provide an important diagnostic tool to select patients for avoidance and for procedures of allergen-specific immunotherapy, but the clinical relevance of positive APT reactions awaits standardized provocation and avoidance testing.

PMID: 20082949 [PubMed - as supplied by publisher]

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The historical basis of a misconception leading to undertreating atopic dermatitis (eczema):facts and controversies.

Clin Dermatol. 2010 Jan;28(1):45-51

Authors: Farhi D, Taïeb A, Tilles G, Wallach D

The quest for clarifying the pathophysiology of atopic dermatitis (eczema) has lasted for 25 centuries. Yearning to discern the primum movens of atopic dermatitis, physicians aimed to identify the curative therapy. Recent scientific efforts has brought to the light an ever-growing amount of interplaying pathophysiologic factors, including the epidermal barrier, the digestive flora, food, early infections and antigenic stimulations, and innate and adaptive immune response; however, overfocusing on some of these factors, along with misconceptions about the benefit/risk balance of topical therapies, has sometimes led topical therapies being disregarded. Reviewing the history of pathophysiologic concepts, we aim to return topical therapies to the center of the clinical management of atopic dermatitis.

PMID: 20082950 [PubMed - as supplied by publisher]

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Malignancy concerns of topical calcineurin inhibitors for atopic dermatitis: facts and controversies.

Clin Dermatol. 2010 Jan;28(1):52-56

Authors: Thaçi D, Salgo R

Topical calcineurin inhibitors have developed a bad connotation because of a black-box warning that was based on safety concerns of hypothetic systemic absorption and because systemic treatment with calcineurin inhibitors in patients who receive organ transplants is associated with an increased cancer risk. A few case reports of lymphoma and skin cancer in patients treated with topical calcineurin inhibitors initiated the discussion. These drugs were recommended for use as second-line therapy for the short-term and noncontinuous treatment of atopic dermatitis in patients who do not respond adequately to topical corticosteroids or in whom they are contraindicated. According to the latest knowledge, there is no scientific evidence of an increased risk for malignancy due to a topical treatment with calcineurin inhibitors.

PMID: 20082951 [PubMed - as supplied by publisher]

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Complementary therapy for atopic dermatitis and other allergic skin diseases: facts and controversies.

Clin Dermatol. 2010 Jan;28(1):57-61

Authors: Boneberger S, Rupec RA, Ruzicka T

The term complementary or alternative medicine encompasses numerous diverse therapeutic concepts, ranging from as herbal medicine, diet with essential fatty acids, and probiotics, to acupuncture. The main focus of these treatment methods is inflammatory skin disease, in particular atopic dermatitis. Although integrative medicine enjoys increasing popularity, particularly in industrialized countries, clinical studies that meet the double-blind, placebo-controlled standard are rare or nonexistent. The aim of this contribution is to provide the various concepts of integrative medicine.

PMID: 20082952 [PubMed - as supplied by publisher]

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Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study.

J Eur Acad Dermatol Venereol. 2010 Jan 11;

Authors: Leibovici V, Canetti L, Yahalomi S, Cooper-Kazaz R, Bonne O, Ingber A, Bachar E

Abstract Background There is a vast literature describing the association between psoriasis, atopic dermatitis (AD) and psychological distress. Some of these studies were uncontrolled and others used non-dermatological diseases as control, but only a few used chronic skin diseases as controls. Objective To compare well being, psychopathology and coping strategies of psoriatic, AD and healthy controls in a prospective case-control study. Methods Thirty-seven psoriatic patients and 31 AD patients were recruited from the Hadassah Ein Karem Hospital, Jerusalem, Israel, outpatient and inward clinic. The participants in the control group were 31 healthy workers and volunteers with no dermatological diseases from Kaplan Hospital, Rehovot, Israel. We used self-report questionnaires [Mental Health Inventory (MHI) and Adjustment to Chronic Skin Diseases Questionnaire (ACSD)], a projective technique (Hand Test) and assessment tools (Clinical Global Impression). Results Psoriatic patients experienced reduced well being (P = 0.007) and more anxiety and depression (P = 0.018) than normal controls. Psoriatic patients also displayed more severe psychopathology (P = 0.039) a more passive attitude towards life, and loss of meaning in life (P = 0.001) as measured by the projective technique compared with AD patients and normal controls. Conclusions We propose two explanations, derived from the psychological and the psycho-neuro-immunological domains. First, greater mental distress in psoriasis is because of the greater stigma it bears compared with AD. Alternatively, we hypothesize that the psoriatic inflammatory process may possibly have a direct central nervous system effect.

PMID: 20070455 [PubMed - as supplied by publisher]

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Successful treatment of lichen amyloidosus associated with atopic dermatitis using a combination of narrowband ultraviolet B phototherapy, topical corticosteroids and an antihistamine.

Clin Exp Dermatol. 2009 Dec;34(8):e833-6

Authors: Oiso N, Yudate T, Kawara S, Kawada A

Lichen amyloidosus (LA) is a type of primary localized cutaneous amyloidosis characterized by multiple pruritic discrete hyperkeratotic papules with amyloid deposition in the papillary dermis. Clinical regression is usually difficult to achieve, even after treatment. In this study, we report a case of an adult man with LA associated with atopic dermatitis (AD) which was successfully treated with narrowband ultraviolet B (NB-UVB) phototherapy, topical corticosteroids and an oral antihistamine. This case suggests that NB-UVB phototherapy may be a useful adjuvant for LA associated with AD.

PMID: 20055846 [PubMed - in process]

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A case report and critical appraisal of the literature on the use of DermaSilk in children with atopic dermatitis.

Clin Exp Dermatol. 2009 Dec;34(8):e901-3

Authors: Vlachou C, Thomas KS, Williams HC

Atopic dermatitis (AD) is easily aggravated by detergents, synthetic and woollen clothing, and bacterial colonization. Cotton clothing is often recommended for children with AD, but cotton can contain rough fibres that may act as skin irritants. In contrast, silk is characterized by smooth fibres with minimal potential for irritation. We report a sericin-free silk (DermaSilk), which is treated with AEGIS AEM5772/5, a product that has antibacterial properties, and evaluate its use in the treatment of AD.

PMID: 20055862 [PubMed - in process]

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Systemic allergic contact dermatitis due to consumption of raw shiitake mushroom.

Clin Exp Dermatol. 2009 Dec;34(8):e910-3

Authors: Kopp T, Mastan P, Mothes N, Tzaneva S, Stingl G, Tanew A

Shiitake (Lentinus edodes) is a mushroom that is very popular in Asian cuisine. After ingestion of the raw fungus, dermatitis may occur in rare cases, and is commonly assumed to be a toxic reaction. We report a 52-year-old man who developed a generalized pruritic papulovesicular eruption 2 weeks after daily consumption of uncooked shiitake mushrooms. Prick-to-prick and scratch tests with uncooked mushrooms resulted in an eczematous reaction at 24 h that peaked at 72 h and persisted for 1 week. In contrast, no cutaneous reactions could be elicited in 20 healthy people. We conclude that our patient had systemic allergic contact dermatitis due to consumption of raw shiitake mushroom.

PMID: 20055865 [PubMed - in process]

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