Atopic dermatitis (eczema)

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A 20-year analysis of previous and emerging allergens that elicit photoallergic contact dermatitis.

J Am Acad Dermatol. 2010 Feb 15;

Authors: Victor FC, Cohen DE, Soter NA

BACKGROUND: Retrospective chart reviews are periodically needed to update allergen series to detect changes in photoallergic contact dermatitis (PACD) over time. OBJECTIVE: We sought to evaluate photopatch test results during a 13-year period and extend the observations to 20 years. METHODS: A retrospective chart review was conducted in patients who were photopatch tested. RESULTS: In all, 76 patients were evaluated. A total of 69 positive photopatch and 45 positive patch test reactions were detected in 30 and 23 patients, respectively. The frequencies of the positive photopatch test reactions were sunscreens 23.2%, antimicrobial agents 23.2%, medications 20.3%, fragrances 13%, plants and plant derivatives 11.6%, and pesticides 8.7%. Of the positive photopatch reactions to antimicrobial agents, 60% were caused by Fentichlor. LIMITATIONS: This study was a retrospective chart analysis, and the number of patients was small. CONCLUSIONS: Sunscreens and antimicrobial agents were the most frequent allergens eliciting PACD, and there was a decrease in PACD caused by fragrances. The number of reactions to medications increased. This study also demonstrated that pesticides can be a cause of PACD. The detection of reactions to Fentichlor was unexpected and, although they have been attributed in some studies to cross-reactions to sulfanilamides and bithionol, such a robust association was not observed in this study. This study extends our experience of the changes in the allergens that elicit PACD to 20 years.

PMID: 20163891 [PubMed - as supplied by publisher]

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Twice-weekly treatment with tacrolimus 0.03% ointment in children with atopic dermatitis: clinical efficacy and economic impact over 12 months.

J Eur Acad Dermatol Venereol. 2010 Feb 10;

Authors: Thaci D, Chambers C, Sidhu M, Dorsch B, Ehlken B, Fuchs S

Abstract Background Rational healthcare decision-making based on clinical and economic evidence is essential to provide the best possible care for patients with atopic dermatitis (AD). Objective To evaluate treatment outcomes, resource use and cost associated with twice-weekly tacrolimus 0.03% ointment treatment vs. standard flare-only therapy in children with moderate-to-severe AD. Methods In a pan-European, Phase III multicentre randomized clinical trial, children with mild-to-severe AD were randomized to 0.03% tacrolimus ointment or vehicle twice weekly for 12 months. Disease flares were treated using open-label tacrolimus 0.03% ointment twice daily. Clinical efficacy data were evaluated in a subgroup of 153 children with moderate-to-severe AD, with resource use data - collected prospectively using caregiver questionnaires - available from 146 children. Pooled costs of resource use were determined using German unit cost data. Direct and indirect costs were considered from third-party payer, patient and caregiver, and societal perspectives. Results Twice-weekly tacrolimus ointment reduced the number of flares compared with standard therapy (P < 0.001) and prolonged time to first flare (146 vs. 17 days, P < 0.001). Mean +/- SD annual costs per patient for standard and twice-weekly therapy respectively were euro2002 +/- 2315 vs. euro1571 +/- 1122 for severe AD and euro1136 +/- 1494 vs. euro1233 +/- 1507 for moderate AD. Conclusions In children with AD, twice-weekly treatment with tacrolimus 0.03% ointment reduces the number of flares and prolongs time spent free from flares with no additional cost in children with moderate AD, and may be cost-saving in those with severe AD.

PMID: 20158589 [PubMed - as supplied by publisher]

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Cystic fibrosis presenting with dermatitis.

Arch Dermatol. 2010 Feb;146(2):171-4

Authors: Wenk KS, Higgins KB, Greer KE

BACKGROUND: Patients with cystic fibrosis classically present with evidence of pulmonary disease, exocrine pancreatic insufficiency, and high sweat chloride concentrations. Dermatitis as an initial manifestation of the disease is uncommon and has been attributed to multiple nutritional deficiencies. Observation We describe the case of a 3-month-old female infant with cystic fibrosis presenting with dermatitis in the setting of protein-energy malnutrition. A review of the laboratory study results in this case and others showed that a deficiency in zinc, essential fatty acids, and protein likely contributes to the development of the rash seen in cystic fibrosis. CONCLUSIONS: Given the frequent delay in diagnosis, as well as the increased morbidity and mortality associated with protein-energy malnutrition in these patients, it is important to consider cystic fibrosis as a possible diagnosis in any infant presenting with a rash and other signs of malnutrition. The relative contribution of specific nutritional deficiencies and the degree to which they influence and interact with each other in producing the dermatitis remain unclear, although they may all affect a common underlying metabolic pathway.

PMID: 20157028 [PubMed - in process]

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Nickel allergy presenting as mobile phone contact dermatitis.

Australas J Dermatol. 2010 Feb 1;51(1):23-5

Authors: Roberts H, Tate B

A 39-year-old man presented with a 6-month history of a treatment-resistant facial dermatitis. The patient regularly used his mobile phone, predominantly on the left cheek. Patch testing confirmed the clinical suspicion of mobile phone contact dermatitis from nickel contained in the phone casing. Although infrequently reported, with the trend towards metallic mobile phone casings and the high incidence of nickel sensitization in the community, the incidence of mobile phone contact dermatitis is likely to increase.

PMID: 20148836 [PubMed - in process]

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Defining the Antigen Determinant for T-Cell-Mediated Contact Dermatitis Using p-Phenylenediamine: A Gateway to Chemical Immunology.

J Invest Dermatol. 2010 Mar;130(3):641-3

Authors: Elliott G, Das PK

By binding to host proteins to form haptens, low-molecular-weight compounds such as p-phenylenediamine (PPD) can become contact sensitizers. In this issue, Jenkinson et al. demonstrate that it is possible to use chemically characterized hapten-protein complexes to analyze T-cell responses in cells from allergic individuals. This approach may help in the development of in vitro tests for diagnosing contact dermatitis.

PMID: 20145640 [PubMed - in process]

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Comparative molecular analysis of methicillin-resistant Staphylococcus aureus isolates from atopic dermatitis children and healthy subjects in Taiwan.

Br J Dermatol. 2010 Feb 3;

Authors: Lo WT, Wang SR, Tseng MH, Huang CF, Chen SJ, Wang CC

Summary Background: Children with atopic dermatitis (AD) are more frequently colonized by Staphylococcus aureus than healthy children. Objective: To assess whether any relationship exits between nasal MRSA colonization and subsequent skin and soft-tissue infections (SSTI). Methods: From 2005 through 2006, comparative molecular analyses of 23 methicillin-resistant S. aureus (MRSA)-colonizing isolates from 133 AD children, 44 MRSA-colonizing isolates from 490 healthy controls, and 12 MRSA-infecting isolates from 20 AD children with concurrent SSTI were conducted. Results: Nasal MRSA colonization in AD children was significantly higher compared to normal individuals (17.3% versus 9.0%; P = .01). The molecular characteristics differed significantly between the MRSA isolates from AD children and the MRSA-colonizing isolates from healthy controls. The clone characterized as sequence type (ST)59 (338)/pulsotype B/staphylococcal cassette chromosome mec (SCCmec) V(T)/Panton-Valentine leukocidin (PVL)-positive/staphylococcal enterotoxin B (SEB)-positive accounted for half of the MRSA isolates from AD children, and another clone, characterized as ST59/pulsotype A/SCCmec IV/PVL-negative/SEB-positive accounted for 61% of the MRSA-colonizing isolates from healthy controls. Conclusion: We found MRSA colonize the anterior nares of a large number of Taiwanese children, especially among those with AD. Analysis of our data provides evidence that links MRSA-colonizing isolates to MRSA-infecting isolates from concurrent SSTI in AD children.

PMID: 20132206 [PubMed - as supplied by publisher]

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Enhanced Expression and Secretion of Antimicrobial Peptides in Atopic Dermatitis and after Superficial Skin Injury.

J Invest Dermatol. 2010 Jan 28;

Authors: Harder J, Dressel S, Wittersheim M, Cordes J, Meyer-Hoffert U, Mrowietz U, Fölster-Holst R, Proksch E, Schröder JM, Schwarz T, Gläser R

Human skin can defend itself against potentially invading microorganisms by production of antimicrobial peptides (AMPs). The expression of AMPs in atopic dermatitis (AD) is still emerging. To gain more insight into the role of AMPs in AD, we systematically analyzed the expression of ribonuclease 7 (RNase 7), psoriasin, and human beta-defensins (hBD)-2 and -3 in AD compared with psoriatic and healthy control skin as well as after experimental barrier disruption. Immunostaining revealed enhanced expression of all AMPs in the lesional skin of untreated AD and psoriasis when compared with non-lesional skin and controls. Accordingly, induced in vivo secretion of RNase 7, psoriasin, and hBD-2 was detected using ELISA on lesional skin in AD and in even higher concentrations in psoriasis. The secretion of AMPs did not correlate with severity of AD and Staphylococcus aureus colonization. Skin barrier disruption caused enhanced immunoreactivity of hBD-2 and hBD-3 after 24 hours. Strong secretion of RNase 7 was already detected after 1 hour, whereas hBD-2 secretion was significantly enhanced after 24 hours only under occlusion. Thus, a disturbed skin barrier may trigger AMP induction in AD and psoriasis. The functional role of AMP in AD, especially with regard to the control of S. aureus colonization, needs further analysis.Journal of Investigative Dermatology advance online publication, 28 January 2010; doi:10.1038/jid.2009.432.

PMID: 20107483 [PubMed - as supplied by publisher]

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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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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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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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