The case for ultraviolet light therapy in nephrogenic fibrosing dermopathy--report of two cases and review of the literature.
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Adult↗
Biomedical subjects
Eric L Simpson
Publications and source records attributed to Eric L Simpson.
Allergic contact dermatitis from a natural deodorant: a report of 4 cases associated with lichen acid mix allergy.
BACKGROUND: Botanical ingredients used in personal care products are a significant and underreported cause of allergic contact dermatitis. OBJECTIVE: To evaluate allergic contact dermatitis from a widely-used botanical deodorant. METHODS: We conducted patch testing in four patients who were using the botanical deodorant and were referred to the contact dermatitis clinic; three patients had axillary dermatitis and one had dermatitis of the external ear. RESULTS: All four patients had positive patch test reactions to lichen acid mix and D-usnic acid. Of the three patients who were patch tested to the botanical deodorant, all had positive reactions. LIMITATIONS: We did not test to the specific lichen used in the natural deodorant but rather used our own lichen acid mix and d-usnic acid in addition to testing to the actual product. One of the patients declined to be tested with the natural deodorant, but did test positive to the lichen acid mix and d-usnic acid. CONCLUSION: Personal care products such as deodorants may represent a new route of exposure to lichen extract, a known allergen.
Adult↗
Atopic dermatitis.
Atopic dermatitis (AD) is an eczematous, highly pruritic chronic inflammatory skin disease. It usually begins early in life and often occurs in people with a personal or family history of asthma and allergic rhinitis. The prevalence is high, especially in children,and it has been rising in recent decades, in parallel with asthma prevalence. Although AD is often described as an "allergic" dis-ease, allergic causation is difficult to document, and AD is increasingly viewed as a skin disease that predisposes to allergies. This interpretation, based on clinical, epidemiologic, and animal stu-dies, may greatly influence our approach to therapy and prevention of atopic diseases in the coming years.
Dermatitis, Atopic↗
Prevalence and morphology of hand eczema in patients with atopic dermatitis.
BACKGROUND: Patients with hand eczema frequently have a history of atopic dermatitis or atopy. No specific morphologic pattern of hand eczema helps distinguish atopic hand eczema from other etiologies. There are few studies of hand eczema prevalence and morphology in a well-defined population of patients with atopic dermatitis. METHODS: We evaluated 777 consecutive patients with atopic dermatitis (diagnosed by standard criteria) for hand involvement. An additional 100 patients had further evaluations, including evaluation of the historical and morphologic characteristics of their hand eczema. RESULTS: The prevalence of hand involvement in patients with active atopic dermatitis was 58.9% (458 of 777 patients). Nail dystrophy was present in 16% (124 of 777) of patients. There was a significant trend toward an increasing prevalence of hand involvement with increasing age. Hand eczema tended to involve primarily the dorsal hand surfaces and the volar wrist. CONCLUSIONS: The hands are frequently involved in patients with active atopic dermatitis and present unique physical, social, and therapeutic challenges for patients. During the evaluation of patients presenting with hand eczema, the involvement of dorsal hand surfaces and the volar wrist may suggest atopic dermatitis as a contributing etiologic factor.
Adolescent↗
Cell death-induced activation of epidermal growth factor receptor in keratinocytes: implications for restricting epidermal damage in dermatitis.
Recent findings have implicated Fas/Fas ligand (FasL) in mediating the death of keratinocytes in spongiotic lesions. We asked whether dying keratinocytes could potentially initiate a protective response of the skin to limit the destruction of the epidermis in the spongiotic areas. In addition to apoptosis, treatment of keratinocyte cultures in vitro with FasL triggers a profound phoshorylation of the epidermal growth factor receptor (EGFR) and of its downstream effectors ERK and protein kinase B (PKB/Akt). Using a variety of inhibitors and blocking antibodies, we demonstrated that: (i) apoptosis is required for the generation of the signal(s) leading to the activation of EGFR, ERK, and Akt; (ii) the activation of EGFR, ERK, and Akt by FasL is indeed mediated by its bona fide receptor Fas; (iii) the activation of EGFR is essential for the subsequent activation of ERK and Akt; and (iv) apoptotic keratinocytes secrete soluble EGFR ligands (including amphiregulin) that are processed from membrane-bound proligand forms by metalloproteinase(s). Our findings demonstrate a potential mechanism for the restriction and repair of spongiotic damage in eczemas.
Apoptosis↗
Tacrolimus ointment: utilization patterns in children under age 2 years.
Atopic dermatitis (AD) is a common eczematous skin condition; as many as 10-17 percent of all children are affected, and 35-60 percent of affected patients manifest symptoms manifest during the first year of life. Treatment principles for AD in young children involve conservative measures such as avoidance of hot water and environmental irritants, combined with liberal use of emollients after bathing. Low potency topical corticosteroids (TCS) are the current standard of therapy for AD in young children, reserving mid- and high-potency TCS for severe disease. However, complications of long-term use of TCS include skin atrophy, stria formation, telangiectasia, hypopigmentation, secondary infections, steroid acne, allergic contact dermatitis, and miliaria. The pediatric population is also at increased risk for systemic absorption because of their high ratio of skin surface to body mass. Systemic absorption may result in hypothalamic-pituitary-adrenal axis suppression and ultimately growth retardation. Although most topical and systemic corticosteroids are not approved by the Food and Drug Administration for use in children less than 2 years of age, conservative treatment often fails in this age group and frequently patients are treated with TCS, antibiotics, and antihistamines.
Administration, Cutaneous↗
Prevalence of botanical extract allergy in patients with contact dermatitis.
BACKGROUND: Botanical extracts are used widely in over-the-counter products. They are primarily added for fragrance and their purported healing properties. Numerous case reports of allergic contact allergy to botanical extracts have been published; however, little is known regarding the prevalence of allergic reactions to botanical extracts. OBJECTIVE: To determine the prevalence of allergic patch-test reactions to a collection of botanical extracts in patients referred for patch testing. METHODS: A total of 140 patients were patch-tested to a study tray containing 47 botanical extracts. Patients were divided into two groups: (1) a high-risk group consisting of 21 patients with a clinical diagnosis of contact allergy who were using botanical products and whose contact dermatitis was not fully explained by testing to standard allergens and (2) a control group consisting of 119 patients with no history of botanical extract use and who were being evaluated in a contact dermatitis clinic. RESULTS: Ten of 21 patients (47.6%) in the high-risk group had at least one relevant botanical extract positive reaction. Only 4 patients (3.4%) in the control group had a relevant positive reaction. Four patients in the high-risk group had more than one relevant botanical reaction. Tea tree oil caused the most common relevant positive reaction. CONCLUSIONS: Contact allergy to botanicals was common in this highly selected group of patients. Contact dermatitis patients who use botanical products and whose reactions are not fully explained by standard patch testing may benefit from more extensive patch testing to botanical extracts.
Allergens↗
A cross-sectional survey of complementary and alternative medicine use in patients with atopic dermatitis.
BACKGROUND: Studies from Europe reveal that a large percentage of patients with atopic dermatitis use some form of complementary and alternative medicine for the treatment of their skin disease. There are no studies from the United States that examine the prevalence and types of complementary and alternative medicine use among patients with atopic dermatitis. OBJECTIVE: The goal of this study was to determine the prevalence of complementary and alternative medicine use and the patterns of this use among atopic dermatitis patients referred to a university clinic. METHODS: Using a self-administered questionnaire, investigators performed a cross-sectional survey of 70 consecutive patients diagnosed with atopic dermatitis. RESULTS: Of the patients surveyed, 50.4% used some form of complementary and alternative medicine for the management of their skin disease. Common motivating factors were dissatisfaction with conventional treatment and frustration with the chronic nature of the condition. Vitamin supplementation and herbal creams were the most common alternative treatments used. CONCLUSION: The significant percentage of patients seeking alternative care for atopic dermatitis underscores the need for physicians to be familiar with alternative therapies for skin disease.
Adolescent↗
Atopic dermatitis prevention.
A shift in focus from disease therapy toward disease prevention is occurring in many medical specialties, including dermatology. There are no generally accepted strategies for the prevention of atopic dermatitis. Most research has focused on allergen avoidance and has not produced consistently effective interventions. Immune cell modulation and skin barrier protection are examples of new approaches that hold promise for preventing, or modifying the course of, this common disease.
Allergens↗
Patterns of care and referral in children with atopic dermatitis and concern for food allergy.
Although many providers believe that up to 30% of atopic dermatitis (AD) is food induced, food challenge studies show that food-induced eczematous reactions are rare. When food allergy is suggested to cause AD, it often leads to allergy testing with a high false-positivity rate, in turn further focusing parents on food allergy. Study subjects were children less than 11 years old with AD and food allergy suspicion. Prior diagnoses, provider, and testing patterns were assessed by questionnaire given to the parents. Thirty-eight patients with AD were enrolled. Most subject's parents suspected food allergy induced AD. Initial skin diagnoses were made by pediatricians (79%) and family practitioners (18%) as eczema. Allergy was suggested by providers as cause for AD in 63% of the present study's patients. Seventy-nine percent had allergy testing. Greater than 90% of parents claimed their children had food allergy and food-induced AD. Sixty-six percent had positive food allergy tests and 37% had definite history of immediate IgE reactions to food. The majority of this population had allergy suggested as causative for eczema by their primary care provider and were subsequently evaluated by allergist and allergy testing. Consensus about the role of food allergy between the different providers of AD in children would result in more effective, efficient, and less costly health care.
Child Welfare↗