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PubMed1983

Early diagnosis of infantile seborrhoeic dermatitis and atopic dermatitis--clinical features.

In a prospective study of thirty-seven infants presenting with dermatitis in infancy it was found that pruritus, a positive family history of atopy, and the age of onset of skin lesions were of little value in distinguishing atopic dermatitis from infantile seborrhoeic dermatitis. The most useful distinguishing features were the increased incidence of lesions on the forearms and shins in atopic dermatitis, and in the axillae in infantile seborrhoeic dermatitis. The onset of skin lesions solely in the napkin area favoured a diagnosis of infantile seborrhoeic dermatitis, but when more than one site was involved the distinction was less clear. Infantile seborrhoeic dermatitis carried a much better prognosis than atopic dermatitis. In thirty-six out of thirty-seven infants the definitive diagnosis could be made with confidence on clinical grounds by the age of I year, but was often difficult at first presentation in early infancy.

Dermatitis, Atopic↗
PubMed1992

Serum eosinophil cationic protein (ECP) is a sensitive measure for disease activity in atopic dermatitis.

Atopic dermatitis (AD) is characterized by alterations in cellular and humoral immunity including elevated serum levels of IgE, IL-2 receptor (IL-2R) and eosinophil cationic protein (ECP). In order to evaluate the relevance of these serum parameters as indicators of disease activity, the concentrations of IgE, IL-2R and ECP were measured in serum samples of patients with an acute exacerbation of AD (n = 19) on admission to hospital and every 6 days up to discharge, and compared with those from normal non-atopic controls (n = 15). The severity of the disease in the AD patients was examined using an established clinical scoring system. On admission, AD patients showed significantly elevated serum levels of IgE, IL-2R and ECP compared with normal controls (P less than or equal to 0.0001). Clinical improvement was associated with a decrease of both the clinical score (P less than or equal to 0.001) and serum ECP levels (P less than or equal to 0.005). No significant changes in serum IgE and serum IL-2R were observed. In addition, there was a significant correlation between serum ECP and the clinical score (R = 0.67, P less than or equal to 0.001). These data indicate that serum ECP may be a helpful tool for monitoring disease activity in AD.

Acute Disease↗
PubMed1992

Relationship between increased cyclic AMP-phosphodiesterase activity and abnormal adenylyl cyclase regulation in leukocytes from patients with atopic dermatitis.

Atopic dermatitis (AD) is characterized by a variety of abnormal physiologic and pharmacologic responses in the skin. Leukocyte abnormalities of the cyclic nucleotide system include increased cAMP phosphodiesterase (PDE) and adenylyl cyclase activities. We have evaluated the possibility that a defect of the inhibitory GTP-binding protein (Gi) might cause inadequate modulation of adenylyl cyclase activity in AD leukocytes. We carried out a series of studies assessing adenylyl cyclase and Gi subunits in monocyte membranes. Using both pertussis toxin ribosylation and direct monoclonal antibody labeling of Gi proteins, we have shown evidence for a decrease or possible absence of one of the Gi proteins in atopic monocyte membranes. A genetic defect or toxin-mediated abnormality in leukocyte membrane Gi could account for these findings. Increased cAMP degradation by PDE may be a compensatory mechanism for increased cAMP synthesis that is regulated by GTP-binding proteins. But this increased PDE activity also rendered AD leukocytes hypo-responsive to immunofunction regulatory signals mediated by cAMP.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1997

Soluble CD30 in pediatric patients with atopic dermatitis.

Atopic dermatitis (AD) is a chronic, inflammatory skin disease in which a pathogenetic role of Th2 cells has been supposed. This study investigated the presence of soluble CD30 (sCD30), an activation marker of T-cell clones able to produce Th2-type cytokines, in sera from pediatric patients affected by AD (n = 25) with no symptoms of asthma or rhinitis. The severity of the disease was graded by both the SCORAD and Costa et al. clinical scoring systems. Serum levels of sCD30 were significantly higher in patients with AD in respect to both normal donors (n = 20) and urticaria patients (n = 10), and a positive correlation between serum sCD30 and clinical score was found (r = 0.508; P = 0.01) when AD patients were evaluated by Costa et al.'s method. Furthermore, a significant association (r = 0.443; P = 0.027) between sCD30 and serum levels of the soluble interleukin (IL)-2 receptor (sIL-2R) was observed in AD. The presence of high amounts of sCD30 in atopic patients seems to confirm the role of this molecule as an activation marker useful for in vivo evaluation of a Th2 immune response, and the correlation observed with both clinical score and sIL-2R levels indicates the role of sCD30 as an additional marker of disease activity in pediatric patients with AD.

Child↗
PubMed2005

Compartmental imbalance and aberrant immune function of blood CD123+ (plasmacytoid) and CD11c+ (myeloid) dendritic cells in atopic dermatitis.

Atopic dermatitis (AD) is a pruritic, chronically relapsing skin disease in which Th2 cells play a crucial role in cutaneous and extracutaneous immune reactions. In humans, CD11c+CD123- myeloid dendritic cells (mDC) and CD11c-CD123+ plasmacytoid DC (pDC) orchestrate the decision-making process in innate and acquired immunity. Since the number and function of these blood dendritic cell (DC) subsets reportedly reflect the host immune status, we studied the involvement of the DC subsets in the pathogenesis of AD. Patients with AD had an increased DC number and a low mDC:pDC ratio with pDC outnumbering mDC in the peripheral blood compared with normal subjects and psoriasis patients (a Th1 disease model group). The mDC:pDC ratio was correlated with the total serum IgE level, the ratio of IFN-gamma-producing blood cells:IL-4-producing blood cells, and the disease severity. In vitro allogeneic stimulation of naive CD4+ cells with atopic DC showed that the ability of pDC for Th1 induction was superior or comparable to that of mDC. In skin lesions, pDC infiltration was in close association with blood vessels expressing peripheral neural addressins. Therefore, compartmental imbalance and aberrant immune function of the blood DC subsets may deviate the Th1/Th2 differentiation and thus induce protracted allergic responses in AD.

Adolescent↗
PubMed2005

[Malassezia species in patients with seborrheic dermatitis and atopic dermatitis].

Malassezia species, organisms normally colonizing the skin surface, are thought to play a role as either the cause or an exacerbating factor in a number of skin conditions, including pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis (SD) and atopic dermatitis (AD). Using a non-cultural PCR method, we analyzed Malassezia spp. extracted from the skin surface of SD and AD patients. The species most commonly detected in both patient groups were M. globosa and M. restricta, and the number of Malassezia spp. In these patients was higher than in healthy subjects. After a topical application of 2% ketoconazole cream, changes in the population of Malassezia spp. in 20 intractable cases of AD were recorded. The addition of the 2% ketoconazole cream to the standard topical treatments was found to have reduced the Malassezia spp. population by 90%, and showed a clinical efficacy rate of 70%. Furthermore, a combination of azole agents and tacrolimus produced a synergistic anti-fungal effect against Malassezia spp. in vitro. A clinical trial using this drug combination conducted on the face and neck of patients with intractable AD showed a 66.6% efficacy rate in both the reduction of the flora and in clinical improvement. From these results it was evident that Malassezia is one of the factors exacerbating AD, and that removal of the organism results in an improvement in the clinical condition of the patient.

Dermatitis, Atopic↗
PubMed2003

Effect of oral cyclosporin A in children with Staphylococcus aureus-colonized vs S aureus-infected severe atopic dermatitis.

Atopic dermatitis (AD) is frequently associated with skin colonization or infection with Staphylococcus aureus strains producing exotoxins. The aim of this investigation was to evaluate the effect of oral cyclosporin A (CsA) on disease severity and bacterial counts in colonized and infected patients. Eleven children with severe AD (SCORAD index >50, mean objective SCORAD score >40) were treated for 8 weeks with 2.5-5 mg/kg CsA. In five patients, the skin was only colonized with S. aureus whereas the remaining six patients presented clinically relevant suppurative S. aureus skin infections characterized by small pustules, crustings, pus and increased pruritus in the presence of S. aureus as determined by contact sampling and culture which regularly resulted in the indication for antibiotic treatment. Clinical and microbiological investigations were performed before and after CsA therapy. Clinical signs and symptoms of AD improved in all patients with a reduction in mean SCORAD index from 74 to 29 (p < 0.001). However, disease severity and bacterial counts were more reduced by CsA in the colonized patients compared with the patients with clinical overt infections. In conclusion, treatment with CsA resulted in an improvement of clinical symptoms in children suffering from severe AD. However, anti-infective treatment administered before immunomodulatory therapy is likely to be decisive for the long-term therapeutic effect.

Administration, Oral↗
PubMed1992

Allergic contact dermatitis in atopic dermatitis.

Of 73 adult patients attending a clinic specially provided to treat patients with atopic dermatitis, 31 (42%) showed one or more positive patch reaction on contact testing. There was a striking female preponderance in the patch test positive group (26F:5M) in contrast to those with negative test results (9F:17M). The commonest allergens identified were fragrances in 13 patients, nickel (7), rubber (5), lanolin (4) and formaldehyde (3). In 21 patients, topical preparations, cosmetic or medically prescribed, could be implicated. Contact sensitivity seems to be relatively common in adult patients who have a continuing problem with their atopic dermatitis. Recognizing this sensitization may be important in their management.

Adolescent↗
PubMed2006

Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization: results from a prospective birth cohort study.

OBJECTIVE: Prophylactic feeding guidelines recommend a delayed introduction of solid foods for the prevention of atopic diseases. Scientific evidence for this is scarce. This study investigates whether a delayed introduction of solids (past 4 months or 6 months) is protective against the development of atopic dermatitis (AD) and atopic sensitization when considering reverse causality. METHODS: Data from 2612 infants in an ongoing birth cohort study were analyzed at 2 years of age. Information on diet and on symptoms and diagnoses of AD was collected semiannually, and information on specific immunoglobulin E levels was collected at 2 years of age. RESULTS: Solid food introduction past the first 4 months of life decreased the odds of symptomatic AD but not for doctor-diagnosed AD, combined doctor-diagnosed and symptomatic AD, or atopic sensitization. Postponing the introduction beyond the sixth month of life was not protective in relation to either definition of AD or atopic sensitization. There was also no evidence for a protective effect of a delayed introduction of solids on AD and atopic sensitization in children of atopic parents. There was clear evidence for reverse causality between early skin or allergic symptoms and the introduction of solids. CONCLUSIONS: This study does not find evidence supporting a delayed introduction of solids beyond the sixth month of life for the prevention of AD and atopic sensitization. We cannot rule out that delaying the introduction of solids for the first 4 months of life might offer some protection. Measures to avoid reverse causality have to be considered in the conduction, analysis, and interpretation of cohort studies on the topic.

Cohort Studies↗
PubMed2001

Evaluation of efficacy of a skin lipid mixture in patients with irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis: a multicenter study.

Disturbances of skin barrier function occur in several skin diseases, e.g., atopic dermatitis (AD), irritant/allergic contact dermatitis (ICD, ACD). Skin barrier damage triggers the production of cytokines that stimulate lipogenesis which may also cause inflammatory processes. The aim of this study was to evaluate the efficacy of a topical skin lipid mixture in the treatment of ICD, ACD and AD. 580 consecutive patients suffering from ICD, ACD or AD were treated with a skin lipid mixture containing ceramide-3 and patented nanoparticles. Patients received the lipid mixture alone or in combination with topical corticosteroids until clearance or for 8 weeks. Both treatment groups statistically improved all parameters considered at week 4 and 8 as compared to baseline. Between the 2 treatment groups, there was a statistically significant difference in favour of combined therapy for (ICD, ACD, AD, respectively): erythema, pruritus and overall disease severity; erythema and pruritus; erythema, pruritus, fissuring and overall disease severity. No statistically significant difference was found for (ICD, ACD, AD, respectively): dryness, scaling and fissuring; scaling, fissuring and overall disease severity; dryness and scaling. Between the 2 ACD treatment groups, there was a statistically significant difference in favour of the skin lipid mixture for dryness. In conclusion, the study shows that balanced lipid mixtures are effective in improving barrier properties and the clinical condition of the skin in contact dermatitis.

Administration, Topical↗
PubMed2001

Interleukin-18 is elevated in the sera from patients with atopic dermatitis and from atopic dermatitis model mice, NC/Nga.

BACKGROUND: Several lines of in vitro and in vivo studies have demonstrated that interleukin-18 (IL-18) shows both antiallergic and allergy-promoting activities. But its expression in allergic diseases remains unknown. METHODS: Serum IL-18 levels from atopic dermatitis (AD) model mice, NC/Nga and control mice and from patients with AD and healthy volunteers were measured by ELISA. The relationship between IL-18 levels and serum IgE levels or clinical severity was also examined. RESULTS: Serum IL-18 levels from NC/Nga mice were significantly increased compared to those from control mice. The elevation of IL-18 in the sera was observed prior to the onset and during the development of dermatitis in NC/Nga mice. In addition, IL-18 levels in the sera from patients with AD were significantly (p < 0.05) elevated compared to those from healthy volunteers. However, serum IL-18 levels tended to correlate negatively with serum IgE levels in patients with AD and NC/Nga mice. CONCLUSION: IL-18 is overexpressed in AD.

Adolescent↗
PubMed1995

Pityrosporum ovale in healthy children, infantile seborrhoeic dermatitis and atopic dermatitis.

The occurrence of Pityrosporum ovale was studied in healthy children, children with infantile seborrhoeic dermatitis (ISD) and in patients with atopic dermatitis (AD). Twenty children with ISD and twenty healthy infants were subjected to culture for P. ovale. Positive cultures were found in 18 of 20 infants with ISD, compared with 4 of 20 controls. The same culture medium containing olive oil as one of the lipids was used to evaluate the frequency of positive P. ovale cultures in 60 patients with AD, 40 patients with rhinoconjunctivitis and/or asthma (RA) and 40 children and young adults with no atopic history (HC). The results of the quantitative cultures from the forehead did not differ between the groups. P. ovale cultures were positive in 0-20% of children aged 0-10 years and in 60-90% of the 11-20-year-old subjects. Positive P. ovale cultures were found in 87% of 138 healthy children aged 2 months to 15 years when cultures were performed on a medium containing whole fat cows' milk as one lipid source. The largest number of colonies was found among children aged 2-23 months and among children older than 9 years. The occurrence of specific IgE antibodies to P. ovale was evaluated with a skin prick test (SPT) and RAST and compared in 3 groups (AD, RA, HC) of patients aged 0-20 years. Specific IgE were found most often in patients with AD. In patients with AD on different parts of the body, 15% had a positive SPT to P. ovale. In another group of patients, aged 14-53 years, with AD localised mainly to the head and neck area, the SPT was positive in 55% of the patients. Sera from 13 patients with positive SPT to P. ovale were further analysed with IgE immunoblotting using both P. ovale and C. albicans antigens. Simultaneous IgE-binding to both these yeasts was found in 5 sera and these were analysed with RAST-inhibition. Cross-reacting IgE antibodies to P. ovale and C. albicans were found in two of these sera. Cross-reacting sera were pooled and used as an IgE probe in crossed radioimmunoelectrophoresis and Tandem-crossed immunoelectrophoresis. Cross-reacting epitopes were suggested to be located in the mannan polysaccharide of C. albicans and in a high molecular weight fraction of P. ovale.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1990

[Herpetiform dermatitis and atopic dermatitis].

History data and clinical pattern were analysed in 33 children with herpetiform dermatitis (DH) and in 34 children with atopic dermatitis (DA). The differences are stressed between DH and DA as which it is frequently misdiagnosed, which is the cause of delayed treatment in DH (in the studied group 2.8 years on the average). The development of skin changes with accompanying itching in a child at preschool age should suggest the supposition of DH.

Adolescent↗
PubMed2006

[Therapy of atopic dermatitis].

Atopic eczema is one of the most common diseases in dermatology. Patients suffer from both the chronic relapsing skin disease and the associated emotional stress. Itching and visible lesions on the face and hands are the most unpleasant features for many often young patients, seriously reducing their quality of life. New therapeutic approaches have changed the management of atopic eczema in recent years. Relatively potent new drugs with fewer side effects than corticosteroids help to control the disease. This review focuses on the basic principles of modern atopic eczema treatment, emphasizing basic emollient therapy and topical therapy with calcineurin inhibitors.

Adolescent↗
PubMed1992

[Clinical diagnosis of atopic dermatitis].

Atopic eczema is a pruriginous dermatosis that most often starts before one year, but which may show for the first time after 50 years. The diagnosis is essentially clinical, with signs of banal eczema (especially acute in young infants, more chronic later) but of which the topography develops characteristically as a function of age and in the context of atopy. The development of is chronic, dotted with inflamed eruptions and may be complicated by an alteration of general state with bacterial (very frequent) or viral superinfections. The appearance of asthma is frequent when the dermatosis is extended. It usually disappears before adult age. Differential diagnosis is needed especially when there is an atypical form or association with another pruriginous dermatosis. Questioning must cover the environment, food habits and search for signs that may show the responsibility of an allergen.

Adolescent↗
PubMed1983

Early diagnosis of infantile seborrhoeic dermatitis and atopic dermatitis--total and specific IgE levels.

Total and antigen-specific IgE levels using the radioallergosorbent test (RAST) were measured in a prospective study of thirty-seven infants with dermatitis of early infancy, with the aim of distinguishing between atopic and infantile seborrhoeic dermatitis at an earlier age than is usually possible on clinical grounds. The results were correlated with the clinical diagnoses made after 1-2 years close follow-up. They showed that a RAST screen to egg white and to milk antibodies, and to a lesser extent total IgE levels, are of value in diagnosing atopic dermatitis at an early age and distinguishing this from infantile seborrhoeic dermatitis.

Dermatitis, Atopic↗
PubMed1993

The involvement of eosinophils in the patch test reaction to aeroallergens in atopic dermatitis: its relevance for the pathogenesis of atopic dermatitis.

Atopic dermatitis (AD) is considered a T-cell mediated disease. Activated T-cells, mainly of the CD4-subtype, are abundantly present in lesional AD skin. Although not many intact eosinophils are present, deposits of eosinophil derived major-basic-protein (MBP) and eosinophil-cationic-protein (ECP) suggest eosinophil involvement. After patch testing AD patients with aeroallergens, an eczematous reaction develops after 24-48 hr at the site of application. This patch test reaction shows macroscopic resemblance to lesional AD skin and does not take place in normal individuals, asthma and allergic rhinitis patients. Lymphocytes together with eosinophils infiltrate into the dermis 2-6 hr after allergen application. Twenty-four to forty-eight hours after patch testing, eosinophils are in an activated state since they release ECP (being EG2-positive). At this point in time eosinophils have also infiltrated the epidermis. Here they are EG2-negative. Forty-eight to seventy-two hours after patch testing the eczematous reaction decreases. This coincides with disappearance of eosinophils from both the dermis and the epidermis; then, a dendritic staining pattern can be observed in the epidermis with anti-eosinophil peroxidase. Thus, eosinophils infiltrate the dermis and epidermis after patch testing AD patients with aeroallergens and release part of their granular constituents. Recent in vitro investigations revealed that eosinophils from the circulation of AD patients react more powerfully in in vitro test systems such as chemiluminescence, chemotaxis and endothelial adherence and transmigration. It is very likely that this activated (= primed) state is caused by the influence of lymphocyte-derived cytokines like IL-3, IL-5 and GM-CSF, since activated lymphocytes in the circulation (and tissue) may release these cytokines. The primed state of the eosinophils may facilitate tissue infiltration. The subsequent activation of eosinophils within the tissue leading to mediator release and the function of these mediators need to be further elucidated. The close similarity between the cellular events after a patch test reaction to aeroallergens in AD patients and those present in lesional AD skin suggests that the patch test reaction may be a helpful in vivo model to study the pathogenesis of AD. The prominent involvement of lymphocytes and eosinophils in this reaction also suggests some similarity with late phase reactions (LPR) observed in the skin after intracutaneous allergen challenge.

Allergens↗