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PubMedDate not supplied

Psychobiological aspects of atopic dermatitis: an overview.

Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease with increasing incidence characterized by eczematous inflammation of the skin, a chronically relapsing course and severe pruritus. In the last decade, there has been growing evidence indicating that psychological factors such as personality and stress may play an important role in the pathogenesis of AD. While there is only little consensus on an AD-specific personality profile and its etiological significance, a growing number of reports support the role of psychosocial stress in the onset and the course of AD symptomatology. However, although a close association between psychosocial stress and skin condition in AD patients has been demonstrated by several investigators, pathological models that integrate stress and its effect on atopy-relevant biological processes, e.g. immune processes, are still missing. This overview summarizes the role of immunological and psychological factors in AD pathogenesis and discusses potential psychobiological pathways of stress-related modulation of AD symptoms.

Depressive Disorder↗

PubMed2003

High iron and low ascorbic acid concentrations in the dermis of atopic dermatitis patients.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease in which reactive oxygen species (ROS) may be involved. Iron catalyses ROS formation and ascorbic acid (AA) scavenges these species. OBJECTIVE: The aim of this work was to determine iron and AA levels in AD patients' dermis and to compare their concentrations with those of healthy volunteers' dermis. METHODS: Five AD patients and 5 healthy subjects (controls) were enrolled in this study. Iron and AA were collected from human dermis by microdialysis and assessed by atomic absorption spectrometry and gas chromatography-mass spectrometry, respectively. RESULTS: The AD dermis demonstrated higher iron concentrations (44.3 +/- 4.6 microg/l) compared to controls (21.8 +/- 1.2 microg/l) as well as a significantly lower concentration of AA (46.7 +/- 0.6 vs. 176.8 +/- 14.5 microg/ml, respectively). CONCLUSION: These results suggest that iron and AA dermis levels could be indicators of inflammatory tissues and might be implicated in dermatological diseases such as AD.

Adult↗

PubMed2001

Atopic dermatitis in childhood.

Atopic dermatitis (eczema) is the commonest of the childhood dermatoses, accounting for 20% of all dermatological referrals with many cases continuing into adulthood. The morbidity and costs to society are high.

Anti-Inflammatory Agents↗

PubMed1993

Clinical application of low reactive level laser therapy (LLLT) for atopic dermatitis.

Patients with atopic dermatitis (AD) were treated with diode low reactive level laser therapy (LLLT), and the following results were obtained. 1) Itchy sensation decreased in 79 of 112 cases (71%) after this therapy. 2) Skin eruptions improved in 69 of 112 cases (62%). 3) There were no side effects during and after LLLT. 4) Major histocompatibility complex (MHC) class II antigen and inter-cellular adhesion molecule (ICAM)-1 expression on epidermal cells decreased after the therapy. 5) The number of CD1 positive epidermal dendritic cells did not significantly change before and after LLLT.

Adolescent↗

PubMedDate not supplied

Oral sodium cromoglycate in the management of atopic dermatitis in children.

Atopic dermatitis (AD), a common, multifactorial, and extremely complex disorder, should be examined from various points of view, and it requires all the skill a physician can gather because it can be a challenge for pediatricians, dermatologists, and allergists. The role of dietary factors in AD has long been a subject of controversies, and several investigators have demonstrated the effectiveness of elimination diets in the management of AD. The treatment of choice for AD due to food sensitivity (FS) is the elimination of the offending food(s). This can be easily achieved when the child is allergic to foods that are not common items in the diet or when the offending food is not an important nutrient. Problems arise when the child is allergic to food(s) common in the diet and/or that have a high nutritional value, SCG, the salt of a bischromone carboxylic acid, has been shown to be of some efficacy in the prophylaxis of bronchial asthma, allergic rhinitis, and other disorders associated with mast cell degranulation, such as mastocytosis. We reviewed 12 papers on the use of SCG in the management of AD children, which included 281 children aged 0.5 to 15 years. Analysis of the studies shows that five were carried out in the open, one in the single-blind, six in the double-blind fashion. Four out of five open trials yielded positive results, that is, SCG was effective in the management of AD. The double-blind studies were positive in three cases and negative in three. The only trial with doubtful results was conducted in the open fashion.

Administration, Oral↗

PubMed1998

[Management of atopic dermatitis].

Management of atopic dermatitis should be based on cooperation among the physician, the child and the parents. There is no "radical" treatment that can eradicate the signs of this chronic affliction, which most often regresses during the first years of life. The aim of treatment is thus to combat infectious factors and to treat flares. In most cases, simple, daily and careful attention, using anti-infectious treatment, anti-inflammatory treatment by local corticosteroid application, and palliating skin dryness will assure the child of normal quality of life.

Anti-Inflammatory Agents↗

PubMedDate not supplied

Interleukin-18 is associated with increased severity of atopic dermatitis in children.

Atopic dermatitis (AD) is a chronic relapsing skin disease characterized by reduced interferon (IFN) gamma production with concurrent up-regulation of interleukin (IL)-4. Recently, it was reported that IL-18, formerly called IFN gamma-inducing factor, induces the production of T helper (Th)2-related cytokines without help from IL-12. This study was performed to evaluate the contribution of IL-18 in the pathogenesis of AD. Significantly higher serum IL-18 concentrations were found in patients with severe AD than in healthy subjects. Under staphylococcal enterotoxin B stimulation, IL-18 secretion was increased in peripheral blood mononuclear cells from patients with AD. There were significant differences in the concentrations of IL-10, IL-12, and soluble Fas ligand between AD patients and normal controls. In conclusion, increased serum IL-18 concentrations may be involved in the pathogenesis of AD.

Antigens, Bacterial↗

PubMed2005

[Treatment of atopic dermatitis: practical approach].

Atopic dermatitis (AD) is a chronic disease frequent in childhood. The treatment is based on regular moisturizing of the skin, information to the parents on the chronic course with recurrent flares, topical anti-infectious therapy for superinfections and colonization of the skin by staphylococcus aureus, and topical steroids. The immuno-modulatory macrolides (tacrolimus and pimecrolimus) represent a new alternative to topical steroids. These molecules are well tolerated, but theirs effects on the long-term are unknown. A food allergy may be responsible for a AD flare in up to a third of the cases, but the presence of an allergy should be demonstrated before the prescription of an elimination diet. AD is often the first manifestation of atopy: the physician should be aware of the future occurence of respiratory symptoms.

Adrenal Cortex Hormones↗

PubMed2005

[The role of therapeutic education in the treatment of atopic dermatitis in children].

Atopic dermatitis (AD) is a chronic disease of the skin that has heavy impact on the quality of life of children affected and raises the question of compliance, which frequently leads to treatment failure. Various problems are at the origin of poor compliance, such as the progressive loss of parents' motivation, the complexity of treatments, the corticosteroid phobia of health care workers and patients, and the side effects induced by treatment, their inefficiency and their cost. Therapeutic training is aimed at helping the patients to cope with their disease and to avoid the related complications. Its aim is to permit patients, and those who surround them, to acquire competence and sufficient knowledge so as to become autonomous. This acquisition and appropriation of competence by the patients requires personalised surveillance. Hence, therapeutic education is a continuous process of accompanying the patient throughout training. It is not a substitute to treatment but is conducted in parallel, to enable the patients to optimize their quality of life. Therapeutic training is already recognised as a crucial element in the management of many diseases. Despite the difficulties encountered, educational centres would clearly improve the management of AD.

Child↗

PubMed2006

[Atopic dermatitis in children].

Atopic dermatitis is a chronic inflammatory and recurrent dermatosis, the frequency of which increases regularly in industrialised countries. It begins in the first months of life and the clinical presentation changes with the age of the child. The diagnostic is clinical in the majority of cases. Sometimes allergological explorations are necessary. The treatment has two objectives: treatment of the flares (mainly topical corticosteroids) and preventive adjuvant measures. The use of topical immunosuppressors reinforces the therapeutic management, after failure of topical corticosteroids.

Child, Preschool↗

PubMed1983

Effects of thymopoietin pentapeptide (TP-5) on in vitro and in vivo IgE production by atopic dermatitis cell subsets.

Atopic dermatitis (AD) patients exhibit multiple immune abnormalities, including T-cell defects that may be partially correctable by the administration of thymic hormones. Our investigations confirmed that peripheral blood mononuclear leukocytes obtained from patients with AD spontaneously synthesized markedly elevated amounts of IgE in vitro. The thymic hormone thymopoietin pentapeptide (TP-5) greatly inhibited this synthesis. An antihuman pan-T cell monoclonal antibody (Lyt3) was used to separate T-cell marker-positive (T+) T cells from marker-negative (T-) B-enriched cells. TP-5 pretreatment of T+ cells resulted in significant reduction of in vitro IgE synthesis by recombined T+ and T- cells, whereas pretreatment of T- B-enriched cells resulted in a nonsignificant reduction in in vitro IgE synthesis. Thus, although pretreatment of both subsets resulted in some degree of reduction, TP-5-induced inhibition of in vitro IgE synthesis was primarily mediated via T cells. The majority of patients' untreated T+ and T4+ cells showed enhanced IgE synthesis, but only one patient's T8+ cells were capable of suppressing IgE synthesis. Thus TP-5 may either induce suppressor T-cell activity or reduce helper T-cell activity. A six-week double-blind clinical trial of TP-5 produced evidence of clinical improvement and alterations of abnormalities of OKT8+ cells, although no significant effects on serum IgE were seen.

Antigens, Ly↗

PubMed1993

[Serum and secretory immunoglobulins in atopic dermatitis].

In 58 atopic dermatitis patients from 93 was determined the total and specific IgE. Majority of the cases (84.5%) were extrinsic in type and it is an evidence for the local (through the body surfaces) crossing route of allergens. Thus the body surfaces are the most important factors in case of host defense in the first line. To investigate the local defending factors, the body fluids (whole saliva and tear taken from patients, n = 11) were examined too (preliminary study). According to amount of IgA and IgA/IgG ratio, the tear proved to be pure glandular secretum. In the further sistemically arranged study the sera and tear samples were simultaneously examined (n = 35). In follows is scheduled the measurement of total and specific IgE not only in sera, but the tear sample of patients.

Adolescent↗

PubMed1997

Normal recovery of the stratum corneum barrier function following damage induced by tape stripping in patients with atopic dermatitis.

Patients with atopic dermatitis (AD) constantly inflict mechanical damage to their skin by scratching induced by pruritus. On excoriated lesions of the cheek we found exceedingly high levels of transepidermal water loss (TEWL) as compared to those in the normal skin of healthy subjects. However, it is not clear whether the skin of patients with AD also shows an abnormally slow recovery after mechanical damage. We compared the recovery of the barrier function of the stratum corneum (SC), after its complete removal by tape stripping, in patients with AD and age-matched healthy control subjects. On the normal-looking skin of the flexor forearm, we found no difference in the recovery process of the water barrier function of the SC between the two groups. This suggests that ability to reconstruct SC barrier function after mechanical damage is not impaired in AD patients.

Adult↗

PubMed1998

Atopic dermatitis in childhood.

Atopic dermatitis is one of the major challenging skin disorders in infants and children. Many flare factors come into play. Treatment is complicated. A simplified approach and overview to the problem is presented here. A parent education handout used in our clinic and reprinted here may be reproduced for patient education purposes.

Administration, Topical↗

PubMed2002

The genetics of atopic dermatitis.

PURPOSE OF REVIEW: Atopic dermatitis is typified by itchy, inflamed skin. It is increasingly common in the developed world and is a major cause of morbidity in infants and young children. Most children with the disease have high levels of immunoglobulin E and many have concomitant asthma. The cause of the disease is unknown, but it is highly heritable. Identification of the genes and genetic variants underlying atopic dermatitis may lead to new treatments and better classification of children with the disease. RECENT FINDINGS: Preliminary genetic studies have identified genes or clusters of genes that are expressed in the outermost layer of the skin to be just as important as genes that may modify the atopic process. These genes may influence other diseases, including psoriasis. Genome screens in mouse models seem to indicate involvement of some of the equivalent chromosomal regions as for human disease. SUMMARY: The findings suggest that atopy in atopic dermatitis may be a secondary process, rather than the cause of the disease. The barrier function of the skin is seen not to be merely passive. Identification of the genes underlying atopic dermatitis is feasible and likely within a few years.

Allergens↗

PubMed1999

T cells and T cell-derived cytokines as pathogenic factors in the nonallergic form of atopic dermatitis.

A subgroup of patients with atopic dermatitis are known to have normal serum total immunoglobulin E levels, undetectable specific immunoglobulin E, and negative skin prick tests towards allergens. This form of the disease has been termed nonallergic atopic dermatitis. In this study, we found that, among 1151 chronic atopic dermatitis patients, about 10% had normal serum immunoglobulin E levels with no evidence for immunoglobulin E sensitization. We investigated immunologic mechanisms of patients with "allergic" and "nonallergic" atopic dermatitis using peripheral blood and skin biopsy samples. Our data suggest that T cells are likely involved in the pathogenesis of both forms of atopic dermatitis. Skin T cells equally responded to superantigen, staphylococcal enterotoxin B, and produced interleukin-2, interleukin-5, interleukin-13, and interferon-gamma in both forms of the disease. Interleukin-4, however, was not detectable in the skin biopsies of both atopic dermatitis types and was secreted in very low amounts by T cells cultured from the skin biopsies. Moreover, skin T cells from nonallergic atopic dermatitis patients expressed lower interleukin-5 and interleukin-13 levels compared with allergic atopic dermatitis patients. Accordingly, T cells isolated from skin biopsies of atopic dermatitis, but not from the nonallergic atopic dermatitis, induced high immunoglobulin E production in cocultures with normal B cells that was mediated by interleukin-13. In addition, B cell activation with high CD23 expression was observed in the peripheral blood of atopic dermatitis, but not nonallergic atopic dermatitis patients. These data suggest, although high numbers of T cells are present in lesional skin of both types, a lack of interleukin-13-induced B cell activation and consequent immunoglobulin E production in nonallergic atopic dermatitis.

Adult↗

PubMed2003

Type I sensitization in adolescents: prevalence and association with atopic dermatitis. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis (TOACS).

The prevalence of Type I sensitization and its relationship to atopic dermatitis were assessed in a cohort of 1501 8th grade schoolchildren (aged 12-16) in Odense, Denmark. The protocol included a questionnaire, a clinical examination, IgE measurements and skin prick tests. A history of atopic dermatitis was found in 21.3%, allergic asthma in 6.9% and allergic rhinitis in 15.7% of the adolescents. One or more positive specific IgE measurements (CAP FEIA) were found in 29.6% of the schoolchildren (inhalant allergens 28.4%, food allergens 8.5%, pityrosporum ovale 1.5%) and a considerable proportion were sensitized without clinical relevance. The association between atopic dermatitis and Type I sensitization was related to concomitant inhalant allergy. A clear association with atopic dermatitis was indicated only for the allergen pityrosporum ovale.

Adolescent↗

PubMed2004

Food allergy and atopic dermatitis in infancy: an epidemiologic study.

Atopic dermatitis is common in infancy. The role of food allergy in atopic dermatitis of infancy is unclear. We examined the relationship between atopic dermatitis and immunoglobulin E (IgE)-mediated food allergy in infancy. A birth cohort of 620 infants with a family history of eczema, asthma, hayfever or immediate food allergy in a parent or sibling: 487 children had complete data including skin prick tests (SPTs) to evaluate IgE-mediated food allergy to cow milk, egg and peanut. Participants were grouped as no atopic dermatitis (Gp 0) or in quartiles of increasing severity of atopic dermatitis (Gps 1-4) quantified by days of topical steroid use as reported monthly. Adverse reactions to foods were recorded. The cumulative prevalence of atopic dermatitis was 28.9% to 12 months (10.3% of the cohort of moderate severity). As atopic dermatitis severity increased so did the prevalence of IgE-mediated food allergy (Gp 0, 40/346 vs. Gp 1, 6/36 vs. Gp 2, 8/35 vs. Gp 3, 12/35 vs. Gp 4, 24/35; chi(2) = 76; p < 10(-6)), and the frequency of reported adverse food allergy reactions (Gp 0, 43/346 vs. Gp 1, 4/36 vs. Gp 2, 8/35, vs. Gp 3, 5/35, vs. Gp 4, 13/35; chi(2) = 17; p = 0.002). The relative risk of an infant with atopic dermatitis having IgE-mediated food allergy is 5.9 for the most severely affected group. Atopic dermatitis is common in infancy. There is a strong association between IgE-mediated food allergy and atopic dermatitis in this age group.

Dermatitis, Atopic↗