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PubMed2003

Immune mechanisms leading to atopic dermatitis.

The incidence of atopic dermatitis is increasing, and this poses a major burden on health care costs. A precise understanding of the genetic and immunologic mechanisms is crucial for development of effective treatment strategies for atopic dermatitis. Various studies indicate that it has a multifactorial cause, with activation of complex immunologic and inflammatory pathways. The current review will examine recent advances that have been made in our understanding of the genetic and pathophysiologic prerequisites that form the basis of this common recalcitrant skin disorder.

Dermatitis, Atopic↗

PubMed1999

Quality of life improvement in a patient with severe atopic dermatitis treated with photopheresis.

Atopic dermatitis is a common skin disease characterized by severely pruritic eczematous patches, papular and lichenified plaques, excoriations, cracks, and erosions. Photopheresis has been shown to ameliorate the signs and symptoms of atopic dermatitis in some patients. We describe successful results with photopheresis for refractory disease in a patient who chronicled his quality of life weekly for more than 15 years before and during extracorporeal photochemotherapy.

Administration, Cutaneous↗

PubMedDate not supplied

Longitudinal case analysis in atopic dermatitis.

The current knowledge on atopic dermatitis comes mainly from cross-sectional studies, which are not suited to establish time-courses or causal links in complex diseases. As an alternative approach, the method of longitudinal case analysis by the autoregressive integrated moving average (ARIMA) method has been introduced to investigate the pathogenesis of atopic dermatitis. The method was applied to the investigation of 2 patients suffering from severe and moderate atopic dermatitis. Disease activity, peripheral blood parameters (differential blood count, lymphocyte subpopulations, immunoglobulin E, eosinophilic cationic protein, soluble interleukin-2 receptor), mental stress and environmental factors were determined daily for 50 days. Both patients showed a positive correlation between CD4+ and CD25+ T-cells, a negative correlation between CD16/56+ natural killer cells and CD4+ T-cells, a negative correlation between eosinophils and polymorphonuclear leukocytes, and a time-shifted positive correlation of up to 2 days between scores quantifying mental stress and disease activity. A positive correlation between T-cells and polymorphonuclear leukocytes, CD4+ T-cells and the CD45RA+ subtype, as well as a negative correlation between stress and eosinophils, sports and eosinophils, and sports and disease activity were found only in one patient with more severe atopic dermatitis. In conclusion, longitudinal time-series analysis might represent an interesting and adequate method to generate and test new hypotheses on biomedical problems which cannot be addressed by cross-sectional studies.

Adult↗

PubMed1990

Lysozyme and IgA values in patients with atopic dermatitis.

Ten patients with atopic dermatitis had significantly depressed lysozyme levels in saliva, compared with controls, whereas no differences were found in lysozyme activity in serum of patients and controls. The concentrations of IgA in saliva of patients with atopic dermatitis were also significantly lower than in controls, whereas IgA in patients' serum was within normal levels.

Adolescent↗

PubMed1994

Atopic dermatitis and ichthyosis vulgaris.

Atopic dermatitis remains a common skin problem in the pediatric age group. General approaches to management focus on reducing inflammation and pruritus as well as preventing xerosis. Ichthyosis vulgaris is the most common form of the ichthyoses and often is associated with atopic dermatitis. Recognition of these conditions is necessary to institute therapy that will alleviate the discomfort experienced by affected individuals.

Child, Preschool↗

PubMed1997

Conversion of the CD4+ T cell profile from T(H2)-dominant type to T(H1)-dominant type after varicella-zoster virus infection in atopic dermatitis.

Skin lesions of atopic dermatitis were examined for cytokine expression by reverse transcription-polymerase chain reaction. The profile of mRNA for various cytokines revealed that both T(H1) and T(H2) types of CD4+ T cells, probably including T(H0) type, infiltrate into the skin lesion. We observed that atopic skin lesions improved after varicella infection. In such lesions, expression of T(H1) type cytokines predominated. The peripheral blood T cells from atopic patients exhibited a differentiation into T(H2) type cells upon in vitro stimulation with mite antigen. In contrast they differentiated into T(H1) type cells upon stimulation by varicella antigen. Since IL-12 has been reported to switch the in vitro recall response of allergen-specific T cells of atopic donors from a T(H2)- to a T(H1)-like phenotype, we examined its local production in varicella lesions. IL-12 p35 and p40 mRNA were expressed in fresh lesions. Peripheral blood mononuclear cells from atopic patients expressed p40 mRNA upon in vitro stimulation with live varicella zoster virus, but they did not show p40 mRNA without stimulation. This finding suggested that in atopic skin lesions containing the virus, IL-12 was produced and the cell type was changed to T(H1) type-predominance. These results suggested that patients with atopic dermatitis always have highly reactive CD4+ T cells infiltrating into their skin, and that the switch to T(H1) or T(H2) dominance is related to whether the lesion is improved or exacerbated.

Antigens, Viral↗

PubMed2004

Estimation of heritability of atopic dermatitis in Labrador and Golden Retrievers.

OBJECTIVE: To estimate the heritability of atopic dermatitis in Golden and Labrador Retrievers. ANIMALS: 429 dogs related to 13 dogs with atopic dermatitis. PROCEDURE: Atopic dermatitis was defined on the basis of the type and frequency of clinical signs recorded in the clinical records, and each dog was classified with atopic dermatitis or probable atopic dermatitis or as nonatopic. By use of data from atopic and nonatopic dogs, regression analyses of parental status on offspring status were performed to estimate heritability. RESULTS: There was no difference in the frequency of atopic dermatitis between sexes or between breeds. There was a marked association between the atopic status of the parent and that of the offspring, particularly for sires. By use of data from 32 litters in which the status of both parents was known and considering only those dogs classified with atopic dermatitis or as nonatopic, the heritability (+/- SE) of atopic dermatitis was estimated to be 0.47 (+/- 0.17). CONCLUSIONS AND CLINICAL RELEVANCE: Atopic dermatitis has a strong genetic component, and breeding of dogs with clinical signs of atopic dermatitis should be discouraged.

Animals↗

PubMed2003

Tacrolimus ointment for the management of atopic dermatitis.

The management of atopic dermatitis is set for a major shift with the introduction of the first new topical treatment for the condition in 40 years--the non-steroidal topical immunomodulator tacrolimus (Protopic). Backed by strong clinical data, tacrolimus ointment is a valuable addition to topical steroids in the management of moderate-to-severe atopic dermatitis.

Administration, Topical↗

PubMed1995

London-born black Caribbean children are at increased risk of atopic dermatitis.

BACKGROUND: Previous reports suggest that atopic dermatitis is more common in black Caribbean children born in the United Kingdom than in white children. It is unclear whether these differences are caused by selection bias or variations in the use of the word "eczema" in the groups studied. OBJECTIVE: Our objective was to explore ethnic group differences in the prevalence of atopic dermatitis in London schoolchildren. METHODS: A cross-sectional prevalence survey of 693 junior school children in three schools was performed. Atopic dermatitis was defined in three ways: (1) by a dermatologist, (2) by visible flexural dermatitis as recorded by an independent observer, and (3) by a history of flexural dermatitis according to the child's parents. RESULTS: The prevalence of atopic dermatitis according to examination by a dermatologist was 16.3% in black Caribbean children and 8.7% in white children. This increased risk was present for different methods of defining of a atopic dermatitis and persisted after adjustment for potential confounders. CONCLUSION: London-born black Caribbean children appear to be at an increased risk of having atopic dermatitis.

Black or African American↗

PubMed1998

Infantile and childhood types of atopic dermatitis--a clinical comparison.

Atopic Dermatitis also known as infantile eczema in infants, is a chronic endogenous eczema which manifests with different characteristic distribution in infants, children and adults. Absence of any reliable laboratory investigation to confirm the diagnosis makes it very difficult to differentiate it from other eczemas especially in infantile and childhood types. This study compares a small group to patients belonging to infantile and childhood types of atopic dermatitis and documents the changes observed in these category of patients.

Age Distribution↗

PubMed2003

Patch-test reaction patterns in patients with a predisposition to atopic dermatitis.

Patients with a predisposition to atopic dermatitis often need to be patch tested in order to detect possible contact sensitization. However, it is unknown whether immunologic or other peculiarities of atopic skin are related to altered patch-test reaction patterns. Our study was aimed at answering this question, because patch-test reaction patterns are of considerable practical importance in the reading and interpretation of patch tests. Therefore, we compared patterns of patch-test reactions in patients with a predisposition to atopic dermatitis and in control patients matched for sex, age, reason for testing and test centre. Patch-test results from 9 centres (2322 patients with a disposition to atopic dermatitis and 2126 matched controls) were evaluated retrospectively. All patients were tested with nickel sulfate, fragrance mix, potassium dichromate, lanolin alcohol, formaldehyde and mercury ammonium chloride. Patch tests applied for 1 day with readings on days 1, 2 and 3 were evaluated in order to cover the early phase of the reactions. Not unexpectedly, we found that, compared to the matched controls, patients with a predisposition to atopic dermatitis tended to have more doubtful and irritant reactions on day 1. As a new observation, it turned out that they had less reactions of crescendo pattern and more strong reactions on day 3. All these differences were slight/insignificant. A higher skin irritability in patients with a predisposition to atopic dermatitis is a likely explanation. In conclusion, standard methods for patch testing can be applied in patients with a predisposition to atopic dermatitis, but minor differences in reaction patterns should be considered.

Adult↗

PubMed2003

Treatment options and new therapeutic approaches in atopic dermatitis.

Many patients with atopic dermatitis feel that their treatment is ineffective and 25% may be noncompliant with treatments involving corticosteroids. Developing safe and effective pharmacologic alternatives to steroids has presented a challenge to physicians and drug researchers. A new class of nonsteroid immunomodulators, topical calcineurin inhibitors, overcome some of the difficulties and concerns associated with steroid use. The introduction of new drug therapies reinforces the importance of dermatology nursing in managing atopic dermatitis.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1990

Immunologic aspects of atopic dermatitis.

The immunology of atopic dermatitis is complex, multilayered, and multifaceted. In one realm are the IgE-mediated, type I hypersensitivity reactions that can be elicited in at least 80% of patients. A second realm is that associated with cell-mediated immunity and delayed-type hypersensitivity (type IV) reactions. Scattered between these immunologic paradigms are the various splinters: immune complex abnormalities, putative late-phase reactions, and cutaneous basophil hypersensitivity. The inflammatory lesion of atopic dermatitis probably is a composite of the many model reactions that investigators have glimpsed but never resolved into a reasonable concept.

Dermatitis, Atopic↗

PubMed2004

Pimecrolimus: new preparation. Me-too: too many risks, not beneficial enough in atopic dermatitis.

(1) Symptomatic treatment of atopic dermatitis is initially based on simple measures and moisturising creams. Topical corticosteroids are reserved for treatment of inflammatory exacerbations. (2) After topical tacrolimus, marketing authorisation has been granted in France for a second topical immunosuppressant, pimecrolimus, as a short-term symptomatic treatment for atopic dermatitis in children from the age of two years, and intermittently for long-term prevention of new exacerbations. (3) Short-term treatment with pimecrolimus has been tested in three trials in children with mild to moderate dermatitis (against the excipient), in one adult trial against the excipient, and in one dose-finding study in adults that included a group treated with topical corticosteroids. (4) Longer term treatment periods of 6 to 12 months have been tested in two trials versus excipient in children, and two adult trials, one versus moderately active topical corticosteroids. (5) These trials show that pimecrolimus works better than the excipient, but not nearly as well as moderately active topical corticosteroids. Pimecrolimus has not been compared with topical corticosteroids in children, the age group most vulnerable to atopic dermatitis. (6) The commonest adverse effects observed in clinical trials were local and included a burning sensation at the site of application and skin infections. Systemic adverse effects (mainly infections) were most marked in infants. Long-term risks, especially the risk of skin cancer, have not been assessed. (7) In practice, the reference treatment for exacerbations of atopic dermatitis is a topical corticosteroid; in children, it seems best to begin with a weak preparation. There is no reason to use pimecrolimus, which is less active than topical corticosteroids and whose potential long-term adverse effects, especially in children, are unknown.

Administration, Cutaneous↗

PubMed1991

[Clinical aspects and allergy-immunologic parameters in 40 children 0-7 years of age with atopic dermatitis].

Forty children with atopic dermatitis were evaluated for history, clinical features and allergologic-immunologic parameters. Lichenoid skin lesions were found in 67.5%, follicular lesions in 57.5%, and eczematoid lesions in 50% in children. 25% of children suffered from associated food allergy, 15% from respiratory atopy, and 5% from contact urticaria. The diagnostic efficiency to show specific sensitization was 93% for Pediatric Phadiatop, 90% for Food-Multidisc (fx5 Pharmacia), 88% for skin tests (Prick), 73% for elevated total serum IgE, 65% for Phadiatop, and 60% for family history. The classification of atopic dermatitis into an extrinsic type with specific sensitizations to allergens and into an intrinsic type without specific sensitizations appears to be useful because specific sensitizations significantly correlate with severer skin condition and disease course.

Allergens↗

PubMed1990

[Papaverin--effective in therapy of pruritus of atopic dermatitis?].

Patients suffering from atopic dermatitis show increased phosphodiesterase activity in leucocytes. As a result, the level of intracellular c-AMP is reduced, which can produce a number of metabolic dysfunctions: We found strong evidence that an enhanced release of several inflammation mediators can favor itching, which in turn promotes the development of eczema, since it induces reflectory scratching. In order to solve the question whether papaverine as a phosphodiesterase inhibitor might offer a new approach in the systemic therapy of itching, we performed a placebo-controlled study on 51 patients with atopic dermatitis, who were orally treated with papaverin-HCl over 8 weeks. However, we did not observe any improvement of itching or eczema during treatment. Some other recently developed phosphodiesterase inhibitors are discussed.

Administration, Oral↗

PubMed2005

[What environmental measures should be taken for the treatment of atopic dermatitis in children and the prevention of other atopic manifestations?].

The association of atopic dermatitis, asthma and allergy is frequent. Hence, it is logical to imagine that eviction of the main indoor allergens (dust mites, animal danders) would have a preventive effect on the onset and progression of atopic dermatitis and the risk of asthma. Recent epidemiological studies are generally negative with regard to primary and also secondary and tertiary prevention. Only one study appeared positive; it combined eviction of food allergens and of indoor allergens during the first year of life. Other studies are warranted to assess the interest and efficacy of eviction of inhalant allergens in atopic dermatitis.

Child↗

PubMedDate not supplied

[Lymphocyte apoptosis in atopic dermatitis treated with transfer factor].

BACKGROUND: Atopic dermatitis is an inflammatory dysfunction in whose physiopathology the lymphocytes T play an important role in the regulation of the inflammatory process. OBJECTIVE: To determine and to characterize the role of apoptosis of lymphocytes in patients with moderate to severe atopic dermatitis before and after treatment with transfer factor. MATERIAL AND METHODS: Fifteen patients with moderate to severe atopic dermatitis in a range of age from 5 to 45 were included in the study. Fifteen healthy subjects were taken as a control group. In all subjects it was determined the apoptosis of the lymphocytes by means of annexin and TUNEL techniques, as well as the expression of CD95 cells. The 15 patients with atopic dermatitis received treatment with transfer factor in stepped dose as follows: 1 U/day/5 doses, 1 U/week/3 doses, 1 U/15 days/2 doses, 1 U/30 days, until completing three months. At the end of this period new determinations were done to measure apoptosis of lymphocytes and PMN. At the beginning and at the end assessments of the severity in relation to the scale SCORAD were made. RESULTS: By means of both techniques no significant difference was found in the percentage of apoptotic lymphocytes between patients and control subjects. Differences of the expression of CD95 between patients and control subjects before and after treatment were not significant. There was a significant difference (p < 0.01) of severity from the beginning to the end of treatment with transfer factor in patients with atopic dermatitis. CONCLUSION: No significant differences of apoptosis of lymphocytes were found in patients with atopic dermatitis who received treatment and control subjects, neither before not after the treatment with transfer factor. It was verified the decrease in the severity of the symptoms related to the treatment with transfer factor.

Adolescent↗