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PubMed1989

Intracutaneous tests with pityrosporon extract in atopic dermatitis.

In patients with atopic dermatitis and in a control group prick and intracutaneous tests were performed with Pityrosporon extracts. Moreover, specific IgE against Pityrosporon was determined in these patients. Significant differences existed between the results obtained with these methods in both groups of patients. Therefore, both skin tests with Pityrosporon extract and IgE determinations may contribute to a diagnosis of AD; moreover, it is likely that Pityrosporon may be of significance in the pathogenesis of AD.

Allergens↗

PubMed1992

Positive antinuclear antibody in atopic dermatitis.

Serum samples from atopic dermatitis (AD) patients were examined with two antinuclear antibody-detecting methods, using HEp-2 cells as substrate. 34.0% of 47 AD patients tested with FITC-conjugated polyvalent immunoglobulins (method 1) had positive antinuclear antibody (ANA). 26.3% of 57 AD patients examined with FITC-conjugated anti-IgG (method 2) had positive ANA. We found that AD patients who had facial lesions tended to have positive ANA, whereas severe AD patients tended to have high titres of ANA.

Adolescent↗

PubMed2002

Alternative treatments for atopic dermatitis: a selected review.

Atopic dermatitis (AD) is a chronic itchy, inflammatory skin disease that is extremely difficult to treat. Effective therapeutic agents are limited in number, and may have long-term toxic side-effects. Frustrated by these realities, many patients stop seeking help from conventional physicians and turn to alternative medical approaches. These can include so-called natural products, herbal products and over-the-counter (OTC) treatments. Herbs and medications share a common history, as most of our well-known medications were derived from plants. However, herbal remedies are largely unregulated. Many may have scientific merit and clinical benefit, but they are still scientifically invalid and inadequately monitored. Dermatologists need information about the effects of herbal remedies in order to better serve their patients.

Dermatitis, Atopic↗

PubMed2003

[Effects of administration of bifidobacteria on fecal microflora and clinical symptoms in infants with atopic dermatitis].

Fifteen children with atopic dermatitis who had Bifidobacterium-deficient microflora were selected for this study. Eight subjects in the bifidobacteria-administered group were given oral administration of lyophilized bifidobacteria (Bifidobacterium breve M-16V strain). The changes in fecal microflora and clinical symptoms were compared with the control group. In the bifidobacteria-administered group, the proportion of Bifidobacterium in the fecal microflora was increased (P=0.0173) and the proportion of aerobic bacteria was decreased (P=0.0499) after 1 month of administration. Furthermore, significant improvement of allergic symptoms (P=0.0176 in cutaneous symptom score, P=0.0117 in total allergic score) was also observed in the bifidobacteria-administered group. The tendency of allergic symptom improvement in the bifidobacteria-administered group was remarkable compared with the control group; however there was no correlation between changes in fecal microflora and allergic symptoms.

Bifidobacterium↗

PubMed2003

Still elusive relationship between atopic dermatitis and allergic contact dermatitis.

The relationship between atopic dermatitis (AD) and allergic contact dermatitis (ACD) has long been and continues to be an unsolved and frequently discussed issue. Whereas AD patients have traditionally been considered to have a decreased frequency of ACD, recent studies revealed that these individuals are more or equally likely to develop ACD. The aim of the present review was to determine whether the results of recent experimental studies and theoretical considerations might lead to a parallel shift in our concept on the causal relationship between AD and ACD. It has been shown that Th2 and Th1-type immune responses are not mutually exclusive, and that at least in AD a mixture of both Th2 and Th1 occurs and the interactions between them account for the clinical characteristics of the disease. This new concept on the immunopathomechanism of AD challenges our previous belief that the cytokine pattern of the affected skin is unsuitable for the development of delayed-type hypersensitivity. Since we do not know the exact quantitative balance between Th1 and Th2 reactions along a time axis, we cannot predict whether the cytokine pattern of AD patients favors or inhibits the development of ACD. What we do know with a greater degree of certainty, is that when the eczematous excoriated skin of AD patients, with its defective epidermal barrier (enhancing the penetration of many antigenic substances) is chronically exposed to skin care products and various sensitizing topical medications, it is more likely to develop a superimposed ACD.

Cytokines↗

PubMed2004

Diagnostic criteria for atopic dermatitis in Thai children.

Atopic dermatitis (AD) is a common skin disease in Thai children. There is no clinical or laboratory gold standard for the diagnosis. It is generally based on the guideline proposed by Hanifin and Rajka. Many studies have shown that some criteria are probably not all that significant in making the diagnosis. This study was designed to evaluate the frequency and diagnostic significance of clinical features of AD in Thai children. The authors studied 108 patients with AD and 103 controls including patients with other skin diseases. The AD group consisted of 60 girls and 48 boys. The mean age was 60.3+/-36.1 months. All previously proposed features were evaluated and the difference infrequency was tested with the chi-square test. History of pruritus, rash on typical distribution, chronically relapsing course, duration more than 6 months, personal or family history of atopy, age of onset before 2 years, recurrent conjunctivitis, itch when sweating, intolerance to rough textile, food and milk intolerance, history of dry skin, seasonal variation, visible dermatitis, dermatitis of a typical distribution, xerosis, ichthyosis vulgaris, foot dermatitis, Dennie-Morgan infraorbital fold, orbital darkening, periorbital dermatitis, pityriasis alba, peri-auricular dermatitis, anterior neck fold, truncal dermatitis, perifollicular accentuation, white dermographism and diffuse scaling of scalp were all significantly more frequent in AD (p < 0.05). A minimum set of diagnostic criteria for AD was derived by using multiple stepwise logistic regression technique. It consisted of history of itchy rash, history of flexural dermatitis, chronicity more than 6 months, and visible xerosis, periorbital dermatitis and perifollicular accentuation.

Case-Control Studies↗

PubMed1989

[Holistic-integrated therapy model of neurodermitis constitutionalis atopica (atopic dermatitis)].

The treatment of atopic dermatitis requires the consideration of numerous psychosomatic aspects, including their respective sociopsychic dimensions. This implicates a holistic concept of therapy as well as the interdisciplinary cooperation of therapists of various disciplines, also involving the patient himself. Taking the patient out of his everyday circumstances can give him the opportunity of developing new concepts and strategies of behavior, which in turn may promote his subsequent (re-)integration into his social environment.

Adaptation, Psychological↗

PubMed1993

[Comparison of food specific IgE antibody test (RAST) and skin tests in children with atopic dermatitis].

Thirty children with atopic dermatitis were enrolled in our study to evaluate the food specific IgE antibody assay (RAST) and skin tests as a screening test for food hypersensitivity. Our results showed that eight food antigens (fish, shrimp, crab, soybean, milk, egg-white, peanut, wheat) frequently elicited positive hypersensitivity reactions. Twenty-four patients had at least a positive skin reaction to one of the foods tested. Of the 240 skin tests, 30% (72/240) yield positive reactions. Eighteen patients had at least a positive RAST reaction to one of the foods tested, 20.9% (50/240) yield positive reaction. The agreement between skin test and RAST was 79.6%. Crab and shrimp accounted for most frequent positive reaction in both tests. The skin tests produced more positive results in skin testing than RAST, but gave a higher frequency of false positive results. The diagnosis of food allergy may be suspected from the medical history or by food specific IgE antibodies together with skin test as a screening test. Furthermore, the double blind placebo controlled food challenge should be considered as standard for clinical investigations.

Adolescent↗

PubMed1997

Genetic studies of atopy and atopic dermatitis.

Atopy and the atopic disorders are likely to result from multifactorial inheritance, with interaction between genetic and environmental factors. It has been proposed that at least two major mechanisms, non-antigen specific (total IgE levels) and antigen specific (specific IgE antibodies and skin tests), regulate the immune response to allergens in humans: firstly, a gene/genes independent of the human leucocyte antigen system which is involved in the regulation of total IgE levels, and secondly, a specific immune response gene/genes associated with major histocompatibility complex class II genes which are involved in antigen-specific mechanisms. Candidate genes have been proposed for both mechanisms and linkage has been found between atopy and at least three different gene loci. This paper reviews the evidence supporting a genetic basis for atopy and atopic dermatitis and outlines recent advances in the molecular genetic mapping of genes associated with these disorders.

Dermatitis, Atopic↗

PubMed2000

[Atopic dermatitis: the first allergic step in children].

Atopic dermatitis is an early manifestation of atopy and is frequently present already during the first year of life. Atopic dermatitis is often associated with increased levels of serum IgE and with sensitization to food allergens. Some foods may be responsible for exacerbations of skin inflammation, but their pathogenic role need to be clinically assessed before an avoidance diet is prescribed. Staphylococcus aureus, which is known to colonize the skin of atopic dermatitis patients, may also exacerbate skin lesions and need to be treated with topical antibiotics. Children with atopic dermatitis are prone to allergies and are at risk to develop later respiratory allergic manifestations. In particular, if a sensitization to egg is present early in life, the risk for developing later an asthma due to house dust mites is increased. The care of children with atopic dermatitis should not be limited to the treatment of skin lesions, but should also involve preventive measures for respiratory allergies.

Age Factors↗

PubMed2003

[Stigmatization and quality of life of patients with psoriasis and atopic dermatitis].

BACKGROUND AND OBJECTIVE: Psoriasis and atopic dermatitis patients are often influenced by the psychosocial consequences of their skin diseases. In order to assess these experiences reliably, the stigmatization feeling and the quality of life of these patient groups were studied. PATIENTS/METHODS: The short form of the "Questionnaire on Experience with Skin Complaints" (QES) was validated in a sample of 463 in-patients with psoriasis and atopic dermatitis. In addition, the Dermatology Life Quality Index (DLQI) was ascertained. RESULTS: The dimensions "impairment of self-esteem and withdrawal", "rejection experienced", "concealment", and "composure" of the QES could be confirmed by factor analysis. As expected, middle high correlations between the QES and the DLQI were found in both patient groups. However, the stigmatization experience and the quality of life were not significantly different in a subgroup of psoriasis and atopic dermatitis patients with comparable sociodemographic characteristics. CONCLUSIONS: The short form of the QES with 23 items is a valid instrument for the examination of social and psychic burdens of psoriasis and atopic dermatitis patients. The recording of the stigmatization feeling and of the quality of life determines different, supplementary aspects of the illness-related stress of patients with chronic skin diseases.

Adolescent↗

PubMed2005

Mast cells and vasculature in atopic dermatitis--potential stimulus of neoangiogenesis.

BACKGROUND: Atopic dermatitis skin lesions are characterized by inflammatory changes and epithelial hyperplasia requiring angiogenesis. As mast cells may participate in this process via bidirectional secretion of tissue-damaging enzymes and pro-angiogenic factors, the present study aimed to assess the occurrence and possible function of mast cells in the papillary dermis and in epidermal layers of atopic dermatitis lesions. METHODS: Semi-thin and serial sections in combination with immunohistochemistry, histochemistry and proliferating cell nuclear antigen (PCNA)-activity assays were used and related to epidermal thickness and targeted gene expression studies. RESULTS: Mast cells were located in the papillary dermis and migrated through the basal lamina into the epidermis of atopic dermatitis lesions. An increased PCNA-activity in cells of superficial epidermal layers indicated an activation of keratinocytes and stimulation of endothelial growth. Only approximately 30% of the papillary mast cells stained with the tryptase were toluidin-blue-positive, and approximately 80% were chymase positive. A high number of mast cells expressed c-kit. Most papillary and epidermal mast cells were localized close to endothelial cells. Vascular expression of endoglin (CD105) demonstrated neoangiogenic processes. Mast cells stimulation led to the expression of proangiogenic factors. Also, gene expression of tissue-damaging factors such as matrix metalloproteinases was increased. CONCLUSIONS: These data suggest that in atopic dermatitis, mast cells are abundantly localized close to and within the epidermis where they may stimulate neoangiogenesis. Via the new vessels, inflammatory cells, together with complement components and antibodies, can be transported to the epidermis to aid in the defense against environmental antigens and to maintain chronic inflammation.

Blood Vessels↗

PubMed1986

Monocyte localization of elevated cAMP phosphodiesterase activity in atopic dermatitis.

Patients with atopic dermatitis (AD) manifest a number of immune abnormalities which correlate with in vitro defects including lymphocyte transformation, chemotaxis, and cytotoxicity. Past studies have shown reduced leukocyte cyclic 3',5'-adenosine monophosphate (cAMP) levels after exposure to adenylate cyclase-active agonists, and we have demonstrated that this results from increased catabolism due to elevated cAMP-phosphodiesterase activity. These results were obtained in preparations containing mixtures of lymphocytes and monocytes. In order to determine more precisely the cellular site of the defect we have separated the leukocytes into lymphocyte- and monocyte-enriched preparations using either Percoll-gradient centrifugation or adherence isolation. Both techniques yielded over 93% pure lymphocytes, whereas the former yielded 64% monocytes compared with the latter method which generated 94% pure monocytes. Atopic monocytes, obtained by either technique, consistently showed elevated phosphodiesterase activity compared with those of the nonatopic monocytes. Such differences were not evident in lymphocyte preparations from normal and atopic subjects. In spite of the increased rate of cAMP degradation in atopic leukocytes, the resting cAMP levels do not differ from those of normal subjects. We questioned whether this is caused by increased cAMP synthesis and evaluated cellular adenylate cyclase activity. We found no evidence in AD cells for an increased rate of adenylate cyclase catalysis, either basal activity or after stimulation by forskolin. Therefore, the resting cAMP levels must have been compensated by other mechanisms. Impaired cyclic nucleotide metabolism in atopic monocytes may affect a number of immunologic and inflammatory reactions and could account for many of the clinical abnormalities in atopic diseases.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMedDate not supplied

[Analysis of selected constitutional and environmental factors in patients with atopic dermatitis].

In 156 children and adolescents with atopic dermatitis retrospective analysis was carried out for establishing the effect of constitutional and environmental factors on the process of development and clinical course of this disease. It was demonstrated that the type of feeding during infancy was related to the beginning of the first symptoms. The onset of atopic dermatitis was earliest and most frequent in children with a history of only brief breast-feeding (up to 2 months) or fed with cow milk formulas since birth. Breast-feeding during 2-6 months delayed the onset of atopic dermatitis by about 2 months in relation to the former group. The effect of environmental factors manifested itself also as exacerbation of skin changes after contact with house dust, animal hairs, feathers and other antigens (fish food, contact with plants). At the same time positive results were observed of point tests with these allergens. A significant effect of the constitutional factor on the development of atopic dermatitis included familial occurrence of atopic diseases (mostly atopic dermatitis). Only 12.8% of the studied children had no family history of atopy.

Adolescent↗

PubMed2000

Association and linkage of atopic dermatitis with chromosome 13q12-14 and 5q31-33 markers.

Atopic dermatitis is a chronic inflammatory skin disease that affects 10-20% of the population. Linkage of atopy, asthma, allergic rhinitis, and total serum IgE levels to several different chromosomal regions have been described extensively, but little is known about the genetic control of atopic dermatitis. We tested for the association and linkage between atopic dermatitis and five chromosomal regions: 5q31-33, 6p21.3, 12q15-24.1, 13q12-31, and 14q11.2/14q32.1-32.3. Marker analysis was performed in two Caucasian populations: (i) 192 unrelated German children with atopic dermatitis and 59 non-atopic children from a German birth cohort study (MAS'90), parental DNA was tested in 77 of 192 children with atopic dermatitis; (ii) 40 Swedish families with at least one family member with atopic dermatitis selected from the International Study of Asthma and Allergy in Children. Evidence for linkage and allelic association for atopic dermatitis was observed for markers on chromosome 13q12-14 and 5q31-33.

Child↗

PubMedDate not supplied

The relationship between plasma thrombospondin level and the clinical course of atopic dermatitis.

The tests currently used to monitor atopic dermatitis in children--serum IgE level and eosinophil count--are not sensitive enough to accurately track the course of the disease. Because previous studies have shown that atopic dermatitis is an inflammatory disease and because our previous work has shown that plasma thrombospondin level correlates well with the course of other inflammatory diseases, we conducted this study to determine the relationship between plasma thrombospondin level and the severity of skin inflammation in children with atopic dermatitis. Eosinophil count, serum IgE level, and plasma thrombospondin level were measured in 48 children with atopic dermatitis at onset of flare-up, 2 weeks after treatment started, and 2 months after treatment started. The results of all three tests were better after 2 months of therapy than they had been at the initial visit, but only plasma thrombospondin level showed a statistically significant decrease, which coincided with clinical improvement. Plasma thrombospondin level seems to correlate with the clinical course of patients with atopic dermatitis better than do serum IgE level or eosinophil count.

Adolescent↗

PubMed1999

Prevalence and role of serum IgE antibodies to the Staphylococcus aureus-derived superantigens SEA and SEB in children with atopic dermatitis.

BACKGROUND: The skin of patients with atopic dermatitis exhibits a striking susceptibility to colonization and infection with Staphylococcus aureus. In this context it has been previously shown that S aureus-derived superantigens could function as classic allergens, inducing production of functionally relevant specific IgE antibodies. OBJECTIVE: The aim of this study was to determine the prevalence and the role of circulating staphylococcal enterotoxin A (SEA)- and staphylococcal enterotoxin B (SEB)-specific IgE antibodies in children with atopic dermatitis. METHODS: In a cross-sectional study of 58 children with atopic dermatitis, the presence of IgE antibodies to SEA and SEB was correlated with the severity of the disease and the total and other unrelated allergen-specific IgE titers and density of colonization with S aureus strains on atopic skin and episodes of superficial S aureus skin infections. RESULTS: Twenty of 58 children (34%) were sensitized to superantigens (45% to SEB, 10% to SEA, 45% to SEA and SEB). In this group, severity of atopic dermatitis and levels of specific IgE to food and air allergens were significantly higher. The degree of disease severity correlated to a higher extent with the presence of SEA/SEB-specific antibodies than with total serum IgE levels. Density of colonization with superantigen-secreting S aureus strains was higher in the superantigen IgE-positive group. Sixty-three percent of these children experienced repeated episodes of superficialS aureus skin infections. CONCLUSIONS: Sensitization to S aureus-derived superantigens may be involved in disease exacerbation. The presence of SEA/SEB-specific antibodies had additional explanatory value for disease severity and therefore may be helpful in the characterization of children with severe atopic dermatitis.

Adolescent↗

PubMed1993

Atopic dermatitis in children: who cares? Who pays?

BACKGROUND: Atopic dermatitis is an important cause of morbidity in children of all ages. Despite its high prevalence, there has been no examination of ways in which care for atopic dermatitis is delivered. OBJECTIVE: This study reviewed the costs for care of childhood atopic dermatitis in an urban setting and estimated the national cost for treatment of the disease. METHODS: We used data from one children's hospital to study the use of the emergency room for atopic dermatitis and used national data sets to estimate the cost of care in the United States. RESULTS: A large proportion of visits occur in the emergency department, during daytime office hours, and mostly by patients who have public insurance. The total national cost for treatment of childhood atopic dermatitis is $364 million annually, which is a conservative estimate. CONCLUSION: Given its high prevalence, associated morbidity, and cost, resources must be better allocated to improve the organization of care for patients with atopic dermatitis.

Adolescent↗