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Results for “DERMATITIS, ATOPIC”

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PubMed1998

Successful monotherapy of severe and intractable atopic dermatitis by photopheresis.

BACKGROUND: Patients with chronic atopic dermatitis can become unresponsive to standard immunosuppressive therapy and thus pose a serious therapeutic problem. OBJECTIVE: Our purpose was to evaluate the therapeutic effectiveness of photopheresis in the management of patients with severe and intractable atopic dermatitis. METHODS: Photopheresis was used as monotherapy in patients (n = 3) who previously did not respond to treatment with glucocorticosteroids, cyclosporine, phototherapy, or photochemotherapy. Patients were treated at 2-week intervals (total number of treatments = 10). RESULTS: In all patients, photopheresis induced clinical improvement and reduction of elevated serum levels of eosinophil cationic protein and total IgE. Prolongation of the intervals between treatments from 2 to 4 weeks caused worsening in one patient, whereas shortening of treatment-free intervals improved both clinical and laboratory findings. CONCLUSION: These studies indicate that photopheresis may be used as monotherapy for the treatment of patients with severe atopic dermatitis that has become intractable to standard therapeutic modalities.

Adult↗

PubMed2004

Interleukin-5, interleukin-3 and granulocyte-macrophage colony-stimulating factor prime actin-polymerization in human eosinophils: a study with hypodense and normodense eosinophils from patients with atopic dermatitis.

Characteristic features of atopic diseases (AD) are immigration and local activation of eosinophils. Reorganization of the cytoskeleton modulates the function of leukocytes and is a prerequisite for the motility response. In this work, the regulation of actin polymerization has been investigated by flow cytometry using NBD-phallacidin and right angle light scatter measurements in purified eosinophils isolated from patients with atopic dermatitis and normal individuals. Stimulation of eosinophils with chemotaxins such as complement fragment C5a (C5a), CC chemokine RANTES/ CCL5 and platelet activating factor (PAF) induced a reversible polymerization of actin. Normodense eosinophils purified from patients with AD showed a decreased chemotaxin-induced actin response as compared to normodense eosinophils from healthy subjects and hypodense eosinophils from patients. Stimulation of eosinophils with Th2-cytokines such as interleukin-3 (IL-3), interleukin-5 (IL-5), granulocyte-macrophage colony-stimulating factor (GM-CSF) did not exert a significant effect on actin polymerization. However, pretreatment with IL-3, IL-5 or GM-CSF potentiated the chemotaxin-induced actin polymerization and graded the differential responsiveness between normodense and hypodense eosinophils. We demonstrate a different actin responsiveness in eosinophils from atopic patients and healthy subjects which could be overcome by modulating effects of Th2-cytokines.

Actins↗

PubMed2005

[What is the value of allergologic tests for the diagnosis and management of atopic dermatitis?].

The prevalence of atopic dermatitis (AD) in children has considerably increased in industrialised countries over the past 20-30 years. Determination of the interest of supplementary examinations, notably allergological explorations, is fundamental for all the practitioners who manage children suffering from the disease. ALLERGOLOGICAL TESTS: WHEN AND FOR WHO? Children suffering from eczema and describing concomitant manifestations such as urticaria, an oral syndrome or asthma should benefit from allergological tests. The latter are conducted as markers of the progression in the infant (aged under 24 months) presenting with atopic eczema without any concomitant manifestations. Such tests are aimed at defining the prognosis of AD and specifying the risk of progression towards an asthmatic syndrome. Allergological tests are conducted in the case of severe AD of early onset and in the presence of a family history of atopy. ALLERGOLOGICAL TESTS: WHICH? They explore immediate and delayed hypersensitivity. They include determination of IgE-dependent sensitivity using cutaneous tests or specific IgE measurements with validated methods. Allergy to food concerns very young children of around 2 years old. The diagnosis of such allergies is based on the efficacy of the eviction and oral provocation test, when there is discordance between the clinical history and the results of the determination of a specific IgE-related sensitivity. Prick-tests are performed to search for contact hypersensitivity, more frequent in older children. They are performed for contact allergens, aero-allergens and foodstuff and are supplemented by interrogation data. The pertinence of such tests remains to be determined. ALLERGOLOGICAL TESTS: WHAT FOR? An allergic factor enhances AD in one child out of two. Evictions adapted to the results of the allergological tests always improve the status of the children. They may even modify the natural history of the disease.

Child↗

PubMed1995

Intraoperative observation of the vitreous base in patients with atopic dermatitis and retinal detachment.

PURPOSE: Patients with atopic dermatitis often develop tears around the vitreous base. An attempt was made to determine whether these patients had any abnormalities of the vitreous base that would lead to formation of such tears. METHODS: The medical records and intraoperative videotape recordings of 12 patients with atopic dermatitis and retinal detachment who underwent vitrectomy were reviewed. RESULTS: Tears were located at the ora serrata or in the nonpigmented epithelium of the pars plana or plicata of the ciliary body. The vitreous gel at its base was condensed like fluffy cotton in all of the patients, whereas the retina and the continuing nonpigmented epithelium around the ora serrata were wrinkled by contraction of the overlying abnormal gel. CONCLUSION: Frequent occurrence of oral dialyses and tears of the nonpigmented epithelium of the ciliary body in patients with atopic dermatitis could be attributed to the abnormal vitreous gel at its base.

Adolescent↗

PubMedDate not supplied

The differential diagnosis of atopic dermatitis in childhood.

Atopic is the most common of the dermatitides seen in infancy and childhood, but there are numerous other diseases that can mimic the skin findings. These include seborrheic dermatitis, immunodeficiency, and psoriasis in infancy; scabies, tinea corporis infection, perioral, nummular, contact, and molluscum dermatitis in childhood. It is sometimes extremely difficult to differentiate between ichthyosis and AD, and it is also important to differentiate AD from erythrodermic conditions including acrodermatitis enteropathica, biotin deficiency, and Netherton syndrome. A rare condition in children that may mimic AD is mycosis fungoides.

Child↗

PubMed1993

A speculative view of atopic dermatitis: barrier dysfunction in pathogenesis.

The development of atopy or atopic dermatitis is undoubtedly influenced by immunological abnormality. However, the question of factors which induce tolerance breakthrough and hypersensitivity to non-selective multiple antigens in atopy has remained unanswered. The broad clinical spectrum of this disease cannot be explained simply by allergy or immunological abnormalities. This speculative article is the first attempt to answer these questions and to explain the concept of atopic dermatitis by the barrier dysfunction theory based on our experimental results which demonstrated and increased permeability of the stratum corneum in patients with atopic dermatitis. We consider immunological abnormality and mucocutaneous barrier dysfunction as two major defects of atopy or atopic dermatitis. The wide range of clinical manifestations presented by this disease can be more easily comprehended by partial overlapping of these two core abnormalities. A mucocutaneous barrier defect readily allows penetration of multiple antigens or haptens. Repeated encounters with allergens may induce not only tolerance breakthrough and non-selective hypersensitivities but also enhancement of the allergic inflammation. On the other hand, an allergic inflammation stemming from the immunological abnormalities breaks down barrier functions. This sequence results in a 'vicious circle', which plays the most important role in pathogenesis of atopic dermatitis and probably of other atopic diseases.

Dermatitis, Atopic↗

PubMed2004

Effects of atopic dermatitis on young American children and their families.

OBJECTIVE: The psychologic, physical, and social impact of atopic dermatitis is complex and varies among children of different ages, and the effects of atopic dermatitis on the quality of life of very young American children and their families are not well understood. This study was conducted to document these effects of atopic dermatitis on young children and their families. METHODS: Directed focus sessions were performed with parents of 26 young children with atopic dermatitis and 6 expert clinicians. Specific mentions of the ways in which atopic dermatitis affected the children and parents were reviewed, rank ordered, and categorized according to similarity in content. The categories were examined to determine the domains represented, and the domains were used to compose a conceptual framework of all of the ways that atopic dermatitis affects children and their families. RESULTS: Parents and experts mentioned a total of 181 specific quality-of-life effects. A conceptual framework, developed from the 181 effects, contains the domains of physical health, emotional health, physical functioning, and social functioning; each domain includes effects on both the child and the parents. CONCLUSIONS: Atopic dermatitis greatly affects the quality of life of afflicted children and their families. The comprehensive conceptual framework summarizes the ways in which atopic dermatitis affects the quality of life in young American children. This conceptual framework forms the basis from which quality-of-life instruments can be developed.

Child, Preschool↗

PubMed2003

Recalcitrant atopic dermatitis due to allergy to Compositae.

Atopic dermatitis is often complicated by allergic contact dermatitis, although patch testing may reveal positive reactions of uncertain relevance. We report a case of a 35-year-old woman with recalcitrant atopic dermatitis, with a positive patch-test reaction to Compositae mix (CM). Initially, sensitization appeared to be of past relevance only, due to use of calendula. However, it turned out that she followed a self-devised diet consisting largely of food products of the Compositae family. On excluding these food products her skin condition improved quickly. This case report underscores the difficulty in determining the relevance of positive patch tests, and shows that thorough analysis of positive patch tests, by both patient and physician, may reveal unexpected or less common sources of contact allergens.

Adult↗

PubMed2004

Perinatal predictors of atopic dermatitis occurring in the first six months of life.

OBJECTIVE: Previous studies of predictors of atopic dermatitis have had limited sample size, small numbers of variables, or retrospective data collection. The purpose of this prospective study was to investigate several perinatal predictors of atopic dermatitis occurring in the first 6 months of life. DESIGN: We report findings from 1005 mothers and their infants participating in Project Viva, a US cohort study of pregnant women and their offspring. The main outcome measure was maternal report of a provider's diagnosis of eczema or atopic dermatitis in the first 6 months of life. We used multiple logistic regression models to assess the associations between several simultaneous predictors and incidence of atopic dermatitis. RESULTS: Cumulative incidence of atopic dermatitis in the first 6 months of life was 17.1%. Compared with infants born to white mothers, the adjusted odds ratio (OR) for risk of atopic dermatitis among infants born to black mothers was 2.41 (95% confidence interval [CI]: 1.47, 3.94) and was 2.58 among infants born to Asian mothers (95% CI: 1.27, 5.24). Male infants had an OR of 1.76 (95% CI: 1.24, 2.51). Increased gestational age at birth was a predictor (OR: 1.14; 95% CI: 1.02, 1.27, for each 1-week increment), but birth weight for gestational age was not. Infants born to mothers with a history of eczema had an OR of 2.67 (95% CI: 1.74, 4.10); paternal history of eczema also was predictive, although maternal atopic history was more predictive than paternal history. Several other perinatal, social, feeding, and environmental variables were not related to risk of atopic dermatitis. CONCLUSIONS: Black and Asian race/ethnicity, male gender, higher gestational age at birth, and family history of atopy, particularly maternal history of eczema, were associated with increased risk of atopic dermatitis in the first 6 months of life. These findings suggest that genetic and pre- and perinatal influences are important in the early presentation of this condition.

Cohort Studies↗

PubMed1994

Detection of plasma interleukin-8 in atopic dermatitis.

Plasma interleukin-8 (IL-8) concentrations were measured in patients with atopic dermatitis. Plasma IL-8 was not detected in 25 controls (0/25), in allergic rhinitis (0/20), or in bronchial asthma during remission (0/13), while low concentrations of IL-8 were detectable in a few patients with urticaria (1/19), contact dermatitis (4/17), and bronchial asthma at the time of attack (6/16). In contrast, IL-8 was detectable in most cases of atopic dermatitis (41/52). Moreover, IL-8 concentrations were significantly higher in severe than in mild or moderate atopic dermatitis. IL-8 concentrations decreased as atopic dermatitis was improved by treatment, and IgE production in vitro was also decreased while serum IgE concentrations remained unchanged. IL-8 measurement may be a useful tool for the study of the pathogenesis and clinical course of atopic dermatitis.

Adolescent↗

PubMed1998

Blood eosinophils and serum IgE as predictors for prognosis of interferon-gamma therapy in atopic dermatitis.

BACKGROUND: Interferon-gamma (IFN-gamma) therapy has been reported to be effective in atopic dermatitis. However, IFN-gamma therapy in atopic dermatitis has not yet been well established. In this study, immunologic variables were evaluated as predictors for the prognosis of IFN-gamma therapy in atopic dermatitis. METHODS: Sixty-eight atopic dermatitis patients were each treated 18 times with 2 x 10(6) units/m2 IFN-gamma. Blood IgE level, eosinophil percentage, eosinophil count, and levels of IFN-gamma, interleukin-4 (IL-4), IL-5, and IL-10 were investigated. According to clinical responses, patients were classified into three groups: patients with improved clinical severity scores of over 20% were included in group A; those with improved scores of 20% or less in group B; and those with no improvement in group C. RESULTS: Serum IgE levels and blood eosinophil percentages were the lowest in group A. Most atopic dermatitis patients with an eosinophil percentage over 9% and IgE level over 1500 IU/ml did not respond to IFN-gamma therapy. Initial IL-10 levels were the highest in group A. IL-4 levels in group A, and IL-5 and IL-10 levels in all groups were significantly decreased by IFN-gamma therapy. CONCLUSIONS: IFN-gamma therapy may be recommended for atopic dermatitis patients with blood eosinophil percentages less than 9% and serum IgE levels less than 1500 IU/ml.

Adolescent↗

PubMed2006

Quality of life in patients with atopic dermatitis: impact of tacrolimus ointment.

BACKGROUND: Atopic dermatitis (AD), a significant problem in Japan, has a major impact on health-related quality of life (QOL). The development of steroid phobia in patients with AD may restrict the therapeutic options available to these patients. Tacrolimus ointment is a safe and effective nonsteroid treatment for AD. It may be an appropriate alternative for patients with AD and steroid phobia. The aim of this study was to determine the impact of AD on QOL and to investigate the effect of tacrolimus ointment on QOL in patients with steroid phobia. METHODS: Firstly, QOL scores were investigated in patients with AD and steroid phobia using the World Health Organization Quality of Life instrument, WHOQOL-26, and were compared with QOL scores from a previous study in volunteers from Tokyo, Japan. Secondly, patients with steroid phobia received tacrolimus ointment treatment for 12 weeks. Quality of life scores were assessed using WHOQOL-26 at baseline and study end. RESULTS: The overall mean QOL score of 106 patients with AD was significantly lower than that of 708 volunteers (3.1 +/- 0.5 vs. 3.3 +/- 0.5, P < 0.001). The overall QOL score improved from 2.9 +/- 0.4 at baseline to 3.3 +/- 0.4 following 12 weeks' tacrolimus ointment treatment in 35 patients with AD and steroid phobia (P < 0.001). CONCLUSIONS: Atopic dermatitis significantly lowers QOL. Tacrolimus ointment is associated with a significant improvement in QOL in patients with steroid phobia, indicating that it is an effective alternative to topical corticosteroids in these patients.

Attitude to Health↗

PubMed1998

Topical sodium cromoglycate in the treatment of moderate-to-severe atopic dermatitis.

BACKGROUND: Unsatisfactory treatment results for severe atopic dermatitis have led to many experimental therapies, including cromolyn sodium in various vehicles at concentrations ranging from 1% to 10%. Results suggest that the vehicle used to deliver the cromolyn is relevant to its effectiveness. OBJECTIVE: To test the efficacy of low concentrations of cromolyn in a water-soluble vehicle in the treatment of moderate-to-severe atopic dermatitis in a double-blind, placebo-controlled study. METHODS: Twenty-six pediatric patients who had failed to respond to conventional therapy were randomized into 2 treatment groups: patients in group A used the study drug for 1 month (phase I), then received the placebo for 1 month (phase II); and patients in group B used the placebo for 1 month, then received the study drug for 1 month. The study drug was cromolyn sodium inhalation solution mixed into a water-based emollient cream to a final concentration of 0.21%. Upon enrollment and at each follow-up visit, every patient was given a severity score based on extent and severity of skin involvement. RESULTS: At enrollment, there were no significant differences between groups A and B in severity scores, age, sex, race, skin test and/or RAST positivity, eosinophil levels, IgE concentrations, or the presence of concomitant rhinitis or asthma. After the first phase of the study treatment, severity scores had decreased significantly for both groups with a significant difference between group A (cromolyn) and group B (placebo). After crossover, both groups had significantly lower severity scores than at entry into the study. CONCLUSION: Treatment with topical cromolyn in a hydrophilic emollient vehicle has a significant anti-inflammatory effect on moderate-to-severe atopic dermatitis. We have now incorporated this treatment into our clinical practice.

Administration, Topical↗

PubMed2002

Common respiratory infections early in life may reduce the risk of atopic dermatitis.

Infections that occur early in life may protect against atopic disease later in life. To investigate the relationship between common acute respiratory infections and atopic dermatitis in early childhood, we closely observed a cohort of 329 children from the ages of 2 to 24 months. We assessed the effect of proven viral infections and acute otitis media on the occurrence of atopic dermatitis. If the child had his or her first respiratory infection before the age of 6 months, the child's remaining risk of developing atopic dermatitis was reduced by 49% (95% confidence interval, -24% to 79%). The individual risk of developing atopic dermatitis was similarly reduced after infection experienced at >/=6 months of age, but the remaining risk was low, because most cases of atopic dermatitis had manifested by this time. Our results are consistent with the hypothesis that early infections may reduce the risk of atopic disease.

Child↗

PubMed1997

[Routine immunologic tests in atopic dermatitis].

The study comprised 100 examinees with atopic dermatitis and 50 examinees with chronic urticaria (adult patients and children), as well as 50 examinees in a control group. The parameters for monitoring included laboratory findings; values of eosinophiles, total lymphocytes, T and B lymphocytes, serum immunoglobulin (IgG, IgA, IgM) total IgE and specific IgE; results of cutaneous tests: prick and intradermal test to inhalative and nutritive allergens, scratch test to preservatives and additives, and epicutaneous (patch) test to contact allergens. In detection and monitoring of patients with atopic dermatitis, several methods were applied with different diagnostic success. The values of total number of lymphocytes and T and B lymphocytes were mainly within the normal limits, therefore these were not good diagnostic parameters. Eosinophiles were mainly higher and were useful in determination of AD. Mainly normal values of IgE, IgA and IgM were found by radial immunodiffusion, but the ELISA method, as well as the RIST method, showed high values of total IgE. Of the applied skin tests, the most important was intradermal test which gave most of the positive results in the patients with atopic dermatitis (97.7%), then followed scratch test (83.3%), patch test (64.3%), and finally epicutaneous test (57.1%).

Adolescent↗

PubMed1986

Protein-losing enteropathy in atopic dermatitis.

We evaluated a child with atopic dermatitis associated with protein-losing enteropathy, which responded to a chicken-based diet. Allergic gastroenteropathy is a potentially hazardous disease that may be more frequent in children with atopic dermatitis than is currently realized.

Asthma↗

PubMed2005

Interleukin-10 downregulates anti-microbial peptide expression in atopic dermatitis.

Recurrent skin infections in extrinsic atopic dermatitis (EAD) may be because of the suppression of anti-microbial peptide (AMP) expression by interleukin (IL)-4 and IL-13. Twenty to thirty percent of AD, however, are classified as intrinsic atopic dermatitis (IAD). They exhibit normal serum IgE levels, no allergen-specific sensitization, and lower levels of IL-4 and IL-13 than EAD. Both forms of AD have increased propensity to skin infection, suggesting a novel mechanism for infection in IAD. In this study, we observed significantly decreased human beta-defensin (HBD)-2 gene expression in the skin of both IAD (p = 0.010) and EAD (p = 0.004), as compared with psoriasis patients. Conversely, IAD (p = 0.019) and EAD (p = 0.002) skin lesions exhibited elevated IL-10 gene expression when compared with psoriasis. Using primary keratinocytes, we found that the deficiency in AMP expression is an acquired rather than a constitutive defect. Interestingly, neutralizing antibodies to IL-10 augmented the production of tumor necrosis factor-alpha and interferon-gamma by peripheral blood mononuclear cell from AD patients. Additionally, treatment of AD skin explants with anti-IL-10 augmented the expression of both HBD-2 and LL-37. Thus, increased levels of IL-10 may contribute to the AMP deficiency in both IAD and EAD by reducing cytokines that induce AMP.

Adult↗

PubMed1994

Retinal detachment with atopic dermatitis similar to traumatic retinal detachment.

PURPOSE: The cause of retinal detachment (RD) with atopic dermatitis remains uncertain. The purpose of this study is to show that the probable cause of RD with atopic dermatitis is ocular contusion. METHODS: The authors retrospectively compared the fundus findings of 24 eyes (16 patients) that had RD and atopic dermatitis with 36 eyes (36 patients) that had traumatic RD. RESULTS: The authors found similar characteristics. Retinal breaks at vitreous base borders characterized by ocular contusion occurred in 79.2% of eyes with RD and atopic dermatitis and in 75.0% of eyes with traumatic RD. Irregular retinal traumatic breaks in the equatorial zone occurred in 20.8% of eyes with RD and atopic dermatitis and in 47.2% of eyes with traumatic RD. Objective signs of ocular contusion outside the retina appeared in 54.2% of eyes with RD and atopic dermatitis. CONCLUSIONS: The authors' data support the conclusion that self-inflected ocular contusion by tapping the eyes can cause RD with atopic dermatitis.

Adolescent↗