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At least 739 records · Page 41Linked to original sources
PubMed1998

Altered reactivity of the hypothalamus-pituitary-adrenal axis in patients with atopic dermatitis: pathologic factor or symptom?

Atopic dermatitis (AD) is a chronic inflammatory skin disease with the principal symptoms of dry skin, lichnification, eczematous inflammation, and an intense pruritus. Despite general acceptance that AD is a multifactorial skin disorder, dysregulation of immune functions (e.g., hypersecretion of immunoglobulin-E, altered cytokine profiles) is considered to be mainly involved in AD pathogenesis. Considerable evidence points to an immunoregulatory function for the hypothalamus-pituitary-adrenal (HPA) axis, suggesting that appropriate reactivity of the HPA axis is necessary to prevent the immune system from reaching a level that may be damaging for the host. It is further hypothesized that dysfunctional reactivity of the HPA axis may increase the vulnerability of the organism to immune-related disorders such as inflammatory diseases. In the present paper the role of the HPA axis for the development and chronification of allergic inflammation will be summarized and the potential pathological significance of a dysfunctional HPA axis in AD pathogenesis will be discussed.

Animals↗
PubMed2005

Prominent involvement of activated Th1-subset of T-cells and increased expression of receptor for IFN-gamma on keratinocytes in atopic dermatitis acute skin lesions.

BACKGROUND: Atopic dermatitis (AD) is an allergic skin disease mediated by antigen-specific IgE and an important role has been ascribed to CD4+ cells (Th cells). The objective of the study was to evaluate humoral and cellular immunological factors in the blood and the skin lesions of AD patients, and to analyze the presence of inflammatory cell-surface markers in blood and skin biopsies. METHODS: The parameters for monitoring of 40 AD patients included results of prick test to inhalant allergens and epicutaneous (patch) test to contact allergens; values of total IgE, serum immunoglobulins (IgG, IgA, IgM) and different cell markers in the sera (CD3, CD4, CD8, CD20, CD21, CD23, HLA-DR). We also analyzed the presence of inflammatory cell-surface markers (CD3, CD4, CD8, CD20, CD20, CD1a, CD23, CD29, CD45Ro, IFNgamma+ markers) in the biopsies of skin lesions from 10 AD patients and 5 healthy controls (HCs) by immunohistochemical analysis (method of avidin-biotin immunoperoxidase). RESULTS: Beside increased total serum IgE and positive skin tests, a significantly higher percentage of CD23+ cells with lower percentage of CD21+ cells was revealed in peripheral blood of AD patients in comparison to HCs. A positive epidermal expression of the majority of markers of T cells (CD3+, CD4+, CD8+, CD29+, CD45Ro+, IFNgamma+) and those of Langerhans' cells (LCs) (CD1a, CD23+), without those of B cells (CD20+) were noted in AD patients, but no in the skin of HCs. Furthermore, significant difference was also found between the two groups for increased expression of CD3, CD4, CD8, CD29, CD45Ro, IFNgamma+ markers (markers for IFNgamma receptor) and higher intraepidermal CD23+ LCs and intradermal CD1a+ LCs in AD skin lesions. CONCLUSIONS: The obtained results suggest involvement of various humoral factors with increased production of IgE and cooperation between Th subsets and LCs, with higher production of related cytokines, and disturbed cellular immunity, including epidermal LCs with IgE receptors of high and low affinity in AD. The annotation of activated Th1 cells with increased producing of IFNgamma in acute AD skin lesions is notable, and might lead to IFNgamma binding to keratinocytes and consequently inflammatory skin changes in the disease.

Acute Disease↗
PubMed2006

The importance of bacterial superantigens produced by Staphylococcus aureus in the treatment of atopic dermatitis using povidone-iodine.

Atopic dermatitis (AD) is frequently associated with intestinal and cervical lesions. Staphylococcus aureus produces many kinds of toxins, the bacterial superantigens. The detection rate of toxins was 80.1% from 196 S. aureus strains. Neurological examinations revealed abnormalities in 59 out of 81 AD patients. Cervical magnetic resonance imaging (MRI) was performed in 46 patients randomly and showed abnormal findings in 38 of these patients. In 23 patients who underwent MRI and duodenal biopsy, 3 were found to be normal neurologically and 2 patients showed normal duodenal tissue. However, 18 patients had abnormal findings both on neurological examination and in duodenal tissue. Serial duodenal biopsy tests were performed in 10 AD patients. In 5 patients, the findings of chronic duodenitis disappeared after the therapy with povidone-iodine. These data indicate that the therapy was effective not only for the skin lesions, but improved gastrointestinal tract lesions and cervical myelopathy, by eradicating bacterial superantigens.

Adolescent↗
PubMed1994

Frequency and significance of the major and minor features of Hanifin and Rajka among patients with atopic dermatitis.

In 481 patients with atopic dermatitis (AD), 4 major features of Hanifin and Rajka were found in 72%, and in 96% over 6 minor features were seen, which is much more than the minimum required by these authors for making a 'firm diagnosis'. The incidence of particular minor features in all patients was varying significantly, and in subgroups of patients they appeared with different frequency. For example, asthma occurred more often in AD patients with the onset of skin lesions before the 6th month of life, and food intolerance was more frequently observed in patients with very high serum IgE level. In the control groups some minor features also occur but less frequently than in AD patients. We conclude that the anterior neck folds and Dennie-Morgan infraorbital fold should be regarded as minor AD features.

Adult↗
PubMed2006

Efficacy and safety of silver textile in the treatment of atopic dermatitis (AD).

BACKGROUND: Patients with atopic dermatitis (AD) have an increased tendency to develop bacterial skin infections. Colonization with Staphylococcus aureus is known to be a major trigger and might also play a pathophysiological role. Because of their antiseptic action, silver-coated textiles suppress S. aureus colonization and toxin formation, thus damping the inflammatory reaction. OBJECTIVES: To evaluate the clinical effectiveness and safety of a special silver textile in the treatment of patients suffering from acute AD. METHODS: In a randomized phase II monocenter parallel-group comparative study 30 patients were recruited (average age 25.5 years, min. 4 years, max. 70 years) who were affected by AD in an acute phase. During the first study phase from Day 1 to Day 14, 10 patients received a silver textile (Group 1), 10 a silver-free textile (Group 2), and 10 prednicarbate ointment (Group 3). In the second phase from Day 15 to Day 28 all patients wore the silver textile, and during the follow-up period from Day 28 to Day 56 no textiles were used. Prednicarbate ointment was allowed as emergency medication, but ointment consumption was measured. The overall severity of the disease was evaluated using the SCORAD index as the primary efficacy parameter. Secondary parameters included severity of pruritus and the patients' assessment of their disease control (uncontrolled, limited, good or complete). Safety tests included hematology, blood chemistry, urinalysis for silver, and physical examination for silver deposits in the skin and mucous membranes. RESULTS: The initial SCORAD was 61.6 (IQR 26.6, min. 30.6, max. 99.9). At the end of the Study Phase 1 the SCORAD had improved significantly in the patients of Groups 1 (74.6-29.9, p = 0.005) and 3 (57.8-24.0, p = 0.009). During Study Phase 2 healing of eczema continued in Group 1 (SCORAD 29.9-18.1, p = 0.037), was observed in Group 2 (48.2-24.1, p = 0.015), and remained at an improved level in Group 3 (SCORAD 24-23.5). Consumption of prednicarbate ointment (Phase 1, Phase 2, follow-up period, medians are given): Group 1: 135 g, 10 g, 45 g; Group 2: 13 g, 0 g, 0 g; Group 3: 145 g, 30 g, 90 g. Silver textiles reduced the severity of the pruritus (p = 0.031); silver-free textiles (n.s.) and prednicarbate (n.s.) were less effective. No undesired events were observed. CONCLUSION: The elastic silver textile worn directly against the skin led to an impressive improvement of AD and a reduction in the use of prednicarbate ointment.

Adolescent↗
PubMed1993

Interferon-alpha treatment decreases the number of blood eosinophils in patients with severe atopic dermatitis.

Eight patients with severe atopic dermatitis were treated with interferon-alpha (IFN-alpha 2b), given by subcutaneous injection, three times a week. The maximum doses varied from 3 to 9 x 10(6) U and the period of treatment from 6 to 14 weeks. The therapy was well tolerated. No changes were observed in eczema or IgE levels, although IFN-alpha 2b treatment significantly decreased blood eosinophils.

Adult↗
PubMed1992

The in vivo effect of UVB radiation on skin bacteria in patients with atopic dermatitis.

Fourteen patients suffering from atopic dermatitis under treatment with UVB radiation were subjected to aerobic bacterial cultures in order to investigate whether this ultraviolet waveband has any in vivo germicidal effects, and, if so, whether there is a correlation with clinical improvement. Treatments were given 3 times a week for 8 weeks. Bacterial samples were collected before, midway and after the termination of therapy. On the latter two occasions, cultures were performed 30 min and 24 h post-UVB irradiation. The main bacteria found were Staphylococcus epidermidis and S. aureus. S. aureus carriage was found in 12 patients in lesional, dermatitic skin, and in 11 patients in clinically non-lesional skin. UVB radiation was found to have an antimicrobial effect primarily concerning S. aureus. Bacterial counts of this organism in lesional skin were decreased from a mean of 1.3 x 10(3) to 1.2 x 10(1) bacteria per cm2 skin at the 8-week 30-min count (p less than 0.01) and 7.5 x 10(1) at the 8-week 24-h count (p less than 0.05). The treatment yielded a statistically significant clinical improvement.

Adult↗
PubMed1999

[Recommendations for choosing the right basic topical drugs in atopic dermatitis].

For the treatment of atopic dermatitis topical therapy prevails. The proper choice of the appropriate base is hereby decisive for an optimal topical therapy. It is governed by the clinical assessment of the state of the skin. Of particular importance is furthermore the persistent use of a basic treatment with ointments in order to restore skin fat and an active involvement of the patient in the choice for the appropriate preparation.

Dermatitis, Atopic↗
PubMed1992

Efficacy of hyperbaric oxygenation in atopic dermatitis.

Ten patients (5 with atopic dermatitis and 5 with asthma-prurigo) aged 8-38 years, were treated with hyperbarie oxygenation, at the Institute of Maritime and Tropical Medicine. Daily one exposure was applied at 0.1 MPa pure oxygen, during 15 days. Parallelly to the clinical evaluation also G, M, E immunoglobulins and the level of C3 and C4 complement were determined. All patients given this treatment improved clinically. In 9 of them, the level of IgE immunoglobulin decreased. The complement levels also decreased.

Adolescent↗
PubMed2004

Topical treatment for atopic dermatitis in the 21st century.

Atopic Dermatitis (AD) is a common cutaneous inflammatory disease. Recent estimates of prevalence in United States school children range from 10-20%. Topical treatment of AD is unsatisfactory. Now two new topical agents, tacrolimus and pimecrolimus, are revolutionizing the treatment of AD. Here we review AD as well as these breakthrough therapies.

Dermatitis, Atopic↗
PubMed1992

[Clinical implications of sensitization to inhalants in atopic dermatitis].

In 104 children with atopic dermatitis (AD) and RAST tests for 2 inhalant and 9 food allergen mixtures, RAST results, severity of skin involvement and presence of respiratory symptoms by history were analyzed in addition to total serum IgE values available in 66 children. Overall frequency of sensibilization was high (74%) with more positive RAST results for foods than inhalants, although of the latter the only two tested were among the more frequently positive. When the subjects positive for inhalants were considered alone, the frequency of respiratory symptoms was significantly higher in those sensitized to both inhalant mixtures tested (dermatophagoides and graminaceae) and the presence of more severe skin lesions was more common among those sensitized to graminaceae.

Allergens↗
PubMed1989

[RAST positivity for food in atopic dermatitis].

In 113 children with atopic dermatitis RAST results for 9 food mixtures were analyzed. Sixty-eight children (60%) were RAST positive (greater than or equal to ++) for one or more mixture and 87% of those RAST positive had specific IgE for egg and/or cereals and/or legumes. Sensitization to egg, cow milk and meat was more frequent in the first years of life. RAST for the mixture of cereals and each single cereal, performed in 37 children, gave concordant results in 76%; agreement for the positive results was 88%, but only 54% for the negative ones. Breast versus cow milk feeding in the first months of life was not found to affect intensity of the skin manifestations or frequency of RAST positivity for the food mixtures or the respiratory symptoms.

Child↗
PubMed1979

Lymphocyte response to phytohemagglutinin in atopic dermatitis.

Studies of patients with atopic dermatitis (AD) have demonstrated several clinical and laboratory indications of immunity defects, but with frequently contradictory results. We have recently shown that many patients with negative cutaneous delayed type hypersensitivity to candidin and streptokinase-streptodornase may have normal in vitro lymphocyte transformation to the same antigens. We hypothesized that this represents recovery of immunocompetent cells when they are isolated in vitro. This report describes phytohemagglutinin-induced transformation of lymphocytes immediately after isolation and after four days in culture (precultured). Responses of lymphocytes from patients with AD were initially subnormal, but increased to normal levels after the preculture period. Our results suggest that defective immune function in AD is not due to a permanent intrinsic lymphocyte defect, but is more likely due to factors associated with disease activity and severity.

Adolescent↗
PubMedDate not supplied

Atopic dermatitis: the itch that rashes.

Atopic dermatitis (AD) is a frequently encountered problem in pediatric primary care. Confusion about management of AD exists among parents and providers alike. This review of the literature addresses identification, prevalence, etiology, pathogenesis, clinical presentation, and health maintenance from a preventive perspective.

Child↗
PubMed2000

Positive atopy patch test reactions to Pityrosporum orbiculare in atopic dermatitis patients.

BACKGROUND: Pityrosporum orbiculare, although a part of our normal cutaneous microflora, can cause skin infections and induce specific immunoglobulin (Ig) E antibodies in atopic dermatitis patients. P. orbiculare is therefore considered to be one of the trigger factors for atopic dermatitis. OBJECTIVE: To investigate if P. orbiculare can induce an eczematous reaction in atopic dermatitis patients, seborrhoeic dermatitis patients and healthy controls. METHODS: Fifteen atopic dermatitis patients, eight seborrhoeic dermatitis patients and eight healthy controls were patch tested with extract of P. orbiculare on non-lesional, tape-stripped skin of the back. NaCl was used as a negative control. The patch tests were evaluated after 24, 48 and 72 h. Skin biopsies were taken from P. orbiculare patch test sites at 24 h and 72 h, from NaCl patch test sites at 72 h, from non-lesional skin and, in the atopic dermatitis patients, also from lesional skin. The skin biopsies were investigated with immunohistochemical techniques. P. orbiculare-specific IgE in serum was analysed with RAST. RESULTS: Specific IgE to P. orbiculare was found in serum from 13/15 atopic dermatitis patients and in eight of them a positive patch test reaction to P. orbiculare was observed, with a maximal reaction at 48 h. Significantly higher serum levels of P. orbiculare-specific IgE were detected in patch test-positive compared with patch test-negative atopic dermatitis patients (P < 0. 01). The seborrhoeic dermatitis patients and healthy controls were RAST and patch test-negative for P. orbiculare. In the patch test-positive atopic dermatitis patients an infiltration of CD4+ T cells and eosinophils was observed at the P. orbiculare patch test sites together with an upregulation of ICAM-1 and HLA-DR expression. CONCLUSIONS: P. orbiculare can induce an eczematous reaction in sensitized atopic dermatitis patients and may be an important trigger factor in these patients. The P. orbiculare patch test can be of diagnostic value in this subgroup of atopic dermatitis patients.

Adolescent↗
PubMed1980

HLA antigens in atopic dermatitis. A family study.

The HLA antigens in a family with atopic dermatitis were studied. All family members with atopic dermatitis had haplotype A2, Bw35, Cw4. It has been recently demonstrated that HLA type Bw35 is found with an increased frequency in atopic dermatitis. There appears to be an inconsistent and weak correlation between atopic dermatitis and HLA-A, HLA-B and HLA-C loci.

Dermatitis, Atopic↗
PubMed1999

Sleep fragmentation in children with atopic dermatitis.

OBJECTIVE: To characterize the sleep pattern of children with atopic dermatitis in clinical remission. METHODS: Fourteen children with atopic dermatitis, with a mean+/-SD age of 6+/-2 years, were recruited consecutively from a pediatric dermatology clinic. No participant had any other medical or psychiatric illness. The control group (n = 9, mean age 7+/-1.8 years) was composed of children with mild "benign" snoring and no evidence of respiratory disturbance during sleep. All participating children were evaluated by formal all-night polysomnography, scratch electrodes, and self-reported questionnaires filled in by their parents. RESULTS: The patients were studied when their skin condition was in remission. Sleep latency, total sleep time, and sleep efficiency were similar to the control group. The atopic dermatitis group had an average of 24.1+/-8.1 events per hour of arousals and awakenings, compared with 15.4+/-6.2 events per hour in the control group (P<.001). Direct observation, video monitoring, and scratch electrodes provided evidence of between 1 to 19 bouts of scratching per night, accounting for only 15% of the arousals and awakenings. The rest of the arousals and awakenings were not associated with any specific, identifiable polysomnographic event, such as apnea or jerks. CONCLUSION: Children with atopic dermatitis in clinical remission have sleep disturbances that are not related to scratching per se.

Case-Control Studies↗