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PubMed1982

On the resident aerobic bacterial skin flora in unaffected skin of patients with atopic dermatitis and in healthy controls.

In 14 patients with atopic dermatitis the superficial bacteria from unaffected skin were extracted with the scrub method, aerobically cultured, and analysis qualitatively and quantitatively. For comparison, 12 healthy subjects served as control group. Staphylococcus aureus, as well as coagulase-negative staphylococci were significantly increased in patients with atopic dermatitis. It is assumed that special characteristics of the horny layer in atopic dermatitis favor the growth of aerobic bacteria. The qualitative biotyping and phage typing gave no support to the claim that special bacteria dominate the microbial flora of the skin of patients with atopic dermatitis.

Adult↗
PubMed1977

Evaluation of RAST in atopic dermatitis.

Eighty-two patients with atopic dermatitis were examined for specific IgE antibodies by RAST. A higher number of positive RAST reactions were found in patients with high serum IgE values and with coexisting asthma and/or allergic rhinitis. Positive RAST reactions against mite and house dust were found in many of these patients and even in about one-half of patients with atopic dermatitis only. The comparisons between intradermal tests and RAST were made with various allergens and the mite extract showed the best agreement between these two tests.

Adolescent↗
PubMedDate not supplied

Pediatric atopic dermatitis: should we treat it differently?

Atopic dermatitis is an extremely common childhood skin disease that can have far-reaching impact on patients and families. Pediatric patients, particularly infants, pose special concerns for parents and providers, and equal emphasis must be placed on both nonpharmacologic and prescription interventions. Concerns for adverse effects of prescription therapies and a universal parental fear of an undetected allergy are hallmarks of pediatric atopic dermatitis care. The purpose of the present study is to highlight important educational and therapeutic strategies designed to optimally care for this patient population.

Child↗
PubMed2005

The first images of atopic dermatitis: an attempt at retrospective diagnosis in dermatology.

BACKGROUND: Atopic dermatitis was defined in 1933. Earlier descriptions have yet not been thoroughly studied. OBJECTIVE: Our purpose was to identify the first images of atopic dermatitis among historical illustrations of skin diseases. METHODS: We posted 20 selected images on an Internet site and asked experts in pediatric dermatology to decide whether or not they represented atopic dermatitis. RESULTS: By means of the Delphi technique, a consensus could be reached for 19 of the 20 images. The experts' accuracy was good. LIMITATIONS: Thirty-one experts participated. No validated criteria were used for the selection of the images. CONCLUSION: The first representations of atopic dermatitis are engravings of skin diseases described under the names of strophulus confertus (Willan, 1796), lichen agrius (Willan, 1796), porrigo larvalis (Bateman, 1816), and eczema rubrum (Rayer, 1835). Teledermatology techniques can be reliably applied to retrospective diagnosis.

Anatomy, Artistic↗
PubMedDate not supplied

Patch test response to house dust mites is positive in children with atopic dermatitis and in their parents.

We studied the patch test response to Dermatophagoides pteronyssinus in 79 atopic children and in their parents. The atopic children were divided into 3 groups: 1) children with atopic dermatitis (group 1); 2) children who had suffered from atopic dermatitis but the disease was cured (group 2); and 3) atopic children with asthma and without atopic dermatitis (group 3). Our data show that a significantly higher proportion of children with atopic dermatitis (groups 1 and 2) have positive patch tests to Dermatophagoides pteronyssinus in comparison to atopic children without atopic dermatitis (group 3) and the controls (p < 0.001). In addition, we have shown that a positive patch test to Dermatophagoides pteronyssinus is significantly more common in parents of children with atopic dermatitis with respect to parents of children with asthma or parents of control children.

Adolescent↗
PubMed1994

Methylprednisolone bolus: a novel therapy for severe atopic dermatitis.

Seven children suffering from severe atopic dermatitis, unresponsive to standard therapy, received an iv bolus dose of methylprednisolone (20 mg/kg/day) for three days. Immunological parameters were evaluated before and after treatment. At the end of bolus therapy both skin lesions and itching improved for several months in five of seven patients. No side effects were observed, but a significant and transient lymphopenic response occurred, with lower CD4+ than CD8+ lymphocyte counts. Our data suggest that this therapy may be a novel and safe therapeutic approach in severe atopic dermatitis.

Adolescent↗
PubMed1987

Investigation of adrenomedullary function in atopic dermatitis.

Adrenomedullary function in patients with atopic dermatitis was assessed by measurement of plasma levels of catecholamines (adrenalin and noradrenalin) and cyclic AMP in response to the stimuli of standing after lying supine, and a 5-min infusion of histamine in the standing position (i.e. histamine plus standing). Plasma clearance of adrenalin was examined by measurement of plasma catecholamine and cyclic AMP levels following a 15-min intravenous infusion of adrenalin in the supine position. Resting plasma levels of adrenalin, cyclic AMP and noradrenalin were not statistically different in atopic patients and normal controls. Standing or intravenous infusion of histamine in the standing position caused a rise in plasma catecholamine levels. Plasma adrenalin, cyclic AMP and noradrenalin levels in response to these stimuli and the rate of clearance of exogenous adrenalin from the plasma were not significantly different in patients with atopic dermatitis and in normal subjects.

Adolescent↗
PubMed1997

Evaluation of scratch movements by a new scratch-monitor to analyze nocturnal itching in atopic dermatitis.

Itching is very important in atopic dermatitis, but the details of itching or scratch movements, especially during sleep at night, have not yet been fully comprehended. We designed a new, simple device, the Scratch-Monitor (SM), to evaluate scratch movements at night and assessed the usefulness of this device by a comparison involving 26 patients and 17 healthy controls. The SM, a box weighing only 25 g with a pressure sensor on the bottom, is attached to the back of each hand under a cotton glove and records the number as scratch movements per minute in the case of more than three successive changes of pressure. The SM indicated that patients with atopic dermatitis scratched more frequently and suffered more severe sleep disturbance than healthy controls. Although the SM had several problems related to specificity and sensitivity, we conclude that the SM is a useful tool for evaluating nocturnal itching.

Adolescent↗
PubMed1996

The occurrence of atopic dermatitis in north Europe: an international questionnaire study.

BACKGROUND: Atopic dermatitis is a common multifactorial disease that seems to be increasing in frequency. OBJECTIVE: Our purpose was to determine the increased prevalence of atopic dermatitis in North Europe. METHODS: Approximately 3000 7-year-old children in Denmark, Germany, and Sweden were enrolled in a cross-sectional questionnaire study that was conducted in the autumn of 1992 with common protocols and standardized procedures. RESULTS: The response rate was 90%. The frequency of atopic dermatitis was calculated to be 15.6% (95% confidence interval 14.2% to 17%) with some regional differences. Girls more often had flexural eczema and outnumbered boys in a ratio of 1.3:1.0. Boys more often had a personal history of asthma, whereas girls more often had a family history of asthma. CONCLUSION: The increasing prevalence of atopic dermatitis has been confirmed. This simple questionnaire model works well, is cost effective, and is sufficiently sensitive and specific to conduct large-scale epidemiologic investigations in school children.

Asthma↗
PubMed1984

Increased plasma histamine concentrations after food challenges in children with atopic dermatitis.

Thirty-three patients with atopic dermatitis underwent double-blind placebo-controlled food challenges for evaluation of the role of histamine in hypersensitivity to food. After suspect foods were eliminated for 10 days, oral challenges were performed with up to 8 g of dehydrated food. A total of 35 positive challenges elicited symptoms that were cutaneous (31), gastrointestinal (17), nasal (8), and respiratory (6) within 10 to 90 minutes. Forty-one food challenges were negative, and all 60 placebo challenges were negative. Only the group of patients with positive food challenges had a significant mean (+/- S.E.M.) rise in the plasma histamine concentration, from 296 +/- 80 pg per milliliter before challenge to 1055 +/- 356 after challenge (P less than 0.001). Rises in plasma histamine that were seen after these positive oral food challenges implicate mast-cell or basophil mediators in the pathogenesis of food allergy, including cutaneous changes in patients with atopic dermatitis.

Adolescent↗
PubMed1983

Role of immediate food hypersensitivity in the pathogenesis of atopic dermatitis.

Twenty-six children with atopic dermatitis and markedly elevated serum IgE concentrations were evaluated for clinical evidence of hypersensitivity to foods with double-blind placebo-controlled food challenges. Selection of foods for challenges was based on positive prick skin tests (greater than 3 mm wheal) or a convincing history. At least one positive skin test to a food antigen was found in 24/26 patients. A total of 111 double-blind placebo-controlled challenges were performed in these children after suspect foods were eliminated from their diets for 10 to 14 days. There were 23 positive challenges in 15 children, 21 of which manifested as cutaneous symptoms, primarily pruritus and an erythematous macular and/or maculopapular rash involving 5% (or greater) of the body surface. In all, 14 children (54%) developed cutaneous symptoms after food challenges. All symptoms occurred within 10 min to 2 hr of challenge; nasal symptoms, mild wheezing, and gastrointestinal symptoms were seen in some children. No symptoms occurred in 104 placebo challenges. There were 86/111 clinically insignificant positive skin tests (77%) and three false-negative skin tests. These studies demonstrate that in some children with atopic dermatitis, immediate food hypersensitivity can provoke cutaneous pruritus and erythema, which leads to scratching and subsequent eczematoid lesions.

Adolescent↗
PubMed2001

An application of the United Kingdom Working Party diagnostic criteria for atopic dermatitis in Scottish infants.

The United Kingdom Working Party diagnostic criteria for atopic dermatitis have been characterized in infants and children; however, the need for visual confirmation of flexural dermatitis by a trained investigator limits their use in large epidemiologic studies. We have administered the complete United Kingdom Working Party criteria in a postal questionnaire format to the mothers of year old infants and determined the concordance between mothers' and trained investigator's reports of visual flexural dermatitis. Based on mothers' responses to the questionnaire, 59 infants with atopic dermatitis and 59 controls were identified. In subsequent home interviews conducted by a trained investigator, the United Kingdom criteria questions were repeated and sites of current visible dermatitis were identified by mothers and the investigator as per United Kingdom Working Party protocol. Agreement between the mothers' postal and home interview responses was high: kappa= 0.75-0.94 for individual criteria; kappa= 0.93 for diagnosed atopic dermatitis. Agreement between the mothers' and investigator's observations of visible flexural dermatitis was high for all sites: kappa= 0.88-1.0. The results demonstrate that mothers are able to apply the United Kingdom criteria and accurately report visible flexural dermatitis in their year old infants. The postal application of the United Kingdom Working Party's diagnostic criteria for atopic dermatitis in year old infants appears to be a practical, reliable, epidemiologic tool in the investigation of atopic dermatitis with results comparable with formal application of the criteria by a trained investigator.

Adult↗
PubMed2003

Increased serum cutaneous T cell-attracting chemokine (CCL27) levels in patients with atopic dermatitis and psoriasis vulgaris.

BACKGROUND: Both atopic dermatitis (AD) and psoriasis vulgaris (PsV) are characterized as chronic and relapsing inflammatory skin diseases associated with various immunologic abnormalities. Cutaneous T cell-attracting chemokine (CTACK; CCL27) is a member of the CC chemokine family and a functional ligand for CC chemokine receptor 10. It is selectively expressed in skin and attracts CC chemokine receptor 10-expressing skin-homing memory T cells. The epidermal keratinocyte is a main source of CTACK, suggesting the involvement of various inflammatory skin diseases. OBJECTIVE: The purpose of this investigation was to clarify whether CTACK produced by keratinocytes is detected in the sera of patients with AD and PsV and to examine the correlation between the serum CTACK levels and disease activity of patients with AD and PsV. METHODS: We measured the serum CTACK levels in 50 patients with AD, 30 patients with PsV, and 22 healthy control subjects. We also divided 50 patients with AD into 3 groups (ie, those with mild, moderate, and severe disease) and compared them among 3 categories. Moreover, we compared the serum CTACK levels of patients with AD and PsV with clinical or laboratory data. Immunohistochemical staining of CTACK and IFN-induced protein of 10 kd (IP-10; CXCL10) was performed on the lesional skin of patients with AD and PsV. RESULTS: The serum CTACK levels in patients with AD and PsV were significantly higher than those in healthy control subjects. The serum CTACK levels in patients with AD significantly correlated with scoring atopic dermatitis (SCORAD) scores, serum soluble IL-2 receptor levels, serum soluble E-selectin levels, serum thymus and activation-regulated chemokine levels, and serum macrophage-derived chemokine levels. Serum CTACK levels in patients with PsV significantly correlated with the serum IP-10 levels but not with the Psoriasis Area and Severity Index score. Immunohistochemical staining showed CTACK was strongly expressed in lesional ke-ratinocytes of patients with AD and PsV, whereas IP-10 was strongly expressed in lesional keratinocytes of patients with PsV and focally in those with AD. CONCLUSION: These results suggest that CTACK might be one of the important chemokines for the pathogenesis of AD and PsV.

Adult↗
PubMed1993

Eczematous skin reaction from patch testing with aeroallergens in atopic children with and without atopic dermatitis.

To determine whether aeroallergens could induce eczematous lesions, 30 patients with atopic dermatitis were studied in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 and 14 years of age. Patch testing with five aeroallergens--housedust, mite, cockroach, mold mix, and grass mix--was done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with atopic dermatitis, patch testing with aeroallergens induced eczematous lesions at one or more sites. Mite, cockroach, house dust, mold mix, and grass mix caused reactions in 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis (P < 10(-6)). Intradermal skin tests in both groups were not significantly different. This study supports previous reports that aeroallergens plays an important role in causing eczematous skin lesions.

Adolescent↗
PubMedDate not supplied

The incidence of atopic dermatitis in Nigeria.

The incidence of atopic dermatitis among a recent group of 4000 consecutive dermatology patients was assessed; 3.1 percent of the patients had atopic dermatitis. The ratio of F:M was 1.3:1. Sixty-five percent gave family histories of atopic diathesis. Twenty-three percent of the patients were born and residing in temperate countries when the dermatitis started. Patients tend to report late because of widespread use of topical corticosteroid preparations. Secondary bacterial infections were common, and it is not advisable to avoid the use of soap in this environment.

Adolescent↗
PubMed2001

The ACVD task force on canine atopic dermatitis (XXII): nonsteroidal anti-inflammatory pharmacotherapy.

The pharmacotherapy of canine atopic dermatitis has relied primarily on the use of glucocorticoids and anti-histamines. During the last decade, other anti-inflammatory drugs have been investigated in clinical trials. This paper will review the studies using misoprostol, cyclosporine, tacrolimus, phosphodiesterase inhibitors, capsaicin, leukotriene inhibitors and serotonin-reuptake inhibitors for treatment of dogs with atopic dermatitis. For each drug the mechanism of action, the rationale for use in atopic dermatitis, the clinical efficacy, reported adverse effects and strength of recommendation for treatment of canine atopic dermatitis are described. At the time of this writing, there is fair evidence to support the recommendation for using cyclosporine, misoprostol and pentoxifylline for treatment of canine atopic dermatitis. This recommendation can be strengthened by the performance of additional blinded randomized controlled trials with larger number of dogs. In contrast, there is insufficient evidence to recommend for or against treatment with tacrolimus, leukotriene inhibitors, serotonin-reuptake antagonists and capsaicin.

Animals↗