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Irritant susceptibility and weal and flare reactions to bioactive agents in atopic dermatitis. II. Influence of season.

Many atopic dermatitis (AD) patients have exacerbations of their skin disease in winter. These exacerbations may be caused by non-immunological 'non-specific' factors, such as low sun exposure and low temperature. To date, the influence of season on non-specific skin reactivity in AD has not been studied. The aim of the present investigation was to assess the influence of season on two skin parameters which may be used as quantitative measures of non-specific skin reactivity in AD: (i) susceptibility to repeated epicutaneous irritant (sodium lauryl sulphate, SLS) exposure, and (ii) weal and flare responses to intracutaneous injection of bioactive agents (codeine, FMLP, histamine, methacholine, substance P, trypsin). Four of 16 AD patients had dermatitis which was more severe in November than in July. Susceptibility to SLS was increased in November, both in AD patients and in control subjects. AD patients were more susceptible to SLS than control subjects in both July and November. Pre-exposure barrier function and skin hydration were reduced in November. The increased irritant susceptibility in November may be attributed to reduced barrier function, reduced skin hydration, and/or absence of the beneficial effects of ultraviolet light on cellular targets beneath the stratum corneum. Flare responses to codeine, methacholine, substance P and trypsin were also increased in November compared with July, especially in AD patients. However, smaller flares were observed in AD patients than in control subjects, in both July and November. Flare values were negatively correlated with dermatitis severity, probably because of down-regulation. Weal responses did not show a clear seasonal variation. Hence, susceptibility to epicutaneous irritants and reactivity to intracutaneously injected bioactive agents are parameters which may be used to monitor season-dependent changes in non-specific skin reactivity.

Adolescent↗

Atopic dermatitis--messengers, second messengers and cytokines.

Atopic dermatitis (AD) shows many complex and interacting abnormalities of pharmacology, immunology and cellular control. Recent research in atopy has concentrated on abnormalities of cytokine production by T-helper cells. It is possible that cytokine imbalance causes many of the pharmacological and immunological changes seen in the disease. However, studies of second messenger control of cytokine release show that different second messenger signals may relate to the release and activation of particular cytokines. This review summarizes these findings and discusses how the second messenger defects reported in AD may relate to the abnormal cytokine profiles and the pharmacological abnormalities seen in the condition.

Cyclic AMP↗

Staphylococcus aureus re-colonization in atopic dermatitis: beyond the skin.

Patients with atopic dermatitis (AD) are often heavily colonized by Staphylococcus aureus, which adversely affects eczema severity. Strategies to control S. aureus in AD include antibiotic and or antiseptics. However long-term efficacy is unclear. In this study we consider extra-cutaneous factors that may cause S. aureus re-colonization in adult AD. Twenty-one patients with AD were recruited and were assessed for: duration of AD, use of topical or oral antibiotic within the preceding 3 months, the number of hospital admissions during the preceding year and current treatment. The types of topical treatments used, vehicle, container and the expiry dates were also recorded. The severity of AD was assessed by SCORAD index. Microbiological assessment for S. aureus carriage from affected skin, anterior nares, emollient and topical steroid was undertaken using culture, Staphaurex test and antibiotic resistance. Of the patients 86% had S. aureus colonization. The median SCORAD score were greater in those colonized with S. aureus (P = 0.02) and those with contaminated treatments (P = 0.05). Prior antibiotic treatment, prior hospital admission and nasal carriage did not influence the median SCORAD. Three extra-cutaneous mechanisms by which S. aureus can re-colonize the skin were identified: antibiotic resistance, nasal carriage and treatment contamination.

Adolescent↗

Risks of milk formulas containing peanut oil contaminated with peanut allergens in infants with atopic dermatitis.

Four cases of infants with atopic dermatitis are reported. In all cases, a sensitization to peanut is demonstrated. Any ingestion of peanuts can be excluded, with the exception of a daily consumption of peanut oil, contained in milk formulas. Oral challenges with peanut oil induce a rash, and elimination of these brands is followed by the disappearance of eczematous lesions. The presence of residual allergenic proteins in peanut oil is thus suspected. Owing to the growing incidence of peanut hypersensitivity, the elimination of peanut oil from all milk formulas, food for babies, and ointments, seems to be highly advisable.

Allergens↗

Careers advice to youths with atopic dermatitis.

Adolescents who have suffered from atopic dermatitis frequently start training or apprenticeship for unsuitable jobs. The School Medical Serivce and the Youth Employment Service have now been linked with the Employment Medical Advisory Service to afford help to such young people. It is suggested that family doctors and parents be reminded of this with Guidance Notes.

Adolescent↗

Bronchial responsiveness to mite allergen in atopic dermatitis without asthma.

Eight patients with atopic dermatitis (AD) without a history of asthmatic episodes and 8 patients with mite-allergic bronchial asthma (BA) were subjected to bronchial inhalation challenge with a nonspecific stimulus (acetylcholine) and an immunologically specific stimulus (house dust mite allergen). AD patients had a significantly greater concentration of IgE (p less than 0.01) and antimite IgE antibody (p less than 0.05) than BA patients. Nonspecific bronchial hyperreactivities of AD patients distributed from normal to asthmatic range. After allergen challenge, all 8 AD patients and all 8 BA patients showed an immediate asthmatic response (IAR). The mite extract concentration to induce an IAR was significantly (p less than 0.01) greater in AD patients than in BA patients. A late asthmatic response was observed in 6 out of 8 BA patients, whereas it was not observed in any AD patient. Our results showed that AD patients are less reactive to a specific mite allergen than BA patients in spite of greater concentrations of antimite IgE antibody. They suggest that this difference in the bronchial reactivity to the allergen concerns the difference in the onset of clinical symptoms and that a certain level of bronchial hyperreactivity to the allergen is a prerequisite for the development of asthmatic symptoms.

Adolescent↗

Lack of pancreatic maldigestion in atopic dermatitis.

Twenty adult patients affected by atopic dermatitis (AD) were submitted to the p-aminobenzoic acid (PABA) test in order to evaluate the proteolytic pancreatic function. All but one showed a normal PABA test. These results seem to exclude a proteolytic maldigestion as a pathogenetic factor in AD.

4-Aminobenzoic Acid↗

Immune response to Staphylococcus aureus in atopic dermatitis.

The skin of patients with atopic dermatitis (AD) is severely colonized with Staphylococcus aureus. Therefore, a study was conducted to assess some basic features of the S. aureus-specific immune response in patients with AD and healthy nonatopic individuals. Some particular features were found: a selective hyporesponsiveness to purified S. aureus cell walls (PCW) in delayed skin reactivity; half of our AD patients showed serum IgE to PCW and soluble S. aureus protoplast antigens; elevated PCW-IgE did not correlate with positive immediate skin reactions to whole S. aureus and their cell walls; regional lymphadenopathy but not impetiginization was associated with increased PCW-IgE and high total IgE. It is suggested that these changes in the immune response to S. aureus are related to the chronic S. aureus colonization of the skin.

Adolescent↗

The immune response to S. aureus in atopic dermatitis.

The skin of patients with atopic dermatitis is heavily colonized with S. aureus, and their immune response to S. aureus shows some particular features: (1) A selective hyporesponsiveness to purified S. aureus cell walls in delayed type hypersensitivity skin reactions. (2) The presence of IgE to cell walls and soluble antigens of S. aureus in patients with high serum IgE levels. (3) Elevated cell wall IgE do not correlate with positive immediate skin reactions to whole S. aureus and their cell walls. (4) Regional lymphadenopathy but not impetiginization is associated with high total IgE and S. aureus cell wall IgE. We suggest that these changes in the immune response to S. aureus are related to the chronic S. aureus colonization of the skin.

Adult↗

[Malassezia and atopic dermatitis].

Although many exacerbating factors for atopic dermatitis (AD) have been discussed, we are focusing on fungus antigen as a pathogenesis for this condition. About half of the patients were sensitized by Candida albicans and/or Malassezia furfur (MF) using IgE. Patients with severe eruption tended to have a higher concentration of specific IgE. IgE to purified antigens such as manganese superoxide dismutase (MnSOD), cyclophilin, and Malf2 from MF was also detected, while the pattern of positive IgE was varied among the patients so that the major allergen could not be determined. Skin testing gave a positive reaction to MF after 24 hours as well as an immediate type reaction; this delayed type reaction was AD specific since a small number of patients with bronchial asthma showed a positive response to MF. Peripheral mononuclear cells co-cultured with crude MF antigen in vitro produced IL-5 in some AD patients. This response was correlated with the severity of facial eruption, indicating that Th2 type response to MF might make these eruptions worse. MF was easily detected from various skin regions,but we were not able to explain why fewer colonies were obtained from a region with dermatitis than from a non-dermatitis region. From these results, we speculate there are patients who have IgE and Th2 cells which respond to MF. The exact mechanism, however, is still obscure as to how normal flora such as MF can react and exacerbate AD. Further investigations should be done to learn more about the relationship between AD and MF.

Antigens, Fungal↗

Elimination diet in young children with atopic dermatitis.

Thirteen children with severe current atopic dermatitis unresponsive to topical treatment were started on an elimination diet. One child was excluded because she could only keep to the diet for 3 days. Twelve children aged 0.8-4.1 years maintained the diet for 2-4 weeks. In six children the dermatologist's score showed a clear improvement while on diet, in 2 children there was a minor improvement and in 4 children the dermatologist's score did not change during elimination diet. Challenges were performed with egg, milk and wheat in 6 children and with milk and wheat in 2 children. The challenges were done in an open way except for the dermatologist, who was unaware of which food the child had received. No child in the study had an immediate reaction but 3 children had late reactions, one after egg, one after milk and one child after challenge with wheat.

Animals↗

[Study of tolerance and efficacy of cosmetic preparations with lenitive action in atopic dermatitis in children].

PURPOSE: In AD (atopic dermatitis), the barrier function of skin is impaired, causing dryness and vulnerability: the first-end point to achieve is restoring skin's function to avoid relapses. Our aim was to assess tolerability and effecacy of two cosmetics with moisturizing and lenitive action in subjects affected by AD. PATIENTS AND METHODS: We used a topical preparation (product A) and a new formulation of it (product B) containing glycyrrhetinic acid, alpha-bisabolol, squalene, oryzanol and hohoba-oil. Product B was then compared with a third one (product C), also based on glycyrrhetinic acid and bisabolol. 30 subjects, aged between 4 months and 16 years, were included in the study (13 girls and 17 boys), suffered from mild-moderate AD, not treated with steroids. Patients were treated twice a day for 21 days, as follows: 12 product A (Decortil lipocrema IDI Farmaceutici); 9 product B (Decortil crema, IDI Farmaceutici); 9 product B on the right and product C (Lichtena AI crema UCB Pharma) on the left. We also did: photografic documentation, SCORAD Index, evaluation of objective (erythema, exudation, excoriation, dryness) and subjective (itching and burning) simptomatology (scoring 0-3) and physiopatological cutaneous tests as TEWL (Trans Epidermal Water Loss), corneometry and pHmetry at beginning and at end of treatment. RESULTS: All groups improved both clinically and instrumentally. Corneometry increased, TEWL lowed and pH turned to normality. CONCLUSIONS: Product A is better for restoring cutaneous physiology, B resulted more efficient in rehydration, in acute phase and as emollient agent, whereas C has more lenitive action.

Adolescent↗

[Clinical aspects of atopic dermatitis].

Discusses the diagnostic criteria of atopic dermatitis. Basing on a review of modern literature, suggests the following diagnostic signs as the basic ones: a certain clinical picture and its age-specific features, the disease onset within the first months or years of life, polyvalency of the allergic reaction, concomitant respiratory allergies, a family history of allergies, a seasonal pattern of the disease course, immunologic shifts.

Adolescent↗

[Serum ECP level of infants of atopic dermatitis].

Forty-seven infants with atopic dermatitis (AD) were examined for ECP (eosinophil cationic protein) levels in sera at 3 to 4, 6 to 7, 12 and 18 months after birth. ECP levels in AD were significantly higher than those of control infants at every examination. The levels of ECP in AD were significantly correlated with the severity of dermatitis judged by a slightly modified version of the method of Businco et al. We concluded that ECP levels in sera are a useful marker for the severity of dermatitis in infants with AD.

Biomarkers↗

Evaluation of a new moisturizer (Exomega milk) in children with atopic dermatitis.

BACKGROUND: Although the benefits of emollient therapy are widely accepted in atopic dermatitis, there is a relative lack of clinical evidence supporting their efficacy in these conditions. The aim of this study was to evaluate the efficacy, the tolerance and the effects on children's quality of life of a new moisturizer milk (Exomega milk) in childhood atopic dermatitis. METHODS: This controlled, randomized, multi-centric study had two parallel groups, involving children aged 6 months to 12 years, with mild and moderate atopic dermatitis (Scorad<35). The treated group applied the moisturizer milk twice a day for 2 months, in association with a cleansing bar. The non-treated group had only the cleansing bar. The use of strong and moderate topical corticoids was allowed and quantified. The following parameters were evaluated: Scorad, tolerance and the children's quality of life index. RESULTS: A total of 76 children (mean age 4 years) were included: 37 in the treated group, 39 in the non-treated group. After 2 months, the decrease of the Scorad index in the treated group was not statistically significant (p = 0.051) but detailed evaluation showed a significant improvement of xerosis (p = 0.01) and pruritus (p = 0.01) in the treated group compared with the non-treated group. Clinical improvement in the treated group after 2 months of treatment was correlated to a significant improvement of the children's quality of life index (p = 0.0011). Tolerance was good to excellent in 97% of cases. CONCLUSION: The milk emollient studied was found to provide an interesting auxiliary treatment in childhood atopic dermatitis since it gave positive results, in particular on xerosis and pruritus, as well as an improvement of the quality of life of the children.

Administration, Cutaneous↗

Phenotypic differences between human blood monocyte subpopulations in psoriasis and atopic dermatitis.

Peripheral blood monocytes seem to be of importance in the initiation and maintenance of cutaneous inflammatory disorders such as psoriasis and atopic dermatitis. Functional abnormalities of monocytes have been observed in both diseases. We sought to determine whether these abnormalities are reflected by an altered phenotypic expression of functionally active surface molecules. Peripheral blood monocyte subsets varying in cellular density and cell size from patients with psoriasis and atopic dermatitis were investigated using FACS analysis employing a panel of monoclonal antibodies (CD14, CD16, HLA-DR, HLA-DO, Fc epsilon RII, IL-2R, ICAM-1, CR3). Furthermore, the modulation of expression by interferon-gamma in monocyte subsets from patients was compared to normal controls. The results show that HLA-DR and -DQ expression on monocyte subsets in psoriatic patients was significantly decreased; "large" monocytes expressed significantly less HLA-DR than "small" monocyte subpopulations. Decreased HLA-DR and -DQ expression could be upregulated by incubation of psoriatic monocytes with IFN gamma. In atopic dermatitis, a different phenotype pattern of monocyte subsets was demonstrated: HLA-DR expression and HLA-DQ expression were both decreased in both "large" and "small" monocytes as compared to normal controls. However, there were no significant differences in HLA-DR and HLA-DQ expression between "large" and "small" monocyte subpopulations in atopic dermatitis. Moreover, the ICAM-1 and IL-2R expression of "large" and "small" monocyte subpopulations was significantly decreased in atopic patients from levels in normal controls and psoriatic patients. The altered expression of HLA-DR, -DQ ICAM-1 and IL-2R could be upregulated by incubation of atopic monocytes with IFN gamma. In addition, there was a significant increase in the percentage of monocytes in the differential count of patients with psoriasis or atopic dermatitis. We conclude that the differential phenotype pattern of surface molecules on monocytes in psoriasis and atopic dermatitis may reflect an abnormal monocyte maturation/differentiation state. This may explain the functional abnormalities of monocytes observed in patients with psoriasis and atopic dermatitis.

Adolescent↗

[Follow-up of atopic dermatitis after early childhood].

A total of 106 patients, 57 women and 49 men, had had atopic dermatitis even in infancy and were monitored by means of questionnaires at a mean age of 23.5 years. Items of interest were the course of the dermatosis, influences on its course and the frequency of respiratory allergic manifestations. The persistence rate of atopic dermatitis was 60.4%. It was possible to identify ten different courses of atopic dermatitis. Only 11.3% of these patients had suffered from the eczema exclusively during infancy. In 27.4% of cases the patients were free of manifestations for an average of 9 years, after which they had a new attack of the illness. Almost one third of the patients showed a continuous type of development of their atopic dermatitis, which had persisted since infancy. The most common localizations were the antecubal fossa (48.4%), the fingers (45.3%) and the face (37.5%). The course of atopic dermatitis was influenced by the seasons in 71% of these patients, and 59.4% observed a connection between psychic stress and the exacerbation of skin conditions or a new attack of the dermatosis. As adults, 59.4% of all patients suffered from one or more respiratory allergic manifestation: 41.5% had pollinosis, 24.5% allergic rhinitis, and 25.5% bronchial asthma. Respiratory allergies disappeared in 24 cases (19.8%), bronchial asthma at a mean age of 13 years, and pollinosis at 15.3 years and perennial rhinitis at 16 years on average.

Adolescent↗