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PubMed1993

Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis.

In an open study of 21 severely affected adult atopic dermatitis patients, air-conditioned narrow-band UVB phototherapy using the Philips TL-01 lamp three times weekly for 12 weeks resulted in a 68% reduction in atopic dermatitis severity scores, with a concomitant 88% reduction in potent topical steroid use. Follow-up at 24 weeks revealed that six patients had relapsed to > 70% of pre-phototherapy severity scores; the remaining 15 continued to derive long-term benefit. The mean value of potent topical steroid use remained 50% below pre-phototherapy needs. Narrow-band UVB (TL-01) phototherapy appears an effective, steroid-sparing treatment for chronic severe atopic dermatitis, offering long-term benefits in the majority of those treated.

Adult↗
PubMed2005

Clinical features associated with nasal Staphylococcus aureus colonisation in Chinese children with moderate-to-severe atopic dermatitis.

INTRODUCTION: Staphylococcus aureus colonisation/infection is common in children with atopic dermatitis (AD). MATERIALS AND METHODS: We evaluated the nasal and body swabs of Chinese children with moderate-to-severe AD as assessed using SCORing-Atopic-Dermatitis (SCORAD) score. Swabs were taken from the right nostril, 5 flexural sites (anterior neck, antecubital fossae and popliteal fossae) and the skin area most severely affected (with oozing/crusting) for bacteriologic culture. RESULTS: Fifty-five children (30 males and 25 females) were evaluated. Moderate-to-heavy growth of S. aureus was present in 12 (22%) of the nasal swabs, and in 1 or more flexural swabs of 32 (58%) of these children. Only 7 (35%) out of the 20 patients who had swabs taken from the worst skin area had moderate-to-heavy growth of S. aureus. Significant nasal S. aureus colonisation was associated with higher total (P=0.029) and objective SCORAD scores (P=0.040), more extensive disease (P=0.025), the presence of oozing or crusting (P=0.023) and higher eosinophil counts (P=0.038). All specimens of methicillin-sensitive S. aureus were sensitive to cloxacillin and 71% to erythromycin. Methicillin-resistant S. aureus (MRSA), sensitive to vancomycin, was only isolated in 1 patient. CONCLUSIONS: In this study, S. aureus is a principal pathogen. Cloxacillin and first-generation cephalosporins have a favourable sensitivity profile even in children with moderate and severe atopic dermatitis. The anterior nares are an important harbour for S. aureus and significant nasal S. aureus colonisation was clinically associated with more extensive lesions and the presence of oozing or crusting.

Child↗
PubMed2005

Clinical trial evaluating the efficacy and safety of cyclosporine in dogs with atopic dermatitis.

OBJECTIVE: To determine efficacy and safety of cyclosporine in the treatment of atopic dermatitis among dogs in North America. DESIGN: Randomized controlled (phase 1) and open-label (phase 2) trials. ANIMALS: 268 dogs with atopic dermatitis. PROCEDURE: In phase 1, dogs were randomly assigned to be treated with cyclosporine (5 mg/kg [2.3 mg/Ib], PO, q 24 h) or a placebo. In phase 2, all dogs were treated with cyclosporine for 16 weeks. Frequency of cyclosporine administration was decreased if dogs improved clinically. RESULTS: At the end of phase 1, canine atopic dermatitis extent and severity index (CADESI) scores for dogs treated with cyclosporine were significantly lower than scores for control dogs. Percentage of dogs with severe pruritus decreased from 67% to 16% for the cyclosporine group but from 66% to only 61% for the control group. During phase 2, cyclosporine dosage was decreased to every-other-day administration in 39% of the dogs after 4 weeks. After 12 weeks, 22% of the dogs were treated twice weekly and 36% were treated every other day. After 16 weeks, CADESI score had decreased > 50% in 68% of the dogs and 47% of dogs had no or mild pruritus. The most frequent adverse reactions were gastrointestinal tract signs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that cyclosporine is efficacious for the treatment of atopic dermatitis in dogs and that frequency of cyclosporine administration can be reduced following an initial induction period. The drug was well tolerated.

Administration, Oral↗
PubMed1978

Atopic dermatitis and congenital deafness.

In a family with perceptive, non-progressive hearing loss several of the members suffered from atopic dermatitis. The proband had a severe atopic dermatitis and an extremely high IgE value. Some of the family members suffered from atopic dermatitis, others from deafness, and some from both diseases. The co-existence of these two disorders has been previously described in two families. Atopic dermatitis and perceptive, non-progressive congenital deafness might be genetically associated.

Adolescent↗
PubMed2002

[Atopic dermatitis in paediatric practice].

Atopic dermatitis is the most frequent dermatitis amongst children under 11 years of age. It is an inflammatory cutaneous disease, chronic and recurrent, and it involves numerous outbreaks and relapses that affect the child, and hence his family milieu, generally for several years. Its chronic character and the lack of fully satisfactory therapies force the primary care paediatrician to consider this entity as a factor conditioning the quality of life of the patients and as a warning sign for the possible development of other allergic processes. As we do not have a curative treatment available, special relevance is assumed by family collaboration, by the measures for preventing relapses and by efficacy in their symptomatic treatment.

English Abstract↗
PubMed1996

Hypoalbuminemia, oliguria and peripheral cyanosis in an infant with severe atopic dermatitis.

A six-month old male infant with severe atopic dermatitis was admitted with hypoalbuminemia, oliguria and cyanosis of the extremities. There was marked edema and generalized eczema with foul, yellowish exudates. The patient's major clinical manifestations were attributed to the loss of albumin through the skin. Although atopic dermatitis is a common disease in children, here we want to show that systemic disturbances may arise from such condition, describe the total care given the patient, and emphasize the wholistic approach in managing cases of severe atopic dermatitis. Intensive treatment was instituted and the patient was discharged after three weeks and remained in a stable condition.

Cyanosis↗
PubMed1976

Psychological profile of patients with atopic dermatitis.

Tests designed to measure psychopathological characteristics common to the neurotic population were administered to patients with atopic dermatitis, patients with other dermatological disorders and to a control group of normal individuals. The parameters tested were manifest anxiety, neurosis, extroversion, depression, hypochondriasis and hysteria. The scores were statistically analyzed. The results showed that patients with atopic dermatitis responded significantly differently from patients with other dermatological diseases and from the control group in specific psychometric scales. Moreover, patients with skin conditions other than atopic dermatitis also responded significantly differently from the control group. The study clearly shows that patients with atopic dermatitis have a characteristic psychological profile not shared by the other two groups. The atopic dermatitis patients tend to be in a state of high manifest anxiety, depressed, neurotic and hypochondriac.

Adolescent↗
PubMed1996

Leukotriene A4 hydrolase in peripheral leukocytes of patients with atopic dermatitis.

We examined the enzymatic activity of leukotriene (LT) A4 hydrolase, which catalyzes the conversion of LTA4 to LTB4, in peripheral leukocytes of patients with atopic dermatitis. The patients were divided into three categories (severe, moderate and mild) on the basis of clinical severity. The LTA4 hydrolase activities in the supernatant fraction of peripheral blood polymorphonuclear leukocytes (PMN) were significantly higher in preparations of cells from severe atopic dermatitis patients (123.94 +/- 16.61 pmol/10(6) cells per min) than in those from moderate (49.03 +/- 9.43 pmol/ 10(6) cells per min; P < 0.01) and mild (28.75 +/- 11.42 pmol/10(6) cells per min; P < 0.01) atopic dermatitis patients and normal controls (15.14 +/- 1.74 pmol/10(6) cells per min; P < 0.01). LTA4 hydrolase activities were also higher in peripheral blood mononuclear cells (PBMC) from severe atopic dermatitis patients (27.81 +/- 8.28 pmol/10(6) cells per min) than in those from moderate (11.31 +/- 2.11 pmol/10(6) cells per min; P < 0.05) and mild (6.16 +/- 2.62 pmol/10(6) cells per min; P < 0.05) atopic dermatitis patients and normal controls (11.17 +/- 0.83 pmol/10(6) cells per min; P < 0.05). LTA4 hydrolase activities in PMN were reduced after improvement of the disease in eight patients with severe or moderate atopic dermatitis. These results suggest that LTA4 hydrolase, which synthesizes LTB4, plays a significant role in the pathogenesis and development of atopic dermatitis.

Adolescent↗
PubMed1999

Atopic dermatitis: a clinical review for the primary care physician.

Atopic dermatitis is a common disease, causing significant morbidity. The histology and cellular mechanisms suggest that atopic dermatitis is an atopic disease similar to asthma and allergic rhinitis, with helper T type 2 lymphocytes being at least a component of the pathogenesis of the disease. Specific allergies, including food allergies, should be explored and treated. Treatment should be directed at increasing the patient's quality of life. Antihistamines, topical steroids, and lubricants are the keystones of therapy. In severe cases, oral steroids may be necessary but should be used sparingly. Interferon, cyclosporine, phototherapy, and immunosuppressive agents may be necessary in refractory cases. It appears that leukotriene inhibitors may have a future role in therapy. Clinical assessment and follow-up are important, as other atopic diseases such as asthma and allergic nasosinus disease may eventually develop in many of these patients.

Dermatitis, Atopic↗
PubMed1990

The cutaneous pathology of atopic dermatitis.

Sixteen skin biopsy specimens from early eruptive, evolving papules and well-developed plaques were obtained from eight patients with established atopic dermatitis. We found that the chronological and histopathological sequence begins with a perivascular interstitial spongiotic dermatitis, evolves into a psoriasiform microvesicular spongiotic dermatitis, which is sometimes focally lichenoid, and eventually concludes as a psoriasiform dermatitis. Thus, atopic dermatitis has characteristic and diagnostic histopathologic findings. These are portrayed and contrasted to what has been previously reported.

Adult↗
PubMed1989

IgE antibody to sweat in atopic dermatitis.

Of 45 patients with atopic dermatitis skin-tested with their own sweat, 43 showed positive immediate-type skin reactions to titres between 1 and 256. Of 22 non-atopic patients 18 showed negative reactions. Skin reactivity of the atopic patients to the sweat and house dust did not run parallel. Radioallergosorbent test (RAST) using the sweat collected from a healthy subject detected IgE antibody in 24 atopic patients with a score from 0.5 to 3.5, whereas all the control subjects showed the score 0. This IgE antibody to sweat did not cross-react with the mite extract (Dermatophagoides farinae) or Staphylococcus aureus. These results indicate that atopic patients have specific IgE antibody to sweat.

Adolescent↗
PubMed1967

Radioautography of noradrenaline-14-C in atopic dermatitis.

Since storage-time of administered noradrenaline in the skin of patients with atopic dermatitis may be prolonged, it would be of interest to demonstrate the site of uptake of noradrenaline-(14)C in atopic dermatitis as compared with other eczematous and normal skins. Two adult patients with longstanding atopic dermatitis, a patient with contact dermatitis to nickel and one with normal skin, were studied. Identical sites in the four patients were injected intradermally with 0.02 mug. DL-noradrenaline-7-(14)C acetate. An 8-mm. punch biopsy of the injected site was performed 24 hours later. Radioautographs were developed between three and 199 days, according to the technique of Kopriwa and Leblond.(2) At 199 days, the number of grains in atopic dermatitic skin was greater than in contact dermatitis or normal skin. There was a concentration of grains over arrectores pilorum muscles and the upper one-third of the epidermis of atopic skin. Grains were also visible in proximity to arteriolar walls. There were few grains visible in the control sections. The results confirm earlier studies suggesting that atopic dermatitic skin retains noradrenaline longer than other dermatoses. Noradrenaline concentrates in the arrectores pilorum muscles and the upper epidermis. These findings may explain the cutis anserina (goose-flesh) appearance in atopic dermatitis.

Adult↗
PubMedDate not supplied

Update on atopic dermatitis: insights into pathogenesis and new treatment paradigms.

Atopic dermatitis (AD) is a common skin disorder whose prevalence has increased, similarly to other atopic diseases. The immunopathogenesis of AD is complex, although Staphylococcus aureus may play an important role in cutaneous inflammation, possibly resulting from a deficiency in antimicrobial peptide secretion in the skin. Although more than 50% of patients will go on to develop asthma and allergies, atopic dermatitis is often the start of the "atopic march." Studies with topical fluticasone provide a rationale for maintenance therapy, whereas studies with the topical nonsteroidal immunomodulator pimecrolimus in patients as young as 3 months of age suggest that early intervention may be an effective strategy in treating this chronic, relapsing skin disease.

Administration, Topical↗
PubMed2006

Prevalence and features of canine atopic dermatitis in Hungary.

Medical records of 600 dogs diagnosed with atopic dermatitis were reviewed and evaluated with reference to history, geographical distribution, breed predilection, clinical signs and positive reactions to allergens as determined by intradermal skin testing (IDT) manufactured by Artuvetrin Laboratories. In 66.6% of dogs, the age of onset of atopic dermatitis was between 4 months and 3 years. Dogs living in the garden suburb of Budapest were more sensitive to house dust mites, fleas and moulds, and dogs from the western part of Hungary were more sensitive to weeds than to other allergens (p < 0.01). Positive reactions were most common to Dermatophagoides farinae followed by human dander. The breed distribution found in the present study was consistent with that reported in the literature, except for the breeds Hungarian Vizsla, Pumi, French bulldog, Doberman Pinscher and Bobtail which were over-represented among atopic dogs compared to the breed distribution of the general dog population of a large city in Hungary. Breeds with verified adverse reaction to food were Cocker spaniels, French bulldogs, Bullmastiffs, Bull terriers, St. Bernards, Tervurens, West Highland White terriers and American Staffordshire terriers (p < 0.05). The clinical signs of atopic dermatitis and their occurrence are in accordance with the data described in the literature.

Age Factors↗
PubMed2005

[Effectiveness of specific immunotherapy in the treatment of children and youngsters suffering from atopic dermatitis. Part III. Serum concentrations of selected immunologic parameters].

Etiology and pathomechanism of atopic dermatitis still remains partially unclear and therefore contemporary methods of treatment are not always satisfactory from the clinical standpoint. The aim of this study was to evaluate selected immunological parameters (tIgE, ECP, sIL-2R, IFN-gamma, IL-4,IL-5) in sera of atopic dermatitis patients in the course of specific immunotherapy performed for the time period of 3 years. Novo-Helisen Depot allergy vaccines of appropriate composition were used for the treatment of 36 children and youngsters with atopic dermatitis, allergic to house dust mites (24 patients) and grass pollen allergens (12 patients). The control group consisted of 20 patients with atopic dermatitis and analogous IgE-mediated airborne allergy who were treated with conventional methods. There was a clear difference between two investigated groups of patients in terms of immunological parameters. In the group treated with allergy vaccines serum concentrations of total IgE and ECP tended to decrease (p < 0.001) as well as sIL-2R (p < 0.01). On the contrary in the control group serum tIgE increased and IL-4 as well as IL-5 concentrations tended to increase significantly (p < 0.01; p < 0.05 respectively).

Adolescent↗
PubMed1999

Clinical aspects, epidemiology, and prognosis of atopic dermatitis.

OBJECTIVE: This review article examines the clinical aspects, epidemiology, and prognosis of atopic dermatitis. DATA SOURCES: These are studies and review articles from textbooks of dermatitis and allergy in general, as well as more recent epidemiologic surveys published in specialist journals of allergy and dermatology. STUDY SELECTION: Included studies meet the criteria of being a survey of the prevalence of atopic dermatitis published recently in a respected peer-reviewed journal. Particular emphasis is placed on those that examine both the prevalence of the problem and significant causative and associated factors. RESULTS: Atopic dermatitis is frequently a severe illness that develops in early infancy. It can persist beyond the childhood years and is often found in association with significant respiratory complications. The exact pathogenesis is unclear but it appears that it has a complex immunologic origin. Early surveys lack the methodologic refinements of more recent data from the mid-1990s, including the SCARPOL study. Collectively, these point to a high current prevalence rate of 10% to 15%, a figure that has risen steadily in the preceding decades. The most common associations of atopic dermatitis are a risk of developing respiratory disorders, such as allergic rhinitis and asthma (40% to 60%), and a persistence rate after puberty (40% to 60%), which is indeed much higher than previously suspected. CONCLUSIONS: A clear recognition of the various disease subgroups along with intervention studies that evaluate reduction of risk are needed before more precise treatment strategies can be devised.

Adolescent↗