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PubMed1976

[Cytokinetics of epidermal and dermal cells in allergic contact dermatitis and atopic dermatitis (author's transl)].

The cytokinetics of epidermal and dermal cells was examined in 16 patients with subacute or chronic allergic contact dermatitis and 11 with atopic dermatitis. In allergic contact dermatitis a H3-thymidine-labelling index (H3-1) of 4.55 +/- 2.4% was found in the epidermis and of 0.7 +/- 0.44% in the dermal infiltrate. In comparsion, in atopic dermatitis the values were 5.5 +/- 2.31% in the epidermis and 0.93 +/- 0.72% in the dermis. The DNA-synthesis-time (ts) was lengthened slightly with 11.4 +/- 2.4 h in allergic contact dermatitis and 11.75 +/- 3.68 h in atopic dermatitis. In comparsion with normal skin, the cell-cycle-time (tc) was slightly shortened in allergic contact dermatitis (244 +/- 110 h) and in atopic dermatitis (233 +/- 83 h). There was no significant difference between both types of dermatitis regarding cytokinetics.

Cell Division↗

PubMed2000

Clinical aspects of atopic dermatitis.

Atopic dermatitis (AD), or atopic eczema, is the most common, chronic inflammatory disease among children in industrialized countries. We still lack knowledge of its pathophysiology and in particular the role of allergy as both an eliciting factor for disease expression and for disease activity. This article describes the clinical symptoms of the disease and its qualitatively different aspects. AD cannot be understood as being induced by one factor only, e.g. allergy, and this is important when planning treatment strategies. It is also important to realize the very wide range of disease intensity: from subclinical, or latent AD, in which only a few symptoms are present and thus which prevents a clear diagnosis of AD, to its most severe forms including erythroderma. It's unknown aetiology, the wide range in symptomatology, and the fluctuating course (including the many eliciting factors) form the background for our diagnostic and therapeutic difficulties of atopic eczema. AD is prevalent in childhood, but the atopic trait continues, not only for later respiratory allergies, but also for skin diseases in adulthood (such as AD itself or the frequent irritant contact dermatitis of the hands). A child with an acute and first attack of AD is therefore a challenge to the child, its parents and - certainly - to the doctor. However, after stressing the chronicity of the disease, it is equally important to assure the parents that this disease is, in most cases, controllable through correct treatment and that it has a good prognosis: It is not a 'life sentence', but a controllable disease in an otherwise healthy child.

Adult↗

PubMed2003

Evaluation of skin barrier function in allergic contact dermatitis and atopic dermatitis using method of the continuous TEWL measurement.

PURPOSE: The aim of study was to determine usefulness of the method of continuous TEWL measurement in the evaluation of skin barrier function in physiological conditions and in allergic contact dermatitis (ACD) and atopic dermatitis (AD). MATERIAL AND METHODS: Study was conducted on a group of 86 persons: 48 patients with allergic contact dermatitis, 18 with atopic dermatitis and 20 healthy individuals. Measurements of transepidermal water loss were made using custom-constructed device for continuous TEWL measurement. In each person the measurements of TEWL were made 4 times: measurement 0 (baseline)--before occlusion with 1% lauryl sulphate for 24 h, measurement 1-15 minutes after SLS patch removal, measurement 2-30 minutes after measurement 1 and measurement 3-30 minutes after measurement 2. Obtained data were statistically analyzed. RESULTS: TEWL ratio values obtained in measurement 0 were as follows in individual groups of patients: 13.20 +/- 8.25 in the AD patients, 10.09 +/- 8.29 in ACD patients and 9.02 +/- 5.99 in control group. Analogous TEWL values in the subsequent measurements were: in measurement 1--16.08 +/- 11.17; 11.63 +/- 6.43; 17.39 +/- 12.41, in measurement 2--23.72 +/- 14.58; 14.71 +/- 6.46; 17.55 +/- 8.25, measurement 3--24.09 +/- 14.93; 16.34 +/- 6.32; 18.44 +/- 8.26. TEWL ratio values were higher in both groups of patients as compared to control group but not statistically significant (p = 0.1778). After 24 h exposition to SLS, TEWL ratio values increased in all examined groups as compared to baseline (0) measurement. All measurements, except for measurement No 1 in AD group of patients, showed statistically significant differences. The highest increase of TEWL values were observed in group of AD patients. CONCLUSIONS: Delay in skin reaction to SLS in patients with atopic dermatitis provides evidence for different properties of water barrier of the skin in this group as compared to healthy individuals. Increasing tendency in TEWL values 1 hour after SLS removal might reflect persistent damage to water barrier of the skin by detergent. Method of continuous assessment of water barrier of epidermis, through the possibility of multiple measurement by TEWL in examined periods of time, decreased the risk of mistake and increased accuracy of measurement. Measurement of TEWL values allows for assessment of otherwise unnoticed damage to water barrier of the skin.

Adolescent↗

PubMed1995

Modulatory effects of staphylococcal superantigen TSST-1 on IgE synthesis in atopic dermatitis.

Atopic dermatitis (AD) is a chronic skin disorder associated with elevated serum IgE and colonization of the skin by Staphylococi which secrete toxins with superantigenic activity. The present study examined the immunomodulatory effects of toxic shock syndrome toxin (TSST)-1, a prototypic superantigen, on IgE synthesis by interleukin (IL)-4-stimulated peripheral blood mononuclear cells (PBMC) from five patients with AD and five normal subjects. TSST-1 inhibited IL-4-induced IgE synthesis by AD and normal PBMC (P < 0.05). In contrast, IgG synthesis was not similarly affected (P > 0.30). Inhibition of IL-4-induced IgE production was associated with induction of interferon (IFN)-gamma synthesis by TSST-1 (P < 0.02). Normal PBMC synthesized significantly more (P < 0.005) IFN-gamma than AD PBMC. A neutralizing antibody to IFN-gamma reversed TSST-1-induced suppression of IgE synthesis by the normal PBMC (P < 0.03), but not the AD PBMC. In AD, but not normal, PBMC anti-IFN-alpha antibody reversed the suppression of IgE synthesis induced by TSST-1. These results demonstrate that TSST-1 uses different mechanisms for modulation of IgE synthesis in AD versus normal PBMC. Furthermore, the reversal of TSST-1-induced suppression of IgE synthesis in AD PBMC by anti-IFN-alpha, but not anti-IFN-gamma, is consistent with the concept that AD is associated with defective Th1 cell function and enhanced monocyte activity.

Adult↗

PubMed1992

Recent advances in the pathogenesis of atopic dermatitis.

Atopic dermatitis (AD) is an inflammatory skin disorder affecting 5%-10% of children. Although basic mechanisms remain largely speculative, recent studies on the pathogenesis have elucidated new insights, pointing to the importance of food and inhalant allergens. The pathogenesis of AD can be more easily explained by the model of late skin reaction occurring after mast cell activation. The present report highlights some of the more recent developments in the mechanisms of AD which can be important in understanding and treating this troublesome disease.

Allergens↗

PubMedDate not supplied

Managing childhood atopic dermatitis.

Atopic dermatitis, a chronic inflammatory skin disorder that affects up to 20% of school-aged children, can profoundly influence quality of life. Basic therapy consists of avoidance of triggering factors and optimal skin care. Until now, corticosteroids have been the usual treatment for acute flares. Short-term safety profiles are reasonable, but long-term use of corticosteroids may involve significant adverse effects. Topical immunomodulators (tacrolimus and pimecrolimus) are beneficial and safe for adults and children and represent a major new alternative to chronic corticosteroid use, especially in children.

Adjuvants, Immunologic↗

PubMed2006

Increased production of vascular endothelial growth factor in the lesions of atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by severe itching, erythema and edema resistant to anti-histamine therapy. Vascular endothelial growth factor (VEGF) is a potent agent that causes hyperpermeability of blood vessels and endothelial cell proliferation, and might be involved in the persisting erythema and edema in AD. In this study, we used extraction of stratum corneum with physiological saline to detect VEGF produced in the lesions of AD. Biological activity of VEGF was assayed by proliferation of cultured human umbilical vein endothelial cells in vitro. As a result, we found that the amount of VEGF produced in lesional scales was approximately 25 times higher than that in normal stratum corneum. Moreover, VEGF 121 isoform that exclusively induces hyperpermeability of blood vessels was a predominant component in the lesional scales suggesting that this factor plays an important role in the persisting erythema and edema in the AD lesions.

Capillary Permeability↗

PubMed2005

Atopic dermatitis.

Atopic dermatitis (AD) is commonly associated with immunoglobulin E (IgE) antibody-related mechanisms, which are the focus of this article. The vast majority of patients with AD exhibit hyperproduction of IgE, particularly during disease onset or flare. IgE-dependent late-phase reactions may influence the chronic inflammatory response in AD. Clearly, genetics plays a major role in determining who develops AD. However, the recent increase in AD prevalence suggests that a complex interaction between environmental factors and susceptibility genes results in clinical expression of the disorder. These immunologic "triggers" differ among individuals and include various foods, airborne allergens, irritants and contactants, hormones, stress, climate, and microorganisms. Although much about AD remains to be elucidated, our current understanding of its pathophysiology has provided clinicians with the ability to construct more rational therapeutic interventions, including multiple-agent regimens that provide both immediate relief and effective long-term management. Future advances will come from identification of the genes causing this disease and further elucidation of the immunoregulatory mechanisms involved in the pathogenesis of AD.

Adult↗

PubMed2006

The genetics of atopic dermatitis.

Atopic dermatitis (AD) is a chronic itching (pruritic) skin disease. It results from a complex interplay between strong genetic and environmental factors. Genome screens of families with AD have implicated chromosomal regions that overlap with other skin diseases and with inflammatory and autoimmune diseases. These, together with candidate gene studies, provide novel insights into the pathogenesis of AD. The findings suggest a common theme of generalized epidermal dysfunction manifesting as a compromised skin barrier and failure to protect against, or aberrant responses to, microbial insults and antigens. Recent genetic advances with high-throughput methods for gene identification, such as DNA microarrays and whole-genome genotyping, will help further dissect this complex trait. This will aid disease-defining criteria and focused therapies for AD.

Chymases↗

PubMed2006

Role of vasculature in atopic dermatitis.

Atopic dermatitis (AD) lesions are characterized by differences in the activation state of endothelial cells and vascular smooth muscle cells and the release of inflammatory mediators by and toward the vasculature. The vascular system, including endothelial cells and smooth muscle cells, is ultimately involved in clinical symptoms of AD, such as erythema, edema, leukocyte recruitment, and white dermographism. Various mediators and bidirectional neurovascular interactions regulate the inflammatory response during AD. T cell-endothelial cell interactions are a crucial component to establish acute AD. Various immune cells, including monocytes and mast cells, communicate with the endothelium by releasing inflammatory mediators, thereby stimulating inflammatory mediator release from activated endothelial cells. The process of adhesion, tethering, and transmigration of infiltrating cells is a highly regulated and an active communication process between endothelial cells and leukocytes. Endothelial cells play a pivotal role in the pathophysiology of AD and represent future targets for the treatment of AD.

Animals↗

PubMed2006

Innate immune defects in atopic dermatitis.

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease that becomes clinically apparent in the pediatric population. It is well recognized that subjects with AD have an increased susceptibility to cutaneous colonization and infection with bacteria, fungi, and viruses. The notion that subjects with AD have a cutaneous immune defect has received widespread acceptance, and several plausible explanations for this have been proposed. We will review the evidence that this susceptibility to cutaneous infection is at least in part due to a defect in the first line of defense against microbes, namely the innate immune system.

Dermatitis, Atopic↗

PubMed2006

Management of sleep disturbance associated with atopic dermatitis.

Atopic dermatitis (AD) is a common childhood skin disease that also affects adults. Sleep problems are frequently associated with AD and negatively affect both patients and their families. Although this problem is well recognized, there are currently limited studies of patients with AD to guide clinical management of sleep disturbances. This targeted review will inform clinicians of the potential therapeutic agents available to manage sleep disturbances and will review literature relevant to improving the sleep of children and adults with AD. On the basis of our clinical experience and the limited data available, we provide a suggested algorithm for clinicians treating sleep problems associated with AD, but clearly more studies are needed to both further characterize the sleep of patients with AD and to test the efficacy and effectiveness of candidate agents in clinical trials.

Algorithms↗

PubMed2005

Anticardiolipin antibodies in children with atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial etiology. Immunological abnormalities (cell-mediated immune hyperactivity, elevated IgE serum levels and eosinophil-derived mediators) have been observed. In a recent issue, Szakos et al. describe, in children with extrinsic type of AD, an association between the occurrence of anticardiolipin (ACL) IgM and specific IgE against mite, and also in relation to the severity of the disease. We studied 51 children (35 males and 16 females, mean age 44 months) with AD, whose diagnosis was made on the basis of Hanifin and Rajka's criteria. The evaluation of the severity of the disease was made using the SCORAD index. Eleven children had intrinsic type AD (group A); 40 children had extrinsic type AD, 14 of them had specific IgE only against food allergens (group B); 26 children had specific IgE also against inhalant allergens (group C). Twelve children without allergy were designated as the control group. Specific IgEs were determined using the CAP-System (Pharmacia, Uppsala, Sweden) for food and inhalant allergens. The measurement of ACL IgG and IgM was carried out by ELISA (Orgentec Diagnostika, Mainz, Germany). An increase in serum levels of ACL was observed in 13 children (25.5%): 1 child (9%) from group A, 7 children (50%) from group B and 5 children (19.2%) from group C with a statistically significant difference (P=0.038). Our study shows the presence of ACL-IgG above all in extrinsic AD, but no association was found between high levels of ACL and increased severity scoring of AD. Increased levels of ACL were observed in younger children (mean age 26.5 months; P=0.025) especially if sensitized against food allergens.

Allergens↗

PubMed2001

Increased oxidative stress in childhood atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease of unknown etiology. To examine the involvement of impaired homeostasis of oxygen/nitrogen radicals in childhood AD, we compared the levels of urinary 8-hydroxy-2'-deoxyguanosine (marker of oxidative stress), nitrite/nitrate (marker of nitric oxide synthesis) and selenium (marker of selenium store) in 27 children with AD to those of 25 healthy control children. Urinary 8-hydroxy-2'-deoxyguanosine was significantly higher and nitrite/nitrate levels were significantly lower in patients with AD than in the control. Urinary selenium levels were similar in both groups. Our findings suggest that impaired homeostasis of oxygen/nitrogen radicals and increased oxidative stress are involved in the pathophysiology of childhood AD, and indicate that suppression of oxidative stress might be a potentially useful strategy for the treatment of AD.

8-Hydroxy-2'-Deoxyguanosine↗

PubMed1999

Pathogenesis of atopic dermatitis.

Atopic dermatitis (AD) is a common inflammatory skin disease with increasing prevalence since World War II. Recent studies have shed light on how the complex interrelation of genetic, environmental, immunologic, and pharmacologic factors contributes to the development of AD. The current review will examine the cellular and immunologic mechanisms underlying AD as well as the potential role of microbial superantigens in the pathogenesis of AD. An understanding of the relative contributions of allergens, IgE, T cells with skin homing capability, Langerhans cells, keratinocytes, eosinophils, and mast cells to the inflammatory process in AD may lead to improved treatments for this potentially debilitating disease.

Dermatitis, Atopic↗

PubMed1999

Update on therapy of atopic dermatitis.

Atopic dermatitis (AD) is complicated and often difficult to manage. Effective therapy is commonly impeded by 3 ambivalencies: (1) prioritization of skin care versus allergy treatment; (2) uncertainty about optimal bathing and moisturizing, and (3) hesitation about the use of adequate topical corticosteroid therapies. With a confident, well-planned approach, effective therapy management may be achieved. On initial assessment, an evaluation form is a tool to keep the focus on important history and physical features critical for the diagnosis and to review trigger factors and past therapies. Patients and parents must be educated to become more aware of the trigger factors that may lead to an exacerbation of their disease. Errors in bathing and moisturizing are the major cause of persistent AD, and the confusing paradox that water is both good and bad for the skin must be resolved to achieve therapeutic success. Avoidance/approach conflicts regarding recommendations of topical steroid use has a detrimental effect on patient outcomes. With the proper use of mid-strength topical agents and with the recent development of topical macrolides for use in AD, effective management for this disease can be realized.

Combined Modality Therapy↗

PubMed2000

Atopic dermatitis.

Atopic dermatitis is a chronic skin disorder. It affects up to 15% of the childhood population in the United States and more than half of these patients into adulthood. A clinical diagnosis is made based on the superficial, inflammatory, erythematous and puritic eruptions. Control of symptoms involves patient and parent education with regard to skin care and avoidance of triggers. Treatment includes corticosteroids, with newer strategies emerging.

Dermatitis, Atopic↗

PubMed2003

Atopic dermatitis.

Atopic dermatitis is a highly pruritic chronic inflammatory skin disorder affecting 10-20% of children worldwide. Symptoms can persist or begin in adulthood. It is also the most common cause of occupational skin disease in adults. This disease results from an interaction between susceptibility genes, the host's environment, pharmacological abnormalities, skin barrier defects, and immunological factors. New management approaches have evolved from advances in our understanding of the pathobiology of this common skin disorder.

Administration, Topical↗