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Results for “DERMATITIS, ATOPIC”

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PubMed1991

The influence of the menstrual cycle and pregnancy on atopic dermatitis.

The prevalence of a premenstrual deterioration in the symptoms of atopic dermatitis, as determined by a postal questionnaire completed by 150 women, was 33%. There was a significant association between a premenstrual worsening of atopic dermatitis and the presence of the symptoms of the premenstrual syndrome (P less than 0.002). Pregnancy had an adverse effect on atopic dermatitis in the majority of cases (52%), usually starting in the first 20 weeks of gestation, although an appreciable proportion of women (24%) had improved during their pregnancy.

Adolescent↗

PubMed2005

Atopic dermatitis: beyond the itch that rashes.

The prevalence of atopic dermatitis is increasing, and more than 50% of children with atopic dermatitis go on to develop asthma and allergies. A better understanding of the underlying immune abnormalities of this complex chronic relapsing skin disease is needed. Although the optimal treatment approach remains to be defined, several recent studies suggest a rationale for using topical calcineurin inhibitors as early intervention and adding topical corticosteroids as rescue therapy if needed.

Adrenal Cortex Hormones↗

PubMed1977

HLA antigens and susceptibility to atopic dermatitis.

The possible association between peculiar HLA antigens ant atopic dermatitis associated allergic rhinitis and/or bronchial asthma was investigated. (1) Atopic dermatitis (no deviation in HLA), complicating allergic rhinitis (HLA-BW40), and bronchial asthma (HLA-B12) are associated by different HLA antigens. (2) The diseases are associated through the same antigen (HLA-BW15), if the concept of disease resistant antigen is accepted. (3) No association is found between HLA antigens and serum IgE levels in patients.

Adolescent↗

PubMed1996

Detection of Pityrosporum orbiculare reactive T cells from skin and blood in atopic dermatitis and characterization of their cytokine profiles.

BACKGROUND: Atopic dermatitis (AD) is associated with increased levels of serum IgE, and T-helper (Th) cells are thought to a play role in the pathogenesis. Individuals with AD often develop IgE antibodies against the yeast Pityrosporum orbiculare, a member of the normal cutaneous flora. OBJECTIVE: The role of P. orbiculare in atopic dermatitis was investigated by examining the T-cell reactivity for P. orbiculare. METHODS: Freshly isolated peripheral blood mononuclear cells (PBMC) were isolated from 10 AD patients with serum IgE antibodies against P. orbiculare, and from six healthy controls. The proliferative response after P. orbiculare stimulation, measured by [3H]thymidine incorporation, was examined in the PBMC and in T-cell clones (TCC) obtained from skin and blood of one patient. The cytokine profile of the TCC was determined by enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA) and reverse transcriptase-polymerase chain reaction (RT-PCR) following challenge with either P. orbiculare extract or anti-CD3 antibodies and phytohaemagglutinin. RESULTS: The PBMC response to P. orbiculare was significantly higher in the AD patients than in the control group (P < 0.05). Twenty-nine out of 36 tested TCC derived from one responding patient were reactive for P. orbiculare. The clones were CD2+ and CD4+, except for one CD8+ blood clone. A majority of the TCC derived from lesional skin showed a Th2- or Th2/Th0-like cytokine profile. A co-expression of interleukin-5 (IL-5) mRNA and IL-13 mRNA was detected in five out of six P. orbiculare-reactive clones analysed for their cytokine gene expression with RT-PCR. CONCLUSION: Our data suggest that P. orbiculare can induce a T-cell response in AD patients. The Th2-like profile of P. orbiculare-reactive TCC derived from lesional skin indicates that P. orbiculare may play a role in maintaining IgE-mediated skin inflammation in AD.

Adolescent↗

PubMed2003

Cough sensitivity in atopic dermatitis.

The aim of study was to investigate the cough sensitivity (C2) to capsaicin (CAPS) in patients with atopic dermatitis without clinical respiratory symptoms. Cough sensitivity (C2) is defined as the lowest CAPS concentration, which evokes two or more coughs. Forty eight dermatological patients (21 M, 27 F; mean age 44 yr) and 24 healthy volunteers (14 M, 10 F; mean age 37 yr) inhaled deep breath (2 l) of CAPS aerosol in doubled concentrations (from 0.02 to 200 micromol/l) (Pari Provokationstest I, PARI WERK; mass median diameter 1.2 microm). Cough sensitivity (C2) expressed as geometric mean (95% CI) of CAPS concentration was 0.13 micromol/l (0.06-0.31) in 26 patients with atopic dermatitis (10 M, 16 F; mean age 41 yr), 5.51 micromol/l (1.33-22.90) in 22 patients with psoriasis (11 M, 11 F; mean age 46 yr) and 4.29 micromol/l (2.54-7.26) in 24 controls. There is significant difference of cough sensitivity (C2) between patients with atopic dermatitis and healthy volunteers (p<0.001) and also between patients with atopic dermatitis and psoriasis (p<0.001). Cough sensitivity (C2) in atopic dermatitis patients without clinical respiratory symptoms is significantly increased. In patients with psoriasis cough sensitivity (C2) is not significantly changed.

Adult↗

PubMed1981

In vitro cyclic nucleotide responsiveness of leukocytes and platelets in patients suffering from atopic dermatitis.

Peripheral blood leukocytes from patients with severe atopic dermatitis (serum IgE levels between 1,560 and 28,000 U/ml) showed a significantly weaker increase in intracellular cAMP after stimulation with epinephrine (10(-5)-10(-3) M) than leukocytes from normals. At the same time stimulation with methylcholine (10(-10)-(10(-4) M) induced a significantly higher increase in intracellular levels of cGMP in the atopic group compared to normals. The immunomodulating agent levamisole induced a slight increase in cAMP and cGMP response both in leukocytes from atopic patients and in normals. Platelet cAMP concentrations were lowered by epinephrine stimulation both in atopics and controls. There was no effect of methylcholine upon platelet cyclic nucleotide levels in the dose range examined. The data support the concept that abnormal cyclic nucleotide responsiveness--not only as beta-adrenergic blockade but also as cholinergic hyperreactivity--may plays a role in the pathogenesis of atopic dermatitis.

Adult↗

PubMedDate not supplied

Formulary review of therapeutic alternatives for atopic dermatitis: focus on pimecrolimus.

OBJECTIVE: Atopic dermatitis (AD), often called eczema, is characterized by intense pruritus, erythema, dry skin, and inflammation. The condition is chronic and relapsing, and often occurs in patients with a family history of the atopic triad (asthma, allergic rhinitis, and AD). Use of topical steroids has been the mainstay of medical treatment for AD. Steroid-free treatments for AD, with a more favorable safety profile, have become available within the past 2 years. Tacrolimus ointment, a topical immunomodulator, became available in early 2001 and is indicated for moderate-to-severe AD. A similar but highly skinselective cytokine inhibitor, pimecrolimus cream 1%, became available in March 2002. Pimecrolimus is indicated for mild-to-moderate AD. The objective of this article is to review the key characteristics that differentiate pimecrolimus from steroids and tacrolimus in the treatment of AD. METHODS: Using secondary resources, the clinical aspects and conventional treatment strategies for AD are reviewed as are the pivotal clinical studies with pimecrolimus and literature on quality of life and economic burden of disease for AD patients and families. SUMMARY: Pimecrolimus is an effective, steroid-sparing therapy for mild-tomoderate AD. Early treatment prevents flares, the agent works quickly to reduce signs and symptoms of more advanced AD, and it is safe and appropriate for intermittent long-term therapy. Pimecrolimus has fewer side effects than topical steroids and a better side-effect profile than tacrolimus. It can also be used as a first-line therapy. In studies with patients aged 2 to 17 years, it has been shown to be particularly effective in improving eczema of the face and neck, and its use may improve quality of life for many patients, especially children. A single-strength dose (1%) is safe and medically beneficial for pediatric, adolescent, and adult patients. The direct drug cost of pimecrolimus compares favorably with tacrolimus, but it is significantly more expensive than generic topical steroid creams.

Complementary Therapies↗

PubMed1990

[Hepatobiliary system function in atopic dermatitis patients].

A total of 300 patients with atopic dermatitis were examined for the status of their gastrointestinal tract, liver and pancreas functioning. Besides clinical and laboratory studies, ultrasonic scanning of the liver and pancreas, fibrogastroduodenoscopy, radioimmunoassay of serum trypsin, C peptide, insulin, cholylglycine, radionuclide hepatography, and gamma pancreatoscintigraphy were carried out. Analysis of the findings permit a conclusion that chronic pancreatitis and impaired function of the liver and bile excretion are quite frequent in atopic dermatitis patients.

Adolescent↗

PubMed1993

Reduced responses of peripheral blood lymphocytes to heat-denatured food antigens in food-sensitive atopic dermatitis.

Although some patients with food-sensitive atopic dermatitis exhibit allergic symptoms to certain raw foods, they do not exhibit or scarcely exhibit allergic symptoms to boiled or cooked foods. In this study, although peripheral blood mononuclear cells responded to raw food antigens (ovalbumin or bovine serum albumin), the proliferative responses of peripheral blood mononuclear cells were reduced in heat-denatured food antigen-stimulation, in the hen egg- or cow milk-sensitive patients with atopic dermatitis who did not exhibit or scarcely exhibited allergic symptoms to the boiled or cooked foods although the patients exhibited allergic symptoms to the raw foods. Our results show that proliferative responses of peripheral blood mononuclear cells to heat-denatured food antigens are good parameters for diet counseling in food hypersensitivity.

Antigens↗

PubMed2006

Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial.

OBJECTIVE: To determine the effects of age related, structured educational programmes on the management of moderate to severe atopic dermatitis in childhood and adolescence. DESIGN: Multicentre, randomised controlled trial. SETTING: Seven hospitals in Germany. PARTICIPANTS: Parents of children with atopic dermatitis aged 3 months to 7 years (n = 274) and 8-12 years (n = 102), adolescents with atopic dermatitis aged 13-18 years (n = 70), and controls (n = 244, n = 83, and n = 50, respectively). INTERVENTIONS: Group sessions of standardised intervention programmes for atopic dermatitis once weekly for six weeks or no education (control group). MAIN OUTCOME MEASURES: Severity of eczema (scoring of atopic dermatitis scale), subjective severity (standardised questionnaires), and quality of life for parents of affected children aged less than 13 years, over 12 months. RESULTS: Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups (total score for severity: age 3 months to 7 years - 17.5, 95% confidence intervals - 19.6 to - 15.3 v - 12.2, - 14.3 to - 10.1; age 8-12 years - 16.0, - 20.0 to - 12.0 v - 7.8, - 11.4; - 4.3; and age 13-18 years - 19.7, - 23.7 to - 15.7 v - 5.2, - 10.5 to 0.1). Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales, whereas parents of affected children aged 8-12 years experienced significantly better improvement in three of five quality of life subscales. CONCLUSION: Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease.

Adolescent↗

PubMed1988

Passage of food antigens into circulation of breast-fed infants with atopic dermatitis.

We have selected 13 babies presenting with atopic dermatitis during exclusive breast feeding. After evaluation of reaginic reaction, we detected beta-lactoglobulin (BLG) in breast milk and babies sera before and after maternal elimination diet and after maternal challenge. beta-Lactoglobulin was present only in the sera of infants ingesting breast milk containing BLG. We have seen reaginic reactions to cow's milk in seven babies. The maternal elimination diet improved eczema in 11/13 infants, maternal challenge worsened atopic dermatitis in 9/9 children. We demonstrated the transport of food antigen via breast milk into infants' circulation.

Breast Feeding↗

PubMed1998

A UVB phototherapy protocol with very low dose increments as a treatment of atopic dermatitis.

From 1991 to 1992, 15 patients with atopic dermatitis were treated with a new UVB treatment regimen guided by skin reflectance measurements. The new treatment was characterized by very low dose increments from start to end of therapy. The median cumulative dose increment during therapy was only 20%. The severity of the disease, the efficacy of the treatment, the occurrence of adverse effects and the cumulative UVB dose were obtained from the case records. This data were compared in an open study with the data obtained from 17 patients with atopic dermatitis who were treated from 1988 to 1991 at the department with a standard UVB treatment regimen with stepwise dose increments. There was no difference in the severity of the disease at the beginning of the therapy between the two groups. The skin reflectance-guided low-dose UVB therapy was not significantly faster (3.5 weeks) than the regimen with stepwise dose increments (4.5 weeks). The cumulative UV exposure was four times lower with the new treatment regimen (34 standard erythema doses) compared with the old regimen (161 standard erythema doses), P<0.001. The healing score was significantly higher with the new treatment regimen compared with the old, P<0.05. This study indicates that skin reflectance-guided UVB phototherapy may enable the dermatologist to lower the cumulative UVB exposure significantly without losing effect.

Adult↗

PubMed1979

Localized herpes simplex infections in atopic dermatitis.

Herpes simplex infections, localized to areas of atopic dermatitis, were documented in ten children. The typical clinical picture consisted of low-grade fever and exacerbation of the eczema with discrete vesicles localized to affected skin, followed by punched-out ulcerations. Recurrent attacks were observed in seven cases and coincided with active attacks of herpes labialis in other family members or close friends, suggesting reinfection as the source. In no patient did a disseminated Kaposi's varicelliform type of eruption develop. Viral cultures in 30 additional patients with acute flares of atopic dermatitis without vesicles or ulcerations failed to disclose any herpes simplex.

Child↗

PubMed2004

Pimecrolimus: a review of its use in atopic dermatitis.

Pimecrolimus (Elidel) is a topically active, nonsteroid, calcineurin inhibitor that has shown efficacy in controlling symptoms of atopic dermatitis in adult and pediatric patients. Topical pimecrolimus 1% cream is approved in the US for the short-term and intermittent long-term treatment of mild-to-moderate atopic dermatitis in non-immunocompromised patients aged >/=2 years who do not respond well to, or may have adverse effects with, conventional treatments. Pimecrolimus 1% cream is an effective and well tolerated treatment for atopic dermatitis in infants, children, adolescents, and adults. Pimecrolimus is effective at reducing the incidence of disease flares and, thus, the need for rescue treatment with topical corticosteroids. The drug also improves the health-related quality of life (HR-QOL) of children and adolescents, and improves the QOL of parents of children with atopic dermatitis. Furthermore, pimecrolimus does not cause skin atrophy, a problem commonly associated with topical corticosteroids, and is not associated with clinically relevant systemic adverse events. Thus, topical pimecrolimus 1% cream is an effective treatment option for the management of mild-to-moderate atopic dermatitis.

Administration, Cutaneous↗

PubMed2006

Tacrolimus: focusing on atopic dermatitis.

Tacrolimus ointment is an effective treatment for atopic dermatitis. As a calcineurin inhibitor, it works through the FK-binding protein, inhibiting calcineurin and preventing dephosphorylation of nuclear factor of activated T cells (NFAT). Systemic absorption from the drug is minimal, allowing a favorable safety profile. In head-to-head clinical trials with pimecrolimus, tacrolimus proved to be a more effective treatment. Tacrolimus ointment has also been compared to standard topical cortico-steroid treatments and is equally effective if not superior to several topical steroids. Overall, tacrolimus ointment is a safe and effective treatment for atopic dermatitis and can be used as an adjunctive treatment to standard management with topical corticosteroids.

Calcineurin↗

PubMed1992

Food hypersensitivity and dietary management in atopic dermatitis.

Although immune dysfunction is known to play an integral role in the development of atopic dermatitis, no clear delineation of the underlying pathogenic mechanism(s) responsible for this disorder has been proposed. Several factors are known to trigger flares of atopic dermatitis. In the extrinsic form of this disorder, food and airborne allergens may provoke flares of eczema. Research implicating food hypersensitivity in the pathogenesis of atopic dermatitis includes studies of food allergen avoidance in newborn infants at high risk for atopic disease, investigations of children with blinded food challenges, and therapeutic trials of allergen-elimination diets. Taken together, these studies demonstrate a significant pathogenic role for food hypersensitivity in about one-third of children with atopic dermatitis.

Child, Preschool↗

PubMed2007

Topical therapy of atopic dermatitis: controversies from Hippocrates to topical immunomodulators.

Although atopic dermatitis can be treated efficiently, there is still much controversy about the risk/benefit ratio of both topical corticosteroids and topical immunomodulators. Conflicting data may be found about the usefulness of bathing, diet regulation, and other therapeutic interventions. These controversies result in part from the persistence of Hippocratic doctrines in modern medical thinking. Humoralist and diathetic doctrines, as they pertain to eczema, are reviewed. The paradoxical worsening of oozing and the deadly hazards of hospitalization before the era of antibiotics are brought to mind. We hope that this historical review will improve the understanding of current controversies and help dermatologists to manage patients with atopic dermatitis and other chronic skin diseases.

Dermatitis, Atopic↗

PubMed2004

[Clinical assessment and evaluation of total immunoglobulin E concentrations in blood of atopic dermatitis patients with allergy to airborne allergens].

UNLABELLED: Atopic dermatitis (AD) is a disease with a complex pathomechanism, in which immunoglobulin E plays an important role. The aim of the study was to evaluate the immediate allergic response to airborne allergens in patients with AD, with consideration of serum level of total immunoglobulin E (total IgE). Severity of AD clinical symptoms was analyzed and correlated with the results of allergological diagnostics. MATERIAL AND METHOD: 529 patients with AD (aged 0.5-60 years) who fulfilled basic Hanifin and Rajka criteria were included in the study. The control group comprised 60 healthy volunteers. Both groups were comparable in terms of age and gender of subjects. All subjects had total serum IgE measured. Severity of AD symptoms was measured in the AD group using an atopic dermatitis index. RESULTS: Similar values of the AD index were found in AD patients with negative results of allergological diagnostics and those with positive results. The levels of total serum IgE were highest in the group of AD patients sensitive to airborne and food allergens (1271.1 +/- 792.0 kU/l) and in the group sensitive only to airborne allergens (750.9 +/- 680.3 kU/l). The levels of total IgE in these groups were significantly higher than in patients sensitive only to food allergens (184.3 +/- 250.1 kU/l). CONCLUSIONS: AD clinical picture does not allow identification of potential provoking factors. A high level of total serum IgE suggests participation of airborne allergens in the development of the disease.

Adolescent↗