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PubMed2002

Adjuvant botulinum toxin A in dyshidrotic hand eczema: a controlled prospective pilot study with left-right comparison.

OBJECTIVE: Dyshidrotic hand eczema is a therapeutic challenge. A prospective pilot study was performed with left-right comparison in order to investigate whether chemical de-innervation of sudoriferic nerves would be superior to standard therapy with topical corticosteroids. BACKGROUND: Botulinum toxin A (BTXA) is a potent inhibitor of acetylcholine release, that induces eccrine sweat production and release. Inhibition of sweating by other measures such as tap water iontophoresis has been shown to be beneficial in dyshidrotic hand eczema. METHODS: Eight adult patients suffering from dyshidrotic hand eczema (atopic type) were included in a prospective, side-by-side controlled clinical pilot study using topical corticosteroids on both hands in combination with intracutaneous injections of 100 units of BTXA (Botox) on the more severely affected hand on day 1. The dyshidrotic hand eczema was classified using the DASI (Dyshidrotic Eczema Area and Severity Index) before treatment (0), after 1 week, 4 weeks and 8 weeks. RESULTS: Six patients completed the study, two dropped out because of social and personal reasons. The mean DASI score changed from 28 to17 with topical therapy alone and from 36 to 3 with adjuvant BTXA (P < 0.01). Itching and vesiculation were inhibited earlier when using the combination of corticosteroids and BTXA. There was one relapse in the corticosteroid group. Relapses have not been seen in the BTXA group. CONCLUSIONS: Interruption of sweating by BTXA improves the outcome and reduces relapses in patients with dyshidrotic hand eczema. BTXA is antipruritic as well suggesting that it does not only interact with acetylcholine release but substance P.

Adult↗
PubMed2005

Prevalence of asthma, rhinitis, and eczema from ISAAC survey of schoolchildren in Central Taiwan.

Asthma is a common disease among schoolchildren in Taiwan. It is clearly a trend that the prevalence of asthma, rhinitis, and eczema has been increasing in developed countries such as Taiwan, but the data remain limited. This study is part of an effort to evaluate the epidemiology of asthma, rhinitis and eczema in Taiwan and to assess the prevalence and severity of those disorders among school age in central Taiwan. The International Study of Asthma and Allergies in Childhood (ISAAC, phase III) standard written questionnaire was administered to 7,873 first grade schoolchildren, 6 to 8 years of age from 47 different elementary schools in Changhwa county, which is located in central Taiwan. The overall cumulative and 12-month prevalence of wheezing is 10.4% and 5.0%, respectively. The prevalence of diagnosed asthma by doctor is 7.0%. Rhinitis is 24.6% and eczema 18.0%. Multiple logic regression analysis shows that a higher prevalence of wheezing and rhinitis is associated with males. Among these school-age children, the peak incidence of asthma and rhinitis is in the winter months, especially in December and January.We also compared the prevalence of asthma, rhinitis, and eczema in two severely polluted areas in Changhwa County with the prevalence in less polluted parts of the county. One is the area near a huge petrochemical company, TaiHao Petroleum Company, located in the central area of the county. The other is XiZhao, a rural area located near an incinerator. These were compared with the less-polluted Coast-Area and with the rest Changhwa County area. The school-age children living near the TaiHao Company have a higher prevalence of wheezing, diagnosed asthma, and diagnosed eczema, but there are no differences for rhinitis. As for XiZhao and Coast areas, those children have significantly higher rates of nasal problems, diagnosed rhinitis, and eczema than the rest of the area, but we did not find a significant difference in the prevalence of asthma. Among school-age children who lived in the Coast area, we found a higher prevalence of rhinitis and nasal problems with associated itchy eyes than among children in other areas of the county.

Asthma↗
PubMed2004

Incidence of hand eczema-a population-based retrospective study.

When etiological relationship is of interest, the incidence rate is a preferred measure. The aim of the present retrospective study was to estimate the incidence rate of self-reported hand eczema in a sample from the general population and to study the relation of this to age, sex, and atopy. A questionnaire was mailed to 3000 individuals aged 20-65 y, randomly selected from the population register of Göteborg, Sweden. This gave a response rate of 73.9%. Questions were asked about ever having had hand eczema, time of onset of the disease, history of childhood eczema, and history of asthma/hay fever. The crude incidence rate of self-reported hand eczema was 5.5 cases per 1000 person-years (females 7.1 and males 4.0). There was no difference, however, in incidence rate between women and men above 30 y of age. In a Poisson regression analysis, female sex, childhood eczema, and asthma/hay fever were all significantly associated with hand eczema, but only at ages below 30 y. A moderate influence of recall bias and a probable tendency to underreport imply that the incidence rates presented are to be considered as minimum rates.

Adolescent↗
PubMed2004

Environmental contact factors in eczema and the results of patch testing Chinese patients with a modified European standard series of allergens.

Environmental contact factors in eczema were investigated in China by clinical questionnaire and patch testing patients with a modified European standard series of allergens. 217 consecutive eczema patients were studied. Contact dermatitis (CD) was clinically diagnosed in 30% of the patients. Among the patients patch tested, 46 patients had clinically diagnosed allergic CD (ACD), 20 patients clinically had non-ACD (NACD) (including 16 cases of irritant contact dermatitis, 1 case of phototoxic contact reaction and 3 cases of asteatotic eczema) and 115 patients had clinically suspected ACD. 45 patients (98%) in the ACD group went on to have relevant patch test results. The most common ACD was from metals, fragrance materials, cosmetics and rubber materials. The most common contact allergens identified were nickel, fragrance mix, para-phenylenediamine (PPD), carba mix and thimerosal. No adverse reactions were observed to patch testing, except for pruritus in patch-test-positive patients. The positive rate of patch testing in ACD was much higher than that in NACD (98% versus 15%, P < 0.05, chi(2)-test). 60 (28%) patients had facial dermatitis (FD). Among these, 20 (33%) were confirmed as having ACD. 48 (22%) patients had hand dermatitis (HD). Among these, 7 (15%) were confirmed as having ACD. Fewer patients were confirmed as having ACD in the HD group than in the FD (15% versus 33%, P < 0.05, chi(2)-test). Although the difference was not significant, the total positivity rate in the HD group (55%) was lower than in the other groups. 65 (30%) patients had unclassified endogenous eczema (UEE). The total positive rate of patch testing in the UEE group (56%) was no different from that in the FD or HD groups. However, the relevance of positive patch tests was hard to determine in UEE. These results indicate that CD is common in eczema; relatively more patients with FD have ACD, while other factors, such as irritation, may play more of a role in HD. The total positive rate of patch testing in the UEE group was no different from that in the FD or HD groups, suggesting that patch testing should be stressed in UEE and the relevance of positive patch test results in UEE should be studied further. It is effective and safe to patch eczema patients with a modified European standard series of allergens in China.

Adult↗
PubMed2006

What causes worsening of eczema? A systematic review.

BACKGROUND: Flares of eczema are attributed to many factors, often with minimal scientific evidence. OBJECTIVES: Systematically to search, summarize and critically appraise the scientific evidence to support the roles of individual 'flare factors' in eczema. METHODS: We searched Medline from 1966 until 20 April 2005 to identify relevant articles for inclusion in this review. No language restrictions were imposed. All study designs were included and were ranked according to the strength of evidence. Experimental and provocation studies were restricted to those using a double-blind design. We included randomized controlled trials if they were provocation studies. Meta-analysis was not possible due to differences in study populations and methodology. The studies are therefore described qualitatively. RESULTS: The roles of foodstuffs (13 studies), house dust mite (three), other aeroallergens (two), seasonality (two), bacterial infections (one), textiles (three), detergents (one), sunlight (one) and stress (two) were assessed in different study populations, using a variety of study designs. All studies were performed on selected groups and only four were longitudinal in design. Collectively, these studies provide some evidence that certain foods, house dust mite, stress and seasonal factors are relevant causes of disease worsening in certain subgroups with eczema. No good evidence could be found to support the role of detergents, textiles and irritants in causing worsening of eczema. CONCLUSIONS: Despite anecdotal lists in textbooks and review articles, very little good evidence exists for 'flare factors' in eczema. The focus of all of the included studies was on disease worsening rather than clinically relevant flares. Studies of longitudinal design are required to clarify the roles of these and other putative flare factors in eczema.

Allergens↗
PubMed1981

Eczema and infant diet.

The relationship between prenatal atopy, breast-feeding, early solid food diet and the rate of eczema was studied in a birth cohort of 2-year-old children. Rates of eczema varied significantly with parental atopy and solid feeding: children of atopic parents given solid food during the first 4 months had over two-and-a-half times the rate of eczema of children not given solid food and who had non-atopic parents. Further, rates of eczema increased in almost direct proportion to the number of different types of solid food that the child had been given during the first 4 months. Breast-feeding had no significant effect on rates of eczema. The results suggest that both parental atopy and diversity in early diet are factors which contribute towards rates of childhood eczema.

Analysis of Variance↗
PubMed1997

Inflammation markers and symptom activity in children with bronchial asthma. Influence of atopy and eczema.

BACKGROUND: Eosinophil cationic protein (ECP) has been reported to reflect the eosinophil inflammatory activity in asthma. However, the relative impact of asthma symptoms and atopic eczema upon serum (s)-ECP in asthmatic children has not been established. OBJECTIVES: To examine s-ECP levels and s-myeloperoxidase (MPO) in relation to asthma symptoms and atopic eczema in asthmatic children. METHODS: S-ECP and s-MPO were assessed in relation to symptom activity, lung function, exercise-induced bronchoconstriction and bronchial responsiveness in 101 children; median age 9 years, range 1-16 years; with moderate to severe asthma, admitted to Voksentoppen Center. RESULTS: S-ECP was significantly higher in children with persistent compared to episodic or no asthma symptoms in the past four weeks. S-ECP was also higher in children with atopic compared to non-atopic asthma, as well as in those with active compared to past history or no history of atopic eczema. S-MPO was higher in children with persistent asthma symptoms, but did not differ in relation to atopy or eczema state. Persistent asthma symptoms had the greatest impact upon s-ECP levels, followed by atopy and active eczema. CONCLUSION: S-ECP may be used in assessing symptom activity in asthmatic children, but with the realisation that active eczema and the presence of atopy may also influence levels.

Adolescent↗
PubMed2006

Allergic conjunctivitis in children with asthma, rhinitis and eczema in a secondary outpatient clinic.

Little evidence is available on the prevalence of allergic conjunctivitis in pediatric populations. The objective of this study was to assess the cumulative prevalence of allergic conjunctivitis in children with rhinitis, asthma and eczema in a secondary pediatric outpatient clinic. Children aged 5-15 yr referred during the period of 2002-2004 in whom allergic conjunctivitis, asthma, allergic rhinitis or eczema was diagnosed were included in a retrospective survey. At referral patient characteristics, history, symptoms, signs and results of type 1 allergy tests were entered into an electronic form. Four hundred and fifty-eight children with a mean age of 9.4 yr were studied. Of 316, 324 and 149 children with rhinitis, asthma or eczema, respectively, 133 (42%), 78 (24%) and 45 (30%) had concomitant allergic conjunctivitis. One hundred and thirty-seven (30%) had allergic conjunctivitis, of whom 133 (97%) also had allergic rhinitis, 77 (56%) asthma and 45 (33%) eczema. One hundred and twenty-five (91%) of the children with allergic conjunctivitis had positive allergy tests to one or more allergens, sensitization to house dust mites being more frequent in chronic allergic conjunctivitis than in acute allergic conjunctivitis (95% vs. 53%; p < 0.01). Sensitization to grass was more frequent in children with acute allergic conjunctivitis (78% vs. 57%; p = 0.03). In a secondary pediatric outpatient clinic allergic conjunctivitis is a frequent co-morbidity to allergic rhinitis and to asthma and eczema. Allergic conjunctivitis need to be included as an important co-morbidity in future guidelines on asthma, rhinitis and eczema management.

Allergens↗
PubMed2007

Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients.

BACKGROUND AND OBJECTIVE: Pimecrolimus cream 1% is an effective treatment for atopic eczema. The aim was to investigate its efficacy in asteatotic eczema, a skin disease similar to atopic eczema and its associated dry skin and itching. METHODS: Single-centre, randomized, double-blind, vehicle controlled study in 40 patients with asteatotic eczema. Efficacy was assessed by eczema area and severity index (EASI), investigators global assessment (IGA), patient's self-assessment, and pruritus severity. RESULTS: After 4 weeks of treatment, EASI, the primary efficacy variable, was reduced by 62+/-7% from baseline in patients on pimecrolimus, compared to 21+/-14% in patients on vehicle (P=0.013). With pimecrolimus there was also a better control of pruritus (P=0.042) at week 4 whereas a better control of disease according to self-assessment could only be observed at weeks 2 (P=0.01) and week 3 (P=0.08). CONCLUSION: Pimecrolimus cream 1% is effective in patients with asteatotic eczema.

Adult↗
PubMed1984

Prevalence, incidence and course of eczema on the hands and forearms in a sample of the general population.

In 1979, the inhabitants of a geographically defined area were examined for skin disorders of the hands and forearms. In 1982 this cohort was invited for re-examination. In persons with eczema, patch testing was performed. Irritant factors were found to play a rôle in 73% of the cases, whereas a contact allergy could be detected in 30%. The most frequent allergens were nickel sulphate (20%), potassium dichromate (6%) and cobalt chloride (4%). In some persons with a definite history of allergy to metals, no positive patch test with nickel, chromate or cobalt could be obtained; other mechanisms may be involved. Significantly more positive patch tests were found among persons with an eczema of longer than 2 years duration compared with persons with eczema present for a shorter period of time, indicating that many cases of eczema are primarily of irritant nature, but later complicated by sensitisation. In 41%, the eczema was healed. A poor healing tendency was observed in those with a combination of irritant and allergic eczema. Relatively few ascribed healing to medical treatment.

Cross-Sectional Studies↗
PubMed1985

Work-related hand eczema in atopics.

549 individuals with severe (group 1), 406 with moderate (group 2) atopic dermatitis in childhood, 222 with respiratory allergy but no atopic dermatitis in childhood (group 3), and 199 without personal or family atopy (group 4) were studied as to occupational health symptoms due to hand eczema. In groups 1, 2 and 4, there was a slightly significant difference (P less than 0.05) between the frequency of hand eczema in individuals with and without occupational exposure to chemicals, water, soil or wear (friction). Despite no such work, 55% in group 1 and 44% in group 2 had developed hand eczema. About 1/4 of the atopics in extreme risk occupations, such as ladies' hairdressers and nursing assistants, had not developed hand eczema. Altogether, 9% in groups 1 and 2 and 3% in group 4 had changed their jobs due to hand eczema, the majority from work with to work without exposure to chemicals, water, soil or wear. Social factors had usually contributed to the change. The healing rate after taking up a new occupation was 15% in group 1, 36% in group 2 and 67% (4 out of 6) in group 4. The majority of the patients whose eczema had not healed had improved in their new occupations. It is claimed that medical reasons for change of occupation should be carefully weighed against social reasons.

Adolescent↗
PubMed1990

Consequences of having hand eczema.

Consequences of hand eczema were studied in 1238 patients who had the diagnosis confirmed in a prevalence study of hand eczema in the population of Gothenburg. It was found that 2/3 of the patients had consulted a doctor on some occasion and 1/5 had been on sick leave for their hand eczema. The mean total time on sick leave was 18.9 weeks, the median 8 weeks. Patients in service occupations reported more periods of sick leave than other occupational groups. Local steroid preparations were used by 1/2 the patients, emollients by 85%. Change of work was reported by 8% and was most common in service occupations. Hairdressers had the highest rate of change. 80% of the patients experienced some kind of disturbance to their social and emotional lives, considered to be caused by the hand eczema. Frequent itching was reported by 1/2 the patients, occasional itching by another 1/3. Comparing different types of hand eczema, allergic contact dermatitis seemed throughout to cause more serious consequences. It is concluded that good care of a hand eczema patient includes attention to the impact of the disease on the patient's total situation.

Absenteeism↗
PubMed1991

Risk factors for cement eczema.

Risk factors for cement eczema were studied among workers employed in the Danish construction industry. 2 cohorts exposed to cement containing different concentrations of water-soluble chromate were examined. A statistically significant decrease in the number of workers with allergic cement eczema was found in the cohort exposed to cement with the lower water-soluble chromate concentration. Allergic cement eczema was found to have a greater extent of involvement than irritant cement eczema. A 3rd cohort was followed to evaluate individual risk factors. The degree of exposure to wet cement seems to have a certain, though not statistically significant, effect on the risk of developing irritant cement eczema. Individual preventive measures, such as the use of gloves and creams, did not seem to reduce the development of irritant cement eczema.

Chromates↗
PubMed1995

Atopic dermatitis, nickel sensitivity and xerosis as risk factors for hand eczema in women.

Knowledge of the relationship between a history of atopic dermatitis and nickel sensitivity as risk factors for hand eczema is limited. Our objective was to study the relative importance of atopic manifestations and nickel sensitivity as risk factors for hand eczema in women. From women referred for patch testing with a dental series, 100 consecutive nickel-positive and 95 nickel-negative patients were studied. A history of atopic manifestations and a history of 5 symptoms of hand eczema, i.e., dry erythemas, maculopapules, vesicles, erosions and hyperkeratoses were recorded. A history of atopic dermatitis was found to increase the risk of the 5 symptoms of hand eczema and sick leave due to hand eczema highly significantly. Nickel sensitivity increased only the risk of vesicles and erosions. Xerosis increased the risk of dry erythemas and vesicles. We concluded that a history of atopic dermatitis was more important than nickel sensitivity as a risk factor for hand eczema in women.

Age of Onset↗
PubMed1996

Development of hand eczema in junior hairdressers: an 8-year follow-up study.

The development of hand eczema was evaluated in an 8-year follow-up study carried out in 51 junior hairdressers. Predisposing factors were investigated. Data were collected by use of a self-administered questionnaire: 74% response. None of the junior hairdressers presented with hand eczema at the start of the survey. After 8 years, however, 51% had developed hand eczema. No significant difference in prevalence of hand eczema was found between practicing and non-practicing hairdressers (58% versus 33%). Development of hand eczema was not related to atopic constitution or nickel sensitivity. Dry skin type was associated with increased risk of developing hand eczema.

Adult↗
PubMed1983

Breast feeding, eczema, asthma, and hayfever.

The association of breast feeding with rates of atopic illness during the first five years of life was assessed in a national study of 13 135 children studied during the first week and at age 5 years. Eczema was reported more often in children who had been breast fed; this relationship persisted even after allowance was made for social and family factors influencing the likelihood both of breast feeding and of eczema; the other factors most significantly associated with rates of eczema were parental history of eczema or asthma and advantaged family socioeconomic status. A similar, but less pronounced, positive association of breast feeding with reported hayfever became non-significant after adjustment for intervening factors. Rates of reported asthma were not influenced by breast feeding. "Any wheezing" including asthma was reported more often in children who had not been breast fed, but this association disappeared after adjustment for parental asthma and maternal smoking. Breast feeding does not appear to protect against these atopic diseases. The positive association with reported eczema might relate to accuracy of diagnosis or to associated influences not considered in the analysis; alternatively, it might be due to (recent) environmental contaminants crossing in breast milk, causing eczema in the child.

Asthma↗
PubMed2004

Influence of pimecrolimus cream 1% on different morphological signs of eczema in infants with atopic dermatitis.

BACKGROUND: In the published studies on the efficacy of the topical immunomodulator pimecrolimus, different eczema scores were used, and the impact on morphological key signs of eczema was not analysed. OBJECTIVE: To compare the influence of pimecrolimus cream 1% on different standard eczema scores in infants with atopic dermatitis and to analyse the impact of treatment on the individual morphological key signs of eczema. METHODS: Pimecrolimus cream 1% (n = 129) or double-blind vehicle control (n = 66) was administered for 4 weeks. The Eczema Area and Severity Index (EASI), Investigators' Global Assessment (IGA) and Scoring Atopic Dermatitis Index (SCORAD) were determined and were correlated with each other. RESULTS: Following treatment with pimecrolimus, the EASI, IGA and SCORAD were significantly reduced on day 29 as compared with the vehicle group (p < 0.001, p < 0.001, p = 0.002, respectively). There was a close correlation between EASI, IGA and SCORAD. The single parameters of the EASI were already significantly decreased by day 4 in the pimecrolimus group as compared to vehicle (each p < 0.001). CONCLUSION: Treatment with pimecrolimus 1% cream leads to a rapid improvement of all morphological signs of eczema. The close correlation of different scores was shown for the first time.

Administration, Topical↗
PubMed2007

Breastfeeding and infant eczema in the first year of life in the KOALA birth cohort study: a risk period-specific analysis.

OBJECTIVE: We studied the association between breastfeeding and eczema, taking into account the possible influence of reverse causation, with risk period-specific analyses. METHODS: Information on breastfeeding, determinants, and outcomes at 1 year of age was collected with repeated questionnaires for 2405 mother-infant pairs participating in the KOALA (Child, Parent and Health: Lifestyle and Genetic Constitution [in Dutch]) birth cohort study. By using multivariate logistic regression analysis, we compared an overall analysis with risk period-specific analyses. RESULTS: By the age of 1 year, 535 infants (22.2%) had developed eczema. In an overall analysis, we found a weak nonsignificant trend toward a reduced risk of eczema in the first year of life with increasing duration of breastfeeding (lowest risk for those breastfed for > or = 7 months versus never breastfed). In the risk period-specific analysis (confined to infants "at risk" for eczema onset after 3 months of age), no indication for reverse causation was found (results were not very different, compared with the overall analysis). Infants who were breastfed from birth on had a slightly (although not statistically significantly) increased risk for eczema in the first 3 months of life, compared with infants who were formula fed from birth on. CONCLUSIONS: Our results indicated that no strong effect of breastfeeding on eczema in the first year of life was present. This conclusion was strengthened by risk period-specific analysis, which made the influence of reverse causation unlikely.

Breast Feeding↗