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PubMedDate not supplied

Disulfiram and low nickel diet in the management of hand eczema: a clinical study.

BACKGROUND: Hand eczema due to nickel sensitivity is a challenging task for the dermatologist. The average human diet provides sufficient amount of nickel, which acts as a provocating factor in nickel-sensitive individuals. When such patients are treated with steroid or other immunosuppressives, only short-term remission is obtained. This is because unless the dietary intake of nickel is minimized and the existing amount of nickel in the body of the sensitized individual is depleted, long-term remission is unlikely. AIM: To evaluate the efficacy of oral disulfiram, a nickel-chelating agent and low nickel diet (LND) in reducing the clinical symptoms and preventing frequent relapse of hand eczema in nickel-sensitive individuals. METHODS: A total of 21 patients with chronic vesicular hand eczema with nickel sensitivity were taken for this study. Patients were randomly divided into two groups: (a) Study group consisting of 11 patients (8 females and 3 males). They were prescribed disulfiram orally for a period of 4 weeks; they started LND 2 weeks prior to initiation of disulfiram therapy and continued till the end of follow-up period. (b) Control (placebo) group consisting of 10 patients (7 females and 3 males). They were allowed to continue with normal diet. Each of them received lactose tablet daily as placebo for 4 weeks. It was a comparative study and participants were not aware if they belonged to study group or control group (single blind trial). RESULTS: Hand eczema healed completely in 10 (90.9%) out of 11 patients treated with disulfiram and LND during the treatment period in the study group, compared with 1 out 10 patients in control (placebo) group (non significant). Mild relapse was noted in 5 patients in between 2-12 weeks of follow-up period. CONCLUSION: Low nickel diet and short course of oral disulfiram therapy can be considered a good option for the control of chronic hand eczema in nickel-sensitive individuals.

Administration, Oral↗
PubMed2005

Asthma, atopic eczema and allergic rhino-conjunctivitis in school children.

International Study of Asthma and Allergies of Childhood (ISAAC) phase one study had already been completed in two age groups in 156 collaborating centers of 56 countries involving a total of 721601 children. Bangladesh did not participate earlier in this worldwide study. To determine the prevalence of asthma, allergic rhinitis and eczema in school children of Dhaka district using ISAAC protocol. A school based cross sectional study done in 2000 by using both written questionnaires (WQ) and video questionnaires (VQ). Students of class-VIII (13-14 years) filled up both the WQ and VQ and the parents of class I (6-7 years) filled up only the WQ on behalf of the students. Sixty five (6)5 primary schools and 39 high schools were randomly selected from all 19 thanas to cover equally both the urban and rural schools of the entire area of Dhaka district. A total of 6260 written questionnaires were eligible for the analysis (3029 form 6-7 years of class I and 3231 from 13-14 years of class VIII). In addition, the validated international video questionnaires were used for the older age group (3231). The symptoms of atopic diseases in the previous 12 months or ever in all children, both age groups, both sexes and in both urban and rural areas. The life time (ever) and 12-month period (recent) prevalence of three allergic conditions with 95% CI were as follows : wheezing 13.8% (12.9-14.6), 7.6% (6.9-8.2); allergic rhinitis 25.0% (23.9-26.1), 20.0% (19.1-21.1) and eczema 8.7% (CI 8.0-9.4), 6.5% (5.9-7.2). respectively. The prevalence of wheezing and other atopic features in both age groups of 6-7 years and 13-14 years showed higher features of recent wheeze in the younger children than in the older children, recent wheeze 9.1% Vs 6.1%; but the other atopic features were found lower in younger age group, recent rhinitis 16.3% Vs 23.5%, 0.001; conjunctivitis 6.4% Vs 8.3%, 0.001; recent eczema 6.0% Vs 7.1% 0.001. Male children were found to be more suffering from all types allergic conditions than their female peers: recent wheeze 9.0% Vs 5.9%, recent rhinitis 21.9% Vs 17.9%, recent allergic conjunctivitis 8.7% Vs 6.7% and recent eczema 6.8% Vs 6.2%). Though the prevalence of asthma and atopic eczema was lower than those of developed countries but still appeared to be a major health problem for our children. Allergic rhinitis was the commonest of all atopic problems in children. The younger children (6-7 years) were more likely to suffer from wheeze (asthma) but other allergic problems were more in older group of children (13-14 years). Male children were more prone to all types of allergic problems, whether wheeze or other atopic conditions, than the female peers.

Adolescent↗
PubMed1992

Noninvasive measuring methods for the investigation of irritant patch test reactions. A study of patients with hand eczema, atopic dermatitis and controls.

The aim of the study was to assess the susceptibility of clinically normal skin to a standard irritant trauma under varying physiological and patophysiological conditions. Evaluation of skin responses to patch tests with sodium lauryl sulphate (SLS) was used for assessment of skin susceptibility. The following noninvasive measuring methods were used for evaluation of the skin before and after exposure to irritants: measurement of transepidermal water loss by an evaporimeter, measurement of electrical conductance by a hydrometer, measurement of skin blood flow by laser Doppler flowmetry, measurement of skin colour by a colorimeter and measurement of skin thickness by ultrasound A-scan. The studies were carried out on healthy volunteers and patients with eczema. In the first studies the standard irritant patch test for assessment of skin susceptibility was characterized and validated. SLS was chosen among other irritants because of its ability to penetrate and impair the skin barrier. The implications of use of different qualities of SLS was investigated. The applied noninvasive measuring methods were evaluated, and for quantification of SLS-induced skin damage measurement of TEWL was found to be the most sensitive method. Application of the standard test on clinically normal skin under varying physiological and patophysiological conditions lead to the following main results: Seasonal variation in skin susceptibility to SLS was found, with increased susceptibility in winter, when the hydration state of the stratum corneum was also found to be decreased. A variation in skin reactivity to SLS during the menstrual cycle was demonstrated, with an increased skin response at day 1 as compared to days 9-11 in the menstrual cycle. The presence of active eczema distant from the test site increased skin susceptibility to SLS, indicating a generalized hyperreactivity of the skin. Taking these sources of variation into account healthy volunteers and patients with hand eczema and atopic dermatits were studied and compared. In healthy volunteers increased baseline TEWL and increased light reflection from the skin, interpreted as "fair" skin, was found to be associated with increased susceptibility to SLS. Hand eczema patients were found to have fairer and thinner skin than matched controls. Increased susceptibility to SLS was found only in patients with acute eczema. Patients with atopic dermatitis had increased baseline TEWL as well as increased skin susceptibility as compared to controls. Skin susceptibility is thus influenced by individual- as well as environment-related factors. Knowledge of determinants of skin susceptibility may be useful for the identification of high-risk subjects for development of irritant contact dermatitis, and may help to prevent the formation of the disease.

Colorimetry↗
PubMed2006

[Epidemiology and pathophysiology of eczemas].

Pathophysiological characteristics of these two types of eczema, both involve antigen specific effector T lymphocytes and down-regulatory CD4+ T cells (Treg). These cells are responsible for the cutaneous inflammatory response through the production of inflammatory cytokines and the destruction of keratinocytes by apoptosis. The main difference between these two types of disease is the nature of the environmental antigen. Indeed, protein allergens are involved in cases of atopic dermatitis whereas non protein chemicals (calles haptens) are responsible for allergic contact dermatitis. The skin lesions of eczema follow the activation of antigen specific T lymphocytes within the skin, leading to the production of inflammatory cytokines and to the destruction of keratinocytes by apoptosis. CD4+ Treg cells are endowed with down-regulatory and tolerogenic functions since they limit the skin inflammation in patients and prevent sensitization and induction of eczema in normal individuals. Eczema should therefore be considered as inflammatory dermatoses caused by the loss of immune tolerance to environmental antigens. Different strategies capable of restoring immune tolerance could avoid eczema outbursts and/or induce prolonged remissions of the disease.

Eczema↗
PubMed1990

Early solid feeding and recurrent childhood eczema: a 10-year longitudinal study.

The relationship between early solid feeding practices and risks of recurrent or chronic eczema in childhood was examined in a birth cohort of New Zealand children studied to the age of 10. By the age of 10 years, 7.5% of children had chronic or recurrent eczema. There were clear and consistent associations between the diversity of the child's diet during the first 4 months and risks of eczema. Even when due allowance was made for a range of confounding factors--including parental atopic illness, atopic illness in siblings, the child's early milk diet, and family social background--children exposed to four or more different types of solid food before 4 months had risks of recurrent or chronic eczema that were 2.9 times those of children who were not exposed to early solid feeding. It is concluded that early exposure to a diet diverse in potential food antigens may act to predispose susceptible children to recurrent or chronic childhood eczema.

Chronic Disease↗
PubMed1989

[Clinico-epidemiologic characteristics of eczema in patients with arterial hypertension].

A statistical analysis of 1007 eczema case histories has revealed arterial hypertension, mostly in bacterial eczema, in 24.8% of patients. A close multiple-factor relationship between eczema clinical manifestations and course and the presence of concomitant hypertension was revealed. A direct correlation was detected between the patients' age, sex, clinical manifestations and involved skin area in eczema and the level of arterial pressure. The authors emphasize that the detected specificities of eczema course in the presence of hypertension indicate a certain relationship between these diseases involving manifest abnormalities in the skin microcirculatory bed.

Age Factors↗
PubMed1998

Prevalence of asthma, rhinitis and eczema in children from the Bangkok area using the ISAAC (International Study for Asthma and Allergy in Children) questionnaires.

Within the past three decades, there has been a rising trend for prevalences of asthma and allergic diseases worldwide, particularly from developed and industrializing countries. In Thailand, limited studies on epidemiology of atopic diseases have indicated relatively low prevalences of these conditions among the Thais. Recently, a standardized phase I questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) has been developed to study and to compare geographical and temporal trend for prevalences of asthma, allergic rhinitis and eczema in children. The objectives of phase I ISAAC study in Thailand are to study prevalence of the three most common allergic diseases i.e. asthma, allergic rhinitis and eczema among Thai children of the two age groups (i.e., 6-7 and 13-14 years) living in the Bangkok metropolitan area and to collect basic epidemiologic data of these diseases among these children. The Thai translated version of phase I ISAAC questionnaires was administered to Thai children of the two age groups as above. Questionnaires were answered by parents of younger children, whereas, they were self-administered by 13-14 years old children. In addition, the validated international video questionnaires were used with older children. Fourteen primary schools and 13 secondary schools were randomly selected to cover the entire Bangkok metropolitan area. A total of 7341 questionnaires were eligible for the analysis (3628 from the younger age group and 3713 from the older age group). Data were entered and analysed by the Epi-Info program. The cumulative and 12 month period prevalences of the three conditions for all children were as follows; wheezing, 18.3 per cent, 12.7 per cent; rhinitis, 44.2 per cent, 38.7 per cent; and eczema, 15.4 per cent, 14.0 per cent, respectively. The period prevalence of wheezing for older children (13.6%) was higher than for younger children (11.7%). Prevalences of severe wheeze and exercise wheeze were more common among older children (4.0% and 15.7%). Both age groups reported high percentages for night cough (23.6% and 28.6%). A significantly large number of children from both groups reported symptoms of rhinitis with the majority indicating that symptoms were severe enough to limit their daily activities. Nevertheless, when confined only to those with eye symptoms, the prevalence decreased to 13.1 per cent. Eczema, in contrast to the other two conditions, occurred more frequently among younger children than among older children (period prevalence of 16% vs 9.1%). The rash was of a relatively mild nature since 77 per cent of children reporting symptoms indicated that the rash had cleared within the past 12 months. Allergic conditions are very common among children residing in Bangkok. Compared to the last survey in 1990, the period prevalence of wheezing has increased 4 fold, allergic rhinitis has increased nearly 3 fold whereas, eczema has remained stable. A large number of children in Bangkok are suffering from rhinitis symptoms. Results of this phase I ISAAC study indicate that allergic diseases are perhaps the most common childhood diseases in Thailand and could lead to a substantial economical loss for the country. There is an urgent need for an in-depth study to define epidemiological factors responsible for this increase.

Adolescent↗
PubMed1998

Hand eczema.

Hand eczema is a common disorder of healthcare providers. The pattern of eczema can help to distinguish endogenous (dyshidrosis, atopy) causes from exogenous (contact irritant and allergic dermatitis) and the common differential diagnoses (psoriasis, fungus infections). Appropriate strength topical steroids, moisturizers, antibacterials, and systemic agents are all used to treat hand eczema depending on the type of eczema and its severity. Patients with contact allergic eczema should be assessed for possible latex allergy.

Adult↗
PubMed2000

Outcome measures of disease severity in atopic eczema.

BACKGROUND: An essential component of evidence-based medicine is the use of valid and reliable outcome measures in clinical trials. There is much confusion in the field of atopic eczema regarding how to best measure disease severity objectively. OBJECTIVE: To establish the extent to which existing objective clinical scales for atopic eczema have been tested for validity, reliability, sensitivity to change, and acceptability. DESIGN: An electronic bibliographic search was performed for published data on all currently available named atopic eczema scales. RESULTS: Thirteen scales were identified in total. Data on construct or criterion validity were available for 10 scales. Only 5 scales had been tested for reliability (interobserver variability, intraobserver variability, or internal consistency). Data on responsiveness to change were available for 8 scales. An estimated time to administer the measure had been given for 3 scales. The only severity scale for which published data could be found on validity, reliability, sensitivity, and acceptability testing was the Severity Scoring of Atopic Dermatitis index, although problems occurred with interobserver variation of the index. CONCLUSION: The rapidly increasing number of severity scales for atopic eczema, many of which have been inadequately tested, has made the interpretation of patient outcomes confusing, and comparison of results between studies almost impossible. Consensus among clinicians and researchers on the use of severity scales for atopic eczema should be based on evidence of adequate validity), reliability, sensitivity to change, and ease of use.

Clinical Trials as Topic↗
PubMed2005

Measuring atopic eczema severity visually: which variables are most important to patients?

BACKGROUND: There is wide variation in the objective visual variables used to measure atopic eczema severity in clinical trials, making comparison and interpretation of results difficult. OBJECTIVE: To provide a rationale for simplifying and standardizing objective atopic eczema scoring by investigating which visual variables provide the best measure of disease severity from the patient's perspective. SETTING: The dermatology outpatient department at the Queen's Medical Centre, University Hospital in Nottingham, and 5 local general practices. PATIENTS: One hundred eighty individuals with atopic eczema. INTERVENTIONS: Clinical examination with scoring of 7 clinical signs and disease extent, followed by regression analyses of visual variable scores against a patient-rated measure of current disease severity. RESULTS: Objective measurements account for only a quarter of the variation in patient-rated disease severity. Three clinical signs were independent predictors of patient-rated disease severity: excoriations, erythema, and edema/papulation. Disease extent measurements do not reflect patient-rated disease severity in a linear manner, with mean severity scores increasing little above 30% body surface area involvement. CONCLUSIONS: From the patient's perspective, the measurement of 3 clinical signs-excoriations, erythema, and edema/papulation-provides as much information about current atopic eczema severity as more complex scoring systems that measure multiple clinical signs and disease extent. The simplicity of the Three Item Severity score, a previously published atopic eczema score based on measurement of these 3 clinical signs, makes it a suitable tool for research studies or clinical practice.

Adolescent↗
PubMed2000

Maternal antigen avoidance during lactation for preventing atopic eczema in infants.

OBJECTIVES: To assess the effects of prescribing an antigen avoidance diet to lactating mothers of infants with atopic eczema on the severity of the eczema. SEARCH STRATEGY: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. SELECTION CRITERIA: All acceptably controlled comparisons of maternal antigen avoidance prescribed to lactating mothers of infants with atopic eczema, regardless of the degree of antigen avoidance (number of foods eliminated from the diet) or its duration. DATA COLLECTION AND ANALYSIS: Data were extracted by the author from published reports, and supplemented by additional information from trialists contacted by the author. MAIN RESULTS: One trial involving 17 women was included. Based on this single small trial, maternal antigen avoidance was associated with a nonsignificant reduction in eczema severity. REVIEWER'S CONCLUSIONS: The unimpressive results of this single trial should be interpreted with caution both because of its small size (n=17) and because the trial compared exposure to cow milk and egg with exposure to soya milk (soya can itself be allergenic). Maternal reports of changes in the severity of their breast-fed infants' eczema following ingestion of certain foods should be pursued by performing multiple (preferably double-blinded) challenges and dechallenges with the suspected foods.

Dermatitis, Atopic↗
PubMed2005

[Prevention of atopic eczema. Evidence based guidelines].

With an estimated prevalence of 12% for preschool children and 3% for adults, atopic eczema is a serious public health problem. This disease severely jeopardizes quality of life and is associated with considerable costs. Since there is still no causal therapy, primary and secondary prevention are especially important. Here the evidence basis for recommendations on prevention of atopic eczema is discussed on the basis of the first evidence-based consensus guideline (S3) on allergy prevention. This recommends that babies should be breastfed exclusively for at least 4 months and exposure to passive smoking be avoided even during pregnancy; restriction of the maternal diet during pregnancy has no influence, though during breastfeeding it can lower the incidence of eczema among babies at risk. Thereby this measure should be balanced with potential consequences of malnutrition. There seems to be a positive correlation between keeping small rodents (rabbits, guinea pigs), and possibly cats, and the occurrence of atopic eczema, while keeping dogs has no effect or even a protective effect. Avoidance of an unfavorable indoor climate is probably also helpful in preventing eczema. There is no evidence to support deviating from the current recommendations of the standing committee for vaccination.

Clinical Trials as Topic↗
PubMed1991

Prevention of dryness and eczema of the hands of hospital staff by emulsion cleansing instead of washing with soap.

The acceptability of two handwashing/cleansing methods, cleansing with emulsion or washing with liquid soap and water, were compared in a randomized, prospective long-term study. Thirty-eight members of hospital staff who had a history of hand skin dryness or eczema and a need for frequent handwashing used either liquid soap or emulsion for handwashing or cleansing. The clinical assessment of skin condition was done blindly by the same dermatologist at the onset of the study, and after 2 and 4 months with a predetermined scoring system. The median skin dryness index of persons in the liquid soap group increased significantly from an initial 1.4 to 3.6 during the 4-month winter study period (P less than 0.001), while the corresponding figure in the emulsion group decreased during the same time from 1.9 to 1.1 (P = 0.053). The difference in dryness between the groups was significant after 2 months (P = 0.04) and after 4 months (P less than 0.001). After 4 months, six people in the emulsion group had no dryness of the hands compared to only one in the liquid soap group. Similar trends were noticed in the occurrence of eczema. The median eczema index decreased significantly in the emulsion group from 0.4 to 0.1 during the study. In the liquid soap group, the increase in the median eczema index was from 0.4 to 0.7 (difference not significant). On an individual level, the eczema became worse in only one subject in the emulsion group, but in seven in the liquid soap group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Onset of action of pimecrolimus cream 1% in the treatment of atopic eczema in infants.

BACKGROUND: Data on the efficacy of pimecrolimus cream 1% within the first days of treatment are scarce, as in previous studies, the first postbaseline assessment was performed only after 1 week. OBJECTIVE: We sought to investigate the onset of action of pimecrolimus cream 1% in infants with mild to very severe atopic eczema. METHODS: We used pimecrolimus cream 1% (n = 129) or vehicle cream (n = 66) administered in a double-blind manner for 4 weeks and then open-label pimecrolimus cream 1% for 12 weeks, with a 4-week follow-up period. RESULTS: Pimecrolimus cream 1% reduced the mean Eczema Area and Severity Index at 4 weeks by 71.5% compared with an increase of 19.4% with vehicle ( P < .001). The reduction in the Eczema Area and Severity Index with pimecrolimus cream 1% was significant at day 4 (38.5% vs 17.6% increase with vehicle). Significant improvements in caregivers' assessments of pruritus and sleep loss were observed with pimecrolimus cream 1% by day 2 ( P < .03) and day 3 ( P = .002), respectively, compared with vehicle. Responses to pimecrolimus cream 1% were sustained during the open-label phase, and pimecrolimus cream 1% was well tolerated. Symptoms of atopic eczema returned gradually after discontinuation. CONCLUSION: Pimecrolimus cream 1% was well tolerated and effective in patients with mild to very severe atopic eczema, with rapid onset of action and no disease rebound after discontinuation.

Dermatitis, Atopic↗
PubMed1996

Evaluation of the gut mucosal barrier: evidence for increased antigen transfer in children with atopic eczema.

BACKGROUND: Intestinal antigen handling determines subsequent immune response to the antigen. Antigens are absorbed across epithelium along two functional pathways. The main pathway is degradative, which reduces the immunogenicity of the antigen. A minor pathway allows the transport of intact proteins, which is crucial for antigen-specific immune responses. The Ussing chamber method allows the quantitative measurement of protein transfer across the intestinal mucosa. OBJECTIVE: This study was designed to explore the theory that altered antigen transfer across the intestinal mucosa is a factor in the pathogenesis of atopic eczema, characterized by hyperactivity to environmental antigens. METHODS: The absorption and degradation of horseradish peroxidase (molecular weight, 40,000 d) were studied in vitro in Ussing chambers. Eighteen biopsy specimens of upper small intestinal mucosa from 14 patients (aged 0.5 to 8 years) with atopic eczema and 18 specimens from 15 age-matched control subjects were examined. RESULTS: The mean (95% confidence interval) absorption of intact horseradish peroxidase was significantly higher in children with atopic eczema than in control subjects: 242 (81-404) pmol . hr(-1) . cm(-2) versus 23 (12-33) pmol . hr(-1) . cm(-2); t = 2.86, p = 0.007. The absorption of degraded horseradish peroxidase was 972 (732-1213) pmol . hr(-1) . cm(-2) in patients with atopic eczema and 672 (532-811) pmol . hr(-1) . cm(-2) in control subjects; t = 2.29, p = 0.03. CONCLUSIONS: Our results may reflect a primarily altered antigen transfer in patients who have atopic eczema, which may initiate and perpetuate prompt immune responses to common environmental antigens, including foods.

Allergens↗
PubMed1999

Identifying genes predisposing to atopic eczema.

BACKGROUND: Genetic and environmental factors are known to play a role in the development of atopic diseases, such as asthma, eczema, and rhinitis. However, the atopy gene (or genes) has yet to be defined. Studies of familial asthma have identified several regions that may contain genes predisposing to atopy, but the data for candidate regions do not show agreement, which may be due to heterogeneity, ascertainment bias, or stochastic factors. Factors such as an early age of onset, a positive family history, and a clearly defined phenotype favor a genetic origin and improve the chance of identifying genes that predispose to atopy. OBJECTIVE: We sought to define genes that predispose to the development of atopic eczema. METHODS: We have studied nuclear families with multiple cases of early-onset atopic eczema for involvement of the candidate regions on chromosomes 5q31 (IL gene cluster), 11q13 (high-affinity FCepsilon receptor), 14q11.2 (mast cell chymase), and 16p12 (IL-4 receptor alpha-chain, IL4RA gene). RESULTS: Using a recessive model, we find a maximum parametric log of the odds of linkage score of 2. 25 and nonparametric score of 2.54 (P =.006) for a region on chromosome 5q31, which we postulate contains a gene predisposing to atopic eczema, but lack of support for linkage to 11q13. Transmission disequilibrium tests do not support an association with candidate polymorphisms in the mast cell chymase and IL4RA genes. CONCLUSION: We have identified a clinically homogeneous cohort of patients with atopic eczema to identify genetic factors predisposing to the development of atopy. We postulate that there are certain loci that predispose to atopy in general and other loci that determine which of the atopic phenotypes is expressed.

Adolescent↗
PubMed2003

Close association of predominant genotype of herpes simplex virus type 1 with eczema herpeticum analyzed using restriction fragment length polymorphism of polymerase chain reaction.

Herpes simplex virus type 1 (HSV-1) strains belonging to the same genotype can possibly share biological properties and clinical manifestations common to the genotype. We classified previously 66 HSV-1 strains into 35 genotypes (F1-F35) using restriction fragment length polymorphism (RFLP) and F1 and F35 genotypes were revealed to be predominant [Arch. Virol. 13 (1993) 29]. It was found later that the F35 genotype seemed to be closely associated with eczema herpeticum [J. Med. Virol. 49 (1996) 329]. In the present study, a convenient method was developed for classification of two predominant genotypes by RFLP of polymerase chain reaction (RFLP-PCR). Using this method, genotypes of 21 strains isolated from eczema herpeticum were analyzed; seven of 21 strains (33.3%) were of F1 and five of 21 (23.8%) were of F35. Genotypes of 19 strains isolated from facial herpes other than eczema herpeticum were as follows; six of 19 (31.6%) strains were of F1 and one of 19 (5.3%) were of F35. Thus, strains belonging to F35 were appear to have been isolated more frequently from eczema herpeticum (5/21) than from facial herpes (1/19). These ratios showed a statistically significant difference. These results support the hypothesis that F35 strains is clearly associated with eczema herpeticum, in agreement with previous study. This is the first report of PCR-based approach for classification of HSV-1 strains into genotypes seeking an association of a genotype with clinical manifestation.

Dermatitis, Atopic↗
PubMed1999

Quality of life, health-state utilities and willingness to pay in patients with psoriasis and atopic eczema.

Skin diseases have been shown to have a significant adverse impact on the health-related quality of life of patients that may be underestimated by objective assessments of clinical severity. The main aim of this study was to measure the health-state utilities on a scale between 0 (dead) and 1 (full health) of patients with psoriasis and atopic eczema, and to measure the willingness to pay for a cure for psoriasis and atopic eczema. A second aim was to analyse how these measures are related to different dimensions of health-related quality of life, as measured by general and disease-specific quality of life instruments and a subjective measure of disability activity. This study was based on data from a questionnaire administered to, and interviews conducted with, 366 patients with psoriasis and atopic eczema aged 17-73 years, attending the dermatology outpatient clinic in Uppsala, Sweden from November 1996 to December 1997. The survey included: a rating scale question, a time trade-off question, a standard gamble question, a dichotomous choice willingness to pay question, a bidding-game willingness to pay question, a generic quality of life instrument (SF-36), a disease-specific quality of life instrument (the Dermatology Life Quality Index) and a subjective measure of disease activity (on a visual analogue scale). The mean health-state utility was 0.69 (rating scale), 0.88 (time trade-off) and 0.97 (standard gamble) for patients with psoriasis. The corresponding health-state utilities for patients with atopic eczema were 0.73, 0.93 and 0.98. On average, patients were willing to pay between 1253 and 1956 Swedish crowns (SEK) per month for a psoriasis cure and between SEK 960 and 1083 per month for an atopic eczema cure ($1 = SEK 8.25 and pound1 = SEK 13.23). The health-state utilities were related to SF-36, the Dermatology Life Quality Index and disease activity in the expected direction and the correlations were strongest for rating scale and weakest for standard gamble. The willingness to pay was correlated with the Dermatology Life Quality Index and disease activity, but not with SF-36. The study indicates that it is feasible to measure health-state utilities and willingness to pay in this patient population, and the sizeable willingness to pay suggests that skin diseases are associated with substantial reductions in quality of life.

Adolescent↗