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PubMed2006

Distinct pattern of commensal gut microbiota in toddlers with eczema.

BACKGROUND: Recent studies have demonstrated differences in the composition of gut microbiota in infants with and without allergic diseases, particularly eczema. METHODS: A case-control study involving 21 toddlers (age 3.0 +/- 0.5 years) with and 28 age-matched toddlers without eczema was conducted. Four groups of aerobic gut microbiota were identified and quantitated in stool samples grown on selective media. Three groups of anaerobes were enumerated by fluorescent in situ hybridization followed by quantitative flow cytometry. We also performed molecular typing of lactic-acid-producing bacteria (LAB) and enterococcal isolates to facilitate detailed analysis at species level by bacterial 16S rDNA sequencing. RESULTS: Toddlers with eczema harbored significantly lower counts of Bifidobacterium [(median 0.14 (25th and 75th percentile: 0.04 and 0.47) vs. 0.71% (0.16, 1.79) of cells acquired, p = 0.003)] and Clostridium [(0.28 (0.09, 0.78) vs. 0.83% (0.35, 1.82) of cells acquired, p = 0.012)] but significantly higher counts of total LAB [7.3 (6.1, 8.5) vs. 5.7 (4.4, 7.3) log CFU/g, p = 0.006] in particular enterococci [6.3 (4.8, 7.4) vs. 5.0 (3.4, 6.4) log CFU/g, p = 0.018]. There was no significant correlation between eczema severity score and bifidobacterial counts. CONCLUSION: The results further confirm previous reports that the gut microecosystem differs between children with and without eczema and extend them beyond infancy.

Bacteroides↗

PubMed2006

Factors promoting psychological adjustment to childhood atopic eczema.

Research has found that children with atopic eczema are more likely to experience psychosocial difficulties than would be expected within the general population. This article aims to explore the relationship between child, parent and family factors in promoting positive adjustment to atopic eczema. Children aged five to 11 years with atopic eczema and their parents were identified from a specialist children's dermatology clinic. Seventy-four respondents completed questionnaires assessing child behaviour, parental well-being and family functioning. Parental psychological health, a supportive family environment and low impact of atopic eczema on family functioning were found to predict lower levels of internalizing behaviour (anxiety, depression and social withdrawal). These findings emphasize the importance of family and parental psychological processes rather than biomedical variables in promoting positive adjustment to atopic eczema.

Adaptation, Psychological↗

PubMed2007

Genetics of parentally reported asthma, eczema and rhinitis in 5-yr-old twins.

The aim of the present study was to examine the genetic and environmental contributions to the individual differences in susceptibility to asthma, eczema and rhinitis in childhood and their role in the association among these conditions. Information on asthma, eczema and rhinitis was obtained by parental report. Parents were asked whether a physician had ever diagnosed the condition. Complete data were available for 8,633 5-yr-old twin pairs born between 1986 and 1998. The frequency of parentally reported asthma, eczema and rhinitis was 8.7, 16.8 and 4.4%, respectively, and was higher in males than females. Genetic factors accounted for approximately 90% of the variance in the susceptibility to asthma, eczema and rhinitis. The magnitude of genetic factors did not differ between males and females. The remaining part of the variance was explained by environmental factors not shared by family members. The phenotypic correlations between parentally reported asthma, eczema and rhinitis were moderate and mainly mediated by the same genetic factors. The high heritability and the limited influence of shared environmental factors may point to gene x environment interactions. Future research should focus on this type of interaction processes.

Asthma↗

PubMedDate not supplied

The benefits of Tubifast Garments in the management of atopic eczema.

Atopic eczema is a chronic inflammatory condition affecting mainly children and is one of the most common skin disorders in the Western world. It has a strong genetic component associated with atopic conditions such as asthma, hayfever or urticaria. The onset is usually within the first year of life and it affects mainly the face, after which the pattern often changes to involvement of the flexures. The most prominent characteristic of atopic eczema is pruritus (itch) together with dry skin. An important treatment of atopic eczema is the application of emollients (moisturizers) to rehydrate and restore the barrier function of the skin. Wet wrapping using large quantities of emollients is a well recognized therapy for atopic eczema and other dry skin conditions. The introduction of new Tubifast Garments by Medlock Medical makes this topical therapy easy to apply for parents and carers in the management of children's eczema.

Administration, Topical↗

PubMed1995

Histamine-induced itch and alloknesis (itchy skin) in atopic eczema patients and controls.

Alloknesis ("itchy skin") after histamine iontophoresis was studied together with itch sensations and skin reactions in 19 atopic eczema patients and 20 controls at the forearm and at the scapular area. Compared to controls, atopic eczema patients showed significantly reduced alloknesis or total lack of it in the area around a skin site to which histamine had been iontophoretically applied, although histamine elicited itching in most patients. As previously demonstrated, patients with atopic eczema also developed significantly smaller flares. However, covariance analysis revealed that the smaller alloknesis areas in atopic patients were not statistically related to the smaller flares. Our results suggest that in atopic eczema a diminished responsiveness of primary afferent nerves to histamine is not compensated by a higher central nervous sensitivity reflected in more vivid alloknesis responses to histamine. Therefore, we conclude that histamine is probably not the key factor of the spontaneous itch experienced by patients with atopic eczema.

Administration, Cutaneous↗

PubMed2005

[Varicose eczema: the etiology, pathogenesis and diagnosis. Part I].

Varicose eczema is a prevalent complication of chronic venous insufficiency. In view of the fact that the complicated forms of chronic venous insufficiency (classes 4-6 according to the clinical classification CEAP) are marked by the presence of dermatological changes, the reliable diagnosis of the given pathology is fairly pressing. The diagnosis of varicose eczema may be difficult for the phlebologist and, not infrequently, for the dermatologist because of the diversity of its manifestations. Besides, there is a number of diseases which resemble varicose eczema but require a different approach to their treatment. The Russian literature practically lacks the papers related to varicose eczema. The problems of the diagnosis and treatment including organizational questions have not been worked out. The surgeons regard this disease as dermatologic whereas the dermatologists consider it as surgical. As a result, the majority of patients do not receive adequate treatment. This paper covers the phlebologist's viewpoint of the problem of varicose eczema.

Chronic Disease↗

PubMed1985

Breast feeding as prophylaxis for atopic eczema: a controlled study of 368 cases.

The present study was undertaken in an attempt to draw data whether breast-feeding is beneficial in prevention of atopic eczema. Three-hundred and sixty-eight babies given different feeding modalities were examined for the presence of atopic eczema at the age of three and six months. Seven percent of breast-fed infants developed eczema compared to 10% of formulae-fed and 6% of mixed breast and formulae-fed infants. No difference in the severity of atopic eczema was recorded in the three study groups. Our experience demonstrates the absence of a protective effect of breast-feeding against the development and severity of atopic eczema.

Breast Feeding↗

PubMed1998

Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee.

BACKGROUND: Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema. METHODS: We studied 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children. FINDINGS: We found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema, with four-fold to 12-fold variations between the 10th and 90th percentiles for the different disorders. For asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia. For allergic rhinoconjunctivitis, the centres with the highest prevalences were scattered across the world. The centres with the lowest prevalences were similar to those for asthma symptoms. For atopic eczema, the highest prevalences came from scattered centres, including some from Scandinavia and Africa that were not among centres with the highest asthma prevalences; the lowest prevalence rates of atopic eczema were similar in centres, as for asthma symptoms. INTERPRETATION: The variation in the prevalences of asthma, allergic rhinoconjunctivitis, and atopic-eczema symptoms is striking between different centres throughout the world. These findings will form the basis of further studies to investigate factors that potentially lead to these international patterns.

Adolescent↗

PubMed2000

Dyshidrotic eczema and occupation: a descriptive study.

Dyshidrotic eczema (DE) is a chronic and/or recurrent vesicular eczema of the palmar sides of the hands and sometimes the soles of the feet. The major aetiologies to be considered are atopic DE, contact DE, systemic contact DE and DE due to fungal or microbial allergy. To clarify the role of occupational contact allergens, 59 workers with DE were examined to determine whether they had atopy, environmental contact sensitization and/or contact allergy coupled with work activity. For all, patch testing was carried out using the European standard series and the material brought in by the patients. No significant difference was found between the rate (42.4%) of history of atopy among the 59 workers with DE and that (30.6%) observed among 160 workers with other forms of hand eczema (HE). Positive patch test reactions were found in 72.8% of dyshidrotic patients. A relationship to occupational activity was strong for 18 (30.5%) of them but this rate was significantly lower than that (55%) observed among the 160 with other types of eczema. Results of the present study showed that contact sensitization is as much involved in workers with DE as in workers with other form of HE, even though the relationship to work is significantly less frequent for DE. It also suggests that atopic histories are no more involved in DE than in other forms of HE.

Adolescent↗

PubMed2002

Maternal history, sensitization to allergens, and current wheezing, rhinitis, and eczema among children in Costa Rica.

Little is known about the factors associated with asthma, allergic rhinitis, and eczema in Latin American countries. We investigated the relation between potential risk factors and current wheezing, allergic rhinitis, and eczema among 208 Costa Rican children aged 10-13 years participating in phase II of the International Study of Asthma and Allergies in Childhood (ISAAC). The geometric mean ( +/- SD) serum total IgE level of children with current wheezing was significantly higher than that of children without current wheezing (533.8 +/- 5.2 vs. 144.7 +/- 6.0 IU/mL, P < 0.01). In a multivariate analysis, a maternal history of asthma, skin test reactivity (STR) to house dust mites, and STR to Alternaria were significantly associated with current wheezing. Children who had a maternal history of asthma had 2.4 times higher odds of current wheezing than those without maternal history of asthma (95% CI for OR = 1.1-5.3). Sensitization to either house dust mite or Alternaria was associated with 3.3 times increased odds of current wheezing (95% CI for OR for STR to dust mite = 1.6-6.7; 95% CI for OR for STR to Alternaria = 1.1-11.0). In a multivariate analysis, STR to house dust mite and STR to cat dander were significantly associated with allergic rhinitis, and a maternal history of eczema and STR to dog dander were associated with eczema in the child. The interaction between familial factors and lifestyle changes resulting from social reforms implemented 60 years ago may explain the high prevalence of atopic diseases in Costa Rica.

Adolescent↗

PubMed1998

[Therapy of hyperhidrosis with tap water iontophoresis. Positive effect on healing time and lack of recurrence in hand-foot eczema].

Hyperhidrosis is due to an overfunction of eccrine glands (triggered by the autonomous nervous system) and may be a cofactor for palmoplantar eczema (dermatitis). Tapwater iontophoresis was used in 54 patients with hyperhidrosis manuum et pedum. After 10 applications directed by the dermatologist, 89% of patients noted an improvement in their hyperhidrosis. 20 patients suffering from palmoplantar eczema (dermatitis) who continued the treatment at home for at least 6 months were compared with a historical sex- and age-matched group of 20 eczema-patients without iontophoresis: The factors evaluated were the time needed for clearing and the relapse-free interval. Though iontophoresis-treated patients had a slightly faster clearing, this was statistically not significant (20 vs. 22.3 days; p > 0.05). However, the difference for relapse-free interval between the two groups was statistically highly significant (24.8 weeks vs. 8.35 weeks; p < 0.0001). Tapwater iontophoresis seems to be effective not only to control sweating. According to recently published data, galvanization seems to have a capsaicin-like effect as well. Our hypothesis is therefore, that galvanization with tapwater iontophoresis interrupts the neurogenic inflammation and prolongs the relapse-free interval in hyperhidrotic palmoplantar eczema (dermatitis).

Adult↗

PubMed2004

The effect of two skin cleansing systems on moderate xerotic eczema.

BACKGROUND: Moderate xerotic eczema, characterized by stratum corneum desquamation, erythema, and pruritus is a common condition that can be induced or worsened by skin cleansing. Traditional dermatologic therapy includes the use of emollients, medium or high potency topical corticosteroids, and a change in bathing habits. OBJECTIVE: To investigate the effect of two cleansing systems: a synthetic detergent bar soap applied with a cotton washcloth and a petrolatum-delivering body wash applied with a polyethylene puff as part of a topical treatment approach to moderate xerotic eczema. METHOD: Sixty patients with moderate xerotic eczema were enrolled in a 4-week investigator-blinded study. Half were randomly treated with a strong topical corticosteroid cream (0.05% fluocinonide) and a traditional cleansing system consisting of a synthetic detergent bar soap applied with a washcloth. The remaining patients were treated with a weaker, medium strength topical corticosteroid cream (0.1% triamcinolone acetonide) and a novel cleansing system consisting of a petrolatum-delivering body wash applied with a polyethylene puff. Dermatologist investigator evaluations and patient self-assessments were conducted at baseline, 2 weeks, and 4 weeks. RESULTS: Patients using the novel petrolatum-delivering body wash and polyethylene puff cleansing system and the lower potency corticosteroid cream demonstrated significantly greater clinical improvement than those patients using the traditional cleansing system of a synthetic detergent beauty bar and washcloth system and the higher potency corticosteroid cream after both 2 and 4 weeks of treatment. CONCLUSION: The cleansing system of a petrolatum-delivering body wash delivered by a polyethylene puff may be useful as a cleanser for patients with moderate xerotic eczema.

Administration, Topical↗

PubMed2004

Umbilical cord and maternal blood red cell fatty acids and early childhood wheezing and eczema.

BACKGROUND: Few studies have explored whether fetal exposure to n-6 and n-3 fatty acids influences the inception of atopic disease. OBJECTIVE: To assess prenatal fatty acid exposures as predictors of early childhood wheezing and eczema. METHODS: In the Avon Longitudinal Study of Parents and Children, late pregnancy maternal blood samples and umbilical cord blood samples were assayed for n-6 and n-3 fatty acids (percentage of total red cell phospholipid), and mothers were asked about wheezing and eczema in their children. We measured associations of 11 n-6 and n-3 fatty acid exposures with wheezing at 30 to 42 months, with wheezing patterns defined by presence (+) or absence (-) of wheezing during 2 periods, 0 to 6 months and 30 to 42 months (transient infant, +/-; later-onset, -/+; persistent, +/+; n=1191 and n=2764 for cord and maternal analyses, respectively), and with eczema at 18 to 30 months (n=1238 and n=2945 for cord and maternal analyses, respectively). RESULTS: In cord blood red cells, the ratio of arachidonic:eicosapentaenoic acid was positively associated with eczema (adjusted odds ratio [OR] per doubling, 1.14; 95% CI, 1.00-1.31; P=.044), the ratio of linoleic acid:alpha-linolenic acid was positively associated with later-onset wheeze (OR, 1.30; CI, 1.04-1.61; P=.019), and the ratio of alpha-linolenic acid:n-3 products was negatively associated with later-onset wheeze (OR, 0.86; CI, 0.75-0.99; P=.040). However, these associations were no longer significant after adjusting for multiple comparisons. CONCLUSIONS: It seems unlikely that fetal exposure to n-6 and n-3 fatty acids is an important determinant of early childhood wheezing and atopic disease.

Child, Preschool↗

PubMed2005

Polymorphisms in the 5' region of the CD14 gene are associated with eczema in young children.

BACKGROUND: Variants in the CD14 gene (CD14) are hypothesized to be associated with atopic disorders. However, most studies have only investigated one polymorphism in this gene. OBJECTIVE: We sought to study the association of 5 single nucleotide polymorphisms (SNPs) in the 5' flanking region of CD14 with eczema and serum IgE levels in young children. METHODS: We genotyped 5 SNPs in an approximately 6.5-kb region in the 5' region of CD14 in 344 2-year-old white children from 2 birth cohorts in the northeastern United States. We examined the relation of both single SNPs and haplotypes in CD14 with the atopic outcomes. RESULTS: Two SNPs were significantly associated with eczema. In dominant models adjusted for potential confounders, SNP rs2569193 was associated with significantly decreased risk for eczema (odds ratio [OR] for CT/TT vs CC, 0.5; 95% CI, 0.3-0.8), whereas SNP rs2569190 (also reported as the C-159T) was associated with significantly increased risk for eczema (OR for CT/TT vs CC, 2.3; 95% CI, 1.4-3.8). The CT/TT genotypes of SNP rs2569190 also had higher geometric means of serum IgE than the CC genotype (24.6 vs 15 IU/mL, P = .025). Haplotype analyses provided results similar to those of the single SNP analyses. CONCLUSIONS: Our results contradict previous reports that have found a protective effect of the T allele of SNP rs2569190 (C-159T) against atopic disorders. Nevertheless, these results confirm the importance of polymorphisms in CD14 in the development of atopy, and future studies of this gene region will need to account for linkage disequilibrium and environmental exposures unique to the study population.

5' Flanking Region↗

PubMed2005

Association of atopy and eczema with polymorphisms in T-cell immunoglobulin domain and mucin domain-IL-2-inducible T-cell kinase gene cluster in chromosome 5 q 33.

BACKGROUND: The T-cell immunoglobulin domain and mucin domain (TIM) gene family and the gene for IL-2-inducible T-cell kinase (ITK), located in chromosome 5 q 33 and potentially involved in the T-cell proliferation and differentiation, are good candidate genes for allergic diseases. OBJECTIVE: We assessed the role of polymorphisms in the TIM family genes and ITK in atopy, eczema, and asthma. METHODS: Twenty-one polymorphisms in the TIM-ITK gene cluster were genotyped in 564 children enrolled in the Tucson Children's Respiratory Study. Skin prick tests to common allergens were performed at age 6.1 years (n=508), age 10.8 years (n=539), and age 16.6 years (n=424). Asthma and eczema were assessed by questionnaire at these 3 points. Averaged relative risks were estimated. RESULTS: One 15-bp insertion/deletion in exon 4 of TIM 1 was significantly related to atopy and eczema (relative risk associated with carrying at least 1 rare allele=1.24 [1.07--1.45], P=.005; and 1.43 [1.01--2.01], P=.004, respectively). The 3 tested single nucleotide polymorphisms (SNPs) in TIM 3 were significantly related to atopy and eczema. One of them, at position +4259 calculated from the translation start site, predicts a putative change in the amino acid sequence of the protein, and was the most strongly related to atopy (relative risk=1.28 [1.12--1.47]; P=.0003). SNPs in the 5' genomic region in ITK, which show moderate linkage disequilibrium with those in TIM 3, had an independent effect on atopy. None of the polymorphisms studied was related to asthma. CONCLUSION: Our findings support a potential role for SNPs in TIM 1, TIM 3, and ITK, independent of each other, in allergic diseases.

Adolescent↗

PubMed2006

Endotoxin in inner-city homes: associations with wheeze and eczema in early childhood.

BACKGROUND: An inverse association between domestic exposure to endotoxin and atopy in childhood has been observed. The relevance of this aspect of the hygiene hypothesis to US inner-city communities that have disproportionately high asthma prevalence has not been determined. OBJECTIVES: To measure endotoxin in the dust from inner-city homes, evaluate associations between endotoxin and housing/lifestyle characteristics, and determine whether endotoxin exposure predicted wheeze, allergic rhinitis, and eczema over the first 3 years of life. METHODS: As part of an ongoing prospective birth cohort study, children of Dominican and African-American mothers living in New York City underwent repeated questionnaire measures. Dust samples collected from bedroom floors at age 12 or 36 months were assayed for endotoxin. RESULTS: Among the samples collected from 301 participants' homes, the geometric mean endotoxin concentration (95% CI) was 75.9 EU/mg (66-87), and load was 3892 EU/m2 (3351-4522). Lower endotoxin concentrations were associated with wet mop cleaning and certain neighborhoods. Endotoxin concentration correlated weakly with cockroach (Bla g 2: r = 0.22, P < .001) and mouse (mouse urinary protein: r = 0.28; P < .001) allergens in the dust. Children in homes with higher endotoxin concentration were less likely to have eczema at age 1 year (odds ratio, 0.70 [0.53-0.93]) and more likely to wheeze at age 2 years (odds ratio, 1.34 [1.01-1.78]). These associations were stronger among children with a maternal history of asthma. CONCLUSION: Endotoxin levels in this inner-city community are similar to those in nonfarm homes elsewhere. In this community, domestic endotoxin exposure was inversely associated with eczema at age 1 year, but positively associated with wheeze at age 2 years. CLINICAL IMPLICATIONS: Endotoxin exposure in the inner-city community may be related to wheeze in the early life; however, given the inverse association seen with eczema, the long-term development of allergic disease is still in question.

Allergens↗

PubMed2006

Evaluation and interference of serum and skin lesion levels of leukotrienes in patients with eczema.

To evaluate the levels of leukotrienes (LTs), interleukin-2 (IL-2), interleukin-4 (IL-4), interferon-gamma (IFN-gamma) in patients with eczema and observe the effects inversed by mizolastine. Serum LTB4, LTC4, IL-2, IL-4, IFN-gamma and urinary LTE4 levels were detected by enzyme-linked immunosorbent assay (ELISA) and LTB4, LTC4, LTE4 concentrations of cutis tissue were measured by reverse-phase high-pressure liquid chromatography (RP-HPLC) in 10 eczema patients and 10 healthy volunteers. Eczema patients received mizolastine 10 mg once a day for 5 days, respectively, for comparison between before and after treatment. The above markers were assayed again after treatment. Serum LTB4, LTC4, IL-2, IFN-gamma and urinary LTE4 and skin tissue LTB4, LTC4, LTE4 levels in patients are higher than those in healthy volunteers significantly (P < 0.05). But serum IL-4 level did not show significant difference between patients and normal controls (P > 0.05). Mizolastine significantly reduced serum LTB4 and IFN-gamma levels as well as skin lesion LTB4, LTC4, LTE4 concentrations. LTs are involved in the pathogenesis of eczema. Mizolastine clearly reduces LTs levels in skin lesion.

Adolescent↗

PubMed1981

Do breast-feeding and delayed introduction of solid foods protect against subsequent atopic eczema?

Previous studies relating infant feeding to subsequent atopic eczema have had methodologic flaws that include insensitive study designs, nonblind observation, and failure to control for confounding variables. To avoid these flaws, we conducted a case-control study of 636 patients attending a dermatology clinic. The dermatologic problem in each patient was classified as atopic eczema (case), dermatologic condition unrelated to atopy (control), or dermatologic condition with questionable relation to atopy (uncertain). The feeding history was ascertained later, along with family history and demographic data, by an assistant blind both to the question under study and to the case vs control status of each subject. Breast-feeding was not associated with any reduction in the estimated relative risk of developing atopic eczema. No significant relationship was found among the cases between severity of disease and breast-feeding nor between age of onset of disease and duration of breast-feeding or age at introduction of solid foods. Even when breast-feeding was redefined as "pure" and exclusive (no nonhuman milk or solids) for greater than or equal to 2 months, no protective effect was uncovered. We conclude that breast-feeding and delayed introduction of solids do not protect against atopic eczema, and that previous claims of protective effects were based on data probably biased by nonblinding and important confounders.

Adolescent↗