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PubMed2006

A survey-based assessment of the prevalence and severity of chronic hand dermatitis in a managed care organization.

Although studies conducted outside of the United States have found a 7% to 12% prevalence of chronic hand dermatitis, no US general population-based estimates have been reported. The objective of this study was to quantify the prevalence of chronic hand dermatitis in a US managed care organization population. A 13-item self-assessment questionnaire was developed and validated, with 85% sensitivity and 95% specificity. The questionnaire was mailed to 2 random member samples from a Massachusetts managed care organization: 502 general members and 878 members with dermatitis. The questionnaire had a 36.74% overall response rate, with a chronic hand dermatitis point prevalence of 17.49% and 33.33% in the general and dermatitis populations, respectively. Among the general population, the questionnaire results identified 16.94% members who had chronic hand dermatitis but had not sought dermatitis-related medical services. After direct standardization to the 2000 US Census population with respect to age, gender, and race distributions, the projected point prevalence was estimated at 16.36% in the US general population. In conclusion, we found a higher prevalence of chronic hand dermatitis than previously reported. Approximately 1 in 6 members did not seek medical attention, suggesting that chronic hand dermatitis may be underdetected and untreated and may require more awareness and effective management.

Adult↗
PubMed1990

The prognosis of contact dermatitis.

This article reviews the prognosis of contact dermatitis, particularly of occupational contact dermatitis. Most studies document a poor prognosis for occupational and nonoccupational contact dermatitis. The prognoses of occupational and nonoccupational contact dermatitis, irritant contact dermatitis, and allergic contact dermatitis are similar. Only a minority of studies on the prognosis of occupational contact dermatitis have found that a job change by the affected worker leads to clearing of the dermatitis. Dermatologic and nondermatologic factors associated with a poor prognosis are discussed.

Chronic Disease↗
PubMed2006

Inhibition of scratching behavior associated with allergic dermatitis in mice by tacrolimus, but not by dexamethasone.

Itching is the most important problem in many allergic and inflammatory skin diseases especially in atopic dermatitis. However, animal models for allergic dermatitis useful for the study of itching have rarely been established. We established a mouse allergic dermatitis model involving frequent scratching behavior by repeated painting with 2,4-dinitrofluorobenzene (DNFB) acetone solution onto the mouse skin, and comparatively examined the effects of tacrolimus and dexamethasone on the dermatitis and associated scratching behavior. Repeated DNFB painting caused typical dermatitis accompanied by elevated serum immunoglobulin E (IgE) and frequent scratching behavior. An apparent thickening of the epidermis and dermis, and the significant accumulation of inflammatory cells were observed. Increased interferon (IFN)-gamma mRNA expression and the induction of interleukin (IL)-4 and IL-5 mRNA expression were also observed in the skin lesion. The scratching behavior was inhibited by dibucaine and naloxone. Although tacrolimus reduced the increased expression of IFN-gamma and IL-4 mRNA, dexamethasone potently depressed that of IFN-gamma, IL-4 and IL-5 mRNA. Dexamethasone inhibited the accumulation of lymphocytes and eosinophils, although tacrolimus did not. Both drugs failed to inhibit the elevation of serum IgE levels. Tacrolimus significantly inhibited the scratching behavior that was associated with the inhibition of nerve fiber extension into the epidermis, whereas dexamethasone failed to have any effect. The mouse dermatitis model seems to be beneficial for the study of itching associated with allergic dermatitis, such as atopic dermatitis, and tacrolimus seems to exhibit an anti-itch effect through the inhibition of nerve fiber extension at least in part.

Allergens↗
PubMed1997

Contact dermatitis.

LEARNING OBJECTIVES: Reading this article will reinforce the reader's knowledge of the definition, pathophysiology, differential diagnosis, evaluation, and management of the most common of all the "eczemas," contact dermatitis, which can have an allergic and/or an irritant pathogenesis. DATA SOURCES: Relevant articles and current texts on contact dermatitis were referenced and reviewed. The personal experiences of the authors in an Environmental Medicine Clinic, their private practices, and their teaching of residents and other physicians were evaluated. A MEDLINE database using subject keywords was searched from 1986 to date. STUDY SELECTION: Book chapters, pertinent articles, data source abstracts, guidelines for the management of contact dermatitis set by the American Academy of Dermatology, and the American Contact Dermatitis Society were critiqued. RESULTS: The recent elucidation of the pathoimmunology of contact dermatitis is concisely reviewed, highlighting its clinical implications. The protean clinical presentations of contact dermatitis, both "allergic" and "irritant" type are cited. The signs and symptoms warranting the search for a contactant are outlined. The most likely regional contactants are listed, but the need to reference a more complete textbook is often required. That patch testing is the gold standard to identify an allergenic agent causing allergic contact dermatitis is stressed. While the "who" and "when" to patch test is amply described, a cookbook "how" to patch test has been omitted in order to emphasize the importance of "hands on" experience for such testing. The advantages and limitations of the commercially available standard patch tests (Hermal, and T.R.U.E.) are described, plus the sources for "nonstandard" patch tests is made available. Therapeutic modalities, topical and systemic, for management of the uncomfortable patient are outlined. CONCLUSION: The physician who manages a patient with an "eczematous" rash must be aware of the complete differential diagnosis of that clinical presentation. Suspicion that a "contactant" is the cause must have high priority, especially when the rash is persistent, and fails to respond to "appropriate" therapy. The value of a skin biopsy is limited to confirming its eczematous (spongiotic) nature and ruling out other diseases. Appreciating the paradox of patch testing, namely the deceptive simplicity of application versus the required expertise for interpretation and recognition of clinical significance, is the key to the proper management of the patient with contact dermatitis.

Allergens↗
PubMed1988

Influence of age and severity of dermatitis on the percutaneous absorption of hydrocortisone in children.

The results of 55 4-h hydrocortisone absorption tests in 38 children with atopic or seborrhoeic dermatitis were analysed to evaluate the effect of age and severity of the dermatitis on percutaneous absorption of hydrocortisone. The children were divided into three groups on the basis of the severity of the dermatitis. The absorption of hydrocortisone caused a significantly higher mean rise of serum cortisol in 20 children with severe dermatitis (Group A) than in 17 children with moderate dermatitis (Group B). The mean post-application rise of serum cortisol in 18 children with mild dermatitis (Group C) was significantly lower than in the children with moderate dermatitis. There was a significant negative linear correlation between age and the post-application rise of serum cortisol in Groups A and C. In these groups the mean post-application rise of serum cortisol was significantly higher in children aged under 18 months than in children aged 18 months or over. Severe widespread dermatitis and an age under 18 months are two relevant risk factors in the topical use of hydrocortisone.

Administration, Topical↗
PubMed1996

Airborne contact dermatitis from unexpected exposure to rosin (colophony). Rosin sources revealed with chemical analyses.

We report 3 cases of contact dermatitis in rosin-sensitive individuals caused by exposure to airborne rosin components from different sources. Case no. 1 was a female office worker with a facial dermatitis caused by rosin components which emanated from the linoleum floor covering in her office. Floor material containing wood flour and rosin was released into the air, causing a facial dermatitis in the rosin-sensitive subject. Case no. 2 involved a woman who worked in a factory producing dairy product cartons and had a dermatitis on her lower legs, lower arms and upper chest. Her dermatitis was caused by dust from the paper cartons and contact allergy to rosin components probably aggravated her dermatitis. Case no. 3 was a female office worker with a relapsing dermatitis on her eyelids. Her dermatitis was caused by a rosin-containing floor polish, which was seen as a powder on the office floor. Extracts of suspected material and products were patch tested and analysed for the presence of rosin components with HPLC and GC techniques. A discussion and recommendations on chemical analyses of rosin components follow. We conclude that a thorough investigation, including chemical analyses, can rule out non-specific diagnoses and offer a solution to the patient's skin problems.

Air Pollutants↗
PubMed1977

Atopic dermatitis and tuberculin reactivitiy.

Transient suppression of already established tuberculin reactivity by a wide-spread, allergic contact dermatitis as well as by primary irritant contact dermatitis has been recently reported. Similar transient suppression of tuberculin reactivity by the eczematous inflammation of atopic dermatitis is now shown to occur. Thus, when the dermatitis is active, atopic dermatitis patients show diminished tuberculin reactivity. While they are in remission, however, a significant increase of their tuberculin reactivity occurs. Before the onset of dermatitis, their tuberculin reactivity was normal. Healed patients showed normal tuberculin reactivity. The presence of dermatitis may play an important role in the diminished cell-mediated immunity in atopic dermatitis.

Adolescent↗
PubMed2002

In the United States, blacks and Asian/Pacific Islanders are more likely than whites to seek medical care for atopic dermatitis.

BACKGROUND: There have been population-based studies conducted in England and the United States that suggest an increase in prevalence of atopic dermatitis among black and/or Asian children. OBJECTIVE: To assess whether health care utilization for atopic dermatitis differs among different ethnic groups in the United States. DESIGN: Weighted data on representative office visits by whites, blacks, and Asian/Pacific Islanders were analyzed using a cross-sectional study, the National Ambulatory Medical Care Survey (NAMCS), from 1990 through 1998 using statistical software. SETTING: The NAMCS is an ongoing data collection effort by the Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention. The survey samples representative visits to US office-based physicians during a representative week of practice. PATIENTS: All outpatient visits were analyzed and compared with those for patients diagnosed as having atopic dermatitis (International Classification of Diseases, Ninth Revision, Clinical Modification, code 691.80). MAIN OUTCOME MEASURE: Diagnosis of atopic dermatitis by race. RESULTS: Of 570 million estimated visits for skin conditions, 7.9 million were for atopic dermatitis. The numbers of per capita visits for atopic dermatitis among blacks and Asian/Pacific Islanders were 2-fold and 6-fold higher, respectively, than among whites. The odds ratios (95% confidence intervals) for atopic dermatitis visits by blacks and Asian/Pacific Islanders relative to whites were 3.4 (2.5-4.7) and 6.7 (4.8-9.5), respectively. CONCLUSIONS: Blacks and Asian/Pacific Islanders are much more likely to visit physicians for atopic dermatitis than are whites and may benefit from education and early intervention efforts concerning the disease.

Asian↗
PubMed2005

Incidence rates, costs, severity, and work-related factors of occupational dermatitis: a workers' compensation analysis of Oregon, 1990-1997.

UNLABELLED: Objectives To extend and update past research on occupational dermatitis by examining recent workers' compensation claims data. DESIGN: Retrospective analysis of workers' compensation claims from Oregon (1990-1997). SETTING: All dermatitis-related workers' compensation claims were merged with US census data to estimate rates of dermatitis by age, sex, occupation, and industry. Associated claim costs and disability times were also calculated from these data. PARTICIPANTS: All individuals with accepted dermatitis claims (N = 611) were included in the analyses. MAIN OUTCOME MEASURES: The overall claim rates of individuals by age, sex, industry, and occupation were estimated. Total costs and average disability time were computed. Monthly patterns of dermatitis claims were examined. RESULTS: The average claim rate of occupational dermatitis was estimated to be 5.73 per 100 000 workers (95% confidence interval, 5.66-5.80). Statistically significant differences (P<.001) in claim rates by age, sex, industry, and occupation were found. More than 47% of all claimants had 1 year of job tenure or less. Employees in the farming, forestry, and fishing occupations and industries had significantly higher claim rates compared with employees in other occupations. The average cost per claim was $3552, and the average disability time was 23.9 days. Some temporal trends in claim rates were observed. CONCLUSIONS: Occupational dermatitis remains a significant problem in workplace settings. In addition, certain types of occupations and industries seem to be particularly affected by occupational dermatitis. Interventions may be particularly valuable for workers with little job tenure.

Adolescent↗
PubMed1995

London-born black Caribbean children are at increased risk of atopic dermatitis.

BACKGROUND: Previous reports suggest that atopic dermatitis is more common in black Caribbean children born in the United Kingdom than in white children. It is unclear whether these differences are caused by selection bias or variations in the use of the word "eczema" in the groups studied. OBJECTIVE: Our objective was to explore ethnic group differences in the prevalence of atopic dermatitis in London schoolchildren. METHODS: A cross-sectional prevalence survey of 693 junior school children in three schools was performed. Atopic dermatitis was defined in three ways: (1) by a dermatologist, (2) by visible flexural dermatitis as recorded by an independent observer, and (3) by a history of flexural dermatitis according to the child's parents. RESULTS: The prevalence of atopic dermatitis according to examination by a dermatologist was 16.3% in black Caribbean children and 8.7% in white children. This increased risk was present for different methods of defining of a atopic dermatitis and persisted after adjustment for potential confounders. CONCLUSION: London-born black Caribbean children appear to be at an increased risk of having atopic dermatitis.

Black or African American↗
PubMed2006

The effect of pre-calving environment on the development of digital dermatitis in first lactation heifers.

Digital dermatitis is commonly reported to be most severe in first lactation heifers. It has been suggested that this initial infection is followed by the development of a limited immunity to the organisms which cause digital dermatitis. If this is the case then exposure to digital dermatitis prior to calving should reduce its severity after calving. A study was undertaken to examine whether such exposure significantly affected the development of digital dermatitis post-partum. Twelve weeks prior to calving, 60 Holstein heifers were blocked on the basis of their antibody titre to Borrelia burgdorferi and randomly allocated to one of three pre-calving environments: clean straw, used straw or cubicles. There was no significant effect of pre-calving environment on the development of digital dermatitis after calving indicating that "exposure" pre-calving did not reduce the development of digital dermatitis after calving. The most important factors determining the development of digital dermatitis after calving were presence of absence of visible lesions of digital dermatitis at Week-12 and at calving.

Animals↗
PubMed1997

Predominance of type 2 cytokine-producing CD4+ and CD8+ cells in patients with atopic dermatitis.

BACKGROUND: Recently, increased IL-4 and decreased interferon-gamma (IFN-gamma) production in peripheral blood mononuclear cells (PBMCs) from patients with atopic dermatitis have been reported by several groups. They measured the total amount of each cytokine in culture supernatants in their studies. These studies suggested a predominance of type 2 cytokine-producing cells in atopic dermatitis. However, it is still unclear whether the cytokine imbalance is the result of an imbalance of specific T-cell subsets or of dysregulation of the cytokine-producing ability in T-cell subsets. Here, we examined frequencies of IL-4-, IFN-gamma-, or IL-2-producing CD4+ cells and CD8+ cells in PBMCs from patients with atopic dermatitis at a single cell level by using flow cytometry. METHODS: PBMCs from 45 patients with atopic dermatitis and 24 healthy control subjects were stimulated with immobilized anti-CD3 monoclonal antibody for 6 hours in the presence of monensin. Cells were fixed, made permeable, and stained for intracellular cytokines in combination with staining for cell surface markers CD4 and CD8. RESULTS: The frequency of IL-4-producing CD4+ cells and CD8+ cells from patients with atopic dermatitis was significantly higher (p < 0.001) than that from healthy control subjects. In contrast, the frequency of IFN-gamma-producing CD4+ cells and CD8+ cells was significantly decreased (p < 0.01) in the patients with atopic dermatitis. The frequency of IL-2-producing cells from patients with atopic dermatitis was comparable to that from healthy control subjects. CONCLUSION: Our findings indicate that frequencies of type 2 cytokine-producing cells, not only among CD4+ cells but also among CD8+ cells, were significantly higher in patients with atopic dermatitis than in healthy control subjects.

Adolescent↗
PubMed2001

Association between atopic dermatitis and insulin-dependent diabetes mellitus: a case-control study.

BACKGROUND: Up to two-thirds of children with atopic dermatitis have IgE-mediated allergic reactions and a Th2 immune reactivity pattern with low production of interferon gamma and high production of interleukin 4 after allergen stimulation of T lymphocytes. Insulin-dependent diabetes mellitus (IDDM) seems to be associated with a Th1 immune reactivity pattern. We therefore postulated that these diseases may be inversely associated. METHODS: We designed a case-control study including 920 children with IDDM, registered in the Danish Registry for Childhood Diabetes, and a sample of 9732 non-diabetic children registered in the Danish Medical Birth Registry. The children were aged 3-15 years. Information on atopic dermatitis was obtained by questionnaires. FINDINGS: The cumulative incidence of atopic dermatitis up to age 15 years was 13.1% among children with IDDM and 19.8% in non-diabetic children (p<0.0001). Among children who developed IDDM, the incidence of atopic dermatitis was significantly lower than in the controls before onset of IDDM (73 cases in 5314 person-months vs 1375 in 57432 person-months; odds ratio 0.49 [0.39-0.63]). After onset of IDDM, diabetic and non-diabetic groups did not differ in incidence of atopic dermatitis (1.36 [0.89-2.07]). INTERPRETATION: Our findings may be explained by different acquired or inherited reactivity patterns associated with atopic dermatitis (Th2) and IDDM (Th1). The results do not allow us to find out whether early development of atopic dermatitis reduces the risk of IDDM, or a propensity for IDDM reduces the risk of early-onset atopic dermatitis.

Adolescent↗
PubMed1987

The pathogenesis of dermatitis herpetiformis: recent advances.

Over the last two decades a rapid expansion of our knowledge regarding dermatitis herpetiformis has occurred, including the discovery of IgA in the skin, the discovery of an associated gluten-sensitive enteropathy, the noting of an increased prevalence of the human lymphocyte antigens (HLA)-B8 and -DRw3, and the documentation that the skin disease of many dermatitis herpetiformis patients can be controlled by a gluten-free diet. It has also been noted that two distinct forms of dermatitis herpetiformis occur, those with granular deposits of IgA at the dermoepidermal junction (85%-95% of dermatitis herpetiformis patients) and those with linear IgA deposits (10%-15% of dermatitis herpetiformis patients). These findings are reviewed with particular emphasis on the form of dermatitis herpetiformis associated with granular IgA deposits. The current findings regarding the nature and origin of the cutaneous IgA deposits, the role of the gluten-sensitive enteropathy, and the spectrum of both the immunologic and the nonimmunologic abnormalities associated with dermatitis herpetiformis are presented, and from these data pathophysiologic mechanisms are proposed that may be involved in dermatitis herpetiformis.

Celiac Disease↗
PubMed1987

Familial incidence of dermatitis herpetiformis.

Dermatitis herpetiformis and gluten-sensitive enteropathy are diseases in which exposure to gluten results in an inflammatory response. Both diseases are associated with certain human lymphocyte antigen alleles, and gluten-sensitive enteropathy is well known to cluster in families. Gluten-sensitive enteropathy has also been reported in families of patients with dermatitis herpetiformis. Despite this evidence that dermatitis herpetiformis is a genetic disease, reports of the familial occurrence of dermatitis herpetiformis are rare. We have obtained family histories from 92 patients with dermatitis herpetiformis with 740 first-degree relatives. Six of these relatives have dermatitis herpetiformis. Comparison of these data with the expected prevalence of dermatitis herpetiformis shows this incidence to be highly significant (p less than 0.0001), strongly suggesting that dermatitis herpetiformis is a familial disease, presumably because of shared genetic factors but possibly because of a shared environment.

Adolescent↗
PubMed1989

A review of 79 cases of eyelid dermatitis.

Seventy-nine patients with eyelid dermatitis and 1012 patients with dermatitis at other sites were assessed with patch tests. Eighty-nine percent of the eyelid cases involved women. Only the eyelids were involved in 78.5% of cases. Of the patients with eyelid dermatitis 46% had allergic contact dermatitis, 15% had irritant contact dermatitis, and 23% had atopic dermatitis. Only 13% were work related. Positive reactions to patch tests for cinnamic alcohol, diazolidinyl urea, and neomycin sulfate occurred more frequently, whereas those for cobalt and nickel occurred less frequently, in patients who had eyelid dermatitis when compared to the reactions of patients who did not have eyelid dermatitis.

Adult↗
PubMed1989

IgA antiendomysial antibodies in dermatitis herpetiformis.

Sera from 24 patients with dermatitis herpetiformis and 80 control subjects (patients with other bullous diseases, nonbullous dermatoses, and noncutaneous diseases) were studied to determine the usefulness of assay for IgA antiendomysial antibodies (IgA-EMA) in the diagnosis of dermatitis herpetiformis. The overall sensitivity of IgA-EMA for the diagnosis of dermatitis herpetiformis was 79% and the specificity was 96%. When the three patients with dermatitis herpetiformis who were faithfully following gluten-free diets were excluded, the sensitivity was 90% and the specificity was 96%. No patient in the bullous disease control group (including patients with linear IgA bullous dermatosis) had circulating IgA-EMA. One patient, who did not have direct immunofluorescence evidence for dermatitis herpetiformis but had IgA nephropathy, had a positive IgA-EMA result, an interesting association in light of the rare reports of dermatitis herpetiformis in patients with IgA nephropathy and IgA antigliadin antibodies associated with IgA nephropathy. Although direct immunofluorescence testing of skin biopsy specimens remains the most definitive diagnostic test for dermatitis herpetiformis, indirect immunofluorescence assay of serum for IgA-EMA is a minimally invasive study with a high sensitivity and specificity for dermatitis herpetiformis.

Adult↗
PubMed2001

Differences in efficacy between intention-to-treat and per-protocol analyses for patients with psoriasis vulgaris and atopic dermatitis: clinical and pharmacoeconomic implications.

BACKGROUND: Pharmacoeconomic outcome research is based on three criteria: (i) evaluation of objective therapeutic effects; (ii) quality of life; and (iii) treatment costs. Evaluation of therapeutic effect is mainly based on the results of clinical trials using objective clinical measures, e.g: Psoriasis Area and Severity Index (PASI) (score for psoriasis vulgaris) and the Severity Scoring of Atopic Dermatitis (SCORAD) (score for atopic dermatitis). In most studies, only results for a treatment-optimized subpopulation (patients treated according to the protocol) are presented in publications. The relevance of such data for daily routine therapy is doubtful. OBJECTIVES: Our purpose was to investigate the expected loss of effectiveness of switching from a clinical trial to daily routine therapy for the synchronous application of narrow-band ultraviolet (UV) B phototherapy (311 nm) and bathing in 10% Dead Sea salt solution (synchronous balneophototherapy) for patients with psoriasis vulgaris and atopic dermatitis. METHODS: We conducted a multicentre, uncontrolled observational study of outpatients. To achieve data for 'clinical trial' and 'daily routine' situations, two populations were compared: (i) all patients strictly treated according to the protocol (ATP) with no protocol deviations (data published in clinical trials), and (ii) all patients participating in the study who received active treatment at least once, despite treatment irregularities, non-compliance, early withdrawal or other protocol violations [intention-to-treat-population (ITT), model for 'daily routine']. RESULTS: A total of 2526 patients were included in the ITT analysis for psoriasis vulgaris (n = 487 for atopic dermatitis), of which 818 patients could be analysed according to protocol (n = 104 for atopic dermatitis). Striking differences in the therapeutic effect between both groups (ITT and ATP) were found using relative PASI and SCORAD score improvement: 11% (57% 'daily routine' vs. 68% in 'clinical trial') for psoriasis vulgaris and 16% (39% 'daily routine' vs. 55% 'clinical trial') for atopic dermatitis. The main reasons for excluding patients from the 'clinical trial' group were early study withdrawal in 29% (atopic dermatitis, 47%) of patients and fewer treatments per week than planned in the protocol in 24% (atopic dermatitis, 52%). CONCLUSIONS: Our data clearly indicate that for the prediction of the therapeutic effect for daily routine therapy the ITT data appear to be more relevant than the ATP results (i.e. those presented in clinical trials). Although these data are only a first step for evaluating the 'real' therapeutic effect of a treatment modality in daily routine, they seem to support the requirements for ITT analyses in efficacy studies and demonstrate the necessity of ITT data for pharmacoeconomic evaluation.

Adult↗