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Essential changes in the mononuclear glycocalix structure and function and a reduction of the blood natural cytotoxicity have been detected in children suffering from neurodermatitis. These shifts depended on the disease pattern and did not recover in clinical remission.
For patients with neurodermatitis nutrition gains an increasing importance as part of therapy. To evaluate the psychological meaning of nutrition, 150 patients were given a questionnaire. 124 of them answered. 75% believe a diet to be indispensible or important. On the other hand, 17-37% never have been on diet and only 6-7% dieted with the only purpose to better their skin symptoms. This discrepancy coincides with the fact that these patients feel not sufficiently informed. This leads to the hypothesis that the wish for a diet is often based on unfullfillable hopes. Therefore the next step after allergological diagnostics is the information of the patient which should also become an integrative part of further therapy.
Using experimental-psychological methods, the characteristics of the disease awareness were studied in 25 patients with psoriasis and neurodermatitis. The structure of the disease awareness was found to be strongly dependent on the degree of the cosmetic defect: in patients with a marked defect, the emotional and motivational levels occupy the leading position in the structure of the disease awareness, whereas in patients with a mild cosmetic defect, the sensitive level is predominant.
The author examined 150 patients with psoriasis and neurodermatitis. A total of 102 patients had such neuropsychic disturbances as neurotic reactions, neurotic developments, psychopathic reactions, and the psychoorganic syndrome. A definite relationship was found between the premorbid features of the personality, the severity and duration of the underlying disease on the one hand and the type of neuropsychic disturbances on the other. The time-course of the disturbances in the process of treatment is described. The comparison of the therapeutic effect showed that the best results (a regressive time-course of neuropsychic disorders, an improvement in the course of dermatosis) were seen in patients receiving as a part of multiple modality therapy both psychocorrective treatment and hemosorption.
Neurodermatitis, or lichen simplex chronicus, generally found in females between the ages of 25 and 55 years, is highly inflammatory and may become generalized. The patients are hypersensitive and are not good candidates for surgery as a Köbner-like phenomenon may occur at the site of the incision with consequent breakdown of the incision, wound dehiscence, and infection. If these patients are to respond normally to treatment, it is sometimes necessary for the surgeon to treat their tensions.
A long-term study on the therapy of atopic dermatitis with topical urea agents was conducted by over 400 practising dermatologists and pediatricians in Western Germany from March 1989 to March 1991. 1905 patients of all ages who had a baseline diagnosis of acute exacerbation of their neurodermatic skin condition were entered into this open, uncontrolled, multicenter study. Acute attacks were treated with a combination of hydrocortisone and urea. Once the acute symptoms had subsided, therapy was continued with a 10% urea ointment. Over the 12-month observational period, a total of 84% of the patients were exclusively treated with the two trial preparations and only 16% additionally required other corticosteroids.
This is a report on the therapeutic experience gained in 10 patients treated with a urea ointment combination alternatively with and without 1% hydrocortisone. Four of the ten patients successfully completed the therapy as planned after 12 months. The reasons for therapy drop-outs will be discussed. Based on our observations, the above-mentioned therapeutic regimen can be recommended in conjunction with all treatment measures for longer term therapy of neurodermatitis if the patients are well instructed.
Blood serum alkaline phosphatase (AP) level was found elevated in the patients suffering from eczema, neurodermatitis, eczema with large skin sites involved, and in those with trophic ulcers of various origins, as against normal subjects and reference patients with sarcoidosis and Kaposi's sarcoma. Elevated level of the enzyme activity is directly related to exacerbation stage and size of the skin site involved; this level reduced after therapy and this reduction was associated with clinical improvement. No concomitant visceral abnormalities (calculous cholecystitis, liver cirrhosis, or malignant tumors) were detected in the examinees, that might influence the blood serum AP activity.
The problem in terminology, regarding diffuse neurodermatitis or atopic dermatitis, is discussed from a viewpoint of an expert physician evaluating the health status of certain patients populations. The author advocates A. A. Kalamkarian and V. A. Samsonov's view point, for it permits expert evaluation of the subjects' health status from a universal clinical and methodological standpoint.
Basing on their own observations and analysis of data on the clinical picture and pathogenesis of atopic dermatitis, the authors suggest that four clinical forms of this condition be distinguished: erythematous squamous, erythematous squamous with lichen transformation, lichenoid, and prurigo-like. They consider it advisable that such terms as catarrhal exudative diathesis, childhood eczema, and diffuse neurodermatitis be used no more. Itching is suggested to be considered as a symptom and not cause of itching dermatoses.
Neurodermatitis or atopic dermatitis appears to be more widespread among animals than has been assumed hitherto. We report on a female gorilla in Saarbrücken Zoo; after years of captivity the animal developed recurrent eczema in the crooks of the elbows and knees. An interesting aspect of this case is that apparently psychological factors stemming from a partner conflict led to manifestation of the disease. We discuss the feasibility of determining the presence of IgE.
The problem of dermatologic terminology at large is discussed as exemplified by the synonymous terms concerned with diffuse neurodermatitis.
Characteristics of haemogramme were studied in 28 patients with eczema, 25 patients with neurodermatitis disseminata, 38 patients with cutaneous form of psoriasis, in whom dermatosis was manifested by extensive skin involvement. Statistical data on relative and absolute values for the groups studied confirm the rise in the numbers of monocytes, eosinophiles, lymphocytes and segmentonuclear neutrophils in the peripheral blood, this being most characteristic abnormality in the haemogramme, which was particularly noticeable in patients with clinically apparent acuity of cutaneous manifestations, universal or erythrodermic type of its affliction, lingering exacerbation state. Current knowledge about hemopoiesis and pathogenesis of the above dermatoses allow the changes being detected in the haemogramme to be considered secondary to chronic unspecific inflammation developing in the skin, being characterized, from the immunological standpoint, in a general sense, by T-cellular (tissue) immunodeficiency.
Concentrations of hormones of the hypophysis, thyroid gland and adrenal cortex were measured in blood plasma of those patients presenting with neurodermatitis. A statistically significant reduction in the blood content of thyroid-stimulating hormone (TSH) and hydrocortisone and rise in aldosterone, adrenocorticotrophic hormone (ACTH), triiodothyronine and thyroxin were revealed in this patient population. Combined non-drug therapy treatments involving endovascular helium-neon laser therapy and EHF electromagnetic radiation resulted in improvement in more than half of the measurements done: blood levels of TSH and hydrocortisone got increased while those of ACTH, thyroxin and aldosterone decreased, which fact correlated with the positive clinical picture of the condition in question.
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