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PubMed1991

A comparison of expression of surface-bound immunoglobulin E on antigen-presenting cells in cutaneous tissue between patients with allergic, irritant and atopic dermatitis.

The expression of surface-bound immunoglobulin E by dendritic cells within cutaneous tissue has been compared in atopic and contact dermatitis. 45 patients were recruited into 4 groups using clinical criteria and patch testing to a standard series of allergens: atopic (12 cases), allergic contact dermatitis (14 cases), irritant contact dermatitis (10 cases) and the control group (9 cases); using clinical criteria and patch testing to a standard series of allergens. Skin biopsies from each patient were analysed by the indirect immunofluorescence technique. This differentiated 3 patterns of cutaneous IgE distribution: (i) no detectable cutaneous IgE; (ii) detection of IgE solely within the dermis; (iii) detection of IgE within both epidermis and dermis. Detection of IgE within the epidermis was always associated with the presence of IgE within the dermis. In each case, IgE was surface-bound by dendritic cells. Immunoglobulin E was detected within both epidermis and dermis in skin biopsies from 8 (66.7%) atopic patients and 2 (20%) patients with irritant contact dermatitis. No other cases demonstrated IgE deposition within both the epidermis and dermis. Atopic patients were significantly more likely to have detectable IgE deposition, within both epidermis and dermis, than patients with contact dermatitis (allergic and irritant groups combined, p = 0.0011) or controls (p = 0.0049). This finding suggests that the demonstration of IgE within both epidermis and dermis supports a diagnosis of atopic dermatitis. It would therefore be of value in differentiating between atopic and contact dermatitis, where clinical diagnosis is in doubt.

Dendritic Cells↗
PubMed1998

Quantitative immunohistochemical differences in Langerhans cells in dermatitis due to internal versus external antigen sources.

Cutaneous hypersensitivity reactions can develop against antigens delivered through the epidermis (contact dermatitis) or through the blood vessels (e.g., drug eruptions). On routine histology alone, it is not always possible to determine the route of the antigen. Langerhans cells (LC) are the main antigen-presenting cells in contact dermatitis. Dermal dendrocytes (DC) are antigen-presenting cells and may be involved in dermal reactions. We tested the hypothesis that there is a difference between dermatitis due to external and internal antigen sources with regard to the number or function of LC and DC. In 85 cases of dermatitis, numbers of S100 and HLA-DR reactive cells per linear millimetre of epidermis were counted. The amount of epidermal spongiosis was evaluated qualitatively. In 35 cases, the number of DC per mm2 (as defined by Factor XIIIa expression) was evaluated. The patients were then divided into two groups based on whether the final clinical evaluation considered the dermatitis to be secondary to an external (35 cases) or internal antigen (50 cases). Dermatitis due to external antigens had significantly more LC/mm and more frequent HLA-DR expression than dermatitis due to internal antigens, mean +/- SEM; 21.2+/-2.04 vs. 9.1+/-1.02 (p<0.00001) and 16.3+/-2.49 vs. 6.0+/-0.92 (p=0.0001), respectively. Spongiosis was more marked in external antigen cases. DC were more numerous in internal than in external antigen cases, but the differences were not statistically significant. In our model, determination of numbers of LC/mm is the variable with the highest power to discriminate between internal and internal sources. Quantification of HLA-DR+ LC and degree of spongiosis provide little additional discriminatory power.

Adolescent↗
PubMed1996

IgA and IgG binding components of wheat, rye, barley and oats recognized by immunoblotting analysis with sera from adult atopic dermatitis patients.

IgA and IgG antibody response of adult atopic dermatitis patients against neutral/ acidic fractions of wheat, rye, barley and oats was analyzed utilizing an immunoblotting method. Moreover, the antibody response against ethanol-soluble fraction of wheat was examined with serum pools of healthy donors, atopic dermatitis patients and patients with dermatitis herpetiformis or adult celiac disease. All patient sera revealed polymorphic IgA and IgG binding to cereal peptides with molecular weights of 11-97 kD. The antibody staining was essentially identical with atopic dermatitis patients and controls. Patients with dermatitis herpetiformis or celiac disease showed more intensive staining with the ethanol extract of wheat and showed more IgA-stained bands in immunoblotting. It seems that the presence of IgA and IgG antibodies to different cereal antigens is a result of natural exposure and in atopic dermatitis displays little diagnostic significance, in contrast to antigliadin antibody response in dermatitis herpetiformis and celiac disease.

Adolescent↗
PubMed1999

Contact dermatitis: evaluation and treatment.

Contact dermatitis is a common condition that can be categorized as irritant dermatitis and allergic contact dermatitis. Although each of these conditions may have a similar presentation, allergic contact dermatitis is immunologically mediated, whereas irritant contact dermatitis is not. Contact dermatitis can be acute, subacute, or chronic, and each of these phases may progress into the next. Almost any substance may induce a cutaneous reaction, depending on its concentration, the duration of contact, and the condition of the contacted skin. It is estimated that there are more than 6 million chemicals in the environment; approximately 3000 are potential sensitizers. A careful history may identify the responsible agent. If the contactant is identified and eliminated, the contact dermatitis can be a self-limited, mild condition. If the exposure is not discontinued, a cycle of itching, scratching, and skin disruption occurs, which leads to chronic changes in the skin. The history of presentation, including occupational exposures, and distribution of the rash are important in identifying the offending agent. More severe cases may require more extensive evaluation, possibly including patch testing, to determine the offending agent. This article reviews treatment, including antihistamines, topical and oral steroids, physical measures such as cold water compresses, and the treatment of secondary infection.

Dermatitis, Allergic Contact↗
PubMedDate not supplied

An international survey on the prognosis of occupational contact dermatitis of the hands.

Prognosis is a crucial topic in contact dermatitis. We recently reviewed the extensive literature on the prognosis of contact dermatitis. The majority of patients in these studies had persistent dermatitis. Job changes usually did not lead to a significant improvement for most patients with occupational contact dermatitis. We performed a worldwide survey of colleagues with expertise in treating patients suffering from occupational contact dermatitis of the hands. Of 65 experts, 51 returned questionnaires for analysis. 67% of European and 29% of respondents from Sweden, Denmark, Finland, United States of America, Canada, and Mexico stated that more than 75% of workers with severe hand dermatitis required a job change. 78% of the respondents found that chromate and 57% found that nickel allergy were associated with the worst possible prognosis. 98% felt that barrier creams were no more effective than bland emollients in the prevention of hand dermatitis.

Chronic Disease↗
PubMed1986

[Histamine reactivity of affected and unaffected skin in endogenous eczema and in chronic allergic contact dermatitis].

In 30 patients with atopic dermatitis and 40 with allergic contact dermatitis in the chronic stage intracutaneous tests were performed with 0.1 ml histamine 1:10,000 in affected and non-affected skin. The erythematous and wheal reactions were compared with 40 age- and sex-matched controls. The diameters of the erythema and wheals were significantly reduced in affected and non-affected skin of the atopic dermatitis (p less than 0.01). In allergic contact dermatitis only the erythema of the affected and non-affected skin was reduced (p less than 0.05), but not the wheal reaction. The erythematous reaction was, however, less reduced in non-affected skin than in the affected one of the allergic contact dermatitis (p less than 0.05). The reduced histamine reactivity seems to be a typical basic mechanism in atopic dermatitis. It is suggested to be due to the histamine mediated immune modulation and the increased release from mast cells, leading to a refractory behaviour of histamine receptors of the blood vessels like in tachyphylaxis. It is interpreted as a secondary phenomenon in allergic contact dermatitis. Although the histamine reaction shows differences for the groups of patients, it is not suitable to discriminate single cases.

Dermatitis↗
PubMedDate not supplied

[Infantile seborrheic dermatitis and related syndromes. Diagnostic and pathogenetic problems].

Infantile seborrhoeic dermatitis is a dermatosis affecting infants characterized by little or no itching and by completely typical skin symptoms, distribution and evolution. Infantile seborrhoeic dermatitis should therefore be differentiated from atopic dermatitis and from diaper-rash although interferences be possible. In fact the high frequency of the atopic dermatitis and of diaper rash may cause these two manifestations to sometimes superimpose on infantile seborrhoeic dermatitis. This in turn causes rather complex clinical situations that may be very hard, but not impossible to diagnose if use is made of laboratory findings to support clinical features. The pathogenesis and etiology of infantile seborrhoeic dermatitis are still debated although recent results assign the dominant role to Candida albicans. This mycete also plays a relevant role in the genesis of diaper rash and particularly of Leiner's exfoliative erythrodermas, which can be interpreted as a generalized and erythrodermic expression of infantile seborrhoeic dermatitis. Systematic cultural investigations and appropriate antimycotic treatments, that would stimulate antibody response, will allow to clarify in the near future this interesting etiological problem, with important therapeutical consequences.

Age Factors↗
PubMed1981

Infraorbital fold in atopic dermatitis.

An infraorbital fold (Dennie-Morgan fold) occurred in 74 (25%) of 300 patients with atopic dermatitis. Lower eyelid dermatitis was initially seen in 69 (23%) of these 300 patients. Of the 69 patients with lower eyelid dermatitis, 57 (83%) showed the infraorbital fold. However, such a fold was seen only in 17 (7%) of 231 patients who lacked lower eyelid dermatitis. An infraorbital fold also was observed in eight of 11 patients with contact dermatitis of the lower eyelid. Thus, it is likely that an infraorbital fold develops when the lower eyelid is affected with eczematous dermatoses of diverse origins. The frequent occurrence of an infraorbital fold in patients with atopic dermatitis may be caused by the fact that the eyelid is a site of predilection for this dermatitis.

Adolescent↗
PubMed1996

Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis.

BACKGROUND AND DESIGN: Colonization of inflammatory skin diseases with Staphylococcus aureus is a frequent phenomenon and may cause exacerbation of the skin disease. Staphylococcus aureus strains present on atopic dermatitis are capable of releasing staphylococcal enterotoxins, a group of superantigens that are very potent T-cell activators. To determine whether the superantigen staphylococcal enterotoxin B can induce inflammation when applied on the skin, staphylococcal enterotoxin B was applied with and without occlusion on the volar aspect of the skin on the forearm of 10 subjects without skin disease and six subjects with atopic dermatitis of minimal activity and no eczema on the volar aspect of the skin on their forearm. The main outcome measures were clinical rating; determination of the increase of the thickness of the skin-fold; and determination of skin blood flow. RESULTS: Clinically, staphylococcal enterotoxin B induced skin changes of erythema and induration in 10 of 10 healthy volunteer subjects and six of six subjects suffering from atopic dermatitis, while the vehicle induced clinically evident skin changes in only one of 10 healthy subjects and none of six subjects with atopic dermatitis. On day 3 after the application of an occluded patch containing 10 micrograms/cm2 of staphylococcal enterotoxin B in the healthy subjects, the thickness of the skinfold increased 0.47 +/- 0.49 mm (mean +/- SD) (n = 9; P < .02) relative to the increase in the thickness of the skinfold following application of the vehicle. The Doppler laser-measured skin blood flow index had increased from 1.0 +/- 0.4 to 5.3 +/- 3.7 (mean +/- SD) (n = 10; P < .002). On day 3 after the application of occluded patchs containing 10 micrograms/cm2 of staphylococcal enterotoxin B in the subjects suffering from atopic dermatitis, the increase in the thickness of the skinfold increased 0.20 +/- 0.24 mm (n = 6; P, not significant) relative to the increased thickness in the skinfold following application of the vehicle. The Doppler laser-measured skin blood flow index had increased from 1.1 +/- 0.4 to 3.7 +/- 2.2 (n = 6, P, not significant). Three of six subjects suffering from atopic dermatitis experienced a flare of their disease in the elbow flexure ipsilaterally to where the staphylococcal enterotoxin B patch was applied. CONCLUSIONS: The superantigen staphylococcal enterotoxin B applied on intact skin from both normal subjects and patients with atopic dermatitis induces an inflammatory reaction. This finding suggests that superantigens released from S aureus present on the skin in inflammatory skin diseases may exacerbate and sustain the inflammation.

Adult↗
PubMed2002

Relationship of occupation to contact dermatitis: evaluation in patients tested from 1998 to 2000.

BACKGROUND: Both irritant and allergic contact dermatitis can be influenced by occupational and nonoccupational environmental exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing was conducted with the 50 screening allergens of the North American Contact Dermatitis Group and occupational coding by the Surveillance Branch of the National Institute of Occupational Safety and Health. RESULTS: Of the 5,839 patients patch tested for contact dermatitis, 1,097 (19%) were deemed to be occupationally related. Of the occupational cases, 60% were of allergic and 32% were of irritant origin. The hands were the primary body part affected in 64% of allergic occupational cases and 80% of irritant occupational cases. Epoxy resin was the only allergen tested that was associated more with an occupational exposure than nonoccupational exposure. The allergens encountered most frequently in the occupational cases were carba mix, thiuram mix, epoxy resin, formaldehyde, and nickel. The medical field is overrepresented in the data compared with other occupations. CONCLUSIONS: Occupational contact dermatitis frequently was found to be multifactorial and associated with several specific allergens and occupations.

Adult↗
PubMed2004

[Perianal dermatitis and its benign simulants].

Perianal dermatitis is one of the most common proctological disorders. Concerning the etiology, three different types of dermatitis must be distinguished-the most common irritative contact dermatitis, atopic dermatitis and allergic contact dermatitis. The correct diagnosis is essential for adequate and successful treatment. A variety of benign and malignant disorders must be considered in the differential diagnosis of anal dermatitis. Dermatitic clinical disorders which do not respond to therapy should always be biopsied.

Adult↗
PubMed2004

[The diagnosis and treatment of perianal dermatitis].

Perianal dermatitis is one of the most common proctological disorders. The anatomy of the anal region provides suitable conditions for the development of dermatitis. In the diagnostic work-up and the management of patients with perianal dermatitis, three types need to be distinguished: irritant contact dermatitis, atopic dermatitis, and allergic contact dermatitis. Each type has its aetiological and pathogenetic factors, which will provide clues to the diagnosis and subsequent management of the condition. In the differential diagnosis of the condition, consideration should be given to inflammatory diseases of the perianal region which may produce eczema-like patterns.

Dermatitis, Allergic Contact↗
PubMed2004

Eyelid dermatitis: a report of 215 patients.

Between April 2001 and October 2003, 215 persons presented with eyelid dermatitis for the first time. They ranged in age from 4 months to 95 years, with an average age of 49.6 years and a median age of 51 years. There were 173 females and 42 males. 165 of 215 had allergic contact dermatitis (ACD) and another 9 had protein contact dermatitis without relevant positive patch tests. Atopic eczema comprised 37 of 215 (17%), but 33 of 37 also had contact allergies. Seborrheic dermatitis, psoriasis or both were found in 35 (16%). Sources of ACD included personal care products in 54 (25%), including 12 with at least 1 positive patch test to cosmetic applicators and 12 sensitive to at least 1 botanical ingredient. Allergy to artificial nails and/or nail lacquer occurred in 18 of 215 (8%). 5 persons had rosacea or periorbital dermatitis, and 2 had dermatomyositis. Other causes included bacterial, fungal and viral infections, some of which were quite unusual. The evaluation of persons presenting with eyelid dermatitis remains a relatively complex but rewarding discipline.

Administration, Topical↗
PubMed2005

Chemical exposure and symptoms of hand dermatitis in construction painters.

Studies on the prevalence of hand dermatitis in construction painting are rare. Our aim was to study the painters' chemical exposure and the prevalence of self-reported skin symptoms on hands and forearms. A cross-sectional questionnaire survey was conducted on 1000 Finnish male construction painters and 1000 carpenters (response rates 60.6% and 60.4%, respectively). We used 2 definitions for symptom-based hand dermatitis (liberal > or = 2 symptoms and strict criteria > or = 3) and logistic regression analysis, adjusted with age and atopy. Painters reported more symptoms of hand dermatitis than carpenters (12-month prevalence 22.5% and 14.2%, P < 0.05; strict criteria 13.3% and 6.4%, P < 0.05). A dose-response relationship was found for reporting symptoms and exposure to several solvent-based (SB) and water-based (WB) products. When exposure was combined into 1 variable, daily use of SB epoxy/urethane paints (OR 5.3, 95% CI 2.2-12.9; strict criteria 6.8, 2.3-19.9) and WB putties/plasters (1.9, 1.2-3.0; strict criteria 2.0, 1.1-3.9) were associated with hand dermatitis, whereas using only WB paints was not a risk factor. In conclusion, painters reported significantly more symptoms of hand dermatitis than carpenters. Putties/plasters emerged as a risk factor for dermatitis in construction painting.

Adult↗
PubMed1975

Occupational dermatitis in a 10-year material.

This study included 1,752 patients considered to have occupational dermatoses. The most common diagnosis was contact dermatitis. The dermatitis was of an allergic type in three-quarters of men and in half of women. One-fifth of the women with irritant contact dermatitis had an atopic history. Contact dermatitis was localized on the hands in 94% of women and in 84% of men. The most common allergens in men were chromium, rubber and plastic, and in women nickel, rubber and chromium. Chromium allergy occurred in four-fifths of the men in the building, metal and tanning industries. In one-fifth of the women, nickel allergy developed in cleaning work. Rubber allergy developed in the rubber industry in one-fifth of the cases. Half of the women with contact dermatitis were engaged in either nursing or cleaning work. A follow-up 2-3 years after treatment of 555 patients with contact dermatitis was completed by means of questionnaires. The eczema was healed in one-quarter of the patients, one-half had periodic symptoms, and one-quarter had permanent symptoms. The prognosis was the same for those who changed their work or stopped working as it was for those who continued their eczema-inducing work.

Adult↗
PubMed2004

Dermatitis and the newborn rash of hyper-IgE syndrome.

OBJECTIVE: To characterize the dermatitis, the newborn rash, and cutaneous findings in hyper-IgE syndrome, also known as Job's syndrome. DESIGN: Prospective and retrospective evaluation and treatment of cutaneous manifestations in patients with a clinical diagnosis of hyper-IgE syndrome (HIES). Analysis of the newborn rash encountered in this population. SETTING: Dermatology clinic at the National Institutes of Health, Bethesda, Md. PATIENTS: Forty-three patients seen in our clinic between January 1998 and August 2003 who had a clinical diagnosis of HIES. INTERVENTIONS: The UK Working Party's Diagnostic Criteria for Atopic Dermatitis were used to assess for atopic dermatitis in this population. To assess the newborn rash, we performed a retrospective chart review and an in-person or telephone interview of the parent or caregiver of each patient. RESULTS: Twenty-eight (65%) of 43 patients fulfilled the criteria for atopic dermatitis. Thirty-five (81%) of 43 patients reported a newborn rash. Eight (19%) of 43 were born with the rash; 23 (53%) of 43 had acquired the rash within 7 days; 32 (74%) of 43 within 14 days; 34 (79%) of 43 within 30 days; and 35 (81%) of 43 had the rash within 35 days of birth. CONCLUSIONS: The dermatitis in HIES resembles classic atopic dermatitis but may have distinctive features. A newborn rash is almost always a presenting sign of HIES. After the newborn period, skin findings include retroauricular fissures, external otitis, infected dermatitis of the axillae and groin, folliculitis of the upper back and shoulders, cutaneous abscesses, mucocutaneous candidiasis, and in some patients pitted scarring of the face.

Adolescent↗
PubMed1996

Leukotriene A4 hydrolase in peripheral leukocytes of patients with atopic dermatitis.

We examined the enzymatic activity of leukotriene (LT) A4 hydrolase, which catalyzes the conversion of LTA4 to LTB4, in peripheral leukocytes of patients with atopic dermatitis. The patients were divided into three categories (severe, moderate and mild) on the basis of clinical severity. The LTA4 hydrolase activities in the supernatant fraction of peripheral blood polymorphonuclear leukocytes (PMN) were significantly higher in preparations of cells from severe atopic dermatitis patients (123.94 +/- 16.61 pmol/10(6) cells per min) than in those from moderate (49.03 +/- 9.43 pmol/ 10(6) cells per min; P < 0.01) and mild (28.75 +/- 11.42 pmol/10(6) cells per min; P < 0.01) atopic dermatitis patients and normal controls (15.14 +/- 1.74 pmol/10(6) cells per min; P < 0.01). LTA4 hydrolase activities were also higher in peripheral blood mononuclear cells (PBMC) from severe atopic dermatitis patients (27.81 +/- 8.28 pmol/10(6) cells per min) than in those from moderate (11.31 +/- 2.11 pmol/10(6) cells per min; P < 0.05) and mild (6.16 +/- 2.62 pmol/10(6) cells per min; P < 0.05) atopic dermatitis patients and normal controls (11.17 +/- 0.83 pmol/10(6) cells per min; P < 0.05). LTA4 hydrolase activities in PMN were reduced after improvement of the disease in eight patients with severe or moderate atopic dermatitis. These results suggest that LTA4 hydrolase, which synthesizes LTB4, plays a significant role in the pathogenesis and development of atopic dermatitis.

Adolescent↗
PubMed1990

Dermatitis herpetiformis in two American blacks: HLA type and clinical characteristics.

Dermatitis herpetiformis is a rare blistering skin disease characterized in part by granular IgA deposits at the dermoepidermal junction, an associated gluten-sensitive enteropathy, and a strong association with the human histocompatibility leukocyte antigen (HLA)-A1 (74% of patients with dermatitis herpetiformis), -B8 (88%), -DR3 (95%), and -DQw2 (100%). Dermatitis herpetiformis is rarely seen in American blacks and some investigators have postulated that this finding may be due to the decreased frequency of HLA-A1 and -B8 in American blacks compared with Caucasians (American blacks: HLA-A1 = 15.3%, HLA-B8 = 10.7%; Caucasian: HLA-A1 = 26.4%, HLA-B8 = 18.3%). This report describes two American blacks with dermatitis herpetiformis and reports the results of HLA typing of these subjects for HLA-A, -B, -C, -DR, and -DQ antigens. HLA typing revealed that neither patient expressed HLA-A1 or -B8; however, both patients did express the class II antigens most frequently seen in dermatitis herpetiformis, HLA-DR3 and -DQw2. Comparison of HLA class II antigen frequency in normal American blacks and Caucasians reveals a similar frequency of HLA-DR3 and -DQw2 (American blacks: HLA-DR3 = 27.6%, HLA-DQw2 = 40.9%; Caucasian: HLA-DR3 = 22.6%, HLA-DQw2 = 32.9%). These data confirm the importance of the HLA class II region in the pathogenesis of dermatitis herpetiformis. In addition, these data suggest that the rare occurrence of dermatitis herpetiformis in American blacks is not due to the decreased frequency of the HLA class I antigens -A1 and/or -B8 but rather is related to differences in the HLA class II region not detected by routine HLA typing.

Biopsy↗