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PubMed2006

Ocular complications of atopic dermatitis in children.

Ocular complications of atopic dermatitis in adults are blepharitis, keratoconjunctivitis, keratoconus, uveitis, subcapsular cataract and retinal detachment. Their frequency varies from 25% to 50%. The aim of this study was to assess the frequency and type of ophthalmological complications in children with atopic dermatitis. The secondary objectives of the study were to determine whether there is a correlation between severity of atopic dermatitis, face involvement, external ocular signs and the presence of ocular complications, and to identify risk factors for ophthalmological complications. Thirty-seven boys and 22 girls, mean age 36.2 months, with atopic dermatitis were examined. Atopic dermatitis severity was mild according to the SCORAD index (31.6 +/- 17.0). Fifteen (25.4%) children had external ocular signs, one had a nuclear cataract, 11 had benign papillofollicular conjunctivitis, one had purulent bacterial conjunctivitis, one had chronic atopic blepharitis and one had amblyopia. Severity of atopic dermatitis, face involvement, and external ocular signs did not seem to influence the incidence of ocular involvement. This study suggests that severe ocular complications are rare in young children with mild atopic dermatitis.

Adolescent↗
PubMed2004

Epidemiological change of atopic dermatitis and food allergy in school-aged children in Korea between 1995 and 2000.

Little is known about the prevalence of atopic dermatitis and food allergy outside North America and Europe. We evaluated the prevalence of atopic dermatitis and food allergy with the comparison of prevalence between 1995 and 2000 in Korea and evaluated the correlation of prevalence between atopic dermatitis and food allergy. A cross-sectional questionnaire survey was conducted on random samples of schoolchildren 6 to 14 yr at two time points, 1995 and 2000 throughout Korea. The last twelve months prevalence of atopic dermatitis in Korean school-aged children was increased from 1995 to 2000. The twelve-month prevalence of atopic dermatitis and food allergy were higher in Seoul than in any other provincial cities in 1995, but the prevalence of both diseases in Seoul and Provincial Centers became to be similar in 2000. The rate responded to food allergy of children with atopic dermatitis (9.5%) was lower than that of the western countries (60%). And our data demonstrated paternal and maternal allergy history is very significantly correlated to developing atopic dermatitis in their offspring. The further objective evaluations are required to confirm these outcomes because the environmental and risk factors may be different among the countries according to their living cultures.

Adolescent↗
PubMed1999

The epidemiology of atopic dermatitis at a tertiary referral skin center in Singapore.

Atopic dermatitis is a common chronic, relapsing, pruritic ecematous skin condition with a predilection for the flexural areas and occurs in patients with a personal or family history of atopy. The aim of this study is to describe the profile of atopic dermatitis seen at the National Skin Centre in Singapore. A retrospective chart review was conducted of all the patients with atopic dermatitis seen during the first six months of 1994. There were 492 patients whose ages ranged from one month to 74 years with an equal sex ratio. The prevalence was 2%. The onset of the disease occurred before the age of 10 years in 61.2% of patients. In 13.6% of the patients, the onset was after the age of 21 years. Two hundred and fifty-four patients (52%) had "pure" atopic dermatitis without concomitant respiratory allergies. Two hundred and thirty-eight patients (48%) suffered from a "mixed" type, with 23% having allergic rhinitis, 12% having asthma and 13% having both asthma and allergic rhinitis. Two hundred and thirty-one patients (47%) had at least one first-degree family member with atropy: atopic dermatitis (17%), asthma (15%) and allergic rhinitis (15%). Most of the patients, 416 (84.5%), had subacute eczema at presentation. Ichthyosis vulgaris was present in 38 patients (8%) and pityriasis alba in 13 patients (3%). The most common infective complication was bacterial infection (impetiginized eczema, folliculitis, cellullitis) present in 95 patients (19%) followed by viral infections (eczema herpeticum, viral warts and molluscum contagiosum) in 17 patients (3%). Allergies were noted in 43 patients (9%) based on the history given. The most common was drug allergies (penicillin and co-trimoxazole) in 28 patients followed by food allergies in 11 patients. Common aggravating factors reported include heat, sweating, stress, thick clothing and grass intolerance. Most patients could be controlled with a fairly simple regimen of moisturizers, topical steroids and antibiotics for acute flares. Short courses of systemic steroids were used in 78 patients (16%). Three patients were treated with phototherapy, Two on UVAB and one on PUVA. The pattern of atopic dermatitis in Singapore is similar to that reported in the Western literature except for a lower prevalence and a significant proportion of adult onset atopic dermatitis.

Adolescent↗
PubMed2001

[Atopic dermatitis in Tunisia: epidemiological and clinical aspects].

INTRODUCTION: The prevalence of atopic dermatitis is usually high in western countries, varying from 18 p. 100 to 20 p. 100. Recent studies suggest an increasing of this frequency. The aim of our study is to determine the epidemiological and clinical characteristics of atopic dermatitis in Tunisia through the analysis of a retrospective cohort. PATIENTS AND METHODS: We retrospectively studied all the medical reports of atopic dermatitis registrated in the department of dermatology during a 7 years period (1992-1998). We analysed epidemiological and clinical features of every medical report. We used diagnosis criteria of Hanifin and Rajka. RESULTS: Four hundred fifty-one cases of atopic dermatitis have been diagnosed (54 adults and 397 infants). Relative frequency of new cases of atopic dermatitis compared to new diagnosis was 0.37 p. 100 in 1992 and 0.72 p. 100 in 1998. Mean age was 3.2 years. A personal history of atopy was observed for 15.2 p. 100 of patients and a family history of atopy for 35.9 p. 100. A few numbers of complications were observed. Bacterial infections interested 15.3 p. 100 of cases. Hospitalisation was needed for 4 patients (0.88 p. 100). Class III and IV topical corticosteroids were usually used (84.8 p. 100). Potent corticosteroids (class I) were required for only 3.2 p. 100 of cases. CONCLUSIONS: We notice a low frequency of atopic dermatitis in this study and a predominance of mild forms of the disease. Other studies are needed to confirm these results and to determine the prevalence of atopic dermatitis in Tunisia.

Adolescent↗
PubMed2002

Tacrolimus ointment: a new therapy for atopic dermatitis--review of the literature.

Atopic dermatitis is a chronic inflammatory skin disease characterized by severe pruritus, typical morphology and distribution of skin lesions, and personal and family history of atopy. The management of atopic dermatitis is directed at preventing the inflammation, itch, and secondary lesions. Therapy relies on general management measures, anti-inflammatory agents, antiprurites, antibiotics, and immunosuppressants. Treatment options for patients with severe or longstanding disease, extensive body surface area involvement of facial lesions are limited. Tacrolimus ointment is the first in the class of topical immunomodulators that has been formulated for the treatment of atopic dermatitis in children (2 to 15 years of age) and adult patients. The mechanism of action of tacrolimus in atopic dermatitis seems to involve T-cells, Langerhans cells, mast cells and basophiles. Experimental evidence suggests that tacrolimus inhibits T-lymphocytes activation by binding to an intracellular protein, FKBP-12. This binding phenomenon inhibits the ability of calcineurin to activate the promotor region of the gene for IL-2, IL-3, IL-4, IL-5, interferon gamma, tumor necrosis factor alpha, and granulocyte macrophage colony-stimulating factor, all of which participate in the early immune response and play a role in the pathogenesis of atopic dermatitis. Tacrolimus ointment is not atrophogenic, and is associated with minimal systemic absorption. There were no consistent changes in any laboratory variable during topical tacrolimus therapy. The most common adverse events associated with its use were transient skin burning and pruritus at the site of application. Tacrolimus ointment is safe and efficacious therapy for the treatment of pediatric and adult patients with atopic dermatitis on all skin regions including the face, neck and intertriginous areas. An overview is given of tacrolimus in atopic dermatitis.

Dermatitis, Atopic↗
PubMed2002

[Analysis of IgE reactivities of purified allergens from Candida albicans and Malassezia furfur among patients with atopic dermatitis].

We analyzed the reactivities of a series of purified allergens from Candida albicans (C. albicans) and Malassezia furfur (M. furfur) with IgE antibodies in sera from patients with atopic dermatitis. We compared the specific IgE antibody levels to manganese superoxide dismutase (Mn SOD), cyclophilin, enolase, secretory aspartic protease (SAP 2) and type A mannan from C. albicans and Mn SOD, cyclophilin and Mal f 2 from M. furfur in 21 sera from patients with atopic dermatitis and 20 sera from patients with asthma without atopic dermatitis. The prevalence of IgE antibodies and the mean IgE antibody levels to all of the allergens tested were higher among patients with atopic dermatitis than among those with asthma without atopic dermatitis. More than 50% of patients with atopic dermatitis were IgE antibody-positive to Mn SOD, cyclophilin and type A mannan from C. albicans, and Mn SOD and cyclophilin from M. furfur. The availability of these purified allergens will facilitate studies on the contribution of fungal allergens to the development of atopic dermatitis.

Adult↗
PubMed2002

Childhood atopic dermatitis: a measurement of quality of life and family impact.

Atopic dermatitis is the commonest skin disease in children, causing psychological, social and functional disability to them and their families. This study assessed the family impact and quality of life using the translated Malay version of The Dermatology Family Impact (DFI) and The Children's Dermatology Life Quality Index (CDLQI) questionnaires. Seventy-two children, aged between 6 months and 16 years attending the Paediatric Dermatology Clinic at the Paediatric Institute and the Dermatology Department, Hospital Kuala Lumpur participated in this study. Thirty-nine patients (54.2%) were males and 33 patients (45.8%) were females. The median age of the patients was 74 months (Q1 6, Q3 104 months). The median age of diagnosis was 22 months (Q1 1, Q3 36 months). The median disease duration was 44 months (Q1 3, Q3 65). The severity of eczema was assessed using the SCORAD severity index (maximum score = 83). The median SCORAD (European Task Force On Atopic Dermatitis) score was 36 (n = 72, SD = 16.2). The majority of patients in this study suffered from moderately severe eczema (n = 40, mean, SCORAD = 29.3) followed by severe eczema (n = 27, mean SCORAD = 54.3). The mildly affected patients formed the minority group (n = 5, mean SCORAD = 9.0). The family impact was shown to be greater in severe atopic dermatitis compared to moderate atopic dermatitis (Anova, p = 0.02). The children's quality of life impairment was also greater in severe atopic dermatitis compared to moderate atopic dermatitis (Anova p = 0.08). This study confirms that quality of life and family impact are related to the severity of atopic dermatitis.

Adolescent↗
PubMed2002

Occupational airborne and hand dermatitis to hop (Humulus lupulus) with non-occupational relapses.

We report a case of a 57-years-old female farmer with occupational airborne dermatitis and hand dermatitis to hop (Humulus lupulus). The disease appeared at the age of 46, after 30 years of working with hop without any health problems. The patient had skin erythema of the face, neck and décolleté , oedema of the eyelids, conjunctivitis, as well as acute dermatitis of the hands. The symptoms were provoked both by fresh and dried hop, appeared after half-an-hour of working and persisted over 1-2 days. There were no other skin or allergic problems. Skin tests were carried out with hop leaves (saline extract: prick positive, patch negative; glycerol extract: prick positive, patch negative) and hop cones (saline extract: prick positive, patch negative; glycerol extract: prick negative, patch positive after 48 and 72 hours). Despite discontinuing work, the patient experienced several relapses of her dermatitis. We identified new sources of hop allergens: a beauty cream and a herbal sedative, both containing hop extract. During the next hop cultivation period it also turned out that sleeping in one bed with her husband was provoking relapses of the patient's dermatitis. The husband admitted that sometimes he felt too tired to wash thoroughly after working on the plantation. Our case shows that connubial contacts with husband working in the same workplace may cause relapses of occupational dermatitis. To our knowledge, this is the first report on the concurrent occupational and connubial dermatitis to hop.

Agricultural Workers' Diseases↗
PubMed2002

Correlation of the density of yeast Malassezia with the clinical severity of seborrhoeic dermatitis.

OBJECTIVE: To correlate the density of the yeast Malassezia with the clinical seventy of seborrhoeic dermatitis. METHOD: Fifty patients and twenty control subjects were selected for the study. The patients were evaluated both clinically for the severity of seborrhoeic dermatitis and microscopically for the presence of the yeast Malassezia. RESULTS: Out of 50 patients Malassezia was present in 41 patients (82%). On microscopic evaluation it was found that patients with mild seborrhoeic dermatiis had a density of 2+ (more than 5 but less than 10 yeast cells per high power field (hpf). Patients with moderate seborrhoeic dermatitis had a density of 3+ (more than 10 but less than 20 yeast cells per hpf) and patients with severe seborrhoeic dermatitis had a density of 4+ (more than 20 yeast cells per hpf). Of the 20 normal subjects only 8 (40%) had Malassezia and they had a density of 1+ (5 or fewer yeast cells per hpf). The results show a strong correlation of the yeast Malassezia to the severity of seborrhoeic dermatitis (p value < 0.05). CONCLUSION: Malassezia increases in proportion with the severity of seborrhoeic dermatitis; an antifungal agent should therefore be used in the treatment of seborrhoeic dermatitis.

Adolescent↗
PubMed2005

Hand dermatitis: a problem commonly affecting nurses.

Hand dermatitis is regarded as one of the most often observed dermatological disorders among nurses. The factors that increase the risk of developing hand dermatitis are as follows: frequent washing hands, using disinfectants, wet-work conditions, exposure to medical substances, detergents and wearing rubber gloves. Most cases of occupational hand dermatitis is due to chronic exposure to irritants that cause the inflammation on the nonallergic pathway. Recurring contact to irritants disturbes the natural skin barrier and causes inflammation. There are reports showing the presence of skin barrier alterations among nurses working in operating room units. The most common contact allergens in the hospital environment include rubber, latex, medicaments and antiseptic products. In our study the incidence of self-reported hand dermatitis in hospital staff was very high. About 70% of respondents declared the presence of symptoms of hand eczema within the last 12 months and about 46% of the studied group had skin lesions at the moment of self-examination. Almost 75% of employees with hand dermatitis had observed the worsening of skin problems in relation to work and 79% reported improvement of skin changes during the leisure time. We also noted that a personal or family history of atopy increases the risk of developing hand dermatitis in nurses. We would also like to emphasize the psychological consequencies that affect nurses with hand dermatitis. According to our data 48% of hospital employees with hand eczema declare psychological distress caused by their skin lesions.

Adult↗
PubMed2005

The new scoring system for evaluation of skin inflammation extent and severity in patients with atopic dermatitis.

The new scoring system for assessment of the extent and severity of skin inflammation index in atopic dermatitis patients, W-AZS, is presented. The system provides detailed assessment of both subjective and objective signs and symptoms of atopic dermatitis. With the use of W-AZS, acute and chronic skin manifestations of inflammatory process are appropriately evaluated and scored. It also enables the practitioner to assess various localizations of skin lesions at different time points. W-AZS is a relatively easy and rapid index to perform, and it seems very beneficial for clinicians. Other scoring systems used in atopic dermatitis are also presented, analyzed and compared, e.g., Atopic Dermatitis Area and Severity Index (ADASI), SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Six Area, Six Sign Atopic Dermatitis (SASSAD), and Three-Item Severity score (TIS). There is a strong necessity to standardize clinical evaluation of the extent and severity of skin diseases such as atopic dermatitis, as laboratory techniques and parameters are not really of great use for practitioners.

Dermatitis, Atopic↗
PubMed2005

Result of standard patch test in patients suspected of having allergic contact dermatitis.

Contact dermatitis is a common skin disease. Disease was diagnosed by a history of contact substance together with geographic distribution of lesion. Up till now, standard patch test is one of the most reliable test to identify and confirm causative agent of allergic contact dermatitis. To determine the rate of positive standard patch test and to identify the common allergen of contact dermatitis in Thailand, we performed the standard patch test in 129 patients, suspected having allergic contact dermatitis at Department of Dermatology, King Chulalongkorn Memorial Hospital, Thailand from June 1, 2003 to September 1, 2004. The rate of positive standard patch test is 59.7% (n = 77/129). The most 3 common positive allergens were nickel sulfate (18.60%), cobalt chloride (17.05%) and fragrance mix (14.73%), respectively. The chance of positive standard patch test significantly correlated with sex (woman), initial diagnosis as contact dermatitis and history of house-worker (p = 0.017, p = 0.005 and p = 0.023, respectively). Whereas, there were no significant correlation between the chance of positive standard patch test and age of patient, location of lesion, history of recurrence, history of atopy, history of drug and food allergy. In addition, history of metal allergy significantly correlated with the chance of positive nickel sulfate or cobalt chloride in standard patch test (p = 0.017). In conclusion, this study demonstrated the prevalence of causative allergen of contact dermatitis in Thai patients using that standard patch test. Moreover, our data shown that the chance positive standard patch test was greater in patient, who were women or initial diagnosed as contact dermatitis or had history of houseworker or history of metal allergy.

Adolescent↗
PubMedDate not supplied

Predictability of early onset atopic dermatitis by cord blood IgE and parental history.

Cord blood IgE and atopic family history have been used as predictors of atopic disease in infants for more than 20 years. In recent years, the value of cord blood IgE in predicting the development of atopic dermatitis has been questioned, while family history of atopy has consistently been regarded as a useful predictor for atopic dermatitis. A birth cohort was followed-up to 6 months of age to record the development of atopic dermatitis and to study its association with cord blood IgE levels and parental history of atopy. The cumulative incidence of atopic dermatitis over the 1st, 3rd and 6th months of life amounted to 5.0%, 8.2% and 14.0%, respectively. When the cutoff value for cord blood IgE was set at 0.5 kU/L, there was a significant association between elevated cord blood IgE level and atopic dermatitis at 1, 3 and 6 months of age; when the cutoff value was set at 0.9 kU/L, the association was only found at 3 months of age. There was a significant association with atopic history of the mother. The effect of maternal atopic history on atopic dermatitis seen only at 1 month was lost by 3 months of age. There was no correlation between paternal history and atopic dermatitis. In our study, the predictive capacity of maternal history and cord blood IgE was not high enough to recommend them as screening factors.

Dermatitis, Atopic↗
PubMed1991

Production of interleukin-2 by mononuclear cells in vitro in patients with atopic dermatitis and psoriasis. Comparison with serum interleukin-2 receptor levels.

Atopic dermatitis is associated with profound immunological alterations, in particular decreased lymphoproliferative responses upon stimulation with T-cell mitogens. T-cell blastogenesis involves the production of the soluble cytokine interleukin-2 (IL-2), which in turn upregulates the expression of its own receptor. To investigate the potential role of this cytokine for the pathomechanisms present in atopic dermatitis, 24-h supernatants of PHA-stimulated peripheral blood mononuclear cells from patients with atopic dermatitis (n = 30) of a moderate to severe disease activity were tested for IL-2 activity. In addition, serum concentrations of soluble interleukin-2 receptor (IL-2R) were measured. Non-atopic healthy controls (n = 19) and patients with psoriasis (n = 20), an inflammatory skin disorder with distinct pathogenesis, served as controls. In comparison with psoriasis patients and normal controls, PHA-stimulated mononuclear cells of atopic dermatitis patients released significantly less IL-2 into supernatants. Moreover, there was an inverse correlation between IL-2 concentrations and body surface involvement or serum IgE levels. In contrast, serum IL-2R levels were significantly elevated in both atopic dermatitis and psoriasis, as compared with healthy controls. Furthermore, IL-2R levels in atopic dermatitis patients showed a significant correlation with IgE levels and body surface involvement. The data indicate that T cell activation may occur in both skin diseases. Atopic dermatitis, however, is further characterized by the decreased capacity of mononuclear cells to release IL-2 upon stimulation in vitro.

Adolescent↗
PubMed1976

Atopic dermatitis: etiology and pathogenesis.

Atopic dermatitis is a recognizable phenotype that most likely results from several mechanisms. An increasing number of children with atopic dermatitis are recognized as having immune defects, although the exact incidence of such immunodeficiency states among patients with atopic dermatitis is unknown. Children with atopic dermatitis who suffer recurrent or persistent infections should undergo immunologic evaluation. Ideally, this should include evaluation of cell-mediated immunity as well as neutrophil and monocyte chemotaxis. Further investigation into the beta-blockade theory may enhance our understanding of atopic dermatitis. Careful attention to factors exacerbating atopic dermatitis is essential in understanding this problem. Abnormal sweating, dry skin, sensitivity to contactants, and emotional stress should always be considered in evaluation of children with atopic dermatitis.

Child↗
PubMed1988

[Dry hands (irritative contact dermatitis) in housewives which is not alleviated on cessation of domestic work: clinical varieties].

There are three types of hand dermatitis in housewives. The most usual are cured when housework is stopped. Another type is that of housewife contact dermatitis which appears on pre-existing endogenous lesions such as dyshidrosis or nummular eczema. The third form is housewife hand contact dermatitis which appears, or coexists with, localized endogenous lesions of the hands. The last two forms are not cured when housework is stopped. In some cases the three forms may coexist or appear one after another. It is not usual for a person suffering from typical flexural atopic dermatitis to present with one of the described three forms of hand dermatitis. Nevertheless, without having some relationship to atopic diathesis no woman could suffer from any of these three forms of dermatitis. In spite of the lack of analytical data, everyday clinical facts (one example being these different forms of housewife hand dermatitis) suggest the need to accept a subgroup of cutaneous atopic diathesis.

Dermatitis, Contact↗
PubMed1995

Seborrhoeic dermatitis and Pityrosporum yeasts.

The connection between P. ovale and seborrhoeic dermatitis has been clearly demonstrated in a number of treatment studies but we still do not know how P. ovale induces skin lesions. An enhanced growth of P. ovale cannot be the cause, because a number of studies with quantitative determinations of P. ovale have not been able to show any difference in the number of yeast cells between patients and healthy controls. The number of P. ovale is probably only important for the individuals who are susceptible to seborrhoeic dermatitis. An abnormal immune response to P. ovale could be another explanation. Sohnle et al. have shown that P. ovale can activate complement by both the classical and the alternative pathway. A defective cell-mediated immunity to P. ovale in patients with seborrhoeic dermatitis has been demonstrated by Wikler et al. In patients with AIDS, who are known to have a diminished T-cell function, a high incidence of seborrhoeic dermatitis has been found. Activation of the alternative complement pathway by P. ovale, which does not require T-cell function, could be an explanation for the inflammatory response. I also believe that the skin lipids are important in the pathogenesis. An improvement of seborrhoeic dermatitis has been demonstrated after treatment with drugs that reduce the sebum excretion. Pityrosporum has lipase activity and may generate free fatty acids, which could also contribute to the inflammatory response. There are a number of factors which are probably important in the pathogenesis of seborrhoeic dermatitis, that is, the number of P. ovale, P. ovale lipase activity, skin lipids, immune function, heredity, atmospheric humidity and emotional state. A reduction in the number of P. ovale in patients suffering from seborrhoeic dermatitis and being treated with antimycotic treatment is, at the present state of knowledge, the best way to treat the disease.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Atopic dermatitis and related factors observed at infant physical examination at health centers].

We investigated the incidence of atopic dermatitis and related factors at infant physical examination at health centers. Subjects were 900 infants (290 four-month-old infants, 298 one-year and six month-old infants, 312 three-year-old infants) who participated in infant physical examinations in Kanazawa-ku, Yokohama City. Overall, we analyzed 696 infants whose mothers had cooperated with the survey by completing questionnaires during physical examinations, and who submitted to examination by consulting dermatologists. The incidence of atopic dermatitis was 11.6% in 4-month-old infants, 12.2% in 1.5-year-old infants, and 12.1% in 3-year-old infants. The following were found to be related to the atopic dermatitis of infants. 1. Family history of atopic dermatitis in their mothers and older siblings. 2. Mothers' limited diet during pregnancy (avoiding some food which are suspected allergens). 3. Past history of molluscum contagiosum. 4. The frequency of taking bath. While epidemiological surveys of atopic dermatitis have previously been performed, the criteria at each survey was not identical and results could not be compared precisely. In this survey, 1. Dermatologists specializing in atopic dermatitis performed examinations. 2. All diagnoses were made according to standardized criteria which are applied nationwide. 3. All subjects were from a specific region. Because of this approach, this survey provides important information that can form the basis of comparison for future epidemiological surveys of atopic dermatitis.

Age Factors↗