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[Pulmonary function tests and bronchial reactiveness with histamine in patients with atopic dermatitis and bronchial asthma].

Atopic dermatitis and bronchial asthma are genetically dependent diseases, connected with an over-synthesis of IgE antibodies, in which a chronic inflammation is characteristic for their pathogenesis. The coincidence of bronchial hyperresponsiveness and symptoms of atopic dermatitis suggests to investigate the degree of bronchial reactions in atopic dermatitis or asthma patients. The main goal of this analysis was to compare the pulmonary functional tests and the bronchial histamine induced reactiveness in 71 patients. The investigation included 27 atopic dermatitis patients, 12 asthma-prurigo patients and 32 bronchial asthma patients. All of them were tested with "Pneumoscreen" (Jaeger), in order to define: VC, FEV1, FEF50, and Raw. The bronchial reactiveness with 1% histamine solution, was tested on "Bronchoscreen" (Jaeger). In atopic dermatitis and asthma-prurigo patients, no obstructive ventilation impairment was found. The bronchial hyper-reactiveness to histamine was found in 11.1% of atopic dermatitis patients, 16.7% of asthma-prurigo patients and 78.1% of bronchial asthma patients. The coexistence of bronchial asthma and atopic dermatitis increases the degree of bronchial reactiveness.

Adolescent↗

Successful treatment of severe atopic dermatitis-complicated cataract and male infertility with a natural product antioxidant.

There has been a recent dramatic change in the features of atopic dermatitis and male infertility, including a marked increased prevalence of severe and treatment-resistant atopic dermatitis; an increase in severe atopic dermatitis complicated by cataracts, especially in urban and industrial areas; and an increase in the number of infertile men with poor sperm motility. Previously we have attributed these changes to the increased free radicals produced by environmental toxicity. We have reported the increase in lipid peroxide levels and decrease in superoxide dismutase inducibility in severe atopic dermatitis patients, and shown that lipid peroxides attach to the stratum corneum, promoting loss of skin moisturization and resulting in the worsening of atopic dermatitis. Cataracts which occur with severe atopic dermatitis are also formed by the diffusing of lipid peroxides through the posterior lens. Regarding aspermia, the standard levels of sperm motility according to the World Health Organization Guidelines have been reduced to 50% from 60%, but nonetheless the prevalence of infertile men is increasing. It has been reported that antioxidants such as ascorbate, catalase and glutathione-Px can reverse the decrease in sperm motility in the seminal plasma of infertile men. We have developed an oral antioxidant, named AOA, which is produced from natural plants and seeds (e.g., soybean, sesame, wheat germ), treated by heating with far infrared rays (4-14 microns wavelength), brewed with Aspergillus oryzae, and lipophilized with similarly heated sesame oil. These procedures liberate low-molecular-weight antioxidants that exist naturally in an inactive form of repeating subunits of polymers, to produce free, activated forms of antioxidants. This natural medicinal product, AOA, has been applied to the treatment of both cataract complicated with atopic dermatitis and male infertility. Approximately half the patients tested have shown marked improvement.

Administration, Oral↗

[Peripheral eosinophil counts relates the improvement of the skin lesions of atopic dermatitis patients more sensitive than serum eosinophil cationic protein levels].

We described the severity of skin lesions and detected peripheral eosinophil counts (Eos) and serum eosinophil cationic protein levels (s-ECP) in 81 patients with atopic dermatitis (male 33, female 48, age 20.7 +/- 8.8) at the first consultation. Eos were 583.3 +/- 560.2/mm3 and s-ECP were 18.0 +/- 21.7 micrograms/l (normal 6.88 +/- 3.46). After approximately 30 days treatment, the improvement of dermatitis were estimated and those lavatory findings were rechecked. Eos were 446.7 +/- 367.6/mm3 and s-ECP were 13.2 +/- 11.7 micrograms/l. At 5 percent level, positive correlations were observed between Eos and s-ECP (R = 0.75), Eos and the severity of dermatitis (R = 0.52) and s-ECP and the severity of dermatitis (R = 0.51) at the first consultation. We found a positive correlation between Eos and the improvement of dermatitis (R = 0.40) but no correlation between s-ECP and the improvement of dermatitis (R = 0.10). Eos related the improvement of the skin lesions of atopic dermatitis more sensitive than s-ECP.

Adolescent↗

Erythema multiforme associated with contact dermatitis to poison ivy: three cases and a review of the literature.

Erythema multiforme (EM) is a hypersensitivity reaction that occurs mainly after exposure to certain medications or in the setting of infection, most commonly that due to herpes simplex virus. Rare cases of EM have been reported after allergic contact dermatitis due to various substances. There has been one case in the literature of EM following Rhus contact dermatitis. We report three patients who developed EM after allergic contact dermatitis due to poison ivy. In all three patients, targetoid lesions developed primarily on the palms and soles, either after a brief course of prednisone or during its taper. Two of the patients have had more than one episode of EM after poison ivy dermatitis. Although EM has been described after allergic contact dermatitis due to a variety of antigens (nickel being the most common), there is only one report in the literature of EM following Rhus contact dermatitis. Given the prevalence of allergic contact dermatitis due to poison ivy, this may be an under-reported complication.

Adolescent↗

Compositae dermatitis.

Compositae dermatitis is an allergic contact dermatitis. The most important allergens in the Compositae family are sesquiterpene lactones (SL), which are present in the oleoresin fraction of leaf, stem, flower and possibly pollen. Compositae dermatitis is most frequently seen in middle-aged and elderly people in patterns reflecting airborne or direct contact with the allergens. The pattern typically starts in summer and disappears in the autumn or winter. Repeated exposure over many years may lead to a chronic and, at times, a disseminated pattern. Seasonal variation does not occur in occupational Compositae dermatitis. In addition to the classically described airborne pattern of face, 'V' of neck, hands and forearms, hand dermatitis is now recognized to be an equally common presentation. This variability of clinical features, and the frequent occurrence of atopic dermatitis and contact allergy to one or more compounds, highlights the need for routine patch testing with sesquiterpene lactone mix 0.1% (Thermal, Hamburg, Germany), combined with aimed patch testing with Compositae plants and extracts. Avoidance of the plants and plant extracts of this large family can be difficult due to its widespread occurrence in flower, herb and vegetable gardens, urban and rural weed population and native vegetation. Importantly, Compositae plant extracts are present in many cosmetics, shampoos, herbal creams and ingested herbal remedies and tonics.

Adrenal Cortex Hormones↗

A nurse-led clinic in chronic and allergic contact dermatitis.

It has generally been acknowledged that the incidence and prevalence of contact dermatitis has increased in recent years. It can develop at any stage of a person's life span (rare before puberty), and in many different circumstances and occupations. The demand on consultant dermatologists for contact dermatitis services has resulted in the depletion of some essential components to the investigation process, and patient outcomes have been affected. In recent years it has also resulted in the development of nurse-led contact dermatitis services. The traditional role of the dermatology nurse in contact dermatitis is to carry out patch testing. Nurse-led services require the wider acquisition of skills and knowledge in relation to contact dermatitis. This article is an attempt to introduce the complexities of contact dermatitis, and nurse-led services.

Ambulatory Care Facilities↗

Papillomatous digital dermatitis and associated risk factors in US dairy herds.

The objective of this study was to describe the incidence of papillomatous digital dermatitis in the US (including regional and herd size patterns) and to evaluate specific herd-level management factors associated with high incidence of digital dermatitis in US dairy herds. The study design was a population-based cross-sectional survey. US dairy operations with at least 30 cows in 20 states, representing 79% of US dairy cows, were sampled. On participant operations, a questionnaire was administered by veterinary medical officer or animal-health technicians on-farm to dairy managers. Papillomatous digital dermatitis was reported in milk cows in the previous 12 months from 43.5% of US dairy herds. Seventy-eight percent of affected herds reported that their first cases occurred in 1993 or later. Regions of the USA with the highest percent of herds affected included the Southwest, Northwest, and Northeast. Factors associated with high (> 5%) incidence of papillomatous digital dermatitis included region, herd size, type of land lactating cows accessed on a daily basis, flooring type where lactating cows walked, percent of cows born off the operation, use of a primary hoof trimmer who trimmed cows' hooves on other operations, and lack of washing of hoof-trimming equipment between cows. Papillomatous digital dermatitis has been recently reported from dairy herds across the US. This study suggests that a high percentage of herds with digital dermatitis could be prevented. Management strategies to potentially prevent or reduce incidence of digital dermatitis on dairy operations include those related to biosecurity and 'cow hoof' environmental conditions.

Animals↗

A randomized comparison of an emollient containing skin-related lipids with a petrolatum-based emollient as adjunct in the treatment of chronic hand dermatitis.

Hand dermatitis is a multifactorial skin disorder in which skin barrier impairment is involved in the pathogenesis. The development of topical agents that improve skin barrier function is therefore a promising approach for the management of hand dermatitis. Topically applied lipids may interfere with skin barrier function, and emollients containing skin-related lipids have been suggested to facilitate repair of the skin barrier. However, evidence for the superiority of emollients containing skin-related lipids over the more traditional emollients is still lacking. The aim of this study was to compare an emollient containing skin-related lipids (Locobase Repair) with a traditional petrolatum-based emollient for the management of hand dermatitis. Adult males and females (n = 30) with mild to moderate chronic hand dermatitis were treated twice daily for 2 months either with an emollient containing skin-related lipids or with a pet.-based emollient. In the case of exacerbation, the patients of both treatment groups were allowed to use a mild corticosteroid according to instructions. Both treatment regimes significantly improved clinical signs of hand dermatitis as assessed by the investigator global assessment, hand eczema area and severity score. We did not observe significant differences in the improvement of clinical signs, itching, patients' assessment of efficacy, cosmetic acceptability or usage of topical corticosteroids between both treatment groups. In conclusion, this study confirms that the frequent use of emollients may be useful in the therapy of hand dermatitis. However, we could not demonstrate the superiority of this particular emollient containing skin-related lipids in patients with chronic hand dermatitis.

Administration, Topical↗

Periorbital dermatitis as a side effect of topical dorzolamide.

AIM: To report periorbital dermatitis as a late side effect of topical dorzolamide hydrochloride (Trusopt), a drug used to reduce intraocular pressure. METHODS: A retrospective study of 14 patients who developed periorbital dermatitis while using topical dorzolamide hydrochloride was undertaken. Six patients underwent patch testing for sensitivity to Trusopt, dorzolamide hydrochloride, and the preservative benzalkonium chloride. RESULTS: The periorbital dermatitis occurred after a mean period of 20.4 weeks of commencing dorzolamide hydrochloride therapy. 13 patients had used preserved topical beta blocker treatment for a mean period of 34.2 months without complication before the introduction of dorzolamide. In eight (57.1%) the dermatitis resolved completely after discontinuing dorzolamide but in six (42.9%) resolution of the dermatitis did not occur until the concomitant preserved beta blocker was stopped and substituted with preservative free drops. Patch testing for sensitivity to Trusopt, dorzolamide hydrochloride, and benzalkonium chloride was negative. CONCLUSION: These findings suggest that dorzolamide can cause severe periorbital dermatitis. Although the dermatitis may resolve when dorzolamide is discontinued, this does not always occur and in some patients all topical medication containing benzalkonium chloride needs to be stopped.

Administration, Topical↗

[Chronic actinic dermatitis. Concept and case examples].

Two women patients with chronic eczematous dermatitis, who also developed extremely severe, persistent photosensitivity during a course of 10 and over 40 years, are presented. Both patients had an atopic history with positive immediate skin reactions. Patch and photopatch tests revealed sensitization to several contact allergens, and in one case also a photocontact allergy. The action spectrum of the photosensitivity was confined to UV-B; it was possible to provoke eczematous skin reactions with doses smaller than 1 mJ/cm2 UV-B. Both patients were successfully treated with PUVA therapy. These case reports demonstrate the difficulty of nosological classification of chronic eczematous photosensitive dermatoses under the traditional terms persistent light reaction, photosensitive eczema, photosensitivity dermatitis, and actinic reticuloid. Chronic actinic dermatitis is defined clinically by chronic dermatitis on skin exposed to sun, histologically by spongiotic dermatitis, and photobiologically by experimental provocation of spongiotic dermatitis with UV-B and often also longer wavelengths in the absence of a photoallergen. Chronic actinic dermatitis should be used as a general term in addition to the more specific terms listed above.

Biopsy↗

Topical pimecrolimus in the treatment of human allergic contact dermatitis.

BACKGROUND: Contact dermatitis is a common clinical problem, with prevalent sensitizers being cosmetics, metals, medicines, and plants. Plants of the Toxicodendron species cause allergic contact dermatitis (ACD) in 50% to 70% of the population. Pimecrolimus is an ascomycin macrolactam developed for the treatment of inflammatory skin diseases and approved by the US Food and Drug Administration for atopic dermatitis. There are studies supporting the effectiveness of macrolactams when administered before antigen challenge, but there are no studies describing the effectiveness of these drugs in the treatment of established human ACD. OBJECTIVE: To investigate the effect of topical pimecrolimus in the treatment of Toxicodendron-induced ACD once rash is evident. METHODS: Poison ivy tincture was applied to the bilateral anterior forearms of 12 subjects with Finn Chambers (Allerderm Diagnostic Products, Petaluma, CA). After dermatitis was evident, volunteers treated each arm twice daily with either 1% topical pimecrolimus cream or placebo in a blinded fashion. Outcomes measured were a dermatitis grading score and time to rash and itch resolution. RESULTS: The median +/- SEM time for rash resolution was 16.55 +/- 1.59 days in the treatment group and 16.27 +/- 1.82 days in the placebo group (P = 0.601). The median time for itch resolution was 4.73 +/- 1.56 days in the treatment group and 4.91 +/- 1.59 days in the placebo group (P = 0.167). The average dermatitis score was 2.26 +/- 0.17 in the treatment group and 2.32 +/- 0.15 in the placebo group (P = 0.62). CONCLUSIONS: The application of topical pimecrolimus is ineffective in the treatment of ongoing Toxicodendron-induced ACD.

Administration, Topical↗

Interdigital dermatitis: sentinel skin damage in hairdressers.

In the course of a cohort study, 2275 hair-dressing apprentices were examined a median of 6 weeks after the start of their training in the years 1992. 1993 and 1994. Skin changes were noted in 821 (36%). The site most often affected was the interdigital web space (664 of those with skin changes: 81%). The proportion of participants with a high atopy score and previous hand and flexural dermatitis was larger in the subset with interdigital dermatitis than in healthy persons, but was particularly elevated in those affected by dermatitis involving other sites. Interdigital dermatitis can be regarded as a potential precursor of more severe hand dermatitis in hairdressers, and probably of irritant hand dermatitis in wet work occupations in general. Thus, it is an important sentinel for secondary prevention. e.g. regular and thorough application of emollients.

Barbering↗

Soluble oil dermatitis: a review.

Cutting fluid technology has rapidly developed, presenting dermatologists and occupational physicians with a changing pattern of skin disease. The use of soluble oils has increased, and has been followed by an increase in the incidence of eczematous dermatitis. This is usually an endemic, chronic, irritant contact dermatitis, but thorough patch testing can also reveal allergic contact dermatitis. In conditions of heavy exposure, the prevalence of dermatitis can be as high as 30 per cent. Individual susceptibility is very variable. Research into resistance factors in those who do not develop dermatitis, and susceptibility factors in those who do, may elucidate basic mechanisms of irritancy. Efforts must continue to be directed at prevention because, once established, soluble oil dermatitis can be slow to resolve, even after specialist treatment and change of job. Prevention can be directed at the machine operative, the soluble oil, and the machine.

Dermatitis, Contact↗

Epidemiology of dermatitis among California farm workers.

To estimate the prevalence of dermatitis and risk factors for skin disease in California farm workers, a cross-sectional survey was conducted among grape, citrus, and tomato workers. The prevalence of contact dermatitis was 2% and lichenified hand dermatitis was 13%. Grape workers were more likely to report rashes in the last 12 months than were tomato workers or citrus workers. Grape workers were more likely to have contact dermatitis and lichenified hand dermatitis than were citrus or tomato workers. Increasing hours per week in agriculture, male sex, and not wearing gloves were associated with more lichenified hand dermatitis. We conclude that skin disease in agricultural workers may be causally associated with crop-specific exposures and lack of protective equipment.

Adult↗

The outcome of primary irritant hand dermatitis.

Four hundred and sixty-two patients suffering from primary irritant hand dermatitis were sent postal questionnaires after 1-16 years regarding the outcome of their dermatitis. Two hundred and thirteen patients replied (a compliance rate of 46%). Of the 213 replies 188 were accepted for analysis, of whom only 58 (30.8%) had complete remission of their dermatitis, whilst 130 patients (69.2%) had continuous, or intermittent disease. Of sixty-four patients who changed their occupation only twenty-one (32.8%) had complete remission of their dermatitis as opposed to thirty-seven (29.8%) of 124 who continued their occupation after the diagnosis of primary irritant hand dermatitis was made. It would appear that the outcome of primary irritant hand dermatitis is not favourable, even after 10 years, and change of occupation has no significant effect.

Dermatitis, Contact↗

Peroral challenge tests with food additives in urticaria and atopic dermatitis.

Double-blind, placebo controlled challenge tests with benzoic acid butylhydroxytoluene, butylhydroxyanisole, beta-carotene, beta-8-apo-carotenal, and sodium metabisulfite were made in 44 cases of chronic urticaria, 91 cases of atopic dermatitis, and 123 cases of contact dermatitis, as a comparison group. Positive reactions were seen in four patients, two of whom had urticaria, one atopic dermatitis, and one contact dermatitis. Two of these reactions were caused by the placebo, one in a patient with urticaria and the other in a contact dermatitis patient. For one patient who reacted to the placebo and one who reacted to benzoic acid, the challenges were repeated with positive results in both instances. In nine patients, equivocal test results were produced with all the active substances and the placebo, but in all nine cases, retesting 4 days later produced negative results. This suggests that common food additives are seldom if ever of significance as precipitating factors in chronic urticaria or atopic dermatitis.

Adolescent↗

Thoughts on irritant contact dermatitis.

An attempt is made to formulate some kind of working hypothesis concerning the pathophysiology, clinical appearance and treatment of irritant contact dermatitis. Acute irritant dermatitis may be caused by one single overwhelming external exposure of comparatively short duration. It is usually accidental and therefore recognized early as cause and effect. Chronic irritant dermatitis may be the result of a too early repetition of one impairing factor (chronic irritant dermatitis "traumiteration' type), but is more commonly the result of the influence of a variety of stimuli, each starting to be active before recovery from the foregoing stimuli has been completed (chronic irritant dermatitis 'summation' type.) By repetition of the same stimulus, or by a combination of varying stimuli, the degree of impairment surpasses a critical level, in consequence of which a clinical disease (irritant contact dermatitis) ensues. This clinical disease, however, is only 'the tip of the iceberg'. Such stimuli may be chemical, mechanical and/or climatic. To find out which are the harmful factors requires a detailed case history about the patient's work, habits and hobbies, thus enabling him to avoid as many damaging exposures as is practical, and hence reducing the sum of causative factors. A number of causative factors are enumerated. The article is intended to be a catalyst to promote discussion on this subject.

Acute Disease↗

Occupational contact dermatitis among rubber workers.

The occurrence of occupational contact dermatitis among workers in a rubber factory from 1976 to 1980 was studied. Insurance compensation was paid to 50 workers with dermatitis. 21 of the cases were allergic and 27 toxic contact dermatitis, giving a contact dermatitis frequency of 5.6/1000 workers. Paraphenylenediamine compounds were the main cause of allergic contact dermatitis and solvents the main cause of toxic contact dermatitis.

Dermatitis, Contact↗