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89 patients with atopic dermatitis were tested with regard to hydration of the horny layer. The measurements were taken at different topographic areas of the skin. It could be demonstrated that the hydration of the stratum corneum in patients with atopic dermatitis does not basically differ from that of healthy skin.
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In individuals free from skin diseases, the resistance and the neutralisation to alkali, and the quantity of lipids at the surface of the skin, are constitltional factors; these idiotypically (genetically) controlled factors are subject to paratypical (environmental) variations. The frequency of a reduced alkali neutralisation and of sebostasis in case of neurodermitis atopica and of ichthyosis vulgaris is not dealt with in the literature, but it results from literature findings that a pathologic alkali resistance is a facultative feature in neurodermitis atopica, while it is an obligatory one in ichthyosis vulgaris. The difference seems to be conditioned genetically. In neurodermitis atopica, the genotype is in itself of no pathogenic importance since the disease is induced exclusively by exogenous and endogenous, non hereditary agents. In ichthyosis vulgaris, the reduced alkali resistance falls into the pleiotropic character of the disease.
The therapy of atopic dermatitis remains a challenge. The success of any therapeutic concept is based on a broad and early diagnostic approach which allows to rule out relevant provocation factors and allergens. During remission periods the regular use of a topical basic therapy consisting of drug-free emolients is recommended. Topical corticosteroids as well as systemic or local antimicrobial therapy and antihistamines are essential during periods of acute exacerbations. Although during the last years a great number of new therapeutic approaches have been published, data of most of these therapeutic modalities are not sufficient to allow an unrestricted use in all patients with atopic dermatitis.
General and local factors affecting the development of atopic cheilitis, alone and in association with disseminated neurodermatitis, have been studied. Health disorders were more incident in children with cheilitis concomitant with disseminated neurodermatitis than in those with cheilitis alone (without other skin involvement). The most significant general risk factors are an unfavorable course of antenatal development, exudative catarrhal diathesis, food allergies, gastrointestinal diseases, intestinal dysbacteriosis. Local risk factors were impaired joining of the lips and disordered nasal breathing, long soother sucking, harmful habits, and maxillodental abnormalities. Clinical symptoms in isolated cheilitis and cheilitis concomitant with disseminated neurodermatitis are similar, but cheilitis associated with disseminated neurodermatitis runs a more severe course.
Our objective was to test the hypothesis that the risk of childhood leukemia is associated with allergies or a family history of allergy. We used a German population-based case-control study with self-reported information on allergies of the children and their first-degree relatives. Our study included a total of 1,130 cases of acute lymphoblastic leukemia (ALL), 164 cases of acute myeloid leukemia (AML) and 2,957 controls. A major finding of our study is that hay fever, neurodermatitis and contact eczema are underrepresented within the group of children with ALL, with respective odds ratios (OR) of 0.45 (95% confidence interval [CI] 0.31-0.66) for hay fever, of 0.49 (CI 0.34-0.71) for neurodermatitis and of 0.62 (CI 0.39-0.99) for eczema, respectively. Atopic diseases, comprising hay fever, neurodermatitis and asthma, are much stronger related with a reduced risk of ALL than other allergies (OR 0.52, CI 0.40-0.67 vs. OR 0.89, CI 0.66-1.21). The strongest association is seen with an atopy in the index child; however, ALL risk is also reduced if one of the parents or a sibling had an atopic disease. No such consistent pattern is seen for AML. Our data suggest that atopy or a family history of atopy are associated with a reduced risk of childhood ALL. Recall bias remains a concern, but sensitivity analysis provided some evidence that the protective effect is unlikely to be attributable to this bias in its entirety.
In the development of clinical symptoms of atopic constitutional neurodermatitis, the application of urea can 1. regulate corneal layer lipids by hydrating the corneal layer and influencing transepidermal water loss, 2. reduce itching via inhibition of tryptic enzymes in the skin and, 3. diminish the susceptibility of the skin to infection by directly acting on the cell membranes of bacteria and fungi. In the present study, the combination of urea and hydrocortisone was used for acute attacks and urea ointment for chronic therapy. The study comprised 1905 patients ranging from small children to adults and was conducted by dermatologists as well as pediatricians. Medical monitors supervised the course of the study. Statistical assessment of the results obtained consolidated previous knowledge and led to new results and epidemiological insights which will be presented at the Neurodermatitis Symposium. Urea therapy in the form of a hydrocortisone-urea ointment represents an effective and low-side effect therapy of this type of chronic dermatosis. 84% of the patients showed very good to good results. Local therapy with other corticosteroids was only reported as necessary in 16% of the cases. The antiinflammatory value of hydrocortisone and its high tolerability became particularly evident. In addition to its special properties in the therapy of neurodermatitis, urea also ranks high as a physiological substitution.
Lichen planus (LP) is an entity endowed with a striking polimorphysm and with a diversity of topographic localizations. In spite of the diagnostic difficulties that the combination of these factors occasionally produce, the histopathology of the lesion is tipical and diagnostic. Our presentation seems to be justified since, to the best of our knowledge, the anal localization of the disease has not been reported and it is also rare. The finding of these anal manifestation has not been casual. With the certitude that there was no reason why LP could not appear in a semimucosa so much alike that of the lips we have systematically examined the anal region of patients bearing lesions of LP elsewhere. Anal lesions that appeared to correspond to LP were detected and their histopathology confirmed the existence of LP in some of these cases. The structural changes permit the grouping of cases in four categories: Tipical LP of the anal semimucosa. LP of the anal semimucosa masked by coexistent lichen simplex chronicus (neurodermatitis). Serial sections of the paraffin block or biopsy of a nearby area usually prove diagnostic. Neurodermatitis associated to a lichenoid tissue reaction: Focal effacement of the basal membrane associated to lymphoid infiltrate of the upper dermis. Neurodermatitis without lichenoid features. It is our interpretation that this localization of LP may be due to a Köbner's phenomenon provoked by scratching induced by pruritus, as it occurred in our cases, or by other microtraumas so common to the area.(ABSTRACT TRUNCATED AT 250 WORDS)
Valid questions for atopic eczema are necessary to identify risk factors in epidemiological studies. We have examined the influence of cultural and educational factors on the validity of some questions on atopic eczema used in the International Study of Asthma and Allergies in Childhood by using data from a cross-sectional study on 1511 children aged 6 years from East and West Germany. We tested three questions in relation to a point prevalence of atopic eczema as recorded by a dermatologist: (i) has a physician ever diagnosed eczema in your child? (ii) Has your child ever had an itchy rash which came and went for at least 6 months? (iii) Has your child ever had 'neurodermatitis' (atopic eczema, endogenous eczema)? The point prevalence of atopic eczema on the day of investigation was 11.1% (134 of 1217). According to the questionnaire, 15.7% of the children had had physician-diagnosed eczema, 14.1% had had neurodermatitis and 11.3% had had an itchy rash for > 6 months. Fifty-one per cent of parents who had a child with atopic eczema on the day of investigation said that their child had had an itchy rash which came and went for at least 6 months. This sensitivity value is less than that found in another community survey conducted in the U.K., suggesting that the German wording of the question seems to mean something more severe to the parents than the English one. The education of the parents had an influence on the validity of the three questions: parents with < 10 years of schooling often answered symptom and diagnosis questions less positively. Parents with academic degrees, contrary to expectation, did not answer most precisely, this being especially true for the symptom questions. The association between symptom questions and clinical diagnosis was higher in West than in East Germany. We compared lifetime eczema symptoms and diagnosis with a point prevalence clinical diagnosis. In the absence of knowledge of how extraneous factors measured in this paper can affect diseases chronicity, it is difficult to say with certainty that such factors affect the validity of symptom and diagnosis questions on atopic eczema. Our study suggests that more studies are needed to examine the influence of social class, education and location on the validity of symptom questionnaires for atopic eczema. Until then, we recommend that information about such variables should be gathered routinely.
A long-term review of 108 women suffering from various forms of vulval dermatosis is described and a detailed analysis of those with chronic hypertrophic vulvitis, lichen sclerosus et atrophicus, and neurodermatitis is made. One case of neurodermatitis and two cases of lichen sclerosus progressed to carcinoma but no case of chronic hypertrophic vulvitis became malignant. It is possible that vulval dermatoses occur more commonly in the nulliparous than in the parous women and there is a slight preponderance of women who are blood group A. It is suggested that the term "leukoplakia" should be abandoned and that vulval lesions should be described in precise and meaningful histological terms.
The efficacy and tolerance of 0.1% diflucortolone valerate (Nerisona) in cream, ointment and fatty ointment formulations were investigated in a study in which no control preparations were used. The study was conducted in 657 children over a period of three weeks. The results were compared with those of a trial with the same design conducted with 4,878 adults. Our observations were mainly concentrated on the two groups eczema/dermatitis and neurodermatitis (atopic dermatitis). Nearly 90% of the children taking part in the study exhibited these clinical pictures. By far the best therapeutic results were obtained in neurodermatitis. There was only one therapy failure among 198 patients (99.5%). Overall the results obtained in children were markedly better than those recorded for adults.
The activities of glutamic-pyruvic transaminase (GPT) and catalase are increased by 42 to 283% in patients with neurodermatitis, eczema, and psoriasis, whereas the activities of glutamic-oxaloacetic transaminase, alkaline phosphatase, and cholinesterase are unchanged. In women with neurodermatitis and psoriasis the level of GPT is by 24-28% lower than in men. In psoriasis catalase activity in women is by 50% higher than in men. Hence, the activities of some enzymes in disease are related to patients' sex. Blood serum catalase measurements are diagnostically valuable in skin diseases.
Double blind study with contralateral comparison, between diflucortolon valerianat, 0.1% and the flumetason pivalat, 0.02% in pomades (ointments). Selection of 52 patients both sexes and variable ages with bilateral dermatological inflamatory lesions and with simetric preference: Psoriasis, "eczema vario" and neurodermatitis. In psoriasis, diflucortolon offered better results: the same occurred in the cases of eczema, and in neurodermatitis. The efficacy was similar. There were no appearances of negative secondary effects because of the used doses and time.
Coal tar ointments have been used for many years in the treatment of chronic eczematoid dermatitis. The possible carcinogenic effect of coal tar ointment and ultraviolet light (Goeckerman regimen), considered individually or in combination, has been of concern to physicians. A 25-year follow-up study was completed on 426 patients with atopic dermatitis and neurodermatitis who were hospitalized and treated with coal tar ointments and ultraviolet light at the Mayo Clinic from 1950 through 1954. These results were compared with those from a similar study that examined patients with psoriasis who also were treated with coal tar ointments and ultraviolet light. The results of this study suggest that the incidence of skin cancer is not significantly increased above the expected incidence for selected populations of the United States. This study offers reassurance about the relatively small risk of skin cancer developing in patients with atopic dermatitis and neurodermatitis treated with coal tar ointments and ultraviolet light (Goeckerman regimen).
Biofeedback can improve cutaneous problems that have an autonomic nervous system component. Examples include biofeedback of galvanic skin resistance (GSR) for hyperhidrosis and biofeedback of skin temperature for Raynaud's disease. Hypnosis may enhance the effects obtained by biofeedback. Cognitive-behavioral methods may resolve dysfunctional thought patterns (cognitive) or actions (behavioral) that damage the skin or interfere with dermatologic therapy. Responsive diseases include acne excoriée, atopic dermatitis, factitious cheilitis, hyperhidrosis, lichen simplex chronicus, needle phobia, neurodermatitis, onychotillomania, prurigo nodularis, trichotillomania, and urticaria. Hypnosis can facilitate aversive therapy and enhance desensitization and other cognitive-behavioral methods. Hypnosis may improve or resolve numerous dermatoses. Examples include acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Hypnosis can also reduce the anxiety and pain associated with dermatologic procedures.
IgE levels in the serum of individuals with burns were sequentially measured and compared to IgE levels in normal control blood donors. Following a burn, the levels of IgE protein showed a significant, although modest, increase, usually evident of IgE protein showed a significant, although modest, increase, usually evident between days 14 and 22. In an occasional patient, the IgE levels rose by as much as five times in value during this period. Because of the complexity of the clinical situation associated with the burn patients, we cannot ascribe these elevations of IgE to the burn per se, but must consider the possibility of other factors, especially those involved in the treatment of the burn as well as the infection. The magnitude of the elevation of IgE in the burn patients (geometric mean=272 ng/ml) was considerably lower than the magnitude of the elevations seen in atopic dermatitis and generalized neurodermatitis (geometric means=2265 and 2071 ng/ml, respectively). Thus simple trauma to the skin is not a sufficient explanation for the elevated serum IgE levels in atopic dermatitis and generalized neurodermatitis.
The anogenital area is a common location for pruritic complaints. Specific terms for chronic itch in this location have included pruritus vulvae, pruritus ani, lichen simplex chronicus, and neurodermatitis. A male counterpart to pruritus vulvae, pruritus scroti, is less common. Acute anogenital pruritus is usually caused by infections or contact dermatitis. In chronic pruritus, inflammatory dermatoses and malignancies must be ruled out. In idiopathic anogenital pruritus or neurodermatitis, the skin findings should be limited to lichenification and excoriations. Skin findings may be entirely absent. When treating anogenital pruritus, topic irritants and potential sensitizers must be eliminated. Cleansing and toilet habits must be addressed. A short course of a high-potency topical steroid should bring moderate to complete relief. Sedating antihistamines may limit nighttime symptoms. In some patients, psychotropic agents are required to achieve adequate sedation. Antidepressants may be required in patients refractory to treatment or with underlying psychiatric disorders.