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PubMed2001

Occupational allergic contact dermatitis in Singapore.

Singapore has a resident population of 3,000,000 and a workforce of 1,780,000. Most are employed in manufacturing, services and commerce (245,000). From 1996 to 1998, 3472 cases were notified to the Ministry of Manpower and confirmed as occupational diseases. Noise-induced hearing loss accounted for 82% of cases, while only 11% of cases were industrial dermatitis. Occupational allergic contact dermatitis was not common, comprising approximately one third of the 369 cases of industrial dermatitis that were notified. However, we believe that the majority of cases are not notified to the authorities. The main occupational contact allergens were chromates, nickel, rubber chemicals, cutting fluids and resins. Most affected workers were from the construction, electronics and metalworking industries. Case series of occupational dermatoses among electronics and metal workers have been published. Of the cases of occupational dermatoses among electronics workers seen at a tertiary dermatological centre, 41% of 149 had allergic contact dermatitis (ACD). The commonest allergens were nickel, resins and rubber chemicals. In another case series of 252 metalworkers seen at the same dermatological centre, 23% suffered from ACD. The common allergens were metals and cutting fluids. Besides the common causes of ACD, unusual allergens have also been described. One example is ACD to grasses, which is seen mainly among military personnel. Population studies have been conducted in several industries. A survey of 2567 electronics workers revealed a 2% point prevalence of ACD. Of the occupationally relevant cases, 46 were nickel sensitive, 7 reacted to colophony, and 1 case to epoxy resin. A study of 272 prefabrication construction workers showed a 14% prevalence rate of occupational dermatitis. Of the 38 cases, 42% were ACD to chromates and rubber chemicals. Occupational ACD in Singapore is not as uncommon as the reported statistics suggest. Population-based reports, which overcome the problem of under-notification, show that the prevalence is variable in different industries.

Chemical Industry↗
PubMed1999

Prevalence and role of serum IgE antibodies to the Staphylococcus aureus-derived superantigens SEA and SEB in children with atopic dermatitis.

BACKGROUND: The skin of patients with atopic dermatitis exhibits a striking susceptibility to colonization and infection with Staphylococcus aureus. In this context it has been previously shown that S aureus-derived superantigens could function as classic allergens, inducing production of functionally relevant specific IgE antibodies. OBJECTIVE: The aim of this study was to determine the prevalence and the role of circulating staphylococcal enterotoxin A (SEA)- and staphylococcal enterotoxin B (SEB)-specific IgE antibodies in children with atopic dermatitis. METHODS: In a cross-sectional study of 58 children with atopic dermatitis, the presence of IgE antibodies to SEA and SEB was correlated with the severity of the disease and the total and other unrelated allergen-specific IgE titers and density of colonization with S aureus strains on atopic skin and episodes of superficial S aureus skin infections. RESULTS: Twenty of 58 children (34%) were sensitized to superantigens (45% to SEB, 10% to SEA, 45% to SEA and SEB). In this group, severity of atopic dermatitis and levels of specific IgE to food and air allergens were significantly higher. The degree of disease severity correlated to a higher extent with the presence of SEA/SEB-specific antibodies than with total serum IgE levels. Density of colonization with superantigen-secreting S aureus strains was higher in the superantigen IgE-positive group. Sixty-three percent of these children experienced repeated episodes of superficialS aureus skin infections. CONCLUSIONS: Sensitization to S aureus-derived superantigens may be involved in disease exacerbation. The presence of SEA/SEB-specific antibodies had additional explanatory value for disease severity and therefore may be helpful in the characterization of children with severe atopic dermatitis.

Adolescent↗
PubMed1999

Methicillin-resistant Staphylococcus aureus infections after scleral buckling procedures for retinal detachments associated with atopic dermatitis.

OBJECTIVE: To determine the incidence and the clinical course of methicillin-resistant Staphylococcus aureus as a cause of acute-onset infections in patients with atopic dermatitis after a scleral buckling procedures. DESIGN: A retrospective chart review. PARTICIPANTS: Two hundred eighty-seven patients (293 eyes) who underwent scleral buckling procedures to treat rhegmatogenous retinal detachments at either Osaka Rosai Hospital or Osaka University Medical School between July 1, 1995, and June 30, 1997, participated. Of these, 32 eyes (10.9%) were associated with atopic dermatitis. INTERVENTION: Demographic and clinical data were abstracted from patients' medical records. MAIN OUTCOME MEASURES: The incidence, clinical features, and management of postoperative infections associated with methicillin-resistant S. aureus were studied. RESULTS: Methicillin-resistant S. aureus infection after scleral buckling procedures was identified in 6 (18.8%) of 32 eyes of patients with atopic dermatitis but in only 1 (0.4%) of the other 261 cases without atopic dermatitis (P < 0.001). The average interval from the scleral buckling procedures to the initial onset of infection was 8.3 +/- 9.1 days (range, 2-28 days). Bacterial infection and inflammation were controlled in four eyes by prompt removal of the infected buckle in combination with vancomycin administration. In the other three eyes, however, repeat intravitreous injections of vancomycin or emergent vitrectomies were required because of the development of endophthalmitis. CONCLUSIONS: Methicillin-resistant S. aureus is an important causative pathogen of scleral buckling infections, particularly in patients with retinal detachment associated with atopic dermatitis. Preoperative evaluation and intraoperative attention to contamination are recommended to prevent methicillin-resistant S. aureus infections in these patients.

Acute Disease↗
PubMed2001

The ACVD task force on canine atopic dermatitis (I): incidence and prevalence.

There is an increasing incidence of atopic diseases (asthma, allergic rhinitis and atopic dermatitis) in humans, especially in developed countries. Although there is a genetic predisposition to the development of these diseases, the rapid rise in incidence is suspected to be caused by environmental rather than genetic factors. Neither the incidence nor the prevalence of atopic dermatitis in the general canine population has been studied. As many of the environmental factors associated with the increasing incidence of atopic dermatitis in humans are consistently found in the environment of dogs, it would seem likely that a similar increase in the incidence of this disease would be occurring also in dogs. Epidemiological studies of canine atopic dermatitis are needed to characterize the incidence and prevalence of atopic dermatitis, and to further study the factors that contribute to the development of this disease.

Animals↗
PubMed2001

The ACVD task force on canine atopic dermatitis (XXII): nonsteroidal anti-inflammatory pharmacotherapy.

The pharmacotherapy of canine atopic dermatitis has relied primarily on the use of glucocorticoids and anti-histamines. During the last decade, other anti-inflammatory drugs have been investigated in clinical trials. This paper will review the studies using misoprostol, cyclosporine, tacrolimus, phosphodiesterase inhibitors, capsaicin, leukotriene inhibitors and serotonin-reuptake inhibitors for treatment of dogs with atopic dermatitis. For each drug the mechanism of action, the rationale for use in atopic dermatitis, the clinical efficacy, reported adverse effects and strength of recommendation for treatment of canine atopic dermatitis are described. At the time of this writing, there is fair evidence to support the recommendation for using cyclosporine, misoprostol and pentoxifylline for treatment of canine atopic dermatitis. This recommendation can be strengthened by the performance of additional blinded randomized controlled trials with larger number of dogs. In contrast, there is insufficient evidence to recommend for or against treatment with tacrolimus, leukotriene inhibitors, serotonin-reuptake antagonists and capsaicin.

Animals↗
PubMed2001

Peripheral blood mononuclear cell responses to Dermatophagoides farinae in canine atopic dermatitis.

Atopic dermatitis is a chronic inflammatory and pruritic skin disease commonly seen in dogs and humans that is characterised by the presence of allergen-specific IgE. Data from skin tests and serological analysis suggest that the house dust mite Dermatophagoides farinae is the most important allergen in dogs with atopic dermatitis. The aim of this study was to determine if D. farinae specific peripheral blood mononuclear cell (PBMC) responses could be detected in dogs with atopic dermatitis. PBMCs were isolated by the density centrifugation from dogs with atopic dermatitis that were skin test positive for D. farinae, dogs with atopic dermatitis that were skin test negative for D. farinae, and healthy dogs. Cells were cultured with increasing concentrations of the D. farinae extract, no antigen, vaccine antigens or concanavalin A (ConA). There was significantly greater responsiveness of PBMCs from the D. farinae positive dogs than from either the D. farinae negative or healthy dogs (ANOVA, P<0.05). In contrast, no significant differences were observed in the control responses between the three groups. This is the first study to demonstrate that D. farinae specific circulating memory cells are involved in the pathogenesis of canine house dust mite hypersensitivity.

Animals↗
PubMed2002

Topical treatment of digital dermatitis associated with severe heel-horn erosion in a Swedish dairy herd.

Two experiments were run in a commercial dairy herd to test the efficacy of topical treatments of digital dermatitis associated with severe heel-horn erosion. In Experiment I, topical treatments with solutions of either glutaraldehyde or oxytetracycline were compared with foot trimming and cleansing alone. After trimming of all feet, one front and one rear foot in each cow were treated with either glutaraldehyde or oxytetracycline (regardless of dermatitis status), while the other feet were used as controls and only trimmed. Two hundred foot records were obtained from 34 Swedish Red and White and 16 Swedish Holstein cows. The proportions (p) of feet cured from digital dermatitis were compared between each group of medically treated feet and the control feet, assuming the feet to be independent observations with respect to curing. Oxytetracycline was significantly more effective than hoof trimming alone (p=0.87 and 0.34, respectively; P<0.001) and than glutaraldehyde (p=0.41; P=0.004). Treatment with glutaraldehyde was no more effective than hoof trimming alone. In Experiment II, a specially designed footbath with two longitudinal compartments was used to study the effectiveness of a solution of acidic ionised copper in preventing or curing digital dermatitis. The footbath--using water in one compartment--was constructed to make within-cow comparisons of treatment efficacy possible. The hoof health of 44 dairy cows (also included in Experiment I) were studied when the animals first were turned out to pasture and at the end of the grazing season (approximately 6 months later). During the grazing season, the cows were walked through the footbath twice daily after milking for a total of 47 days, divided into five separate periods ranging in length from 3 to 16 days. As judged by a two-sample comparison of proportions, a higher proportion of the cows' hind feet that were affected by dermatitis were cured by the copper solution (20/24) than by water alone (12/23). The copper solution had no significant preventive effect on healthy feet.

Administration, Topical↗
PubMed1989

Lichenoid dermatitis: a clinicopathologic and immunopathologic review of sixty-two cases.

We reviewed 62 cases (26 men and 36 women, median age 55 years) of previously diagnosed lichenoid dermatitis and correlated the histologic and immunodermatologic findings with the clinical diagnosis and course. The clinical diagnostic groups were contact dermatitis (6 cases), drug eruption (14), lupus erythematosus (6), lichen planus (3), cutaneous T cell lymphoma (3), chronic dermatitis or neurodermatitis (19), and miscellaneous dermatologic disorders (11). With the use of individual histologic features, a correlation with specific clinical conditions was possible, and the clinical groups of dermatitis, drug eruption, lupus erythematosus or lichen planus, and T cell infiltration could be selected histologically. Direct immunofluorescence studies were of most help in the diagnosis of lupus erythematosus and atypical lichen planus, but these studies should be performed in all cases involving lichenoid inflammation. Although previously the nonspecific term lichenoid dermatitis was used to classify the histologic features in these cases, we found that by careful correlation of histologic, immunodermatologic, and clinical features, we were often able to provide a specific diagnosis.

Adolescent↗
PubMed1989

Aeroallergen contact can exacerbate atopic dermatitis: patch tests as a diagnostic tool.

Previous studies have documented that atopic dermatitis can worsen when patients ingest specific foods to which they are sensitive. In this article we demonstrate that patient contact with specific aeroallergens can cause flares of atopic dermatitis. Marked improvement in skin symptoms was noted when 12 patients (eight males and four females; ages, 1 to 54 years) were removed from their unusual environment. In response to prick tests, these patient had markedly positive, immediate wheel-and-flare reactions to a variety of aeroallergen extracts (tree, grass, and weed pollen; house dust mite; animal protein; and mold spores). The same patients were subsequently patch tested on uninvolved, nonabraded skin with the allergen extracts that had yielded positive prick tests. Patch tests were applied for 48 hours, removed, and interpreted 24 hours later. The patients reacted to specific aeroallergens with an eczematous eruption at 48 and 72 hours. Positive delayed cutaneous reactions correlated strongly with aeroallergens identified in the patient's environment or suspected by the patients as provocateurs of their atopic dermatitis. Delayed cutaneous reactions were negative to allergens not historically relevant. Continued avoidance of aeroallergens that elicited an eczematous reaction at patch test sites resulted in marked improvement or resolution of dermatitis in all patients. We conclude that aeroallergen contact plays an important role in select patients with atopic dermatitis.

Adult↗
PubMed1988

Contact dermatitis.

Allergic contact dermatitis and irritant contact dermatitis in the small animal may result in clinical lesions with similar anatomical locations. Allergic contact dermatitis is generally noted in ventral and lightly haired regions as a papular, erythematous, and sometimes vesicular dermatitis. It is intensely pruritic and is the result of many months (and usually years) of exposure to the contact allergen. Total avoidance of the allergenic substance is the only successful long-term management. Irritant contact dermatitis occurs when an irritating substance is applied to the skin. It is a sequela that would occur in the majority of a population having contact with the compound. It is generally more painful than pruritic. Removal of the irritant will permit resolution of the signs.

Animals↗
PubMed2000

Skin barrier function in patients with completely healed atopic dermatitis.

Although it has been well established that the dry skin often seen in patients with atopic dermatitis shows a deranged barrier function, there is no unanimity of opinion as to whether the barrier in normal-appearing skin of patients with the disease is deranged or not. Hence, it remains unclear whether individuals with atopic dermatitis constitution have an intrinsic derangement of skin barrier function or not. To settle this problem, in the present study we examined transepidermal water loss and stratum corneum water content in normal appearing skin of the upper back of 16 patients with completely healed atopic dermatitis who had been free from skin symptoms for 5 years or more, 30 patients with active atopic dermatitis, and 39 healthy subjects. The transepidermal water loss values and the stratum corneum water content values in normal-appearing skin of the completely healed patients were not different from the values in normal controls. These findings indicate that skin barrier function is not disturbed in patients with completely healed atopic dermatitis.

Adult↗
PubMed2001

Characterization of itch-associated responses of NC mice with mite-induced chronic dermatitis.

To clarify the behavioral and pathological features of spontaneous scratching of NC mice with mite-induced chronic dermatitis, we investigated the spontaneous and pruritogen-evoked scratching of NC mice. Although the frequency of scratching of NC mouse did not increase under specific pathogen-free environment, it gradually and markedly increased from 3 to 6 weeks after transfer to conventional environment. The onset of increase in spontaneous scratching was similar to that of dermatitis development and the elevation of plasma concentration of immunoglobulin E. At chronic stage (16 weeks after environment change), the frequency of spontaneous scratching was roughly parallel to the degree of dermatitis, but not to the plasma concentration of immunoglobulin E. The spontaneous scratching of NC mice with dermatitis was inhibited by distraction and the opioid antagonist naltrexone, suggesting that the scratching is itch-associated response. An intradermal injection of serotonin, but not histamine and substance P, elicited scratching of the injected site. Methysergide and cyproheptadine inhibited the serotonin-induced scratching but not spontaneous scratching. The results suggest that marked elevation of plasma immunoglobulin E is not always the cause of spontaneous itch-associated response of NC mice with dermatitis. Serotonin, histamine and substance P may not play an important role in spontaneous itch-scratch response at a chronic stage.

Animals↗
PubMed2001

Autoantibodies in atopic dermatitis.

Recent progress in the autoimmune aspects of atopic dermatitis has clarified that patients with atopic dermatitis develop IgE-class autoantibodies mainly against intracellular proteins. The cloning of cDNAs encoding autoallergens with human expression cDNA libraries and serum IgE from atopic dermatitis patients has unraveled the molecular characteristics of IgE-binding autoantigens. Some patients with atopic dermatitis also have IgG-class autoantibodies, especially anti-nuclear antibodies. One of the nuclear autoantigens was identified as DFS70/transcription coactivator p75. In addition, p80-coilin in nuclear coiled bodies is also targetted. Several lines of evidence suggest that a subset of atopic dermatitis may be associated with an autoimmune response.

Adaptor Proteins, Signal Transducing↗
PubMed2002

Overactivation of IL-4-induced activator protein-1 in atopic dermatitis.

Atopic dermatitis is regarded as mediated by Th2-type immunity. In fact, it frequently coincides with the elevation of immunoglobulin (Ig)-E in patients' sera. Due to the pivotal role of interleukin (IL)-4 in regulation of IgE, we hypothesized if atopic dermatitis represents a hyper-reactive condition in response to IL-4 when it coincides the higher serum level of IgE. To address this possibility, peripheral blood mononuclear cells (PBMC) isolated from patients with atopic dermatitis with the high serum IgE level, from those with psoriasis or from healthy volunteers were stimulated with recombinant IL-4 and analyzed for activation of transcription factors including activator protein (AP)-1 or signal transducers and activators of transcription (STAT)-6 by employing electrophoretic mobility shift assays. Although no significant difference between atopy patients and other groups was observed in the STAT-6 binding activity in IL-4-stimulated PBMC, it over-activated the binding of AP-1 in PBMC of the patients with atopic dermatitis. The AP-1 binding was interfered by the use of an antibody directed against JunB. This is the indication that IL-4-overactivated AP-1 is composed of JunB. Furthermore, semi-quantitative RT-PCR analyses revealed marked down-modulation of a Th1 cytokine, interferon (IFN)-gamma, in IL-4-stimulated PBMC derived from atopy patients, but not that from healthy individuals. Together, our present study indicates that AP-1 is over-activated by IL-4 in PBMC of the atopic patients with the higher IgE level, thereby implying that IL-4-induced over-activation of AP-1 might be one of pathogenic factors in atopic dermatitis.

Dermatitis, Atopic↗
PubMed1997

Anxiety, depression and psychosomatic symptoms in patients with atopic dermatitis: comparison with normal controls and among groups of different degrees of severity.

Atopic dermatitis is a common skin disorder. The age distribution is mainly located from infancy to adolescence, which period is the most important for forming character or effecting their psychological condition. We used three types of psychological tests to investigate anxiety, depression and psychosomatic symptoms in 45 patients with atopic dermatitis and 34 normal controls. These tests consisted of the manifest anxiety scale (MAS), self-rating depression scale (SDS) and Cornell Medical Index (CMI). On the MAS, the atopic dermatitis group did not show any statistical difference from normal controls. However, the SDS and the CMI produced statistically significant differences (P < 0.05 and P < 0.01, respectively). Furthermore, we classified their symptom in three degrees of severity (mild: 15; moderate: 14; severe: 16). Patients with mild symptoms did not show any statistical difference from normal controls on the three tests. Patients with moderate symptoms showed a statistically significant difference from normal controls on the SDS (P < 0.01) and the CMI (P < 0.05), but not on the MAS. Finally, patients with severe symptoms (in-patients) produced somewhat lower test scores than those with moderate symptoms. We conclude that the patients with atopic dermatitis were more depressive and psychosomatic symptom-prone than normal controls, and suggest that some patients with atopic dermatitis should be treated both dermatologically and psychiatrically.

Adolescent↗
PubMed1998

A variety of skin responses to ultraviolet irradiation in patients with atopic dermatitis.

Skin responses to ultraviolet irradiation in patients with atopic dermatitis were studied to evaluate the role of sunlight in the exacerbation of atopic dermatitis. A total of 15 patients, seven males and eight females, with atopic dermatitis who complained of exacerbation of their dermatitis after sun exposure were examined by photo testing with UVB and UVA irradiation and photopatch tests. Nine out of 15 patients showed abnormal skin reactions. Lowered minimal erythema doses (MEDs) to a single exposure of UVB, papular or erythematous responses after single or repeated exposures to UVB or UVA and positive photopatch test reactions to sunscreen ingredients and fragrances were found. There are apparently multiple mechanisms of photoexacerbation in patients with atopic dermatitis.

Adult↗
PubMed2005

Psoriasiform contact dermatitis due to propolis in a beekeeper.

BACKGROUND: More than 250 cases of allergic contact dermatitis due to propolis have been described. A few of these occurred in beekeepers. OBJECTIVE: To describe a case of psoriasiform dermatitis caused by propolis in a beekeeper who thought that his lesions were related to honeybee stings. METHODS: A 45-year-old beekeeper experienced hand dermatitis for the past 5 years. He believed that the lesions occurred and worsened when he was stung by honeybees. He was prescribed topical corticosteroids several times, but because he was stung frequently, the drugs never helped control the lesions. In the past few years, he frequently had contact with propolis during honey collection, but he denied the role of propolis because he was wearing gloves while handling the beehives. For diagnostic evaluation, skin biopsy, skin prick tests (SPTs), identification of specific IgE antibodies, and atopic patch tests were performed. RESULTS: Skin biopsy showed psoriasiform contact dermatitis. Results of SPTs to honeybee and serum specific IgE for Apis mellifera remained negative. Results of the atopic patch test performed using A mellifera SPT material were also negative in the first 20 minutes and on the second and third days. However, propolis showed a positive erythematopapular reaction on day 2. The patient never again worked as a beekeeper, and neither did he, as far as he knew, use any medical or cosmetic products that contained propolis. His hand lesions improved almost completely. CONCLUSION: Dermatitis due to propolis should never be disregarded in beekeepers, and every effort should be put forth to make a correct diagnosis and to convince the patients of the cause.

Biopsy↗
PubMed1999

Clinical aspects, epidemiology, and prognosis of atopic dermatitis.

OBJECTIVE: This review article examines the clinical aspects, epidemiology, and prognosis of atopic dermatitis. DATA SOURCES: These are studies and review articles from textbooks of dermatitis and allergy in general, as well as more recent epidemiologic surveys published in specialist journals of allergy and dermatology. STUDY SELECTION: Included studies meet the criteria of being a survey of the prevalence of atopic dermatitis published recently in a respected peer-reviewed journal. Particular emphasis is placed on those that examine both the prevalence of the problem and significant causative and associated factors. RESULTS: Atopic dermatitis is frequently a severe illness that develops in early infancy. It can persist beyond the childhood years and is often found in association with significant respiratory complications. The exact pathogenesis is unclear but it appears that it has a complex immunologic origin. Early surveys lack the methodologic refinements of more recent data from the mid-1990s, including the SCARPOL study. Collectively, these point to a high current prevalence rate of 10% to 15%, a figure that has risen steadily in the preceding decades. The most common associations of atopic dermatitis are a risk of developing respiratory disorders, such as allergic rhinitis and asthma (40% to 60%), and a persistence rate after puberty (40% to 60%), which is indeed much higher than previously suspected. CONCLUSIONS: A clear recognition of the various disease subgroups along with intervention studies that evaluate reduction of risk are needed before more precise treatment strategies can be devised.

Adolescent↗