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PubMed1999

Localization of interleukin-13 gene-expressing cells in tuberculin reactions and lesional skin from patients with atopic dermatitis.

Interleukin (IL)-13 is a cytokine thought to play an important role in IgE-mediated allergic reactions. The aims of the present study were to localize IL-13 mRNA in positive tuberculin reactions and atopic dermatitis lesions using in situ hybridization and to study the possible influence of atopy on the cytokine gene expression in tuberculin reactions. Punch biopsy specimens were taken from tuberculin reactions in 17 nonatopic and 12 atopic (Phadiatop positive), but otherwise healthy, individuals 72h after injection of purified protein derivative, from chronic lichenified lesions and nonlesional skin in six patients with atopic dermatitis and from normal skin in 12 healthy individuals. IL-13-mRNA-producing cells were located mainly in the dermal-cell infiltrates, both in atopic dermatitis lesions and tuberculin reactions. In the atopic dermatitis lesions, IL-13-mRNA expression was found in close apposition to the epidermis. Higher numbers of IL-13-mRNA-producing cells were observed in the dermal-cell infiltrates of chronic lichenified skin lesions of patients with atopic dermatitis (13.3 cells/mm2, range 0.6-42.4 cells/mm2) than in the tuberculin reactions (1.1 cells/mm2, range 0-3.8 cells/mm2) (P<0.01) despite the larger cell infiltrates in the tuberculin reactions. No significant difference in IL-13 or interferon-gamma gene expression in the tuberculin reactions was seen between atopic and nonatopic individuals.

Adolescent↗
PubMed2003

Concurrent follicular dysplasia and interface dermatitis in Boxer dogs.

Recurrent or persistent follicular dysplasia and interface dermatitis are described in nine Boxers. Data on age, sex, seasonality of alopecia and histopathological features of the follicular dysplasia in these nine Boxers are comparable with those described in previous reports. The interface dermatitis was characterized by multifocal annular crusted lesions confined to the areas of follicular dysplasia. The inflammatory lesions were neither pruritic nor painful and affected dogs were otherwise healthy. Histopathologically the clinically inflammatory lesions were characterized as an interface dermatitis. Immunohistochemical studies failed to demonstrate immunoglobulins or complement at the basement membrane zone or within blood vessel walls. In dogs with recurrent or persistent disease, the follicular dysplasia and interface dermatitis ran identical, concurrent courses of spontaneous remission and recurrence, or persistence, respectively. One dog with persistent disease was treated successfully with tetracycline and niacinamide for the interface dermatitis, and melatonin for the follicular dysplasia. Although the aetiopathogenesis of this newly described condition and the relationship between the two histological reaction patterns are not known, photoperiod and genetic predisposition appear to play a role.

Animals↗
PubMed1998

Azathioprine in the treatment of Parthenium dermatitis.

BACKGROUND: Parthenium dermatitis is a chronic disorder whose management is extremely difficult. Allergen avoidance is almost impossible, topical corticosteroid therapy provides only partial relief, and prolonged systemic corticosteroid therapy has unacceptable side-effects. METHODS: Twenty patients with chronic Parthenium dermatitis, with relative contraindications to systemic corticosteroids or their side-effects, were treated with oral azathioprine (100-150 mg daily). The severity of dermatitis was assessed at 0, 1, 3, 6, and 12 months using a modified PASI scoring system. RESULTS: The mean age of the patients was 54 years (range, 40-72 years) and the mean duration of dermatitis was 7.6 years (range, 3 months to 36 years). The mean initial score was 18.9 (range, 3.3-42), which decreased to 8.8 (range, 1.6-18.2) at 3 months, 4.8 (range, 0.6-14.6) at 6 months, and 0.7 (range, 0.2-1.4) at 12 months. Of the 15 patients evaluated at 6 months, all but one showed a response. Ten (66.6%) patients showed near-total clearance, i.e. reduction in score by more than 90%, and three patients (20%) showed more than 50% reduction in score. No significant side-effects were noted. CONCLUSIONS: Azathioprine is an effective and safe alternative to corticosteroid therapy in the treatment of chronic Parthenium dermatitis. It is especially useful in patients with side-effects or contraindications to corticosteroid therapy.

Administration, Oral↗
PubMed2001

Azone enhances clinical effectiveness of an optimized formulation of triamcinolone acetonide in atopic dermatitis.

BACKGROUND: Atopic dermatitis is a chronic, relapsing condition affecting up to 14% of the population in Western countries. Topical corticosteroids are the mainstay of treatment. Triamcinolone acetonide, a corticoid of intermediate potency, has proven useful in the treatment of atopic dermatitis. AIM: To evaluate the effectiveness of a triamcinolone acetonide-laurocapram combination in the treatment of atopic dermatitis. METHODS: One hundred and fifty patients were enrolled in a three-arm, parallel group, controlled clinical trial evaluating the effectiveness of a triamcinolone acetonide (0.05%) and laurocapram combination, applied twice daily for 2 weeks, in the treatment of atopic dermatitis. Fifty patients received triamcinolone acetonide-laurocapram (TNX), 50 triamcinolone acetonide (TN), and 50 a vehicle control formulation (AN). Response to treatment was evaluated by change in disease severity at 6 h, at 3, 8, and 15 days after the start of treatment, and by the global change in disease status. RESULTS: TNX effected a significantly higher degree of improvement in the signs and symptoms of atopic dermatitis (erythema, induration, and pruritus) and a greater overall improvement in disease status compared with treatment with TN or AN. Treatment-associated side-effects were local reactions, occurring in three, two, and six patients in the TNX, TN, and AN groups, respectively. CONCLUSIONS: The results suggest that the incorporation of laurocapram in the formulation enhances the effectiveness of triamcinolone acetonide, without compromising its safety profile.

Anti-Inflammatory Agents↗
PubMed2002

Evaluation of dietary intake of vitamin E in the treatment of atopic dermatitis: a study of the clinical course and evaluation of the immunoglobulin E serum levels.

BACKGROUND: Vitamin E (VE) is a potent antioxidant that can improve the immune macrophage-mediated response, decrease the production and/or release of prostaglandins in humans, and decrease the serum levels of immunoglobulin E (IgE) in atopic subjects. AIM: To compare the effects of placebo (PL) and VE intake (400 IU/day) on subjective symptoms and serum IgE levels in 96 subjects with atopic dermatitis. MATERIALS AND METHODS: A single-blind clinical analysis was performed on 96 subjects randomly divided into two groups. Fifty subjects were given orally 400 IU (268 mg) of VE of natural origin, once a day for 8 months, and 46 took PL for the same period. Complete blood count, serum IgE levels, radioallergosorbent test (RAST) score, antinuclear antibodies (ANA), and biochemical analysis were obtained at the time of enrollment and every 15 days during the 8 months of the study. To evaluate VE therapy, a questionnaire was sent to each subject for completion at the end of the study. RESULTS: The results were as follows: (A) four subjects treated with VE worsened, compared to 36 in the PL group; (B) six subjects in the VE group and five in the PL group showed no change; (C) slight improvement was observed in 10 subjects in the VE group and four in the PL group; (D) 23 of the 50 subjects treated with VE showed great improvement, compared to only one in the PL group; and (E) there was almost complete remission of atopic dermatitis in seven of the 50 subjects in the VE group, but none in the PL group. Females showed less progression of atopic dermatitis than males in both groups and a higher percentage of almost complete remission (five females and two males). The range of serum IgE levels varied markedly from 1005 to 490 IU/mL in the VE group and from 1239 to 812 IU/mL in the PL group over 8 months. Subjects with great improvement and near remission of atopic dermatitis in the VE group demonstrated a decrease of 62% in serum IgE levels based on initial conditions, while, in subjects taking PL, the difference was approximately 34.4%. No complications were observed in either group. A remarkable improvement in facial erythema, lichenification, and the presence of apparently normal skin was reported. Eczematous lesions healed mostly as a result of decreased pruritus. CONCLUSIONS: The correlation between VE intake, IgE levels, and the clinical manifestations of atopy indicates that VE could be an excellent therapeutic tool for atopic dermatitis.

Adolescent↗
PubMed2000

Concordance of dermatitis herpetiformis and celiac disease in monozygous twins.

Celiac disease can be defined as the classical manifestation of gluten sensitivity, which primarily affects the small intestine. Gluten sensitivity has also a skin manifestation, i.e., dermatitis herpetiformis. Both diseases have a strong genetic association with HLA DQ on chromosome 6. In this study we tried to estimate how much different clinical expressions of gluten sensitivity are determined by genetic factors, and hence how feasible they are for genetic mapping; therefore, we studied all six monozygous twin pairs found among 1292 prospectively collected patients of dermatitis herpetiformis in Finland. Three of the six twin pairs were concordant for dermatitis herpetiformis and for simultaneous enteropathy, celiac disease. Two other twin pairs were partially discordant, one of each pair had dermatitis herpetiformis and celiac disease, whereas the other had solely the gut manifestation of gluten sensitivity, i.e., celiac disease. Only one pair was found to be discordant for gluten sensitivity. All the pairs had typical risk alleles for gluten sensitivity, i.e., either HLA DQ2 or DQ8. These results demonstrate that the genetic component in gluten sensitivity as broadly defined is very strong (5/6 concordant). Genetically identical individuals can have clearly distinguished phenotypes, either dermatitis herpetiformis or celiac disease, suggesting that environmental factors determine the exact phenotype of this multifactorial disease. These findings are of importance in genetic linkage analyses, which focus to only certain phenotypic properties of a complex trait.

Adult↗
PubMed2000

Chemical activation of innate and specific immunity in contact dermatitis.

Recent reports have suggested that chemical-induced allergic contact dermatitis may not be a traditional type IV hypersensitivity, in part due to the dual irritant and antigenic properties of sensitizing chemicals. In order to investigate the contribution of these properties to the molecular and cellular mechanism underlying allergic contact dermatitis, we evaluated oxazolone-induced changes in cell populations and cytokine production in the dermis of transgenic mice with impaired innate immunity (the FcgammaR subunit knockout mouse), and absent specific immunity (the athymic mouse), and the appropriate B6,129F2 and C57BL/6 control mice. Oxazolone and croton oil were applied in a single sensitizing dose, or in sensitizing and challenge doses, and the dermal response was evaluated by immunohistochemistry. In the wild type mice, with or without sensitization to oxazolone or croton oil, we observed mixed Th1/Th2 cytokine production and both CD4+ and CD8+ T lymphocytes; however, the neutrophil was the predominant cell in the dermis, even 72 h after final chemical application. Athymic mice displayed a similar neutrophil response with moderate Th1/Th2 cytokine production, and FcgammaR subunit knockout mice exhibited very mild dermatitis when treated with either oxazolone or croton oil. These results provide support for the hypothesis that allergic contact dermatitis is not a classic delayed type hypersensitivity, demonstrate the importance of the interaction between the irritant and antigenic properties of sensitizing chemicals in the development of allergic contact dermatitis, and suggest that the irritant effect of chemicals may be mediated through the cutaneous innate immune system.

Adjuvants, Immunologic↗
PubMed2002

Positive atopy patch test reaction to Malassezia furfur in atopic dermatitis correlates with a T helper 2-like peripheral blood mononuclear cells response.

The yeast Malassezia furfur belongs to the normal cutaneous flora, but is also a triggering allergen that can contribute to atopic dermatitis. To illuminate the effect of circulating allergen-specific T cells in atopic dermatitis, the peripheral mononuclear cell response was correlated with the in vivo skin prick test and atopy patch test reactivity to M. furfur. None of 16 healthy controls showed any positive in vivo reaction. The 40 atopic dermatitis patients, of whom 18 had serum IgE reactivity to M. furfur, were subdivided according to their in vivo reaction to M. furfur extract into three groups: skin prick test positive/atopy patch test positive (n = 12), skin prick test positive/atopy patch test negative (n = 12), and skin prick test negative/atopy patch test negative (n = 16). The skin prick test positive/atopy patch test positive and the skin prick test positive/atopy patch test negative groups had a significantly higher peripheral mononuclear cell stimulation index than the healthy controls. Interestingly, the stimulation index values in the skin prick test positive/atopy patch test positive group were significantly higher than in the skin prick test positive/atopy patch test negative group. In the M. furfur skin prick test positive atopic dermatitis patients (n = 24) a correlation was found between stimulation index and the M. furfur atopy patch test reactions, but not between stimulation index and M. furfur-specific serum IgE levels. Skin prick test positive and/or atopy patch test positive reactions to the recombinant M. furfur allergens rMal f 1, rMal f 5, and rMal f 6 were observed in 7, 14, and 16 of the 40 atopic dermatitis patients, respectively. Further, there was a correlation between production of the T helper 2-related cytokines interleukins 4, 5, and 13 and stimulation index to M. furfur extract, but not between the T helper 1-related interferon-gamma and stimulation index to M. furfur extract. Our data strongly suggest a relationship between circulating specific T cells with a T helper 2-like cytokine profile and positive atopy patch test reactions.

Adult↗
PubMedDate not supplied

Prominent pruritic periumbilical papules: A diagnostic sign in pediatric atopic dermatitis.

Establishment of diagnostic criteria for atopic dermatitis has been a subject of controversy and frequent reevaluation. The diagnostic criteria of Hanifin and Rajka are those most frequently cited. In order to fit the diagnosis, a patient must demonstrate three major criteria plus four or more minor criteria. Although individually the minor criteria are not diagnostic, their presence suggests the possibility of atopic dermatitis. Recently we evaluated several children who developed prominent periumbilical papules as a major component of their atopic dermatitis. This finding, while not present in all children with atopic dermatitis, can provide a specific clue to diagnosis and should be considered as a new minor criterion for atopic dermatitis in children.

Child↗
PubMedDate not supplied

Clinical evaluation of atopic hand-foot dermatitis.

Clinical manifestations of atopic hand-foot (H-F) dermatitis have not been well studied. This study examined 108 atopic dermatitis (AD) patients with H-F dermatitis between May 1997 and July 1999 at our AD clinic to determine the clinical characteristics of atopic H-F dermatitis and to assess its etiologic associations. It usually began in childhood with an early onset of AD. Pruritus was the most frequent symptom, and erythema, scales, lichenification, hyperkeratosis, fissures, and keratolysis exfoliativa were also common signs. Both the hands and feet were involved in 47 (44.0%) patients, and either hand or foot involvement was observed in 15 (13.9%) and 46 (42.6%) patients, respectively. Palmar or plantar surfaces were more frequently involved than the dorsal aspects. The great toe was affected more often than the other toes. Two-thirds of patients presented with manifestations of the ichthyosis triad and sandpaper-like skin lesions on the elbow, knee, and lateral malleolus. Palmar or plantar hyperhidrosis was reported in 15% and 20%, respectively. The ichthyosis triad-associated group showed a significantly higher incidence of sandpaper-like (thickened, roughened) skin lesions, and these patients had lesions on the dorsal hands or heels and lateral malleolus more frequently than ichthyosis triad-absent patients. The hyperhidrosis-associated group showed an association with glassy lesions, localized to palmar or plantar areas. Atopic H-F dermatitis is associated with the nonallergic etiologies of AD and clinical subgroups can be identified on the basis of nonallergic backgrounds.

Child↗
PubMed2000

Hydrogel barrier/repair creams and contact dermatitis.

BACKGROUND: Barrier creams are important to protect the skin in occupations with chemical exposure. The value of hydrogels in barrier creams has never been studied. OBJECTIVE: The purpose of this study was to evaluate the current technology in barrier cream formulation and explore the utility of hygrogels in skin protection. METHODS: A total of 80 men, women, and children between the ages of newborn to 80 years >were studied with the following dermatologic conditions: household hand dermatitis (21), occupational hand dermatitis (18), latex glove irritant contact dermatitis (9), diaper dermatitis (5), cutaneous wounds (17), and allergic contact dermatitis (ACD) (10). In this study, the investigators used a split body approach, in a double-blind randomized fashion, where one body site was treated with a traditional petrolatum-based cream while the other body site was treated with a hydrogel-based barrier/repair cream. Both subject and investigator assessments were recorded by questionnaire. RESULTS: The hydrogel barrier/repair cream showed better skin improvement than the petrolatum-based cream in both subject assessment (62%, P =.0048) and investigator assessment (75%, P =.0000003). CONCLUSION: Hydrogel barrier/repair creams might represent a new, effective approach to skin protection.

Adolescent↗
PubMed1989

Spontaneous release of histamine from basophils and histamine-releasing factor in patients with atopic dermatitis and food hypersensitivity.

Patients with hypersensitivity to food documented by a double-blind, placebo-controlled oral food challenge have been reported to have a high rate of release of histamine from basophils in vitro. To determine whether patients with atopic dermatitis and food hypersensitivity had similar high rates of spontaneous histamine release in vitro, whether dietary elimination of relevant food antigens affected this release, and whether a cytokine, histamine-releasing factor, could account for it, we evaluated 63 patients with atopic dermatitis and food hypersensitivity (38 of whom had eliminated the offending foods from their diets), 20 patients with atopic dermatitis without food hypersensitivity, and 18 normal volunteers. Patients with atopic dermatitis and food hypersensitivity were found to have higher rates of spontaneous release of histamine from basophils than controls (mean +/- SE, 35.1 +/- 3.9 percent vs. 2.3 +/- 0.2 percent; P less than 0.001). Those who had eliminated the offending food allergen from the diet for an extended period had a significantly lower rate of histamine release (3.7 +/- 0.5 percent; P less than 0.001). In patients with atopic dermatitis without food hypersensitivity, the rate (1.8 +/- 0.2 percent) did not differ from that in normal controls. Mononuclear cells from persons with food allergies spontaneously produced a histamine-releasing factor in vitro that provoked the release of histamine from the basophils of other food-sensitive persons, but not from those of normal controls. Patients who adhered to a restricted diet had a decline in the rate of spontaneous generation of the factor by their mononuclear cells. The histamine-releasing factor was found to activate basophils through surface-bound IgE. We conclude that in patients with food hypersensitivity, exposure to the relevant antigens produces a cytokine (histamine-releasing factor) that interacts with IgE bound to the surface of basophils, causing them to release histamine.

Adolescent↗
PubMed2001

A double-blinded, randomized, placebo-controlled trial of cetirizine in preventing the onset of asthma in children with atopic dermatitis: 18 months' treatment and 18 months' posttreatment follow-up.

BACKGROUND: Because asthma is not a curable condition, the development of strategies for prevention of the disease has a high priority. Atopic dermatitis is a common precursor to the development of asthma, and 2 studies have suggested that the use of an H(1) receptor antagonist might reduce the development of asthma while the treatment is being administered, at least in subgroups with evidence of high IgE levels. However, no trial to date has conducted follow-up after the initial treatment has been stopped to establish whether the intervention has merely suppressed symptoms or truly prevented disease. OBJECTIVE: We sought to establish whether the use of cetirizine compared with placebo for 18 months in infants with atopic dermatitis suppressed or truly delayed the onset of asthma, even after cessation of therapy. METHODS: The Early Treatment of the Atopic Child study was a double-blinded, parallel-group, randomized trial of 0.25 mg/kg body weight cetirizine administered twice daily compared with placebo given to infants between 1 and 2 years of age with atopic dermatitis. After 18 months of treatment, follow-up continued for a further 18 months. This article reports the outcome over the full 3 years of follow-up and relates the outcomes to the allergic status on the basis of IgE antibody measurements at recruitment. RESULTS: Although there was no difference in cumulative prevalence of asthma between active and placebo treatment in the intention-to-treat population (P = .7), those infants with evidence of sensitivity to house dust mite, grass pollen, or both who were treated with cetirizine were significantly less likely to have asthma compared with those treated with placebo over the 18 months of treatment (P = .005 and .002, respectively), and this effect was sustained for the grass pollen-sensitized infants over the full 36 months (P = .008). In the house dust mite-sensitized group there was a gradual narrowing of the difference between active and placebo treatment in terms of cumulative prevalence of asthma at the end of 36 months but no evidence of a rebound immediately after the treatment stopped (P = .04). In the placebo population there was a significantly higher risk of development of asthma in those sensitized at baseline to egg (relative risk, 1.4 [95% CI, 1.1-1.7]), house dust mite (relative risk, 1.6 [95% CI, 1.3-1.9]), grass pollen (relative risk, 1.7 [95% CI, 1.4-2.1]), or cat (relative risk, 1.5 [95% CI, 1.2-1.9]). Early and persistent sensitization conferred a higher risk than transient or later sensitization. CONCLUSIONS: Cetirizine compared with placebo truly delays or, in some cases, prevents the development of asthma in a subgroup of infants with atopic dermatitis sensitized to grass pollen and, to a lesser extent, house dust mite. Further studies are required focusing specifically on sensitized groups to substantiate this finding. The study also highlights risk factors for asthma in infants with atopic dermatitis and indicates that early and persistent aeroallergen sensitization confers a higher risk than later development of sensitivity.

Adolescent↗
PubMed2002

Recognition of pathogenically relevant house dust mite hypersensitivity in adults with atopic dermatitis: a new approach?

BACKGROUND: The pathogenic importance of the ubiquitous house dust mite, Dermatophagoides pteronyssinus (Dp), in atopic dermatitis is unclear. OBJECTIVE: We aimed to explore the relevance of Dp hypersensitivity in adult patients with atopic dermatitis by using an in vivo topical challenge method and in vitro assays for T-cell reactivity. METHODS: Dp and control skin prick test solutions were applied to the cubital fossae of 20 patients twice daily for 4 days; the severity of dermatitis and pruritus in the challenge sites were determined before and after testing. The same solutions were used in PBMC proliferation assays that included 10% fresh, autologous serum, the latter aimed at maximizing IgE facilitated allergen presentation. RESULTS: Although most patients had markedly elevated Dp-specific serum IgE levels, only 6 of 20 patients developed increases in cubital fossa dermatitis severity and pruritus scores that were greater at sites of application of Dp solution than at control sites. In addition, PBMC proliferation in response to Dp solution in the presence of autologous serum was significantly greater in the in vivo challenge-positive patients than in those who did not respond to challenge. A subgroup of patients (7/20) also developed transient but pronounced contact urticaria at sites of Dp application. CONCLUSION: These findings suggest that hypersensitivity to Dp might be clinically relevant in approximately one third of the adult atopic dermatitis population studied. They also point to methods of identifying patients who might respond to house dust avoidance measures.

Adult↗
PubMed2001

Tacrolimus ointment for the treatment of atopic dermatitis in adult patients: part I, efficacy.

A total of 632 adults with atopic dermatitis applied tacrolimus ointment (0.03% or 0.1%) or vehicle twice daily for up to 12 weeks in two randomized, double-blind studies. This report focuses on the efficacy of tacrolimus ointment in these studies. The mean percent body surface area (%BSA) affected at baseline was 45%, and 56% of patients had severe atopic dermatitis. Evaluations included a physician's global evaluation of clinical response, %BSA affected, individual signs of atopic dermatitis, the Eczema Area and Severity Index (EASI) score, and the patient's assessment of pruritus. A 90% or greater improvement from baseline in disease status was observed for 6.6%, 27.5%, and 36.8% of patients in the vehicle, 0.03% tacrolimus ointment, and 0.1% tacrolimus ointment groups, respectively (P<.001), and 50% or better improvement was observed for 19.8%, 61.6%, and 72.7% of patients, respectively. Tacrolimus ointment-treated patients showed significantly greater improvement than vehicle-treated patients for all efficacy parameters evaluated, including the %BSA affected, the total score and individual scores for signs of atopic dermatitis, the patient's assessment of pruritus, and EASI score. The 0.1% concentration was more effective than the 0.03% concentration, particularly in patients with severe disease and/or extensive BSA involvement at baseline and in African Americans. Tacrolimus ointment is an effective therapy for the treatment of adult patients with atopic dermatitis on all skin regions including the head and neck.

Adolescent↗
PubMed2001

A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients.

The safety and efficacy of 0.03% and 0.1% tacrolimus ointment for the treatment of atopic dermatitis were evaluated in a 12-week, randomized, double-blind, vehicle-controlled study of 351 children 2 to 15 years of age with moderate to severe atopic dermatitis. The mean age of patients was 6.1 years. A total of 61.5% of patients had severe atopic dermatitis at baseline. The mean percentage of body surface area affected was 47.7%, and 83.5% of patients were affected on the head and/or neck. Significantly more patients (P<.001) achieved clinical improvement of 90% or better with 0.03% or 0.1% tacrolimus ointment compared with vehicle. Significant improvements in the signs and symptoms of atopic dermatitis, percent body surface area affected, and the patient's assessment of pruritus were also observed early in treatment and were maintained throughout the study. Adverse events with a statistically significantly greater incidence in the 0.03% tacrolimus ointment treatment group compared with vehicle were limited to the sensation of skin burning, pruritus, varicella, and vesiculobullous rash ("blisters"). Varicella and vesiculobullous rash occurred at a low incidence (<5%). No adverse event occurred at a statistically higher incidence in the 0.1% tacrolimus ointment-treated group compared with vehicle. Tacrolimus ointment was equally safe for younger (2-6 years) and older (7-15 years) children. Both tacrolimus ointment concentrations (0.03% and 0.1%) were safe and significantly more effective than vehicle for the treatment of atopic dermatitis in children.

Adolescent↗
PubMed2001

Cellular and immunologic mechanisms in atopic dermatitis.

Atopic dermatitis is a chronic inflammatory skin disease that is frequently associated with respiratory allergies. Atopic dermatitis develops as a result of a complex interrelationship of environmental, immunologic, genetic, and pharmacologic factors. Efforts to understand the relative contributions of these factors have led to research seeking to identify the relevant effector cells and mediators involved in the pathogenesis of atopic dermatitis. These factors include the pattern of local cytokine release, the differentiation of helper T cells, multiple roles of IgE, skin-directed cell responses, infectious agents, and superantigens. This article reviews these cellular and immunologic mechanisms underlying atopic dermatitis and discusses how an understanding of their role in the inflammatory process may lead to improved treatments for atopic dermatitis.

Dermatitis, Atopic↗
PubMed2001

Balsam-related systemic contact dermatitis.

BACKGROUND: Positive patch tests to balsam of Peru (BOP) or fragrance mix (FM) suggest the possibility of systemic contact dermatitis from balsam-related foods and spices. OBJECTIVE: This was a retrospective study to determine whether avoidance of balsam-related foods results in an improvement of dermatitis in these patients. METHODS: A review of the records of all patients seen from July 1 to Dec 31, 1998 with positive patch tests to BOP, FM, cinnamic aldehyde, and balsam of tolu was performed 9 to 14 months after their evaluation in a tertiary dermatology center. All patients were contacted via telephone to assess the status of their dermatitis and whether they were able to note any specific balsam-related food allergies. RESULTS: A total of 75 patients were identified, and 71 could be contacted. Fourteen were only allergic to BOP or FM on testing; 31 were positive to BOP/FM and other allergens with presumed relevance to BOP/FM; 26 were positive to BOP/FM and others with other allergens felt to be responsible for the dermatitis and were not placed on a BOP diet. Excluding this last group, 21 of 45 (47%) had complete or significant improvement that they related to dietary modification. Ten did not modify their diet, with 8 reporting no improvement. Eight improved with fragrance or other allergen avoidance only, and 6 modified their diet unsuccessfully. Most commonly implicated foods included tomatoes, citrus, and spices. CONCLUSION: Almost half of the subjects with positive patch tests to BOP or FM who followed a BOP reduction diet reported significant to complete improvement of their dermatitis.

Adolescent↗