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At least 955 records · Page 53Linked to original sources
PubMed2002

Interstitial granulomatous dermatitis with plaques.

BACKGROUND: Interstitial granulomatous dermatitis is a histopathologic pattern with variable clinical appearance associated with autoimmune systemic diseases. The frequency of its different cutaneous expressions and its association with autoimmune diseases are not known. OBJECTIVE: We describe the clinical, serologic, and histologic features in 17 patients with interstitial granulomatous dermatitis with a clinical presentation consisting of large erythematous plaques. METHOD: Skin biopsy specimens fulfilling criteria for diagnosis of interstitial granulomatous dermatitis were selected and correlated with the clinical and laboratory findings. RESULTS: The study included 1 man and 16 women with multiple, asymptomatic, round to oval, erythematous plaques, most often on folds of the skin, in a bilateral and somewhat symmetric distribution. Most of patients had rheumatoid polyarthralgias along with various serologic abnormalities, often connected to collagen vascular diseases. Histologic examination disclosed a distinctive interstitial granulomatous dermatitis characterized by a diffuse infiltration of the interstitium by histiocytes with piecemeal fragmentation of collagen and formation of small granulomas around degenerative areas in concert with variable numbers of polymorphonuclear leukocytes sprinkled within the infiltrate. Churg-Strauss granulomas in miniature and flame figures were occasionally observed and indicated continued or increased activity of the associated autoimmune disease(s). CONCLUSIONS: Interstitial granulomatous dermatitis with plaques is a distinct entity with highly reproducible clinical and histopathologic features; recognition of these features identifies a patient who may have an underlying systemic autoimmune disorder.

Adult↗
PubMed2003

Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis.

BACKGROUND: The water content of the stratum corneum and skin surface lipids are important factors in the appearance and function of the skin. A disruption of the balance between the two may lead to the clinical manifestation of dryness of skin in patients with atopic dermatitis. OBJECTIVE: The aim of our study was to examine the so-called dry skin of patients with atopic dermatitis using objective parameters. We compared the epidermal hydration and the skin surface lipids, the so-called hydro-lipid film, of the clinically unaffected skin of patients suffering from atopic dermatitis with that of healthy subjects. METHODS: A total of 48 patients of either gender were included in this retrospective case-control study. We used the Corneometer CM 820 (Courage+Khazaka Electronic GmbH, Cologne, Germany) and the Sebumeter SM 810 (Courage+Khazaka Electronic GmbH) as noninvasive measuring methods. RESULTS: The results showed marked decreases in the atopic dermatitis group for both the Corneometer and Sebumeter measuring methods. CONCLUSION: Our results show that the dry skin of patients with atopic dermatitis, as previously shown, is due not only to a decrease in skin moisture but also to a reduction of skin lipids. This finding gives rise to a new understanding of the condition, and therefore one should always speak of a hydro-lipid film.

Adult↗
PubMed2003

Fluocinolone acetonide 0.01% in peanut oil: therapy for childhood atopic dermatitis, even in patients who are peanut sensitive.

BACKGROUND: Fluocinolone acetonide 0.01% in a blend of refined peanut and mineral oils has been used as treatment for scalp psoriasis for several years, but only more recently for atopic dermatitis. OBJECTIVE: We sought to study the effectiveness for atopic dermatitis, potential for adrenal axis suppression, and safety of the fluocinolone acetonide 0.01% in oil in children with atopic dermatitis, including children with atopic dermatitis and peanut allergic sensitivity. METHODS: Three separate studies were performed in children aged 2 to 12 years with atopic dermatitis: multicenter double-blind, randomized, and vehicle-controlled trial; cortisol stimulation testing; and prick testing, patch testing, and monitored medication use in children with peanut allergic sensitivity. RESULTS: Improvement of >/=50% was demonstrated within 2 weeks in 81% to 87% of 81 patients treated with active medication versus 39% of 45 children treated with vehicle oil alone. No adrenal suppression occurred after 4 weeks of therapy in 32 patients. None of 9 patients who were peanut sensitive reacted to either the full formulation or vehicle in prick or patch testing; 20 children who were peanut sensitive showed no allergic reactions after application of the medication. CONCLUSION: Fluocinolone 0.01% in peanut oil is an effective alternative to the use of topical corticosteroid agents in ointment, cream, and lotion forms in children. No evidence of adrenal suppression or adverse local effects were demonstrated in these studies. The medication was well tolerated in patients with peanut allergic sensitivity.

Administration, Topical↗
PubMed2003

Evaluation of the histologic characteristics of patch test confirmed allergic contact dermatitis.

BACKGROUND: Microscopic features of experimentally induced allergic contact dermatitis (ACD) have been reported; however, the histologic characteristics of environmentally induced ACD have not been definitively elucidated. OBJECTIVE: This pilot study was conducted to describe the histologic features most useful in differentiating ACD from other forms of eczematous dermatitis. METHODS: A retrospective chart review of patients who underwent evaluation for contact dermatitis was performed. The results of skin biopsy were reviewed in a blinded manner, and two subgroups were compared: gold standard ACD cases and control cases (eczematous dermatitis with negative results of patch testing). RESULTS: Of 317 cases reviewed, 39 fulfilled the inclusion criteria. Many histologic similarities were noted: both subgroups had substantial acanthosis and lymphocytic infiltration. In addition, present to a moderate degree in both groups were hyperkeratosis, spongiosis, eosinophils, and dermal dendritic fibrohistiocytic (DFH) cells. However, compared with the control cases, eosinophilic spongiosis and multinucleate dermal DFH cells were found to a considerably greater degree in the standard ACD cases. CONCLUSIONS: Eosinophilic spongiosis and multinucleate dermal DFH cells, in the presence of acanthosis, lymphocytic infiltrate, dermal eosinophils, and hyperkeratosis, are particularly suggestive of ACD. While such findings alone are not diagnostic of ACD, the presence of these combined histologic features supports the pursuit of patch testing in cases of chronic eczematous dermatitis.

Adult↗
PubMed2002

IgE-mediated hypersensitivity against human sweat antigen in patients with atopic dermatitis.

Sweating aggravates itch in atopic dermatitis, but the mechanism is unclear. In this study, we examined the involvement of type I hypersensitivity in the aggravation of atopic dermatitis by sweating. Skin tests with autologous sweat were positive in 56 of 66 patients (84.4%) with atopic dermatitis, but only in 3 of 27 healthy volunteers (11.1%). Sweat samples from both patients and healthy volunteers induced varying degrees of histamine release from basophils of patients with atopic dermatitis. However, the histamine release was impaired by removal of IgE on the basophils. Incubation of basophils with myeloma IgE before sensitization with serum of patients blocked the ability to release histamine-induced sweat. IgE antibody against antigen(s) in sweat may be present in serum of patients with atopic dermatitis. Key words:

Adolescent↗
PubMed2005

The occurrence of atopic dermatitis in Greenland.

Until recently there was no information available on the prevalence of atopic dermatitis in Greenland. Our objective was to determine the prevalence of atopic dermatitis in younger schoolchildren in Greenland. In the autumn of 2000 we used our previously elaborated questionnaire in a cross-sectional study of 954 schoolchildren aged 7-8 years, who lived in five Greenlandic towns. The findings were compared to data on atopic dermatitis from Denmark. The response rate was 65% (622). The lifetime prevalence of atopic dermatitis was calculated to be 14.0% (95% confidence interval 11.3-16.7) using our standard score criteria with an absolute lower limit estimate of 4.5%. Taking the response rate of 65% into consideration this study indicates that in 2000 the lifetime prevalence of atopic dermatitis among younger schoolchildren in Greenland was in the range of 10-15%.

Child↗
PubMed2001

Contact dermatitis: clinics and pathology.

Contact dermatitis or eczema is a polymorphic inflammation of the skin. It occurs at the site of contact with irritating or antigenic substances. In the acute phase there is occurrence of itching erythema, papules, and vesicles, whereas in the chronic phase there is dryness, hyperkeratosis, and sometimes fissures. Contact dermatitis can be divided into irritant and allergic types. Allergic contact dermatitis is a type-IV T-cell-mediated reaction occurring in a sensitized individual after contact with the antigen/allergen. Such antigens are usually low molecular weight substances (MW approximately 500), called haptens; 3000 contact allergens are known. The diagnosis of contact allergy is made on the basis of the history, clinical findings, and a positive epicutancous test result. Allergic, but not irritative, contact dermatitis can spread beyond the area of contact to other body parts. Eczematous lesions are characterized by a mononuclear infiltrate consisting mainly of T cells in the dermis and epidermis, together with an intercellular epidermal edema that is. spongiosis. In allergic contact dermatitis, skin-applied antigen is taken up by epidermal Langerhans cells and transported with the afferent lymph to the regional lymph nodes. Here, naive T lymphocytes are sensitized to become antigen-specific effector T cells, which then leave the lymph node, enter the circulation, and are recruited to the skin by means of specific cell surface molecules, to form the infiltrates. Cytokines released by infiltrating T cells eventually cause keratinocyte apoptosis.

Allergens↗
PubMed2004

A multicenter trial of the efficacy and safety of 0.03% tacrolimus ointment for atopic dermatitis in Korea.

BACKGROUND: Atopic dermatitis is a chronically relapsing, common inflammatory skin disease, which significantly affects quality of life negatively in many respects. Topical steroids are the mainstay of atopic dermatitis treatment but they carry the risk of local side effects. A topical formulation of tacrolimus, a macrolide calcineurin inhibitor, has recently been developed. OBJECTIVE: To evaluate the efficacy and safety of 0.03% tacrolimus ointment for the treatment of moderate to severe atopic dermatitis in Korea. METHODS: An open, non-comparative, multi-center study with 4 weeks' follow-up was performed. A total of 180 patients (aged 2-57 years old) were enrolled. Tacrolimus ointment (0.03%) was applied to all involved areas twice daily. Efficacy was evaluated by an investigator's global assessment, the eczema area and severity index score, and by the patient's assessment of pruritus and clinical response at baseline, and after weeks 1, 2 and 4. Dermatology life quality index (DLQI), children's DLQI (CDLQI) and toddler's DLQI were assessed at baseline and at week 4. The safety assessment included monitoring all adverse events and clinical laboratory values. RESULTS: All efficacy parameters were improved. The mean EASI (eczema area and severity index) score was 19.7 at baseline and reduced to 8.0 at the end of the study. Moderate improvement was observed by the investigator's global assessment after 4 weeks' treatment. A marked decrease of pruritus was observed, and mild or moderate improvement was observed by patients' global assessments after the treatment period. Significant benefits in terms of quality of life in adults and children with atopic dermatitis were obtained. The most common adverse events associated with tacrolimus treatment were transient skin burning sensation (45.3%) and pruritus (41.6%) at the site of application. CONCLUSION: 0.03% tacrolimus ointment should be considered effective and safe in both Korean children and adults with moderate to severe atopic dermatitis.

Administration, Cutaneous↗
PubMed2005

A randomized study of the safety, absorption and efficacy of pimecrolimus cream 1% applied twice or four times daily in patients with atopic dermatitis.

BACKGROUND: Pimecrolimus cream 1% (Elidel), a non-steroid inhibitor of inflammatory cytokines, is effective in the treatment of atopic dermatitis, without corticosteroid-related side effects such as skin atrophy. It is indicated for twice-daily application. More frequent applications might be expected either to enhance efficacy or increase toxicity. This study compared the safety, efficacy and systemic absorption of pimecrolimus administered twice daily (recommended dose) and four times daily early in the treatment of patients with moderate to severe atopic dermatitis. METHODS: Adolescent and adult patients with moderate to severe atopic dermatitis were randomly assigned to a twice daily (BID) treatment group (n = 24) or a four times daily (QID) group (n = 25). During days 1-7, patients in the QID group applied pimecrolimus four times daily, and patients in the BID group applied pimecrolimus twice daily plus vehicle equivalent twice daily. During days 8-21, all patients were required to use pimecrolimus twice daily and had the option to use up to two further daily treatments (pimecrolimus in the QID group and vehicle equivalent in the BID group). Blood sampling occurred 2, 4, and 6 hours after the first morning application on days 1 and 5 and then prior to the first morning application on days 8 and 15, and any time on day 22. RESULTS: Only 3 (12%) QID patients and 4 (17%) BID patients reported adverse events (primarily mild, transient application-site burning) with no significant difference between treatment groups in the frequency, type, or severity of adverse events. The median daily number of applications in the QID group during days 8-21 when two additional doses were optional remained at four. Pimecrolimus blood levels from a subgroup of 22 patients showed no difference in systemic exposure between the two dosing regimens. All but three (one in the QID group, two in the BID group) patients had blood levels below the limit of quantification; the highest single blood level of pimecrolimus measured in any patient was 1.37 ng/ml (QID group). Both the QID and BID regimens improved the signs and symptoms of atopic dermatitis similarly as measured by improvements in pruritus severity score, Investigator's Global Assessment, Eczema Area and Severity Index, percentage of body surface area affected, and patient's self-assessment of disease control. CONCLUSIONS: The data suggest that increasing pimecrolimus application from twice daily to four times daily to treat moderate to severe atopic dermatitis for up to 3 weeks does not alter the safety profile nor does it increase the efficacy of treatment. Systemic absorption of pimecrolimus applied BID and QID is minimal and is not different between dosing regimens. Patients and physicians familiar with the potential hazards of overuse of topical corticosteroids should be reassured that if pimecrolimus is applied at twice the recommended BID dose for short periods of time, there is no effect on safety, tolerability, or systemic absorption.

Administration, Topical↗
PubMed1993

Risk assessment of the allergic dermatitis potential of environmental exposure to hexavalent chromium.

Although hexavalent chromium, Cr(VI), is a potent sensitizer and inducer of allergic contact dermatitis and is found in many common materials, no standard or guideline currently exists for protection against these effects in environmental exposure. There appears to be a generalized allergenic potential among the various compounds of Cr(VI). Estimates of the prevalence of Cr sensitivity in the population are uncertain, but range from about 2% of the total population in Finland to as high as 20% in U.S. populations with a dermatitis. Based on the thresholds reported for nine separate patch-test studies and statistical analysis of the aggregate dose-response relationship from 72 separate observations from these studies and on studies of allergic responses to bleaches and detergents, the effective threshold for elicitation of allergic contact dermatitis in sensitized populations is about 10 ppm (mg/L) Cr(VI) (as chromium) in solution. Based on evaluation of the literature on cement dermatitis, the threshold concentration of extractable Cr(VI) in solid material may be as low as 10 ppm (microgram/g). For ingestion of Cr(VI), the lowest observed effect level (LOEL) dose for elicitation is 0.26 microgram/kg. In calculating the threshold concentration of Cr(VI) in soil for elicitation of contact dermatitis, extractability must be taken into account.

Adult↗
PubMed2002

Common respiratory infections early in life may reduce the risk of atopic dermatitis.

Infections that occur early in life may protect against atopic disease later in life. To investigate the relationship between common acute respiratory infections and atopic dermatitis in early childhood, we closely observed a cohort of 329 children from the ages of 2 to 24 months. We assessed the effect of proven viral infections and acute otitis media on the occurrence of atopic dermatitis. If the child had his or her first respiratory infection before the age of 6 months, the child's remaining risk of developing atopic dermatitis was reduced by 49% (95% confidence interval, -24% to 79%). The individual risk of developing atopic dermatitis was similarly reduced after infection experienced at >/=6 months of age, but the remaining risk was low, because most cases of atopic dermatitis had manifested by this time. Our results are consistent with the hypothesis that early infections may reduce the risk of atopic disease.

Child↗
PubMed2004

The genetics of psoriasis, psoriatic arthritis and atopic dermatitis.

Psoriasis and atopic dermatitis are chronic and relapsing inflammatory diseases of the skin associated with various immunologic abnormalities. Approximately 30% of psoriasis patients also have joint involvement, indicative of psoriatic arthritis. Genes and environment play a key role in the pathogenesis of these diseases. Genome-wide linkage scans have identified multiple loci linked to each disease and revealed overlap with psoriasis and atopic dermatitis susceptibility loci on chromosomes 1q21, 3q21, 17q25 and 20p12. The genes from these loci have not yet all been identified, or systematically tested for a role in psoriasis and atopic dermatitis; however, these locations suggest that some susceptibility factors lie within genes or gene families with common effects upon epithelial immunity. A strong HLA association is described for psoriasis, but not for atopic dermatitis. Knowledge of the genetic factors leading to these diseases will lead to an understanding of their variable age at onset, their waxing and waning and the variability of body surface environment. The effect of environmental triggers may also be understood once the altered pathways are elucidated. Genes implicated so far in atopic dermatitis are SPINK5, FcepsilonRI-beta and PHF11. Genes implicated in psoriasis so far are HLA-C, SLC9A3R1, NAT9, RAPTOR and SLC12A8. Genetic modifiers such as CARD15 may predispose to psoriatic arthritis.

Arthritis, Psoriatic↗
PubMed1996

Clinical assessment in the workplace: dermatitis.

The clinical assessment of dermatitis in the workplace is put forward as a series of four decisions: (1) is it dermatitis and not psoriasis, tinea, scabies, etc? (2) Is it contact dermatitis and not atopic, seborrhoeic, discoid, stasis or unclassified eczema? (3) Is it irritant contact dermatitis or allergic contact dermatitis? (4) What is/are the probable cause(s)?

Dermatitis, Occupational↗
PubMed1987

Ripple pigmentation of the neck in atopic dermatitis.

Ripple pigmentary lesions of the neck were observed in 12 patients with atopic dermatitis. Biopsy specimens from three cases revealed no amyloid substances. From the review of cases with either atopic dermatitis or ripple pigmentation seen in our hospital, it was concluded that ripple pigmentation of the neck was always associated with atopic dermatitis and appeared in 1.7% of all 751 patients with atopic dermatitis. It is suggested that ripple pigmentation is not necessarily specific or diagnostic of amyloidosis, as is generally believed. Possible relationships involving ripple pigmentation, atopic dermatitis, and macular amyloidosis are also discussed.

Adolescent↗
PubMed1990

The cutaneous pathology of atopic dermatitis.

Sixteen skin biopsy specimens from early eruptive, evolving papules and well-developed plaques were obtained from eight patients with established atopic dermatitis. We found that the chronological and histopathological sequence begins with a perivascular interstitial spongiotic dermatitis, evolves into a psoriasiform microvesicular spongiotic dermatitis, which is sometimes focally lichenoid, and eventually concludes as a psoriasiform dermatitis. Thus, atopic dermatitis has characteristic and diagnostic histopathologic findings. These are portrayed and contrasted to what has been previously reported.

Adult↗
PubMed1991

Paederus fuscipes dermatitis. A histopathological study.

Paederus fuscipes (PF) dermatitis is a self-healing blistering disorder of the skin caused by a small insect belonging to genus Paederus, family Staphylinidae, order Coleoptera. Crushing PF on the skin causes acute dermatitis within 24 hours, corresponding in shape and dimensions to the area affected by the substance released (pederin). The acute vesicular lesions become crusted and scaly within a few days and heal completely in 10-12 days, with a transitory postinflammatory hypercromic patch. Twenty consecutive cases of PF dermatitis at different stages were studied histologically by routine light microscopy. The pederin causes a spectrum of histopathologic changes ranging from acute epidermal necrosis and blistering in acute stages, to marked acanthosis with mitotic figures in the late stages. PF dermatitis is an entomological model of irritant contact dermatitis, having histopathologic features of intraepidermal and subepidermal blistering, epidermal necrosis and acantholysis. The presence of some acantholytic foci, relatively far from the foci of clinically involved skin, in four of the cases considered suggests a possible role of pederin in inducing acantholysis indirectly. Acantholysis is probably caused by the release of epidermal proteases.

Animals↗
PubMed2004

Autoimmunity and atopic dermatitis.

PURPOSE OF REVIEW: It has been demonstrated that a considerable percentage of patients suffering from atopic dermatitis mount IgE autoantibodies against a broad variety of human proteins. This review summarizes evidence for autoimmune mechanisms in atopic dermatitis and suggests novel pathomechanisms that may be involved in this disease. RECENT FINDINGS: It has been shown that patients suffering from atopic dermatitis exhibit IgE autoreactivity to human proteins. These autoantigens are expressed in a variety of cell and tissue types. Complementary DNAs coding for IgE autoantigens have been identified, cloned and characterized at the molecular level. Using purified recombinant IgE autoantigens, it has been shown in paradigmatic models that IgE autoimmunity may be a pathogenetic mechanism in atopic dermatitis. Moreover, it has been shown that the levels of IgE autoantibodies are associated with severity of disease. SUMMARY: Patients suffering from severe manifestations of atopy mount IgE autoantibodies against a variety of human proteins. The levels of IgE autoantibodies correspond with disease severity. Several mechanisms of IgE autoimmunity may contribute to the pathogenesis of atopic dermatitis.

Allergens↗
PubMed2005

Suggestions regarding a more appropriate understanding of atopic dermatitis.

PURPOSE OF REVIEW: The importance of consistency and accuracy of medical terminology must be recognized by all health care providers and researchers. Yet, recent publications by recognized authorities regarding atopic dermatitis seem to defy that basic tenet. I (an allergist/dermatologist) have (objectively) reviewed and (subjectively) interpreted the currently (peer reviewed) published designations etymologically, and some of their concepts scientifically. RECENT FINDINGS: Interdisciplinary, regional and international meetings have been discussing, assessing, and deliberating the newest data and observations, consistently realizing little consensus. The concluding trivial agreement denotes their individual bias. Given the same information, allergists, dermatologists, and generalists do not conceptualize, and yet dogmatically manage patients with atopic dermatitis. SUMMARY: Etymologically, and scientifically, atopic dermatitis can only be distinctively designated as the dermatologic syndrome, which heralds the atopic diathesis. Concomitantly, atopic dermatitis without atopy would be an oxymoron. Definitions based on anachronistic criteria demand updating. IgE, like eosinophilia, must be appreciated as epiphenomena of the transient Th1/Th2 cell reversal, which clearly differentiates 'atopic eczema' from all the 'other' eczemas. Failure to recognize the isomorphic feature of the eczema of atopic dermatitis denies patients with an essential therapeutic modality, namely 'Do not scratch, nor rub'. Education regarding the 'triggers' of itch would yield greater success (from recurrences), than prescribing immunomodulation.

Dermatitis, Atopic↗