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PubMed1996

Two-point discrimination of itch in patients with atopic dermatitis and healthy subjects.

The ability to perceive two pruritic stimuli as separate depending on the distance between them (two-point discrimination of itch) was determined in a single-blind study of 20 patients with atopic dermatitis and 20 healthy subjects. Itch was induced with pairs of histamine injections (0.1 micrograms each) given on the upper arm, either along its axis (longitudinally within a dermatome) or at right angles to it (transversally involving more than one dermatome). The interinjection distances were varied in 3-cm steps until the shortest distance at which the two itching stimuli could be perceived as separate was found. Pairs consisting of one injection of histamine (0.1 micrograms) and one of saline served as controls. The two-point discrimination of itch was significantly better in the atopic dermatitis patients than in the healthy controls, both longitudinally (atopic dermatitis: median 12 cm, range 3-21 cm; healthy controls: 15 cm, range 9-21; p < 0.01) and transversally (atopic dermatitis: median 6 cm, range 3-18; healthy controls: 12 cm, range 6-21; p < 0.001). The two-point discrimination of itch did not correlate with the subject's age, two-point discrimination of touch, or, for the atopic dermatitis patients, with their eczema scores or serum IgE levels. The quality, intensity or spatial summation of itch did not differ significantly between the two groups of subjects.

Adolescent↗
PubMed2002

Late-phase reactions to intradermal testing with Dermatophagoides farinae in healthy dogs and dogs with house dust mite-induced atopic dermatitis.

OBJECTIVE: To determine the prevalence of late-phase reactions to intradermal testing with Dermatophagoides farinae in healthy dogs and dogs with atopic dermatitis and an immediate reaction to D farinae. ANIMALS: 6 healthy dogs and 20 dogs with atopic dermatitis and immediate reactions to D farinae. PROCEDURE: ntradermal tests were performed with D farinae at 1:1,000 wt/vol and 1:50,000 wt/vol concentrations, and skin reactivity was evaluated after 0.25, 6, and 24 hours. Serum D farinae-specific IgE antibodies were assayed. Extent of lesions (atopy index) and pruritus (visual analogue scale) were evaluated in dogs with atopic dermatitis. RESULTS: Late-phase reactions were observed in healthy dogs at 6 hours (n = 2 dogs) and 24 hours (1) with the 1:1,000 wt/vol concentration, and at 6 hours (1) and 24 hours (1) with the 1:50,000 wt/vol concentration of allergen. Late-phase reactions in healthy dogs were only observed in dogs with an immediate reaction to D farinae. Late-phase reactions were observed in 11 of 20 dogs with atopic dermatitis at 6 and 24 hours with the 1:1,000 wt/vol concentration and in 10 of 20 at 6 and 24 hours with the 1:50,000 wt/vol concentration of allergen. There was no difference in mean atopy index, mean visual analogue scale of pruritus, or mean serum D farinae-specific IgE concentration of dogs with a late-phase reaction, compared to dogs without a late-phase reaction. CONCLUSIONS AND CLINICAL RELEVANCE: Late-phase reactions may be observed after an immediate reaction to intradermal skin testing in healthy and allergic dogs but are more commonly observed in dogs with atopic dermatitis.

Allergens↗
PubMed2001

Episioplasty for the treatment of perivulvar dermatitis or recurrent urinary tract infections in dogs with excessive perivulvar skin folds: 31 cases (1983-2000).

OBJECTIVE: To evaluate the effectiveness of episioplasty for the treatment of perivulvar dermatitis or chronic or recurrent urinary tract infections (UTI) believed to be secondary to excessive perivulvar skin folds in dogs and to document whether a causal relationship exists between the presence of chronic or recurrent UTI and excessive perivulvar skin folds in female dogs. DESIGN: Retrospective study. ANIMALS: 31 female dogs. PROCEDURE: Medical records of dogs with vulvar dermatitis (group 1; n = 15) or UTI (group 2; 16) were reviewed for history, signalment, physical examination findings, hematologic findings, results of urine or vaginal bacteriologic culture, and results of additional diagnostic procedures. RESULTS: 14 of 15 dogs in group 1 had complete resolution of perivulvar dermatitis and associated clinical signs following episioplasty. One dog had a relapse of clinical signs and vulvar dermatitis 2 years after surgery in association with a 9-kg (1 9.8-1b) weight gain. Sixteen of 16 dogs in group 2 had complete resolution of clinical signs of UTI following episioplasty. Urine samples were obtained via cystocentesis no earlier than 1 month after surgery to confirm resolution of UTI in 13 of 16 of dogs in group 2. Mild-to-moderate incisional swelling was the only surgical complication reported for either group, with the exception of 1 dog in group 2 that had wound dehiscence. All owners were satisfied with surgical outcomes. CONCLUSIONS AND CLINICAL RELEVANCE: All owners reported complete resolution of clinical signs for both groups of dogs. Episioplasty is an effective low morbidity treatment for perivulvar dermatitis and chronic UTI associated with excessive perivulvar skin folds.

Animals↗
PubMedDate not supplied

The relationship between plasma thrombospondin level and the clinical course of atopic dermatitis.

The tests currently used to monitor atopic dermatitis in children--serum IgE level and eosinophil count--are not sensitive enough to accurately track the course of the disease. Because previous studies have shown that atopic dermatitis is an inflammatory disease and because our previous work has shown that plasma thrombospondin level correlates well with the course of other inflammatory diseases, we conducted this study to determine the relationship between plasma thrombospondin level and the severity of skin inflammation in children with atopic dermatitis. Eosinophil count, serum IgE level, and plasma thrombospondin level were measured in 48 children with atopic dermatitis at onset of flare-up, 2 weeks after treatment started, and 2 months after treatment started. The results of all three tests were better after 2 months of therapy than they had been at the initial visit, but only plasma thrombospondin level showed a statistically significant decrease, which coincided with clinical improvement. Plasma thrombospondin level seems to correlate with the clinical course of patients with atopic dermatitis better than do serum IgE level or eosinophil count.

Adolescent↗
PubMed1999

Percutaneous absorption of biotin in healthy subjects and in atopic dermatitis patients.

The study was designed to test the ability of sequential applications of biotin-containing ointment to increase serum biotin levels. Twenty atopic dermatitis patients (mean age, 20.5 yr) and 11 healthy subjects (mean age, 25.5 yr) volunteered to participate in this study. The diagnosis of atopic dermatitis was established dermatologically. Seven grams per day of ointment containing 0.3% biotin and 1-4 g per day of steroid ointment were both applied sequentially. The healthy subjects applied only biotin ointment. The biotin concentration was determined microbiologically. Before biotin treatment, the average serum biotin level was significantly lower in atopic dermatitis patients than in healthy subjects. The percutaneous application of biotin-containing ointment caused a significant increase in the serum biotin concentration in both healthy subjects (from 41.5 +/- 10.0 to 50.2 +/- 9.2 nmol/L) and in atopic dermatitis patients (from 27.9 +/- 17.4 to 50.7 +/- 21.6 nmol/L), especially in patients whose initial level was low, and also could be effective in regulating the atopic allergic response involving eosinophils. In conclusion, biotin appears to be readily absorbed through both normal and dermatitis-affected human skin.

Absorption↗
PubMed1999

Intravenous immune globulin (i.v.IG) therapy in steroid-resistant atopic dermatitis.

Many trials have been done on steroid-resistant atopic dermatitis. Recently, intravenous immune globulin (i.v.IG) was reported to be effective in the treatment of steroid-dependent atopic dermatitis. The aim of this study was to clarify whether i.v.IG therapy is effective in steroid-resistant atopic dermatitis. Forty-one steroid-resistant atopic dermatitis patients were tested in this study. Patients who weighed less than 30 kg were administered 500 mg/kg of i.v.IG. Patients who weighed 30 kg or more were administered 15 g of i.v.IG. Patient evaluations and laboratory tests with peripheral bloods such as eosinophil percentages and serum IgE levels were performed at days 0, 1, 7, and 21. In the present study, patients who responded to i.v.IG therapy were classified as Group A. Twelve patients who showed transient effects with lower clinical significance were classified as Group B (29.3%). Remaining 12 patients (29.3%) in Group C showed no improvement at all. Serum IgE levels and blood eosinophil percentages were markedly decreased in Group A. I.v.IG therapy may be recommended in the treatment of atopic dermatitis with extremely high serum IgE levels.

Adolescent↗
PubMed2006

Adolescents' jobs and the course of dermatitis symptoms throughout puberty.

OBJECTIVES: This study evaluated the course of dermatitis symptoms throughout puberty taking into account occupational exposures in a population-based study. METHODS: Participants enrolled in the ISAAC-II (International Study of Asthma and Allergies in Childhood) study in Munich and Dresden in 1995 and 1996 were sent a postal questionnaire in 2002 (age at follow-up 16 to 18 years). The questionnaire included items on atopic diseases, jobs, including holiday jobs and vocational training, and potential confounders. The most recent of the adolescents' jobs held for at least 8 hours a week, and for at least 1 month, were coded according to the ISCO-88 system. RESULTS: Overall, data of 3785 adolescents were included in the analyses. The incidence of dermatitis symptoms during puberty among those without such symptoms at baseline was 7%. Altogether 31% of the participants reported an employment history. Those already employed were more likely to report a new onset of dermatitis symptoms. Jobs associated with a new onset of symptoms were work in the health care sector, vocational training in bakeries, and cleaning. The first 9 months of exposure were particularly relevant for new cases of dermatitis symptoms (odds ratio 3.7, 95% confidence interval 1.5-9.6). CONCLUSIONS: Early occupational exposure is associated with the development of symptoms of dermatitis. The types of skin alterations need to be assessed in the next stage of the study.

Adolescent↗
PubMed1996

Evacuation of an Aboriginal community in response to an outbreak of blistering dermatitis induced by a beetle (Paederus australis).

OBJECTIVE: To describe an outbreak of dermatitis induced by the beetle Paederus australis and the public health measures implemented to control it. SETTING: A remote Aboriginal community in the Northern Territory of Australia. METHODS: Inspection of the community and interviews with residents to document skin lesions, sleeping locations and beetle activity. Samples of the beetle were collected for identification. RESULTS: The community was affected by a plague of beetles. All 40 residents reported painful, blistering, skin lesions. Four required hospitalisation for treatment of an extensive exfoliating and ulcerating dermatitis. The community was evacuated to allow skin lesions to heal and the beetle plague to decline. CONCLUSION: This is the first reported en masse outbreak of Paederus dermatitis in Australia. Paederus dermatitis should be considered as a differential diagnosis of vesicular dermatitis in tropical Australia.

Animals↗
PubMed1992

Phototherapy of atopic dermatitis with ultraviolet radiation.

Studies were conducted in order to evaluate the efficacy of different ultraviolet wavelength regions for the treatment of atopic dermatitis, the risks associated herewith and the in vivo effect of ultraviolet radiation (UVR) on the bacterial skin flora. In bilateral left-right comparisons, adult patients suffering from atopic dermatitis were subjected to treatment with lamps mainly emitting ultraviolet radiation A, UVA, (315-400 nm), UVB (280-315 nm) and combined UVA-UVB, UVAB, respectively. UVAB proved to be most efficacious, with objective and subjective statistically significant superiority to the other types of UVR. UVB was found to be the least efficacious of the three, while the efficacy of UVA was found to lie in between UVAB and UVB. UVAB yielded clearing or considerable improvement in 90% of the patients, while UVA and UVB did so in about 70% of the subjects. Objective differences were less pronounced than subjective ones. The two most common side-effects, xerosis and first-degree burn, were tolerable and clearly correlated to the UVB content of the UVR sources. Uncommon side-effects included polymorphic light eruption (all three types of UVR) and folliculitis (UVB). A typical patient with atopic dermatitis undergoing phototherapy with UVB or UVAB was found to receive an erythemally effective dose of 1 J/cm2 per year, a figure considerably lower than that for UVB-treated psoriasis patients, who, according to previously reported data, receive an annual dose of 4J/cm2. Treatment for 15 years from the age of 25 years will result in an increase in the risk of non-melanoma skin cancer by the age of 60 of 1.15 compared with the risk in untreated individuals. The risks with phototherapy for atopic dermatitis were thus judged to be small. Phototherapy with UVB radiation was shown to possess in vivo antistaphylococcal properties, which were paralleled by clinical efficacy. It is concluded that phototherapy is an effective mode of therapy in patients with mild or moderate atopic dermatitis.

Adult↗
PubMed1992

Type I allergy to foods in atopic dermatitis. Comparison between RAST-positive and RAST-negative cases.

Radioallergosorbent tests (RASTs) with five common foods were performed in 183 patients with atopic dermatitis. The results showed that about half of the patients had type I allergy to at least one of the five foodstuffs. The RAST results correlated roughly to the severity of dermatitis. In each group of patients with mild, moderate and severe atopic dermatitis, positive RAST reactions to common foods occurred predominantly in patients who had a personal or a family history of respiratory atopy. Positive RASTs were rare in patients with pure atopic dermatitis who had neither personal nor family history of respiratory atopy. It seems likely that type I food allergy occurs predominantly in those patients with atopic dermatitis who have a predisposition to respiratory atopy.

Adolescent↗
PubMed1976

Patch testing, tuberculin testing and sensitization with dinitrochlorobenzene and nitrosodimethylanilini of patients with atopic dermatitis.

Cell-mediated immunity was studied in patients with atopic dermatitis. 113 patients were patch tested with ten contact allergens. The frequency of positive reactions to patch testing with "common contact allergens" was found to be lower in patients with "high IgE values" than in those with IgE less than or equal to 1000 U/ml. A larger number of patients with severe dermatitis reacted negatively to PPD and were more difficult to sensitize with DNCB and NDMA as compared with the patients with mild dermatitis. The results of this investigation support the findings of earlier workers that patients with atopic dermatitis show disturbances in the cell-mediated immune system and these disturbances appear to be correlated to the degree of severity of the dermatitis.

Adolescent↗
PubMed1999

[Atopic dermatitis on infant physical examination].

The prevalence rate of atopic dermatitis was investigated in 4-month-old infants, who were examined by dermatologists at regular health checks at a health center. Among 739 infants examined, 150 were diagnosed as having atopic dermatitis, giving a prevalence rate of 20.3%. Most of the cases were mild, and no severe cases were observed. The prevalence rate in spring and autumn was significantly higher than that in summer and winter. The eruptions were seen mainly on the head, face, and trunk. A familial history of atopic dermatitis was positively correlated with infant atopic dermatitis in this series, whereas a familial history of bronchial asthma and allergic rhinitis showed no such correlation. It is important to make a correct diagnosis of mild atopic dermatitis by differentiation from other diseases by dermatologists, and it will be of interest to observe the condition of the infants when they attend for their next physical examination at the age of 18 months.

Dermatitis, Atopic↗
PubMed2000

A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life.

BACKGROUND: Cyclosporine has shown to be effective in severe atopic dermatitis. Little has been reported on the new microemulsion form (Sandimmune, Neoral) in the treatment of this disease. Also, it has not been investigated whether a body-weight-independent dosing regimen of cyclosporine is appropriate for the treatment of atopic dermatitis. OBJECTIVE: The goal of this study was to investigate a body-weight-independent dosing regimen of cyclosporine microemulsion in severe atopic dermatitis by comparing high and low starting doses of treatment. METHODS: A total of 106 adults with severe atopic dermatitis were enrolled in this double-blind study and randomized to receive a starting dose of either 150 mg (low) or 300 mg (high) of cyclosporine microemulsion daily. After 2 weeks the dose could be reduced by 50% if the clinical symptom score was reduced by 50% or more. After 8 weeks the responders entered a 4-week follow-up phase and were randomized to either stop treatment or to continue on their last effective dose every second day. RESULTS: After 2 weeks of treatment the total symptom score decreased from 59.0 to 39.3 with 150 mg and from 60.7 to 33.2 with 300 mg cyclosporine (P <.05). Until week 8 there was a further decrease in the clinical symptom score to 30.8 with low-dose therapy and 25.5 with high-dose therapy. Similar positive effects could be observed in assessments of affected body surface area, itching, sleep loss, and quality of life. At week 2, there was an increase of 0.6% in serum creatinine in patients receiving 150 mg, and 5.8% in the 300 mg group (P <.01). At week 8, the effect on serum creatinine was similar, with a 1.1% rise in the low dose group and a 6.0% increase in the high dose group. Body weight had no influence on efficacy or tolerability in this study. CONCLUSION: Body-weight-independent dosing with cyclosporine seems to be feasible in the short-term treatment of severe atopic dermatitis. Although the starting dose of 300 mg/day is more effective than 150 mg/day, the 150 mg dose would be preferable for the initiation of therapy because of its excellent renal tolerability.

Adult↗
PubMed2000

[Atopic dermatitis: the first allergic step in children].

Atopic dermatitis is an early manifestation of atopy and is frequently present already during the first year of life. Atopic dermatitis is often associated with increased levels of serum IgE and with sensitization to food allergens. Some foods may be responsible for exacerbations of skin inflammation, but their pathogenic role need to be clinically assessed before an avoidance diet is prescribed. Staphylococcus aureus, which is known to colonize the skin of atopic dermatitis patients, may also exacerbate skin lesions and need to be treated with topical antibiotics. Children with atopic dermatitis are prone to allergies and are at risk to develop later respiratory allergic manifestations. In particular, if a sensitization to egg is present early in life, the risk for developing later an asthma due to house dust mites is increased. The care of children with atopic dermatitis should not be limited to the treatment of skin lesions, but should also involve preventive measures for respiratory allergies.

Age Factors↗
PubMed2000

[Atopic dermatitis at 18-months physical examination].

In order to know the prevalence rate and severity of atopic dermatitis, and to compare them to those previously done for 4-month-old infants, the authors examined atopic dermatitis of 18-month-old children at regular health checks at a health center. Among 769 children examined, 69 were diagnosed as having atopic dermatitis, giving a prevalence rate of 9.0%. Most of cases were mild, and no severe cases were observed. In contrast to the location of eruptions on head, face, and trunk at 4-month-old, the eruptions were seen mainly on the trunk and extremities. The prevalence rate in summer and autumn was significantly lower than that in winter and spring. Among 501 children whom we could examine both at 4-month and 18-month-old, 102 cases were diagnosed as having atopic eruptions at 4 months. The eruptions, however, were disappeared in 83 cases when they were 18-month-old. The severity of atopic dermatitis also came to be mild when they grew up. Altogether, a quarter of children had atopic eruptions either at 4 months or 18 months, or both. It will be of interest to observe the transition of atopic dermatitis in childhood and we are planning to follow them at next physical examination at 3-year-old.

Dermatitis, Atopic↗
PubMed2000

[Management of atopic dermatitis: practical guidelines suggested by the conclusion of systematic assessment in 500 children].

Allergic management of AD may be worthwhile since allergy may trigger the disease. A systematic evaluation of sensitizations overtime and study of their clinical involvement in 500 children with AD was carried out, including minor, moderate, and severe patients (defined by clinical scores). Standardized methods assessed the possibility of contact dermatitis as well as IgE dependant allergies. Contact dermatitis concerned fragrances and nickel. Contact dermatitis was observed in minor and moderate AD with a progressive increase: 11% of children under 2 years and 58% in those over 15 years of age. Later in older children, sensitization to cosmetics and occupational allergens occurred in close connection with the specific environment. As for IgE sensitization, investigation should be electived advised in moderate and severe AD. Inhalant allergen sensitization was observed in 66% in moderate AD and 93% in severe AD in the group of 7 or 15 years. Clinical confrontation was a better indicator of cutaneous involvement than atopen patch-test. It mainly concerned respiratory symptoms. In severe AD, food allergy was constantly observed and presented as a marker for severe atopic dermatitis. The main trophallergen differ according to the age and cultural habits: in children under 2 years of age, eggs, peanuts, milk, fish were the main offending agents. Later, main trophallergens were wheat flour, shellfish. Although spontaneous decrease of food allergy is sometimes observed, it must be pointed out that food allergy may still persist as a triggering factor in teenagers as well as in adult-hood. The allergologic diagnosis of atopic dermatitis should not focus on IgE dependent sensitization without patch testing.

Adolescent↗
PubMed2001

The frequency of common skin conditions in preschool-age children in Australia: atopic dermatitis.

OBJECTIVE: To determine the prevalence and severity of atopic dermatitis in a stratified cross-section of preschool-age children examined throughout Victoria, Australia. DESIGN: A cross-sectional skin survey using a selected cluster sample of the various centers throughout Victoria. SETTING: The study population included Victorian children attending child-care centers, preschools, and Maternal and Child Health Centres, with the reference population being Australian children aged 5 years and younger. PARTICIPANTS: Of 1634 potential participants, 1116 children (68.3%) were examined. INTERVENTION: A dermatologist performed a total skin examination, including head and neck, limbs, and trunk, on all children. The diaper area was examined in children younger than 12 months. MAIN OUTCOME MEASURE: All parents were administered a questionnaire to elicit demographic information, history of skin conditions, and family history of skin problems or related diseases. The examiner recorded the presence, site, and severity of atopic dermatitis for calculation of age- and sex-specific prevalence rates. RESULTS: The age- and sex-adjusted point prevalence was 30.8% (95% confidence interval [CI], 28.0%-33.5%). Most children (63.7%) were classified as having minimal or mild disease. Only 5.8% of children with atopic dermatitis did not have face or flexural involvement. Of the 237 children with atopic dermatitis and information available, 209 used 1 or more products to treat their condition. CONCLUSIONS: Atopic dermatitis is common, decreasing in prevalence after the first 3 years of life. Most children have mild disease requiring little if any treatment, and much could be prevented with simple measures. Educational programs directed at those caring for preschool-age children that provide information on simple preventive measures, where practical, and sources of advice for treatment, if necessary, could substantially reduce the morbidity of this condition in predisposed children.

Child Day Care Centers↗
PubMedDate not supplied

A randomized trial of leukotriene receptor antagonist montelukast in moderate-to-severe atopic dermatitis of adults.

Leukotriene receptor antagonists are recommended for the treatment of asthma, and have proved anecdotally successful even in atopic dermatitis. Standard treatments of atopic dermatitis are often unsatisfactory. Accordingly, we compared montelukast, 10 mg/day, with a combined regimen (orally administered cetirizine and clarythromycin, topical corticosteroids and hydrating preparations) for treatment of moderate-to-severe atopic dermatitis of adults. The trial was designed as a randomized single-blind study. SCORAD, eosinophilic cationic protein (ECP), eosinophilic protein X (EPX) serum levels were assessed at baseline and after 6 weeks in 32 adult patients with atopic dermatitis (16 treated with montelukast; 16 treated with the combined regimen). Similar improvements, evaluated in term of SCORAD reductions, were detected in both groups (Mann-Whitney, p < 0.05), while ECP and EPX levels significantly reduced within each group (Welch's approximate t, p < 0.05). We conclude that montelukast is as effective as the comparison combined regimen to treat atopic dermatitis of adults.

Acetates↗