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PubMed1996

[Allergologic survey in 251 patients with moderate or severe dermatitis. Incidence and value of the detection of contact eczema, food allergy or sensitization to air-borne allergens].

INTRODUCTION: Because of the increased recruitment of uncontrolled atopic dermatitis (AD) necessitating chronic use of dermocorticosteroids, we developed a prospective allergologic survey in a serie of 251 patients presenting with moderate or severe AD. PATIENTS AND METHOD: 251 patients were refered for allergologic assessment and followup. The clinical severity was assessed by use of standardized scores. Patients were grouped by age: group 1 (70 children younger than 2 years), group 2 (93 children between 2 and 7 years), group 3 (23 children between 7 and 15 years), group 4 (65 children over 15 years and adults). All the patients were systematically screened for contact dermatitis and IgE mediated sensitization (inhallant and food allergens) with blood tests for IgE, prior to evaluation of clinical relevance. RESULTS: Aero-allergen sensitization was demonstrated in 51 p. 100 of children and 89 p. 100 of adults. It was present earlier in severe AD with main clinical involvement for nose and throat and respiratory symptoms. Clinical responsibility for dermatitis was documented in only 6 p. 100 of AD. Food allergy was early incriminated as flare factors in most of severe AD (96 p. 100 of children and 81 p. 100 of adults) with major and persistant improvement under eviction diet. Main allergens were eggs (46 p. 100), pea-nuts (29 p. 100), shellfish (24 p. 100), milk (20 p. 100), flour (14 p. 100), fish (14 p. 100), soybeans (8.9 p. 100). Food allergy to yeasts (7.2 p. 100) was important in adults. Food allergy is the earliest allergy in the course of severe AD and the number of involved trophallergens increases in older patients. Patch tests were positive in 40 p. 100 of patients (i. e. 31 p. 100 of children and 66 p. 100 of adults) with a greater incidence in moderate AD. Main allergens were metals (54 p. 100), fragrances (19 p. 100), balsam of Peru (10 p. 100), parabens (8 p. 100) and lanoline (4 p. 100). CONCLUSION: When AD is not efficiently controlled by dermocorticosteroids, allergologic screening and treatment of children and adults proves to be very interesting. Specific measures regarding food allergy and contact dermatitis reduce or vanish cutaneous flares. As for inhallant sensitizations, Dermatologists should be awared that they may play a role regarding assessment of sensitization and prevention of respiratory symptoms in moderate and severe AD since the risk of complications is important in both groups.

Adolescent↗

PubMed1996

Occupational contact dermatitis toward sesquiterpene lactones in a florist.

Many plants and flowers can cause dermatitis in florists, growers, and others working in the industry. In the United States, Alstromeria, also called Peruvian Lily, has frequently been reported to cause hand eczema in floral workers. This interesting report details sesquiterpene lactone allergy in the occupational setting. Fortunately, in this case, it seems that resolution of the dermatitis was achieved fairly rapidly by avoiding the occupational situation. Unfortunately, for many of our patients with airborne compositae dermatitis, there is no way to avoid the allergen; therefore, many of these individuals develop severe, chronic recalcitrant dermatitis requiring aggressive therapy. Diagnosis of this condition is not always easy, as it appears that the sesquiterpene lactone mix allergen that we have commercially available misses a number of cases, at least in the United States. Better characterization of the allergens involved and better supply of allergenic extracts for testing is critical to improve our diagnostic ability.

Adult↗

PubMed1997

The profile of a patient with contact dermatitis and a suspicion of contact allergy (history, physical characteristics, and dermatology-specific quality of life).

According to the National Center for Health Statistics Survey, a large proportion of patients with contact dermatitis, atopic dermatitis, or eczema visit nondermatologists, and only approximately 40% visit dermatologists. Therefore, the prompt, proper diagnosis of the cause and prescription of precise treatment can be delayed. We wanted to create a clear understanding of the nuances of the allergic contact dermatitis and its effect on the economics and life quality of the patients for not only the dermatologists but also the primary care physicians. In an observational multicenter study planned for a span of 1 year with approximately 570 patients suspected of allergic contact dermatitis, data were collected at enrollment on their history, physical characteristics, and quality of life and were analyzed using routine statistical procedures. The "quality of life" data on these patients, most of whom have a history of long-standing disease, show a high correlation between the clinical factors such as symptom activity and frequency of episodes and the subscales of quality of life. These patients had a lesser score on mental and vital subscales (SF-36) than US population norms, showing a moderate impact of the disease on their mental health and vitality. There is an urgent need for a simpler and quicker method that could lead to an earlier and more precise diagnosis so the causal substance can be identified and avoided and the disease treated in a timely and cost-effective manner.

Dermatitis, Allergic Contact↗

PubMed1997

An evaluation of the allergic contact dermatitis potential of colloidal grain suspensions.

BACKGROUND: Colloidal grain suspensions have been used for decades as adjuncts in the treatment of atopic dermatitis, especially in the US. In Italy, many young children have been exposed to colloidal grains. Recently, it was suggested that these bath therapies may induce allergic contact dermatitis in some young atopic children. OBJECTIVE: To evaluate the allergic skin reactions to topical oat and rice colloidal grain suspensions of normal and atopic children with and without previous exposure to colloidal grain suspensions. METHODS: A double-blind, randomized patch study. Two concentrations of oat and rice colloidal grains (0.007% and 0.7%) were applied occlusively to the backs of 65 children living in Italy, ages 6 months to 2 years (43 were atopic and 22 were normal). RESULTS: There were neither immediate urticarial nor allergic reactions in any of the 65 study subjects, atopic or nonatopic; 5 of 43 (12%) atopic subjects developed irritant reactions to the test materials. Radioallergosorbent tests (RAST) tests were performed on 55 subjects. The negative RAST test results found in the nonatopic group correlated well with nonatopic status, but positive RAST tests were found in only 8 of 35 (23%) atopic dermatitis subjects. None of the sera from positive RAST scores corresponded to subjects with irritant patch reactions. CONCLUSIONS: The data indicate that topical colloidal grains can be used as an adjunct in the management of mild atopic dermatitis in children under 2 years of age. There was no evidence of sensitization to topical colloidal grains in the group studied.

Avena↗

PubMed1997

Contact hypersensitivity in atopic dermatitis.

From January 1990 to December 1994, a total of 84 patients (56 men and 28 women) with atopic dermatitis (AD) were referred to our Clinic for patch testing. The European standard series of allergens was applied to all subjects together with any additional series indicated in the case history. Sensitization to at least one of the allergens was found in 57.1% of individuals with AD. Positive reactions were more frequently determined in adults than in children with AD. Women and men were equally positive in epicutaneous testing. The commonest sensitizer was nickel sulfate (discriminative in 28.6%). Adult patients with atopic dermatitis significantly differed from patients with chronic urticaria or healthy controls in patch test positive results. Our findings suggest that allergic contact dermatitis is more common in patients with AD than generally assumed and that patch testing is a practicable and clinically worthwhile procedure for determining allergic contact dermatitis in patients with AD.

Adolescent↗

PubMed1998

Contact dermatitis to foods and spices.

Cutaneous reactions to foods and spices occur in both the workplace and at home in those who grow, handle, prepare, or cook food. As spices are also used in cosmetics and perfumes other exposures are found. Several patterns have been described upon contact with food including irritant contact dermatitis, allergic contact dermatitis, contact urticaria, phototoxic contact dermatitis, and protein contact dermatitis. The purpose of this article is to review the approach to a patient suspected of having a cutaneous reaction to food or spices, as well as discuss these reactions and the allergens that cause them.

Dermatitis, Contact↗

PubMed1981

Hyperlinear palms: association with ichthyosis and atopic dermatitis.

The skin and palmar markings were examined in 178 patients with atopic dermatitis, 66 (37%) of whom had ichthyosis vulgaris. Increased palmar markings were found in 49 (28%) patients, while a normal pattern of palmar markings was present in 129 (72%) patients. Increased palmar markings were commonly observed in patients with atopic dermatitis and ichthyosis, while normal palms were found in almost all patients with atopic dermatitis alone. It is suggested that the increased palmar markings often seen in patients with atopic dermatitis are actually a manifestation of concomitant ichthyosis vulgaris.

Adolescent↗

PubMed1989

Familial background of respiratory atopy. A factor of type I allergy to house dust mite in patients with atopic dermatitis.

Skin prick and radioallergosorbent tests with the house dust mite were performed in 120 patients with atopic dermatitis. The results showed that about 60% of the patients had type I allergy to the mite. Results of the prick and radioallergosorbent tests did not relate to the severity of skin involvement, nor to the seasonal fluctuation of the disease. Positive skin and radioallergosorbent tests occurred in many patients with atopic dermatitis who had a personal or family history of respiratory atopy. However, both of these tests were negative in the majority of patients with "pure" atopic dermatitis who had neither a personal nor a family history of respiratory atopy. It was suggested that a familial background of respiratory atopy is an important factor for the development of type I allergy to the house dust mite in patients with atopic dermatitis.

Adolescent↗

PubMed1998

Effectiveness of the ascomycin macrolactam SDZ ASM 981 in the topical treatment of atopic dermatitis.

OBJECTIVE: To compare the safety and efficacy of 1% SDZ ASM 981 cream and a matching placebo cream in the treatment of patients with moderate atopic dermatitis. DESIGN: A randomized, double-blind, placebo-controlled, right-and-left comparison study. SETTING: Academic referral center. PATIENTS: Thirty-four adult patients with moderate atopic dermatitis. INTERVENTION: Topical 1% SDZ ASM 981 cream was applied twice daily (n=16) or once daily (n=18) and compared with a corresponding placebo cream base. MAIN OUTCOME MEASURES: Efficacy was measured using a 4-point (0-3) scale for erythema, pruritus, exudation, excoriation, and lichenification (Atopic Dermatitis Severity Index [ADSI]). The ADSI score was defined as the sum of these 5 ratings (range, 0-15) and was determined on the pretreatment day (1 to 14 days before day 0) and on days 0, 2, 4, 7, 9, 11, 14, 16, 18, and 21. The percentage change from baseline (day 0) in the ADSI score was calculated on each of these days. Safety was evaluated by monitoring of adverse events, physical examination, hematologic examination, clinical chemistry studies, urinalysis, and measurement of blood levels of SDZ ASM 981. RESULTS: Of the 38 patients recruited, 34 started and 28 completed treatment according to the protocol. Sixteen patients used the cream twice daily, with significant improvement after 2 days of treatment. Within 3 weeks of topical therapy with 1% SDZ ASM 981 cream twice daily, a mean reduction of 71.9% in the ADSI score was observed at the actively treated test sites compared with a mean reduction of 10.3% at the placebo-treated test sites (P<.001). Efficacy was significantly less in the group treated once daily (n=18), with mean reductions of 37.7% and 6.2%, respectively. The efficacy was especially apparent for pruritus and excoriation. There were no clinically relevant drug-related adverse effects. CONCLUSIONS: Treatment with 1% SDZ ASM 981 cream was well tolerated. Twice-daily application of 1% SDZ ASM 981 cream was significantly more effective than use of the corresponding placebo and more effective than once-daily treatment. The new macrolactam ascomycin derivative SDZ ASM 981 is a promising agent for the treatment of patients with atopic dermatitis. More elaborate phase 2 and 3 trials are under way to fully investigate the potential of this medication.

Administration, Topical↗

PubMed1999

An evidence-based review of the efficacy of antihistamines in relieving pruritus in atopic dermatitis.

OBJECTIVE: To critically review the body of clinical trials that refute or support the efficacy of antihistamines in relieving pruritus in patients with atopic dermatitis. DESIGN: Review of MEDLINE from 1966 through March 1999, the Cochrane Database of Systematic Reviews, and Best Evidence to identify therapeutic trials of antihistamines in patients with atopic dermatitis. MAIN OUTCOME MEASURES: All randomized controlled trials or clinical trials of antihistamines used in the treatment of atopic dermatitis. We found 16 studies throughout the literature. RESULTS: Large, randomized, double-blind, placebo-controlled clinical trials with definitive conclusions (grade A trials) have not been performed. Two grade B trials (small, rigorous, randomized trials with uncertain results due to moderate to high alpha or beta error) refuted the use of antihistamines in relieving pruritus. One grade B trial supported the efficacy of antihistamines in relieving pruritus. All remaining trials (grade C) lacked placebo controls or randomization, or contained fewer than 20 patients in each treatment group. CONCLUSIONS: Although antihistamines are often used in the treatment of atopic dermatitis, little objective evidence exists to demonstrate relief of pruritus. The majority of trials are flawed in terms of the sample size or study design. Based on the literature alone, the efficacy of antihistamines remains to be adequately investigated. Anecdotally, sedating antihistamines have sometimes been useful by virtue of their soporific effect and bedtime use may be warranted. There is no evidence to support the effectiveness of expensive nonsedating agents.

Clinical Trials as Topic↗

PubMed2002

Age-related prevalence and antibiotic resistance of pathogenic staphylococci and streptococci in children with infected atopic dermatitis at a single-specialty center.

BACKGROUND: Skin staphylococci and streptococci are known to exacerbate atopic dermatitis, but the prevalence changes that occur with age are unknown. This study examined the age-related prevalence and antibiotic resistance of these pathogenic bacteria in children with atopic dermatitis and suspected skin infections. OBSERVATIONS: Medical records of 150 children with atopic dermatitis referred to a regional center, who had skin swabs taken for suspected infection, were studied retrospectively. All patients carried Staphylococcus aureus. The prevalence of methicillin sodium-resistant (P =.05) and fusidic acid-resistant (P =.001) S aureus tripled from infancy to school age. Lancefield groups A and G streptococci were the other pathogens found. The prevalence of group A streptococci was highest in children aged 3 to 6 (53%), compared with 11% of infants and 21% of patients aged 9 to 16 (P =.002). CONCLUSIONS: Significant differences in the age-related prevalence of group A streptococci skin carriage and antibiotic resistance of S aureus isolates occurred in this group of children with atopic dermatitis and suspected skin infections. Skin swabs to determine bacterial type and antibiotic sensitivities provide an important guide to antibiotic prescribing in these children.

Adolescent↗

PubMed2003

The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap).

OBJECTIVE: To determine the prevalence and severity of seborrheic dermatitis and pityriasis capitis in Australian preschool-aged children. DESIGN: A stratified cross-sectional skin survey using cluster sampling of centers throughout Victoria, Australia. SETTING: The study population included children attending child care centers, preschools, and Maternal and Child Health Centers, with the reference population being Australian children 5 years and younger. PARTICIPANTS: Of the 1,634 children in the original sample, 1.116 children aged 11 days to 5 years 11 months were included in the study. INTERVENTION: Parents completed a questionnaire recording demographic information and personal and family history of skin problems and related diseases. A dermatologist performed a total skin examination, including the diaper area for children younger than 12 months. MAIN OUTCOME MEASURE: The age- and sex-specific prevalence rates and site and severity of seborrheic dermatitis and pityriasis capitis were measured. RESULTS: The overall age- and sex-adjusted prevalence of seborrheic dermatitis was 10.0% (95% confidence interval [CI], 8.2%-11.7%): 10.4% (95% CI, 7.8%-12.9%) in boys and 9.5% (95% CI, 7.0%-12.0%) in girls. This was highest in the first 3 months of life, decreasing rapidly by the age of 1 year, after which it slowly decreased over the next 4 years. Most (71.9%) had disease classified as minimal to mild. Pityriasis capitis occurred in 41.7% (95% CI, 38.8%-44.6%) of the 1,116 children examined, with 85.8% categorized as minimal to mild only. CONCLUSIONS: Seborrheic dermatitis and pityriasis capitis are common in early childhood. Most children have minimal to mild disease that would require little if any treatment. Education programs directed at those caring for preschool-aged children are needed to provide information on simple preventative measures and treatment, if necessary, that could easily reduce the morbidity associated with these very common conditions.

Age Distribution↗

PubMed2006

Development of atopic dermatitis during the first 3 years of life: the Copenhagen prospective study on asthma in childhood cohort study in high-risk children.

OBJECTIVES: To describe the development of atopic dermatitis (AD) during the first 3 years of life and identify the localization of the early skin lesions that predicts the development of AD. DESIGN: Prospective, longitudinal, birth cohort study of children born to mothers with a history of asthma, followed up for 3 years with scheduled visits every 6 months as well as visits for onset or acute exacerbations of skin symptoms. SETTING: The cohort was recruited from greater Copenhagen, Denmark, and followed up at a clinical research unit, which controlled all diagnoses and treatment of skin diseases. PARTICIPANTS: A total of 411 infants were enrolled in the cohort; 55 had incomplete follow-up and were excluded from certain analyses. MAIN OUTCOME MEASURES: Atopic dermatitis was defined based on the criteria of Hanifin and Rajka, and severity was assessed by the SCORAD (Scoring Atopic Dermatitis) index. Predictive odds ratios of early skin lesions for those who developed AD vs those who did not were calculated. RESULTS: The cumulative incidence of AD by age 3 years was 44% (155/356). The prevalence rate peaked at age 2 years for boys and at age 2.5 years for girls, but there were no other sex differences in the proportion of children developing AD. Skin involvement in infants with AD was found to begin at the scalp, forehead, ear, and neck in a balaclava-like pattern and continue to the extensor sides and trunk, finally affecting the flexor sides of the extremities. Early skin lesions of arms and joints best predicted AD at age 3 years. CONCLUSIONS: Atopic dermatitis begins at the scalp, forehead, ear, and neck in a balaclava-like pattern. Eczema at the arms and joints provides the highest predictive value for the development of AD at age 3 years. This may be used for early prediction and intervention of AD.

Age Factors↗

PubMed1999

Sleep fragmentation in children with atopic dermatitis.

OBJECTIVE: To characterize the sleep pattern of children with atopic dermatitis in clinical remission. METHODS: Fourteen children with atopic dermatitis, with a mean+/-SD age of 6+/-2 years, were recruited consecutively from a pediatric dermatology clinic. No participant had any other medical or psychiatric illness. The control group (n = 9, mean age 7+/-1.8 years) was composed of children with mild "benign" snoring and no evidence of respiratory disturbance during sleep. All participating children were evaluated by formal all-night polysomnography, scratch electrodes, and self-reported questionnaires filled in by their parents. RESULTS: The patients were studied when their skin condition was in remission. Sleep latency, total sleep time, and sleep efficiency were similar to the control group. The atopic dermatitis group had an average of 24.1+/-8.1 events per hour of arousals and awakenings, compared with 15.4+/-6.2 events per hour in the control group (P<.001). Direct observation, video monitoring, and scratch electrodes provided evidence of between 1 to 19 bouts of scratching per night, accounting for only 15% of the arousals and awakenings. The rest of the arousals and awakenings were not associated with any specific, identifiable polysomnographic event, such as apnea or jerks. CONCLUSION: Children with atopic dermatitis in clinical remission have sleep disturbances that are not related to scratching per se.

Case-Control Studies↗

PubMed2002

Berloque dermatitis mimicking child abuse.

Berloque dermatitis is a type of photocontact dermatitis. It occurs after perfumed products containing bergamot (or a psoralen) are applied to the skin followed by exposure to sunlight. Striking linear patterns of hyperpigmentation are characteristic, corresponding to local application of the scented product. In the acute phase, erythema and even blistering can be seen. We report a case of berloque dermatitis in a 9-year-old girl that was initially reported as child abuse. To our knowledge, this is the first report of berloque dermatitis mimicking child abuse. Questioning to elicit a history of perfume application coupled with sunlight exposure should help to prevent this misdiagnosis in children.

Child↗

PubMed1984

Allergic contact dermatitis in children.

Allergic contact dermatitis accounts for up to 20% of all dermatitis in childhood. The major sources of contact allergy in childhood are metals, shoes, preservatives, and plants. There is considerable variability from region to region and country to country in the prevalence and causes of contact dermatitis in childhood. We suggest that patch testing be done more frequently in evaluating dermatitis in children. Topical or systemic glucocorticosteroids and allergen avoidance are the mainstays of therapy in childhood.

Allergens↗

PubMed1998

Occupational dermatitis causing days away from work in U.S. private industry, 1993.

BACKGROUND: Occupational skin disease is an important cause of disability in the workplace. The aim of this report is to estimate the incidence of occupational dermatitis cases that causes days away from work and to characterize the cases. METHODS: The Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics collects employer reports on work-related dermatitis. Descriptive data are collected on a sample of the cases that result in days away from work. Estimates of the number of cases and days away from work were calculated by industry, occupation, and exposure source. RESULTS: In 1993, there were an estimated 8,835 cases of occupational dermatitis, a rate of 1.12/10,000 workers. The largest number of cases was in health services, while the highest rate was in agricultural crops. The occupation with the largest number of cases was non-construction laborers. Cleaning/polishing agents caused the largest number of cases. Calcium hydroxide and oxides caused a median of nine days away from work. DISCUSSION/CONCLUSIONS: The survey data show that the effect of occupational dermatitis is substantial in the lives of workers. These descriptive data should be used to target interventions.

Absenteeism↗

PubMed1985

Effects of pressure on contact dermatitis.

In human volunteers, firm pressure was applied to deformable plastic chambers containing chemical irritants, glass fibers, and selected allergens to which the subjects were sensitive. Pressure variably intensified irritant dermatitis and strikingly enhanced fiberglass dermatitis. Pressure did not influence allergic contact dermatitis. Pressure is one of several mechanical factors that can aggravate nonallergic contact dermatitis.

Allergens↗