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PubMed1995

Irritant dermatitis among workers cleaning up a pesticide spill: California 1991.

An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacramento River in California after a spill of metam sodium. The spilled chemical decomposes to methylisothiocyanate (MITC), a known skin irritant. A retrospective cohort study was conducted among the inmates and their crew leaders. Among 42 jail group members, 27 had dermatitis involving the feet and ankles; dermatitis was associated with lower extremity water contact (RR = 3.4, 95% CI 1.0-11.8); the attack rate increased with length of time spent in the water. For comparison, other state and federal employees who worked in the river at the same time were also interviewed. None reported dermatitis. Over three-quarters (24/31) of these other clean-up workers whose feet became wet changed to dry clothing immediately; none of the jail group changed immediately. The river concentration of MITC measured 20-40 ppb at the time of exposure. We speculate that prolonged wetness, occlusive boots, friction, and heat contributed to chemical irritation at this low concentration; the experience of the other clean-up workers suggests that this outbreak could have been prevented.

California↗

PubMed1999

Flow cytometric detection of type 1 (IL-2, IFN-gamma) and type 2 (IL-4, IL-5) cytokines in T-helper and T-suppressor/cytotoxic cells in rheumatoid arthritis, allergic asthma and atopic dermatitis.

Type 1 cytokines (a.o. IL-2 and IFN-gamma) play an important role in the pathogenesis of rheumatoid arthritis. On the other hand, IgE-mediated diseases such as allergic asthma and atopic dermatitis show a type 2 cytokine (amongst others IL-4 and IL-5) profile. This study examined simultaneously the intracellular production of IL-2, IFN-gamma, IL-4 and IL-5 in T-lymphocytes of patients with rheumatoid arthritis during treatment with methotrexate or salazopyrin, patients with allergic asthma or atopic dermatitis under stable treatment, compared to healthy controls.A three-colour flow cytometric analysis was used for cytokine detection in T-helper cells and T-suppressor/cytotoxic cells. Compared to controls, patients with symptomatic atopic dermatitis showed an increased number of IL-4-producing T-helper lymphocytes in basal circumstances (P=0.001), in contrast to asymptomatic allergic asthma patients. Compared to controls, rheumatoid arthritis patients, treated with salazopyrin, showed an increased number of IL-2-producing T-helper and T-suppressor/cytotoxic lymphocytes after in vitro stimulation with PMA and ionomycin (P=0.01). In contrast, rheumatoid arthritis patients, treated with methotrexate, a more potent disease modifying drug, did not show this type 1 cytokine profile. A positive correlation was found between the number of IFN-gamma producing T-helper cells and disease activity (Ritchie Index and number of swollen joints) in both rheumatoid arthritis patient groups. Active atopic dermatitis patients showed a type 2 cytokine profile, whereas stable asthma patients with lower disease activity did not show a predominance of type 2 cytokines. Rheumatoid arthritis patients under treatment with salazopyrin had a type 1 cytokine profile, which could not be demonstrated in patients treated with methotrexate. This imbalance between type 1 and type 2 cytokines in different immune mediated disorders can be related with treatment and the grade of disease activity. These results stress the need for further investigation of the influence of therapy on cytokine profiles.

Adolescent↗

PubMed2002

Local but not systemic administration of IFN-gamma during the sensitization phase of protein antigen immunization suppress Th2 development in a murine model of atopic dermatitis.

Biphasic Th1/Th2 development plays a central role in the pathogenesis of atopic dermatitis. In the sensitization phase after protein antigen exposure, an immune response polarized toward Th2 differentiation, which is due to the hosts' genetic proneness to the disease, initiates the skin lesions. Th1/Th2 antagonism is a potential mechanism that could be manipulated to suppress the initial Th2 deviation. IL-12 is the key cytokine for Th1 differentiation. Interferon gamma (IFN-gamma) can assist Th1 development through several mechanisms and suppress Th2 differentiation. We took advantage of a recently developed murine model of atopic dermatitis elicited by epicutaneous sensitization with protein antigen through patch application to examine the effects of different routes of IFN-gamma administration on Th1/Th2 differentiation during the sensitization phase of antigen exposure. Our data showed that systemic administration of IFN-gamma during the sensitization phase could not promote serum levels of specific IgG(2a). However, local administration (intradermal injection or patch application) of IFN-gamma during the sensitization phase could promote serum levels of specific IgG(2a) and suppress serum levels of specific IgE. Moreover, pretreatment of local IFN-gamma with protein antigen has a long-term modulatory effect on serum levels of specific IgG(2a) and IgE after repeated antigen immunization. Our results demonstrate that local but not systemic administration of IFN-gamma during the sensitization phase of protein antigen immunization could suppress the Th2 deviation in this murine model of atopic dermatitis. Thus, this may represent a novel strategy for the treatment and prevention of atopic dermatitis.

Allergens↗

PubMed1994

In vitro genetically aberrant T-cell clones with continuous growth are associated with atopic dermatitis.

Atopic dermatitis is a disease with a genetic predisposition affecting the immune system, with T lymphocytes participating in the immune dysregulation. Most in vitro T lymphocyte studies of atopic dermatitis have focused on antigen-specific T-cell clones. However, antigen-non-specific regulatory T lymphocytes may also take part in the pathway leading to antigen-specific clonal T-lymphocyte proliferation. T lymphocytes from skin biopsy specimens from three patients with severe atopic dermatitis were cultured in the presence of IL-2 and IL-4, but without antigen added. Initially, proliferation was oligo- or polyclonal, but in all cases overgrowth by T cells with clonal chromosomal aberrations was subsequently observed. These abnormal T-cell clones demonstrated continuous growth and complete or partial phenotypic loss of the T-cell antigen receptor complex. In summary, these findings suggest that a subset of aberrant skin-homing T lymphocytes is associated with atopic dermatitis.

Adult↗

PubMed1995

Itch and inflammation induced by intradermally injected interleukin-2 in atopic dermatitis patients and healthy subjects.

To explore the pruritogenic and inflammatory effects of cytokines, a single dose of 20 micrograms recombinant human interleukin-2 was injected intradermally into eight patients with atopic dermatitis and eight healthy controls. The study was double-blind and randomized with glucose as a negative control. The effects were evaluated by recording local itch and erythema over 72 h and by examining skin biopsies taken at 24 h and 72 h. In patients and controls, interleukin-2 provoked a low-intensity local itch with maximal intensity between 6 h and 48 h and erythema with maximal extension between 12 h and 72 h. In the atopic dermatitis patients, these reactions tended to appear earlier and were less pronounced than in the healthy controls. Interleukin-2 induced dermal mononuclear cell infiltrates consisting mainly of CD3+ cells. A majority of the T cells were CD4+. The number of dermal CD25+, HLA-DR+ and ICAM-1+ cells was also increased at the interleukin-2 induced spongiosis and exocytosis as well as HLA-DR+ and ICAM-1+ keratinocytes. The microscopic findings tended to be more prominent at 72 h than at 24 h in both groups, but with a somewhat slower onset in the atopic dermatitis patients. In conclusion, a single intradermal injection of interleukin-2 induced local itch, erythema, dermal T-cell infiltrates, spongiosis, exocytosis and activation of keratinocytes both in atopic dermatitis patients and in healthy controls.

Adult↗

PubMed1993

A retrospective cohort study on the incidence of hand dermatitis in nurses.

Data on the incidence and induction time of hand dermatitis are not available from the literature. To assist the planning of a prospective study on risk factors for hand dermatitis, a retrospective cohort study was performed in nurses and office employees to obtain a rough estimate of the incidence and induction time of hand dermatitis in these occupational groups. Data were collected by means of a self-administered questionnaire with validated questions on symptoms of hand dermatitis. The cohort consisted of 371 nurses and 111 office employees who were newly employed by a University Hospital between 1 January 1987 and 31 December 1988. Follow-up ended on 30 September 1989. Subjects who reported that symptoms had already occurred before entering the study were excluded for analysis on the incidence, leaving 298 nurses and 101 office employees for further analysis. Due to limitations of the retrospective study design, only half of the cases were able to report the exact month of occurrence of symptoms. Therefore only a rough estimate could be made of the incidence and induction period, assuming that the distribution of person-months of observation in cases with a known incidence date was equal to that of cases with unknown incidence dates. Thus, it was estimated that the overall incidence was 6.5 cases/1000 person-months in nurses and 1 case/1000 person-months in office employees. In nurses, 72% of the cases occurred within 3 months of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort Studies↗

PubMed1975

[Eosinophilic leucocytes in the skin lesions of psoriasis and atopic dermatitis (author's transl)].

Using specific techniques (Leder; and Schaefer u. Fischer) we examined the presence of eosinophilic leucocytes (EGr) in sections of various forms of psoriasis, some under treatment with methotrexate. We compared the results with findings in atopic dermatitis. The number of EGr was calculated in proportion to the remaining cells in the relevant section of the horny layer and of the dermis (papillary body, subpapillary dermis). The proportion of eosinophilic leucocytes was found to be considerably smaller than the supposed number seen in H.-E. sections. Also, in psoriasis pustulosa the proportion was relatively small, whereas in the dermis of atopic dermatitis it was 2 times higher. In atopic dermatitis of patients, who acquired the dermatitis as adults, the proportion was lower, although it was possible to examine the tissues of only three such patients. Treatment with methotrexate had no significant influence on the percentage of EGr in the psoriatic infiltrates.

Age Factors↗

PubMed1991

Skin levels of vasoactive intestinal polypeptide in atopic dermatitis.

Atopic dermatitis (AD) can be exacerbated by various factors, including emotional stress, scratching and sweating. The aim of the present study was to evaluate the hypothesis that the inflammatory reaction in AD is also neurogenic. For this purpose, the levels of vasoactive intestinal polypeptide were measured radioimmunologically in whole-tissue homogenates of lesional skin of 13 patients with atopic dermatitis. Radioimmunoassay was performed using an antiserum, AH78, recognizing the carboxy-terminal fragment vasoactive intestinal polypeptide (22-28). Vasoactive intestinal polypeptide immunoreactivity was detected in relatively low amounts in control skin (0.428 +/- 0.08 pmol/g tissue), whereas a marked increase in the peptide was observed in lesional skin of patients with atopic dermatitis (5.62 +/- 1.25 pmol/g tissue). These results seem to suggest that vasoactive intestinal polypeptide could have a pathogenetic relevance in skin lesions of atopic dermatitis.

Adolescent↗

PubMed1993

Paederus dermatitis: an easy diagnosable but misdiagnosed eruption.

Paederus dermatitis is a peculiar irritant contact dermatitis characterised by erythemato-bullous lesions of sudden onset on exposed areas of the body. The disease is provoked by an insect belonging to genus Paederus. This beetle does not bite or sting, but accidental brushing against or crushing the beetle over the skin provokes the release of its coelomic fluid which contains paederin, a potent vesicant agent. Due to the pathogenic mechanism, the morphology and location of the dermatitis change from case to case. The lesion usually resembles the accidental dropping of a caustic or hot liquid. The uncommon association of acute dermatitis with minimal or no complaints, which would be noteworthy in the case of chemical or thermal burns, facilitates diagnosis which is corroborated by the season and by the case history.

Acute Disease↗

PubMed1996

Differential expression of tenascin in the skin during hapten-induced dermatitis.

Tenascin is a large extracellular matrix glycoprotein which is found in limited regions of normal adult tissues including the skin. We investigated the induction of tenascin expression in mouse skin during hapten-induced dermatitis. In the dorsal skin, hapten application first induced a transient expression of tenascin in deeper regions of the skin. Its distribution then spread over the whole dermis corresponding to the infiltration of Mac-2-positive macrophages. In the ear, tenascin was consistently found in the subcutaneous tissue on the inner side, but very little was seen on the outer side. Tenascin did appear transiently, however, on both sides under hapten treatment. In the early phase of allergic contact dermatitis, no apparent induction of tenascin expression was observed in the swollen ear. However, there was an abundant tenascin expression on both sides during healing. Tenascin expressed under normal conditions was mostly the 180-kDa isoform, while the 230-kDa isoform was markedly induced during healing of the dermatitis. These results suggest that tenascin, particularly the larger 230-kDa isoform, may play important roles in the pathogenesis and healing of hapten-induced dermatitis.

Animals↗

PubMed1996

Langerhans cell hyperplasia and IgE expression in canine atopic dermatitis.

Langerhans cells appear to be critical for IgE-mediated allergen capture and presentation in human atopic dermatitis. The present study sought to determine whether epidermal (i.e Langerhans cells) and dermal dendritic cells in the skin of dogs with atopic dermatitis are hyperplastic and expressed surface IgE. Frozen sections of lesional or non-lesional atopic and normal control canine skin were immunostained with CD1a-, CD1c-, and IgE-specific monoclonal antibodies. The enumeration of cells was performed by morphometry in both the epidermis and the dermis. Cell counts were compared with each individual's total serum IgE levels. Higher numbers of epidermal and dermal dendritic cells were present in atopic dogs than in normal control animals. Epidermal Langerhans cell counts were significantly higher in lesional than in non-lesional atopic specimens. IgE+ dendritic cells were observed in lesional atopic epidermis and dermis, and non-lesional atopic dermis, but not in normal control skin specimens. The percentages of IgE+ dendritic cells were correlated with each patient's total serum IgE levels. These results demonstrate dendritic cell hyperplasia and IgE expression in canine atopic dermatitis. Increased epidermal Langerhans cell counts in lesional specimens suggest an epidermal allergen contact in canine atopic dermatitis.

Animals↗

PubMed2001

Acute myocarditis with transient eosinophilia and serum hyper-IgE-emia in a patient with atopic dermatitis.

A 14-year-old girl with acute myocarditis, transient eosinophilia, and hyper-IgE-emia associated with atopic dermatitis is described. The patient was admitted because of severe heart failure and shock, and severe atopic dermatitis was seen. Blood examinations showed moderate eosinophilia (1917/mm3) and hyper-IgE-emia (830IU/ml). The response to treatment with dopamine was excellent, and the congestive heart failure was gradually ameliorated, followed by improvement in her atopic dermatitis. In addition, rapid improvement in eosinophilia and hyper-IgE-emia was observed. Histopathological examination of the right ventricular myocardium obtained by endomyocardial biopsy showed mild interstitial fibrosis and mild infiltrations of inflammatory cells, indicating myocarditis. We speculated that the transient eosinophilia and hyper-IgE-emia in the present case indicated that an allergen induced strong allergic reactions, including type 1 allergy, and caused both acute myocarditis and deterioration of the atopic dermatitis; specifically noteworthy is that the patient's disease rapidly improved without corticosteroid treatment.

Adolescent↗

PubMed2003

[Long term management of childhood atopic dermatitis with calcineurin inhibitors].

The calcineurin inhibitors pimecrolimus and tacrolimus are important tools for long-term management of atopic dermatitis in childhood. These drugs are approved in Germany for the intermittent long-term treatment of moderate to severe (tacrolimus ointment) or mild to moderate (pimecrolimus cream) atopic dermatitis in children older than 2 years. Recent study results show that these agents are also effective in infants (aged 3-23 months) with atopic dermatitis. During the long-term treatment of children and infants with calcineurin inhibitors, the therapeutic success can be maintained and there is a continuous increase in the response rate. Long-term use of calcineurin inhibitors in atopic dermatitis is well tolerated locally and systemically, leads to reduction of disease flares and has a corticosteroid sparing effect.

Administration, Topical↗

PubMed2003

[Stigmatization and quality of life of patients with psoriasis and atopic dermatitis].

BACKGROUND AND OBJECTIVE: Psoriasis and atopic dermatitis patients are often influenced by the psychosocial consequences of their skin diseases. In order to assess these experiences reliably, the stigmatization feeling and the quality of life of these patient groups were studied. PATIENTS/METHODS: The short form of the "Questionnaire on Experience with Skin Complaints" (QES) was validated in a sample of 463 in-patients with psoriasis and atopic dermatitis. In addition, the Dermatology Life Quality Index (DLQI) was ascertained. RESULTS: The dimensions "impairment of self-esteem and withdrawal", "rejection experienced", "concealment", and "composure" of the QES could be confirmed by factor analysis. As expected, middle high correlations between the QES and the DLQI were found in both patient groups. However, the stigmatization experience and the quality of life were not significantly different in a subgroup of psoriasis and atopic dermatitis patients with comparable sociodemographic characteristics. CONCLUSIONS: The short form of the QES with 23 items is a valid instrument for the examination of social and psychic burdens of psoriasis and atopic dermatitis patients. The recording of the stigmatization feeling and of the quality of life determines different, supplementary aspects of the illness-related stress of patients with chronic skin diseases.

Adolescent↗

PubMed2005

[Hypereosinophilic dermatitis. An overlooked diagnosis?].

BACKGROUND: The idiopathic hypereosinophilic syndrome is a rare systemic disease characterized by blood and tissue eosinophilia of unknown etiology, in which multiple organs may be affected. In hypereosinophilic dermatitis the only affected organ besides the blood is the skin. PATIENTS: We present a series of seven patients with hypereosinophilic dermatitis who were treated in our hospital between 2002 and 2003. RESULTS: All patients initially showed characteristic, therapy-resistant, polymorphic skin lesions, presenting with a combination of erythematous, pruritic and urticarial papules and plaques. All had blood eosinophilia without evidence of allergic, parasitic or other causes. The histology showed tissue eosinophilia only in half of the cases; the other histological findings were non-specific. We observed a good response to therapy with systemic corticosteroids, dapsone and light therapy, applied as UVA-1 irradiation or as shower photochemotherapy. CONCLUSIONS: The diagnosis "hypereosinophilic dermatitis" should be based primarily on the characteristic clinical picture together with "idiopathic" peripheral eosinophilia, whereas the histological findings are not always indicative. Because of the multiplicity of possible differential diagnoses and the often non-revealing histology, we assume that the diagnosis "hypereosinophilic dermatitis" is often overlooked.

Adult↗

PubMed2007

[Hematogenous contact dermatitis after intravesicular instillation of mitomycin C].

Mitomycin C is an alkylating chemotherapeutic agent which is instilled intravesically to prevent recurrence of superficial bladder carcinomas. After several cycles of mitomycin C, our patient developed a pruritic genital dermatitis and palmar desquamation. Following exclusion of a fungal infection, we performed patch tests using the standard series, the major basic ointment ingredients, disinfectants, and mitomycin C in concentrations of 0.001 to 0.1%; the resulting diagnosis was allergic contact dermatitis due to delayed-type hypersensitivity to mitomycin C. The skin rash rapidly resolved with application of topical steroids, and the intravesical chemotherapy was changed to doxorubicin. Eczematous skin reactions are quite common side effects after intravesical instillation of mitomycin C. In the majority of cases, they are caused by delayed-type hypersensitivity reactions, presumably elicited by hematogenous spread of the allergen, and not by irritation. The sensitization most likely occurs via the bladder mucosa. In order to differentiate between allergic and toxic contact dermatitis, patch tests with the above-mentioned mitomycin C concentrations are useful. In cases of mild allergic contact dermatitis the intravesical chemotherapy might be continued with concomitant topical steroids.

Administration, Intravesical↗

PubMed1998

[Pustular dermatitis after administration of a too highly concentrated dithranol ointment in seborrhea].

Seborrhoic dermatitis is an erythematosquamous condition of unknown etiology with a prevalence of approximately 2.5%. Frequently difficult to treat, it may respond to the application of low doses of dithranol, a substance which can induce a pustular dermatitis as an adverse side effect depending on the applied concentration and individual susceptibility. We describe a pustular dermatitis after the application of a preparation containing dithranol at an erroneously high concentration in a 30-year-old patient with seborrhoic dermatitis.

Administration, Topical↗

PubMed1998

Nickel and gold in skin lesions of pierced earlobes with contact dermatitis. A study using scanning electron microscopy and x-ray microanalysis.

Cases of contact dermatitis due to nickel and gold especially in pierced earlobes, are increasing in number the world over. However, the presence of these metal fragments has not been demonstrated in the skin lesions. The aim of this study was to demonstrate nickel and gold in contact dermatitis lesions in pierced earlobes. Skin specimens taken from such earlobe lesions were examined using scanning electron microscopy and x-ray microanalysis. The pierced earrings worn when the lesions appeared were examined by the same techniques, and their analysis confirmed. In nickel dermatitis, small, electron-dense fragments were seen in the specimens examined by scanning electron microscopy, and nickel was detected in locations corresponding to these fragments by x-ray microanalysis. In contact dermatitis due to gold, small dense fragments containing gold were observed. It is suggested that small fragments of nickel and gold remain in the skin lesions of pierced earlobes for a long time, even after the studs have been removed, and cause prolonged irritation and various cutaneous reactions.

Adult↗