Eczemaletters

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Smokers report more psoriasis, but not atopic dermatitis or hand eczema: results from a Norwegian population survey among adults.

Dermatology. 2008;216(1):40-5

Authors: Bø K, Thoresen M, Dalgard F

BACKGROUND: Many reports indicate that skin diseases are affected by lifestyle factors. OBJECTIVE: To examine the relationship between reported skin diagnoses, smoking and alcohol consumption in an urban population. METHODS: Cross-sectional questionnaire-based health study among 18,747 adults in Oslo. RESULTS: For current smokers, odds ratio for reporting psoriasis was 1.49 (95% CI 1.11-2.00) for males, and 1.48 (95% CI 1.15-1.91) for females, as compared to never smokers. There was no association between reported atopic dermatitis or hand eczema and smoking. High consumption of cigarettes was associated with an increased reporting of psoriasis in men, but not women. Reporting drinking alcohol 4-7 times per week was crudely associated with reporting psoriasis in men, but not in the adjusted model. CONCLUSION: Cigarette smoking was associated with reported psoriasis, but not with atopic dermatitis or hand eczema.

PMID: 18032898 [PubMed - indexed for MEDLINE]

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Pimecrolimus cream (1%) efficacy in perioral dermatitis - results of a randomized, double-blind, vehicle-controlled study in 40 patients.

J Eur Acad Dermatol Venereol. 2007 Oct;21(9):1175-80

Authors: Oppel T, Pavicic T, Kamann S, Bräutigam M, Wollenberg A

BACKGROUND: Perioral dermatitis (POD) is a common skin disease and difficult to treat. Pimecrolimus cream (1%) successfully controls atopic eczema. OBJECTIVE: Our aim was to investigate its efficacy in POD. STUDY DESIGN: Single-centre, randomized, double-blind, vehicle-controlled study including 40 POD patients with a 4-week treatment and a 4-week follow-up. Efficacy was assessed by a novel Perioral Dermatitis Severity Index (PODSI) and Finlay’s Dermatology Life Quality Index (DLQI). SETTING: Outpatient clinics of a large dermatological hospital in Munich, Germany. RESULTS: During treatment, the PODSI was significantly lower in the pimecrolimus group compared with vehicle (P = 0.005-0.02) whereas at follow-up, no significant differences were observed. At week 2, the responder rates (> or = 50% PODSI improvement) were 50% with pimecrolimus cream (1%) and 25% with vehicle (P = 0.095). DLQI was improved in pimecrolimus group compared with vehicle. CONCLUSION: Results suggest that pimecrolimus cream (1%) effectively treats acute-stage POD.

PMID: 17894701 [PubMed - indexed for MEDLINE]

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A pilot study showing pulsed-dye laser treatment improves localized areas of chronic atopic dermatitis.

Clin Exp Dermatol. 2008 Jan 11;

Authors: Syed S, Weibel L, Kennedy H, Harper JI

Background. Eczematous skin changes overlying port-wine stains have been reported to improve with pulsed-dye laser (PDL) treatment. However, PDL has not as yet been evaluated for the treatment of atopic dermatitis (AD; eczema). Aim. To evaluate in a controlled trial the effects and safety of PDL treatment in children with AD who had chronic localized lesions. Methods. Twelve children with localized, chronic eczema were treated with PDL (595 nm), with untreated areas used as an intrapatient control. Treatment was given at baseline and patients were followed up at 2 and 6 weeks. Clinical outcome measures were localized Eczema Severity Score (ESS), a visual analogue scale (VAS) indicating eczema severity assessed by photographs, and adverse events. Results. After 2 and 6 weeks, a significant decrease in ESS was seen for the PDL-treated areas compared with the control areas (mean +/- SEM reduction in ESS 7.0 +/- 1.0 vs. 3.3 +/- 0.8 at 2 weeks, P = 0.003, and 7.8 +/- 1.4 vs. 4.9 +/- 1.3 at 6 weeks, P = 0.002). A significant difference in eczema severity assessed by VAS at 6 weeks was seen in favour of PDL (mean +/- SEM improvement 78% +/- 20% vs. 52% +/- 10%, P = 0.003). Treatment was well-tolerated. Conclusions. In this pilot study, PDL treatment was effective in treating small areas of chronic localized eczema. This may suggest that in AD dermal vasculature plays an important role or that PDL may have an effect on cutaneous immunological activation.

PMID: 18201257 [PubMed - as supplied by publisher]

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ADAM10-Mediated E-Cadherin Release Is Regulated by Proinflammatory Cytokines and Modulates Keratinocyte Cohesion in Eczematous Dermatitis.

J Invest Dermatol. 2008 Jan 17;

Authors: Maretzky T, Scholz F, Köten B, Proksch E, Saftig P, Reiss K

Acute eczema is an inflammatory skin disease characterized by the formation of small intraepidermal blisters, reduction of the adhesion molecule E-cadherin from the keratinocyte surface, and impaired keratinocyte cohesion. Here, we reveal that the disintegrin and metalloprotease ADAM10 is critically involved in regulating E-cadherin cell-surface expression in cultured primary human keratinocytes and in diseased human skin. Proinflammatory cytokines, transforming growth factor-beta, and lipopolysaccharide led to increased release of soluble E-cadherin by activating mitogen-activated protein kinase signaling in cultured keratinocytes. Moreover, these stimuli decreased the amount of pro-ADAM10 and increased the level of the active protease, leading to loss of E-cadherin from the cell surface and decreased keratinocyte cohesion. In situ examination and immunoblot analyses of E-cadherin and ADAM10 expression in lesional skin of eczema revealed that the reduction of E-cadherin expression in areas of blister formation closely correlated with increased level of ADAM10 expression and elevated E-cadherin shedding. Our data suggest that ADAM10-mediated E-cadherin proteolysis leads to the impaired cohesion of keratinocytes observed in eczematous dermatitis and provide previously unreported insights into the understanding of the molecular mechanisms involved in inflammatory diseases with loss in epithelial integrity.Journal of Investigative Dermatology advance online publication, 17 January 2008; doi:10.1038/sj.jid.5701242.

PMID: 18200054 [PubMed - as supplied by publisher]

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Specific Filaggrin Mutations Cause Ichthyosis Vulgaris and Are Significantly Associated with Atopic Dermatitis in Japan.

J Invest Dermatol. 2008 Jan 17;

Authors: Nomura T, Akiyama M, Sandilands A, Nemoto-Hasebe I, Sakai K, Nagasaki A, Ota M, Hata H, Evans AT, Palmer CN, Shimizu H, McLean WH

Mutations in the gene encoding filaggrin (FLG) have been identified as the cause of ichthyosis vulgaris (IV) and shown to be major predisposing factors for atopic dermatitis (AD). However, these studies have been mainly carried out in European populations. In early 2007, we identified two Oriental-specific FLG mutations in four Japanese families with IV and reported that filaggrin mutations were also significant predisposing factors for AD in Japan. However, the frequency of FLG mutations observed in our Japanese AD cohort (5.6%), was much lower than that seen in Europeans (up to 48%). Here, we studied a further seven Japanese families with IV and identified two additional nonsense mutations in FLG, S2889X, and S3296X. We found that more than 20% of patients in our Japanese AD case series carry FLG mutations, and there is significant statistical association between the four mutations and AD (chi(2) P=8.4 x 10(-6); heterozygote odds ratio 7.57, 95% CI 2.84-23.03). These data emphasize that skin-barrier impairment due to reduced filaggrin expression plays an important role in the pathogenesis of AD and sheds further light on the genetic architecture of atopy in Japan.Journal of Investigative Dermatology advance online publication, 17 January 2008; doi:10.1038/sj.jid.5701205.

PMID: 18200065 [PubMed - as supplied by publisher]

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Oral cyclosporin plus topical corticosteroid therapy diminishes bone mass in children with eczema.

Pediatr Dermatol. 2007 Nov-Dec;24(6):613-20

Authors: Pedreira CC, King E, Jones G, Moore E, Zacharin M, Varigos G, Cameron FJ

Topical corticosteroids remain the most common treatment for eczema; however, it is uncertain whether long-term use of these agents has any adverse effect on bone mass. Cyclosporin is very useful in patients with severe atopic dermatitis who have failed conventional therapy. It has been shown to induce bone loss. We compared 43 children with severe eczema who were using topical corticosteroids with 73 healthy children. Of the 43 patients, six were also taking cyclosporin. Bone mineral density was measured in the lumbar spine and in the femoral neck using dual-energy X-ray absorptiometry. In multivariate analysis, subjects with eczema had lower lumbar spine bone mineral density (-0.03 g/cm(2); p = 0.015) and bone mineral apparent density (-0.01 g/cm(3); p = 0.008) but higher FN BMAD (+0.02 g/cm(3); p = 0.029) compared with controls. Patients with eczema on topical corticosteroids who had used cyclosporin had lower lumbar spine bone mineral apparent density (-0.01; p = 0.006) compared with those only on topical corticosteroids in both adjusted and unadjusted analysis. In conclusion, children with severe eczema have decreased lumbar spine bone mass, which is primarily mediated by cyclosporin use rather than by topical corticosteroid use. This effect is likely to lead to a modest increase in the risk of wrist and forearm fractures in children using this agent.

PMID: 18035982 [PubMed - indexed for MEDLINE]

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Allergic contact dermatitis to topical antibiotics: Epidemiology, responsible allergens, and management.

J Am Acad Dermatol. 2008 Jan;58(1):1-21

Authors: Gehrig KA, Warshaw EM

Topical antibiotics are widely used to treat cutaneous, ocular, and otic infections. Allergic contact dermatitis to topical antibiotics is a rare but well-documented side effect, especially in at-risk populations. The purpose of this article is to review the epidemiology, responsible allergens, and management of allergic contact dermatitis to topical antibiotics. LEARNING OBJECTIVE: After completing this learning activity, participants should be able to describe the epidemiology of allergic contact dermatitis related to topical antibiotics; show knowledge of the most common allergenic topical antibiotics; and understand the allergenic cross-reactivity pattern amongst topical antibiotics.

PMID: 18158924 [PubMed - indexed for MEDLINE]

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The prevalence of atopic triad in children with physician-confirmed atopic dermatitis.

J Am Acad Dermatol. 2008 Jan;58(1):68-73

Authors: Kapoor R, Menon C, Hoffstad O, Bilker W, Leclerc P, Margolis DJ

BACKGROUND: Atopic dermatitis (AD) is often associated with comorbidities such as allergic rhinitis and asthma. OBJECTIVE: We sought to describe the frequency of these comorbidities in children with AD. METHODS: We conducted a cross-sectional study of the first 2270 children with physician-confirmed AD enrolled in a large postmarketing cohort. All were queried for information on comorbidities using a questionnaire from the International Study of Asthma and Allergies in Childhood. RESULTS: In all, 71.3% reported at least one additional form of atopy (symptoms of asthma or allergic rhinitis). A total of 33.3% reported only symptoms of asthma or allergic rhinitis whereas 38.0% reported symptoms of asthma and allergic rhinitis. By age 3 years, nearly 66% reported at least one additional form of atopy. A statistically significant trend toward poorer disease control was observed for those with additional atopic illnesses (P < .001). LIMITATIONS: This is a cross-sectional study. CONCLUSION: Individuals with AD exhibit a predisposition to additional atopic illnesses by age 3 years and in turn the presence of these illnesses correlates with poor disease control.

PMID: 17692428 [PubMed - indexed for MEDLINE]

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The role of furry pets in eczema: a systematic review.

Arch Dermatol. 2007 Dec;143(12):1570-7

Authors: Langan SM, Flohr C, Williams HC

OBJECTIVE: To systematically search, summarize, and critically appraise the literature to examine whether pet exposure in early life is associated with an increased risk of eczema. DATA SOURCES AND STUDY SELECTION: We searched MEDLINE (1950 to June 2006) supplemented by citation lists in retrieved articles and contact with researchers. No language restrictions were imposed. DATA EXTRACTION: Cohort studies were sufficiently similar to allow pooled analysis. Meta-analysis was not possible for cross-sectional studies owing to differences in methods and populations. MAIN OUTCOME MEASURES: Incidence or prevalence of eczema. RESULTS: Evidence from longitudinal studies showed that previous exposure to cats (pooled odds ratio [OR], 0.76; 95% confidence interval [CI], 0.62-0.92), dogs (pooled OR, 0.68; 95% CI, 0.53-0.87), or “any furry pet” (pooled OR, 0.79; 95% CI, 0.74-0.84) is associated with a lower risk of eczema. However, in the only cohort study adjusted for avoidance behavior, this “protective effect” disappeared (for cats: OR, 0.80; 95% CI, 0.33-1.97). Stratified analysis by family history in 2 birth cohort studies showed that dog exposure was protective in patients with atopic families. For cats, 1 study showed reduced risk in atopic families only; the other study showed no effect. Eight cross-sectional studies evaluated past pet exposure; a protective effect was seen in 3 studies for cat, dog, or any pet; no study demonstrated an increased risk. CONCLUSIONS: There was no clear evidence that early pet exposure is associated with increased risks of subsequent eczema. We found some evidence of a possible protective effect of early pet exposure, but this might be explained by avoidance behavior in high-risk families.

PMID: 18087010 [PubMed - indexed for MEDLINE]

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Clinical, pathologic, and immunopathologic features of dermatitis herpetiformis: review of the Mayo Clinic experience.

Int J Dermatol. 2007 Sep;46(9):910-9

Authors: Alonso-Llamazares J, Gibson LE, Rogers RS

BACKGROUND: Dermatitis herpetiformis (DH) is a cutaneous manifestation of gluten sensitivity, occasionally associated with other autoimmune disorders, and reportedly associated with an increased risk of lymphoproliferative disorders. We describe a series of patients with DH, focusing on associated disorders (particularly celiac disease), incidence of lymphoma, histopathology, and sensitivity of direct immunofluorescence (DIF) testing and serologic testing with antiendomysium antibodies for the diagnosis of DH. METHODS: The medical records of 264 patients with DH diagnosed between 1970 and 1996 were reviewed retrospectively. In addition, the records of six patients evaluated before the advent of DIF testing between 1932 and 1969 were reviewed. RESULTS: Established celiac disease was present in 12.6% of patients with DH, autoimmune systemic disorders in 22.2%, malignant neoplasms in 10.4%, sarcoidosis in four patients, and ulcerative colitis in six patients. Lymphoproliferative disorders were found in seven patients. The histopathologic examinations showed a marked predominance of neutrophils in the inflammatory infiltrate. DIF testing was positive in 92.4% of the patients tested. Indirect immunofluorescence assay indicated circulating antiendomysial antibodies in the sera of 40 of the 63 patients tested (63.5%). CONCLUSIONS: In this large series of patients with DH from a single institution, patients had a low incidence of symptomatic gluten-sensitive enteropathy, low risk of lymphoproliferative disorders, and associations with other systemic autoimmune disorders. The value of DIF testing in the diagnosis of DH was confirmed. The detection of antiendomysial antibodies by indirect immunofluorescence was less sensitive than indicated by other reports.

PMID: 17822491 [PubMed - indexed for MEDLINE]

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