Eczemaletters

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Intermittent therapy for flare prevention and long-term disease control in stabilized atopic dermatitis: A randomized comparison of 3-times-weekly applications of tacrolimus ointment versus vehicle.

J Am Acad Dermatol. 2008 Mar 20;

Authors: Breneman D, Fleischer AB, Abramovits W, Zeichner J, Gold MH, Kirsner RS, Shull TF, Crowe AW, Jaracz E, Hanifin JM,

BACKGROUND: Intermittent dosing of a topical calcineurin inhibitor for preventing atopic dermatitis (AD) disease relapse in patients with stabilized AD has not been evaluated. OBJECTIVE: We sought to evaluate the long-term efficacy and safety of 3-times-weekly use of tacrolimus ointment in preventing AD disease relapse. METHODS: Adult and pediatric patients with moderate to severe AD who were clear of disease after up to 16 weeks of treatment with tacrolimus ointment were randomized in a double-blind fashion to 3-times-weekly treatment with either tacrolimus ointment (0.03% or 0.1%) or vehicle for 40 weeks. The primary end point was the number of flare-free treatment days. RESULTS: A total of 125 patients were randomized to tacrolimus and 72 patients to vehicle. The mean number of flare-free treatment days was 177 for tacrolimus and 134 for vehicle (P = .003). Median time to first relapse was 169 days for tacrolimus and 43 for vehicle (P = .037). LIMITATIONS: Generalizability to all patients seen in clinic may be limited because only patients who responded to tacrolimus ointment in the stabilization phase were randomized into the maintenance phase of the trial. CONCLUSIONS: Maintenance therapy with tacrolimus ointment was associated with significantly more flare-free days compared with vehicle, and a significantly longer time until first disease relapse.

PMID: 18359127 [PubMed - as supplied by publisher]

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Discoid lupus erythematosus exacerbated by contact dermatitis caused by use of squaric acid dibutylester for topical immunotherapy in a patient with alopecia areata.

J Dermatol. 2008 Mar;35(3):151-3

Authors: Shimaoka Y, Hatamochi A, Hamasaki Y, Suzuki H, Ikeda H, Yamazaki S

A 57-year-old Japanese male patient with an 18-year history of discoid lupus erythematosus (DLE) presented with alopecia on his scalp, and was clinically diagnosed to have alopecia areata. He was started on topical immunotherapy with squaric acid dibutylester (SADBE) for the treatment of alopecia areata. The patient was first sensitized with the application of 2% SADBE on the right upper arm, followed subsequently by re-exposure to a low concentration of SADBE to provoke contact dermatitis on the scalp as treatment. Approximately 2 months later, he developed multiple red scaly lesions on his scalp and face, which were diagnosed histopathologically as DLE. DLE is known to be exacerbated by a variety of factors, including sunlight, X-rays, tattoos, burns, and some forms of cutaneous trauma, including dermatitis. However, to the best of our knowledge, there have only been two reported cases of DLE exacerbated by contact dermatitis.

PMID: 18346258 [PubMed - in process]

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In vitro and clinical immunomodulatory effects of a novel Pentaherbs concoction for atopic dermatitis.

Br J Dermatol. 2008 Mar 13;

Authors: Leung TF, Wong KY, Wong CK, Fung KP, Lam CW, Fok TF, Leung PC, Hon KL

Background Our group recently reported a randomized and placebo-controlled clinical trial on the efficacy of a twice-daily concoction of five herbal ingredients (Pentaherbs formulation, PHF) in treating children with atopic dermatitis (AD). Objectives To investigate the immunomodulatory effects that may be induced by PHF treatment. Methods We investigated the effects of PHF on cytotoxicity and proliferation of phytohaemagglutinin (PHA)- and staphylococcal enterotoxin B (SEB)-stimulated peripheral blood mononuclear cells (PBMC) isolated from buffy coat of blood donors. PHF-induced immunomodulation for five inflammatory mediators in cultured PBMC was measured by reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay. The effects of a 3-month, open-label study of PHF on circulating inflammatory mediators in children with AD were also assessed. Results PHF at up to 1 mg mL(-1) dose-dependently suppressed PBMC proliferation. The addition of PHF to cultured PBMC reduced supernatant concentrations of brain-derived neurotrophic factor (BDNF), interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha in response to PHA, and BDNF and thymus and activation-regulated chemokine (TARC) following SEB stimulation. PHF increased epithelial cell-derived neutrophil activating peptide-78 levels in culture supernatants. At the RNA level, PHF suppressed the transcription of BDNF, TARC, IFN-gamma and TNF-alpha. Twenty-eight children with AD were treated with PHF for 3 months, and their mean plasma concentrations of BDNF and TARC decreased significantly from 1798 pg mL(-1) and 824 pg mL(-1) at baseline to 1378 pg mL(-1) and 492 pg mL(-1) (P = 0.002 and 0.013, respectively) upon study completion. Conclusions PHF possesses in vitro and in vivo immunomodulatory properties that may mediate the clinical efficacy observed in AD treatment.

PMID: 18341655 [PubMed - as supplied by publisher]

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Pimecrolimus cream 1% in the long-term management of adult atopic dermatitis: prevention of flare progression. A randomized controlled trial.

Br J Dermatol. 2008 Mar 13;

Authors: Gollnick H, Kaufmann R, Stough D, Heikkila H, Andriano K, Grinienko A, Jimenez P,

Background Previous studies suggested that early intervention with pimecrolimus cream 1% at the first signs and/or symptoms of a relapse of atopic dermatitis (AD) following remission may prevent the occurrence of more severe flares and therefore reduce corticosteroid exposure in the long term. However, this possibility was not rigorously evaluated. Objectives To evaluate the effectiveness of pimecrolimus cream 1% for the prevention of flare progression in adults with AD. Methods A 26-week randomized controlled study was conducted in 543 patients aged >/= 18 years, with a history of mild or moderate AD, who were clear/almost clear of disease before randomization to pimecrolimus cream 1% (n = 277) or matching vehicle cream (n = 266). Twice-daily treatment with study medication was started at the onset of the first signs and/or symptoms of a relapse. If disease worsened, despite the application of study medication for at least 3 days, treatment with a moderately potent topical corticosteroid (TCS) was allowed in both groups. The primary efficacy endpoint was the number of days without TCS use for disease worsening. Results The mean number of TCS-free days was significantly higher (P < 0.001) in the pimecrolimus cream 1% group (152 days) than in the vehicle cream group (138.7 days). In comparison with vehicle cream, pimecrolimus cream 1% reduced the mean number of flares requiring TCS use from 1.39 to 0.97 (P = 0.0014). Patients on pimecrolimus cream 1% made 30% fewer unscheduled visits (156) than patients on vehicle cream (223). Conclusions In adults with a history of mild or moderate AD but free of active skin lesions, intervention with pimecrolimus cream 1% at the first signs and/or symptoms of a subsequent recurrence reduces the number of flares requiring TCS use and decreases the number of disease-related office visits.

PMID: 18341665 [PubMed - as supplied by publisher]

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Noninvasive biophysical assessments of the efficacy of a moisturizing cosmetic cream base for patients with atopic dermatitis during different seasons.

Br J Dermatol. 2008 Mar 13;

Authors: Kikuchi K, Tagami H,

Background The use of emollients is recommended for patients with atopic dermatitis (AD) to maintain improved condition. Objectives To ascertain objectively the effectiveness of a moisturizing cream for patients with AD during different seasons. Methods We conducted clinical evaluations, noninvasive biophysical measurements and biochemical analyses of the stratum corneum (SC) components of the volar forearm skin of 23 patients with AD after a moisturizer was applied twice daily for 4 weeks. The moisturizer was formulated according to the consensus of cosmetic scientists belonging to major Japanese cosmetic companies. The nontreated forearm served as a control. Results After using the moisturizer treatment, the hydration of the SC significantly increased together with a decrease in the desquamation measurements and an improvement in the regularity of skin surface corneocytes. An improvement was observed in the SC barrier function in winter, but was achieved only after 4 weeks in late spring during which time there even occurred exacerbation of skin conditions in three patients. With use of the moisturizer treatment, we found no change in the SC content of free amino acids or ceramides, the ratio of interleukin (IL)-1 receptor antagonist to IL-1alpha, the ratio of immature to mature cornified envelopes, the size of the corneocytes or the emergence of parakeratotic cells in the skin surface corneocytes. Conclusion Treatment with an adequate moisturizer is beneficial for the dry skin of patients with AD during the dry, cold season but it does not influence the impaired SC barrier function as effectively in the less arid season.

PMID: 18341667 [PubMed - as supplied by publisher]

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The effect of wet-wrap dressing on epidermal barrier in patients with atopic dermatitis.

J Eur Acad Dermatol Venereol. 2007 Nov;21(10):1360-8

Authors: Lee JH, Lee SJ, Kim D, Bang D

BACKGROUND: Wet-wrap dressing has been shown to be effective for atopic dermatitis; however, the therapeutic mechanism of wet-wrap dressing is only the hypothesis based on the recovery of decreased epidermal barrier function. OBJECTIVES: To examine the therapeutic efficacy as well as the mechanism of wet-wrap dressing in atopic dermatitis patients. METHODS: To examine the difference of non-lesional and lesional atopic skin and to evaluate the change between epidermal barrier function before and after the treatment, SCORAD, epidermal water content, transepidermal water loss, the lipid amount of skin surface, immunohistochemical staining of filaggrin and loricrin, transmission electron microscopic examination, and calcium ion capture cytochemistry method were done in 10 severe form atopic dermatitis patients. RESULTS: In atopic dermatitis patients, SCORAD was clearly decreased, epidermal water content was increased, and transepidermal water loss was decreased after wet-wrap dressing. After wet-wrap dressing, increased release of lamellar body and the recovery of the damaged lamellar structure of intercellular lipid were observed; nevertheless, neither the change in keratinocyte differentiation nor the change of calcium ion gradient was detected. A week after the termination of wet-wrap dressing, increased water content and decreased transepidermal water loss were still maintained. CONCLUSION: We confirmed the abnormality of the epidermal barrier in atopic dermatitis, and the effects of wet-wrap were associated with the recovery of epidermal barrier. In atopic lesions, wet-wrap dressing induced clinical improvement by the release of lamellar body and the restoration of intercellular lipid lamellar structure.

PMID: 17958842 [PubMed - indexed for MEDLINE]

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Clinical differences between atopic and atopiform dermatitis.

J Am Acad Dermatol. 2008 Mar;58(3):407-14

Authors: Brenninkmeijer EE, Spuls PI, Legierse CM, Lindeboom R, Smitt JH, Bos JD

BACKGROUND: Atopic dermatitis (AD) has been divided into the “extrinsic” and “intrinsic” type, in which “intrinsic AD” is characterized by the absence of allergen-specific IgE. Still, there is no consensus whether this “intrinsic type” of AD, which we denominate as atopiform dermatitis (AFD), is a distinct entity. OBJECTIVE: A case-control study was performed to compare the clinical and diagnostic features of AD and AFD. METHODS: Patients with a clinical diagnosis of AD were selected. Cases did not have demonstrable allergen-specific IgE. Matched control subjects were tested positive for allergen-specific IgE. Patients were evaluated for medical history, quality of life, disease severity, and Hanifin and Rajka, U.K. and Millennium diagnostic criteria. RESULTS: Eight percent (n = 34) of the selected patients had, in fact, AFD. Female predominance, absence of atopic diseases, later onset of disease, and milder disease severity were observed in AFD. A history of atopy, recurrent conjunctivitis, palmar hyperlinearity, keratosis pilaris, pityriasis alba, and hand and/or food eczema were significantly less present in AFD. Dennie-Morgan fold was positively associated with AFD. LIMITATIONS: Not all patients with negative allergen-specific IgE participated and a relatively small number of AFD patients were studied. CONCLUSIONS: In addition to the absence of allergen-specific IgE, our findings support that AFD is an entity distinct from AD. With a distinction shown between AFD and AD, patient groups will be better defined and more homogeneous. Implications of this distinction will be of importance for preventive and therapeutic advice; diagnostic processes; and for future research.

PMID: 18280337 [PubMed - indexed for MEDLINE]

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Disease severity, scratching, and sleep quality in patients with atopic dermatitis.

J Am Acad Dermatol. 2008 Mar;58(3):415-20

Authors: Bender BG, Ballard R, Canono B, Murphy JR, Leung DY

BACKGROUND: The relationship between sleep quality and disease severity in patients with atopic dermatitis has not been clearly defined. METHODS: Sleep efficiency and scratching were measured over 2 nights by polysomnography, actigraphy, and self-report in 20 adults with atopic dermatitis. Tumor necrosis factor, interleukin (IL)-6, and IL-10 were assayed from a subset of 9 participants. RESULTS: Sleep measured by actigraphy and polysomnography were strongly associated with each other. Decreased sleep efficiency was associated with increasing disease severity, scratching, and IL-6. Self-reported sleep quality and quality of life were not significantly correlated with either objective sleep measure. LIMITATIONS: Results in this pilot study await confirmation in a larger investigation. CONCLUSION: Objective measures but not self-report documented that increasing severity of atopic dermatitis results in more scratching and declining sleep quality. Our data also suggest an important relationship between sleep and IL-6.

PMID: 18280338 [PubMed - indexed for MEDLINE]

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Lichenoid and other clinical presentations of atopic dermatitis in an inner city practice.

J Am Acad Dermatol. 2008 Mar;58(3):503-4

Authors: Allen HB, Jones NP, Bowen SE

Atopic dermatitis (AD) has many different clinical presentations. In our inner city practice, we have observed a variant of AD in our heavily pigmented patients that we have termed lichen planus-like atopic dermatitis because of its clinical similarity to lichen planus. Clinically, this variant may be distinguished by the presence on extensor surfaces and a more rapid response to treatment. Histologically, in lichen planus-like AD, a spongiotic dermatitis is present; further, there is no lichenoid dermatitis evident. We compare this presentation with the others seen over an eight-month interval in our practice. We report on a lichen planus-like variant of atopic dermatitis in our African American patients. A limitation to this report is the relatively small sample size. Facial/extensor is the most common presentation of atopic dermatitis in our predominantly minority clinic.

PMID: 18280352 [PubMed - indexed for MEDLINE]

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Prognosis of unclassified eczema: a follow-up study.

Arch Dermatol. 2008 Feb;144(2):160-4

Authors: Li LF, Liu G, Wang J

OBJECTIVE: To investigate the outcome of unclassified eczema (UE). Eczema refers to a set of highly heterogeneous clinical conditions including contact dermatitis (CD) and several types of endogenous eczema. In clinics, however, the eczema of a large proportion of patients does not fit any known patterns and has been diagnosed as unclassified eczema. The prognosis of UE is largely unknown. DESIGN: Cohort study with 1-year follow-up. SETTING: Dermatology clinic in Peking University Third Hospital, Beijing, China. Patients All cases of UE in 655 consecutive patients with eczema patch tested with the European Standard series occurring during a 2-year period. Interventions At 1 year after patch testing, all patients were asked to revisit the clinic, and 599 patients returned (91.5%); of these, 192 had UE (32.1%). MAIN OUTCOME MEASURES: The rate of symptom-free skin for at least 3 months without relapse before evaluation. RESULTS: During the follow-up period, only 15.1% of patients with UE had their lesions cleared, which was a much lower rate than for those with CD (50.4%) (P < .001; chi(2) test) but close to the rate of those with atopic dermatitis (7.1%). A total of 11.0% of patients with UE had atopic diathesis, and 72.4% of those with UE had a positive reaction to at least 1 contact allergen, which was a lower rate than that of patients with allergic CD (88.6%) but higher than that for patients with irritant CD (53.8%) (P < .001 and P = .004, respectively; chi(2) test); however, none of these results were relevant to eczema. CONCLUSIONS: Unclassified eczema is a common type of eczema with a very poor prognosis. This important category of eczema should be recognized and studied further.

PMID: 18283172 [PubMed - indexed for MEDLINE]

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