Entries from April 2008
Autoimmune progesterone dermatitis. Case report with histologic overlap of erythema multiforme and urticaria.
Int J Dermatol. 2008 Apr;47(4):380-2
Authors: Walling HW, Scupham RK
BACKGROUND: Autoimmune progesterone dermatitis is a rare eruption that recurs monthly as progesterone levels peak during the menstrual cycle. Clinical and histologic features are variable, and the eruption is thought to represent a hypersensitivity response to endogenous progesterone. METHODS: We present the case of a 38-year-old woman with a pruritic intermittent facial eruption of 18 months’ duration that recurred predictably in the days surrounding menses. RESULTS: The histology showed interface dermatitis with features of both erythema multiforme and urticaria. Intradermal injection of medroxyprogesterone acetate was positive. Her symptoms responded to antihistamine therapy. CONCLUSION: This unusual case is particularly distinctive both in terms of the histologic findings and the response to therapy.
PMID: 18377604 [PubMed - indexed for MEDLINE]
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Generalized xerotic dermatitis with neutrophilic spongiosis induced by erlotinib (Tarceva).
Dermatology. 2008;216(3):247-9
Authors: Lübbe J, Masouyé I, Dietrich PY
Erlotinib is a small molecule tyrosine kinase inhibitor that is used as an anticancer agent. Most patients develop a pustular facial dermatitis within the first week of treatment. Pyogenic granulomas of the nail folds are another typical adverse event occurring in about 10-15% of cases. We report on a patient who developed a generalized dermatitis characterized by neutrophilic spongiosis. Neutrophilic inflammation has been observed in several drugs that interfere with EGFR signaling, suggesting a class effect. The present case may be yet another manifestation of this particular reaction pattern.
PMID: 18182820 [PubMed - indexed for MEDLINE]
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Assessment of health state utilities of controlled and uncontrolled psoriasis and atopic eczema: a population-based study.
Br J Dermatol. 2008 Feb;158(2):351-9
Authors: Schmitt J, Meurer M, Klon M, Frick KD
BACKGROUND: Health utilities are used to express relevant trade-offs for resource allocation. The absence of valid and generalizable utilities for atopic eczema (AE) and psoriasis limits the validity of previous cost-utility analyses. OBJECTIVES: (i) To assess health utilities of standardized scenarios of controlled and uncontrolled AE and psoriasis in participants from the general population and in patients using the time trade-off (TTO) method; (ii) to test the association of the utilities obtained with demographic and patient characteristics; and (iii) to compare these utilities with other health economic outcomes [utilities assessed on visual analogue scale (VAS), willingness to pay (WTP)]. METHODS: A single-centre study conducted in 2006 at the Department of Dermatology, Dresden, Germany. Standardized interactive computer-assisted interviews in a random sample from the general population (n=139), and patients with AE (n=58) and psoriasis (n=62). Information on health states included characteristic clinical pictures and a short text explaining aetiology, signs, symptoms and quality of life impact. RESULTS: In participants from the general population median utilities (TTO) of controlled and uncontrolled AE were 0.97 and 0.64, respectively. For psoriasis the corresponding utilities were 0.93 and 0.56. Utilities were independent of sex and socioeconomic position, and tended to be lower in patients with psoriasis. Correlations between TTO, VAS and WTP responses were weak. CONCLUSIONS: To avoid uncontrolled psoriasis or eczema participants chose an approximately 40% shorter life expectancy. This indicates that severe chronic inflammatory skin diseases may be considered as severe as angina pectoris, chronic anxiety, rheumatoid arthritis, multiple sclerosis or regional oesophageal cancer. The different economic outcomes assessed are not interchangeable.
PMID: 18070214 [PubMed - indexed for MEDLINE]
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Possible Pathogenic Role of Th17 Cells for Atopic Dermatitis.
J Invest Dermatol. 2008 Apr 24;
Authors: Koga C, Kabashima K, Shiraishi N, Kobayashi M, Tokura Y
The critical role of IL-17 has recently been reported in a variety of conditions. Since IL-17 deeply participates in the pathogenesis of psoriasis and keratinocyte production of certain cytokines, the involvement of T helper cell 17 (Th17) in atopic dermatitis (AD) is an issue to be elucidated. To evaluate the participation of Th17 cells in AD, we successfully detected circulating lymphocytes intracellularly positive for IL-17 by flow cytometry, and the IL-17(+) cell population was found exclusively in CD3(+)CD4(+) T cells. The percentage of Th17 cells was increased in peripheral blood of AD patients and associated with severity of AD. There was a significant correlation between the percentages of IL-17(+) and IFN-gamma(+) cells, although percentage of Th17 cells was not closely related to Th1/Th2 balance. Immunohistochemically, IL-17(+) cells infiltrated in the papillary dermis of atopic eczema more markedly in the acute than chronic lesions. Finally, IL-17 stimulated keratinocytes to produce GM-CSF, TNF-alpha, IL-8, CXCL10, and VEGF. A marked synergistic effect between IL-17 and IL-22 was observed on IL-8 production. The number of Th17 cells is increased in the peripheral blood and acute lesional skin of AD. Th17 cells may exaggerate atopic eczema.Journal of Investigative Dermatology advance online publication, 24 April 2008; doi:10.1038/jid.2008.111.
PMID: 18432274 [PubMed - as supplied by publisher]
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Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups.
J Eur Acad Dermatol Venereol. 2008 Apr 15;
Authors: Blessmann Weber M, de Tarso da Luz Fontes Neto P, Prati C, Soirefman M, Mazzotti NG, Barzenski B, Cestari TF
Introduction Atopic dermatitis places a large burden on patients and their families, with greater risk of emotional disorders and behavioural problems. Preliminary evidence suggests that support groups and educational programs are helpful in reducing stress, disease and pruritus severity and improves quality of life (QoL). Objectives To evaluate the intensity of pruritus and the QoL in children with atopic dermatitis and their families after joining support groups. Material and methods Subjects were randomly assigned to intervention or control group and completed the Children’s Dermatology Life Quality Index (CDLQI) and Family Dermatitis Impact (FDI). Pruritus was evaluated by the Yosipovitch’s questionnaire for pruritus. Each patient/family unit was considered as one ‘patient’. Participants were divided into two different groups: one with children under 16 years and the second with patients’ relatives. Each unit was accompanied during 6 months. Results Thirty-two patients and their relatives completed the questionnaires satisfactorily. After intervention, pruritus intensity was similar (P = 0.42), but the pattern of pruritus improved in the intervention group. Overall QoL for CDLQI instruments improved significantly (P < 0.01) and, when specific domains were analysed, personal relationships (P = 0.02) and leisure (P = 0.04) showed marked enhancement. FDI scores failed to demonstrate differences in the QoL of patients’ relatives after treatment. Conclusion The improvement on pruritus and QoL showed that atopic dermatitis patients had benefits with the attendance to support groups. We consider that these non-pharmacological approaches can be a very effective accessory tools in the management of recalcitrant forms of the disease.
PMID: 18422535 [PubMed - as supplied by publisher]
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Prophylactic effect of oral administration of Lactobacillus johnsonii NCC533 (La1) during the weaning period on atopic dermatitis in NC/NgaTnd mice.
Eur J Dermatol. 2008 Apr 21;18(2):136-140
Authors: Tanaka A, Fukushima Y, Benyacoub J, Blum S, Matsuda H
Bacterial exposure in infancy may be one of the determinants of atopic dermatitis (AD) morbidity in later life. Some clinical studies have shown that an intake of probiotics reduced the risks of AD in children; however, the timing and duration of administration for the prevention of AD still remain unclear. The aim of this study was to evaluate the effects on AD development of the administration of Lactobacillus johnsonii NC553 (La1) during the weaning period, using an animal model of human AD, NC/NgaTnd mice. La1 suspended in drinking water was administered to 4-week-old NC/NgaTnd mice for 4 weeks. Mice were kept up to 16 weeks of age in an air uncontrolled conventional condition. Clinical skin severity, scratching behaviour, histological features, and production of regulatory or inflammatory cytokines in spleens were analyzed. The results indicated that oral administration of La1 suppressed exacerbation of the clinical severity of dermatitis when compared to the controls. Scratching duration, which is the most important cause of skin damage, was also suppressed in mice fed with La1. La1 supplementation also suppressed epidermal hyperplasia and infiltration of inflammatory cells in skin. This study showed that exposure to La1 from the early stages might be beneficial to reduce the exacerbation of AD in children at high-risk of allergy.
PMID: 18424371 [PubMed - as supplied by publisher]
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Facing psoriasis and atopic dermatitis: are there more similarities or more differences?
Eur J Dermatol. 2008 Mar-Apr;18(2):172-80
Authors: Wilsmann-Theis D, Hagemann T, Jordan J, Bieber T, Novak N
Atopic dermatitis (AD) and psoriasis vulgaris (Pso) represent the most frequent chronic inflammatory skin diseases. It has been assumed for a long time that these diseases have a completely different background. Recent findings about the genetic, epidemiologic and pathophysiologic factors of both diseases have remarkably improved our knowledge about the complex mechanisms underlying AD and Pso. Beyond that, in view of these findings, the question arises, which similarities and differences between AD and Pso exist. In order to address this point, we provide an overview about the current knowledge in the field of AD and Pso.
PMID: 18424378 [PubMed - in process]
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Repetitive scratching and noxious heat do not inhibit histamine-induced itch in atopic dermatitis.
Br J Dermatol. 2008 Jan;158(1):78-83
Authors: Ishiuji Y, Coghill RC, Patel TS, Dawn A, Fountain J, Oshiro Y, Yosipovitch G
BACKGROUND: Repetitive scratching is the most common behavioural response to itch in atopic dermatitis (AD). Patients with chronic itch often report that very hot showers inhibit itch. We recently reported that scratching and noxious heat stimuli inhibit histamine-induced itch in healthy subjects. However, no psychophysical studies have been performed in AD to assess the effects of repetitive heat pain stimuli and scratching on histamine-induced itch. OBJECTIVES: To examine the effects of repetitive noxious heat and scratching on itch intensity in patients with AD using quantitative sensory testing devices. METHODS: Itch was induced with histamine iontophoresis in 16 patients with AD in both lesional and nonlesional skin as well as in 10 healthy subjects. Repetitive noxious heat and scratching were applied 3 cm distal to the area of histamine iontophoresis. Subjects rated their perceived intensity of histamine-induced itch with a computerized visual analogue scale. RESULTS: Our results demonstrate that repetitive noxious heat and scratching do not inhibit itch intensity in lesional and nonlesional AD skin but do so in healthy skin. Of note, both these stimuli increase itch intensity in lesional AD skin. CONCLUSIONS: Our results strongly suggest that scratching and noxious thermal stimuli have a different effect upon histamine-induced itch perception in patients with AD when compared with healthy controls. This difference may be associated with both peripheral and central sensitization of nerve fibres in AD.
PMID: 17986304 [PubMed - indexed for MEDLINE]
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Irritant contact dermatitis: a review.
Australas J Dermatol. 2008 Feb;49(1):1-9; quiz 10-1
Authors: Slodownik D, Lee A, Nixon R
Irritant contact dermatitis is the most common form of contact dermatitis, and yet is often overlooked. Recent progress in understanding the pathogenesis has reignited the interest of clinicians in this area of dermatology. Irritant contact dermatitis is not a homogenous entity, but rather a number of subtypes contributing to different clinical presentations. The diagnosis of irritant contact dermatitis is often clinical, and may only be possible after the exclusion of allergic contact dermatitis with patch testing. There is no readily available diagnostic test. There is an incomplete understanding of the factors which lead to the development of cumulative irritant contact dermatitis and persistent postoccupational dermatitis. We have used the experience from our tertiary referral occupational dermatology clinic to illustrate various aspects of irritant contact dermatitis, and to highlight the difficulty sometimes encountered in making this diagnosis. We believe that increased awareness of the often pivotal role of irritant contact dermatitis, as well as all the other factors contributing to occupational dermatitis, will lead to improvement in outcomes for patients.
PMID: 18186838 [PubMed - indexed for MEDLINE]
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Fingertip dermatitis refractory to topical corticosteroids associated with nail-patella syndrome.
Australas J Dermatol. 2008 Feb;49(1):55-6
Authors: Sakata S, Opie J, Howard A
A 14-year-old girl and her 47-year-old father presented with fingernails that were hypoplastic, spoon-shaped and ridged since birth. Fingertip dermatitis and paronychia were also observed in the daughter, which had been present since birth and had progressively worsened. The daughter denied trauma to her fingernails or chronic exposure to irritants and allergens. She had previously tried topical corticosteroids for 18 months without any benefit. We put forward the possibility of chronic paronychia and fingertip dermatitis, refractory to topical corticosteroids, as associations of digital nail-patella syndrome.
PMID: 18186852 [PubMed - indexed for MEDLINE]
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