Eczemaletters

Immunosuppressive effect of prolactin-induced protein: a new insight into the local and systemic role on chronic allergic contact dermatitis Immunosuppressive effect of prolactin-induced protein.

Br J Dermatol. 2010 Mar 10;

Authors: Sugiura S, Fujimiya M, Ebise H, Miyahira Y, Kato I, Sugiura Y, Kimura T, Uehara M, Sato H, Sugiura H

Summary Background: Prolactin-induced protein (PIP) has been shown to bind to CD4 and is speculated to block CD4-HLA-DR interaction. However, the immunomodulatory effect of PIP on chronic allergic contact dermatitis (ACD) remains to be elucidated. Objectives: The aim of this work was to define the role of PIP during the immunoresponse. Materials and Methods: Using a low dose oxazolone-induced mouse chronic ACD model, expression of PIP was immunohistologically examined. Furthermore, effects of continued exposure of a peptide mimicking the major binding site of PIP (amino acids 106-132) for CD4 was examined in a mouse chronic ACD model. Results: We clarified that keratinocytes, dermal infiltrating cells and infiltrating mononuclear cells into the spleen are positively stained with anti-PIP antibody. The PIP peptide significantly down-regulated oxazolone-induced mouse ACD compared to the controls. We also found that inflammation of PIP-non-applied control ear was also suppressed in a synchronized manner in late phase of the PIP peptide applied mouse. Conclusions: These findings suggest that PIP might have a local and systemic immunosuppressive effect in mouse chronic ACD.

PMID: 20302584 [PubMed - as supplied by publisher]

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Paederus dermatitis in Egypt: a clinicopathological and ultrastructural study.

J Eur Acad Dermatol Venereol. 2010 Mar 4;

Authors: Assaf M, Nofal E, Nofal A, Assar O, Azmy A

Abstract Background Outbreaks of paederus dermatitis (PD) have been observed in different parts of the world, yet the histopathological and ultrastructural changes and their relationship to pederin toxin have not been described. Objective To describe the clinical presentations of PD in Egypt and to study the effects of pederin toxin on the skin by evaluating the histopathological and ultrastructural changes of some representative cases. Methods One hundred and thirteen patients with PD were studied clinically and epidemiologically. Skin biopsies were taken from 40 patients for histopathological examination and from 20 patients for electron microscopic (EM) examination. Results Clinically, the most common presentation comprised erythematous plaques with micropustules. Blisters exhibited a linear configuration in 40% of the patients and kissing lesions were observed in 13%. Multiple lesions occurred in 78% of the patients and the face was the most commonly involved site (48%). The insect was identified as Paederus alfierii. Histopathological examination revealed features of acute irritant dermatitis in the upper epidermis. Mitotic figures and apoptotic changes such as chromatin condensation and DNA fragmentation were identified in the basal and suprabasal layers. These features were confirmed by EM. Conclusions Clinical, histopathological and, for the first time, ultrastructural characteristics of paederus dermatitis are described. The pathological abnormalities of the upper epidermis are caused by the irritant effect of pederin toxin. The presence of apoptosis within the lower epidermis can be related to this toxin, a point that needs further research, hoping for its future implications in the management of hyperproliferative disorders.

PMID: 20236196 [PubMed - as supplied by publisher]

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Patch testing in allergic contact dermatitis: is it useful to perform the cosmetic series in addition to the European standard series?

J Eur Acad Dermatol Venereol. 2010 Mar 4;

Authors: Ada S, Seçkin D

Abstract Background Cosmetics are the causative agents in 8-15% of patients suspected of having allergic contact dermatitis. Patch testing with standard series identifies 70-80% of the responsible allergens in all contact dermatitis; however, many important cosmetic-related allergens may be missed by using standard series alone. Objective The aim of this study was to determine the value of using cosmetic series in addition to the European standard series in patients with suspected allergic contact dermatitis. Methods In this prospective study, 93 consecutive patients suspected of having allergic contact dermatitis were patch tested with the European standard series, and simultaneously with cosmetic series. Positive allergic reactions were further interpreted as clinically relevant or irrelevant. The clinically relevant reactions were subsequently stratified into three subgroups: (i) reactions only to allergen/allergens in the European standard series; (ii) reactions only to allergen/allergens in cosmetic series; and (iii) reactions both to allergen/allergens in the European standard and cosmetic series. Results A total of 74 positive reactions were observed in 93 patients. However, only 46 (62.2%) of the total positive reactions were found to be clinically relevant. Of all the clinically relevant positive reactions, 27 (58.7%) were caused by the allergens in the European standard series; 19 (41.3%) were caused by the allergens in cosmetic series. Of the 93 patients tested, 44 (47.3%) had at least one positive allergic reaction, 30 (68.2%) of whom had clinically relevance. Of the 30 patients with clinically relevant positive tests, 16 (53.3%) reacted only to allergens in the European standard series; nine (30%) reacted only to cosmetic series allergens; and five (16.7%) reacted both to the European standard and cosmetic series allergens. Among the 45 cosmetic series allergens tested, 15 (33.3%) gave positive reactions of which 14 (93.3%) of those were found to be clinically relevant. The clinically relevant cosmetic series allergens which were found to be over the critical incidence of 1% included methyldibromo glutaronitrile, Euxyl K400, and isopropyl myristate. Conclusion Patch testing with cosmetic series in addition to the European standard series increased the capability to detect the relevant allergen/allergens, particularly in patients with a suspicion of cosmetic allergy. However, it is not practical and cost-effective to test those patients routinely with all 45 allergens in the cosmetic series. As the European baseline series which includes methyldibromo glutaronitrile is now widely used as the guideline minimum set of allergens for routine diagnostic patch test investigations, we additionally recommend Euxyl K400 and isopropyl myristate as the candidates for patch testing.

PMID: 20236197 [PubMed - as supplied by publisher]

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Efficacy and tolerability of pale sulfonated shale oil cream 4% in the treatment of mild to moderate atopic eczema in children: a multicentre, randomized vehicle-controlled trial.

J Eur Acad Dermatol Venereol. 2010 Mar 4;

Authors: Korting HC, Schöllmann C, Cholcha W, Wolff L,

Abstract Background Reports on controlled trials on the efficacy and tolerability of sulfonated shale oils in atopic eczema are not available so far. The aim of this study was to investigate whether topically applied, specially prepared pale sulfonated shale oil (PSSO) cream is capable of improving symptoms/signs of mild to moderate atopic eczema in children more efficaciously than a corresponding vehicle cream. Patients and methods A total of 99 children suffering from mild to moderate atopic eczema were enrolled in this multicentre, randomized, vehicle-controlled study. Verum or vehicle cream was applied to the affected skin area three times a day over 4 weeks. As the primary outcome parameter served the reduction of the total score after 4 weeks of treatment, compared with the initial examination. Secondary outcome parameters were addressed as well. Tolerability was judged by investigators and patients/parents, and adverse events were documented. Results After 4 weeks of treatment, the total score declined from 13.4 +/- 3.7 to 4.5 +/- 7.4 score points in the verum group and from 13.0 +/- 3.1 to 11.7 +/- 8.6 score points in the vehicle group (P < 0.0001). The superiority of verum regarding total score was already apparent after a treatment period of 1 week (reduction by 5.6 +/- 4.3 vs. 1.3 +/- 5.9 score points; P < 0.0001). Tolerability was found superior at the end of the treatment in the verum when compared with the control group - both by investigators (P < 0.0001) and patients/parents (P = 0.0051). Conclusion Pale sulfonated shale oil cream 4% is capable to treat mild to moderate atopic eczema in children more efficaciously than vehicle and is well tolerated. PSSO thus represents a valuable addition to our therapeutic armamentarium. PSSO should be considered in particular when valid alternatives for topical glucocorticoids are sought for.

PMID: 20236198 [PubMed - as supplied by publisher]

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Allergic contact dermatitis to shoes induced by dimethylfumarate: A new allergen imported from China.

Dermatol Online J. 2010;16(3):3

Authors: Santiago F, Andrade P, Gonçalo M, Mascarenhas R, Figueiredo A

BACKGROUND: In the last two years several cases of severe contact dermatitis related to newly acquired sofas and armchairs originating from China have been published. The responsible allergen is dimethylfumarate (DMF), an extremely potent sensitizer and irritant found in sachets inside the furniture. Recently, cases of contact dermatitis related to shoes and riding helmets have also been described. METHODS: We evaluated two patients with allergic contact dermatitis related to shoes manufactured in China that were contaminated by dimethylfumarate found in sachets placed inside the shoeboxes. RESULTS: Patch tests with DMF extracted from the sachets inside the shoeboxes showed positive reactions. Postitive reactions were also obtained using small fragments of the shoes and tissue of the “MouldProof” sachet. The patients were instructed to avoid the suspected shoes and were treated with topical corticosteroids. CONCLUSIONS: Contact dermatitis induced by dimethylfumarate should be suspected in appropriate cases. It is important to remember that this allergen is not included in most series for patch testing.

PMID: 20233560 [PubMed - in process]

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Urinary biomarker of oxidative stress in patients with psoriasis vulgaris and atopic dermatitis.

J Eur Acad Dermatol Venereol. 2009 Dec;23(12):1405-8

Authors: Nakai K, Yoneda K, Maeda R, Munehiro A, Fujita N, Yokoi I, Moriue J, Moriue T, Kosaka H, Kubota Y

BACKGROUND: The involvement of oxidative stress in the pathogenesis of various skin disorders has been suggested for decades. However, few clinical studies have assessed oxidative stress in skin diseases. The easiest and least invasive method to assess oxidative stress in patients may be the measurement of oxidation products in urine. OBJECTIVE: This study aims to assess oxidative stress in psoriasis and atopic dermatitis patients. METHODS: Urine samples were collected from 29 psoriasis patients (25 males and 4 females), 21 atopic dermatitis patients (14 males and 7 females) and 20 healthy controls (16 males and 4 females). The severity and extent of psoriasis and atopic dermatitis was assessed by their area and severity index. We measured nitrate as a metabolite of nitric oxide, malondialdehyde as a major lipid oxidation product, and 8-hydroxydeoxyguanosine (8-OHdG) as a DNA oxidation marker. RESULTS: Urinary nitrate and 8-OHdG levels, but not malondialdehyde, were significantly higher in psoriasis patients than those in healthy controls. On the contrary, only urinary nitrate level was significantly higher in atopic dermatitis patients than those in healthy controls. The severity and extent of both psoriasis and atopic dermatitis significantly correlated with urinary nitrate level and malondialdehyde level, but it did not correlate with urinary 8-OHdG level. CONCLUSIONS: Measurement of these three urinary oxidative products is non-invasive. Above all, measurement of urinary nitrate may be most useful in the clinical assessment of oxidative stress in both psoriasis and atopic dermatitis patients. There is a possibility that urinary 8-OHdG level may indicate the different pathogenesis between psoriasis and atopic dermatitis.

PMID: 20205355 [PubMed - in process]

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Sporadic blau syndrome with onset of widespread granulomatous dermatitis in the newborn period.

Pediatr Dermatol. 2010 Jan 1;27(1):69-73

Authors: Stoevesandt J, Morbach H, Martin TM, Zierhut M, Girschick H, Hamm H

Blau syndrome is a dominantly inherited, chronic autoinflammatory disorder characterized by the clinical triad of granulomatous dermatitis, symmetric arthritis, and recurrent uveitis with onset below 4 years of age. It is caused by activating mutations in the nucleotide-binding oligomerization domain 2 (NOD2) gene, previously referred to as CARD15 gene. Noncaseating granulomas in affected tissues are the pathologic hallmark of the condition. We report the lifelong severe disease course in a 14-year-old Caucasian boy with sporadic Blau syndrome. Unusually, granulomatous dermatitis started in the first week of life. Whereas skin involvement faded away spontaneously in subsequent years, polyarthritis and anterior uveitis appeared in the second and third year of life respectively. Mutational analysis of the NOD2 gene revealed a missense mutation (R334W) previously detected in other Blau syndrome pedigrees. With this report, we would like to stress the rare possibility of Blau syndrome in generalized papular rashes of infancy and the importance of histopathologic study for clarification. The finding of early-onset widespread granulomatous dermatitis should prompt eye and joint examination in regular intervals and entail mutational analysis of the NOD2 gene.

PMID: 20199415 [PubMed - in process]

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The frequency and intensity of topical pimecrolimus treatment in children with physician-confirmed mild to moderate atopic dermatitis.

Pediatr Dermatol. 2009 Nov;26(6):682-7

Authors: Kapoor R, Hoffstad O, Bilker W, Margolis DJ

Atopic dermatitis (AD) is often treated with multiple modalities, including topical medications such as corticosteroids and topical calcineurin inhibitors (TCIs). The aim of this study was to describe the natural history of the utilization characteristics of topical treatment in those with AD. We conducted a longitudinal study of the first 4,105 children with physician-confirmed mild to moderate AD enrolled in an ongoing postmarketing safety study of pimecrolimus. Information was obtained from participants every six months using a questionnaire. Drug utilization was solely determined by the physician and patient. Over the three years of our study, an increasing number of individuals reported at least 6 months of complete control of their disease, without the continued use of a topical medication. While all study participants used pimecrolimus at the start of the study less than 40% continued to use it after 3 years of study participation. If an individual was still using a topical medication after three years of follow-up, it was most likely a topical corticosteroid. For those who continued to use pimecrolimus, the use was limited to about 60 grams of pimecrolimus in 6 months. Community-based use of topical pimecrolimus to treat AD is limited both with respect to the duration of exposure and amount or total dose of the exposure. If a topical therapy is persistent, it is most likely to a topical corticosteroid.

PMID: 20199441 [PubMed - in process]

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Recent Microbiological Shifts in Perianal Bacterial Dermatitis: Staphylococcus aureus Predominance.

Pediatr Dermatol. 2009 Nov;26(6):696-700

Authors: Heath C, Desai N, Silverberg NB

Traditionally, bacterial infections of the anal skin have been found to be caused by Streptococcus. The aim of this study was to determine the breakdown of bacterial isolates and the current presentation of bacterial diseases involving the perineum. From the chart review of children who had bacterial cultures of the anus from 2005 to 2008 in a pediatric dermatology practice population in New York City, 26 pediatric patients (ages 5 months to 12 yrs) who had the indications of anal erythema or recurrent buttocks dermatitis were identified. Bacterial cultures of 17 patients grew pathogens, that of 14 (82% of identifiably infected patients) grew Staphylococcus aureus, in 11 as a solo pathogen (6 MSSA and 5 MRSA in 2 family clusters). Streptococcus was identified in three patients, two on culture and one on latex agglutination test; and two patients were identified as having both group A beta hemolytic Streptococcus and Staphylococcus aureus (2 MSSA and 1 MRSA). In patients with S. aureus perianally, concurrent small papules and pustules of the buttocks or extension of the erythema to adjacent buttock skin was the primary clinical feature distinguishing this condition from isolated streptococcal disease. Whereas Streptococcal infections of the anus and buttocks occur commonly, Staphylococcus aureus has become the leading cause of anal bacterial infection in the setting of skin involvement; therefore, antibacterial therapy for anal and buttock bacterial infections should be tailored accordingly.

PMID: 20199443 [PubMed - in process]

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Systematized contact dermatitis and montelukast in an atopic boy.

Pediatr Dermatol. 2009 Nov 1;26(6):739-43

Authors: Castanedo-Tardan MP, González ME, Connelly EA, Giordano K, Jacob SE

Upon ingestion, the artificial sweetener, aspartame is metabolized to formaldehyde in the body and has been reportedly associated with systemic contact dermatitis in patients exquisitely sensitive to formaldehyde. We present a case of a 9-year-old Caucasian boy with a history of mild atopic dermatitis that experienced severe systematized dermatitis after being started on montelukast chewable tablets containing aspartame. Patch testing revealed multiple chemical sensitivities which included a positive reaction to formaldehyde. Notably, resolution of his systemic dermatitis only occurred with discontinuation of the montelukast chewables.

PMID: 20199453 [PubMed - in process]

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