The Hand Eczema Trial (HET): design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema.

BMC Dermatol. 2010 Aug 31;10(1):8

Authors: Ibler KS, Agner T, Hansen JL, Gluud C

ABSTRACT: BACKGROUND: Hand eczema is the most frequently recognized occupational disease in Denmark with an incidence of approximately 0.32 per 1000 person-years. Consequences of hand eczema include chronic severe eczema, prolonged sick leave, unemployment, and impaired quality of life. New preventive strategies are needed to reduce occupational hand eczema. METHODS: We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease severity (Hand Eczema Severity Index); self-evaluated disease severity; number of eruptions; quality of life; skin protective behaviour, and knowledge of skin protection. The patients are centrally randomised to intervention versus no intervention 1:1 stratified for hospital, profession, and severity score. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary outcome is observer-blinded assessment of disease severity and the secondary outcomes are unblinded assessments of disease severity; number of eruptions; knowledge of skin protection; skin-protective behaviour, and quality of life. Trial registration: The trial is registered in ClinicalTrials.Gov, NCT01012453.

PMID: 20807407 [PubMed - as supplied by publisher]

Systemic Contact Dermatitis in Children: How an Avoidance Diet Can Make a Difference.

Pediatr Dermatol. 2010 Aug 27;

Authors: Matiz C, Jacob SE

Systemic contact dermatitis is an under-recognized skin reaction that occurs secondary to systemic (oral, intravenous, intramuscular, inhaled, or subcutaneous) exposure to a hapten in a previously sensitized individual. Medicaments are the most common cause of SCD in the adult population, but other chemicals like nickel, cobalt, balsam of Peru, and formaldehyde have been implicated as well. Few reports in children exist to date. Dietary restriction has shown to be of some benefit in managing some adult patients. We present a case series of 8 pediatric patients diagnosed with SCD from the contact dermatology clinic, who showed marked improvement of their dermatitis after adequate dietary avoidance. We review common presentations of chemicals causing SCD in children and potential dietary modifications.

PMID: 20807367 [PubMed - as supplied by publisher]

Serum neopterin levels in spontaneous urticaria and atopic dermatitis.

Clin Exp Dermatol. 2010 Aug 27;

Authors: Ciprandi G, De Amici M, Berardi L, Vignini M, Caimmi S, Marseglia A, Marseglia G, Fuchs D

Summary Serum neopterin may be considered a diagnostic marker of the degree of activation of the immune system. This preliminary study was performed to measure serum neopterin levels in patients with acute spontaneous urticaria (ASU), chronic spontaneous urticaria (CSU) and atopic dermatitis (AD). In total, 180 patients [96 men, 84 women; mean age 23.1 years; 41 with spontaneous urticaria (13 ASU and 28 CSU), 48 with AD] and 96 healthy controls were enrolled in the study. Patients with ASU had the highest neopterin levels, and all three groups of patients (ASU, CSU and AD) had higher values than normal subjects. This preliminary study demonstrates that serum neopterin could be a biomarker of immune activation in patients with SU or AD.

PMID: 20804508 [PubMed - as supplied by publisher]

Inhibition of NF-kappaB Signaling Retards Eosinophilic Dermatitis in SHARPIN-Deficient Mice.

J Invest Dermatol. 2010 Sep 2;

Authors: Liang Y, Seymour RE, Sundberg JP

The NF-kappaB pathway performs pivotal roles in diverse physiological processes such as immunity, inflammation, proliferation, and apoptosis. NF-kappaB is kept inactive in the cytoplasm through association with inhibitors (IkappaB), and translocates to the nucleus to activate its target genes after the IkappaBs are phosphorylated and degraded. Here, we demonstrate that loss of function of SHANK-associated RH domain interacting protein (SHARPIN) leads to activation of NF-kappaB signaling in skin, resulting in the development of an idiopathic hypereosinophilic syndrome (IHES) with eosinophilic dermatitis in C57BL/KaLawRij-Sharpin(cpdm)/RijSunJ mice, and clonal expansion of B-1 B cells and CD3(+)CD4(-)CD8(-) T cells. Transcription profiling in skin revealed constitutive activation of classical NF-kappaB pathways, predominantly by overexpressed members of IL1 family. Compound-null mutants for both the IL1 receptor accessory protein (Il1rap(tm1Roml)) and SHARPIN (Sharpin(cpdm)) resulted in mice having decreased skin disease severity. Inhibition of IkappaBA degradation by the proteasome inhibitor bortezomib alleviated the dermatitis in Sharpin(cpdm) mice. These results indicate that absence of SHARPIN causes IHES with eosinophilic dermatitis by NF-kappaB activation, and bortezomib may be an effective treatment for skin problems of IHES.Journal of Investigative Dermatology advance online publication, 2 September 2010; doi:10.1038/jid.2010.259.

PMID: 20811394 [PubMed - as supplied by publisher]

The Self-Administered Eczema Area and Severity Index in Children with Moderate to Severe Atopic Dermatitis: Better Estimation of AD Body Surface Area Than Severity.

Pediatr Dermatol. 2010 Aug 26;

Authors: van Velsen SG, Knol MJ, Haeck IM, Bruijnzeel-Koomen CA, Pasmans SG

The Self-Administered Eczema Area and Severity Index (SA-EASI) is one of the few patient based atopic dermatitis (AD) disease activity scores and was found to be highly correlated with the EASI. Correlation with other frequently used scoring methods has not been investigated. The aim of this study was to evaluate the relation of the SA-EASI with two physician-based disease activity scores (objective SCORAD and SASSAD score) and with a serum marker for AD (Thymus and Activation-Regulated Cytokine [TARC]) in children with AD. Sixty children with moderate to severe AD were included. The SA-EASI was completed by caregivers, and the objective SCORAD and SASSAD scores were measured successively on the same day by a trained investigator. Blood for serum TARC measurement was drawn. The correlation between the SA-EASI and the objective SCORAD was high (rho = 0.61, p = <0.001), mainly based on high correlation between the body surface area (BSA) measurements of both scores (rho = 0.50, p = <0.001). The correlation with the SASSAD score (only severity measurement) was 0.43 (p = <0.001). The correlation with serum TARC levels was 0.46; p = <0.001, mainly based on the BSA score of the SA-EASI (rho = 0.42, p = <0.001). Parents may have more difficulty in scoring severity of AD than scoring BSA involved. Educating parents in severity scoring of AD may improve agreement of the SA-EASI and the objective SCORAD, TARC, and SASSAD score. Additional use of the SA-EASI in routine clinical practice or in trials may then facilitate more frequent but still accurate assessment of AD.

PMID: 20796235 [PubMed - as supplied by publisher]

Eczema Prevalence in the United States: Data from the 2003 National Survey of Children's Health.

J Invest Dermatol. 2010 Aug 26;

Authors: Shaw TE, Currie GP, Koudelka CW, Simpson EL

Using the 2003 National Survey of Children's Health sponsored by the federal Maternal and Child Health Bureau, we calculated prevalence estimates of eczema nationally and for each state among a nationally representative sample of 102,353 children 17 years of age and under. Our objective was to determine the national prevalence of eczema/atopic dermatitis in the US pediatric population and to further examine geographic and demographic associations previously reported in other countries. Overall, 10.7% of children were reported to have a diagnosis of eczema in the past 12 months. Prevalence ranged from 8.7 to 18.1% between states and districts, with the highest prevalence reported in many of the East Coast states, as well as in Nevada, Utah, and Idaho. After adjusting for confounders, metropolitan living was found to be a significant factor in predicting a higher disease prevalence with an odds ratio of 1.67 (95% confidence interval of 1.19-2.35, P=0.008). Black race (odds ratio 1.70, P=0.005) and education level in the household greater than high school (odds ratio 1.61, P=0.004) were also significantly associated with a higher prevalence of eczema. The wide range of prevalence suggests that social or environmental factors may influence disease expression.Journal of Investigative Dermatology advance online publication, 26 August 2010; doi:10.1038/jid.2010.251.

PMID: 20739951 [PubMed - as supplied by publisher]

The association of dermatitis herpetiformis and systemic lupus erythematosus.

J Am Acad Dermatol. 2010 Aug 23;

Authors: Kurano TL, Lum CA, Izumi AK

Dermatitis herpetiformis (DH) is an immune-mediated cutaneous disease occasionally associated with celiac disease, but rarely associated with systemic lupus erythematosus (SLE). The combination of DH and SLE is immunologically mediated and suggests a relationship between the two conditions. We describe a woman with DH and SLE with a novel HLA phenotype.

PMID: 20739096 [PubMed - as supplied by publisher]

"Car Seat Dermatitis": A Newly Described Form of Contact Dermatitis.

Pediatr Dermatol. 2010 Aug 4;

Authors: Ghali FE

Over the last several years, our clinic has documented an increasing trend of contact dermatitis presenting in areas that are in direct contact with certain types of car seats composed of a shiny, nylon-like material. Our practice has encountered these cases in both atopic and nonatopic infants, with a seasonal predilection for the warmer months. This brief report highlights some of the key features of this condition and alerts the clinician to this newly described form of contact dermatitis.

PMID: 20738797 [PubMed - as supplied by publisher]

Immediate contact skin reactions, an update of Contact Urticaria, Contact Urticaria Syndrome and Protein Contact Dermatitis - "A Never Ending Story"

Eur J Dermatol. 2010 Aug 23;

Authors: Gimenez-Arnau A, Maurer M, De La Cuadra J, Maibach H

Listening and paying attention to our patients is crucial for understanding a disease. A good example is Immediate Contact Skin Reactions (ICSR) which manifest as Contact Urticaria Syndrome (CUS), Contact Urticaria (CU) and Protein Contact Dermatitis (PCD). These entities are characterized by the immediate skin development of itchy flares, wheals, and/or dermatitis. All conditions usually appear within minutes of contact with various substances, including chemicals, animal products, antibiotics, cosmetics, and many other materials. From the clinical and diagnostic viewpoint, the patient's clinical report is critical to its description, definition and classification. Its pathogenesis still remains a challenge and our knowledge of the agents potentially responsible is slowly increasing over time, based on the descriptions of a few isolated cases. This text reviews the classic concepts, introduces new compounds responsible for these immediate skin reactions, and suggests further investigation.

PMID: 20732848 [PubMed - as supplied by publisher]

Narrow band UVB: is it effective and safe for paediatric psoriasis and atopic dermatitis?

J Eur Acad Dermatol Venereol. 2010 Aug 18;

Authors: Pavlovsky M, Baum S, Shpiro D, Pavlovsky L, Pavlotsky F

Abstract Background Phototherapy has a time-honoured place in the treatment of variety of skin diseases in adults. The use of this modality in children is limited mainly due to concerns about long-term carcinogenic potential. Only a few clinical trials have been performed on the efficacy and safety of phototherapy in children. Objectives To determine the efficacy and safety of NB-UVB phototherapy in children with atopic dermatitis (AD) and psoriasis. Methods This is a retrospective review of the treatment outcomes of 129 children with psoriasis and AD, who were treated with NB-UVB between 1998 and 2006 at our institute. Results Fifty per cent of the psoriatic patients and 25% of patients with AD achieved clearance by the end of the treatment. NB-UVB phototherapy was well-tolerated, with no serious adverse effects except one doubtful case of melanoma in situ. Conclusions NB-UVB may be considered as a viable therapeutic option in children with psoriasis and AD. Children who are treated by phototherapy should remain under annual dermatologic observation. To determine true carcinogenic risk of UV therapy, longer follow-up is essential.

PMID: 20726938 [PubMed - as supplied by publisher]