Eczemaletters

Two pediatric cases of nonbullous histiocytoid neutrophilic dermatitis presenting as a cutaneous manifestation of lupus erythematosus.

Jeanne Louw — Fri, 21 Nov 2008 21:21:16 +0000

Two pediatric cases of nonbullous histiocytoid neutrophilic dermatitis presenting as a cutaneous manifestation of lupus erythematosus.

Arch Dermatol. 2008 Nov;144(11):1495-8

Authors: Camarillo D, McCalmont TH, Frieden IJ, Gilliam AE

BACKGROUND: Nonbullous neutrophilic dermatoses are seen infrequently in association with lupus erythematosus (LE). A recently described histopathologic variant of Sweet syndrome, to our knowledge, histiocytoid Sweet syndrome (HSS) has not been described in either pediatric or adult patients with LE. OBSERVATIONS: We describe 2 pediatric patients with nonbullous histiocytoid neutrophilic dermatitis in the setting of LE. One case represents the initial presentation of subacute cutaneous LE, while the other case represents a manifestation of established systemic LE. Both cases demonstrate histopathologic findings of HSS. CONCLUSIONS: We believe that the dermatosis observed in these 2 patients represents a nonbullous histiocytoid neutrophilic dermatosis that is best termed HSS. This entity may represent a distinct and important cutaneous manifestation of LE. Additional study is needed to further elucidate the relationship between neutrophilic dermatitis and LE.

PMID: 19015425 [PubMed - in process]

Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004.

Jeanne Louw — Tue, 18 Nov 2008 21:20:35 +0000

Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004.

J Am Acad Dermatol. 2008 Nov 5;

Authors: Warshaw EM, Buchholz HJ, Belsito DV, Maibach HI, Fowler JF, Rietschel RL, Zug KA, Mathias CG, Pratt MD, Sasseville D, Storrs FJ, Taylor JS, Deleo VA, Marks JG

BACKGROUND: Allergy to cosmetics is common. OBJECTIVES: We sought to characterize patients with positive patch test reactions associated with a cosmetic source, to identify common allergens; and to explore gender and occupational associations. METHODS: We performed a retrospective, cross-sectional analysis. RESULTS: Of 6621 female and 3440 male patients, 1582 female (23.8%) and 611 of male (17.8%) patients had at least one allergic patch test reaction associated with a cosmetic source. Of "allergic" patients (>1 allergic reaction, n = 6815), females were 1.21 times more likely to have an allergic reaction associated with a cosmetic source than were male patients (p < .0001, 95% confidence interval [CI] 1.12-1.31). Within the "cosmetic allergic" group (n = 2243), head and neck involvement was significantly higher in female than in male patients (49.3% vs 23.7%, p < .0001). One hundred twenty-five patients had occupationally related allergic reactions associated with a cosmetic. LIMITATIONS: This study is limited by its cross-sectional, retrospective design. CONCLUSION: Of all patients studied, 21.8% had an allergic reaction associated with a cosmetic. Site of dermatitis, cosmetic categories, and specific allergens differed somewhat by gender.

PMID: 18992965 [PubMed - as supplied by publisher]

Belgian observational drug utilization study of pimecrolimus cream 1% in routine daily practice in atopic dermatitis.

Jeanne Louw — Mon, 10 Nov 2008 21:02:54 +0000

Belgian observational drug utilization study of pimecrolimus cream 1% in routine daily practice in atopic dermatitis.

Dermatology. 2008;217(2):156-63

Authors: De Backer M, Morren MA, Boonen H, Boyden B, Vertruyen A, Lecomte P, Paquay C, Lesaffre E, Lambert J

BACKGROUND: For reimbursement purposes of pimecrolimus cream 1%, the Belgian authorities asked to document its consumption, its topical corticosteroid-sparing effect and quality of life within the routine clinical practice. OBJECTIVES: We aimed to address the 3 queries of the Belgian authorities. METHODS: An open-label, observational, multicentre, 1-year study under drug prescription was performed. RESULTS: A total of 416 consecutive patients were enrolled in 49 centres. The mean annual amount of prescribed pimecrolimus cream 1% per patient was 120.8 g (SD = 117.0), with an estimated consumption of 104.4 g (SD = 117.6). The median annual amount prescribed was 90.0 g [interquartile range (IQR) = 45-150] and the estimated consumption 63.6 g (IQR = 32.4-132). Topical corticosteroids had been used before the study in 81.7% of the population. With pimecrolimus cream 1% during the study, 83.3% of the previous corticosteroid users stated less topical corticosteroid use than before and 36% of them did not apply topical corticosteroids at all during the study. The mean improvements compared to baseline in Parents' Index Quality of Life-Atopic Dermatitis and Quality of Life Index-Atopic Dermatitis scores were 34.5% (SD = 84.3) and 31.2% (SD = 70.8), respectively. The median improvements were 50.0% (IQR = 12.5-85.7%) and 46.4% (IQR = 0.0-85.0%), respectively. CONCLUSIONS: In routine practice the consumption of pimecrolimus cream 1% is relatively low, with corticosteroid-sparing effect, improvement in quality of life and good tolerability.

PMID: 18525202 [PubMed - indexed for MEDLINE]

Prognostic factor of adult patients with atopic dermatitis.

Jeanne Louw — Mon, 10 Nov 2008 21:02:53 +0000

Prognostic factor of adult patients with atopic dermatitis.

J Dermatol. 2008 Aug;35(8):477-83

Authors: Katoh N, Hirano S, Kishimoto S

The increased prevalence of atopic dermatitis (AD) in adults in recent decades suggests that dermatologists may be expected to estimate the prognosis of adult patients with AD when they visit as new patients. We therefore evaluated the change in the extent of involvement and analyzed the factors that contribute to the prognosis of adult AD. A retrospective chart review was performed for 65 adults patients (median age at first visit, 25 years) with AD who had been followed monthly for over 10 years. The median area of involvement at first visit was 19%. The area of the eruptions and peripheral eosinophil counts decreased significantly in the fifth and 10th years with standard treatment. The values of immunoglobulin (Ig)E were also reduced after 10 years. Patients with high values of serum total IgE and peripheral eosinophil count, and long duration of AD had wide areas of eruptions 10 years after the first visit. Total IgE had the highest correlation with area of involvement after 10 years. Although the prognosis of adult AD is not poor, patients with high IgE values are expected to have ongoing eczema with wide distribution after 10 years of follow up.

PMID: 18789066 [PubMed - indexed for MEDLINE]

Possible pathogenic role of Th17 cells for atopic dermatitis.

Jeanne Louw — Tue, 04 Nov 2008 20:56:09 +0000

Possible pathogenic role of Th17 cells for atopic dermatitis.

J Invest Dermatol. 2008 Nov;128(11):2625-30

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.

PMID: 18432274 [PubMed - indexed for MEDLINE]

A role for Th17 cells in the immunopathogenesis of atopic dermatitis?

Jeanne Louw — Tue, 04 Nov 2008 20:56:08 +0000

A role for Th17 cells in the immunopathogenesis of atopic dermatitis?

J Invest Dermatol. 2008 Nov;128(11):2569-71

Authors: Di Cesare A, Di Meglio P, Nestle FO

Atopic dermatitis (AD) is a common inflammatory skin disease. Both epidermal barrier dysfunction and immunodysregulation are suggested to influence the pathogenesis of AD. AD has been considered a paradigmatic T helper cell (Th) 2-mediated disease, with a switch to a Th1 cell environment during the chronic phase of the disease. Previously unreported findings now suggest a possible role for Th17 cells as well.

PMID: 18927538 [PubMed - indexed for MEDLINE]

Contact allergy in chronic eczematous lip dermatitis.

Jeanne Louw — Fri, 31 Oct 2008 20:47:37 +0000

Contact allergy in chronic eczematous lip dermatitis.

Eur J Dermatol. 2008 Oct 27;

Authors: Schena D, Fantuzzi F, Girolomoni G

Chronic eczematous cheilitis comprises a heterogeneous group of disorders, the cause of which often remains obscure. Our object was to investigate the frequency of contact allergy in a cohort of patients with chronic eczematous cheilitis attending a tertiary referral clinic. Patients (106 females and 23 males) with chronic eczematous cheilitis were analyzed retrospectively. All patients were tested with a standard patch test series and a fraction with a dedicated patch test series. Children were also tested with atopy patch tests. Moreover, all patients were investigated for past or current presence of atopic diseases. Patch-test reactions of possible or probable relevance were detected in 84 patients (65.1%; 72 females; median age 40), of uncertain or not relevant significance in 26 (20.1%) and negative in 19 (14.7%). An extended series was necessary to reveal hapten hypersensitivity in 42 patients. The most frequent causes of allergic cheilitis were nickel, fragrances, balsam of Peru, chromium salts and manganese salts, present primarily in cosmetics, dental materials and oral hygiene products. Twenty four patients (18 females; median age 21; 18.6%) were diagnosed as having atopic dermatitis of the lips. Four children had allergic contact cheilitis to haptens or food allergens, whereas six had atopic cheilitis. Twenty one cases (16.3%) were considered irritant contact cheilitis. Allergic contact cheilitis is common in adult patients, with the haptens responsible varying with age. Patients with chronic eczematous cheilitis should undergo extended patch testing.

PMID: 18955202 [PubMed - as supplied by publisher]

Photocontact dermatitis to ketoprofen presenting with erythema multiforme.

Jeanne Louw — Fri, 31 Oct 2008 20:47:36 +0000

Photocontact dermatitis to ketoprofen presenting with erythema multiforme.

Eur J Dermatol. 2008 Oct 27;

Authors: Izu K, Hino R, Isoda H, Nakashima D, Kabashima K, Tokura Y

A 74-year-old Japanese man developed erythema multiforme on the inner aspect of his left elbow where ketoprofen-containing tape was applied and exposed to sunlight, and the eruption subsequently spread to the four limbs and trunk. The lesions were successfully treated with systemic corticosteroids without recurrence. Lymphocyte stimulation tests with ketoprofen-photomodified peripheral blood mononuclear cells revealed that the patient had circulating lymphocytes reactive with a photohaptenic moiety of ketoprofen. To our knowledge, this is the first case of erythema multiforme induced by photocontact dermatitis. The presence of circulating photoantigen-reactive T cells seemed to induce erythema multiforme as an unusual manifestation in this patient.

PMID: 18955208 [PubMed - as supplied by publisher]

Occupational carprofen photoallergic contact dermatitis.

Jeanne Louw — Sat, 25 Oct 2008 20:15:39 +0000

Occupational carprofen photoallergic contact dermatitis.

Br J Dermatol. 2008 Sep 25;

Authors: Kerr AC, Muller F, Ferguson J, Dawe RS

Background The nonsteroidal anti-inflammatory drug carprofen was used in humans in the 1980s, before its withdrawal due to adverse effects. It re-emerged for veterinary uses, for which it is still widely prescribed, in the 1990s. There has been one previous report published of photoallergic contact dermatitis (PACD) in a pharmaceutical factory worker exposed to carprofen. Objectives Investigation of carprofen as a cause of PACD in pharmaceutical factory workers presenting with facial dermatitis. Methods Photopatch testing to carprofen dilutions in two pharmaceutical factory workers and three healthy volunteer controls using the European consensus methodology. This was followed by testing of eight further employees, referred by occupational health services, in the same factory. Results The index patient suspected a problem with carprofen and was found to have PACD to carprofen. The second patient presented with a widespread, although especially photoexposed site, dermatitis and was initially labelled as having an 'unclassified dermatitis'. Only subsequently was her exposure (indirect; she did not work in the packaging section of the factory like the first patient) to carprofen recognized and testing confirmed both contact allergy and PACD to carprofen. One of three healthy volunteer controls had an active photoallergy sensitization event to carprofen starting 10 days after photopatch testing. Three of eight factory employees subsequently referred because of skin problems had carprofen PACD. Conclusions Carprofen is a potent photoallergen. These cases emphasize the importance of photopatch testing, and considering agents not included in standard series, when investigating patients presenting with a photoexposed site dermatitis.

PMID: 18945311 [PubMed - as supplied by publisher]

Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis.

Jeanne Louw — Sat, 25 Oct 2008 20:15:39 +0000

Elevation of IgA anti-epidermal transglutaminase antibodies in dermatitis herpetiformis.

Br J Dermatol. 2008 Jul;159(1):120-4

Authors: Hull CM, Liddle M, Hansen N, Meyer LJ, Schmidt L, Taylor T, Jaskowski TD, Hill HR, Zone JJ

BACKGROUND: Dermatitis herpetiformis (DH) is a papulovesicular eruption caused by ingestion of gluten. It is characterized by the deposition of IgA in the dermal papillae. IgA antibodies directed at tissue transglutaminase (TG2) are elevated in gluten-sensitive diseases including DH and coeliac disease (CD). More recently, antibodies directed at epidermal transglutaminase (TG3) were identified in patients with DH, and this may be the dominant autoantigen in this disease. OBJECTIVES: To measure IgA antibodies to TG3 and TG2 in patients with DH and CD, and control populations. METHODS: Serum IgA antibodies against TG2 and TG3 were measured from adults with DH, adults and children with CD, patients with psoriasis, adult Red Cross blood donors, and paediatric controls. RESULTS: Patients with DH and CD had elevated levels of IgA anti-TG2 antibodies compared with control populations. The levels in the patients with DH and adults with CD were similar. IgA anti-TG2 antibodies were higher in the children with CD compared with adults with DH and CD, and with control populations. Patients with DH and adults with CD had elevated levels of IgA anti-TG3 antibodies compared with children with CD and control populations. There was a trend towards higher levels in the patients with DH compared with adults with CD. CONCLUSIONS: IgA antibodies to TG3 are elevated in patients with DH and adults with CD. The progressive expansion of the epitope-binding profile of IgA antitransglutaminase antibodies in patients with CD may explain the development of DH in patients with undiagnosed CD during their adult life.

PMID: 18503599 [PubMed - indexed for MEDLINE]