Specificity of dermal mucin in the diagnosis of lupus erythematosus: comparison with other dermatitides and normal skin

Increased dermal mucin is a feature of lupus erythematosus (LE); however, its amount and distribution have not been well characterized. The differentiation of LE from other forms of dermatitis can be challenging when other features of LE are subtle or equivocal. One hundred and thirty‐five skin specimens showing LE, graft vs. host disease, erythema multiforme/fixed drug eruption, lichen planus, polymorphous light eruption (PMLE), urticaria, eczematous dermatitis and psoriasis and normal skin with and without photodamage were collected. The amounts of mucin in the papillary, superficial reticular and deep reticular dermis were scored from 0 to 3 on hematoxylin–eosin (H&E) and alcian blue (AB) stains, and compared between groups. The mean scores in the reticular dermis were significantly higher in LE than in other categories except PMLE and eczematous dermatitis. A combined H&E + AB score of ≥5 in the superficial reticular dermis gave an overall specificity of 85.7% for LE. Mucin in the papillary dermis failed to distinguish among entities. Normal photodamaged skin showed significantly more mucin in the superficial reticular dermis compared to non‐photodamaged skin. While LE is associated with increased mucin deposition, scant to moderate amount of mucin alone has limited specificity and is common in other dermatitides or photodamaged skin.     

Chronic actinic dermatitis. Concept and case examples]

Two women patients with chronic eczematous dermatitis, who also developed extremely severe, persistent photosensitivity during a course of 10 and over 40 years, are presented. Both patients had an atopic history with positive immediate skin reactions. Patch and photopatch tests revealed sensitization to several contact allergens, and in one case also a photocontact allergy. The action spectrum of the photosensitivity was confined to UV-B; it was possible to provoke eczematous skin reactions with doses smaller than 1 mJ/cm2 UV-B. Both patients were successfully treated with PUVA therapy. These case reports demonstrate the difficulty of nosological classification of chronic eczematous photosensitive dermatoses under the traditional terms persistent light reaction, photosensitive eczema, photosensitivity dermatitis, and actinic reticuloid. Chronic actinic dermatitis is defined clinically by chronic dermatitis on skin exposed to sun, histologically by spongiotic dermatitis, and photobiologically by experimental provocation of spongiotic dermatitis with UV-B and often also longer wavelengths in the absence of a photoallergen. Chronic actinic dermatitis should be used as a general term in addition to the more specific terms listed above.     

Efficacy and safety of topical halometasone in eczematous dermatoses in Indian population: an open label, noncomparative study

Background:

Topical steroids remain the mainstay of treatment in eczema, an inflammatory skin reaction characterized by pruritus, redness, scaling, and clustered oozing papulovesicles. Halometasone is a new potent corticosteroid approved in the Indian market for topical application in the treatment of dermatitis.

Aims:

To evaluate the efficacy and safety of halometasone in the treatment of acute or chronic noninfected eczematous dermatosis in Indian population.

Materials and Methods:

A prospective, open, multicentric, phase 3, noncomparative clinical trial conducted at outpatient departments of seven centres. Two hundred endogenous eczema patients meeting study criteria were enrolled. Halometasone 0.05% cream was applied twice daily for 30 days in chronic and 20 days in acute eczema patients. Calculation of eczema area and severity index, and assessment of investigator''s global assessment of severity of eczema and severity of pruritus score were done at each visit and compared with baseline. All adverse events (AE) were captured and documented. Laboratory investigations including haematological tests, urinalysis, renal and liver function tests were performed at baseline and at end of treatment.

Results:

Of the 200 patients enrolled, 180 were chronic and 20 were acute eczema patients. It was found that there was a significant (P<0.001) improvement in all efficacy parameters compared with baseline. The treatment was shown to be successful in 91% patients. AE were reported in 30 patients and there was no serious AE reported. There was no clinically significant difference in laboratory investigations with treatment.

Conclusions:

Halometasone was shown to be safe and very effective in Indian patients with acute and chronic eczema and the drug was well tolerated.     

皮炎湿疹类疾病规范化诊断术语专家共识

【摘要】 针对皮炎湿疹类疾病在概念、分类和诊断术语等方面的混乱现状,中华医学会皮肤性病学分会免疫学组、中国医师协会皮肤科医师分会指南制定与规范委员会组织专家按照德尔菲法原则对皮炎湿疹类疾病的诊断现状及存在问题进行讨论,提出7条规范化诊断建议,主要包括：①“皮炎”和“湿疹” 是疾病的类别名称而非具体诊断术语;②临床遇到湿疹性皮损时,应积极寻找其临床特征和/或实验室特点,按照特应性皮炎、接触性皮炎和其他皮炎进行分类诊断;③建议暂时保留“湿疹”这一术语,并只用作以湿疹性皮损为表现但尚不能给出确定诊断的、暂时性和描述性诊断用词。本共识旨在推动皮炎湿疹类疾病诊断术语的规范化、同质化,为更好地进行疾病管理、流行病学研究和开展个体化治疗和预防奠定基础。     

Correlation of nipple eczema in pregnancy with atopic dermatitis in Northern India: a study of 100 cases

BackgroundNipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis.ObjectiveTo evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis.MethodsThis was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis.ResultsOut of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant.Study limitationsLack of long term follow-up and no large studies in literature to compare results.ConclusionNipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.     

Inability to Produce White Dermographism in the Early Stage of Infantil Eczema

Abstract: White dermographism constitutes an abnormal vascular reaction characteristically demonstrable in atopic dermatitis; however, there is no information about it in the infantile phase of atopic dermatitis. Therefore we examined 73 infants younger than 3 years of age with eczematous dermatitis for the demonstrablity of white dermographiam after mechanical strocking of the lesional skin. None of the 40 healthy control infants showed white dermographism on their normal skin. In contrast, an age-dependent increase was demonstrated in patients with infantile eczema, from 11% in those 1 to 2 months of age to 85% in those older than 7 months. There was no correlation between the demonstrabllity of white dermographism in early infancy and the prognosls of infantile eczema. Based on our study of various types of dermatitis experimentally induced in adult volunteers, we think that, in addition to the immaturity of infantile skin, the presence of acute dermatitic changes may be related to Inabllity to demonstrate with dermographism in the early phase of infantile eczema.     

Expression of CD30 on T helper cells in the inflammatory infiltrate of acute atopic dermatitis but not of allergic contact dermatitis

Abstract  The CD30 molecule has been proposed as a marker for a subset of CD4⁺CD45RO⁺ (memory) T cells with potent B cell helper activity producing IL-5 and IFN-γ and as a specific marker for Th2 cells. Recently, an association has been demonstrated between elevated serum levels of soluble CD30, which is shed by CD30⁺ cells in vitro and in vivo, and atopic dermatitis but not respiratory atopic disorders or allergic contact dermatitis. We studied the expression of CD30 in the inflammatory infiltrate of atopic dermatitis compared with that of allergic contact dermatitis, with special regard to skin disease activity (acute vs subacute/ chronic). Biopsies were obtained from 16 patients suffering from atopic dermatitis (acute n = 6, subacute/ chronic n = 10), from 7 patients with acute allergic contact dermatitis and from 5 positive patch-test reactions. Paraffin-embedded as well as snap-frozen material was stained with anti-CD30 and anti-CD45RO mAbs according to standard procedures. Double-staining procedures for CD30CD3, CD30CD4, CD30CD45RO and CD30CD68 were also performed. Abundant CD45RO⁺ cells were detected both in atopic dermatitis and in allergic contact dermatitis lesions. We found scattered CD30⁺ cells in only one of six formalin-fixed paraffin-embedded acute atopic dermatitis biopsies, but in all of the respective snap-frozen specimens, possibly because CD30 expression on atopic dermatitis infiltrating cells is weak and sensitive to formalin fixation and paraffin embedding. CD30CD3 and CD30CD4 double staining identified CD30⁺ cells to be helper T lymphocytes. No significant CD30 expression (either in paraffin-embedded or in frozen material) could be found in subacute/chronic atopic dermatitis lesions or in any of the specimens of allergic contact dermatitis. The results suggest a specific regulatory function of CD30⁺ T cells in acute atopic dermatitis. With respect to the view that CD30 is a marker for Th2 cells, our observations confirm previous findings that Th2 cells predominate in the infiltrate particularly of acute atopic dermatitis. CD30 expression in acute atopic dermatitis but not in acute allergic contact dermatitis might be helpful in the histological differentiation of these disorders and in the further characterization of atopy patch testing. Received: 1 April 1998 / Received after revision: 28 May 1998 / Accepted: 3 July 1998     

Psoriasin在亚急性和慢性湿疹中的表达

目的研究Psoriasin(S100A7)蛋白在亚急性和慢性湿疹中的表达。方法用免疫组化SP法检测正常皮肤组织、亚急性和慢性湿疹皮损中Psoriasin蛋白的表达变化。结果 Psoriasin蛋白不表达于正常皮肤组织;在亚急性湿疹中,Psoriasin蛋白表达于角质层及棘层上1～5层,基底层无表达;在慢性湿疹中,可见Psoriasin蛋白表达于角质层及棘层全层,而不表达于基底层;在慢性湿疹和亚急性湿疹中,Psoriasin的水平均显著高于正常皮肤组织(P<0.05);Psoriasin蛋白水平在慢性湿疹中高于亚急性湿疹(P<0.05)。结论 Psoriasin可能参与慢性湿疹和亚急性湿疹的发病,且两者的炎症程度相关。     

Indications for referral to a skin allergy unit

Contact dermatitis is one of the most common reasons for consultation in dermatology. However, general dermatologists do not always appreciate the importance of patch testing. These tests should ideally be performed in specialist skin allergy units, most importantly in cases suggestive of contact dermatitis, severe acute dermatitis, chronic persistent dermatitis, and dermatitis affecting the eyelids, genital region or adjacent to venous ulcers. Eczematous changes in pre-existing skin lesions or lesions at atypical sites in patients diagnosed with atopic eczema should also be investigated. Finally, cases diagnosed as occupational dermatitis can be best managed by the workers' health insurance scheme.     

Histopathologic findings in lupus erythematosus tumidus: review of 80 patients

BACKGROUND: In a recent study, we demonstrated that lupus erythematosus (LE) tumidus (LET) is a distinct subset of cutaneous LE (CLE), which is clinically characterized by erythematous, urticaria-like, nonscarring plaques in sun-exposed areas. OBJECTIVE: Our purpose was to analyze skin biopsy specimens from 80 patients with this disease and to determine whether it could be differentiated from other variants of CLE on histopathologic grounds. METHODS: Skin biopsy specimens from 53 primary and 38 UVA- and/or UVB-induced lesions of 80 patients with LET were examined and compared with skin biopsy specimens from patients with discoid LE (DLE) and subacute CLE (SCLE). RESULTS: Specimens from LET lesions showed a characteristic and diagnostic pattern of perivascular and periadnexal cellular infiltrates in the papillary and reticular dermis composed almost entirely of lymphocytes. In some cases, few scattered neutrophils were present. Furthermore, interstitial mucin deposition was observed in all specimens, as confirmed by colloidal iron staining. In contrast to discoid LE and subacute CLE lesions, epidermal atrophy or alteration at the dermoepidermal junction was not detected. CONCLUSION: Skin lesions of patients with LET present with specific histopathologic features, and the differences compared with subacute CLE and discoid LE further support the concept to consider LET as a separate entity of CLE.     

非特应性的湿疹皮炎患者皮肤马拉色菌携带情况

为探讨非特应性的湿疹皮炎患者皮肤马拉色菌携带情况，选取非特应性的温疹皮炎患者，参照Faergemann的方法取材，采用马拉色菌培养基培养。结果急性及慢性湿疹皮炎患者非脂溢部位皮损马拉色菌检出率显著高于正常人非脂溢部位，接触性皮炎及未分类湿疹患者非脂溢部位皮损马拉色菌检出率也显著高于正常人非脂溢部位。自身对照研究发现，慢性湿疹皮炎患者非脂溢部位皮损马拉色菌检出率显著高于自身正常非脂溢部位。结论示马拉色菌可能与一部分非特应性的湿疹皮炎有一定关系。     

Papular dermatitis (subacute prurigo, “itchy red bump” disease): Pilot study of phototherapy

Background: Some patients with a subacute or chronic pruritic erythematous papular eruption are refractory to treatment. We previously described a number of these patients with papular dermatitis or subacute prurigo. Objective: The purpose of this study was to examine the effectiveness of different types of phototherapy for treatment of papular dermatitis. Methods: We reviewed the medical records of 11 patients who were diagnosed with papular dermatitis and who underwent phototherapy within the last 5 years. Results: Eleven patients had a total of 17 phototherapy courses: psoralen–UVA (PUVA; 9), UVA/UVB light (3), and UVB alone (5). Within the PUVA treatment group, three of nine patients experienced total clearing, and six of nine patients experienced partial improvement. Although patients in all groups relapsed with time, overall the PUVA-treated patients had the best response rate and the best chance of the condition remaining clear after treatment was stopped. Conclusion: PUVA may be an effective treatment for papular dermatitis. The frequency of relapse indicates that maintenance treatments may be necessary for long-term control of the disease. (J Am Acad Dermatol 1998;38:929-33.)     

湿疹患者血清中IL-10,IL-12p40及IL-18水平检测

目的观察湿疹患者血清IL-10,IL-12p40及IL-18的水平,探讨其在湿疹发病机制中的作用和临床意义。方法应用酶联免疫吸附试验(ELISA)法分别检测14例急性期湿疹患者、19例非急性期湿疹患者和15例正常对照者血清中IL-10,IL-12p40及IL-18的水平。结果①血清IL-10水平急性湿疹组低于对照组,非急性湿疹患者组高于对照组(P<0.05)。②血清IL-12p40水平急性湿疹组与非急性湿疹组均高于对照组,且非急性湿疹组高于急性湿疹组(P<0.05)。③血清IL-18水平急性湿疹组与非急性湿疹组均高于对照组(P<0.05),急性湿疹组与非急性湿疹组差异无显著性意义(P>0.05)。结论湿疹患者体内可能存在Th1/Th2型细胞因子分泌紊乱。     

Dermal mucinosis as a sign of venous insufficiency

Dermal mucinoses are a heterogeneous group of disorders characterized by abnormal deposition of dermal mucin, an amorphous substance composed of hyaluronic acid and sulfated glycosaminoglycans. We describe two cases of dermal mucinosis in the setting of chronic venous insufficiency. Both patients presented with painful, edematous lower extremity plaques. Biopsies of all lesions showed striking dermal mucin deposition, a slight increase in small blood vessel density, slightly thickened vessel walls and no inflammation. Neither patient showed laboratory or clinical findings consistent with a secondary mucinosis such as thyroid dysfunction, lupus erythematosus, dermatomyositis, scleroderma, granuloma annulare, graft‐vs.‐host disease or mucin deposition post‐ultraviolet or photochemotherapy treatment. Both patients were diagnosed with localized cutaneous mucinosis secondary to venous insufficiency. The clinicopathological features of this entity are described, and a pathogenic mechanism is proposed. Pugashetti R, Zedek DC, Seiverling EV, Rajendran P. Berger T. Dermal mucinosis as a sign of venous insufficiency.     

Eczema herpeticatum

Patients affected by atopic dermatitis tend to develop viral infections. Probably the most feared complication of atopic dermatitis is eczema herpeticum, a disseminated infection with herpes simplex virus. A monomorphic eruption of dome-shaped blisters, pustules and erosions in the eczematous skin lesions along with severe systemic illness leads to the diagnosis. The clinical diagnosis may be confirmed by polymerase chain reaction, viral culture, electron microscopy with negative staining, Tzanck test, immunofluorescence tests or serology. While intravenous acyclovir is still regarded as standard treatment of eczema herpeticum, several recently-developed antiviral drugs provide therapeutic options.     

Delayed contact allergies in patients with photosensitivity dermatitis

Delayed contact allergies and the clinical course of the skin disease were investigated in 14 patients with photosensitivity dermatitis/actinic reticuloid and 145 patients with polymorphous light eruption type eczema. Hypersensitivity to chromium and rubber chemicals was encountered in photosensitivity dermatitis more often than in polymorphous light eruption eczema and in the comparison series of 1714 patients with other types of dermatitis. In the eczema group, delayed contact allergies to chromium, rubber chemicals, neomycin, clioquinol, balsam of Peru, fragrance and colophonium were more frequent than in the comparison group, suggesting that at least delayed contact allergy to chromium and rubber chemicals may be of significance in the development of photosensitivity in many patients who suffer eczematous reaction to sunlight.     

2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema

BackgroundHand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients'' quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options.ObjectiveThese consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions.MethodsA modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel.ResultsConsensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed.ConclusionThese are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.     

Usefulness of skin-prick tests in children with hand eczema: comparison with their use in childhood and adult eczema

BackgroundHand eczema is not uncommon in children but it is rarely studied using skin-prick tests. Few reports have addressed their usefulness in children and none has specifically analyzed their use in children with hand eczema.Material and methodsWe performed a retrospective study of all children up to 16 years of age with hand eczema who were assessed in the Department of Dermatology at Hospital General Universitario in Alicante, Spain with the standard GEIDAC panel over a 5-year period. We compared the epidemiologic data and results of skin-prick tests in this group with those obtained in children with eczema at any site and in adults with hand eczema.ResultsThe study included a total of 1695 patients: 141 (8.3%) children and 1533 (91.7%) adults. Hand eczema was diagnosed in 496 (31.9%) adults and 32 (22.7%) children. Positive results were obtained in skin-prick tests in 50% of children with hand eczema compared with 37.6% of children with eczema at any site and 50.6% of adults with hand eczema. The current relevance of the positive allergens found in children with hand eczema (76.2%) was greater than that observed in children with eczema at any site (61%) or in adults with hand eczema (43%). The most common allergens in children with hand eczema were kathon CG and fragrance mix I, whereas in the other 2 groups metals were the most common. The most common final diagnosis in children with hand eczema was allergic contact dermatitis (34.3%), which proved to be more common than atopic dermatitis.ConclusionsWe recommend the use of skin-prick tests in all children with chronic hand eczema.     

Two Cases of Infective Endocarditis in Patients with Atopic Dermatitis

Patients with atopic dermatitis have high rates of skin surface colonization of Staphylococcus aureus. At the same time, S. aureus is the major causative organism in infective endocarditis, approximately accounting for 30%~50% cases of infective endocarditis. A 22-year-old male with severe atopic dermatitis presented with fever and myalgia. He was diagnosed with active infective endocarditis causing multiple cerebral infarction, splenic infarction, and septic shoulder requiring synovectomy. Blood culture proved methicillinsensitive Staphylococcus aureus bacteremia, and the culture from the skin revealed same bacteria. After treated with intravenous antibiotics for 6 weeks, patient was improved. Another 42-year-old female with severe atopic dermatitis who presented with fever and chilling was hospitalized due to acute infective endocarditis. She also had left flank pain and visual disturbance, due to splenic infarction and acute cerebral infarction, respectively. As blood culture revealed methicillin-sensitive Staphylococcus aureus bacteremia, she treated with intravenous antibiotics for 6 weeks. The route of entry of two patients was attributed to the patient eczematous scratching lesion of poorly controlled atopic dermatitis. Infective endocarditis can result in the context of acute deterioration of atopic dermatitis. Dermatologists need to pay attention to this risk and actively manage such conditions in order to decrease the risk of infective endocarditis arising from skin lesions in atopic patients. For these reasons, we herein report two cases of infective endocarditis in patients with atopic dermatitis.