Biophysical characteristics of healthy skin and nonlesional skin in atopic dermatitis: short-term effects of ultraviolet A and B irradiation

The present study was designed to evaluate basic differences in surface structure and viscoelastic properties of nonatopic versus atopic skin and facultative acute changes following ultraviolet irradiation. Therefore, biophysical measurements by means of profilometry and cutometry were carried out on sun-protected unaffected gluteal skin areas in both groups before and 24 h after single UVA and UVB irradiations. The results indicate that the clinically unaffected skin of patients with atopic eczema differs from normal skin in terms of increased roughness parameters, but not concerning depth of furrows or viscoelastic properties (viscosity and biological elasticity, cutometrically calculated). Single UVA irradiation with 50 J/cm(2) induced neither measurable changes in the skin's surface structure nor in its viscoelastic properties in both groups after 24 h. However, irradiation with a single erythemogenic dose of 1 MED UVB was followed by a short-term significant increase in the depths of furrows and decrease in biological elasticity in normal and atopic skin, accompanied by an increase in viscosity in normal skin.     

富含亚油酸-神经酰胺的保湿剂在特应性皮炎鼠模型中的作用研究

目的：明确外用富含亚油酸-神经酰胺（Linoleic acid-ceramide, LA-Cer）的保湿剂对特应性皮炎（AD）鼠模型皮肤炎症和屏障的影响。方法：将18只BALB/c小鼠分为疾病组、治疗组和对照组,每组6只。疾病组以卡泊三醇（MC903）涂抹小鼠耳朵2周,诱导特应性皮炎模型;治疗组在诱导特应性皮炎的同时外用富含LA-Cer的保湿剂;对照组以无水乙醇外涂小鼠耳朵。比较各组间临床表型、组织病理、皮肤水含量的改变,通过实时荧光定量PCR检测炎症相关因子（TSLP,IL-4,IL-10,IL-1β,IL-33,IFNγ）的表达。结果：卡泊三醇诱导出较典型的小鼠AD模型。治疗组的鼠耳厚度（0.375±0.015）cm较疾病组（0.510±0.035）cm改善,治疗组皮肤含水量（22.500±2.081）au较疾病组（6.750±1.258）au高。与疾病组比较,治疗组皮损中炎症因子TSLP和IL-1β的表达含量明显降低。结论：外用富含LA-Cer的保湿剂可以减轻卡泊三醇诱导的特应性皮炎小鼠模型皮肤炎症,修护皮肤屏障。     

保湿剂并用糖皮质激素治疗异位性皮炎的疗效观察

目的：研究保湿剂对外用糖皮质激素治疗异位性皮炎疗效的影响。方法：通过随机对照临床研究，采用湿疹面积及严重度指数评分法，对外用糖皮质激素和保湿剂治疗45例轻中度异位性皮炎患者的临床疗效进行评估。结果：与单独外用糖皮质激素或保湿剂相比，联合外用糖皮质激素加保湿剂治疗轻、中度异位性皮炎，较单用糖皮质激素疗效显著，单独外用保湿剂可明显减轻轻中度异位性皮炎患者的临床症状。结论：外用保湿剂能增强局部糖皮质激素的疗效，单独外用保湿剂治疗异位性皮炎可获得与糖皮质激素相近的疗效。     

A randomized half-body,double blind,controlled trial on the effects of a pH-modified moisturizer vs. standard moisturizer in mild to moderate atopic dermatitis

BackgroundHigher skin pH in atopic dermatitis contributes to impaired epidermal barrier. A moisturizer compatible with physiological pH could improve atopic dermatitis.ObjectiveTo determine the effect of a physiologically compatible pH moisturizer in atopic dermatitis.MethodsA randomized half body, double blind, controlled trial involving patients with stable atopic dermatitis was performed. pH-modified moisturizer and standard moisturizer were applied to half body for 6 weeks.ResultsA total of 6 (16.7%) males and 30 (83.3%) females participated. Skin pH reductions from week 0, week 2 and 6 were significant at the forearms (5.315 [0.98] to 4.85 [0.54] to 5.04 [0.78], p = 0.02) and abdomen (5.25 [1.01], 4.82 [0.64], 5.01 [0.59], p = 0.00) but not at the shins (5.01 [0.80], 4.76 [0.49], 4.85 [0.79], p = 0.09) with pH-modified moisturizer. Transepidermal water loss (TEWL) at the forearms decreased (4.60 [2.55] to 3.70 [3.10] to 3.00 [3.55], p = 0.00), abdomen (3.90 [2.90] to 2.40 [3.45] to 2.70 [2.25], p = 0.046). SCORAD improved from 14.1 ± 12.75 to 10.5 ± 13.25 to 7 ± 12.25, p = 0.00. In standard moisturizer group, pH reductions were significant at the forearms (5.29 [0.94] to 4.84 [0.55] to 5.02 [0.70], p = 0.00) and abdomen (5.25 [1.09], 4.91 [0.63], 5.12 [0.66], p = 0.00). TEWL at the forearm were (4.80 [2.95], 4.10 [2.15], 4.60 [3.40], p = 0.67), shins (3.80 [1.40], 3.50 [2.35], 4.00 [2.50], p = 0.91) and abdomen (3.70 [2.45], 4.10 [3.60], 3.40 [2.95], p = 0.80). SCORAD improved from 14.2 ± 9.1 to 10.9 ± 10.65 to 10.5 ± 11, p = 0.00. Reduction in pH was observed with both moisturizers while TEWL significantly improved with pH-modified moisturizer. pH-modified moisturizer resulted in greater pH, TEWL and SCORAD improvements however the differences were not significant from standard moisturizer.Study limitationSkin hydration was not evaluated.ConclusionMoisturization is beneficial for atopic dermatitis; use of physiologically compatible pH moisturizer is promising.     

A double-blind study of tolerance and efficacy of a new urea-containing moisturizer in patients with atopic dermatitis

Background  Atopic dermatitis patients almost all use moisturizers to prevent and treat their skin disease. However, the safety and efficacy of moisturizers are rarely studied in this patient population.
Aims  To evaluate the efficacy and tolerability of urea-containing moisturizers in subjects with atopic dermatitis.
Methods  One hundred subjects with atopic dermatitis were randomized to apply either a new 5% urea moisturizer or a commercially available 10% urea lotion twice a day for 42 days. Scoring Atopic Dermatitis severity index (SCORAD) was performed at Day 0 and Day 42. Cosmetic acceptability questionnaires, adverse events, and a 5-point tolerance evaluation were administered or performed at Day 42.
Results  Both study products were very well tolerated by subjects and only three subjects discontinued their participation in the study due to adverse events. Mean SCORAD significantly decreased between Day 0 and Day 42 by 19.76% and 19.23%, respectively, for subjects treated with the new 5% urea moisturizer or the 10% urea lotion ( P  < 0.001). There was no difference between the two products in SCORAD reduction; however, significantly more subjects preferred using the new 5% urea moisturizer as compared with the 10% urea lotion.
Conclusions  Both the new 5% urea moisturizer and the 10% urea lotion improved atopic dermatitis and were very well tolerated. However, the cosmetic acceptability questionnaire showed that subjects preferred using the new 5% urea moisturizer over the 10% urea lotion.     

特应性皮炎与皮肤微生物态的关系

特应性皮炎是一种慢性、周期性、瘙痒性皮肤病。近年来,我国患病人数迅速上升,尽管越来越多的人深受其困扰,但目前病因尚不清楚,近年来发现皮肤微生物态对全身免疫功能及局部皮肤免疫功能有影响,皮肤屏障完整性的改变会导致皮肤微生物多样性的改变和皮肤菌群的紊乱,诱发并加重特应性皮炎。特应性皮炎的患者与健康人相比,发生皮肤感染的风险也更高。因此,特应性皮炎与皮肤微生物态的关系也成为近年来研究的热点。     

中间丝蛋白与特应性皮炎皮肤屏障功能

特应性皮炎的病因复杂,发病机制尚未明确,可能是遗传、环境、皮肤屏障功能缺陷及免疫相互作用的结果.中间丝蛋白基因是表皮分化复合物基因簇的成员之一,与细胞膜形成及表皮终末分化密切相关.中间丝蛋白基因突变是特应性皮炎发病的重要易患因素之一,中间丝蛋白的减少和缺失,可能是引起特应性皮炎等十燥性皮肤病的主要原因.     

特应性皮炎的部位异质性

特应性皮炎（AD）是一种高度异质性皮肤病,以往在年龄、严重度、炎症模式等方面的分型较为成熟,而对不同部位皮损特征的关注较少。最近发现不同部位AD对度普利尤单抗治疗的应答存在差异,表明不同部位皮损可能具有不同的炎症模式。因此本文提出AD部位异质性的概念,结合生理条件下不同部位皮肤的细胞生物学和微生态特点,分析不同部位AD...     

Skin absorption through atopic dermatitis skin: a systematic review

Patients with atopic dermatitis (AD) have skin barrier impairment in both lesional and nonlesional skin. They are typically exposed daily to emollients and intermittently to topical anti‐inflammatory medicaments, thereby increasing the risk of developing contact allergy and systemic exposure to chemical ingredients found in these topical preparations. We systematically searched for studies that investigated skin absorption of various penetrants, including medicaments, in patients with AD, but also in animals with experimentally‐induced dermatitis. We identified 40 articles: 11 human studies examining model penetrants, 26 human studies examining AD drugs, and three animal studies. We conclude that patients with AD have almost twofold increased skin absorption compared with healthy controls. There is a need for well‐designed epidemiological and dermatopharmacokinetic studies that examine to what extent AD causes patients to be systemically exposed to chemicals compared with nonatopic dermatitis.     

Mast cells and atopic dermatitis. Stereological quantification of mast cells in atopic dermatitis and normal human skin

Stereological quantification of mast cell numbers was applied to sections of punch biopsies from lesional and nonlesional skin of atopic dermatitis patients and skin of healthy volunteers. We also investigated whether the method of staining and/or the fixative influenced the results of the determination of the mast cell profile numbers. The punch biopsies were taken from the same four locations in both atopic dermatitis patients and normal individuals. The locations were the scalp, neck and flexure of the elbow (lesional skin), and nates (nonlesional skin). Clinical scoring was carried out at the site of each biopsy. After fixation and plastic embedding, the biopsies were cut into 2 μm serial sections. Ten sections, 30 μm apart, from each biopsy were examined and stained alternately with either toluidine blue or Giemsa stain and mast cell profile numbers were determined. The study yielded the following results: (1) in atopic dermatitis lesional skin an increased number of mast cell profiles was found as compared with nonlesional skin, (2) comparing atopic dermatitis skin with normal skin, a significantly increased number of mast cell profiles per millimetre squared was found in specimens from the neck, (3) staining with toluidine blue yielded a lower number of mast cell profiles than Giemsa staining, (4) the use of Carnoy’s fixative resulted in a lower mast cell profile count than the use of formaldehyde, and (5) there was no statistically significant correlation between the clinical score and the number of mast cell profiles per millimetre squared. Using stereological techniques, this study indicated that mast cells might participate in the inflammatory process in skin leading to atopic dermatitis. Received: 17 April 1996     

The lack of a relationship between atopic dermatitis and nonmelanoma skin cancers

BACKGROUND: Very little has been published on whether a relationship exists between atopic dermatitis (AD) and skin cancer. OBJECTIVE: The goal of this study was to investigate whether individuals with AD are more likely than other patients with dermatologic conditions to develop nonmelanoma skin cancer. METHODS: This was a case-control, mailed-survey study. RESULTS: Of those contacted, 69.8% (3207 of 4591) filled out the survey. Of the control patients, 18.4% (254) had a history of AD as defined by the United Kingdom Working Party diagnosis criteria and composed 13.7% (210) of the cases. The unadjusted odds ratio of AD to nonmelanoma skin cancer was 0.70 (95% confidence interval 0.57-0.85). After fully adjusting for age, sex, ethnicity, and topical steroid use the odds ratio was 0.78 (0.61, 0.98). Using different definitions of AD had little effect on this result. CONCLUSIONS: It does not appear that patients with a history of AD are more likely to develop nonmelanoma skin cancers than other patients with dermatologic conditions.     

Antimicrobial peptides, skin infections, and atopic dermatitis

The innate immune system evolved more than 2 billion years ago to first recognize pathogens then eradicate them. Several distinct defects in this ancient but rapidly responsive element of human immune defense account for the increased incidence of skin infections in atopics. These defects include abnormalities in the physical barrier of the epidermis, alterations in microbial pattern recognition receptors such as toll receptors and nucleotide binding oligomerization domains, and a diminished capacity to increase the expression of antimicrobial peptides during inflammation. Several antimicrobial peptides are affected including; cathelicidin, HBD-2, and HBD-3, which are lower in lesional skin of atopics compared with other inflammatory skin diseases, and dermcidin, which is decreased in sweat. Other defects in the immune defense barrier of atopics include a relative deficiency in plasmacytoid dendritic cells. In the future, understanding the cause of these defects may allow therapeutic intervention to reduce the incidence of infection in atopic individuals and potentially decrease the severity of this disorder.     

Impaired skin barrier and atopic diathesis in perioral dermatitis

Background: Perioral dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. We investigated skin barrier function and various markers of the atopic diathesis to elucidate their impact on the development of perioral dermatitis. Patients and methods: Forty patients (24 to 69 years of age) with PD were evaluated. Transepidermal water loss was measured in three regions of the face (lateral chin, perinasal cheek and side of the nose) and the patients were assessed for clinical criteria for atopy. Prick tests were performed, and specific IgE against a mixture of aeroallergens (CAP SX1) was measured. The control group consisted of 62 individuals (20 to 68 years of age) without a history of PD or active disease. Results: Transepidermal water loss was significantly increased (P < 0.001) on all regions of the face in the patient over the control group. Significantly (P < 0.001) higher values were also found for the patient group regarding history (52.5 % vs. 17.7 %) and clinical signs of atopic diathesis (≥ 4 features: 72.5 % vs. 0 %), prick test reactivity (≥ 2 reactive prick tests: 60 % vs. 12.9 %), and specific IgE against aeroallergens (CAP SX1 classes ≥ 2: 60.0 % vs. 17.7 %). Conclusions: Our findings emphasize the relevance of impaired skin barrier function as a pathogenic factor in the causation of perioral dermatitis. The susceptibility of atopic skin to irritants increases as soon as the skin becomes eczematous. Therefore, we propose that atopic diathesis serves as an intensifier, supporting development and continued presence of perioral dermatitis after nonspecific irritant mechanisms have induced impaired skin barrier function.     

Staphylococcus aureus skin colonization in atopic dermatitis patients

A study was conducted to compare the Staphylococcus aureus skin colonization of 21 patients with atopic dermatitis (AD) and 22 healthy controls. It was found that the total aerobe count (total CFU/cm2), the S. aureus fraction thereof and the S. aureus carrier frequency were significantly higher in apparently normal skin of AD patients than in healthy individuals. In addition, compared to normal skin of patients S. aureus density was 100 to 1,000 times higher in the 3 different kinds of lesional skin (dermatitic, lichenified and impetiginized sites). 190 S. aureus strains isolated from the skin of AD patients were tested for sensitivity to 5 topically used antibiotics and the results reported. Besides the biological consequences for the person affected by AD this severe colonization with S. aureus is of epidemiological importance. Several outbreaks of S. aureus infections by dispersal from dermatitic skin have been described. Therefore some preventive and therapeutic aspects are discussed.