Atopic dermatitis: an overview for the nurse practitioner

PURPOSE: To provide the primary care provider (PCP) with a review of the clinical presentation, aggravating factors, and basic options for treatment of atopic dermatitis (AD). DATA SOURCES: Selected scientific literature and clinical experiences of the author. CONCLUSIONS: AD is a common, chronic skin condition that is frequently seen in both children and adults. Although AD can be challenging to treat, a number of therapeutic options exist to help alleviate the pruritus and rash that accompany the disorder. IMPLICATIONS FOR PRACTICE: The PCP can manage AD in most patients by prescribing avoidance measures, good skin care, antihistamines, and conservative topical medications. Patients with more severe disease may require aggressive therapies such as phototherapy, balneo-phototherapy, or systemic agents.     

Topical tacrolimus: a new therapy for atopic dermatitis

Atopic dermatitis is a common problem affecting up to 10 percent of all children. The mainstays of therapy have been oral antihistamines, topical emollients, topical doxepin, and topical corticosteroids. Side effects associated with higher potency topical corticosteroids have limited their use in children and for facial areas. Tacrolimus (Protopic) is an immunosuppressive agent typically used systemically in transplant patients. Used topically, it has been found to be effective in treating moderate to severe atopic dermatitis without causing the atrophy that might occur with prolonged use of topical corticosteroids. Tacrolimus works equally well in children and adults, with more than two thirds of both groups having an improvement of greater than 50 percent. Despite its potency, very little of the medication is systemically absorbed, and absorption decreases as the atopic dermatitis resolves. The main side effects are burning and itching, but these also decrease with improvement of the atopic dermatitis.     

血清25-羟维生素D3水平与婴儿特应性皮炎严重度的相关性研究

目的探讨血清25-羟维生素D3(25-(OH)D3)水平与婴儿特应性皮炎严重度的相关性,以进一步探究25-(OH)D3与特应性皮炎的关系。方法选取160例特应性皮炎患儿,收集患儿的相关资料并检测其血清25-(OH)D3、嗜酸性粒细胞比例的水平。对比轻中度特应性皮炎患儿和重度特应性皮炎患儿的血清25-(OH)D3、嗜酸性粒细胞比例水平。分析特应性皮炎患儿25-(OH)D3缺乏的危险因素以及血清25-(OH)D3与SCORAD评分、嗜酸性粒细胞比例的相关性。结果重度特应性皮炎患儿平均月龄为10.01±6.64个月,25-(OH)D3为46.46±18.91nmol/L,显著低于轻中度特应性皮炎患儿,而嗜酸性粒细胞比例为0.125±0.039,显著高于轻中度特应性皮炎患儿(P<0.05)。喂养方式为特应性皮炎患儿25-(OH)D3缺乏的危险因素,其中,母乳喂养患儿发生25-(OH)D3缺乏的风险显著高于人工喂养患儿(P<0.05);补充25-(OH)D3是特应性皮炎患儿25-(OH)D3缺乏的保护性因素(P<0.05)。特应性皮炎患儿血清25-(OH)D3与SCORAD评分、嗜酸性粒细胞比例均呈负相关关系(r=-0.371、-0.342,P<0.05)。结论血清25-(OH)D3水平降低与婴儿特应性皮炎的严重程度相关,临床应重视患儿血清25-(OH)D3水平的检测并积极防治25-(OH)D3缺乏以提高婴儿特应性皮炎的防治效果。     

Diaper dermatitis. Factors to consider in diagnosis and treatment

Diaper dermatitis is a common problem in infants and young children. Although the pathogenesis of diaper dermatitis is not well defined, many associated factors have been identified, including individual predisposition to atopic or seborrheic dermatitis, occlusion and friction caused by the diaper, and overgrowth of bacteria and yeast. General treatment goals involve keeping the diaper area as dry as possible, washing the area as infrequently as possible, and avoiding tight-fitting diapers. Petrolatum, talc, baking soda, and fluorinated topical steroidal medications should be avoided. If all else fails, toilet training provides the final answer.     

Analysis of fatty acid composition of sweat lipids in children and adults with skin disease

Gas-chromatographic analysis of fatty acid composition of sweat lipids in children and adults with neurodermatitis, atopic dermatitis, and eczema showed that sweat can be used as a new noninvasive biological object for evaluation of lipid metabolism disorders.     

Treatment options for atopic dermatitis

Atopic dermatitis is a common inflammatory skin condition that usually affects children. It is a chronic disease, with periods of remission and flare-ups, that adversely affects the quality of life of patients and their families. Aggressive therapy with emollients is an important intervention for patients with atopic dermatitis. Patients should avoid individual disease triggers and allergens. Topical corticosteroids are the mainstay of treatment for flare-ups and are the standard to which other treatments are compared. Topical calcineurin inhibitors should not be used in patients younger than two years or in those who are immunosuppressed, and should be secondline therapies in other patients. Rarely, systemic agents (e.g., cyclosporine, interferon gamma-1b, oral corticosteroids) may be considered in adults.     

Correlation of clinical manifestations of atopic dermatitis in children and the activity of NAD(PH)-dependent dehydrogenases in blood lymphocytes

The bioluminescence was used to study the activity levels of NAD (P)-dependent dehydrogenases in blood lymphocytes of 88 children with atopic dermatitis. The nature and intensity of the investigated enzymes were found to be dependent on age and a disease severity with changes being most pronounced and resistant in the elder age group and in patients with a continuously relapsing disease course. Besides, it was shown that the changes of NAD (P)-dependent dehydrogenases in blood lymphocytes are objectively related with an allergic inflammation clinical course in patients with atopic dermatitis and could be clinically valuable in monitoring the dermatitis progression at the metabolic level, in prognosticating possible relapses and in evaluating a chosen therapy.     

Methodology and didactics of training children and adolescents in topical treatment of atopic dermatitis

There are increasing numbers of education programmes for children and young people with atopic dermatitis. These also include directions for the treatment of atopic dermatitis. However, the methods to be followed and the treatment to be applied are usually not clearly defined or explained. Presented are the key aspects of the local treatment of atopic dermatitis to be taught to children. The introduction of a basic therapeutic concept helps sort out which are the best preparations to use, some with and others without active ingredients. The interactions between basic care, active ingredients and skin conditions are explained in such a way that children can understand them.     

Food allergy

Food allergies affect up to 6% of young children and 3%-4% of adults. They encompass a range of disorders that may be IgE and/or non-IgE mediated, including anaphylaxis, pollen food syndrome, food-protein-induced enterocolitis syndrome, food-induced proctocolitis, eosinophilic gastroenteropathies, and atopic dermatitis. Many complex host factors and properties of foods are involved in the development of food allergy. With recent advances in the understanding of how these factors interact, the development of several novel diagnostic and therapeutic strategies is underway and showing promise.     

Anti-staphylococcal treatment in dermatitis

Question A 10-year-old boy with atopic dermatitis (AD) came for consultation with an exacerbation. He suffered from pruritus and multiple erythematous skin lesions, identified as inflamed but not infected. Because skin colonization with Staphylococcus aureus is very common in AD and can worsen the skin condition, is it reasonable to add topical antibiotic treatment to the anti-inflammatory treatment in this case?Answer Skin colonization with S aureus is prevalent in children and adults with AD, and can aggravate skin inflammation. Although topical combination creams with steroids and antibiotics are widely used for AD flare-ups, their superiority over anti-inflammatory treatment alone is not well established. Antibiotic treatment, whether systemic or topical, should be reserved for cases in which explicit signs of infection are present.     

CAP检测系统在儿童变态反应性及免疫性疾病的应用

目的 了解变应原过筛试验作为筛查吸入物抗原及常见食物抗原血清中特异性IrE(stsE)和嗜酸细胞阳离子蛋白(ECP)在儿童常见变态反应性及免疫相关性疾病中的差异及意义.方法 检测26例特异性皮炎、33例喘息性支气管炎(简称喘支)或哮喘症、20例过敏性紫癜、15例川崎病惠儿及20名健康同龄儿童血总IgE抗体、吸入过敏原特异抗体、食物过敏原特异抗体、ECP等并进行比较.结果 26例特异性皮炎、33例喘支或哮喘、20例过敏性紫癜、15例川崎病患儿混合食物过筛试验(Fx5E)阳性率分别为73.1%、24.2%、25.0%、13.3%,吸入过敏原过筛试验(Phadiatop)阳性率分别为23.1%、69.7%、10.0%、6.6%.特异性皮炎组与喘支或哮喘组比较,Fx5E、Phadiatop阳性率差异均有统计学意义(χ~2值分别13.973、12.646,P均<0.01);与过敏性紫癜组比较,Fx5E阳性率差异有统计学意义(χ~2=10.471,P<0.01),Phadiatop差异无统计学意义(χ~2=1.346,P>0.05);与川崎病组比较,Fx5E阳性率差异有统计学意义(χ~2=13.589,P<0.01),Phadiatop阳性率差异无统计学意义(χ~2=1.809,P>0.05).喘支或哮喘组与过敏性紫癜组比较,Fx5E阳性率差异无统计学意义(χ~2=0.004,P>0.05),Phadiatop差异有统计学意义(χ~2=17.808,P<0.01);与川崎病组比较,FxSE阳性率差异无统计学意义(χ~2=0.744,P>0.05),Phadiatop差异有统计学意义(χ~2:16.388,P<0.01).过敏性紫癜组与川崎病组比较,FxSE、Phadiatop阳性率差异均无统计学意义(χ~2值分别为0.729、0.122,P均>0.05);与正常对照组比较,Fx5E阳性率差异有统计学意义(χ~2=5.714,P<0.05),Phadiatop差异无统计学意义(χ~2=0.00,P>0.05).川崎病组与正常组比较,Fx5E、Phadiatop阳性率差异均无统计学意义(χ~2值分别2.828、0.122,P均>0.05).各疾病组血清ECP、TIgE水平均高于正常对照组(P均<0.05),从高到低分别为喘支或哮喘、特异性皮炎、过敏性紫癜、川崎病,各组间差异有统计学意义(P<0.05).结论 吸入性过敏原及食物过敏原在喘支或哮喘症、特异性皮炎发病中起重要作用,而在川崎病、过敏性紫癜起一定作用.喘支或哮喘症以吸入性过敏为主,特异性皮炎以食物性过敏原为主.     

Atopic dermatitis

Atopic dermatitis (AD) is an eczematous, highly pruritic chronic inflammatory skin disease. It usually begins early in life and often occurs in people with a personal or family history of asthma and allergic rhinitis. The prevalence is high, especially in children,and it has been rising in recent decades, in parallel with asthma prevalence. Although AD is often described as an "allergic" dis-ease, allergic causation is difficult to document, and AD is increasingly viewed as a skin disease that predisposes to allergies. This interpretation, based on clinical, epidemiologic, and animal stu-dies, may greatly influence our approach to therapy and prevention of atopic diseases in the coming years.     

Phytotherapy in paediatric skin disorders – A systematic literature review

ObjectivesAlthough skin disorders in children and adolescents are increasingly treated with phytotherapies in practice, there are very few studies investigating this topic, and no systematic review exists that summarizes the current state of research. This review examines which herbal medicines show to be effective to treat atopic dermatitis, diaper dermatitis, and skin lesions or wounds.MethodsClinical studies were searched according to PRISMA-guidelines in the medical databases of PubMed, EMBASE, and CINAHL and summarised in a systematic review.ResultsAmong the 429 articles screened, 17 studies with a total of 2358 participants were identified that suited our inclusion criteria. Thereof seven studies each on the treatment of atopic dermatitis and skin lesions or wounds and three on diaper dermatitis. The phytotherapeutics investigated were based on the following herbs: Evening primrose, blackcurrant, polypodium leucotomos, calendula, aloe vera, chamomile, comfrey, hamamelis, olive, hypericum, neem, white oak, and myrrh. They have mainly been analysed in randomized controlled trials, but also in (long-term) observational studies, prospective trials and case series.ConclusionsBased on the application of the Jadad score, eight out of 17 of the studies examined were of low quality. Yet we found some indication that evening primrose oil may be effective for treating atopic dermatitis in children, while comfrey appears to have a positive effect on wound healing. Interestingly, none of the studies found positive effects for treating skin disorders with aloe vera or chamomile.     

Endoscopic and histological features of the large intestine in patients with atopic dermatitis

Although atopic dermatitis is known to be closely associated with food antigens, the actual changes in the gastrointestinal tract have not been clarified. The aim of this study was to investigate the macroscopic and histological features of the large intestine in patients with atopic dermatitis. We studied 15 outpatients who had generalized atopic dermatitis. Eight non-dermatitis subjects of a similar age without inflammatory bowel disease were also enrolled as controls. Total colonoscopy, pathological evaluation of biopsy specimens, and detection of Candida albicans were performed in all subjects. Four patients were re-examined after 6 months of treatment with an antifungal drug. Among the 15 patients with atopic dermatitis, 4 patients had melanosis coli. On pathological examinations, prominent infiltration of eosinophils and fragmentation of granulocyte nuclei were observed. There were no changes after an antifungal therapy. In the patients with melanosis coli, lipofuscin deposits were observed in the lamina propria. Candida albicans was not detected in any of the subjects. In conclusion, patients with atopic dermatitis may have a predisposition to develop chronic inflammation of the large intestine.     

Atopic dermatitis: an overview

Atopic dermatitis, also known as atopic eczema, is a chronic pruritic skin condition affecting approximately 17.8 million persons in the United States. It can lead to significant morbidity. A simplified version of the U.K. Working Party's Diagnostic Criteria can help make the diagnosis. Asking about the presence and frequency of symptoms can allow physicians to grade the severity of the disease and response to treatment. Management consists of relieving symptoms and lengthening time between flare-ups. Regular, liberal use of emollients is recommended. The primary pharmacologic treatment is topical corticosteroids. Twice-daily or more frequent application has not been shown to be more effective than once-daily application. A maintenance regimen of topical corticosteroids may reduce relapse rates in patients who have recurrent moderate to severe atopic dermatitis. Pimecrolimus and tacrolimus are calcineurin inhibitors that are recommended as second-line treatment for persons with moderate to severe atopic dermatitis and who are at risk of atrophy from topical corticosteroids. Although the U.S. Food and Drug Administration has issued a boxed warning about a possible link between these medications and skin malignancies and lymphoma, studies have not demonstrated a clear link. Topical and oral antibiotics may be used to treat secondary bacterial infections, but are not effective in preventing atopic dermatitis flare-ups. The effectiveness of alternative therapies, such as Chinese herbal preparations, homeopathy, hypnotherapy/biofeedback, and massage therapy, has not been established.     

Natural killer cell activity in atopic dermatitis: a sequential study

It is well-recognized that patients with atopic dermatitis handle certain cutaneous viral infections poorly. As natural killer (NK) cell activity is considered to contribute to the immune response to viral infection, seven young adults with atopic dermatitis had their NK cell function assessed over a 12-month period. Natural killer cell activity was found to correlate inversely with disease activity. The more active the disease, the greater was the reduction in NK cell function (P less than 0.01. In addition, a strong correlation between clinical activity and IgE was shown (P less than 0.001).     

Computer-Aided Diagnosis in Pediatrics

PREVIEW

The incidence of atopic dermatitis has tripled during the past three decades, and the reasons for this upsurge remain a mystery. The similar increase in the incidence of asthma raises interesting questions about possible links. While there is no cure for atopic dermatitis, it usually can be successfully controlled. In this article, Dr Fleischer reviews the aggravating factors, clinical features, and treatment options available for these patients.     

Atopic dermatitis: the concept of flare factors

A flare factor is a biologic or environmental factor which induces exacerbation of atopic dermatis. Serosis, sweating, scratchy clothes, allergy, infection, scratching, allergic contact dermatitis, anxiety, and coexisting disease are potential flare factors. Different patients have different flare factors, and individual patients may have different flare factors at each patient visit maximizes chances of eliminating or reducing dermatitis.     

Exacerbation of atopic dermatitis in the emergency department.

A 38-year-old man was admitted to the Emergency Department suffering from an exacerbation of atopic dermatitis, fever and a burning sensation in the eyes. He was first treated with systemic corticosteroids. A subsequent dermatological and ophthalmological examination established the diagnosis of Kaposi-Juliusberg disease or eczema herpeticum with bilateral herpetic keratitis. Eczema herpeticum is an uncommon herpes simplex virus infection that occurs in patients with atopic dermatitis. Because it is a possible life-threatening condition, this disease must be recognized by all emergency physicians. The association with herpetic keratitis is not frequent but is a major ophthalmological problem. Treatment consists of the administration of high-dose intravenous acyclovir and acyclovir ophthalmic ointment.     

儿童特应性皮炎患者过敏原检测及氯雷他定联合他克莫司的疗效观察

目的检测儿童特应性皮炎的过敏原及观察氯雷他定联合他克莫司治疗儿童特应性皮炎的临床疗效。方法对78例特应性皮炎患儿采用BICOM生物共振体外过敏原检测系统检测过敏原;选用氯雷他定联合他克莫司治疗,并进行临床观察比较。结果特应性皮炎患儿过敏原检测中以食物组过敏原最常见（χ^2=6．24,P〈0．05）;食物组过敏原中以食品添加剂包括防腐剂、香精、香料、甜味剂、食用色素等所占比例最高,达42．4％,其次是鱼类、鸡蛋、牛奶等食物。氯雷他定联合他克莫司治疗儿童特应性皮炎效果明显。结论食品添加剂是儿童特应性皮炎主要的过敏原,氯雷他定联合他克莫司治疗儿童特应性皮炎有效。