Estudio clínico y alergológico en pacientes con manifestaciones cutáneas minor de dermatitis atópica

.—Background: the minor sings of atopic dermatitis can be the only manifestation of the process or to be a part of the florid disease. Their importance for the diagnose has been object of multiple studies.Objetive: to relate the minor cutaneous manifestations of atopic dermatitis with the atopic constitution, personal and family history and the interrelation with the environmental factors.Methods: fifty children with minor atopic cutaneous manifestatios were investigated. Clinical and analytic exploration, and epidermic and intracutaneous test (True Test®, acari, foods) were performed.Conclusions: minor criteria seem to be more indicative of the atopic consitution than of atopic eczema, in the last, both environment and inheritance influence in an important way. Eosinophils and IgE levels were not related with the intensity of cutaneous process, but with the intensity of the respiratory process and the hypersentivity to acari. Foods did note related with cutaneous manifestations.     

过敏性皮肤病患者血清吸入性过敏原特异性IgE研究

为了了解吸入性过敏原在过敏性皮肤病中的作用，采用酶联免疫吸附试验检测148例荨麻疹，138例湿疹和49例异位性皮炎血清屋尘，尘螨，霉菌，豚草花粉，艾蒿花粉，树花粉等6种常见吸入性过敏原特异IgE。结果显示70．9％荨麻疹，79．0％湿疹和77．6％异位性皮炎患者血清中至少有一种吸入性过敏原特异IgE为阳性，均显著高于健康对照组13．0％的阳性率（P＜0．01），有异位性病史的异位性皮炎患者血清吸入性过敏原特异IgE的阳性率为90．3％，显著高于无异位性病史者的阳性率58．3％（P＜0．05），提示吸入性过敏原诱发的I型变态反应在荨麻疹，湿疹和异位性皮炎的发病中起了一定作用，并且有异位性病史的异位性皮炎患者比无异位性病史的患者对吸入性过敏原敏感。     

过敏专科门诊3 051例湿疹皮炎患者血清特异性IgE检测结果分析

目的分析湿疹皮炎患者血清特异性IgE检测结果。方法回顾2021年4月1日至2022年3月31日于华山医院过敏专科门诊就诊的3 051例湿疹皮炎患者, 利用Phadia过敏原检测系统检测患者的血清特异性IgE水平, 计算各项过敏原的检测阳性率, 分析湿疹皮炎患者的常见吸入性过敏原和食物过敏原。计数资料组间比较采用χ2检验。结果 3 051例湿疹皮炎患者中, 特应性皮炎1 412例, 其他湿疹/皮炎1 639例。1 629例(53%)过敏原阳性, 阳性过敏原数为(3.0 ± 1.6)个。最常见的3种吸入性过敏原分别是粉尘螨(904/1 522例, 59%)、户尘螨(891/1 513例, 59%)和链格孢霉(206/1 068例, 19%);最常见的3种食物过敏原分别是虾(251/1 432例, 18%)、鸡蛋白(165/992例, 17%)和牛奶(149/994例, 15%)。3 051例中, 25例(1%)年龄< 2岁, 571例(19%)2 ～ 12岁, 285例(9%)12 ～ 18岁, 2 170例(71%) > 18岁。在< 2岁、2 ～ 12岁患者组中, 最...     

Atopic disease and dermatitis herpetiformis

Patients with dermatitis herpetiformis were found to have an increased incidence of atopic disorders compared to an age and sex matched control group. The increase in incidence was statistically significant for atopic eczema and any atopic disorder. Serum immunoglobulins (including IgE) were estimated in forty-five dermatitis herpetiformis patients and no significant abnormalities were found.     

Relationship between skin bacterial colonization and the occurrence of allergen-specific and non-allergen-specific antibodies in sera of children with atopic eczema/dermatitis syndrome

In this study we investigated skin bacterial colonization, allergen-specific IgE and antiphospholipid/antinuclear antibodies in 72 children with atopic eczema/dermatitis syndrome (age 2-17 years). Bacteria were found on the skin in 41 cases and serological allergen-specific IgE positivity in 37. The different forms of antibodies appeared in the ratio 21/72 (33 antibodies in 21 children). The occurrence of antiphospholipid antibodies was significantly higher in the patients than in the controls. There were significantly more allergens in the group with bacterial colonization than in the group without colonization. The SCORAD index showed a significant positive association with the skin colonization. We conclude that there are significant relationships between the occurrence of Staphylococcus aureus colonization and the levels of inhalant allergen-specific IgE in children with atopic eczema/dermatitis syndrome, and between the occurrence of antiphospholipid IgM positivity and atopic eczema/dermatitis syndrome.     

Serum IgE in dermatitis and dermatosis: an analysis of 497 cases.

Serum IgE values from 497 patients with various forms of dermatitis, dermatosis, and tinea pedis were analyzed statistically and compared with values from 95 normal controls. The median and geometric mean values were significantly elevated (except in acne without atopy, lichen planus, and tinea pedis), even after exclusion of patients with a history of atopy or of cutaneous reaction to food or drugs. Serum IgE levels and atopic dermatitis have a close correlation. A modest positive correlation (p approximately equal to .05) appeared between the log serum IgE level and peripheral blood absolute eosinophil count in 80 cases of atopic dermatitis. A unique group of adult nonatopic patients had acquired generalized dermatitis and markedly elevated serum IgE levels (greater than 12,000 ng/ml). Our results suggest that, in most common dermatologic disorders, elevated serum IgE is a secondary phenomenon rather than a primary causative factor.     

Unilateral Nipple Eczema in Children: Report of Five Cases and Literature Review

Bilateral nipple eczema on the background of atopy is not an uncommon problem and is a minor criterion in some diagnostic systems for atopic dermatitis (AD), but unilateral atopic nipple eczema is underrecognized and often causes clinical concern. We present the first case series of children with unilateral atopic nipple eczema and discuss the clinical aspects of this unusual distribution.     

The Wiskott-Aldrich syndrome gene as a candidate gene for atopic dermatitis.

Atopic dermatitis is a multifactorial disorder probably caused by environmental factors in combination with susceptibility genes. The clinical similarity between atopic dermatitis and the eczema manifestation in patients with Wiskott-Aldrich syndrome made the previously identified WAS gene in chromosome sub-band Xpl 1.23 an interesting candidate gene for atopic dermatitis. We studied linkage and association to the WAS gene region using four polymorphic microsatellite markers in 406 Swedish families with at least two siblings affected with atopic dermatitis (in total 1514 individuals). In the analyses, we studied two qualitative traits: atopic dermatitis and elevated allergen-specific serum IgE antibodies, and one quantitative trait, a severity score of atopic dermatitis. We found that the marker MAOB gave positive linkage with a maximum lod score of 1.68 (p<0.05) to the severity score of atopic dermatitis. Association could not be seen to atopic dermatitis nor to elevated allergen-specific serum IgE antibodies in this region using the transmission disequilibrium test. Our results indicate that either the WAS gene or another gene in the area contributes to the severity of atopic dermatitis.     

IMMUNOGLOBULIN E IN "HEALED" ATOPIC DERMATITIS AND AFTER TREATMENT WITH CORTICOSTEROIDS AND AZATHIOPRINE

SUMMARY.— In patients with atopic dermatitis, eczema and urticaria, systemic treatment with prednisone had no effect on the serum immunoglobulin E level (IgE) but improved their clinical condition. Neither was there any effect on the IgE level after the immunosuppressive, azathioprine. The increased level of IgE found in patients with atopic dermatitis was not seen in those who had been free from symptoms for more than a year even if they had a persistent or recurring eczema of the hands or nummular eczema.     

Hand eczema: an evaluation of the frequency of atopic background and the difference in clinical pattern between patients with and without atopic dermatitis

In a prospective study of 63 patients with long-lasting hand eczema, a diagnosis of atopic dermatitis could be established in 49%. Comparison between patients with atopic dermatitis and those without atopic dermatitis showed that the hand eczema pattern differed very little between the groups. Hyperlinearity was significantly more common in the palms of the patients with atopic dermatitis.     

SERUM IGE LEVEL AND WHITE DERMOGRAPHISM IN ATOPIC DERMATITIS,ATOPIC SKIN,AND INFANTILE ECZEMA

Serum IgE levels and white dermographism were evaluated in atopic dermatitis, atopic skin, and infantile eczema. Elevated serum IgE levels were found in some atopics. In atopic dermatitis there was an increase in serum IgE levels and a more constant presence of white dermagraphism in association with increased severity of dermatitis. Likewise, in atopic skin there was an association of increased serum IgE levels with white dermographism. In infantile eczema, IgE was not increased above normal adult levels nor was there white dermographism.     

IgE antibodies to Pityrosporum ovale in atopic dermatitis

An enzyme-linked immunosorbent assay (ELISA) was developed to assess serum IgE antibodies directed against Pityrosporum ovale in patients with atopic dermatitis (AD), atopic patients with allergic respiratory disease (ARD: rhinitis or asthma) but without eczema, and in healthy controls. IgE binding to P. ovale extract was demonstrated in 49% (35/72) of AD patients. In contrast, anti-P. ovale IgE was found in only one of 27 atopic controls without eczema; all healthy control sera (n = 17) were negative. Of 37 AD patients tested intracutaneously with P. ovale, 31 showed immediate-type reactivity, and 20 of these 31 patients had anti-P. ovale IgE detectable by ELISA, while sera from the six non-responders were all negative. Levels of anti-P. ovale IgE were highest in AD patients aged 20-30 years. No correlation was found with the severity of AD, but there was a non-significant tendency (P = 0.06) to higher levels in AD patients with concomittant respiratory allergy. Anti-P. ovale IgE was significantly correlated with total serum IgE, with specific IgE against various aeroallergens as measured by RAST, and with levels of anti-Candida albicans IgE, measured with a similar ELISA. Thus, production of IgE antibodies against P. ovale occurs very frequently in AD, and rarely in patients with atopic disease without skin involvement.     

[Translated article] Epidemiological,Clinical, and Allergy Profile of Patients With Atopic Dermatitis and Hand Eczema: Evaluation of the Spanish Contact Dermatitis Registry (REIDAC)

BackgroundHand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings.ObjectiveTo describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD.MethodsAnalysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain.ResultsWe included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P = .0224) and irritant contact dermatitis (18% and 35% respectively, P < .001).ConclusionsAD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different.     

Perfil epidemiológico,clínico,y alérgico en pacientes con dermatitis atópica y dermatitis de las manos. Evaluación del Registro Español de Dermatitis de Contacto (REIDAC)

BackgroundHand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings.ObjectiveTo describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD.MethodsAnalysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain.ResultsWe included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P = .0224) and irritant contact dermatitis (18% and 35% respectively, P < .001).ConclusionsAD is common in patients with predominant hand eczema who undergo patch testing. Patients with hand eczema and AD have different clinical and epidemiological characteristics to hand eczema patients in general and their final diagnosis following patch testing is also different.     

Filaggrin null mutations increase the risk and persistence of hand eczema in subjects with atopic dermatitis: results from a general population study

Summary Background Hand eczema is prevalent in the general population. It remains unclear whether or not filaggrin gene (FLG) null mutations increase the overall risk of hand eczema or only increase the risk of hand eczema in subjects with atopic dermatitis. Objectives To investigate the association between FLG null mutations and hand eczema. Methods A random sample of 3335 adults from the general population in Denmark was patch tested, FLG genotyped for R501X and 2282del4 null mutations and questioned about hand eczema. Results Participants with combined presence of atopic dermatitis and FLG null mutation status had a significantly higher prevalence of hand eczema, an earlier onset of hand eczema and a higher persistence of hand eczema compared with subjects with normal FLG status and absence of atopic dermatitis. Logistic regression analyses revealed positive associations between hand eczema within the past 12 months and FLG null mutation status in participants with a history of atopic dermatitis [odds ratio (OR) 2·98; 95% confidence interval (CI) 1·27–7·01], but not in subjects without atopic dermatitis (OR 0·82; 95% CI 0·41–1·67). Conclusions FLG null mutations were significantly associated with hand eczema (< 12 months) in subjects with atopic dermatitis. Combined atopic dermatitis and filaggrin null mutation status was strongly associated with early onset of hand eczema and hand eczema persistence.     

湖北地区花粉变应原在特应性皮炎患者中作用的研究

目的调查湖北地区特应性皮炎合并和不合并过敏性鼻炎或支气管哮喘患者血清IgE情况,研究皮下注射花粉变应原治疗特应性皮炎的疗效。方法 97例特应性皮炎患者分合并和不合并过敏性鼻炎或支气管哮喘两组,分析患者皮损情况及血清IgE水平,进行常规脱敏治疗观察疗效。结果合并组与不合并组特应性皮炎患者对花粉过敏的差异具有显著性意义(X2=12.4615,P<0.01),常规脱敏治疗5个疗程后合并组有效率为80.0%,明显高于不合并组(50.0%);合并组脱敏疗效与血清中花粉特异性IgE成显著相关,且复发率低。结论花粉在特异性皮炎发病机制中起重要作用,花粉变应原特异性脱敏治疗可用于特异性皮炎患者的治疗。     

Distinct SPINK5 and IL-31 polymorphisms are associated with atopic eczema and non-atopic hand dermatitis in Taiwanese nursing population

Abstract: The term ‘hand dermatitis’ describes inflammatory skin condition localized to the hands. Nurses working at hospital settings are prone to develop hand dermatitis. The current study aimed to evaluate whether certain genetic polymorphisms were associated with the development of atopic eczema or non‐atopic hand dermatitis in Taiwanese population. Nurses of Kaohsiung Medical University Hospital were recruited. Atopic eczema, non‐atopic hand dermatitis and normal control groups were identified. The serine protease inhibitor Kazal type 5 (SPINK5), filaggrin and interleukin‐31 (IL‐31) gene variants were compared between the diseased and control groups. Our results showed that rs2303070 T allele of SPINK5 (assuming recessive model; OR = 3.58, 95% CI 1.63–7.84; P = 0.0014) and rs7977932 G allele of IL‐31 (assuming recessive model; OR = 18.25, 95% CI = 3.27–101.94; P = 0.0009) were associated with increased risks of developing atopic eczema, while rs6892205 G allele of SPINK5 (assuming dominant model; OR = 3.79, 95% CI 1.55–9.28; P = 0.0036) was associated with the development of non‐atopic hand dermatitis. In summary, our results showed that distinct SPINK5 and IL‐31 gene variants were associated with the development of atopic eczema and non‐atopic hand dermatitis. The barrier function, particularly those regulated by SPINK5, may play an important role in the development of both atopic eczema and non‐atopic hand dermatitis.     

A case report of severe dermatitis,allergies, and metabolic wasting (SAM syndrome)

The presence of eczema and elevated IgE in pediatric patients does not always indicate atopic dermatitis. Rare genodermatoses may share this clinical presentation and should be considered in the differential diagnosis for patients with congenital immunodeficiency and severe refractory dermatitis. We describe a case of severe dermatitis, allergies, and metabolic wasting syndrome, due to a novel mutation in DSG1 gene, an additional example of this uncommon genetic disorder of desmosome function.     

Eczema en los pies en una consulta de alergia cutánea: estudio retrospectivo de 13 años

IntroductionFoot eczema is a common complaint encountered by skin allergists.ObjectiveTo study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved.Material and methodsCross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema.ResultsOf the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients > 18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%).ConclusionPatch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement.     

Palmar skin is not involved in severe atopic eczema.

Irritant hand eczema is a well-known risk in adults, who have suffered from severe atopic dermatitis during childhood. We therefore studied the involvement of the skin on the hands in 29 consecutive patients admitted for severe atopic dermatitis. Only 5 of the 29 patients had eczema in the palmar skin (p less than 0.01; sign test). There was no correlation with the existence of hyperlinearity, extent of disease, concomitant asthma, total serum IgE or work.