Chronological clinicopathological characterization of rapidly progressive alopecia areata resistant to multiple i.v. corticosteroid pulse therapies: An implication for improving the efficacy

Intravenous corticosteroid pulse therapy (pulse therapy) has been reported to be effective for rapidly progressive alopecia areata (RP‐AA). Mostly, a single 3‐day administration of corticosteroid (methylprednisolone 500 mg/day) has been performed in Japan; however, to what extent additional administrations improve the outcome has not been fully elucidated. To assess the advantage of repeating the pulse therapy to RP‐AA cases refractory to the initial intervention, retrospective clinicopathological analysis was performed. Detailed chronological analysis was conducted in eight cases (one man and seven women; average age, 38.3 ± 10.4 years) demonstrating total scalp hair loss 3 months after the first pulse therapy and treated with additional rounds of the pulse therapy. All cases manifested total hair loss, scalp edema, itch or pain on the scalp after the initial intervention. Histopathological analyses of affected lesions prior to additional pulse therapies revealed persisting dense perifollicular lymphocytic inflammation in all cases. Interestingly, such inflammatory change tended to be severer when compared with previously reported pulse therapy good responders. Extra pulse therapy resulted in partial regrowth of terminal hairs in three out of eight cases, but all of them experienced relapse in the long run. The literature review also suggested limited efficacy of repeating pulse therapy to severe AA cases. These findings suggested that the efficacy of currently conducted repetitive pulse therapy is limited in RP‐AA cases with extensive perifollicular inflammation and resistant to the initial pulse therapy. Modulation of the dose and the interval of intervention, in combination with alternative approaches, may be required to achieve a successful outcome.     

Levels of Interleukin‐18 and Endothelin‐1 in Children with Henoch‐Schönlein Purpura: A Study from Northern India

Henoch‐Schönlein purpura (HSP) is an acute systemic vasculitis with unknown etiology, although several studies have found HSP to be related to cytokines such as tumor necrosis factor α, interleukin (IL)‐1, and adhesion molecules. In the present study we determined the levels of cytokines such as IL‐18 and endothelin‐1 (ET‐1) in children with HSP. Subjects were divided into three groups (group 1, 20 subjects with HSP; group 2, 10 subjects belonging to group 1 during their follow‐up 4 to 6 months later; and group 3, 16 controls who were healthy siblings of the subjects). IL‐18 and ET‐1 levels were determined using enzyme immunoassay and expressed as mean ± standard deviation. We observed higher IL‐18 levels in children with HSP (767.6 ± 145.1 pg/mL) than in controls (614.6 ± 66.54 pg/mL, p > 0.05), but IL‐18 levels were found to be significantly lower in subjects with HSP in remission (502.7 ± 60.81 pg/mL) than in those who were in an active phase (1,050 ± 244.5 pg/mL, p < 0.05, n = 10). ET‐1 levels were found to be significantly higher in subjects with HSP (1.93 ± 0.19 pg/mL) than in controls (1.10 ± 0.13 pg/mL, p < 0.05), although no significant difference was observed in ET‐1 levels between subjects in group 1 (1.88 ± 0.30 pg/mL) and group 2 (1.91 ± 0.120, p > 0.05, n = 10). A positive correlation was observed between IL‐18 and ET‐1 levels in subjects with HSP (correlation coefficient [r] = 0.5254, p < 0.01). These results suggest that levels of IL‐18 and ET‐1 are worth monitoring during the clinical course of the disease, but caution must be exercised in extrapolating data based on small study samples.     

Predictive factors of response to pulse methylprednisolone therapy in patients with alopecia areata: A follow‐up study of 105 Japanese patients

Pulse corticosteroid therapy is effective for alopecia areata (AA) in the early stage. The risk and efficacy of this therapy for patients with several backgrounds, however, remains controversial. To explore the predictive factors of the response and risk factors of this therapy, data from 105 AA patients treated with methylprednisolone (500 mg) i.v. for 3 days consecutively in our facility were retrospectively analyzed. Among good responders, longer time from the onset to therapy was correlated with longer time required for hair regrowth (P = 0.037, n = 27). Multivariate models demonstrated that “severity”, “relapse” and longer “duration from the latest onset” were significantly and independently associated with poorer outcome (P < 0.01). “History of atopic dermatitis (AD)” was also associated with poorer outcome, but this correlation could be explained by the effect that duration from the latest onset of AA was longer among participants with AD. We propose that earlier initiation of pulse corticosteroid therapy is preferable for better outcome of AA, particularly among patients with AD. Clinicians should be mindful of the occurrence of mild adverse effects in the elderly patients.     

JAK inhibitors for alopecia areata: a systematic review and meta‐analysis

There have been a number of case reports and small clinical trials reporting promising outcomes of Janus Kinase (JAK) inhibitors tofacitinib, ruxolitinib and baricitinib for alopecia areata (AA). The majority of the literature to date is based on small volume data, with a lack of definitive evidence or guidelines. To determine the expected response of AA to JAK inhibitor therapy and factors which influence response and recurrence rates. A systematic review and meta‐analysis was performed according to PRISMA guidelines. From 30 studies and 289 cases, there were 72.4% responders, good responders 45.7% and partial responders 21.4%. Mean time to initial hair growth was 2.2 ± 6.7 months, and time to complete hair regrowth was 6.7 ± 2.2 months. All 37 recurrences occurred when treatment was ceased after 2.7 months. Oral route was significantly associated with response to treatment compared to topical therapy. No difference was found between paediatric and adult cases in proportion of responses. There is promising low‐quality evidence regarding the effectiveness of JAK inhibitors in AA. Future large‐sized randomized studies are required to confirm findings.     

Serum CCL23 levels are increased in patients with systemic sclerosis

The aim of this study is to determine serum CCL23 levels and their clinical associations in patients with systemic sclerosis (SSc). Serum CCL23 levels were examined by ELISA in 66 patients with SSc, 20 patients with systemic lupus erythematosus, 20 patients with dermatomyositis, and 33 healthy individuals. Serum CCL23 levels were elevated in SSc patients (389.1 ± 199.2 pg/mL) compared with healthy individuals (94.1 ± 85.6 pg/mL; P < 0.001) and patients with systemic lupus erythematosus (43.4 ± 39.3 pg/mL; P < 0.001) or dermatomyositis (132.1 ± 104.5 pg/mL; P < 0.001). Among SSc patients, there were no differences in serum CCL23 levels between those with limited cutaneous SSc and those with diffuse cutaneous SSc. SSc patients with elevated CCL23 levels were found to have shorter disease duration than those with normal CCL23 levels (P < 0.001). Furthermore, raised CCL23 levels were associated with a higher frequency of pulmonary arterial hypertension (P < 0.05). The results show that serum CCL23 level was increased in the early phase of SSc. CCL23 could be associated with induction of SSc and as such would be a serologically useful marker for disease activity.     

Detailed clinicopathological characterization of progressive alopecia areata patients treated with i.v. corticosteroid pulse therapy toward optimization of inclusion criteria

The management of progressive alopecia areata (AA) is often challenging. Recently, i.v. corticosteroid pulse therapy has been reported to be effective for acute and severe AA, however, inclusion criteria have not been sufficiently precise, leaving a chance that its efficacy could be further improved by optimizing therapeutic indications. In our attempts to delineate the factors that correlate with favorable outcomes, we minutely evaluated the clinicopathological findings and the prognoses of single‐round steroid pulse‐treated progressive AA cases with full sets of image and pathology records during the course. Almost complete hair regrowth has been achieved and maintained up to 2 years in five out of seven AA patients with varying degrees of clinical severity. Interestingly, the worst clinical presentation observed during the course correlated with the size of the area where hairs with dystrophic roots were pulled rather than the extent of visible hair loss on the first visit. Dermoscopy detected disease spread but contributed little in assessing prognoses. Dense perifollicular cell infiltration was detected in all cases treated within 4 weeks of onset and those treated later but with excellent response. Importantly, the cases with poor or incomplete hair regrowth were treated 6–8 weeks of onset and showed moderate inflammatory change with high telogen conversion rate. These findings mandate global dermoscopy and hair pull test for judging the treatment indication and suggest that early administration of high‐dose corticosteroid, ideally within 4 weeks of onset, enable efficient suppression of active inflammation and maximize the effectiveness of the remedy.     

特应性皮炎患者趋化因子及其受体的研究

目的 探讨几种重要的趋化因子及其受体的表达在特应性皮炎(AD)发病中的作用。方法 采用酶联免疫吸附试验检测39例AD患者及正常人血清中γ干扰素诱导蛋白-10(IP-10)、基质细胞衍生因子-1α(SDF-1α)、嗜酸粒细胞趋化因子、胸腺和活化调节的趋化因子(TARC)及巨噬细胞来源的趋化因子(MDC)等水平;同时用流式细胞仪分析外周血CD4⁺T细胞表面趋化因子受体CXCR3、CXCR4、CCR3、CCR4及CCR5的表达。结果 与正常人对照组相比,AD患者血清SDF-1α、TARC和MDC水平显著升高(P<0.001),IP-10及嗜酸粒细胞趋化因子水平则无明显改变(P>0.05),外周血CXCR3、CCR3、CCR4及CCR5在CD4⁺T细胞表达水平显著增加(P<0.001);血清TARC和MDC水平的变化与疾病严重程度相关(r分别为0.669及0.409,P分别为<0.001及<0.01)。结论 具有生物活性趋化因子及其受体介导的T细胞和嗜酸/嗜碱粒细胞的聚集、激活后释放的炎性介质在AD发病中起着重要作用。     

Serum soluble CD26 levels: diagnostic efficiency for atopic dermatitis,cutaneous T‐cell lymphoma and psoriasis in combination with serum thymus and activation‐regulated chemokine levels

Background CD26 is a multifunctional type II transmembrane glycoprotein, which also exists as a secreted isoform, soluble CD26 (sCD26). The CD26 expression on circulating T cells is decreased in some skin diseases such as cutaneous T‐cell lymphoma (CTCL) and psoriasis. It remains to be determined whether sCD26 can be used as a marker of skin diseases or not. Objective To investigate utility of sCD26 as a diagnostic marker of skin diseases in combination with thymus and activation‐regulated chemokine (TARC). Methods Serum sCD26 levels were measured using enzyme‐linked immunosorbent assay in 130 participants including 32 patients with atopic dermatitis (AD); 45 patients with CTCL; 26 patients with psoriasis; and 27 healthy controls. Results Serum sCD26 levels in patients with CTCL and psoriasis (162.1 ± 80.2 ng/mL and 125.4 ± 82.1 ng/mL respectively) were significantly lower than those of healthy controls (392.6 ± 198.7 ng/mL; P < 0.01 and 0.01 respectively). In patients with CTCL, serum sCD26 levels of patients with advanced stage were 135.0 ± 51.5 ng/mL and they were significantly lower than those with early stage (193.1 ± 96.0 ng/mL; P < 0.05). When we used serum sCD26 and TARC levels for diagnostic criteria, sensitivity, specificity, positive predictive value and negative predictive value for AD, CTCL and psoriasis were 65.2–73.7%, 81.4–97.6%, 65.2–94.4%, and 81.4–88.9% respectively. Conclusion Serum sCD26 levels, combined with serum TARC levels, are helpful in diagnosis of AD, CTCL and psoriasis.     

斑秃患者血浆和皮损中降钙素基因相关肽、血管活性肠肽的研究

目的 探讨降钙素基因相关肽(CGRP)和血管活性肠肽(VIP)在斑秃发病中的作用。方法 利用放射免疫分析法检测30例斑秃患者和20例正常人血浆中的CGRP和VIP水平,利用免疫组化方法检测21例斑秃患者皮损和16例正常人头皮中的CGRP和VIP表达情况。结果 ①斑秃活动期患者血浆中的CGRP水平为(142.63±67.95)pg/mL,低于稳定期(197.33±67.15)pg/mL和正常人(188.40±72.95)pg/mL,差异均有显著性。②斑秃活动期血浆中的VIP水平为(105.94±55.42)pg/mL,低于斑秃稳定期(156.86±47.37)pg/mL和正常人(176.44±84.70)pg/mL,差异均有显著性。③CGRP和VIP在斑秃皮损及其周围的表达明显低于正常人,差异有显著性。结论 CGRP和VIP在斑秃发病中起一定的作用。     

Comparison of High-Dose Corticosteroid Pulse Therapy and Combination Therapy Using Oral Cyclosporine with Low-Dose Corticosteroid in Severe Alopecia Areata

BackgroundSevere alopecia areata (AA) is resistant to conventional treatment. Although systemic oral corticosteroids are an effective treatment for patients with severe AA, those drugs have many adverse effects. Corticosteroid pulse therapy has been introduced to increase therapeutic effects and reduce adverse effects. However, the treatment modality in severe AA is still controversial.ObjectiveTo evaluate the effectiveness of corticosteroid pulse therapy in patients with severe AA compared with treatment with oral cyclosporine with corticosteroid.MethodsA total of 82 patients with severe AA were treated with corticosteroid pulse therapy, and 60 patients were treated with oral cyclosporine with corticosteroid. Both groups were retrospectively evaluated for therapeutic efficacy according to AA type and disease duration.ResultsIn 82 patients treated with corticosteroid pulse therapy, 53 (64.6%) were good responders (>50% hair regrowth). Patients with the plurifocal (PF) type of AA and those with a short disease duration (≤3 months) showed better responses. In 60 patients treated with oral cyclosporine with corticosteroid, 30 (50.0%) patients showed a good response. The AA type or disease duration, however, did not significantly affect the response to treatment.ConclusionCorticosteroid pulse therapy may be a better treatment option than combination therapy in severe AA patients with the PF type.     

Combined oral pulse and topical corticosteroid therapy for severe alopecia areata in children: a long‐term follow‐up study

There are no widely accepted therapy protocols for severe alopecia areata (AA). We treated 65 children/adolescents with AA affecting >30% of scalp. Fourty‐three percent of patients had AA plurifocalis (AAP). Fifty‐seven percent had AA subtotalis (AAS), AAP+ophiasis (AAP+OPH), and alopecia totalis/universalis (AT/AU). Long‐term follow‐up (median 96 months) data were available for 69% of patients. Oral dexamethasone (prednisolone 5 mg/kg equivalent) was given once in 4 weeks. Patients received 6, 9, or 12 pulses. Clobetasol propionate 0.05% ointment under plastic wrap occlusion was applied 6 days a week. Hair growth was assessed on a scale ranging 0–100% of regrowth in individual AA lesions. Regrowth >50% was considered good response. Six to twelve months months after the therapy, 56.9% of patients had >75% of hair regrowth. In AAP, 65.5% had complete regrowth. 61.5% of all patients were considered good responders. Significantly, higher percentage of good responders was found in AA lasting ≤12 months. No patients had serious side effects. There was no change in stability of the hair status at the long‐term follow‐up. Most AA patients had beneficial effects with this protocol. Best results were in AAP and AAP+OPH. Combined topical and oral pulse corticosteroid therapy of AA in children shows long‐lasting results, without serious side effects.     

High‐dose intravenous corticosteroid pulse therapy in alopecia areata: Own experience compared with the literature

Background: Seven prospective studies including 193 patients have been published on high‐dose intravenous corticosteroid pulse therapy in alopecia areata (AA).We compare these data with a retrospective analysis of our own consecutive patients. Patients and Methods: Between 1998 and 2002,25 patients with severe AA were treated at the Department of Dermatology, University of Bern, with infusions of 500 mg methylprednisolone on 3 consecutive days.In addition to the inpatient records, in 2004 all patients were followed up by a questionnaire. Results: Four of 10 patients with multifocal AA and 3 of 9 patients with ophiasis‐type AA had full re‐growth of hair, whereas all 6 patients with AA totalis/universalis failed to respond. Conclusion: Intravenous corticosteroid pulse therapy may be helpful in the treatment of multifocal and ophiasis‐type AA.Patients with an initial episode of short duration have better chances for success.     

Serum‐Level Changes of Vascular Endothelial Growth Factor in Children with Infantile Hemangioma after Oral Propranolol Therapy

Oral propranolol is the first‐line therapy for infantile hemangioma (IH), but its mechanism of action remains unclear. The aim of this study was to evaluate the change in serum vascular endothelial growth factor (VEGF) levels in patients with IH who underwent propranolol treatment. The study included 22 patients with IH receiving propranolol treatment. At three time points—before treatment and 1 and 3 months after treatment—blood samples were examined by enzyme‐linked immunosorbent assay for serum VEGF expression. The mean serum VEGF concentration in children with proliferative hemangiomas was 395.0 ± 176.7 pg/mL, approximately twice as high as in patients with venous malformations (mean 170.7 pg/mL) and in healthy controls (204.8 pg/mL, p = 0.006). After 1 month of propranolol treatment, the level had fallen 21.6% (p = 0.003), although the downward trend was less obvious after 3 months of treatment (18.0%, p = 0.63). VEGF expression correlated significantly with the lesion size (correlation coefficient [R] = 0.43, p = 0.046), whereas no correlation was observed with age (R = 0.13, p = 0.56). Serum VEGF levels were higher in patients with IH and fell after 1 month of oral propranolol treatment. Similar results, although less pronounced, were found after 3 months of treatment. Lesion volume and serum level of VEGF were significantly correlated.     

Serum mucosa-associated epithelial chemokine (MEC/CCL28) in atopic dermatitis: a specific marker for severity

Background Mucosa‐associated epithelial chemokine (MEC; CCL28) is considered to be pivotal in mediating the migration of CC chemokine receptor 3‐ and 10‐ (CCR3‐ and CCR10)‐expressing, skin‐homing, memory, cutaneous lymphocyte‐associated antigen‐positive (CLA⁺) T cells. CCL28 is selectively and continuously expressed by epidermal keratinocytes, but highly upregulated in inflammatory skin diseases, such as atopic dermatitis (AD). Aim This controlled longitudinal study was designed to evaluate the expression of CCL28 in serum in childhood AD and bronchial asthma (BA), and its possible relationship to disease severity and activity. Methods Serum CCL28 levels were measured in 36 children with AD, 23 with BA, 14 with both conditions, and 21 healthy age‐ and sex‐matched controls. Sixteen patients in the AD group were followed up and resampled for serum CCL28 after clinical remission. Serum CCL28 levels were correlated with some AD disease activity and severity variables. Results Serum CCL28 levels in AD, whether during flare [median, 1530 pg/mL; mean ± standard deviation (SD) = 1590.4 ± 724.3 pg/mL] or quiescence (median, 1477 pg/mL; mean ± SD = 1575.2 ± 522.1 pg/mL), were significantly higher than those in healthy children (median, 301 pg/mL; mean ± SD = 189.6 ± 92.8 pg/mL); however, the levels during flare and quiescence were statistically comparable. The serum levels in BA (median, 340 pg/mL; mean ± SD = 201.6 ± 109.5 pg/mL) were significantly lower than those in the AD group, and comparable with those in healthy controls. Serum CCL28 levels in severe AD were significantly higher than those in mild and moderate cases, and correlated positively with the calculated severity scores [Leicester Sign Score (LSS) and Scoring Atopic Dermatitis (SCORAD)]. CCL28 levels during the exacerbation of AD were positively correlated with the corresponding values during remission, the peripheral absolute eosinophil counts, and serum lactate dehydrogenase levels. Serum CCL28 levels were not correlated with the serum total immunoglobulin E values in AD. Conclusions Our data reinforce the concept that CCL28 might contribute to the pathogenesis of AD, probably through the selective migration and infiltration of effector/memory T‐helper‐2 cells in the skin. CCL28 may also represent an objective prognostic marker for disease severity. Further studies may pave the way for CCL28 antagonism among adjuvant therapeutic strategies.     

Thymus and activation regulated chemokines in children with atopic dermatitis: Kyushu University Ishigaki Atopic Dermatitis Study (KIDS)

The purpose of this population-based study was to investigate the clinical significance of serum thymus and activation-regulated chemokine (TARC) in children with atopic dermatitis (AD). Between 2003 and 2004, 1359 Japanese children aged 5 years and under were prospectively followed. Serum levels of TARC by using an ELISA in each child were monitored throughout the study period. The first tested year, the mean serum level of TARC in children with sustained AD (mean; 691.7 pg/mL) was significantly higher than that of regressed AD children (569.9 pg/mL), newly developed AD children (380.1 pg/ mL), and healthy children (506.3 pg/mL). The changes of TARC levels in sustained AD children found no significance between 2003 (691.7 pg/mL) and 2004 (682.0 pg/mL). The mean levels of TARC of both regressed AD and healthy children significantly decreased from 2003 to 2004 (644.2 pg/mL to 448.7 pg/mL and 506.3 pg/mL to 442.1 pg/mL, respectively). The mean TARC level of newly developed AD children significantly increased from 2003 to 2004 (380.1 pg/mL to 491.8 pg/mL). We demonstrated strong associations between TARC levels and the natural course of childhood AD. Monitoring serum TARC levels of AD children may be useful for the biological evaluation of AD.     

Serum levels of ADAM12‐S: possible association with the initiation and progression of dermal fibrosis and interstitial lung disease in patients with systemic sclerosis

Background A disintegrin and metalloprotease (ADAM) 12 is one of the metalloproteinase‐type ADAMs and possesses extracellular metalloprotease and cell‐binding functions. ADAM12 is expressed in two alternative forms, such as a membrane‐anchored form (ADAM12‐L) and a short secreted form (ADAM12‐S). Objective To investigate the clinical significance of serum ADAM12‐S levels in systemic sclerosis (SSc). Methods Serum ADAM12‐S levels were determined by a specific enzyme‐linked immunosorbent assay in 61 SSc patients and 18 healthy controls. Results Serum ADAM12‐S levels were significantly increased in diffuse cutaneous SSc (dcSSc) patients than in healthy controls (0.417 ± 0.389 vs. 0.226 ± 0.065 ng/mL; P < 0.05), while being comparable between limited cutaneous SSc (0.282 ± 0.258 ng/mL) and healthy controls. Serum ADAM12‐S levels significantly elevated in dcSSc patients with disease duration of ≤6 years (0.537 ± 0.449 ng/mL, P < 0.05), but not in dcSSc with disease duration of >6 years (0.225 ± 0.049 ng/mL), compared to healthy controls. Furthermore, in dcSSc patients with disease duration of ≤6 years, serum ADAM12‐S levels correlated positively with modified Rodnan total skin thickness score, ground glass score, and serum C‐reactive protein values, while showed inverse correlation with fibrosis score. Conclusion Elevated serum ADAM12‐S levels are associated with elevated serum inflammatory marker, severity of skin fibrosis, and activity of interstitial lung disease in dcSSc, suggesting the possible contribution of ADAM12‐S to the pathological events in this disorder.     

卡介菌多糖核酸对特应性皮炎患者PBMC中TARC与CCR4表达的影响

目的检测卡介菌多糖核酸治疗前后特应性皮炎(AD)患者外周血胸腺和活化调节的趋化因子(TARC)与其相应受体CCR4的表达,以探讨其治疗特应性皮炎的相关机制。方法采用酶联免疫吸附试验检测45例AD患者卡介菌多糖核酸治疗前后血清中TARC水平;同时用流式细胞仪分析外周血中CCR4的表达。结果与治疗前(1169.1±106.5pg/mL)相比,卡介菌多糖核酸治疗后AD患者血清TARC(810.1±77.6pg/mL)显著降低(P<0.01);与治疗前(60.1±2.4)%相比,卡介菌多糖核酸治疗后AD患者外周血CCR4表达水平(54.6±2.2)%显著降低(P<0.01)。结论卡介菌多糖核酸可能通过降低TARC与CCR4,从而减少Th2细胞的募集、活化而发挥其治疗特应性皮炎的作用。     

Serum measurement of interleukin‐31 (IL‐31) in paediatric atopic dermatitis: elevated levels correlate with severity scoring

Background Interleukin‐31 (IL‐31) is a novel T‐helper‐lymphocyte‐derived cytokine that plays an important role in human T‐cell‐mediated skin diseases. When overexpressed in transgenic mice, IL‐31 induces severe pruritus resembling eczema in humans. Serum IL‐31 was previously found overexpressed in adults with atopic dermatitis (AD). The novelty of this study is the use of a pediatric patient group as well as comparison of IL‐31 levels during flare and quiescence. Objective This case‐controlled longitudinal study was designed to determine the levels of IL‐31 in serum of AD children and its associations in relation to disease activity and severity. Methods Sera were obtained from 50 AD children and 40 healthy volunteers. IL‐31 levels were measured using a sandwich ELISA. All AD patients were followed up and re‐sampled for serum IL‐31 after clinical remission. Serum IL‐31 levels were correlated with AD disease activity and severity variables. Results Serum IL‐31 levels were significantly higher whether during AD flare [median, 1600; mean (SD) = 1457.8 ± 770.4 pg/mL] or quiescence (1040; 958.7 ± 419.5 pg/mL), than those in controls (220; 197.3 ± 91.9 pg/mL). Serum IL‐31 levels were significantly higher in the high disease severity group compared with the moderate or low severity group. Moreover, serum IL‐31 levels correlated positively with the calculated severity scores (LSS, SSS and SCORAD index). Conclusion The results of this study confirm the importance of IL‐31 in AD pathophysiology. Serum IL‐31 level is an objective reliable marker of AD severity in children. It may represent a novel target for antipruritic drug development.     

Increased serum B cell‐activating factor level in children with atopic dermatitis

Background. B cell‐activating factor (BAFF) is a tumour necrosis factor superfamily member best known for its role in the survival and maturation of B cells. BAFF activity is seen in naïve and effector/memory T cells. Aim. To investigate the level and role of BAFF in serum of patients with atopic dermatitis (AD). Methods. Levels of serum BAFF, a proliferation‐inducing ligand (APRIL) and total serum IgE level, and total eosinophil count were measured in 245 children. Results. Patients were characterized as having atopic eczema (AE) (n = 90) or non‐AE (n = 77); the remainder were healthy control subjects (n = 78). Serum BAFF level in children with AE (1625.04 ± 708.32 pg/mL) was significantly higher than in non‐AE children (1194.69 ± 448.44 pg/mL, P < 0.0001) or healthy controls (1062.89 ± 444.74 pg/mL, P < 0.0001). Serum APRIL level was not different between the three groups. Serum BAFF level significantly correlated with total serum IgE level (γ = 0.42, P < 0.0001) and total eosinophil count. It was also positively correlated with serum BAFF and egg‐specific IgE level (γ = 0.252, P = 0.045) in AE. Conclusions. Serum BAFF level is high in AE and might be a useful marker for AE.     

Alopecia areata: topical immunotherapy treatment with diphencyprone

Background Topical immunotherapy with diphencyprone (DPCP) is considered the most effective treatment of alopecia areata (AA). Objective To assess the efficacy of DPCP in the treatment of extensive or long‐lasting AA in Greek patients. Methods Sixty‐four patients with extensive and/or long‐lasting AA were sensitized with 2% diphencyprone. During each weekly subsequent visit, patients were treated with gradually denser concentrations adjusted in order to maintain erythema and itch on the patient's scalp for 48 h. Patients’ hair re‐growth was evaluated every 3 months for 2 years. Results Forty‐five patients responded among the 54 completing therapy (83.3%). Initial response was observed 3.48 ± 1.05 months after the initial treatment. Twenty patients among the responders achieved a grade 4 response, 15 patients achieved grade 3, 9 patients achieved grade 2, and 1 patient achieved a grade 1 response. The mean duration of treatment until maximum response was 6.14 ± 1.48 months. Thirty‐one patients (68.9%) had a relapse during follow‐up and were treated again. The only adverse event among patients completing therapy was contact dermatitis of the face or neck (9 of 54) that resolved after topical corticosteroid application within 7 days. Statistical analysis did not establish any association among duration of AA, age, gender, atopic diathesis, nail involvement and presence of thyroid antibodies with response to treatment. Conclusion Treatment of Greek patients with AA with diphencyprone presents high response rates similar to those reported by previous studies. The treatment is adequately tolerated by most of the patients, and they are willing to repeat it in cases of relapse.