Systemic herpes simplex virus infection in a child with eczema herpeticum

Eczema herpeticum (EH) is a disseminated cutaneous infection with herpes simplex virus (HSV) that develops in patients with atopic dermatitis. The kinetics and clinical significance of HSV viremia in EH are poorly understood. Herein, we report HSV DNAemia in a child with EH 12 months after the completion of chemotherapy for Hodgkin lymphoma.     

Eczema herpeticum in three siblings: clinical features and acyclovir treatment

Three atopic siblings with sequential primary herpes simplex virus (HSV) infection on their eczematous lesions following their father's recurrent herpes labialis were presented. Eczema herpeticum was diagnosed on the basis of their characteristic grouped umbilicated vesicles superimposed on pre-existing atopic eczematous lesions. HSV type 1 was identified from the three patients' Tzanck smears and viral isolation of vesicular contents by monoclonal antibodies. The skin lesions faded spontaneously in the first case, although this elder brother did not receive any antiviral treatment. Later, he developed mild recurrence of skin lesions on his extremities. His younger twin sisters were treated with systemic acyclovir and no recurrences occurred during 2 years of follow up. All of them developed anti-HSV antibody about 7 to 14 days after clinical onset. Acyclovir seems to be an effective antiviral agent in treating eczema herpeticum and reducing subsequent recurrences after primary herpes simplex virus infection.     

Clinical utility of loop‐mediated isothermal amplification assay for the diagnosis of common alpha herpesvirus skin infections

Loop‐mediated isothermal amplification (LAMP) is a nucleic acid amplification method with a high specificity, efficiency and speed. No reports exist regarding the usefulness of LAMP for clinically suspected skin infections caused by herpes simplex virus (HSV) or varicella zoster virus (VZV). The aim of this study was to evaluate the clinical usefulness of LAMP in the diagnosis of common cutaneous alpha herpesvirus (HSV type 1 and 2, and VZV) infections. LAMP and real‐time polymerase chain reaction (PCR) were performed using swab samples collected from 106 patients with clinically suspected alpha herpesvirus skin infections. The results of LAMP performed with DNA extraction did not differ from those performed without DNA extraction. The sensitivity of LAMP tested against real‐time PCR was 96% in herpes simplex, 78% in eczema herpeticum, 93% in herpes zoster and 100% in varicella. No viral DNA was detected by LAMP in all negative real‐time PCR samples. Viral DNA load was significantly lower in samples with false‐negative LAMP results than in the LAMP‐positive samples. LAMP enables confirmation of clinically suspected cutaneous HSV and VZV infections. However, the sensitivity of LAMP is lower than real‐time PCR. The accuracy of LAMP may increase if sufficient viral DNA is obtained from lesions. LAMP performed without DNA extraction remains sensitive; thus, LAMP represents a quick and economical method for the diagnosis of common alpha herpesvirus skin infections.     

Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood

A series of 955 persons aged 24-44 years, with atopic dermatitis in childhood, were interviewed in order to identify factors which increase the risk of developing hand eczema in adult life, or aggravate already existing hand eczema. Endogenous (constitutional) factors were in general of greater importance than exogenous factors, viz. chemicals, water, soil and wear (friction). Eczematous involvement of the hands in childhood was of predominant importance. In individuals without such involvement, severe (widespread) dermatitis in childhood was a dominant factor. Other factors, each of them significantly more important than the exogenous ones, were persistent eczema on other parts of the body and dry/itchy skin. The factors female sex, family history of atopic dermatitis and simultaneous bronchial asthma/allergic rhinitis were associated with increased risk of developing hand eczema in adult life, but were of limited importance compared with the other endogenous and the exogenous factors.     

Cigarette smoking may modify the risk of depression in eczema among adults: a preliminary study using NHANES 2005–2006

Background Eczema has been shown to be associated with an increased risk of depression. However, the effect of cigarette smoking on the association between eczema and depression remains unclear. Objectives In this study, we investigated whether smoking behaviour and tobacco exposure influence the association between eczema and depression. Methods This was a population‐based cross‐sectional study. Subjects (287 eczema patients and 40 patients with depression, out of a total of 2974 subjects in the database) were from the National Health and Nutrition Examination Survey 2005–2006, aged between 20 and 59 years. Lifetime presence of eczema was obtained by self‐reporting questionnaires, and depression was assessed by the Patient Health Questionnaire. Smoking status was determined by self‐report and serum cotinine levels. Univariate and multivariate logistic regressions were used to assess the association between eczema and depression with and without adjusting for smoking behaviour. Stratified analysis was also performed according to smoking status. Results Eczema was significantly associated with depression (adjusted OR: 2.12; 95% CI: 1.59–2.83). This association persisted after additionally adjusting for smoking status. In stratified analysis, the association between eczema and depression was higher and stronger among current smokers than never smokers, former smokers and passive smokers. Conclusion Our findings indicated that cigarette smoking may modify the risk of depression in eczema. We suggested cessation of smoking in eczema patients to decrease the risk of this psychiatric co‐morbidity.     

A real-world Australian experience of upadacitinib for the treatment of severe atopic dermatitis

Upadacitinib is a selective Janus kinase-1 (JAK-1) inhibitor that has been shown in clinical trials to be effective for the treatment of moderate-to-severe atopic dermatitis (AD). This study aimed to evaluate the real-world experience of patients with AD treated with upadacitinib in a single-centre Australian cohort. Our study revealed a higher propensity for herpetic infections compared with previous randomised controlled trials (RCTs).     

Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study

Aim  The intent of our study was to determine the efficacy of oral naltrexone, an opiod antagonist, in the treatment of pruritus in patients with chronic eczema.
Methods  This double-blind, placebo-controlled study recruited 38 patients with eczema complaining from pruritus. Pruritus scores were evaluated. Patients were given placebo ( n  = 20) or naltrexone 50 mg ( n  = 18) for 2 weeks period. During the study, pruritus scores based on visual analogue scale system (VAS) were assessed three times: at the start of study, after 1 week, and after 2 weeks.
Results  In both groups, decreased VAS scores were observed, but naltrexone showed to be significantly more effective than placebo in decreasing VAS score after 1 week ( P <  0.005) and 2 weeks ( P <  0.001).
Conclusion  Naltrexone is more effective than placebo in the treatment of pruritus in patient with eczema. Naltrexone might be considered as an adjunct treatment in the treatment of pruritus. However, further studies in this aspect are highly fostered.

Conflicts of interest

This study and the authors were not supported by any company with a vested interest in the product being studied and the project was funded by Skin Research Center.     

Assessment of the American Academy of Dermatology diagnostic criteria for pediatric atopic dermatitis and modification into a checkbox form: A cross-sectional study

Background/Objectives

Diagnostic criteria for atopic dermatitis (AD) are limited in their performance and/or usability. The American Academy of Dermatology (AAD) consensus criteria include hierarchical categories of disease features to improve these metrics but have not been validated. Our objective was to create and validate a checkbox form of the AAD consensus criteria in the pediatric population.

Methods

We performed a cross-sectional study of 100 pediatric patients with AD (n = 58) and diseases in the differential diagnosis of AD (n = 42).

Results

Having three or more “Essential,” ≥2 “Important,” ≥1 “Associated” features of the AAD criteria was optimal for the diagnosis of AD in children. This combination was 91.4% (95% CI, 84.2%–98.6%) sensitive and 95.2% (88.8%–100%) specific. The UK working party criteria and the Hanifin–Rajka criteria had sensitivities of 96.6% (95% CI 91.9%–100%) and 98.3% (95% CI 94.9%–100%) and specificities of 83.3% (95% CI 72.1%–94.6%) and 71.4% (95% CI 57.8%–85.1%), respectively. The AAD criteria had significantly greater specificity than the Hanifin–Rajka criteria (p = .002).

Conclusions

This study represents an important step in validating the AAD consensus criteria and formulating a useable checkbox form for diagnosing AD in the pediatric population.     

Effectiveness of dupilumab for the treatment of nummular eczema phenotype of atopic dermatitis in adults

Nummular eczema (NE) is currently considered as one of the clinical phenotypes of atopic dermatitis (AD) of the adult. In this multicentre study, 30 adult patients (age ≥ 18 years) affected with nummular‐like AD were treated with dupilumab, a monoclonal antibody against the receptor for interleukin(IL)‐4 and IL‐13. The evaluation of the results after 16 weeks of treatment showed a significant improvement of the disease, as demonstrated by reduction in Eczema Area Severity Score (EASI), visual analogue score (VAS) of pruritus, and Dermatology Life Quality Index (DLQI) scores. Conjunctivitis in one patient was the only side effect. In conclusion, dupilumab seems to be an effective and safe treatment in NE phenotype of AD of the adult.     

Food allergy in patients with eczema: immediate symptoms are usual,with nuts and tomatoes the major allergens

Background Food intolerance is a popular notion in the general population but limited data are available on the presence of food allergy in adult patients with eczema. Objective We wanted to characterize food hypersensitivity in this group of patients. Method A retrospective study was carried out on all patients with food related symptoms attending a cutaneous allergy clinic. Results and conclusion Our study showed that while the reported prevalence of food allergy in adult patients with eczema is low (10%), more than half of these will show immunological evidence of a food allergy which support the clinical history. Immediate symptoms are usual, with nuts and tomatoes the major allergens. Demographic factors such as age, gender and duration of eczema did not significantly correlate with number of foods or an allergen‐specific IgE of ≥ grade 2. Food‐related symptoms were associated with significant anxiety in all our patients leading to a profound effect on their behaviour.     

慢性湿疹和皮炎122例斑贴试验结果分析

目的:探讨慢性湿疹和皮炎患者接触性致敏原及其特点。方法:应用斑贴试验分析122例慢性湿疹和皮炎患者接触性致敏原。结果:列前10位的常见致敏原分别是0.1%硫柳汞、5%硫酸镍、7%芳香混和物、1%甲醛、1%肉桂醇、1%促进剂D、1%氯化钴、20%松香、25%秘鲁香油、3%卡巴混和物;引起手部湿疹和皮炎患者的致敏原主要为0.1%硫柳汞和7%芳香混和物,躯干、四肢湿疹和皮炎患者的致敏原主要为5%硫酸镍和0.1%硫柳汞,面部湿疹和皮炎患者的致敏原主要为0.1%硫柳汞和1%甲醛,脐周皮炎患者的致敏原主要为5%硫酸镍。结论:斑贴试验有助于明确慢性湿疹和皮炎患者的接触性致敏原及其性质。     

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.     

Epidemiology of orofacial herpes simplex virus infections in the general population in France: results of the HERPIMAX study

BACKGROUND: Prevalence of clinically manifest orofacial herpes in the general population is poorly characterized. Objectives To establish the lifetime prevalence of clinically manifest orofacial herpes and its relationship with herpes simplex virus (HSV) serotype in the French general population. PATIENTS/METHODS: Subjects (N = 2796) were serotyped for HSV1 and HSV2 and provided data on herpetic symptoms by questionnaire. Subjects reporting at least one episode of orobuccal ulcerative mucosal lesions were classified as clinically manifest orofacial herpes. RESULTS: Lifetime prevalence of clinically manifest orofacial herpes was 38.3% (42.1% in women, 32.4% in men). Prevalence in subjects seropositive for HSV1 was 50.3%. This prevalence rate was independent of HSV2 serotype. Prevalence in subjects infected with HSV2 alone was similar to that in subjects seronegative for HSV. LIMITATIONS: Lack of case ascertainment limits precision of the data. CONCLUSIONS: Clinically manifest orofacial herpes was reported in one third of the sample, principally associated with HSV1 infection. HSV2 infection did not produce orofacial lesions nor influence clinical manifestations of HSV1 infection.     

Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences

Background. Occupational hand eczema is common in hairdressers, owing to wet work and hairdressing chemicals. Objectives. To estimate the prevalence of hand eczema and its career consequences among hairdressers in Denmark. Methods. A register‐based study was conducted, comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self‐administered postal questionnaire including questions on hand eczema, atopic dermatitis, and career change. A response rate of 67.9% (n = 5324) was obtained. Results. Of the respondents, 44.3% no longer worked as hairdressers and had worked for an average of 8.4 years in the profession before leaving it. Hand eczema was more common among ex‐hairdressers (48.4%) than among current hairdressers (37.6%) (p < 0.0001), and significantly more ex‐hairdressers (26.8%) than current hairdressers (15.7%) had chronic hand eczema (p < 0.0001). Of the respondents with hand eczema, 75% were aged 15–24 years at onset, and 45.5% gave hand eczema as a reason for career change. In this group, logistic regression analysis showed that chronic hand eczema contributed the most to the decision to change career (odds ratio 50.12; 95% confidence interval 18.3–137). Conclusions. Hairdressers work an average of 8.4 years in the profession before leaving it, and hand eczema contributes significantly to this career change.     

Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema

Although gamma-linolenic acid (GLA) has been shown to correct deficiencies in skin lipids associated with reduced delta-6-desaturase activity which should result in improvement of dysregulation of inflammation and immunity in atopic eczema, clinical studies with evening primrose oil containing 10% GLA have yielded contradictory results. We have therefore examined the effect of a higher percentage (at least 23%) GLA-containing borage oil in adults with stable atopic eczema of moderate severity in a double-blind, multicentre study. One hundred and sixty patients were randomized to take daily either 500 mg of borage oil-containing capsules or the bland lipid miglyol as a placebo over a 24-week period. Use of topical diflucortolone-21-valerate cream was allowed as rescue medication, with the amount used until response being defined as primary, and clinical improvement as secondary efficacy criteria. Although several clinical symptoms improved compared with placebo, the overall response to borage oil did not reach statistical significance. Significant differences in favour of borage oil were, however, observed in a subgroup excluding patients who failed to show increased erythrocyte dihomo-gamma-linolenic acid levels and in whom adherence to inclusion criteria and the study protocol were questionable. GLA metabolites increased in borage oil-treated patients only, and serum IgE showed a trend to decrease on overall and subgroup analysis. No substance-related adverse effects were observed. This study shows no overall efficacy of GLA-containing borage oil in atopic eczema, with steroid use being the primary response parameter, although it suggests that a subgroup of patients may benefit from this well-tolerated treatment.