A Role for Th17 Cells in the Immunopathogenesis of Atopic Dermatitis?

Atopic dermatitis (AD) is a common inflammatory skin disease. Both epidermal barrier dysfunction and immunodysregulation are suggested to influence the pathogenesis of AD. AD has been considered a paradigmatic T helper cell (Th) 2-mediated disease, with a switch to a Th1 cell environment during the chronic phase of the disease. Previously unreported findings now suggest a possible role for Th17 cells as well.     

Cyclosporin Treatment of Atopic Dermatitis: Is It Really Associated with Infectious Diseases?

Background

Patients with severe atopic dermatitis (AD) can benefit from cyclosporin (CSA) treatment. Some studies reported that CSA can cause infectious diseases as side effects.

Objective

To investigate the possible association of CSA treatment in AD patients with infectious diseases.

Methods

We performed a case-controled study on 202 patients with AD, 101 of whom were taking CSA and 101 who were not. Retrospective medical record review was held, and the incidence of infectious disease in both groups was compared.

Results

The total number of infectious diseases in the CSA group was slightly lower than in control group but that was not statistically significant. Similarly, the incidence density was almost the same in the two groups. In both groups, eczema herpeticum was the most common infection.

Conclusion

Our results suggest that CSA therapy in AD does not increase the incidence of infectious disease.     

Do Early Skin Care Practices Alter the Risk of Atopic Dermatitis? A Case‐Control Study

The rise in atopic dermatitis prevalence observed in industrialized countries is unexplained. We hypothesized that certain skin care practices early in life may increase the risk for developing atopic dermatitis. Our case-control study could not identify any one practice that increased the odds of developing atopic dermatitis, but it revealed that regular lotion use was very common in infants who later develop atopic dermatitis.     

Time Spent on Treatment of Atopic Dermatitis: A New Method of Measuring Pediatric Morbidity?

Our purpose was to examine if the time spent on treatment (TSOT) is a relevant surrogate measure of pediatric disease severity. The TSOT (min/day) was studied in a group of 42 children with atopic dermatitis (AD) (16 girls and 26 boys; mean age 7.07 years). The TSOT included time spent on all types of topical treatment, on extra cleaning, and on visits to doctors. Objective Scoring Atopic Dermatitis (SCORAD) assessment was performed at each visit. A significant correlation was found between TSOT and SCORAD scores for all visits (p < 0.0001). There was no correlation between TSOT and age or sex or between TSOT/SCORAD and age (p < 0.08). For the 65 visits (by 42 children), TSOT/SCORAD ranged from 0.08 min/point to 28.67 min/point. Older children (10-15 years of age) had a lower TSOT/SCORAD ratio compared to younger children (1-5 years of age). Our data suggest that TSOT in itself may be a useful measure of morbidity among pediatric AD patients. It is speculated that patients with a very high TSOT/SCORAD rate or a very low rate have coping problems and would therefore be suitable candidates for intensified efforts in programs such as "eczema schools."     

Is the prevalence of psoriasis increasing? A 30‐year follow‐up of a population‐based cohort

Background  There is indication of an increasing prevalence of psoriasis in some western populations. However, the results are not conclusive. Objectives  To analyse trends in the prevalence of psoriasis over the past 30 years, separating age, birth cohort and time period effects. Methods  Five population‐based surveys in North Norway, the Tromsø Studies 2–6, collected between 1979 and 2008, were studied. Participants aged 20–79 years with self‐reported psoriasis data in at least one of the surveys were included, yielding a total of 69 539 observations from 33 387 unique individuals born between 1915 and 1977. Trends in psoriasis prevalence were examined using cross‐sectional, time lag and longitudinal designs of graphical plots. Observed trends were further evaluated in generalized linear‐regression models. Results  The self‐reported lifetime prevalence of psoriasis increased from 4·8% in 1979–1980 to 11·4% in 2007–2008. Graphical plots showed an increasing prevalence of psoriasis with each consecutive survey in all examined age groups and birth cohorts, leaving time period effects as the explanation for the increase. The odds for psoriasis in the cohort were 2·5 times higher in 2007–2008 than in 1979–1980 (adjusted odds ratio 2·49, 95% confidence interval 2·08–2·99). The prevalence of persons reporting a doctor’s diagnosis of psoriasis was 9·9% in the last survey. In subgroups of the study population, psoriasis was associated with higher body mass index, lower physical activity during work and leisure time, lower educational level and smoking. Conclusions  Our findings indicate an increasing prevalence of self‐reported psoriasis. This could represent a true increase in prevalence, possibly due to changes in lifestyle and environmental factors, or an increased awareness of the disease.     

Evaluation of Oxidant–Antioxidant Balance in Children with Atopic Dermatitis: A Case–Control Study

Background

Increased reactive oxygen species (ROS) and oxidative stress (OS) has been reported in many allergic and inflammatory skin diseases, including urticaria, psoriasis, and atopic dermatitis (AD). Melatonin is a hormone secreted from the pineal gland and is a potent antioxidant.

Objective

The aim of the study was to measure serum antioxidant melatonin, oxidants of nitric oxide (NO), and malondialdehyde levels to calculate the serum oxidant–antioxidant balance based on the NO/melatonin and malondialdehyde/melatonin ratios and to determine the correlation with the disease severity in children with AD.

Methods

Seventy-three children with AD and 67 healthy controls were included in the study. The clinical diagnosis of AD was based on the diagnostic criteria of Hanifin-Rajka. The severity of AD was evaluated by the scoring AD (SCORAD) index, and atopy was determined by skin prick tests (SPTs) with commercial extracts. The OS-related parameters of serum melatonin, NO, malondialdehyde, and the NO/melatonin and malondialdehyde/melatonin ratios were calculated and compared with the results of healthy controls.

Results

Serum melatonin levels were higher (p < 0.0001) and serum NO levels and the NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls (p = 0.045, p < 0.0001, p < 0.0001, respectively). There was no difference between children with AD and healthy controls in terms of serum malondialdehyde levels (p = 0.119). Serum melatonin levels were significantly lower in severe AD than in mild AD (p = 0.012). However, in terms of serum melatonin levels, there was no difference between mild and moderate AD (p = 0.742) and moderate to severe AD (p = 0.301). There was no significant difference in serum NO and malondialdehyde levels and NO/melatonin and malondialdehyde/melatonin ratios among children with mild, moderate, and severe AD (p > 0.05). A negative correlation was found between serum melatonin levels and the SCORAD index (r = ?0.252, p = 0.031), and a positive correlation was found between NO/melatonin and malondialdehyde/melatonin ratios (r = 0.511, p < 0.0001). There was no statistically significant relationship between age (≤24 or >24 months), disease duration (≤6 or >6 months), and sex for the OS-related parameters (p > 0.05).

Conclusion

The serum oxidant–antioxidant balance was impaired in children with AD. Serum melatonin levels were higher in children with AD; however, this was negatively correlated with disease severity. Serum NO levels and NO/melatonin and malondialdehyde/melatonin ratios were lower in children with AD than in healthy controls. Melatonin might be used as a promising antioxidant to evaluate disease severity in children with AD. Thus, further studies are needed to clarify the role of melatonin in AD pathogenesis.

     

Is season important for the diagnosis of cutaneous melanoma in southern Brazil? A 10‐year hospital‐based study

Background Exposure to sunlight is an important etiologic factor in cutaneous melanoma (CM). In several countries, more cases of CM are diagnosed in summer than in winter. Aim To analyze whether there is seasonal variation in the diagnosis of CM in southern Brazil. Methods Data were collected from a hospital‐based registry, including all cases of CM diagnosed between 1996 and 2005. Summer to winter and spring to fall ratios were used for the analysis, and a 95% confidence interval (CI) was calculated using Poisson regression. Results Two hundred and eighty‐one patients were diagnosed in this period. Although some months were shown to have higher absolute numbers of diagnosed melanomas (April, July, and January), there was no statistically significant seasonal variation in most of the melanomas in terms of either the summer to winter ratio [odds ratio (OR) = 1.09; 95% CI, 0.77–1.44] or spring to autumn ratio (OR = 1.01; 95% CI, 0.71–1.43). Only the number of lentigo maligna melanomas (LMMs) diagnosed in summer was higher than that in winter (OR = 2.83; 95% CI, 1.07–8.78). Conclusions In southern Brazil, CMs do not seem to be more frequently diagnosed in summer than in winter. Darkening of melanocytic lesions and increased awareness of skin lesions during the summer could be possible explanations for LMMs being more frequently diagnosed in summer than in winter in this sample.     

Atopische Dermatitis und allergische Rhinitis ‐ gibt es Co‐Effekte in der Therapie?

Summary Atopic dermatitis and allergic rhinitis frequently appear together in the same patients. The pathogenesis of both disorders is complex and still incompletely understood. Nevertheless, pathophysiological overlaps suggest the existence of potential therapeutic co‐effects. While data pointing towards a positive effect of allergen elimination for both diseases is still limited, there is now increasing evidence showing beneficial effects of specific immunotherapy in patients suffering from atopic dermatitis and additional type I allergies. H₁‐antihistamines were also found to exert moderate positive effects on the symptoms of atopic dermatitis in single studies. In summary, a limited therapeutic co‐effect of the above mentioned treatment options can be expected in case of the parallel existence of atopic dermatitis and allergic rhinitis in the same patient. More studies on this issue during the next years are desirable. In addition, a better understanding of the pathophysiology should have a positive impact on the treatment of atopic manifestations such as atopic dermatitis and allergic rhinitis.     

Palmar‐Plantar Keratoderma of Unna Thost Associated with Atopic Dermatitis: An Underrecognized Entity?

We report six cases of palmar-plantar keratoderma of Unna Thost (PPKUT) associated with atopic dermatitis. All had typical features of PPKUT with diffuse, yellowish thickening on the palms and soles with a well-defined erythematous rim of demarcation on the sides associated with palmar-plantar hyperhidrosis. The changes were obvious since birth or arose during early life, and were persistent. We believe that the association between the two disorders is not coincidental but an underrecognized entity that may shed light on the underlying pathogenesis of these two conditions.     

Is the pain of topical photodynamic therapy with methyl aminolevulinate any different from that with 5‐aminolaevulinic acid?

Topical photodynamic therapy (PDT) using 5‐aminolaevulinic acid (ALA) or methyl aminolevulinate (MAL) is widely used in dermatology. It is commonly stated that MAL PDT is less painful than ALA PDT, although published data are conflicting. We report our experience of the use of ALA (4–6 h) (n = 20) and MAL (3 h) (n = 20) in 40 consecutive patients with Bowen's disease or superficial basal cell carcinoma, treated with PDT using an identical irradiation regime. Although there was a trend to higher pain scores with ALA PDT [visual analogue scale (VAS)score, median 4.50], this was not significantly different from that of MAL PDT (VAS score, median 3.55; P = 0.98), nor considered to be clinically important. Importantly, both ALA and MAL PDT regimes were fairly well tolerated in this patient cohort, supporting the use of these prodrugs in dermatological PDT.     

Is drug allergy less prevalent than previously assumed? A 5‐year analysis

Background Rashes are a frequent conundrum in clinical practice as they may be reactive, drug induced or disease specific. Identification of the culprit drug is important as re‐exposure may be harmful or even life‐threatening and unnecessary avoidance of ‘innocent’ drugs leads to limitations of treatment options. Objective To objectify the cause of suspected cutaneous drug reactions in a large patient population. Method Over 5 years (2006–10), 612 patients with suspected cutaneous drug reactions were evaluated. Histology was assessed. About 200 patients were invited for complete work‐up with skin tests (prick/intracutaneous testing and scratch/patch as indicated) and, if necessary, lymphocyte transformation tests (LTT). In special cases, drug provocation tests were conducted. Results A total number of 141 cases with suspected drug reaction underwent full work‐up (age 6–86 years; 75% female, 25% male). In 107 cases (76%) a drug was identified whereas 34 (24%) were reactive rashes or had other causes. Mostly, cutaneous drug reactions were maculopapular rashes, urticaria/angio‐oedema; less frequently, acute generalized exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms, systemic drug‐related intertriginous and flexural exanthema, toxic epidermal necrolysis and fixed drug eruptions were present. Of all the cutaneous drug reactions investigated, 39·8% were caused by antibiotics, 21·2% by anti‐inflammatories, 7·6% by contrast media and 31·4% by others (oral antidiabetics, antimycotics, antipsychotics, antiepileptics and others). Conclusion Clinical assessment overestimates the role of drug allergies in cutaneous reactions. Assessment of suspected drug reactions can be greatly improved by thorough evaluation including dermatological and allergological work‐up with skin testing and assays such as LTT.     

Whither… the future for contact dermatitis? A report from the 2007 International Review of Current Problems in Contact Dermatitis

In our report we summarize presentations made at the International Review of Current Problems in Contact Dermatitis meeting which took place at the St John's Institute of Dermatology, London, on 1 June 2007, and which brought together over 100 dermatologists from the U.K., continental Europe and the U.S.A. During this small and informal meeting, the state-of-the art lectures on various aspects of contact dermatitis were followed by energetic discussions.     

Is it possible to improve the patch‐test diagnostics for isocyanates? A stability study of petrolatum preparations of diphenylmethane‐4,4′‐diisocyanate and polymeric diphenylmethane diisocyanate

We have previously shown that the concentration of diphenylmethane-4,4'-diisocyanate (4,4'-MDI) in commercial test preparations was so low that patch testing with the same was not reliable. The stability of 4,4'-MDI in petrolatum (pet.) was compared with pet. preparations of polymeric diphenylmethane diisocyanate (PMDI), which consists of a complex mixture of monomeric isomers and oligomers of MDI. Preparations of 4,4'-MDI and PMDI were stored under 3 different conditions, i.e. at room temperature, refrigerated and frozen. They were analysed continuously during 1 year with regard to the content of 4,4'-MDI, 3-ring oligomers and 4-ring oligomers using liquid chromatography-mass spectrometry. PMDI preparations kept frozen were stable for a year. All other preparations failed to fulfil the requirements of stability, i.e. +/-20% of the initial concentration. Storage in a freezer prolonged the lifetime for 4,4'-MDI. The decrease in concentration for preparations kept at room temperature and refrigerated was less rapid in PMDI preparations than in 4,4'-MDI preparations. PMDI preparations are better suited for patch testing patients exposed to MDI because they are more stable and homogeneous than 4,4'-MDI preparations. They better reflect possible allergens that workers are exposed to because products used in industry contain both monomers and oligomers.