Factors associated with palmoplantar or plantar pompholyx: a case-control study

BACKGROUND: Disydrosis or pompholyx is a chronic and recurrent form of dermatosis that poses a number of therapeutic issues. The etiopathology of the condition is unclear. The aim of this study was to identify factors associated with the palmoplantar and plantar dysidrosis. PATIENTS AND METHODS: This was a prospective case-control study conducted between June 2001 and February 2004 at the University Hospital of Lome (Togo). Each case (palmoplantar or plantar pompholyx) was matched for age (+/- 5 years) and sex with two controls. Examination for tinea pedis was performed in all participants (patients and controls) but mycologic culture alone was done in patients with interdigital-plantar intertrigo. RESULTS: One hundred patients with pompholyx were matched with 200 controls. Mean age was 32.8 +/- 14.8 years in the patient group and 31.4 +/- 14.8 years in the control group. For univariate analysis, the main factors associated with pompholyx were: personal atopy (OR = 12.6; CI95%: 6.4 - 25.1) and familial atopy (OR = 5.8; CI95%: 3.2 - 10.5); history of eczema (OR = 5.4; CI95%: 2.6 - 11.4); hyperhidrosis (OR=4.5; CI 95%: 5.5 - 40.7), sport (OR = 8.8; CI 95%: 3.9 - 20.8); tinea pedis (OR = 15.6; CI 95%: 7.5 - 32.9). In multivariate analysis, atopy (OR = 10.5; CI95%: 8.4 - 20.8) and tinea pedis (OR = 18; CI95%: 10.5 - 25.2) were the only factors associated with pompholyx. Trichophyton rubrum was the most common etiology of tinea pedis in both patients and controls.DISCUSSION: The results of this study show atopy and tinea pedis as factors statistically associated with palmoplantar or plantar pompholyx. However, only cohort studies can determine the precise causal relationship between tinea pedis and pompholyx.     

Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies

BACKGROUND: Despite the numerous studies on the possible protective effect of breast-feeding against the onset of atopic dermatitis during childhood, this issue remains controversial. OBJECTIVE: We conducted a systematic review with meta-analysis of prospective studies that evaluated the association between exclusive breast-feeding during the first 3 months after birth and atopic dermatitis. METHODS: A comprehensive search of the 1966-2000 MEDLINE database and review of the reference lists of relevant articles identified 18 prospective studies that met the predefined inclusion criteria. By means of a standardized approach, 2 of the investigators independently assessed the methodologic quality of the studies, duration and exclusivity of breast-feeding, outcome measures, and control for potential confounding factors. The same approach was applied during data abstraction and evaluation of the estimates of association. Summary measures of association were then calculated. RESULTS: The summary odds ratio (OR) for the protective effect of breast-feeding in the studies analyzed was 0.68 (95% confidence interval [CI], 0.52-0.88). This effect estimate was higher in the group of studies wherein children with a family history of atopy were investigated separately (OR = 0.58; CI, 0.41-0.92) than in those of combined populations (OR = 0.84; CI, 0.59-1.19). A small subset of studies of children without a history of atopy in first-degree relatives showed no association between breast-feeding and the onset of atopic dermatitis (OR = 1.43; CI, 0.72-2.86). CONCLUSION: Exclusive breast-feeding during the first 3 months of life is associated with lower incidence rates of atopic dermatitis during childhood in children with a family history of atopy. This effect is lessened in the general population and negligible in children without first-order atopic relatives. Breast-feeding should be strongly recommended to mothers of infants with a family history of atopy, as a possible means of preventing atopic eczema.     

Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies

Background  Breastfeeding is undisputedly preferable to formula feeding for infant nutrition because of its nutritional, immunological and psychological benefits. However, studies on the association between breastfeeding and development of atopic dermatitis (AD) have shown inconsistent results.
Objectives  To examine the association between exclusive breastfeeding for at least 3 months after birth and the development of AD in childhood.
Methods  An electronic literature search of MEDLINE (January 1966–May 2008) and EMBASE (1980–May 2008) was conducted. Prospective cohort studies that met the predetermined criteria were independently assessed by three reviewers. The pooled effect estimate was calculated by random effects model. Heterogeneity across the studies was investigated by meta-regression analysis.
Results  Twenty-one studies with 27 study populations were included for meta-analysis. The summary odds ratio (OR) for the effect of exclusive breastfeeding on the risk of AD was 0·89 (95% confidence interval, CI 0·76–1·04). Heterogeneity was found across the studies (χ² = 83·6, d.f. = 26; P <  0·001). Breastfeeding was associated with a decreased risk of AD (OR 0·70; 95% CI 0·50–0·99) when analysis was restricted to the studies comparing breastfeeding with conventional formula feeding. The pooled OR for study populations with atopic heredity was 0·78 (95% CI 0·58–1·05).
Conclusions  There is no strong evidence of a protective effect of exclusive breastfeeding for at least 3 months against AD, even among children with a positive family history.     

Environmental factors, parental atopy and atopic eczema in primary-school children: a cross-sectional study in Taiwan

BACKGROUND: Parental atopy and environmental exposure are recognized risk factors for atopic eczema (AE) in childhood. However, the relative contributions of specific risk factors and the overall contributions of hereditary and environmental exposure remain unexplored. OBJECTIVES: To identify risk factors, estimate the population attributable risk (PAR) of environmental exposure, and compare the AE data for boys vs. girls in primary-school children. METHODS: During a February to June 2001 cross-sectional, Taiwan-based questionnaire survey, we investigated 23 980 children from 22 primary schools, all located within 1 km of an air-monitoring station. RESULTS: The 12-month prevalence of AE was reported as 6.1% in boys and 4.9% in girls. In both sexes, the risk of AE was strongly associated with parental atopy and perceived ambient air pollution. The presence of cockroaches [odds ratio (OR) 1.18, 95% confidence interval (CI) 1.00-1.40] and visible mould on walls at home (OR 1.46, 95% CI 1.22-1.70) were also significantly related to AE for girls; however, only visible mould on walls (and not the presence of cockroaches) at home was related to AE for boys (OR 1.40, 95% CI 1.18-1.66). While mutually adjusted models were applied, we found adjusted ORs and PARs were similar in boys and girls in hereditary and outdoor environmental factors. The PAR of indoor environmental factors was higher in girls (8.4%) than in boys (5.5%). There was no interaction between parental atopy and environmental factors. CONCLUSIONS: Parental atopy contributed more to AE than indoor or outdoor environmental factors. Girls may be more susceptible to indoor environmental factors than boys.     

Atopic dermatitis and risk factors in poor children from Great Buenos Aires, Argentina

Background.  In recent decades, the prevalence of atopic dermatitis (AD) has risen steadily, and risk factors for AD are currently being investigated worldwide. In Argentina, there are no available data on risk factors of AD.
Aim.  To determine the prevalence of and any gender predilection for AD, and to identify familial and environmental factors that are associated with increased AD risk.
Methods.  In this case–control cross sectional study, 603 children aged 12–60 months old from a poor urban community in Buenos Aires were recruited. AD was defined following UK Working Party Diagnostic Criteria. We evaluated the relationship between AD and the presence of family history of atopy, > 5 family members, wearing synthetic clothes, having a carpeted room, eating ≥ 3 eggs/week, tobacco smoking indoors by family members, and living< 300 m from a main road, polluted stream or industry.
Results.  The prevalence of AD was 41.1% (95% CI 37.2–45.2%). Logistic regression analysis showed that AD was significantly associated only with a family history of atopy (OR = 5.7; 95% CI 3.7–8.8%; P  = 0.0000), wearing synthetic clothes (OR = 2.2; 95% CI 1.4–3.5; P  = 0.0009), having a carpeted room OR = 1.9; 95% CI 1.2–3.0%; P  = 0.009) and living < 300 m from an industry (OR = 1.93; 95% CI 1.2–3.1%; P  = 0.0051).
Conclusion.  We found a high prevalence of AD in our study population. Not all the investigated risk factors for AD had a significant association with the disease.     

The course of eczema in children aged 5-7 years and its relation to atopy: differences between boys and girls

BACKGROUND: The role of atopy in the pathophysiology of eczema is still under debate. The concept and analyses of the nonatopic and atopic subtypes of eczema have gained increasing interest in recent studies. The course of these subtypes and differences between boys and girls have not been investigated so far. OBJECTIVES: To examine the course of nonatopic and atopic eczema in preschool children from Germany with regard to sex. METHODS: Repeated cross-sectional studies were performed in 5-7-year-old preschool children from Germany between 1994 and 2000. Individuals with eczema were identified by a dermatological examination. In addition to a questionnaire, skin prick tests and analyses of serum IgE antibodies against seven and five environmental allergens, respectively, were performed. Atopy was defined by sensitization to at least one of five common aeroallergens (birch, grass and mugwort pollen, house dust mites, cat dander). In part of the study population investigations of spare time behaviour and skin function were carried out (including stratum corneum hydration and skin surface pH). RESULTS: A total of 2693 girls and 2783 boys underwent a full dermatological examination of the skin and determination of sensitization. Among the girls, 8.7% demonstrated eczema clinically at the day of investigation in contrast to 6.1% of the boys. In girls, early onset eczema (< 2 years of age) was strongly related to atopy at age 5-7 years [odds ratio (OR) 3.7; 95% confidence interval (CI) 2.7-5.1], whereas late-onset eczema (> or = 2 years of age) was not (OR 1.0; 95% CI 0.7-1.5). Boys were more often atopic at the age of 5-7 years than girls (28.3% vs. 20.6%), and early and late-onset eczema were related to atopy without such a difference (OR 2.8, 95% CI 2.0-4.0; OR 1.9, 95% CI 1.3-2.8, respectively). The excess of current eczema in 5-7-year-old girls compared with boys was related to the nonatopic type. The higher susceptibility of girls in that age group to develop eczema was reflected by the skin physiological examination: even girls without eczema had significantly higher skin surface pH and lower stratum corneum hydration than boys. Additionally, questionnaire data revealed that girls more often than boys predominantly played indoors, which was associated with more eczema. CONCLUSIONS: Atopy and eczema develop differently in boys and girls. Boys are more often atopic, whereas girls suffer significantly more often from eczema without relation to atopy. The nonatopic type of eczema in preschool girls is noticed predominantly after their second birthday. Genetic and lifestyle factors may contribute to this difference.     

High body mass index, dry scaly leg skin and atopic conditions are highly associated with keratosis pilaris

BACKGROUND: In a previous study we have found that young patients with insulin-dependent diabetes mellitus had a higher prevalence of keratosis pilaris (KP) than healthy controls, with a high correlation with body mass index (BMI) and ichthyosiform skin changes of the legs. Objectives: To investigate whether BMI, dry scaly legs and atopic conditions could be associated with KP in a healthy population of adolescents. METHODS: A total of 202 Jewish adolescents chosen at random among students undergoing a routine medical examination at school participated in the study. The patients filled in a questionnaire for data on ethnic origin, the presence or history of allergic rhinitis, asthma or atopic dermatitis, the presence of thyroid disease, diabetes or dry skin. A similar questionnaire was sent to the family physician for verification. A general inspection of the skin was made for the presence of KP; the lower legs were also examined for dry scaly skin and ichthyosiform skin changes. RESULTS: KP was present in 33 examinees (16%). Factors significantly associated with were dry scaly skin (p < 0.001, odds ratio, OR = 31.3, with 95% confidence interval, CI, 6.4-153.7), BMI >25 (p < 0.001, OR = 4.9, with 95% CI 2.2-11.2) and atopy (p = 0.001, OR = 4.5, with 95% CI 1.8-11.1). Conclusion: It therefore appears that KP is associated with multiple factors, including high BMI, leg skin dryness and atopic conditions.     

Probiotics in pregnant women to prevent allergic disease: a randomized,double‐blind trial

Background Previous reports have suggested that certain probiotics given to mothers and children at risk of atopy halves the incidence of atopic dermatitis (AD) at 2 years of age. Objectives To examine if probiotics given to pregnant women in a nonselected population could prevent atopic sensitization or allergic diseases during the child’s first 2 years. Methods In a randomized, double‐blind trial of children from a nonselected maternal population (ClinicalTrials.gov identifier: NCT00159523), women received probiotic milk or placebo from 36 weeks of gestation to 3 months postnatally during breastfeeding. The probiotic milk contained Lactobacillus rhamnosus GG, L. acidophilus La‐5 and Bifidobacterium animalis subsp. lactis Bb‐12. Children with an itchy rash for more than 4 weeks were assessed for AD. At 2 years of age, all children were assessed for atopic sensitization, AD, asthma and allergic rhinoconjunctivitis. The intention‐to‐treat (ITT) analysis was enabled by multiple imputations. Results Four hundred and fifteen pregnant women were computer randomized. At 2 years, 138 and 140 children in the probiotic and the placebo groups, respectively, were assessed. In the ITT analysis, the odds ratio (OR) for the cumulative incidence of AD was 0·51 in the probiotic group compared with the placebo [95% confidence interval (CI) 0·30–0·87; P = 0·013]. There were no significant effects on asthma (OR 0·68, 95% CI 0·26–1·80; P = 0·437) or atopic sensitization (OR 1·52, 95% CI 0·74–3·14; P = 0·254). Conclusions Probiotics given to nonselected mothers reduced the cumulative incidence of AD, but had no effect on atopic sensitization.     

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND: Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE: The aim of the study was to establish some guidelines for a correct diagnosis. METHODS: A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS: Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION: Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.     

Environmental associations with eczema in early life

BACKGROUND: Although atopic eczema (AE) is a common disease, little is known about its causes. OBJECTIVES: To investigate the role of dietary and environmental factors associated with the development of AE by the age of 2 years. METHODS: A cohort of children was recruited before birth from a consecutive series of newly pregnant mothers presenting for antenatal care at three general practices in Ashford, Kent, U.K. Data up to the age of 2 years were available for 624 (97%) of the original cohort. AE was defined using components of the U.K. diagnostic criteria for AE, maternal report of doctor-diagnosed eczema and maternally reported eczema. Exposures of interest were family history of allergic disease, dietary and breastfeeding patterns, family size and exposure to indoor domestic allergens. RESULTS: The cumulative prevalence of AE using the U.K. diagnostic criteria was 14% (95% confidence interval, CI 11-17%). The prevalence of maternally reported doctor-diagnosed eczema was much higher (31%, 95% CI 27-35%) and almost half (45%) the mothers reported that their child had ever had eczema (95% CI 41-49%). The relationship between parental atopy, parental history of allergic disease and the child's eczema was consistently stronger for the mothers than the fathers. There was a marked increase in the prevalence of eczema with increasing maternal education and in less crowded homes, associations that remained significant after controlling for other factors. CONCLUSIONS: The associations with environmental factors are consistent with the hypothesis that more crowded houses, increased family size and birth order, which may possibly increase early exposure to infections, may offer protection from subsequent development of eczema.     

The effect of environmental tobacco smoke on eczema and allergic sensitization in children

BACKGROUND: The negative impact of environmental tobacco smoke (ETS) on airway diseases in children is well known. Whether there is an effect on atopic eczema is not clear. OBJECTIVES: To determine the impact of ETS on atopic eczema, allergic sensitization and allergic airway diseases in 1669 school beginners. METHODS: The prevalence of atopy-related health outcomes was assessed by questionnaire, dermatological examination, skin prick testing and specific immunoglobulin E measurement. Exposure assessments were based on measurement of cotinine [expressed as cotinine to creatine ratio (CCR)] in spot urine samples (n = 1220) together with questionnaire and interview data on smoking behaviour of the parents. RESULTS: In the total study group, prevalence of atopic eczema diagnosed on examination was significantly associated with urinary CCR values. The odds ratio (OR) and 95% confidence interval (CI), calculated for an increase of 100 ng mg-1 CCR was 1.97 (95% CI 1.23-3.16). The prevalence of skin manifestations according to questionnaire data as well as a history of asthma, wheezing, and hay fever were positively although not significantly associated with ETS exposure. When genetically predisposed children (defined by the presence of parental atopy) were compared with children whose parents had no atopy, the ORs of allergic outcome variables were generally higher in the first group. In the group of predisposed children, significant associations with urinary CCR were found for allergic sensitization against house dust mites as measured by skin prick test (OR 3.10, 95% CI 1.63-5.90). CONCLUSIONS: Children are at a higher risk of developing an atopic eczema when exposed to ETS and genetically predisposed children are at higher risk of developing a sensitization against house dust mites.     

中国16个城区男男性行为人群梅毒感染情况及影响因素分析

目的 了解中国6个省（自治区、直辖市）的16个城区的男男性行为人群（MSM）的梅毒感染情况及其影响因素。方法 于2007年在开展绘制MSM活动场所地理分布图及人群规模估计的基础上，用分类的非概率抽样方法在MSM中开展横断面调查；通过问卷调查收集人口学、危险行为以及梅毒感染等信息。用SPSS软件对数据进行单因素及多因素Logistic回归分析。结果 2007年共收集4211份有效问卷。所调查的MSM平均年龄为28岁，自报为同性恋占66.7%，未婚占72.5%，高中及其以上教育程度占76.4%。近6个月MSM的性行为调查结果显示：8.7%有10个以上的男性性伴，5.6%曾买男性性服务，11.3%曾为男性提供商业性服务，18.9%曾与女性发生过性关系，与男性肛交性行为中的安全套坚持使用率仅为36.3%。所调查MSM的梅毒感染率为10.6%。多因素Logistic回归分析结果显示：年龄 > 25岁［调整OR（AOR） = 1.7，95% CI：1.3 ~ 2.0］、本市户籍（AOR = 1.3，95% CI：1.0 ~ 1.7）、调查地区、酒吧/公园招募对象（AOR = 1.3，95% CI：1.1 ~ 1.7）、买男性性服务（AOR = 1.5，95% CI：1.0 ~ 2.1）、男男肛交行为中不坚持使用安全套（AOR = 1.2，95% CI：1.0 ~ 1.5）和自报性病史（AOR = 1.3，95% CI：1.0 ~ 1.7）是梅毒感染的独立相关变量。结论 16个城区MSM的梅毒感染率已达一定水平、男男商业性服务及不安全性行为的流行率较高，亟待加强MSM的梅毒防治工作，包括梅毒和ＨＩＶ筛查、推广使用安全套等综合干预措施。     

Lack of evidence for a protective effect of prolonged breastfeeding on childhood eczema: lessons from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two

Summary Background Exclusive breastfeeding for at least 4 months is recommended by many governments and allergy organizations to prevent allergic disease. Objectives To investigate whether exclusive breastfeeding protects against childhood eczema. Methods Study subjects comprised 51 119 randomly selected 8‐ to 12‐year‐old schoolchildren in 21 countries. Information on eczema and breastfeeding was gathered by parental questionnaire. Children were also examined for flexural eczema and underwent skin prick testing. Odds ratios (ORs) were calculated for each study centre and then pooled across populations. Results There was a small increase in the risk of reported ‘eczema ever’ in association with ‘breastfeeding ever’ and breastfeeding < 6 months [pooled adjusted OR 1·11, 95% confidence interval (CI) 1·00–1·22 and OR 1·10, 95% CI 1·02–1·20, respectively]. There was no significant association between reported ‘eczema ever’ and breastfeeding > 6 months (pooled adjusted OR 1·09, 95% CI 0·94–1·26). Risk estimates were very similar for exclusive breastfeeding < 2 months, 2–4 months and > 4 months and for eczema symptoms in the past 12 months and eczema on skin examination. As for more severe eczema, breastfeeding per se conveyed a risk reduction on sleep disturbed eczema (pooled adjusted OR 0·71, 95% CI 0·53–0·96), but this effect was lost where children had been exclusively breastfed for > 4 months (pooled adjusted OR 1·02, 95% CI 0·67–1·54). Allergic sensitization and a history of maternal allergic disease did not modify any of these findings. Conclusions Although there was a protective effect of ever having been breastfed on more severe disease, we found no evidence that exclusive breastfeeding for 4 months or longer protects against eczema. Our results are consistent with findings from a recent systematic review of prospective studies. The U.K. breastfeeding guidelines with regard to eczema should be reviewed. Intervention studies are now required to explore how and when solids should be introduced alongside breastfeeding to aid protection against eczema and other allergic diseases.     

Risk factors associated with onychomycosis

OBJECTIVE: To examine possible risk factors related to onychomycosis. BACKGROUND: Onychomycosis is a common disease with multifactorial aetiology, but little is known about the risk factors for this disease. PATIENTS AND METHODS: Questions related to signs, symptoms and possible risk factors associated with onychomycosis were sent to 3992 persons aged 16 years and older selected randomly from the Icelandic National Registry. Patients with suspected onychomycosis, based on photographs, were offered mycological examination. Data from the questionnaire and the results of mycological examination were used to calculate the odds ratio (OR) for several factors that might be associated with onychomycosis. RESULTS: Two thousand four hundred and eighty-six subjects responded to the questionnaire. Prevalence for mycologically determined onychomycosis was 11.1% in the Icelandic population. A history of the following factors more than doubled the risk of onychomycosis: cancer (OR 3.44; 95% CI 1.15-10.35), psoriasis (OR 2.44; 95% CI 1.61-3.72), tinea pedis interdigitalis (OR 3.93; 95% CI 3.11-4.95), the moccasin form of tinea pedis (OR 4.26; 94% CI 3.34-5.45), parents with onychomycosis (OR 2.59; 95% CI 1.89-3.53), children with onychomycosis (OR 3.48; 95% CI 2.05-5.88), spouse with onychomycosis (OR 2.53; 95% CI 1.72-3.72), regular swimming activity (OR 2.57; 95% CI 2.00-3.30) and age 50 years or older (OR 2.74; 95% CI 2.19-3.42). CONCLUSIONS: Several risk factors are associated with onychomycosis. Knowledge of these risk factors is important when treating and educating patients with onychomycosis.     

Allergic contact sensitization in the general adult population: a population-based study from Northern Norway

Few studies have so far addressed the prevalence and risk factors for contact sensitization in the general adult population; however, many such studies have been conducted in hospitals. We present the prevalence of contact sensitization in a general adult population and its relationship to potential risk factors like smoking, ear piercing and atopic diseases. 1236 adults (44.2% men and 55.8% women) were randomly selected from a cross-section of the population in Sør-Varanger municipality, Norway, and patch tested with TRUE Test (Pharmacia, Hillerød, Denmark). Contact sensitivity to at least 1 out of 24 allergens was found in 35.4% of the women and in 14.8% of the men. The most common allergens were nickel (17.6%), cobalt (2.8%), thiomersal (1.9%), fragrance mix (1.8%) and colophony (1.2%). All other allergens were observed in 1.0% or less. In women, ear piercing was an important risk factor for nickel sensitization. No such significant correlation was seen in men [in women relative risk (RR) = 3.30, 95% confidence interval (CI) = 2.01–5.43, and in men RR = 1.82, 95% CI = 0.66–5.00], and contact sensitivity was associated with atopic dermatitis (AD) [adjusted odds ratio (OR) = 1.58, 95% CI = 1.04–2.40] and smoking (adjusted OR = 1.42, 95% CI = 1.01–1.99) in women but not in men. The prevalence of contact sensitivity was common in this general population, especially in women. Smoking and AD might be a risk factor for contact sensitization.     

Results of atopy patch tests with house dust mites in adults with ''intrinsic'' and ''extrinsic'' atopic dermatitis

BACKGROUND: The most frequently employed diagnostic criteria of atopic dermatitis (AD) can be fulfilled in the absence of elevated total circulating IgE or specific IgE to food allergens or environmental aeroallergens and/or in the absence of personal or familial history of atopy as well. Therefore a distinction between 'extrinsic' or 'allergic' and 'intrinsic' or 'non-allergic' AD has been suggested. Recently, a patch test with environmental aeroallergens, named atopy patch test (APT), has been proposed for use in the study of AD. OBJECTIVE The aim of this study was to investigate the reactivity to APT in patients with 'extrinsic' and 'intrinsic' AD. PATIENTS, MATERIALS AND METHODS: Two groups of adult male subjects with AD were examined consecutively in our department (Department of Dermatology, Italian Navy Main Hospital, Taranto, Italy) andpatch tested with whole bodies of house dust mites (HDM) at a concentration of 20% in petrolatum (Dermatophagoides pteronyssinus 50%, D. farinae 50%). The groups included: (i) 95 patients affected by the adult clinical form of 'extrinsic' AD; (ii) 12 patients affected by the adult clinical form of 'intrinsic' AD; and (iii) a control group of 49 adult healthy male subjects with a negative anamnesis for eczema and atopy and negative skin prick test to aeroallergens/food allergens and/or normal level of total circulating IgE, also patch tested with the same allergen. The statistical differences were calculated by chi2 test and 95% confidence intervals (CI) were provided. RESULTS: The APT was positive in 47.4% (CI: 37-57%) of'extrinsic'AD, in 66.6% (CI: 41-93%) of'intrinsic' AD and in 12.2% (CI: 3-21%) of healthy subjects. The differences between the two AD subgroups and the control group were statistically significant (P < 0.001). CONCLUSIONS: APT positivity is more frequent in both 'extrinsic' and 'intrinsic' AD than in unaffected subjects. Other studies are needed to confirm our data and to explain why the APT is positive in the 'intrinsic' form.     

Predictors of atopic dermatitis in Leicester children

There is little contemporary data available on the prevalence of atopic dermatitis (AD) or the risk factors associated with this disease. We therefore performed a prospective study of 1-year-oId children based on a cohort of consecutive births in Leicester hospitals. Parents of 1800 children born between March and May 1992 were asked at the time of the birth to allow their child to be entered on a register. A sample of 499 of these children were invited for interview and examination at 1 year of age. Data were collected on gestational maturity, birth weight, feeding pattern, family history of eczema and atopy, social class and other parameters. Four hundred and thirteen of the 499 children were examined (83%). The overall point prevalence of AD was 10.7% (95% confidence interval, 7·7%–13·7%). The most significant risk factor for a child developing AD was a parental history of eczema.     

Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases

BACKGROUND: Victimization by intimate partner violence (IPV) may play an important role in sexual decision-making, increasing the risk for sexually transmitted diseases (STDs) and HIV. GOAL: To explore the relationship between IPV and high-risk sexual behaviors, substance abuse, partners who had sex outside the relationship, and history of STD among women attending an STD clinic. STUDY DESIGN: A self-administered survey of patients attending a public STD clinic in San Francisco was conducted from October 1996 to March 1997. Topics included STD history, sexual risk behaviors, partner violence history, partner characteristics, and demographics. Logistic regression analysis was used to assess the independent effect of IPV on STD risk factors. RESULTS: Overall, 2115 patients participated, for a response rate of 96%. Data were analyzed for a subgroup of 409 female patients who reported recent male sexual partners. Among these women, 11% reported IPV in the past 12 months; lifetime history of IPV was 24%. A history of IPV was associated with a self-reported history of STD (adjusted odds ratio [OR], 2.15; 95% CI, 1.23-3.77). IPV in the past 12 months was associated with alcohol or drug use before sex (adjusted OR, 2.36; 95% CI, 1.17-4.77) and main partners who had sex outside the relationship (adjusted OR, 3.75; 95% CI, 1.94-7.26). CONCLUSIONS: IPV is common among female STD patients and is associated with risk behaviors and partner factors that increase patients' risk of contracting STD and HIV. Screening and referral for IPV should be routinely conducted for female patients attending STD clinics.     

Environmental risk factors in pediatric psoriasis: a multicenter case-control study

To analyze the effect of possible risk factors, including breastfeeding, on the development of childhood-onset psoriasis, a multicenter case-control study with prospective collection of data was performed. Using a standard questionnaire, personal and specific variables including family history of psoriasis, maternal and environmental tobacco smoke exposure, body mass index (BMI), exclusive and partial breastfeeding for at least 3 and 12 months, cow's milk intake before 1 year, birth delivery method, and stressful life events were collected during 2009 from 537 patients with psoriasis and 511 controls younger than 18. Overall, patients more frequently reported exposure to environmental tobacco smoke at home and stressful life events in the year preceding the diagnosis than controls. The odds ratios (OR) for smoking and stressful life events were 2.90 (95% confidence interval [CI]=2.27-3.78) and 2.94 (95% CI=2.28-3.79), respectively. In addition, children with psoriasis were more likely to have a higher BMI (>26) than controls (OR=2.52; 95% CI=1.42-4.49). High BMI, environmental tobacco smoke exposure at home, and stressful life events may influence the development of pediatric psoriasis.