非特应性的湿疹皮炎患者皮肤马拉色菌携带情况

为探讨非特应性的湿疹皮炎患者皮肤马拉色菌携带情况，选取非特应性的温疹皮炎患者，参照Faergemann的方法取材，采用马拉色菌培养基培养。结果急性及慢性湿疹皮炎患者非脂溢部位皮损马拉色菌检出率显著高于正常人非脂溢部位，接触性皮炎及未分类湿疹患者非脂溢部位皮损马拉色菌检出率也显著高于正常人非脂溢部位。自身对照研究发现，慢性湿疹皮炎患者非脂溢部位皮损马拉色菌检出率显著高于自身正常非脂溢部位。结论示马拉色菌可能与一部分非特应性的湿疹皮炎有一定关系。     

Evaluation of Langerhans' cells in normal and eczematous dermatitis skin by CD1a protein immunohistochemistry: preliminary findings

Background:  Langerhans' cells (CD1a positive, bone marrow–derived cells), are the antigen presenting cells of the skin. Our knowledge about the status of these cells in eczematous dermatitis is incomplete.
Aim:  This study tests the hypothesis that 'the development of eczematous dermatitis is associated with alterations of Langerhans' cells'.
Materials and methods:  Biopsy specimens from patients with eczematous dermatitis and normal skin (20 cases, each) were studied. Langerhans' cells were stained for CD1a using imunoperoxidase-staining methods and mouse monoclonal antibodies.
Results:  In normal skin, CD1a+ Langerhans' cells were seen in suprabasal position. In eczematous dermatitis skin, CD1a positive cells were seen scattered in the acanthotic epidermis. Compared with normal skin, the mean values of the Langerhans' cells were statistically significantly higher in eczematous dermatitis [epidermal Langerhans' cells: 1.20 (standard error of mean, SEM, 0.13) vs. 2.50 (SEM, 0.16); and dermal Langerhans' cells: 1.30 (SEM, 0.15) vs. 2.7 (SEM, 0.15); for normal and eczematous skin, respectively; p < 0.05].
Conclusions:  The higher Langerhans' cell counts in eczematous dermatitis suggest a possible link between antigen presenting capabilities of these cells, and development of these lesions.     

The morphologic characteristics of dry skin in atopic dermatitis

Uninvolved skin sites in 436 consecutive patients, 6 to 25 years old, with atopic dermatitis were observed during the winter months (from November to February). Ichthyosis vulgaris occurred in 133 patients. Of the 303 remaining patients, only 11 (4%) had generalized dry skin; 191 (63%) exhibited focal areas of dry skin; and 95 (33%) showed only normal-appearing skin. Microscopically, in 41 patients, dry skin associated with atopic dermatitis showed mild eczematous changes. Dry skin coexistent with ichthyosis in patients with atopic dermatitis revealed ichthyotic changes frequently superimposed on eczematous changes. We suggest that in patients with atopic dermatitis the presence of dry skin may reflect mild eczematous changes, a manifestation of concomitant ichthyosis, or a complex of both of these changes.     

Profiles of Foxp3+ regulatory T cells in eczematous dermatitis, psoriasis vulgaris and mycosis fungoides

Background It is well known that regulatory T cells (Tregs), identified by their expression of CD4, CD25 and Foxp3, play a crucial role in maintaining peripheral tolerance. Recently, it has been demonstrated that a Treg population resides in normal human skin. However, only a few studies have demonstrated the presence of Foxp3+ Tregs in inflammatory skin disorders. Objectives In this study, we immunohistologically examined the presence of CD4+ CD25+ Foxp3+ Tregs in the lesional skin of psoriasis vulgaris, mycosis fungoides and eczematous dermatitis. Methods We used immunohistochemistry to examine the presence of Foxp3+ Tregs in fixed sections of the lesional skin from 16 patients with psoriasis vulgaris, 17 patients with mycosis fungides and 18 patients with eczematous dermatitis in addition to 10 normal skin samples. Results In normal skin, epidermal and dermal Foxp3+ cells were rare. The psoriasis vulgaris, mycosis fungoides and eczematous dermatitis samples contained substantial numbers of epidermal and dermal CD3+, CD4+ and CD25+ Foxp3+ Tregs. The epidermis contained a higher percentage of CD3+, CD4+ and CD25+ Foxp3+ cells than the dermis. The percentage of Foxp3+ cells among CD3+ or CD4+ cells was significantly lower in eczematous dermatitis than in psoriasis vulgaris or mycosis fungoides, and that of dermal Foxp3+ cells was significantly lower in psoriasis vulgaris than in eczematous dermatitis or mycosis fungoides. Conclusions The lower percentage of epidermal or dermal Foxp3+ cells in eczematous dermatitis or psoriasis vulgaris, respectively, might contribute to their pathogenesis.     

Effector pathways during eczematous dermatitis: where inflammation meets cell death

Abstract:  During eczematous skin inflammation, the main constituents of the skin, keratinocytes (KC), play an important role in inducing and shaping the immunological response to environmental stimuli. This review focuses on the epidermal inflammation caused by keratinocyte-T cell interactions arising from a disturbed barrier function of the skin. In eczematous dermatitis, activated dermis- and epidermis-infiltrating T cells target KC for apoptosis. In turn, damaged KC respond by secreting inflammatory mediators, thus effecting further recruitment of immunocytes to inflamed skin. Further advances will come from identification of the immunoregulatory mechanisms involved in the pathogenesis of eczematous dermatitis. Potential therapeutic interventions are discussed.     

Chronic actinic dermatitis. Concept and case examples]

Two women patients with chronic eczematous dermatitis, who also developed extremely severe, persistent photosensitivity during a course of 10 and over 40 years, are presented. Both patients had an atopic history with positive immediate skin reactions. Patch and photopatch tests revealed sensitization to several contact allergens, and in one case also a photocontact allergy. The action spectrum of the photosensitivity was confined to UV-B; it was possible to provoke eczematous skin reactions with doses smaller than 1 mJ/cm2 UV-B. Both patients were successfully treated with PUVA therapy. These case reports demonstrate the difficulty of nosological classification of chronic eczematous photosensitive dermatoses under the traditional terms persistent light reaction, photosensitive eczema, photosensitivity dermatitis, and actinic reticuloid. Chronic actinic dermatitis is defined clinically by chronic dermatitis on skin exposed to sun, histologically by spongiotic dermatitis, and photobiologically by experimental provocation of spongiotic dermatitis with UV-B and often also longer wavelengths in the absence of a photoallergen. Chronic actinic dermatitis should be used as a general term in addition to the more specific terms listed above.     

Histamine helps development of eczematous lesions in experimental contact dermatitis in mice

Histamine is released from mast cells in the skin, causing urticaria and itching. However, little is known about the roles of histamine in development of eczematous lesions in contact dermatitis. Effects of histamine on development of eczematous lesions in contact dermatitis were assessed using histamine-deficient mice in which contact dermatitis was developed by repeated application of diphenylcyclopropenone. Development of eczematous lesions in contact dermatitis was suppressed in histamine-deficient mice compared to wild-type mice. H₁ agonist ((6-12-(4-imidazol)ethylamino)-N-(4-trifluoro- methylphenyl)hepatanecarboxamide) promoted development of eczematous lesions in histamine-deficient mice. H₁ receptor antagonist (loratadine) suppressed development of eczematous lesions in wild-type mice, whereas H₂ agonist (dimaprit) and receptor antagonist (cimetidine) were ineffective. These results suggest that histamine facilitates the development of eczematous lesions in a murine model of contact dermatitis via H₁ receptors.     

Occupational airborne contact allergy to tetrazepam in a geriatric nurse

A 52‐year‐old geriatric nurse presented with recurrent eczema localized in uncovered skin areas. Patch testing produced an eczematous skin reaction with type IV sensitization to tetrazepam. A relapse of contact dermatitis was successfully prevented by using occupational skin protection measures and organizational measures. Our case indicates that a sensitization to drugs should be considered when allergic contact dermatitis is suspected in nursing personnel.     

Challenge reactions in atopic dermatitis after percutaneous entry of mite antigen

We succeeded in reproducing an eczematous lesion on the apparently normal skin of a patient with atopic dermatitis by scratching and continuous application of an ointment containing ferritin-labelled mite antigen. Percutaneous entry of mite antigen was demonstrated in skin biopsies by Fe-staining. Scratched skin first showed an urticarial reaction typical of type I allergy which later changed into an eczematous reaction typical of type IV allergy. This change was also shown histologically.     

A study of the role of house dust mite in atopic dermatitis

Subjects with positive skin-prick tests to house dust mite (HDM) solution, including those with and without atopic dermatitis, participated in a double-blind, controlled study of the role of HDM exposure in the pathogenesis of atopic dermatitis. HDM solution and diluent control were applied daily to mildly eczematous or clinically uninvolved skin of the antecubital or popliteal fossae, without prior abrasion, for 5 days. Responses were assessed by a clinical grading system and by measurement of area of dermatitis; pruritus was recorded on visual analogue scales. The clinical grading system showed that marked or moderate delayed local reactions developed in one third of patients with atopic dermatitis in response to HDM application to both mildly eczematous and clinically uninvolved skin. Relative to control sites, significant increases in area of dermatitis and degree of pruritus were also recorded in response to HDM application to mildly eczematous sites. Application of HDM solution to normal, unabraded skin of prick test positive subjects without a history of dermatitis, produced pruritus and immediate urticarial responses which were not seen at control sites, findings which demonstrate that HDM antigen may be rapidly absorbed in normal skin. Application of vehicle or antigen solution to which subjects were negative on prick testing, produced no significant local reactions. This study provides objective evidence for a role for cutaneous HDM exposure in the pathogenesis of atopic dermatitis.     

An animal model for altering the irritability threshold of normal skin

Theory behind conditioned hyperirritability (autoeczematization) predicts the lowering of the irritation threshold in the presence of a pre-existing dermatitis. We have attempted to develop an animal model that parallels the syndrome seen in man. Groups of 10 guinea pigs were shaved and depilated; irritation thresholds to benzalkonium chloride and trichloroacetic acid were determined using 1 cm diameter open patches. Reactions were scored 24 h later on the basis of erythema and induration. Animals having as little as 1.56 cm2 of skin acutely inflamed with a known irritant had lowered irritation thresholds to the same irritant on normal skin at remote sites (p less than 0.01). Mild irritation of a much larger surface area produced the same effect (p less than 0.01). More extensive, severe dermatitis did not lower the irritation threshold further. Acute dermatitis induced by a contact allergen (DNCB) lowered the irritation threshold of normal skin to the same level as that obtained with irritants (p less than 0.01). Induction of chronic cutaneous ulcers 3-4 cm in diameter lowered the irritation threshold of normal skin to the same point defined by the acute studies (p less than 0.01). These results indicate that an acute irritant or contact dermatitis, as well as chronic skin ulceration, may alter the reactivity of unaffected normal skin to exhibit a heightened response to irritation. This model appears to differ from that seen in humans, in that a more extensive or chronic dermatitis did not further heighten the susceptibility to irritation.     

皮炎湿疹类疾病规范化诊断术语专家共识

【摘要】 针对皮炎湿疹类疾病在概念、分类和诊断术语等方面的混乱现状,中华医学会皮肤性病学分会免疫学组、中国医师协会皮肤科医师分会指南制定与规范委员会组织专家按照德尔菲法原则对皮炎湿疹类疾病的诊断现状及存在问题进行讨论,提出7条规范化诊断建议,主要包括：①“皮炎”和“湿疹” 是疾病的类别名称而非具体诊断术语;②临床遇到湿疹性皮损时,应积极寻找其临床特征和/或实验室特点,按照特应性皮炎、接触性皮炎和其他皮炎进行分类诊断;③建议暂时保留“湿疹”这一术语,并只用作以湿疹性皮损为表现但尚不能给出确定诊断的、暂时性和描述性诊断用词。本共识旨在推动皮炎湿疹类疾病诊断术语的规范化、同质化,为更好地进行疾病管理、流行病学研究和开展个体化治疗和预防奠定基础。     

Vascular effects of a local anesthetic mixture in atopic dermatitis

An anesthetic cream with an eutectic mixture of 5% lidocaine and 5% prilocaine has been tested on the skin of healthy subjects and patients with atopic dermatitis and generalized eczema. In healthy subjects a blanching was seen when the analgesia was complete after 30-60 min. In the dry skin and eczematous lesions of atopic dermatitis an application time of 5-15 min caused a blanching and a good analgesia. When applied for 30-60 min the eczematous skin became increasingly red and in one patient purpura appeared. The white dermographism turned red in treated areas. The abnormal vascular reactions to the cream in diseased skin can be explained by a rapid and increased percutaneous absorption of the anesthetics. A shortened application time is here recommended.     

In vitro reproduction of clinical hallmarks of eczematous dermatitis in organotypic skin models

Dermatitis is a group of highly pruritic chronic inflammatory skin diseases which represents a major public-health problem worldwide. The prevalence of dermatitis has increased in recent years affecting up to 20% of the general population. Acute skin lesions are characterized by extensive degrees of intercellular edema of the epidermis (spongiosis) and a marked perivenular inflammatory cell infiltrate in the dermis. Keratinocytes within eczematous lesions exhibit a modified expression of proinflammatory cytokines, chemokines and cell-surface molecules. The pathophysiological puzzle of dermatitis is far from being elucidated completely, but skin infiltration of activated memory/effector T cells are thought to play the pivotal role in the pathogeneses. The aim of this study was the set-up of organotypic models mimicking the symptoms of eczematous dermatitis to provide a tool for therapeutic research in vitro. Therefore activated T cells (ATs) were integrated in organotypic skin and epidermis equivalents (SE, EE). These models enabled the reproduction of several clinical hallmarks of eczematous dermatitis: (1) T cells induce keratinocyte apoptosis, which leads to a reduced expression of the adhesion molecule E-cadherin (E-cad) and disruption of the epidermal barrier. (2) Expression of intercellular adhesion molecule-1 (ICAM-1) allows the attachment of leukocytes to epidermal cells. (3) Upregulation of neurotrophin-4 (NT-4) in the epidermis is thought to mediate pruritus in lesions by supporting nerve outgrowth. (4) Elevated levels of pro-inflammatory cytokines (IL-1α and IL-6) and chemokines (IL-8, IP-10, TARC, MCP-1, RANTES and eotaxin) amplify the inflammatory response and lead to an influx of secondary immunocells into the skin. The therapeutics dexamethasone and FK506 markedly reduce cytokines/chemokines production and epidermal damaging in these models. These data underline that activated memory/effector T cells induce eczematous changes in this HaCaT cell based organotypic skin equivalent. Furthermore it can be concluded that these models make it possible to investigate targets of therapeutics in skin.     

Eczematous Skin Reaction from Patch Testing with Aeroallergens in Atopic Children With and Without Atopic Dermatitis

Abstract: To determine whether aeroaltergens could induce eczematous lesions, 30 patients with atopic dermatitis were studied in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 end 14 years of age. Patch testing with five aeroallergens—housedust, mite, cockroach, mold mix, and grass mixwas done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with staple dermatitis, patch testing with aeroallergens Induced eczematous lesions at one or more sites. Mite, cockroach, house dust, mold mix, and grass mix caused reactions In 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis ( P < 10⁻⁵). Intradermai skin tests in both groups were not significantly different This study supports previous reports that aeroallergens play an Important role in causing eczamatous skin lesions.     

Vasoconstrictor and the anti-inflammatory effects of 7 corticosteroids

The vasoconstrictor effect of 7 proprietary corticosteroid creams was compared with their effect on patches of allergic contact dermatitis provoked by patch testing in 20 subjects. A parallel between the blanching effect on the normal skin and the anti-inflammatory effect on the eczematous skin was generally found. A modified patch test method using the Finn chamber technique is described, which (with certain restrictions) offers an opportunity of studying the anti-inflammatory effect of corticosteroids on allergic dermatitis under standard conditions.     

Specificity of dermal mucin in the diagnosis of lupus erythematosus: comparison with other dermatitides and normal skin

Increased dermal mucin is a feature of lupus erythematosus (LE); however, its amount and distribution have not been well characterized. The differentiation of LE from other forms of dermatitis can be challenging when other features of LE are subtle or equivocal. One hundred and thirty‐five skin specimens showing LE, graft vs. host disease, erythema multiforme/fixed drug eruption, lichen planus, polymorphous light eruption (PMLE), urticaria, eczematous dermatitis and psoriasis and normal skin with and without photodamage were collected. The amounts of mucin in the papillary, superficial reticular and deep reticular dermis were scored from 0 to 3 on hematoxylin–eosin (H&E) and alcian blue (AB) stains, and compared between groups. The mean scores in the reticular dermis were significantly higher in LE than in other categories except PMLE and eczematous dermatitis. A combined H&E + AB score of ≥5 in the superficial reticular dermis gave an overall specificity of 85.7% for LE. Mucin in the papillary dermis failed to distinguish among entities. Normal photodamaged skin showed significantly more mucin in the superficial reticular dermis compared to non‐photodamaged skin. While LE is associated with increased mucin deposition, scant to moderate amount of mucin alone has limited specificity and is common in other dermatitides or photodamaged skin.     

Inability to Produce White Dermographism in the Early Stage of Infantil Eczema

Abstract: White dermographism constitutes an abnormal vascular reaction characteristically demonstrable in atopic dermatitis; however, there is no information about it in the infantile phase of atopic dermatitis. Therefore we examined 73 infants younger than 3 years of age with eczematous dermatitis for the demonstrablity of white dermographiam after mechanical strocking of the lesional skin. None of the 40 healthy control infants showed white dermographism on their normal skin. In contrast, an age-dependent increase was demonstrated in patients with infantile eczema, from 11% in those 1 to 2 months of age to 85% in those older than 7 months. There was no correlation between the demonstrabllity of white dermographism in early infancy and the prognosls of infantile eczema. Based on our study of various types of dermatitis experimentally induced in adult volunteers, we think that, in addition to the immaturity of infantile skin, the presence of acute dermatitic changes may be related to Inabllity to demonstrate with dermographism in the early phase of infantile eczema.     

Periadnexal Mucin as an Additional Histopathologic Feature of Chronic Eczematous Dermatitis

BackgroundCutaneous mucinoses are a heterogeneous group of disorders characterized by an abnormal amount of mucin in the skin. However, the pathomechanism of an excessive mucin deposition in the skin is still unknown. Eczematous dermatitis is sub-classified histologically into acute, subacute, and chronic variants. The characteristic histopathologic findings for chronic eczema are variable. However, periadnexal mucin deposition is not known as a feature of chronic eczema.ObjectiveTo evaluate the presence of periadnexal mucin deposition in chronic eczematous dermatitis.MethodsWe analyzed the skin biopsy specimens from 36 patients who were pathologically diagnosed with chronic eczematous dermatitis. Alcian blue, colloidal iron, and periodic acid-Schiff stains were used to evaluate the mucin deposition in histologic sections. Two dermatologists and two dermatopathologists evaluated the degree of mucin deposition using a 4-point scale.ResultsVarious amounts of mucin deposition were observed in the periadnexal area of patients who were diagnosed with chronic eczema. Mucin deposition was more visible after staining with mucin-specific stains. Evaluation of the staining analysis scores revealed that the staining intensities were significantly higher in patients with chronic eczema than age- and site-matched controls (normal, acute to subacute eczema, and psoriasis vulgaris).ConclusionPeriadnexal mucin (secondary mucinoses) may be an additional finding of chronic eczematous dermatitis.     

Chronic eczematous dermatitis of the hands: a comparison of PUVA and UVB treatment

The efficacy of PUVA and UVB treatment in chronic eczematous dermatitis of the hands was compared in a randomised controlled study including 35 patients who were randomly allocated to PUVA or UVB treatment. One hand was exposed to light and the other served as an untreated control. The dermatitis cleared on the treated hand in all PUVA patients, but in 9 out of 14 there was a relapse within three months. In the UVB group clearing of the skin lesions was not achieved, but compared with the "untreated" hands a statistically significant improvement was found at 12 weeks of treatment. A statistically significant improvement of "untreated" hands was found in both groups. PUVA and UVB treatments are alternative treatment modalities in patients with recalcitrant chronic eczematous dermatitis of the hands. PUVA is superior to UVB.