Eczema: quality of life by body site and the effect of patch testing

BACKGROUND: Patients with dermatitis are known to have impaired quality of life. Whether this varies according to body site has not been evaluated. Patch tests have previously been shown to influence quality of life, although no previous studies have shown if this is dependent on the results of the patch tests. OBJECTIVES: To evaluate the impact of patch testing on quality of life according to the outcome of the investigations and to determine how quality of life varies according to eczema body site. METHODS: One hundred and sixty consecutive adult patients with active eczema were selected from a patch test clinic for inclusion into the study. Quality of life was determined using the Dermatology Life Quality Index (DLQI) and the SF-36, prior to patch testing and 2 months later. Perceived eczema severity at each time point was also noted, along with the outcome of patch testing. Baseline comparison of quality of life was performed between four body site groups (face, hand, generalized, other). RESULTS: Patients confirmed as having relevant positive contact allergens were shown to have a significant improvement in both perceived eczema severity (P = 0.0004) and DLQI score (P = 0.0015) at 2 months after patch testing. No significant changes were noted in the SF-36 score, other than a borderline improvement in the pain score (P = 0.048). The improvement in quality of life and eczema severity was not noted in patients with negative patch tests. Eighty-nine per cent of patients diagnosed as having contact allergy were able to comply with avoidance advice. No significant variation was noted in quality of life according to body site affected by eczema. There was a positive correlation between DLQI score and perceived eczema severity (P < 0.0001). CONCLUSIONS: Patients confirmed as having contact allergy show a subsequent improvement in eczema severity and an improvement in quality of life.     

头面部血管肉瘤1例

患者男,80岁。头面部出现簇集血疱样皮疹40d。皮损组织病理:可见不规则的血管腔,管腔由内皮细胞排列而成,内皮细胞异型性。免疫组化检查:CD31,CD34,Vimetin(+)。诊断:头面部血管肉瘤。     

Contact hypersensitivity and allergic contact dermatitis among school children and teenagers with eczema

Background:  Patch testing is an essential procedure in the investigation of eczema in children.
Objectives:  To analyse the frequency of contact hypersensitivity and allergic contact dermatitis among Polish children with eczema.
Patients/methods:  During an allergy screening programme involving 9320 children aged 7 and 16 years, 12.6% reported symptoms of chronic/recurrent eczema. From this group, a representative sample of 229 eczema children underwent patch testing: 96 children aged 7 years and 133 teenagers aged 16 years. Patch testing was with 10 allergens: methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), nickel sulfate, mercury ammonium chloride, thimerosal, cobalt chloride, potassium dichromate, lanolin, fragrance mix I, Myroxylon pereirae (balsam of Peru), and colophonium.
Results:  49.4% tested children were found patch test (PT) positive. 43.8% of 7 year olds with eczema were PT positive, with sensitization to nickel sulfate (30.2%), thimerosal (10.4%), cobalt chloride (8.3%), fragrance mix I (7.3%), MCI/MI (6.3%), potassium dichromate (6.3%), M.   pereirae (3.1%), mercury ammonium chloride (2.3%), and colophonium (1.0%). 52.6% teenagers were PT positive, with sensitization to nickel sulfate (23.3%), thimerosal (27.8%), cobalt chloride (10.5%), potassium dichromate (6.0%), mercury ammonium chloride (2.3%), M. pereirae (1.5%), and MCI/MI (0.8%). The final diagnosis of allergic contact dermatitis was confirmed in 36% of 7 year olds and 26% of 16 year olds.
Conclusions:  Every second child with eczema is PT positive, whereas every third child is finally diagnosed with allergic contact dermatitis.     

自制止痒湿疹合剂治疗慢性湿疹疗效及对血清IL-1、IL-2、IL-6水平的影响

目的探讨本院自制口服中药止痒湿疹合剂对慢性湿疹的疗效及可能的作用机制。方法湿疹患者随机分为西替利嗪组、止痒湿疹合剂组和联合用药组,健康体检者为对照组。治疗前后对观察指标红斑、浸润、丘疹/斑块、鳞屑/结痂和瘙痒进行评估和打分,计算疗效指数。用酶联免疫吸附法测定细胞因子白细胞介素(IL)-1、IL-2和IL-6的表达水平。结果治疗后各组患者的各项观察指标比治疗前均有明显改善。与西替利嗪组治疗后比较,止痒湿疹合剂组治疗后在浸润、丘疹/斑块两方面改善更明显;联合用药组治疗后在红斑、浸润、丘疹/斑块、鳞屑/结痂、瘙痒方面改善均更明显。与西替利嗪组比较,止痒湿疹合剂组和联合用药组的治疗总有效率得到明显提高。与对照组比较,患者组的IL-1、IL-2和IL-6水平均明显增高。各治疗组治疗后的IL-1、IL-2和IL-6水平均明显降低。与西替利嗪组比较,联合用药组的IL-1、IL-2和IL-6水平明显降低。结论止痒湿疹合剂治疗慢性湿疹能明显改善患者的各项观察指标。止痒湿疹合剂治疗慢性湿疹能取得明显的临床疗效,单独使用或与西替利嗪联合使用均比单独使用西替利嗪疗效更好。其机制可能与降低湿疹患者IL-1、IL-2和IL-6的表达水平有关。     

External and internal exposure to the antigen in the hand eczema of nickel allergy

A provocation study was performed in twelve female patients with contact allergy to nickel and hand eczema of the pompholyx type. Intense handling of nickel-contaminated metal objects did not induce any visible eczematous activity. Oral administration of nickel in a double-blind test provoked an aggravation of the hand eczema in nine of the twelve patients, and in seven of the patients this was accompanied by secondary eruptions including outbreaks of earlier, healed eczema. The nickel dose given is probably in the upper limit of the presently known daily intake of the metal, but should be considered to be within the physiologic range. It is concluded that ingestion of small amounts of nickel may be of greater importance in maintaining the hand eczema than external contacts with the metal.     

Contact Leukoderma of the Scalp or an Unusual Variant of Vitiligo?

Contact leukoderma due to hair dyes is strongly suspected in patients presenting with depigmented patches sharply localized to the scalp. We describe three patients with a striking pattern of depigmentation, which stopped abruptly at the hair margins. However, no definite correlation with the use of hair dyes could be made in any of them. Our cases represent an unusual pattern of vitiligo of the scalp, which seems to have been previously attributed mainly to hair colorants. Careful examination of the lesions on the scalp may reveal more cases with this pattern.     

Eczema: an Evidence Based Update. Report from the 9th Nottingham Evidence Based Update Meeting, 13 May 2010, Loughborough,U.K.

The 9th Nottingham Evidence Based Update Meeting was held in Loughborough on 13 May 2010. The theme of the 1‐day meeting was eczema and was attended by delegates from the U.K. and Europe. The broad range of topics included the systemic treatment of severe eczema, eczema educational programmes for patients and their families, the role of allergy testing, the impact of nurse practitioner‐led eczema clinics and the use of probiotics both in the treatment and prevention of eczema.     

Validity and responsiveness of the Osnabrück Hand Eczema Severity Index (OHSI): a methodological study

Background  The Osnabrück Hand Eczema Severity Index (OHSI) is a scoring system for the assessment of the severity of hand eczema (HE).
Objective  To assess the clinimetric value of the OHSI and to validate the longitudinal responsiveness of the OHSI using the Manuscore as a gold standard.
Methods  OHSI and Manuscore scores were compared before and after 3 weeks' inpatient treatment of 62 patients with occupational HE. Correlation coefficients and 95% limits of agreement were calculated and the ability of OHSI to identify severe HE was analysed. The responsiveness of the OHSI in monitoring skin changes over time was evaluated by calculating effect sizes.
Results  High correlation was found between the OHSI and Manuscore at both scoring occasions (around r _s = 0·77). Differences between both measurements were within the 95% limits of agreement for 94% of patients, with a tendency for the OHSI to underestimate the severity at very low and at very high values compared with the Manuscore. Responsiveness to change was good. Both instruments showed significant improvement between the scoring occasions. Using the OHSI values, the proportion of classification to the correct tertile of score change was 69%. Effect size from untreated to treated was 0·6 for the Manuscore and 1·1 for the OHSI, with higher effect sizes in individuals with severe HE.
Conclusions  Even though the OHSI allows less differentiation than the Manuscore, it shows adequate validity and responsiveness to change. Thus the OHSI is suitable for both monitoring the severity of HE and the effects of treatment.     

Contact allergy to fragrances: current patch test results (2005–2008) from the Information Network of Departments of Dermatology*

Background: Contact sensitization to fragrances is common both in clinical and in population samples. The spectrum of allergens is broad and diverse, and to some extent covered by a set of screening agents. Objectives: To examine the current frequency of contact sensitization to fragrance allergens in patients routinely patch tested for suspected allergic contact dermatitis with the baseline series and special series. Patients and methods: Between 2005 and 2008, 40 709 patients were patch tested in the departments of the Information Network of Departments of Dermatology ( http://www.ivdk.org ). Results with selected fragrances were analysed. Results: Of all patients tested with the German baseline series, 15.1% reacted positively to fragrance mix (FM) I (6.6% positive), FM II (4.6% positive) or Myroxylon pereirae resin (balsam of Peru, 6.8% positive). Among the single constituents of FM I, Evernia prunastri [oak moss absolute (abs.)] was the leading allergen, and amyl cinnamal the least frequent allergen. Among fragrances not included in FM I or FM II, Evernia furfuracea (tree moss abs.) was the most common allergen. Conclusions: For diagnostic purposes, it is necessary to combine several screening agents. The frequency of contact sensitization differs greatly between single fragrances.     

Contact allergy and hand eczema in Swedish dentists

Hand eczema and contact allergy in Swedish dentists were studied in a multidisciplinary project. The aims of the study were to establish diagnoses, to investigate the occurrence of contact allergy, in particular to (meth)acrylates, and to evaluate certain consequences of hand eczema. A postal questionnaire on skin symptoms, atopy and occupational experience was mailed to 3,500 dentists aged <65 years, and licensed 1965-1995. The response rate was 88%. Among dentists living in 3 major cities, 14.9% (n= 191) reported hand eczema during the previous year. They were invited to a clinical examination, including patch testing with a standard and a dental series. 158/191 (83%) dentists attended, and hand eczema diagnosis was confirmed in 149/158 (94%). Irritant contact dermatitis was diagnosed in 67% and allergic contact dermatitis in 28%. On patch testing, 50% presented at least 1 positive reaction. The most frequent allergens were nickel sulfate, fragrance mix, gold sodium thiosulfate and thiuram mix. 7 (5%) had positive reactions to (meth)acrylates, all to 2-hydroxyethyl methacrylate and 6 also to ethyleneglycol dimethacrylate. 38% had consulted a physician, 4% had been on sick-leave and 1% had changed occupational tasks due to hand eczema. No dentist with allergy to acrylates had been on sick-leave or changed occupation. It is concluded that dentistry is a high-risk occupation for hand eczema, and that irritant contact dermatitis is most common. The prevalence of contact allergy to acrylates was below 1% in the population of responding dentists, and in most cases did not have serious medical, social or occupational consequences.     

The European standard series in 9 European countries, 2002/2003 -- first results of the European Surveillance System on Contact Allergies

Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.     

Infant feeding and the development of food allergies and atopic eczema: An update

There is an increasing awareness of food allergies in the community. Dermatologists frequently see patients with atopic eczema, where parents are extremely concerned about the role of food allergy. Advice given to parents regarding the timing of introduction of solid foods has changed markedly over the past decade. Whereas previous advice advocated delaying the introduction of solid foods until the infant's gastrointestinal system had matured, recent studies suggest that the introduction of solids from around 4 to 6 months may actually prevent the development of allergies. Studies on maternal dietary restrictions during pregnancy and lactation have led researchers to believe that antigen avoidance does not play a significant role in the prevention of atopic disease. Breastfeeding exclusively for 4 to 6 months has multiple benefits for mother and child, however, it does not convincingly prevent food allergies or decrease atopic eczema. New evidence suggests that the use of hydrolysed formulas does not delay or prevent atopic eczema or food allergy. This article aims to highlight current evidence and provide an update for dermatologists on the role of food exposure in the development of atopic disease, namely atopic eczema.