Hand dermatitis among university hospital nursing staff with or without atopic eczema: assessment of risk factors

Background. Nurses are prone to develop hand dermatitis. Although an atopic constitution has been identified as a genetic risk factor, the behavioural risk factors associated with hand dermatitis in wet work conditions have not been fully explored. Objectives. This study aimed to clarify the impact of atopic eczema (fulfilling the diagnostic criteria during the past 1 year) on the occurrence of hand dermatitis and to identify the behavioural risk factors among non‐atopic nurses with hand dermatitis. Methods. From August 2007 to July 2009, nurses from Kaohsiung Medical University Hospital were recruited. The associations between different risk factors and hand dermatitis were documented. In addition, the behavioural risk factors among non‐atopic nurses were evaluated via observational study. Results. One thousand one hundred and thirty‐two nurses participated in the first part of the study, which revealed that individuals with atopic eczema had a 3.76‐fold increased risk for hand dermatitis. However, among 248 nurses with hand dermatitis, only 43 had atopic eczema. The observational study performed on 140 non‐atopic nurses identified frequency of hand washing as the behavioural risk factor associated with hand dermatitis. Conclusions. Although atopic eczema is the major risk factor for hand dermatitis, those with atopic eczema constitute only 17% of nurses with hand dermatitis. Decreasing hand washing frequency is the most effective strategy to reduce the occurrence of hand dermatitis among non‐atopic nurses.     

Hand eczema in patients with history of atopic manifestations in childhood

A follow-up study of two groups of individuals aged 24-44 years, with a history of severe and moderate atopic dermatitis in childhood (n = 549 and 406 respectively), showed that the most common site of atopic dermatitis was the hands. The prevalence of hand eczema in the two groups was 41% and 25% respectively. The corresponding figure for a group of 222 individuals with respiratory allergy, but not atopic dermatitis in childhood, was 5%, and for a control group (n = 199), without family or personal atopy, 4%. In all four groups the majority of the patients had mild to moderate hand eczema. The fingers were the most common site in all groups. In 69%, 55%, 36% and 12% respectively, hand eczema was found simultaneously with other eczematous manifestations. Irritants were considered by 71-96% in the four groups to aggravate the hand eczema. Contact with various food substances, particularly proteins, was regarded by 38%, 43%, 30% and 9% as an eliciting/aggravating factor. Dust was looked upon as an eliciting/aggravating factor by 25% and 20% of the individuals in the two groups with atopic dermatitis in childhood, but by no one in the control group.     

Heterogeneity of interleukin 5 genetic background in atopic dermatitis patients: significant difference between those with blood eosinophilia and normal eosinophil levels

BACKGROUND: Blood eosinophil levels in patients with atopic dermatitis vary widely during exacerbation of the disease. We considered that in addition to environmental factors, the genetic background involved with elevating blood eosinophil levels might be heterogeneous among atopic dermatitis patients. OBJECTIVE: We attempted to determine whether a polymorphism of the interleukin (IL)5 gene plays a role in atopic dermatitis, particularly in those patients with blood eosinophilia. Due to the close relation of blood eosinophilia to high IgE productivity, we also assessed these polymorphisms in patients with high IgE concentrations. METHODS: We determined the genotype of the IL5 polymorphism -703C/T in 451 atopic dermatitis patients and 116 normal subjects. The patients were classified into three groups by blood eosinophil levels; less than 7%, from 7 to 15%, and more than 15%, as well as by serum IgE concentrations; less than 500 IU/ml, from 500 to 2000 IU/ml, and more than 2000 IU/ml. RESULTS: IL5 -703C/T was not significantly associated with either total atopic dermatitis patients or individual patients who had both blood eosinophilia and high IgE productivity. However, the distribution of the IL5 -703C/T genotype was significantly different between patients with either blood eosinophilia or high IgE productivity and those without either condition (P=0.0476, P=0.0088, respectively). CONCLUSION: These results suggest that the IL5 gene may play a role in blood eosinophilia associated with atopic dermatitis. We also considered that the IL5 -703C/T gene polymorphism does not have a direct relationship to disease specificity.     

Allergic contact dermatitis in patients with atopic dermatitis: A clinical study

BACKGROUND: Atopic dermatitis (AD) is a chronically relapsing dermatitis with no known cure. Due to the chronic nature of the condition, frequent and long term topical therapy is used. This may lead to sensitization, resulting in allergic contact dermatitis (ACD). AIMS: The aim of the study was to observe the frequency of ACD in atopic patients in this part of the country using Indian standard battery. METHODS: A total number of 30 cases of AD were taken for the study. Diagnosis of AD cases was based on the criteria of Hannifin and Rajka (1980). All the selected cases of AD had mild to moderate grade of severity. All these cases were treated and patch tested during the remission period. The duration of the study was 12 months. RESULTS: Out of the 30 AD cases, 7 cases showed positive ACD with patch test allergens. CONCLUSION: This study shows that ACD is not uncommon amongst atopic individuals.     

Prevalence of atopic eczema in the community: the Lothian atopic dermatitis study

Summary An epidemiological study of atopic eczema (AE), based on a semirural community in Scotland, using sound diagnostic criteria, has yielded prevalence data for all age groups including infants and adults. The overall 1-year period prevalence, age-standardized to the Scottish population, was 2.3%. The 1-year period prevalence was highest in the under 2s(9.8%), and showed a continuous reduction with increasing age. Over the age of 40, AE was found to be relatively rare, with a 1-year period prevalence of 0.2%. Adults over 16 years made up 38% of all patients with AE.     

Neutrophil chemotaxis in patients with atopic dermatitis without infection

Atopic dermatitis has been associated with recurrent infection and impaired neutrophil chemotaxis in some patients. In order to determine if dermatitis per se could decrease polymorphonuclear leukocyte (PMN) chemotaxis, we investigated chemotaxis in 13 patients with atopic dermatitis and no clinical or historical evidence of recurrent or severe infections. Most patients had extensive, but mild, disease. Leukocyte chemotaxis was measured by the Boyden chamber and agarose techniques; There was no difference between patient and control neutrophil chemoatactic activity. These findings suggest that atopic dermatitis is not ordinarily associated with impaired PMN chemotaxis in the absence of generalized erythroderma or increased susceptibility to infection.     

The frequency of contact allergy in atopic patients with dermatitis

A prospective study was performed to establish the frequency of contact allergy in atopic patients presenting with dermatitis, compared with non-atopics suffering from dermatitis. During 1987-1988, all new patients aged 15 years or older, who consulted us for dermatitis, were investigated. They were patch tested with the European standard series, methyl(chloro)isothiazolinone and other relevant allergens. In addition, they were prick tested with 24 inhalant and 11 food allergens. Patients having at least 2 positive prick tests, and patients with 1 positive prick test and a (family) history of atopic diseases were defined as atopics, as were those who presented with classic atopic dermatitis but with negative prick tests. 499 patients were evaluated: 159 men and 340 women. 214 patients (43%) were atopic, the other 285 (57%) were non-atopic. In the atopic group, 79 persons (37%) had at least 1 positive patch test reaction. In the group of non-atopics, 149 patients (52%) had contact allergies. The difference is statistically significant (chi 2; p less than 0.05). It is concluded that adult atopics seen in dermatological practice who present with dermatitis are less frequently contact sensitized than such patients who are non-atopic. Nevertheless, a yield of nearly 40% positive patch test reactions in this group still makes routine patch testing necessary.     

Effect of dupilumab on hand eczema in patients with atopic dermatitis: An observational study

Systemic treatment options for chronic hand eczema are limited. Dupilumab is used in atopic dermatitis (AD) but is not licensed for (isolated) hand eczema. In this observational prospective study we aimed to determine the response of hand eczema to dupilumab in patients with AD. Adult patients with hand eczema and AD received dupilumab s.c. at a 600 mg loading dose, followed by 300 mg every 2 weeks. Primary outcome was a minimum improvement of 75% on the Hand Eczema Severity Index after 16 weeks (HECSI‐75). Secondary outcomes were severity, measured using the Photographic guide; quality of life improvement as patient‐reported outcome, measured using the Dermatology Life Quality Index (DLQI); and AD severity, measured using the Eczema Area and Severity Index (EASI). Forty‐seven patients were included (32 males; mean age, 45 years). HECSI‐75 was achieved by 28 (60%). Mean HECSI score reduction was 49.2 points (range, 0–164; 95% within‐subject confidence interval, 46.4–52.0), which was already significantly decreased after 4 weeks (P < 0.001). DLQI score mean improvement was 8.8 points (standard deviation [SD], 6.0) or 70.0% decrease (SD, 26.4) (P < 0.001). Eighteen patients (38%) were classified as responders on the Photographic guide. There was no difference in response between chronic fissured and recurrent vesicular clinical subtypes. Similar percentages of patients achieving EASI‐75 and HECSI‐75 were seen after 16 weeks. In conclusion, this study shows a favorable response of hand eczema to dupilumab in patients with AD. This raises the question whether a response will also be seen in isolated hand eczema.     

咪唑斯汀治疗湿疹和特应性皮炎临床疗效及免疫机制的初步研究

目的:了解咪唑斯汀和西替利嗪治疗湿疹和特应性皮炎的有效性和安全性;并观察治疗前、后湿疹和特应性皮炎患者血清中白介素(IL)-4、IL-5、干扰素(IFN)-γ和肿瘤坏死因子(TNF)-α的水平变化.方法:采用随机对照方法,将患者随机分为咪唑斯汀组、西替利嗪组和对照组,外搽1%达克罗宁霜,治疗3周后观察、比较各组的疗效和安全性,并应用ELISA法检测治疗前、后湿疹和特应性皮炎患者的IL-4、IL-5、IFN-γ和TNF-α水平 .结果:入组前各组的症状、体征无明显差异.治疗后咪唑斯汀组疗效优于对照组和西替利嗪组.治疗前湿疹和特应性皮炎患者血清IL-4、IL-5和IFN-γ水平高于健康对照组,差异有统计学意义(P<0.05);而TNF-α水平与健康人差异无统计学意义(P>0.05);经咪唑斯汀和西替利嗪治疗后血清IL-4、IL-5和IFN-γ水平下降.结论:咪唑斯汀治疗特应性皮炎和湿疹安全、有效;咪唑斯汀对IL-4、IL-5的影响作用强于西替利嗪.     

Allergy and irritation: an adverse association in patients with atopic eczema

The pathomechanism of atopic eczema is complex. Two of the most important exogenous factors for atopic eczema are allergenic and irritant substances. In this study we investigate the combined effect of topical aeroallergens and irritation on the skin of atopic individuals. We performed patch testing with several aeroallergens (atopy patch test) and with an irritant, sodium lauryl sulphate, on clinically unaffected skin of 30 sensitized patients with atopic eczema. Application was conducted alone and as a consecutive application. Healthy volunteers served as controls. Evaluation was made by measurement of transepidermal water loss 2 h after removal of the patches. In atopic patients, we found increased levels of transepidermal water loss induced by the aeroallergens as well as by sodium lauryl sulphate. The most impressive barrier disruption was seen after application of house dust mite, followed by cat dander and grass pollen. However, the consecutive application of aeroallergens and sodium lauryl sulphate led to a highly pronounced increase in transepidermal water loss. Hence, in sensitized atopic subjects the combined effect of aeroallergens and detergents may cause severe skin problems, and this may be relevant in daily practice.     

Reduced frequency of atopic dermatitis in quinoline-allergic patients: the 'hapten-atopy hypothesis'

Background:  While allergy to food proteins is almost exclusively found in association with atopy, it has been our experience that contact allergy to some contact allergens/haptens with both cutaneous and gastrointestinal exposures is reduced in atopic dermatitis (AD) patients as a group.
Objective:  To assess the contact allergy rates of two classes of antimicrobial haptens, one with both cutaneous and gastrointestinal exposures (quinolines) and one with only significant cutaneous exposure (aminoglycosides), with respect to the presence or absence of AD.
Methods:  Contact allergy rates to neomycin (aminoglycoside) and quinoline mix/clioquinol in patients attending the St John's Institute of Dermatology for diagnostic patch testing were retrospectively analysed; current AD and history of AD were noted.
Results:  In comparison to neomycin-allergic subjects, there was a highly significant negative association between quinoline contact allergy and current presence of AD ( P  = 0.0028); negative association between quinoline contact allergy and a history of AD did not reach significance ( P  = 0.07).
Conclusions:  In comparison to an antimicrobial with no significant gastrointestinal exposure (neomycin), contact allergy to quinolines is negatively associated with the presence of AD. This is in contrast to food protein allergy, which is strongly associated with atopy. Possible explanations could include (i) confounding factors or (ii) AD patients are efficient at orally tolerising haptens and inefficient at orally tolerising proteins, secondary to their atopic status or (iii) oral tolerance of haptens antagonizes tolerance of food proteins and also leads to an immunological shift towards atopy (hapten-atopy hypothesis).     

Clinical characteristics and genetic variation in atopic dermatitis patients with and without allergic contact dermatitis

Background

In patients with atopic dermatitis (AD), the risk of contact sensitization may be higher as the disrupted skin barrier may increase the penetration of contact allergens. Therefore, it is necessary to screen for concurrent allergic contact dermatitis (ACD) in AD patients.

Objectives

To identify the clinical characteristics and genetic variation in AD patients with concurrent ACD.

Materials & methods

In total, 281 AD subjects who underwent patch testing were included. Subjects with a positive result were classified as “AD with ACD”, while the others were classified as “AD only”. Clinical characteristics and prevalence of genetic variants (FLG 3321delA, FLG K4022X, KLK7, SPINK5, DEFB1, KDR, IL5RA, IL9, and IL12RB1) were compared between the two groups.

Results

Seventy-one subjects (25.3%) were found to have AD and ACD. Female sex, older age, late onset, self-reported personal or family history ofACD, and presence of prurigo nodularis were associated with concurrent ACD in AD patients. Age was useful for predicting concurrent ACD based on the receiver operating characteristic curve. However, no differences in the frequency of genetic variants were identified between the two groups.

Conclusion

A personal or family history of ACD, late onset, and prurigo nodularis support a suspicion of concurrentACD, although these correlations were less apparent after correcting for age and sex. Patch testing for AD in males >20 years and females >14 years may aid diagnosis of concurrent ACD with high sensitivity and specificity.

     

The atopy patch test: an increased rate of reactivity in patients who have an air-exposed pattern of atopic eczema

Summary In a subgroup of patients with atopic eczema (AE), eczematous skin lesions can he induced by epicutaneous testing with aeroallergens (the atopy patch test: APT). An increased frequency of positive APT has been found in AK patients showing a predictive lesional pattern affecting air-exposed skin areas. This study investigates the dose-response ofthe APT in two dilTerent patient groups with AE. Petrolatum preparations of house dust mite, cat dander and grass pollen allergens in four concentrations (500–10,000) protein nitrogen imits) were tested epicutaneously in 57 patients with AE. who were prospectively divided in two groups according to whether their AE pattern was with (group I) or without (group II) a predictive distribution. Sixty-nine per cent of patients in group I. and 39% in group II. had positive APT reactions (P = 0.02). The reactions in group I were elicitable with lower allergen concentrations (P = 0.03). A clinically recognizable subgroup of patients with AE showed increased cutaneous sensitivity to aeroallergens.