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In addition to its well-established effects on linear growth in childhood and adolescence, growth hormone has both direct and indirect actions on bone remodelling and homeostasis. In this review the limitations of methods of assessment of bone mineral density are highlighted. The influence of growth hormone deficiency of childhood-onset, on bone mineral accretion and, the specific skeletal implications of GHD in long-term survivors of childhood cancers, are discussed. Specific influential factors, which affect peak bone mass achievement and therefore skeletal health in later life, are evaluated. 相似文献
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A. Wollenberg S. Christen-Zäch A. Taieb C. Paul J.P. Thyssen M. de Bruin-Weller C. Vestergaard J. Seneschal T. Werfel M.J. Cork B. Kunz R. Fölster-Holst M. Trzeciak U. Darsow Z. Szalai M. Deleuran L. von Kobyletzki S. Barbarot A. Heratizadeh U. Gieler D.J. Hijnen S. Weidinger L. De Raeve Å. Svensson D. Simon J.F. Stalder J. Ring for the European Task Force on Atopic Dermatitis/EADV Eczema Task Force 《Journal of the European Academy of Dermatology and Venereology》2020,34(12):2717-2744
Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient’s age and also target flare prevention. Basic therapy includes hydrating and barrier-stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti-inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid-potency corticosteroids are proven agents for proactive therapy, which is defined as the long-term intermittent anti-inflammatory therapy of frequently relapsing skin areas. Systemic anti-inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit–risk ratio. The IL-4R-blocker dupilumab is a safe, effective and licensed, but expensive, treatment option with potential ocular side-effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R-blockers) only have limited effects on AD-related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient-specific, and elimination diets should only be advised in case of proven food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress-induced exacerbations. Efficacy-proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults. 相似文献
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A. Heratizadeh E. Haufe D. Stölzl S. Abraham L. Heinrich A. Kleinheinz A. Wollenberg E. Weisshaar M. Augustin F. Wiemers A. Zink R. von Kiedrowski M. Hilgers M. Worm M. Pawlak M. Sticherling I. Fell C. Handrick K. Schäkel P. Staubach-Renz A. Asmussen B. Schwarz M. Bell I. Effendy T. Bieber B. Homey B. Gerlach E. Tchitcherina M. Stahl U. Schwichtenberg J. Rossbacher P. Buck M. Mempel S. Beissert T. Biedermann S. Weidinger J. Schmitt T. Werfel The TREATgermany Study Group 《Journal of the European Academy of Dermatology and Venereology》2020,34(6):1263-1272
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Annice Heratizadeh Claudia Killig Margitta Worm Stephanie Soost Dagmar Simon Andrea Bauer Vera Mahler Christian Schuster Christiane Szliska Yvonne Frambach Ricarda Eben Thomas Werfel Wolfgang Uter Axel Schnuch 《Contact dermatitis》2010,62(6):330-337
Background: While the use of methyldibromo glutaronitrile (MDBGN) in leave‐on products is clearly associated with high sensitization or elicitation risk, such a clear‐cut relation could be questioned with regard to rinse‐off products. Objective: The objective of this study was to find a maximum non‐eliciting concentration for rinse‐off products in MDBGN patch test‐positive patients. Patients and methods: We performed a use‐related test [repeated open application test (ROAT)] in patients sensitized to MDBGN with a liquid soap containing three concentrations of MDBGN (50, 200, and 400 p.p.m. MDBGN, respectively). The soap at 50 p.p.m. was used twice daily for 4 weeks. If no reaction of the skin was observed, the product with the next higher concentration was used for another 4 weeks, etc. Results: In total, 32/37 evaluated cases [86.5%; lower exact one‐sided 95% confidence limit (CL): 73.7%] did not react to any of the preparations. The remaining reacted as follows: 1/37 reacted to 50 p.p.m., 3/37 to 200 p.p.m., and 1/37 to 400 p.p.m. The cumulative non‐response to 50 p.p.m. was 97.3% (lower CL: 87.8%). Conclusions: The majority of subjects sensitized to MDBGN‐tolerated rinse‐off products containing a maximum concentration of 400 p.p.m. A concentration in rinse‐off products in the range of 50 p.p.m. could be regarded as safe for most individuals already sensitized. These concentrations will presumably prevent induction (sensitization) also. 相似文献
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J.P. Thyssen C. Vestergaard M. Deleuran M.S. de Bruin-Weller T. Bieber A. Taieb J. Seneschal M.J. Cork C. Paul C. Flohr S. Weidinger M. Trzeciak T. Werfel A. Heratizadeh S. Barbarot U. Darsow D. Simon A. Torrelo P.V. Chernyshov J.-F. Stalder C. Gelmetti Z. Szalai Å. Svensson L.B. von Kobyletzki L. De Raeve R. Fölster-Holst S. Cristen-Zaech D. Hijnen U. Gieler J. Ring A. Wollenberg 《Journal of the European Academy of Dermatology and Venereology》2020,34(12):e839-e842
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K. Breuer A. Heratizadeh A. Wulf U. Baumann † A. Constien D. Tetau A. Kapp T. Werfel 《Clinical and experimental allergy》2004,34(5):817-824
BACKGROUND: Food allergy is a common problem in patients with atopic dermatitis (AD), particularly in children. While immediate reactions to food are well characterized, the importance of food as a provocation factor for late eczematous reactions has been a subject of debate for several decades. OBJECTIVE: To investigate the importance of food for the induction of late eczematous reactions in children with AD and to correlate the clinical outcome to the results of specific IgE determinations and atopy patch tests (APTs). METHODS: One hundred and six double-blind placebo-controlled food challenges (DBPCFCs) to cow's milk, hen's egg, wheat and soy in 64 children with AD (median age 2 years) were analysed retrospectively. Total and food-specific IgE were determined by CAP RAST FEIA and APTs with native foodstuff were performed. The diagnostic values of specific IgE and APT results were calculated. RESULTS: Forty-nine (46%) of the challenges were related to a clinical reaction. An exacerbation of AD (late eczematous reaction) commonly occurred 24 h after the ingestion of food. Isolated late eczematous reactions were seen in 12% of all positive challenges. Forty-five percent of the positive challenges were associated with late eczematous responses, which followed immediate-type reactions. The sensitivity of food-specific IgE and the APT was 76% and 70%, respectively. Specific IgE and APT were often false positive, which resulted in low positive predictive values (64% and 45%, respectively). CONCLUSIONS: Late eczematous reactions may often be observed upon food challenge in children with AD. Due to the poor reliability of food-specific IgE and APT results DBPCFCs have still to be regarded as the gold standard for the appropriate diagnosis of food responsive eczema in children with AD. 相似文献
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Annice E Kim Timothy Hopper Sean Simpson James Nonnemaker Alicea J Lieberman Heather Hansen Jamie Guillory Lauren Porter 《Journal of medical Internet research》2015,17(11)