Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and/or emollients. An expert panel''s opinion and review of the literature

BACKGROUND: The use of dampened bandages to reduce inflamed eczema (synonyme dermatitis) is an old remedy. In order to evaluate the current indications for so-called wet-wrap treatment (WWT) for atopic dermatitis (AD), and to compare the different currently recognized methods, a group of experts critically reviewed their own expertise on WWT in respect to the existing literature on the subject. RESULTS: WWT is well tolerated in eczema due to the cooling effect on the skin and the rapid improvement in skin inflammation. It has been shown to be an extremely effective treatment for acute erythrodermic dermatitis, therapy-resistant AD and intolerable pruritus. Advantages of WWT include rapid response to therapy, reduction in itch and sleep disturbance, and potential for reduction in usage of topical corticosteroids (TCS). However, disadvantages include high cost, the necessity for special training in usage, potential for increased TCS absorption, increased cutaneous infections and folliculitis, and poor tolerability. Precautions to reduce the risks of long-term treatment should include education, monitoring of weight and height and, if necessary, serum cortisol levels. In adolescents the risk of striae from TCS absorption around puberty is high, and WWT with TCS in this age group should be used as a short-term therapy only and with extreme caution. To reduce risks, dilutions of steroids may be used ranging from 5 to 10%. In the maintenance phase this treatment can be rotated with the use of emollients only. Low potency TCS should be used on the face (with a mask). CONCLUSION: WWT using diluted steroids is a relatively safe addition to the therapeutic treatment options for children and adults with severe and/or refractory AD. Explanation and education is extremely important in the treatment of AD and WWT should only be employed by practitioners trained in its use. Specialized nursing care is essential, especially when using WWT for prolonged periods.     

Messages from the Aalst Allergy Study

Background  The prevalence of sensitization and allergic disease has increased significantly worldwide. The aim of the “Aalst Allergy Study” was to document prevalences of sensitization and allergic symptoms, and to evaluate the effect of personal and environmental influences on these prevalences in an unbiased Belgian pediatric population. Methods  A cross-sectional study was performed in an unbiased population of 2021 Belgian schoolchildren (3.4–14.8 years). Skin prick testing with the most common aeroallergens was performed. Allergic symptoms as well as potential risk factors for sensitization and allergic disease were documented by a parental questionnaire. Results  The prevalence of sensitization to the most common aeroallergens and the prevalence of allergic diseases (eczema, asthma and rhinoconjunctivitis) were in line with the data in the literature. The association of current allergic symptoms with sensitization was only significant in the children aged ≥6 years. Age, gender, body mass index, bedroom environment and exposure to pets were the factors significantly associated with sensitization and allergic symptoms. Conclusions  Our study corroborates the reported prevalences of sensitization and allergic diseases. Moreover the study illustrates the complexity of the search for factors involved in the process of sensitization and allergic disease. The impact of different potential causative factors is not only influenced by mutual interactions of these factors, but also by the existence of distinct subtypes of disease.     

Congenital molluscum contagiosum: report of four cases and review of the literature

Molluscum contagiosum is a viral infection of the skin and mucous membranes that is caused by infection with the molluscum contagiosum virus. Molluscum contagiosum can be acquired from skin to skin contact which may be during play, in a swimming pool, or through sexual contact. Sexually acquired molluscum is rare in younger children, but becomes quite common during adolescence and young adulthood, after the sexual debut. It has been long known that the human papillomavirus, which causes genital warts, i.e., condyloma accuminatum, can be vertically transmitted through an infected genital tract. Children may not manifest condyloma lesions for a few years. The entity of congenital molluscum has been debated in the literature and only three cases of suspected congenital molluscum have been reported. We report on four more infants with congenital molluscum, two children with congenital lesions, and two children with onset of lesions at 6 weeks of age. Two children had single cutaneous lesions on the extremities and two had lesions of the scalp consistent with the site of cervical pressure. Congenital molluscum appears to be a more common entity than previously reported. Vertical transmission of molluscum should be considered for all infantile cases of molluscum.     

Phakomatosis Pigmentovascularis

We report a patient with phakomatosis pigmentovascularis lib and numerous iris hamartomas. Phakomatosis pigmentovascularis lib is characterized by the simultaneous occurrence of a nevus flammeus, a mongolian spot, and sometimes a nevus anemicus in the same individual, with systemic involvement. To our knowledge, the association with multiple iris hamartomas has been reported only once. This second patient suggests that the association might be more common. Additional reports will indicate if such an association is more frequent than is now assumed.     

Pharmacokinetic modelling of the plasma concentration-time profile of the vitamin retinyl palmitate following intramuscular administration

Seven healthy male volunteers (21-24 y) received by the ventro-gluteal route a single dose of 100,000 I.U. of the vitamin retinyl palmitate (RP) in a water-miscible preparation (W) and 5 weeks later the same dose in an oily solution (S). After administration of W median (range) peak plasma concentrations of 5.6 (4.4-8.7). 10(3) micrograms l-1 were reached after 12 h and high levels persisted for another 50 h. At 144 h levels were still, by a factor 3, higher than baseline. Plasma levels of RP after S remained close to baseline (20-50 micrograms.l-1) suggesting negligibly low bioavailability. The plasma level profile of RP after W could well be described by use of a one-compartment model with Weibull-type absorption and Michaelis-Menten elimination. The median (range) absolute bio-availability (estimates of lower limits) was 42 (32-52) per cent.     

Clinical chemical methods for the routine assessment of the vitamin status in human populations. Part I: The fat-soluble vitamins A and E, and beta-carotene

Reliable HPLC methods for the routine determination of vitamin A (only retinol, not the ester) of beta-carotene and of vitamin E in plasma are described. The results found in 150 blood donors are reported; the correlation of the concentrations of vitamin A with retinol-binding protein and of vitamin E with beta-lipoproteins are calculated.