Serum thymus and activation‐regulated chemokine as disease activity and response biomarker in alopecia areata

Serum thymus and activation‐regulated chemokine/CCL17 (sTARC) is known as a good indicator for atopic dermatitis severity. Herein, we investigate whether sTARC correlates with severity and therapeutic response for alopecia areata (AA) in our 121 patients. The sTARC mean of AA totalis and universalis was significantly higher than mild AA. Next, we compared sTARC of diffuse AA (n = 14) and severity‐controlled patchy AA (n = 32) and found that sTARC in diffuse AA (564.2 ± 400.0 pg/mL) was significantly higher than that of the patchy type (344.0 ± 239.8 pg/mL), suggesting a potential role of TARC in active progression of diffuse AA. Ten patients with diffuse AA were treated with i.v. corticosteroid pulse therapy. Then, we tested whether sTARC can predict prognosis after the pulse therapy and found that baseline sTARC in the poor responders (1025.5 ± 484.8 pg/mL) was significantly higher than that in the good responders (complete remission at 24 months after the pulse therapy, 347.8 ± 135.7 pg/mL), indicating sTARC as a response biomarker in the corticosteroid pulse therapy for diffuse AA. Finally, to investigate TARC production in the affected hair follicles, we performed immunohistochemical double staining of TARC and CD68 using scalp skin specimens of diffuse AA with high titers of sTARC. The results showed their co‐localization in the infiltrating cells around the AA hair follicles, suggesting that TARC is mainly produced from CD68⁺ histiocytes. In conclusion, sTARC is a disease activity and response biomarker in AA, providing new insight beyond the T‐helper 1/2 paradigm to solve the immunological pathogenesis of AA.     

Influence of abiotic factors on the antimicrobial activity of chitosan

In an effort to bypass the adverse secondary effects attributed to the traditional therapeutic approaches used to treat skin disorders (such as atopic dermatitis), alternative antimicrobials have recently been suggested. One such antimicrobial is chitosan, owing to the already proved biological properties associated with its use. However, the influence of abiotic factors on such activities warrants evaluation. This research effort assessed the antimicrobial activity of chitosan upon skin microorganisms (Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli) in vitro when subject to a combination of different abiotic factors such as pH, ionic strength, organic acids and free fatty acids. Free fatty acids, ionic strength and pH significantly affected chitosan's capability of reducing the viable numbers of S. aureus. This antimicrobial action was potentiated in the presence of palmitic acid and a lower ionic strength (0.2% NaCl), while a higher ionic strength (0.4% NaCl) favored chitosan's action upon the reduction of viable numbers of S. epidermidis and E. coli. Although further studies are needed, these preliminary results advocate that chitosan can in the future be potentially considered as an antimicrobial of choice when handling symptoms associated with atopic dermatitis.     

异位性皮炎的眼部并发症

目的了解异位性皮炎的眼部并发症,以使患者得到早期治疗。方法对29例异位性皮炎患者采用裂隙灯、三面镜或间接检眼镜、眼部A型超声、B型超声、UBM和角膜地形图进行眼部检查。结果29例（58眼）患者中过敏性结膜炎8眼（13.8%）,角膜结膜炎6眼（10.3%）,白内障6眼（10.3%）,视网膜裂孔3眼（5.2%）,视网膜脱离3眼（5.2%）,圆锥角膜1眼（1.7%）。眼表疾病经治疗大部分可以治愈或缓解;而严重的视网膜脱离会引起视力严重损害。结论异位性皮炎可并发多种眼部并发症,早期常规眼科检查很有必要,特别对于视网膜裂孔或视网膜脱离患者,早期检查可使大部分患者避免手术或防止严重并发症的发生。     

Doxepin affects acetylcholine induced cutaneous reactions in atopic eczema

BACKGROUND: Atopic eczema (AE) is a chronic inflammatory skin disease with strong itching as the prominent symptom. The pathology of itch is still in discussion, but acetylcholine (ACH) seems to be a relevant pruritogenic mediator in AE. Since efficient benefit on pruritus and excoriations has been demonstrated with tricyclic agents, we investigated how the topical treatment with doxepin (5%, Boehringer Standard, Mannheim, Germany), a tricyclic compound with anticholinergic properties, may influence ACH induced itch and cutaneous sensations (erythema, wheal, axonreflex flare). METHODS: Eleven patients with AE were included in this double blind study. For 3 days we applied doxepin cream to a defined area on the volar forearm and basic ointment to the other side 4 times daily. On day 4, ACH and sodium chloride were i.c. injected into the pretreated arms. Vasoreactions and cutaneous sensations were measured similar to studies described in previous publications from our group. RESULTS: Doxepin treatment over 3 days reduced ACH provoked flare size more than 53% (P<0.005) and wheal size about 48% (P<0.005) whereas the maximal antipruritic effect was similiar to the basic therapy. The itch intensity, which is expressed as the mean AUC value, was rated at 6.12 arbitrary units after the neutral cream application and 5.9 arbitrary units after doxepin. CONCLUSIONS: The clinical and experimental effectiveness of doxepin as an antipruritic drug has been known for years. However, studies focusing on ACH as a pruritogenic mediator have not been performed. The duration of the doxepin application in our study seems to be appropriate since flare and wheal development were diminished. The reason why doxepin did not develop more antipruritic action compared to the vehicle cream may be due to the fact that the doxepin free cream already possessed an antipruritic action in this experimental study design. This is probably caused by rehydrating and moisturizing effects.     

异位性皮炎的记忆性T细胞浸润及ICAM－1表达

为了解粘连分子在异位性皮炎（ＡＤ）炎症及免疫反应过程中的作用，对ＡＤ皮损部位细胞间粘连分子－１（ＩＣＡＭ－１）的表达作了研究。结果虽然正常皮肤表皮不表达ＩＣＡＭ－１，但ＡＤ皮损处角朊细胞则局灶性表达ＩＣＡＭ－１，尤其在有严重单个核细胞浸润及表皮内淋巴细胞移入的部位。免疫表型研究表明，ＡＤ真皮浸润中ＣＤ４＋／ＣＤｗ２９＋／ＣＤ４５ＲＡ－记忆性Ｔ细胞占主导，推测它们可能通过分泌某些细胞因子而诱导角朊细胞表达ＩＣＡＭ－１。ＩＣＡＭ－１与淋巴细胞表面的淋巴细胞功能相关抗原－１（ＬＦＡ－１）之间相互作用可能对淋巴细胞在皮肤内的运行起调控作用。     

牛脾转移因子及白三烯C4与异位性皮炎

用牛脾转移因子口服液（ＯＢＳ－ＴＦ）治疗异位性皮炎（ＡＤ）２ 例，井采用3Ｈ放兔法测定了ＯＢＳ－ＴＦ治疗前后ＡＤ患者及正常人血浆及外周血白细胞（ＰＢＬ）中白三烯Ｃ４（ＬＴＣ４）含量。ＡＤ血浆及ＰＢＬ中ＬＴＣ４含量治疗前均明显高于正常人，治疗后则无显著差异，ＡＤ的严重程度与ＬＴＣ４水平相乎行，提示ＬＴＣ４可能作为强效炎症介质之一介入了ＡＤ的发病过程， ＯＢＳ－ＴＦ则可能作为ＬＴＣ４的抑制剂对ＡＤ发挥了治疗作用。     

Staphylococcus aureus: colonizing features and influence of an antibacterial treatment in adults with atopic dermatitis

BACKGROUND: The skin of up to 100% of patients with atopic dermatitis (AD) is colonized with Staphylococcus aureus. Of all S. aureus strains isolated from lesional skin, up to 65% have been shown to produce exotoxins with superantigenic properties. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. These studies did not consider the anterior nares as a reservoir of S. aureus, or the possibility of transmission between patients and their contacts. Moreover, adult patients have not so far been investigated. OBJECTIVES: To investigate the colonizing features of S. aureus in adults with AD and in their contacts, and the effect of an antimicrobial treatment of the patients and their partners. METHODS: Swabs were taken from the skin and anterior nares of 66 adults with AD. S. aureus strains were screened for the production of exotoxins in 32 patients. Ten patients (two with toxigenic strains, eight with non-toxigenic strains) were treated orally with cefalexin, chlorhexidine ointment was applied to the skin, and the anterior nares were treated with mupirocin ointment. A bath containing potassium permanganate was taken daily. In addition, their partners were treated topically. RESULTS: Sixty-two of 66 patients (94%) were carriers of S. aureus, and mostly harboured the bacteria on both skin and anterior nares. Ten of 32 (31%) patients were colonized with toxigenic strains. The Severity Scoring in AD (SCORAD) score decreased in nine of 10 patients who received antimicrobial treatment (P < 0.001), and this effect was more pronounced in patients with a baseline SCORAD > 50. CONCLUSIONS: S. aureus may play an important role as an aggravating factor in adults with AD, as antimicrobial treatment leads to a significant improvement of AD in patients who are colonized with the bacterium.     

异位性皮炎皮损中单一核细胞CD4及TH2型细胞特征因子表达

为了探讨Ｔ细胞尤其是ＴＨ细胞在异位性皮炎（ＡＤ）免疫发病机制中的意义，采用免疫组化法检测８例ＡＤ急性期皮损单一核细胞ＣＤ４、ＣＤ８、ＣＤ４５ＲＯ、ＣＤ２０免疫表型和ＩＬ４，ＩＦＮγ表达。结果：ＡＤ急性期皮损单一核细胞大多数呈ＣＤ４或ＣＤ４５ＲＯ表型，少数呈ＣＤ８表型，无ＣＤ２０表型，ＩＬ４蛋白表达阳性，ＩＦＮγ蛋白表达阴性。ＡＤ急性期皮损单一核细胞大多数为ＣＤ４＋Ｔ细胞，且呈ＴＨ２细胞亚型，提示ＡＤ皮肤炎症反应可能是由ＴＨ２细胞介导的皮肤免疫炎症反应，称之为Ⅱ型迟发型超敏反应（ＤＴＨ２）。     

他克莫司软膏治疗成人中、重度特应性皮炎的临床研究

目的:比较0.1%,0.03%他克莫司软膏与赋形剂治疗中、重度特应性皮炎(AD)的疗效和安全性.方法:采用随机、双盲、赋形剂平行对照临床研究方法,入选病例按1:1:1比例分为三组,分别随机接受0.1%,0.03%他克莫司软膏或赋形剂治疗,每天2次外搽患处,共3周.结果:有效率:他克莫司软膏0.1%组和0.03%组分别为88.9%和87.5%,赋形剂组为25%;治愈率:他克莫司软膏0.1%组和0.03%组分别为55.6%和50%,赋形剂组为25%,差异有统计学意义(P＜0.05).结论:他克莫司软膏(0.1%和0.03%)治疗成人中、重度特应性皮炎疗效好,安全和耐受性均良好.