Prevalence of, and work-related risk factors for, hand eczema in a Norwegian general population (The HUNT Study).

PubMed

Vindenes, Hilde K; Svanes, Cecilie; Lygre, Stein H L; Hollund, Bjørg-Eli; Langhammer, Arnulf; Bertelsen, Randi J

2017-10-01

Chemical exposures at work and at home may cause hand eczema. However, this has been scarcely described for Norway. To investigate the prevalence of, and occupational risk factors for, hand eczema in Norway. Among 50 805 respondents (aged ≥20 years) to the third Nord-Trøndelag Health Study (HUNT3), 5757 persons reported ever having hand eczema, and 4206 answered a hand eczema questionnaire. The lifetime prevalences of hand eczema were 8.4% in men and 13.8% in women (p < 0.001), with onset at age ≤10 years in 24% (men) and 20% (women), and onset at age ≥30 years in 37% (men) and 25% (women) (p < 0.001). Work-related hand eczema affected 4.8% of the population, and was most frequently associated with health/social work (29%) and occupational cleaning (20%) in women, and with farming (26%) and industrial occupations (27%) in men. Cleaning detergents (75%) and other chemicals (36%) were the most common exacerbating factors. The prevalence of hand eczema was 11.3%, and that of work-related hand eczema was 4.8%. Hand eczema was more common in women than in men, but with a later onset in men. Cleaning detergents were the most common aggravating factors. A large proportion of the Nord-Trøndelag population is employed in farming, providing the possibility to identify farming as an important risk factor for hand eczema. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Hand eczema. The clinical classification of the roles of exogenous and endogenous factors in each type].

PubMed

Tamiya, Y

1994-08-01

Hand eczema is one of the most common dermatological disorders. Although it is a general term referring to eczematous dermatitis of the hands, it actually covers a wide range of diseases. The classification of hand eczema is controversial even now, as definitions of individual diseases have not yet been established. It is well-known that exogenous factors, such as chemicals or water, are associated with the occurrence of hand eczema. In this study, we focused on endogenous factors, especially personal or family history of atopy as a causative factor in hand eczema. According to exogenous and endogenous factors, we classified hand eczema into three types: atopic dermatitis, contact dermatitis and dysidrosis. This classification is useful because it makes the definition of each disease clear. Skin-humidity and sebum measurement are simple and rapid methods of determining personal atopy, skin condition and the effect of treatment on hand eczema patients.

[Hand eczema in children. Clinical and epidemiological study of the population referred to a tertiary hospital].

PubMed

Ortiz-Salvador, José María; Subiabre-Ferrer, Daniela; García Rabasco, Ana; Esteve-Martínez, Altea; Zaragoza-Ninet, Violeta; Alegre de Miquel, Víctor

2017-08-21

Hand eczema is a frequent disease in adults. Diagnosing the cause of hand eczema is difficult due to different classifications. There is lack of evidence on hand eczema and its causes in children. A total of 389 children between 0 and 16 years were identified between 1996 and 2016, from whom 42 (10.8%) with exclusively hand eczema were selected. In all cases a standard battery of epicutaneous patch tests was performed, as well as additional batteries depending on the clinical suspicion. The clinical and epidemiological features of these children were recorded and compared against children with eczema in other locations. The 42 children with hand eczema included 25 (60.5%) girls, and 17 (40.5%) boys, with a mean age of 10.6 +- 3.9 years, and did not differ from that of children with eczema in other locations. The definitive diagnosis after patch-testing was Atopic Dermatitis in 15 cases, Allergic Contact Dermatitis in 14 patients, Endogenous Vesiculous Eczema in 6 cases, Endogenous Hyperkeratotic Eczema in 5 cases, and Irritant Contact Dermatitis in 2 cases. The most frequent allergens detected were thiomersal (9 cases), nickel (5 cases), mercury (5 cases), and cobalt (4 cases). Hand eczema is a common condition in children. The most common cause is atopic dermatitis, although cases of allergic contact dermatitis manifesting as hand eczema are not uncommon. Any child with eczema of hands in whom an allergic cause is suspected should be referred for patch- testing. Copyright © 2017. Publicado por Elsevier España, S.L.U.

The Hand Eczema Trial (HET): Design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema.

PubMed

Ibler, Kristina Sophie; Agner, Tove; Hansen, Jane Lindschou; Gluud, Christian

2010-08-31

Hand eczema is the most frequently recognized occupational disease in Denmark with an incidence of approximately 0.32 per 1000 person-years. Consequences of hand eczema include chronic severe eczema, prolonged sick leave, unemployment, and impaired quality of life. New preventive strategies are needed to reduce occupational hand eczema. We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease severity (Hand Eczema Severity Index); self-evaluated disease severity; number of eruptions; quality of life; skin protective behaviour, and knowledge of skin protection. The patients are centrally randomised to intervention versus no intervention 1:1 stratified for hospital, profession, and severity score. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary outcome is observer-blinded assessment of disease severity and the secondary outcomes are unblinded assessments of disease severity; number of eruptions; knowledge of skin protection; skin-protective behaviour, and quality of life. The trial is registered in ClinicalTrials.Gov, NCT01012453.

Life-style factors and hand eczema.

PubMed

Anveden Berglind, I; Alderling, M; Meding, B

2011-09-01

Previous knowledge of the impact of certain life-style factors on hand eczema is scanty. To investigate a possible association between hand eczema and life-style factors such as obesity, physical exercise, stress, smoking and alcohol consumption. In a cross-sectional public health survey in Stockholm, Sweden, 27,994 (58%) randomly chosen individuals aged 18-64 years completed a postal questionnaire regarding physical and mental health, social relations, economic status and work. Of these, 27,793 individuals responded to the question regarding hand eczema and were included in the present study. The association between life-style factors and hand eczema was analysed by prevalence proportion ratios (PPR), using a generalized linear model. Hand eczema was more common among individuals who reported high stress levels, PPR 1·326 (95% CI 1·303-1·350). There was also a positive dose-response relationship between hand eczema and stress. Hand eczema was less common among individuals reporting high physical exercise, and most apparent in women, PPR 0·781 (95% CI 0·770-0·792). Men who reported high alcohol intake reported hand eczema less often, PPR 0·958 (95% CI 0·930-0·987). Obese individuals reported hand eczema more commonly, PPR 1·204 (95% CI 1·174-1·234). There was a slight increase of hand eczema among smokers, PPR 1·025 (95% CI 1·006-1·044). Hand eczema was more common in individuals who reported stress, obesity and smoking. In individuals who reported high physical exercise levels hand eczema was less common. As there appears to be an association between life-style factors and hand eczema it is important to consider life-style factors in clinical practice. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

Treatment with a barrier-strengthening moisturizer prevents relapse of hand-eczema. An open, randomized, prospective, parallel group study.

PubMed

Lodén, Marie; Wirén, Karin; Smerud, Knut; Meland, Nils; Hønnås, Helge; Mørk, Gro; Lützow-Holm, Claus; Funk, Jörgen; Meding, Birgitta

2010-11-01

Hand eczema influences the quality of life. Management strategies include the use of moisturizers. In the present study the time to relapse of eczema during treatment with a barrier-strengthening moisturizer (5% urea) was compared with no treatment (no medical or non-medicated preparations) in 53 randomized patients with successfully treated hand eczema. The median time to relapse was 20 days in the moisturizer group compared with 2 days in the no treatment group (p = 0.04). Eczema relapsed in 90% of the patients within 26 weeks. No difference in severity was noted between the groups at relapse. Dermatology Life Quality Index (DLQI) increased significantly in both groups; from 4.7 to 7.1 in the moisturizer group and from 4.1 to 7.8 in the no treatment group (p < 0.01) at the time of relapse. Hence, the application of moisturizers seems to prolong the disease-free interval in patients with controlled hand eczema. Whether the data is applic-able to moisturizers without barrier-strengthening properties remains to be elucidated.

Prevention of hand eczema: effect of an educational program versus treatment as usual - results of the randomized clinical PREVEX trial.

PubMed

Fisker, Maja H; Ebbehøj, Niels E; Vejlstrup, Søren Grove; Lindschou, Jane; Gluud, Christian; Winkel, Per; Bonde, Jens Peter; Agner, Tove

2018-03-01

Objective Occupational hand eczema has adverse health and socioeconomic impacts for the afflicted individuals and society. Prevention and treatment strategies are needed. This study aimed to assess the effectiveness of an educational intervention on sickness absence, quality of life and severity of hand eczema. Methods PREVEX (PreVention of EXema) is an individually randomized, parallel-group superiority trial investigating the pros and cons of one-time, 2-hour, group-based education in skin-protective behavior versus treatment as usual among patients with newly notified occupational hand eczema, with follow-up after one year. Co-primary outcomes were total sickness absence, health-related quality of life (HR-QoL), and self-reported severity of hand eczema. Results Patients (N=1668) with notified occupational skin diseases from July 2012 to November 2014 were invited to participate in the trial. Of these, 756 were randomized to the intervention (N= 376) versus control (N=380) group. The intervention group had 21% fewer sickness absence days compared with the control group [95% confidence interval (CI) -55-40%, P=0.43]. We found no significant difference in the change of HR-QoL for the intervention compared with the control group (4% lower in the intervention group, 95% CI -18-13%, P=0.67). The ordinal odds of scoring worse on self-reported hand eczema severity was 15% lower in the intervention compared with the control group (95% CI -39-18%, P=0.34). Post-hoc sub-group analyses indicated that the effect of the intervention on severity differed between occupations, being detrimental to healthcare workers and beneficial in all other occupations. Conclusion The educational skincare program had no marked effect on the primary outcomes sickness absence, HR-QoL, and severity of hand eczema when compared with treatment as usual.

Impact of hand eczema severity on quality of life

PubMed Central

Charan, Ujwala Priya; Peter, C. V. Dincy; Pulimood, Susanne A.

2013-01-01

Background: Hand eczema is a common disease seen in dermatological practice comprising of a spectrum ranging from mild disease to a severe distressing and chronic course with a negative impact on the quality of life. Aim: To assess the impact of hand eczema severity on quality of life. Materials and Methods: Patients with hand eczema were enrolled in a prospective study. Disease severity was assessed by hand eczema severity index (HECSI) score and quality of life by dermatology life quality index (DLQI) questionnaire. Results: Forty-six patients participated of which 22 (47.8%) were males and 24 (52.2%) females. The commonest age group affected among men and women was 50-59 years (31.8%) and 40-49 years (41.7%) respectively. History of atopy was found in 23.9% and 63% had persistent disease. In 28 (60.9%), the trigger was washing soaps and detergents of which 21 (87.5%) were housewives. Of those employed, 27.7% reported loss of work days. The mean HECSI score was 14.46 (S.D = 20.98) and mean DLQI score was 9.54 (S.D = 5.62). Gender, age, occupation and duration of disease did not significantly affect the quality of life or disease severity. Increased episodes of eczema (>4 episodes/year) showed a statistically significant correlation with DLQI (P value = 0.021). There was no significant correlation between HECSI score and DLQI in this study. Conclusion: Majority of the patients with hand eczema had a significant impairment of their quality of life. The impairment of quality of life in this study was mainly dependent on increased frequency of the eruptions and not on hand eczema severity. PMID:23741665

Integrated, multidisciplinary care for hand eczema: design of a randomized controlled trial and cost-effectiveness study

PubMed Central

2009-01-01

Background The individual and societal burden of hand eczema is high. Literature indicates that moderate to severe hand eczema is a disease with a poor prognosis. Many patients are hampered in their daily activities, including work. High costs are related to high medical consumption, productivity loss and sick leave. Usual care is suboptimal, due to a lack of optimal instruction and coordination of care, and communication with the general practitioner/occupational physician and people involved at the workplace. Therefore, an integrated, multidisciplinary intervention involving a dermatologist, a care manager, a specialized nurse and a clinical occupational physician was developed. This paper describes the design of a study to investigate the effectiveness and cost-effectiveness of integrated care for hand eczema by a multidisciplinary team, coordinated by a care manager, consisting of instruction on avoiding relevant contact factors, both in the occupational and in the private environment, optimal skin care and treatment, compared to usual, dermatologist-led care. Methods The study is a multicentre, randomized, controlled trial with an economic evaluation alongside. The study population consists of patients with chronic, moderate to severe hand eczema, who visit an outpatient clinic of one of the participating 5 (three university and two general) hospitals. Integrated, multidisciplinary care, coordinated by a care manager, including allergo-dermatological evaluation by a dermatologist, occupational intervention by a clinical occupational physician, and counselling by a specialized nurse on optimizing topical treatment and skin care will be compared with usual care by a dermatologist. The primary outcome measure is the cumulative difference in reduction of the clinical severity score HECSI between the groups. Secondary outcome measures are the patient's global assessment, specific quality of life with regard to the hands, generic quality of life, sick leave and patient satisfaction. An economic evaluation will be conducted alongside the RCT. Direct and indirect costs will be measured. Outcome measures will be assessed at baseline and after 4, 12, 26 and 52 weeks. All statistical analyses will be performed on the intention-to-treat principle. In addition, per protocol analyses will be carried out. Discussion To improve societal participation of patients with moderate to severe hand eczema, an integrated care intervention was developed involving both person-related and environmental factors. Such integrated care is expected to improve the patients' clinical signs, quality of life and to reduce sick leave and medical costs. Results will become available in 2011. PMID:19951404

Oral Alitretinoin in the Treatment of Severe Refractory Chronic Hand Eczema in the Spanish National Health System: Description and Analysis of Current Clinical Practice.

PubMed

Urrutia, S; Roustan, G; Plazas, M J; Armengol, S; Paz, S; Lizan, L

2016-03-01

Hand eczema affects nearly 10% of the population. The condition becomes severe and chronic in 5% to 7% of cases and is refractory to topical corticosteroids in 2% to 4%. This study aimed to describe the current use of oral alitretinoin in treating Spanish national health system patients with hand eczema that is refractory to potent topical corticosteroids. Observational, descriptive, exploratory, cross-sectional study based on the retrospective analysis of records for patients with hand eczema treated with alitretinoin in the Spanish national health system. We reviewed the records for 62 patients in 13 hospitals in 5 different administrative areas (autonomous communities) of Spain. Alitretinoin was usually used at a dosage of 30mg/d. In most cases the physician judged the clinical response to be satisfactory after a single cycle. The recorded adverse effects were foreseeable and of the type reported for systemic retinoids. The dermatologists agreed that the clinical benefits achieved with alitretinoin favored adherence to treatment and an early return to work. The results show that oral alitretinoin is being used according to established recommendations and that response is good, with few adverse effects. The dermatologists agreed that the benefits favored adherence and improved the patients' health related quality of life. Copyright © 2015 AEDV. Published by Elsevier España, S.L.U. All rights reserved.

Hand eczema and atopic dermatitis in adolescents: a prospective cohort study from the BAMSE project.

PubMed

Grönhagen, C; Lidén, C; Wahlgren, C-F; Ballardini, N; Bergström, A; Kull, I; Meding, B

2015-11-01

There is a well-known association between atopic dermatitis (AD) and hand eczema but less is known about how age at onset, persistence and severity of AD influence the risk of developing hand eczema. To examine the role of AD in the occurrence of hand eczema in adolescence. In addition, associations between asthma and rhinoconjunctivitis, sensitization to common airborne and food allergens, and hand eczema were studied. From the population-based birth cohort BAMSE, 2927 adolescents who had been followed up repeatedly concerning allergy-related disease were included. Questionnaires identified adolescents with hand eczema at 16 years, and their blood was analysed for specific IgE. A total of 152 (5·2%) adolescents had hand eczema at the age of 16 years. Many of these adolescents had a history of AD (n = 111; 73·0%) and asthma and/or rhinitis (n = 83; 54·6%), respectively. Children with AD (aged 0-16 years) had more than threefold increased odds ratios (OR) for having hand eczema; those with persistent or severe AD had a crude OR of 6·1 [95% confidence interval (CI) 4·0-9·1] and 5·3 (95% CI 2·9-9·6), respectively. We confirm a strong association between AD during childhood and hand eczema in adolescence. Children with persistent or more severe AD are at greater risk of developing hand eczema. Asthma and/or rhinoconjunctivitis, positive specific IgE or age at onset of AD are not associated with hand eczema in adolescence. © 2015 British Association of Dermatologists.

Hand eczema, atopic dermatitis and filaggrin mutations in adult Danes: a registry-based study assessing risk of disability pension.

PubMed

Heede, Nina G; Thuesen, Betina H; Thyssen, Jacob P; Linneberg, Allan; Szecsi, Pal B; Stender, Steen; Menné, Torkil; Johansen, Jeanne D

2017-08-01

Atopic dermatitis and hand eczema often impair the ability of people to work. Only a few studies have investigated whether individuals with loss-of-function filaggrin gene (FLG) mutations, who often have severe and early onset of dermatitis, experience occupational consequences. To investigate the personal consequences of having atopic dermatitis and/or hand eczema and FLG mutations. Adult Danes from the general population (n = 3247) and patients with atopic dermatitis and/or hand eczema (n = 496) were genotyped for common FLG mutations, and completed a questionnaire about skin symptoms and hand eczema. Socioeconomic variables, including disability pension, and information on work in risk occupations were retrieved from national registries. The reasons for granting disability pension were unknown. Disability pension was associated with hand eczema in the general population, especially among individuals with a history of atopic dermatitis. Moreover, self-reported hand eczema and atopic dermatitis were associated with particularly high risk of disability pension among FLG mutation carriers [odds ratio (OR) 4.02 and 95% confidence interval (CI): 1.15-14.11; and OR 6.01 and 95%CI: 2.37-15.34, respectively]. Furthermore, 60% of the FLG mutation carriers with atopic dermatitis who developed hand eczema had experienced symptoms before adulthood. In the general population, self-reported hand eczema and atopic dermatitis, particularly in individuals with a genetically impaired skin barrier, were associated with disability pension, suggesting that FLG mutations carriers with a history of atopic dermatitis and hand eczema could benefit from early attention with respect to choice of occupation. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Quality of life, use of topical medications and socio-economic data in hand eczema: a Swedish nationwide survey.

PubMed

Bingefors, Kerstin; Lindberg, Magnus; Isacson, Dag

2011-06-01

Hand eczema is common and has an adverse impact on the lives of patients. There is a need for population-based surveys on the pharmacoepidemiological aspects, quality of life and impact of socioeconomic factors in hand eczema. The aim of this cross-sectional study was to investigate these factors. A questionnaire-based nationwide survey of health was performed, including questions on hand eczema, use of pharmaceuticals and socioeconomic factors. Quality of life was estimated with the generic instrument Short Form 36 (SF-36). The questionnaire was sent to 7,985 persons (age range 18-84 years), response rate 61.1% (n = 4,875). The 1-year prevalence of hand eczema in the study population was 7.5%. In this group, quality of life was lower. All dimensions of SF-36 were affected, most markedly general health and those dimensions reporting on mental health. In the group with self-reported hand eczema, 51% reported using topical pharmaceuticals. Hand eczema was more common among women (9.1%, n = 2,630) than among men (5.6%, n = 2,245) and in the age group below 65 years (8.5%, n = 3,274) compared with those aged 65 years and over (4.3%, n = 1,151). This survey clearly demonstrates the impact of hand eczema on several dimensions of life and also highlights age, gender and socioeconomic differences.

A twin study of perfume-related respiratory symptoms.

PubMed

Elberling, J; Lerbaek, A; Kyvik, K O; Hjelmborg, J

2009-11-01

Respiratory symptoms from environmental perfume exposure are main complaints in patients with multiple chemical sensitivities and often coincide with asthma and or eczema. In this population-based twin study we estimate the heritability of respiratory symptoms related to perfume and if co-occurrences of the symptoms in asthma, atopic dermatitis, hand eczema or contact allergy are influenced by environmental or genetic factors common with these diseases. In total 4,128 twin individuals (82%) responded to a questionnaire. The heritability of respiratory symptoms related to perfume is 0.35, 95%CI 0.14-0.54. Significant associations (p<0.05) between perfume-related respiratory symptoms and asthma, atopic dermatitis, hand eczema or contact allergy are not attributable to shared genetic or shared environmental/familial factors, except possibly for atopic dermatitis where genetic pleiotropy with respiratory symptoms to perfume is suggested by an estimated genetic correlation of 0.39, 95%CI 0.09-0.72.

Update on the use of alitretinoin in treating chronic hand eczema.

PubMed

Ghasri, Pedram; Scheinfeld, Noah

2010-04-19

Chronic hand eczema is a debilitating dermatological condition with significant economic, social, and functional impacts. To date, conventional treatments such as topical corticosteroids, phototherapy, and systemic immunosuppressants have yielded disappointing results, owing to either a lack of efficacy or significant adverse events. Oral alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema. Several large-scale clinical studies have demonstrated oral alitretinoin's high efficacy rate of 28% to 89%, its safe tolerability profile, and its positive impact on quality of life, validating it as a therapeutic option for patients with severe chronic hand eczema refractory to standard treatment.

The Quality of Life in Hand Eczema Questionnaire (QOLHEQ): validation of the German version of a new disease-specific measure of quality of life for patients with hand eczema.

PubMed

Ofenloch, R F; Weisshaar, E; Dumke, A-K; Molin, S; Diepgen, T L; Apfelbacher, C

2014-08-01

Health-related quality of life (HRQOL) is widely used as a patient-reported outcome to evaluate clinical trials. In routine care it can also be used to improve treatment strategies or to enhance patients' self-awareness and empowerment. Therefore a disease-specific instrument is needed that assesses in detail all the impairments caused by the disease of interest. For patients with hand eczema (HE) such an instrument was developed by an international expert group, but its measurement properties are unknown. To validate the German version of the Quality of Life in Hand Eczema Questionnaire (QOLHEQ), which covers the domains of (i) symptoms, (ii) emotions, (iii) functioning and (iv) treatment and prevention. The QOLHEQ was assessed up to three times in 316 patients with HE to test reliability and sensitivity to change. To test construct validity we also assessed several reference measures. The scale structure was analysed using the Rasch model for each subscale and a structural equation model was used to test the multi domain structure of the QOLHEQ. After minor adaptions of the scoring structure, all four subscales of the QOLHEQ did not significantly misfit the Rasch model (α > 0·05). The fit indices of the structural equation model showed a good fit of the multi domain construct with four subscales assessing HRQOL. Nearly all a priori-defined hypotheses relating to construct validity could be confirmed. The QOLHEQ showed a sensitivity to change that was superior compared with all reference measures. The QOLHEQ is ready to be used in its German version as a sensitive outcome measure in clinical trials and for routine monitoring. The treatment-relevant subscales enable its use to enhance patients' self-awareness and to monitor treatment decisions. © 2014 British Association of Dermatologists.

Update on the use of alitretinoin in treating chronic hand eczema

PubMed Central

Ghasri, Pedram; Scheinfeld, Noah

2010-01-01

Chronic hand eczema is a debilitating dermatological condition with significant economic, social, and functional impacts. To date, conventional treatments such as topical corticosteroids, phototherapy, and systemic immunosuppressants have yielded disappointing results, owing to either a lack of efficacy or significant adverse events. Oral alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema. Several large-scale clinical studies have demonstrated oral alitretinoin’s high efficacy rate of 28% to 89%, its safe tolerability profile, and its positive impact on quality of life, validating it as a therapeutic option for patients with severe chronic hand eczema refractory to standard treatment. PMID:21437060

Fragrance allergy in patients with hand eczema - a clinical study.

PubMed

Heydorn, Siri; Johansen, Jeanne Duus; Andersen, Klaus E; Bruze, Magnus; Svedman, Cecilia; White, Ian R; Basketter, David A; Menné, Torkil

2003-06-01

Fragrance allergy and hand eczema are both common among dermatological patients. Fragrance mix (FM) and its constituents have a recognized relevance to exposure to fine fragrances and cosmetic products. Based on extensive chemical analysis and database search, a new selection of fragrances was established, including 14 known fragrance allergens present in products to which hand exposure would occur. A non-irritating patch-test concentration for some fragrances was established in 212 consecutive patients. 658 consecutive patients presenting with hand eczema were patch tested with the European standard series and the developed selection of fragrances. 67 (10.2%) of the 658 patients had a positive reaction to 1 or more of our selection of fragrance chemicals present in the new selection. The most common reactions to fragrances not included in the FM were to citral, Lyral (hydroxyisohexyl-3-cyclohexene carboxaldehyde) and oxidized l-limonene. A concomitant reaction to the FM identified potential fragrance allergy in less than (1/2) of these patients. Exposure assessment and a statistically significant association between a positive patch test to our selected fragrances and patients' history support the relevance of this selection of fragrances. Those with a positive reaction to our selected fragrances were significantly more likely to have 1 or more positive patch tests in the standard series. This observation is the basis for the hypothesis concerning cross-reactivity and the effect of simultaneous exposure. The study found that fragrance allergy could be a common problem in patients with eczema on the hands.

Tertiary individual prevention improves mental health in patients with severe occupational hand eczema.

PubMed

Breuer, K; John, S M; Finkeldey, F; Boehm, D; Skudlik, C; Wulfhorst, B; Dwinger, C; Werfel, T; Diepgen, T L; Schmid-Ott, G

2015-09-01

Occupational hand eczema (OHE) is associated with impaired health-related quality of life (QoL) and mental distress. Interdisciplinary inpatient rehabilitation measures in the framework of tertiary individual prevention (TIP) offered by the German employers' liability insurance associations include dermatological treatment, education and psychological interventions. To investigate the effects of interdisciplinary inpatient rehabilitation in the framework of TIP on mental health in patients with severe OHE and the relationships between recovery of OHE and improvement of mental health and QoL. A total of 122 patients participated in the study. A test battery consisting of the German versions of the Hospital Anxiety and Depression Scale (HADS-D), the Dermatology Life Quality Index (DLQI), the Short Form Health Survey-36 (SF-36) and the Trier Inventory for the Assessment of Chronic Stress (TICS) was applied at the time of admission (T1) and 3 weeks after dismissal (T2). Severity of hand eczema was assessed with the Osnabrueck Hand Eczema Severity Index (OHSI). All parameters improved significantly from T1 to T2. A relationship was established between the improvement of QoL and recovery of OHE, while there was no such relationship between the improvement of mental distress and improvement of OHE. Nonresponders had significantly more cumulative days of sickness at T1. Our data underscore the importance of psychological interventions in addition to dermatological treatment in the framework of prevention measures for OHE. These measures should be applied at an early stage of OHE prior to the occurrence of sick leave. © 2015 European Academy of Dermatology and Venereology.

Methyldibromo glutaronitrile: clinical experience and exposure-based risk assessment.

PubMed

Zachariae, Claus; Rastogi, Suresh; Devantier, Charlotte; Menné, Torkil; Johansen, Jeanne Duus

2003-03-01

In the year 2000, the level of methyldibromo glutaronitrile (MDGN) allergy in dermatology clinics in Europe exceeded the level of allergies to all other preservatives, with a prevalence of 3.5%. In the present study, cases of primary sensitization and elicitation to MDGN due to cosmetic products were collected over an 8-month period at the Department of Dermatology, Gentofte University Hospital. The aim was to identify the products related to hand eczema, assess exposure to MDGN in these products and relate the findings to results from a newly developed updated risk assessment model for contact allergy. Out of 24 patients with a positive patch test to MDGN, 17 patients with hand eczema were identified. In 11 of these patients, cosmetic products used in relation to the onset of the disease were shown to contain MDGN (65%). In 8 of these 11 cases, primary sensitization was probable, 5 due to hand/body lotions and 3 due to lotions and/or liquid hand soap. Chemical analysis of 12 products showed that lotions contained 149-390 ppm of MDGN, liquid hand soap 144-399 ppm, a rinsing cream 293 ppm and shampoos 78-79 ppm. The shampoo exposure was not of certain relevance to the eczema. Applying the newly developed updated risk assessment model showed that the concentrations of MDGN in lotions of 149-390 ppm exceeded the calculated maximum acceptable exposure level for MDGN, which would be expected to lead to sensitization in consumers using such products, as seen in the current study. The present cases and updated exposure-based risk assessment process add to the evidence and need for re-defining safe-use concentrations of MDGN in cosmetic products.

Severe occupational hand eczema, job stress and cumulative sickness absence.

PubMed

Böhm, D; Stock Gissendanner, S; Finkeldey, F; John, S M; Werfel, T; Diepgen, T L; Breuer, K

2014-10-01

Stress is known to activate or exacerbate dermatoses, but the relationships between chronic stress, job-related stress and sickness absence among occupational hand eczema (OHE) patients are inadequately understood. To see whether chronic stress or burnout symptoms were associated with cumulative sickness absence in patients with OHE and to determine which factors predicted sickness absence in a model including measures of job-related and chronic stress. We investigated correlations of these factors in employed adult inpatients with a history of sickness absence due to OHE in a retrospective cross-sectional explorative study, which assessed chronic stress (Trier Inventory for the Assessment of Chronic Stress), burnout (Shirom Melamed Burnout Measure), clinical symptom severity (Osnabrück Hand Eczema Severity Index), perceived symptom severity, demographic characteristics and cumulative days of sickness absence. The study group consisted of 122 patients. OHE symptoms were not more severe among patients experiencing greater stress and burnout. Women reported higher levels of chronic stress on some measures. Cumulative days of sickness absence correlated with individual dimensions of job-related stress and, in multiple regression analysis, with an overall measure of chronic stress. Chronic stress is an additional factor predicting cumulative sickness absence among severely affected OHE patients. Other relevant factors for this study sample included the 'cognitive weariness' subscale of the Shirom Melamed Burnout Measure and the physical component summary score of the SF-36, a measure of health-related life quality. Prevention and rehabilitation should take job stress into consideration in multidisciplinary treatment strategies for severely affected OHE patients. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Prevalence, incidence and predictive factors for hand eczema in young adults – a follow-up study

PubMed Central

2013-01-01

Background Hand eczema is common in the general population and affects women twice as often as men. It is also the most frequent occupational skin disease. The economic consequences are considerable for society and for the affected individuals. Methods To investigate the prevalence and incidence of hand eczema and to evaluate risk factors for development of hand eczema in young adults. Subjects and methods; This is a prospective follow-up study of 2,403 young adults, 16 – 19 years old in 1995 and aged 29 – 32 years, 13 years later, in 2008. They completed a postal questionnaire that included questions regarding one-year prevalence of hand eczema, childhood eczema, asthma, rhino-conjunctivitis and factors considered to affect hand eczema such as hand-washing, washing and cleaning, cooking, taking care of small children and usage of moisturisers. These factors were evaluated with the multinominal logistic regression analysis. Results The one-year prevalence of hand eczema was 15.8% (females 20.3% and males 10.0%, p < 0.001). The incidence was 11.6 cases per 1000 person-years (females 14.3 and males 5.2, p < 0.001). Childhood eczema was the most important risk factor for hand eczema. The odds ratios were 13.17 when having hand eczema 1995 and 2008 compared to 5.17 in 2008 (p < 0.001). A high frequency of hand washing was important in predicting hand eczema only when having 1-year prevalence 2008, OR 1.02 (p = 0.038). Conclusions After 13 years an increased 1-year prevalence of hand eczema was found. The significant risk factors for hand eczema changed over time from endogenous to exogenous factors. PMID:24164871

Self-reported hand eczema among dental workers in Japan - a cross-sectional study.

PubMed

Minamoto, Keiko; Watanabe, Takeshi; Diepgen, Thomas L

2016-10-01

Dental workers are considered to have a high risk of developing occupational hand eczema. To estimate the prevalence of work-related hand eczema and associated risk factors in dental workers in Japan. A self-administered questionnaire was sent by mail to all dental clinics of Kumamoto City, Japan. In addition, patch testing with 24 dentistry-related allergens was offered. In total, 46.4% of dental workers (n = 528: response 31.4%, based on 97 clinics) reported a lifetime history of chronic hand eczema. The 1-year prevalence was 36.2%. According to logistic regression analysis, the most important risk factors for the 1-year prevalence were a personal history of atopic dermatitis [odds ratio (OR) 4.7, 95% confidence interval (CI): 2.2-8.8], asthma and/or allergic rhinitis (OR 2.0, 95%CI: 1.3-3.0), dry skin (OR 1.7, 95%CI: 1.1-2.7), shorter duration of work (OR 2.0, 95%CI: 1.2-3.5 for up to 10 years versus >20 years), and washing hands >10 times per day (OR 1.6, 95%CI: 1.0-2.5). Fifty-four workers were patch tested. Rubber chemicals and acrylates were the most frequent occupationally relevant contact allergens. Dental workers in Japan have a high prevalence of hand eczema. Health education to prevent hand eczema and more frequent patch testing are needed. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial.

PubMed

Ibler, Kristina Sophie; Jemec, Gregor B E; Diepgen, Thomas L; Gluud, Christian; Lindschou Hansen, Jane; Winkel, Per; Thomsen, Simon Francis; Agner, Tove

2012-12-12

To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Randomised, observer blinded parallel group superiority clinical trial. Three hospitals in Denmark. 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up. Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted -3.56 (95% confidence interval -4.92 to -2.14); adjusted -3.47 (-4.80 to -2.14), both P<0.001 for difference. The mean score on the dermatology life quality index was also significantly lower (improved) in the intervention group at follow-up: difference of means: unadjusted -0.78, non-parametric test P=0.003; adjusted -0.92, -1.48 to -0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema. A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. ClinicalTrials.gov NCT01012453.

Predictive factors of self-reported hand eczema in adult Danes: a population-based cohort study with 5-year follow-up.

PubMed

Heede, N G; Thyssen, J P; Thuesen, B H; Linneberg, A; Johansen, J D

2016-08-01

Information about predictive factors of hand eczema is crucial for primary prevention. To investigate predictive factors of hand eczema in adult Danes from the general population. Participants from a cross-sectional 5-year follow-up study in the general population, aged 18-72 years (n = 2270), completed questionnaires about skin health and were grouped into four hand eczema groups: 'never', 'incident', 'nonpersistent' and 'persistent'. Multiple logistic regression models adjusted for age group and sex were used to evaluate associations with baseline variables. The participation rate for the follow-up study was 66·5% (29·7% of the participants originally invited to the baseline study). A history of atopic dermatitis (AD) was associated with both persistent and incident hand eczema [odds ratio (OR) 9·0, 95% confidence interval (95% CI) 5·6-14·4 and OR 3·0, 95% CI 1·7-5·2, respectively]. Thus, even in adulthood, a history of AD should be considered as a predictor of incident hand eczema. While filaggrin gene (FLG) null mutations were not associated with incident hand eczema, a statistically significant association was observed with persistent hand eczema (OR 3·1, 95% CI 1·8-5·2). Finally, contact sensitization (23 allergens without nickel) was also associated with persistent hand eczema (OR 2·5, 95% CI 1·2-5·0), independently of a history of AD. This study confirms a history of AD as the strongest predictor of persistent hand eczema. We additionally found that a history of AD was associated with incident hand eczema in adults, in contrast to FLG mutations, which were associated only with persistent hand eczema in individuals with a history of AD, and not with incident hand eczema. Our study adds new knowledge to the interplay between AD, FLG mutations and hand eczema in the adult general population. © 2016 British Association of Dermatologists.

Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences.

PubMed

Lysdal, Susan Hovmand; Søsted, Heidi; Andersen, Klaus Ejner; Johansen, Jeanne Duus

2011-09-01

Occupational hand eczema is common in hairdressers, owing to wet work and hairdressing chemicals. To estimate the prevalence of hand eczema and its career consequences among hairdressers in Denmark. A register-based study was conducted, comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self-administered postal questionnaire including questions on hand eczema, atopic dermatitis, and career change. A response rate of 67.9% (n = 5324) was obtained. Of the respondents, 44.3% no longer worked as hairdressers and had worked for an average of 8.4 years in the profession before leaving it. Hand eczema was more common among ex-hairdressers (48.4%) than among current hairdressers (37.6%) (p < 0.0001), and significantly more ex-hairdressers (26.8%) than current hairdressers (15.7%) had chronic hand eczema (p < 0.0001). Of the respondents with hand eczema, 75% were aged 15-24 years at onset, and 45.5% gave hand eczema as a reason for career change. In this group, logistic regression analysis showed that chronic hand eczema contributed the most to the decision to change career (odds ratio 50.12; 95% confidence interval 18.3-137). Hairdressers work an average of 8.4 years in the profession before leaving it, and hand eczema contributes significantly to this career change. © 2011 John Wiley & Sons A/S.

Valid screening questions useful to diagnose hand and forearm eczema are available in the Spanish language, a new tool for global research.

PubMed

Martí-Margarit, Anna; Manresa, Josep M; Herdman, Mike; Pujol, Ramon; Serra, Consol; Flyvholm, Mary-Ann; Giménez-Arnau, Ana M

2015-04-01

Hand eczema is an impacting cutaneous disease. Globally valid tools that help to diagnose hand and forearm eczema are required. To validate the questions to detect hand and/or forearm eczema included in the "Nordic Occupational Skin Questionnaire" (NOSQ-2002) in the Spanish language. A prospective pilot study was conducted with 80 employees of a cleaning company and a retrospective one involving 2,546 individuals. The responses were analysed for sensitivity, specificity and positive and negative predictive values. The final diagnosis according to the patients' hospital records, the specialty care records and the physical examination was taken as gold standard. The Dermatology Life Quality Index (DLQI) was also evaluated. Sensitivity and specificity, in a worst case scenario (WC) combining both questions, were 96.5% and 66.7%, respectively, and in a per protocol (PP) analysis, were 96.5% and 75.2%. The questions validated detected eczema effectively, making this tool suitable for use e.g. in multicentre epidemiological studies or clinical trials.

Tobacco smoking and hand eczema - is there an association?

PubMed

Sørensen, Jennifer A; Clemmensen, Kim K; Nixon, Rosemary L; Diepgen, Thomas L; Agner, Tove

2015-12-01

Numerous risk factors have been suggested for hand eczema. This systematic review evaluates the association between tobacco smoking and hand eczema. To review the literature systematically on the association between smoking and hand eczema. The PubMed and EMBASE databases were searched up to 27 January 2015 for articles on the association between tobacco smoking and hand eczema, including human studies in English and German only. Experimental studies, studies on tobacco allergy, case reports, reviews and studies on second-hand smoking were excluded. Twenty articles were included. Among studies in occupational settings, three of seven found a statistically significant positive association between tobacco smoking and hand eczema prevalence rate, as did four of eight population-based studies. The association was stronger for studies in occupational settings than for population-based studies. No studies reported tobacco to be a clear protective factor for hand eczema. Two of five studies regarding severity found a positive association between smoking and hand eczema severity. Overall, the data indicate that smoking may cause an increased frequency of hand eczema, particularly in high-risk occupations. However, data from studies controlling for other risk factors are conflicting, and few prospective studies are available. Studies controlling for other risk factors are needed, and information regarding the diagnosis of subclasses of hand eczema, as well as severity, may be important. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Remarkable improvement of relapsing dyshidrotic eczema after treatment of coexistant hyperhidrosis with oxybutynin.

PubMed

Markantoni, Vasiliki; Kouris, Anargyros; Armyra, Kalliopi; Vavouli, Charitomeni; Kontochristopoulos, George

2014-01-01

Dyshidrotic hand eczema is a common condition, which can be resistant to various treatments. Although a number of etiologic factors are involved in the pathogenesis of dyshidrotic eczema, hyperhidrosis is assumed to play a significant role. Oxybutynin is an alternative treatment for hyperhidrosis. We present the cases of two patients suffering from hyperhidrosis and dyshidrotic eczema, who were treated with oxybutynin with impressive results. © 2014 Wiley Periodicals, Inc.

Classification of hand eczema.

PubMed

Agner, T; Aalto-Korte, K; Andersen, K E; Foti, C; Gimenéz-Arnau, A; Goncalo, M; Goossens, A; Le Coz, C; Diepgen, T L

2015-12-01

Classification of hand eczema (HE) is mandatory in epidemiological and clinical studies, and also important in clinical work. The aim was to test a recently proposed classification system of HE in clinical practice in a prospective multicentre study. Patients were recruited from nine different tertiary referral centres. All patients underwent examination by specialists in dermatology and were checked using relevant allergy testing. Patients were classified into one of the six diagnostic subgroups of HE: allergic contact dermatitis, irritant contact dermatitis, atopic HE, protein contact dermatitis/contact urticaria, hyperkeratotic endogenous eczema and vesicular endogenous eczema, respectively. An additional diagnosis was given if symptoms indicated that factors additional to the main diagnosis were of importance for the disease. Four hundred and twenty-seven patients were included, 379 (89%) of the patients could be classified directly into one of the six diagnostic subgroups, with irritant and allergic contact dermatitis comprising 249 patients (58%). For 32 (7%) more than one of the six diagnostic subgroups had been formulated as a main diagnosis, and 16 (4%) could not be classified. 38% had one additional diagnosis and 26% had two or more additional diagnoses. Eczema on feet was found in 30% of the patients, statistically significantly more frequently associated with hyperkeratotic and vesicular endogenous eczema. We find that the classification system investigated in the present study was useful, being able to give an appropriate main diagnosis for 89% of HE patients, and for another 7% when using two main diagnoses. The fact that more than half of the patients had one or more additional diagnoses illustrates that HE is a multifactorial disease. © 2015 European Academy of Dermatology and Venereology.

Self-reported skin diseases, quality of life and medication use: a nationwide pharmaco-epidemiological survey in Sweden.

PubMed

Lindberg, Magnus; Isacson, Dag; Bingefors, Kerstin

2014-03-01

The aim of this study was to determine self-reported consumption of dermatological pharmaceuticals and quality of life (QoL), measured with Short Form 36, in relation to eczema, acne, psoriasis and other inflammatory skin conditions in the Swedish population. A questionnaire containing questions on the occurrence of skin diseases, health-related QoL and the use of pharmaceuticals was sent to a cross-sectional sample of the Swedish population, age range 18-84 years (n = 8,000). The response rate was 61%. The 1-year prevalence of skin diseases was 30-35%, with females reporting a higher prevalence. The prevalence was 11.5% for eczema other than hand eczema, 10.2% for acne, 7.5% for hand eczema, 3.9% for psoriasis and 3.1% for urticaria. QoL was significantly affected and 25% of females and 19% of males had used a dermatological drug. Compared with hand eczema, persons with psoriasis and other eczema reported significantly more use of topical steroids on prescription and more use of dermatological pharmaceuticals in total. Skin conditions are common; they affect QoL and lead to a high consumption of dermatological drugs; which deserves increased awareness in the society.

An observer-blinded randomized controlled pilot trial comparing localized immersion psoralen-ultraviolet A with localized narrowband ultraviolet B for the treatment of palmar hand eczema.

PubMed

Brass, D; Fouweather, T; Stocken, D D; Macdonald, C; Wilkinson, J; Lloyd, J; Farr, P M; Reynolds, N J; Hampton, P J

2017-12-13

Hand eczema is a common inflammatory dermatosis that causes significant patient morbidity. Previous studies comparing psoralen-ultraviolet A (PUVA) with narrowband ultraviolet B (NB-UVB) have been small, nonrandomized and retrospective. To conduct an observer-blinded randomized controlled pilot study using validated scoring criteria to compare immersion PUVA with NB-UVB for the treatment of chronic hand eczema unresponsive to topical steroids. Sixty patients with hand eczema unresponsive to clobetasol propionate 0·05% were randomized to receive either immersion PUVA or NB-UVB twice weekly for 12 weeks with assessments at intervals of 4 weeks. The primary outcome measure was the proportion of patients achieving 'clear' or 'almost clear' Physician's Global Assessment (PGA) response at 12 weeks. Secondary outcome measures included assessment of the modified Total Lesion and Symptom Score (mTLSS) and the Dermatology Life Quality index (DLQI). In both treatment arms, 23 patients completed the 12-week assessment for the primary outcome measure. In the PUVA group, five patients achieved 'clear' and eight 'almost clear' [intention-to-treat (ITT) response rate 43%]. In the NB-UVB group, two achieved 'clear' and five 'almost clear' (ITT response rate 23%). For the secondary outcomes, median mTLSS scores were similar between groups at baseline (PUVA 9·5, NB-UVB 9) and at 12 weeks (PUVA 3, NB-UVB 4). Changes in DLQI were similar, with improvements in both groups. In this randomized pilot trial recruitment was challenging. After randomization, there were acceptable levels of compliance and safety in each treatment schedule, but lower levels of retention. Using validated scoring systems - PGA, mTLSS and DLQI - as measures of treatment response, the trial demonstrated that both PUVA and NB-UVB reduced the severity of chronic palmar hand eczema. © 2017 British Association of Dermatologists.

User evaluation of patient counselling, combining nurse consultation and eHealth in hand eczema.

PubMed

Mollerup, Annette; Harboe, Gitte; Johansen, Jeanne D

2016-04-01

This study reports the findings from a user evaluation of a counselling programme for hand eczema patients in which face-to-face encounters were supplemented with user access to a new website. Patients treated for hand eczema in two different settings were included consecutively. Website utilization was examined by use of the transaction log. Comparisons were made between participants who used the website and those who did not. The patients' perspectives were explored by the use of interviews. Among potential website users (n = 140), 88 patients (63%) had an average of 5.1 site visits. At follow-up, the website users had improved more in quality of life (p = 0.014), current burden of disease (p = 0.053), and itching (p = 0.042). The website users reported more changes in habits than did the non-website users (p = 0.024). No differences in clinical severity of hand eczema were found. The interviewees were generally satisfied with the counselling and the website. The strict log-on procedures were considered to be an obstacle to using the site. The consecutive inclusion of participants was considered to be a barrier to engagement in the dialogue forum. The website users benefited from the website, although this was not substantiated by clinical measurements. The trial design partly hampered website utilization. An initial feasibility study could have been warranted. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Guideline for translation and national validation of the Quality of Life in Hand Eczema Questionnaire (QOLHEQ).

PubMed

Oosterhaven, Jart A F; Schuttelaar, Marie L A; Apfelbacher, Christian; Diepgen, Thomas L; Ofenloch, Robert F

2017-08-01

There is a need for well-developed and validated questionnaires to measure patient reported outcomes. The Quality of Life in Hand Eczema Questionnaire (QOLHEQ) is such a validated instrument measuring disease-specific health-related quality of life in hand eczema patients. A re-validation of measurement properties is required before an instrument is used in a new population. With the objective of arriving at a guideline for translation and national validation of the QOLHEQ, we have developed the design of a reference study on how to adequately assess measurement properties of the QOLHEQ based on interdisciplinary discussions and current standards. We present a step-by-step guideline to assess translation (including cross-cultural adaptation), scale structure, validity, reproducibility, responsiveness, and interpretability. We describe which outcomes should be reported for each measurement property, and give advice on how to calculate these. It is also specified which sample size is needed, how to deal with missing data, and which cutoff values should be applied for the measurement properties assessed during the validation process. In conclusion, this guideline, presenting a reference validation study for the QOLHEQ, creates the possibility to harmonize the national validation of the various language versions of the QOLHEQ. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chronic hand eczema--self-management and prognosis: a study protocol for a randomised clinical trial.

PubMed

Mollerup, Annette; Veien, Niels Kren; Johansen, Jeanne Duus

2012-06-12

Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual's daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named 'The Healthy Skin Clinic' or to the control group. Block-wise randomisation according to setting and gender is carried out.The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.

Chronic hand eczema - self-management and prognosis: a study protocol for a randomised clinical trial

PubMed Central

2012-01-01

Background Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. Discussion The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663. PMID:22691871

Hand eczema among Hong Kong nurses: a self-report questionnaire survey conducted in a regional hospital.

PubMed

Luk, Nai-Ming T; Lee, Hau-Chi S; Luk, Chi-Kong D; Cheung, Yuk-Yin A; Chang, Mang-Chi; Chao, Vai-Kiong D; Ng, Shun-Chin; Tang, Leung-Sang N

2011-12-01

Hand eczema is common in the nursing profession, and has been reported widely in various parts of the world. The aim of this study was to determine the prevalence and severity of hand eczema among nurses working in a regional hospital in Hong Kong, as well as its psychosocial impact and any possible associated risk factors. The study took the form of a self-report questionnaire survey; 1240 nurses in a regional hospital were asked to participate in the survey by completing the questionnaire and returning it anonymously within 2 weeks. Seven hundred and twenty-four nurses returned the questionnaire (a response rate of 59%). The prevalence of hand eczema among the respondents was 22.1% (160/724). More than 90% had moderate to severe hand eczema. Itchiness and dryness were the most common symptoms. Occupational work, housework, mood, social activities and sleep were particularly affected. Multinomial logistic regressions showed that a personal or family history of atopy and a hand washing frequency of >20 times per day were independent risk factors for hand eczema. Hand eczema is common and severe among Hong Kong nurses. The results of this study suggest that hand eczema is an important problem for nurses and that preventive measures should be emphasized. © 2011 John Wiley & Sons A/S.

Hand dermatitis/eczema: current management strategy.

PubMed

Sehgal, Virendra N; Srivastava, Govind; Aggarwal, Ashok K; Sharma, Alpna D

2010-07-01

Ever since its inception a couple of centuries ago, hand dermatitis/eczema has been in the reckoning. Idiosyncrasies continued to loom large thereafter, till it acquired its appropriate position. Dermatitis/eczema are synonymous, often used to indicate a polymorphic pattern of the inflammation of the skin, characterized by pruritus, erythema and vesiculation. A spectrum delineated into acute sub-acute and chronic dermatitis of the hands. Pompholyx, recurrent focal palmer peeling, ring, wear and tear and fingertip eczema, apron, discoid eczema, chronic acral dermatitis, gut and patchy papulosquamous eczema are its clinical variants. Occupational dermatitis/eczema may be contributory. Etiological definitions are clinched by detailed history of exogenous and endogenous factors. However, scientific confirmation of the entity is through patch testing by using available antigens.

[Psychosocial factors of chronic hand eczema].

PubMed

Li, Li; Liu, Panpan; Li, Ji; Xie, Hongfu; Kuang, Yehong; Li, Jie; Su, Juan; Zhu, Wu

2017-02-28

To study the psychosocial factors in patient with chronic hand eczema (CHE).
 Methods: Personality traits, emotional state, and quality of life of 240 patients with CHE and 221 normal control (NC) subjects were assessed by General Questionnaire, Eysenck Personality Questionnaire (EPQ), Self-Rating Depression Scale (SDS), Self-Rating Anxiety (SAS), and Eczema Quality of Life Scale (EQOLS).
 Results: In comparison, EPQ scores, scores of extraversion (E) factor in patients with CHE were significantly lower than those in NC subjects (P<0.01), but scores of neuroticism (N) factor in patients with CHE were significantly higher than those in NC subjects (P<0.01), while there was no significant difference in scores of psychoticism (P) and lie (L) factors between two groups (P>0.05). Patients with CHE had significantly higher scores in SDS and SAS compared with the NC subjects (P<0.01). Patients with CHE had significantly higher scores in scale of morbid, physical, social, psychological, general quality of life, and total scores of EQOLS compared with the NC subjects (P<0.01). The level of skin lesions and the degree of itch were significantly correlated with scores in scale SDS, SAS, morbid, physical, social, psychological, general quality of life, and total scores of EQOLS compared with the NC subjects (P<0.05).
 Conclusion: Personality of patients with CHE is prone to emotional instability of introverts.Patients with CHE have a higher level of depression and anxiety, and exert a negative effect on their quality of life, which is related to severity of disease.

Noninvasive measuring methods for the investigation of irritant patch test reactions. A study of patients with hand eczema, atopic dermatitis and controls.

PubMed

Agner, T

1992-01-01

The aim of the study was to assess the susceptibility of clinically normal skin to a standard irritant trauma under varying physiological and patophysiological conditions. Evaluation of skin responses to patch tests with sodium lauryl sulphate (SLS) was used for assessment of skin susceptibility. The following noninvasive measuring methods were used for evaluation of the skin before and after exposure to irritants: measurement of transepidermal water loss by an evaporimeter, measurement of electrical conductance by a hydrometer, measurement of skin blood flow by laser Doppler flowmetry, measurement of skin colour by a colorimeter and measurement of skin thickness by ultrasound A-scan. The studies were carried out on healthy volunteers and patients with eczema. In the first studies the standard irritant patch test for assessment of skin susceptibility was characterized and validated. SLS was chosen among other irritants because of its ability to penetrate and impair the skin barrier. The implications of use of different qualities of SLS was investigated. The applied noninvasive measuring methods were evaluated, and for quantification of SLS-induced skin damage measurement of TEWL was found to be the most sensitive method. Application of the standard test on clinically normal skin under varying physiological and patophysiological conditions lead to the following main results: Seasonal variation in skin susceptibility to SLS was found, with increased susceptibility in winter, when the hydration state of the stratum corneum was also found to be decreased. A variation in skin reactivity to SLS during the menstrual cycle was demonstrated, with an increased skin response at day 1 as compared to days 9-11 in the menstrual cycle. The presence of active eczema distant from the test site increased skin susceptibility to SLS, indicating a generalized hyperreactivity of the skin. Taking these sources of variation into account healthy volunteers and patients with hand eczema and atopic dermatits were studied and compared. In healthy volunteers increased baseline TEWL and increased light reflection from the skin, interpreted as "fair" skin, was found to be associated with increased susceptibility to SLS. Hand eczema patients were found to have fairer and thinner skin than matched controls. Increased susceptibility to SLS was found only in patients with acute eczema. Patients with atopic dermatitis had increased baseline TEWL as well as increased skin susceptibility as compared to controls. Skin susceptibility is thus influenced by individual- as well as environment-related factors. Knowledge of determinants of skin susceptibility may be useful for the identification of high-risk subjects for development of irritant contact dermatitis, and may help to prevent the formation of the disease.

Hands4U: the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial.

PubMed

van der Meer, Esther W C; Boot, Cécile R L; van der Gulden, Joost W J; Knol, Dirk L; Jungbauer, Frank H W; Coenraads, Pieter Jan; Anema, Johannes R

2015-05-01

Healthcare workers have an increased risk of developing hand eczema. A multifaceted implementation strategy was developed to implement a guideline to prevent hand eczema among healthcare workers. To investigate the effects of the implementation strategy on self-reported hand eczema and preventive behaviour. A randomized controlled trial was performed. A total of 48 departments (n = 1649) were randomly allocated to the multifaceted implementation strategy or the control group. The strategy consisted of education, participatory working groups, and role models. Outcome measures were self-reported hand eczema and preventive behaviour. Data were collected at baseline, and 3, 6, 9 and 12 months of follow-up. Participants in the intervention group were significantly more likely to report hand eczema [odds ratio (OR) 1.45; 95% confidence interval (CI) 1.03-2.04], and they reported significantly less hand washing (B, - 0.38; 95%CI: - 0.48 to - 0.27), reported significantly more frequent use of a moisturizer (B, 0.30; 95%CI: 0.22-0.39) and were more likely to report wearing cotton undergloves (OR 6.33; 95%CI: 3.23-12.41) than participants in the control group 12 months after baseline. The strategy implemented can be used in practice, as it showed positive effects on preventive behaviour. More research is needed to investigate the unexpected effects on hand eczema. © 2014 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

The association between hand eczema and nickel allergy has weakened among young women in the general population following the Danish nickel regulation: results from two cross-sectional studies.

PubMed

Thyssen, Jacob Pontoppidan; Linneberg, Allan; Menné, Torkil; Nielsen, Niels Henrik; Johansen, Jeanne Duus

2009-12-01

An association between nickel contact allergy and hand eczema has previously been demonstrated. In 1990, Denmark regulated the extent of nickel release in the ear-piercing process as well as nickel release from consumer products. This study aimed to evaluate the effect of the Danish nickel regulation by comparing the prevalence of concomitant nickel allergy and hand eczema observed in two repeated cross-sectional studies performed in the same general population in Copenhagen. In 1990 and 2006, 3881 18-69 year olds completed a postal questionnaire and were patch tested with nickel. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). The prevalence of concomitant nickel contact allergy and a history of hand eczema decreased among 18-35-year-old women from 9.0% in 1990 to 2.1% in 2006 (P < 0.01). The association between nickel contact allergy and a history of hand eczema decreased in this age group between 1990 (OR = 3.63; CI = 1.33-9.96) and 2006 (OR = 0.65; CI = 0.29-1.46). Among older women, no significant changes were observed in the association between nickel contact allergy and hand eczema. Regulatory control of nickel exposure may have reduced the effect of nickel on hand eczema in the young female population.

Environmental contact factors in eczema and the results of patch testing Chinese patients with a modified European standard series of allergens.

PubMed

Li, Lin-Feng; Guo, Jing; Wang, Jing

2004-07-01

Environmental contact factors in eczema were investigated in China by clinical questionnaire and patch testing patients with a modified European standard series of allergens. 217 consecutive eczema patients were studied. Contact dermatitis (CD) was clinically diagnosed in 30% of the patients. Among the patients patch tested, 46 patients had clinically diagnosed allergic CD (ACD), 20 patients clinically had non-ACD (NACD) (including 16 cases of irritant contact dermatitis, 1 case of phototoxic contact reaction and 3 cases of asteatotic eczema) and 115 patients had clinically suspected ACD. 45 patients (98%) in the ACD group went on to have relevant patch test results. The most common ACD was from metals, fragrance materials, cosmetics and rubber materials. The most common contact allergens identified were nickel, fragrance mix, para-phenylenediamine (PPD), carba mix and thimerosal. No adverse reactions were observed to patch testing, except for pruritus in patch-test-positive patients. The positive rate of patch testing in ACD was much higher than that in NACD (98% versus 15%, P < 0.05, chi(2)-test). 60 (28%) patients had facial dermatitis (FD). Among these, 20 (33%) were confirmed as having ACD. 48 (22%) patients had hand dermatitis (HD). Among these, 7 (15%) were confirmed as having ACD. Fewer patients were confirmed as having ACD in the HD group than in the FD (15% versus 33%, P < 0.05, chi(2)-test). Although the difference was not significant, the total positivity rate in the HD group (55%) was lower than in the other groups. 65 (30%) patients had unclassified endogenous eczema (UEE). The total positive rate of patch testing in the UEE group (56%) was no different from that in the FD or HD groups. However, the relevance of positive patch tests was hard to determine in UEE. These results indicate that CD is common in eczema; relatively more patients with FD have ACD, while other factors, such as irritation, may play more of a role in HD. The total positive rate of patch testing in the UEE group was no different from that in the FD or HD groups, suggesting that patch testing should be stressed in UEE and the relevance of positive patch test results in UEE should be studied further. It is effective and safe to patch eczema patients with a modified European standard series of allergens in China.

Pompholyx eczema

MedlinePlus

Cheiropompholyx; Pedopompholyx; Dyshidrosis; Dyshidrotic eczema; Acral vesicular dermatitis; Chronic hand dermatitis ... year. You are more likely to develop pompholyx eczema when: You are under stress You have allergies, ...

Carriers of filaggrin gene (FLG) mutations avoid professional exposure to irritants in adulthood.

PubMed

Bandier, Josefine; Ross-Hansen, Katrine; Carlsen, Berit C; Menné, Torkil; Linneberg, Allan; Stender, Steen; Szecsi, Pal B; Meldgaard, Michael; Thyssen, Jacob P; Johansen, Jeanne D

2013-12-01

Loss-of-function mutations in the filaggrin gene (FLG) are associated with xerosis, atopic dermatitis, and early onset of hand eczema. Irritant exposure is a risk factor for occupational hand eczema, and FLG mutations increase the risk of occupational irritant contact dermatitis on the hands in hospital cohorts. It is unknown whether FLG mutations affect the level of irritant exposure. To evaluate whether exposure to occupational irritants was dependent on FLG mutations, atopic dermatitis, and age at hand eczema onset. Randomly chosen Danish adults completed a questionnaire on general health and occupational exposures. Genotyping for FLG mutations (R501X, 2282del4, and R2447X) and patch testing were performed. Overall, 38.7% of subjects reported present or previous occupational exposure to irritants. Among individuals who reported hand eczema onset before entering their work life, 50.6% (45/89) of FLG non-mutation carriers became exposed to irritants, as compared with 28.6% (4/14) of heterozygous and 0% (0/6) of homozygous mutation carriers (p = 0.006). Avoidance was conspicuous among mutation carriers reporting childhood hand eczema and atopic dermatitis (odds ratio 0.08, 95% confidence interval 0.01-0.65). Carriers of FLG mutations who have had hand eczema onset in childhood avoid occupational exposure to irritants; the association is most marked with homozygous mutation status combined with atopic dermatitis. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Fingerprint changes and verification failure among patients with hand dermatitis.

PubMed

Lee, Chew Kek; Chang, Choong Chor; Johar, Asmah; Puwira, Othman; Roshidah, Baba

2013-03-01

To determine the prevalence of fingerprint verification failure and to define and quantify the fingerprint changes associated with fingerprint verification failure. Case-control study. Referral public dermatology center. The study included 100 consecutive patients with clinical hand dermatitis involving the palmar distal phalanx of either thumb and 100 age-, sex-, and ethnicity-matched controls. Patients with an altered thumb print due to other causes and palmar hyperhidrosis were excluded. Fingerprint verification(pass/fail) and hand eczema severity index score. Twenty-seven percent of patients failed fingerprint verification compared with 2% of controls. Fingerprint verification failure was associated with a higher hand eczema severity index score (P.001). The main fingerprint abnormalities were fingerprint dystrophy (42.0%) and abnormal white lines (79.5%). The number of abnormal white lines was significantly higher among the patients with hand dermatitis compared with controls(P=.001). Among the patients with hand dermatitis, theodds of failing fingerprint verification with fingerprint dystrophy was 4.01. The presence of broad lines and long lines was associated with a greater odds of fingerprint verification failure (odds ratio [OR], 8.04; 95% CI, 3.56-18.17 and OR, 2.37; 95% CI, 1.31-4.27, respectively),while the presence of thin lines was protective of verification failure (OR, 0.45; 95% CI, 0.23-0.89). Fingerprint verification failure is a significant problem among patients with more severe hand dermatitis. It is mainly due to fingerprint dystrophy and abnormal white lines. Malaysian National Medical Research Register Identifier: NMRR-11-30-8226

The Patient-Oriented Eczema Measure in young children: responsiveness and minimal clinically important difference.

PubMed

Gaunt, D M; Metcalfe, C; Ridd, M

2016-11-01

The Patient-Oriented Eczema Measure (POEM) has been recommended as the core patient-reported outcome measure for trials of eczema treatments. Using data from the Choice of Moisturiser for Eczema Treatment randomized feasibility study, we assess the responsiveness to change and determine the minimal clinically important difference (MCID) of the POEM in young children with eczema. Responsiveness to change by repeated administrations of the POEM was investigated in relation to change recalled using the Parent Global Assessment (PGA) measure. Five methods of determining the MCID of the POEM were employed; three anchor-based methods using PGA as the anchor: the within-patient score change, between-patient score change and sensitivity and specificity method, and two distribution-based methods: effect size estimate and the one half standard deviation of the baseline distribution of POEM scores. Successive POEM scores were found to be responsive to change in eczema severity. The MCID of the POEM change score, in relation to a slight improvement in eczema severity as recalled by parents on the PGA, estimated by the within-patient score change (4.27), the between-patient score change (2.89) and the sensitivity and specificity method (3.00) was similar to the one half standard deviation of the POEM baseline scores (2.94) and the effect size estimate (2.50). The Patient-Oriented Eczema Measure as applied to young children is responsive to change, and the MCID is around 3. This study will encourage the use of POEM and aid in determining sample size for future randomized controlled trials of treatments for eczema in young children. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study.

PubMed

van der Meer, Esther W C; van Dongen, Johanna M; Boot, Cécile R L; van der Gulden, Joost W J; Bosmans, Judith E; Anema, Johannes R

2016-05-01

The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the control group. Data on hand eczema and costs were collected at baseline and every 3 months. Cost-effectiveness analyses were performed using linear multilevel analyses. The probability of the implementation strategy being cost-effective gradually increased with an increasing willingness-to-pay, to 0.84 at a ceiling ratio of €590,000 per person with hand eczema prevented (societal perspective). The implementation strategy appeared to be not cost-effective in comparison with the control group (societal perspective), nor was it cost-beneficial to the employer. However, this study had some methodological problems which should be taken into account when interpreting the results.

A mild hand cleanser, alkyl ether sulphate supplemented with alkyl ether carboxylic acid and alkyl glucoside, improves eczema on the hand and prevents the growth of Staphylococcus aureus on the skin surface.

PubMed

Fukui, S; Morikawa, T; Hirahara, M; Terada, Y; Shimizu, M; Takeuchi, K; Takagi, Y

2016-12-01

Washing the hands using cleansers with antiseptic materials is the most popular method for hand hygiene and helps maintain health by preventing food poisoning and bacterial infections. However, repeated hand washing tends to induce eczema of the hand, such as dryness, cracking and erythema. Moreover, eczema on the hand leads to increased levels in Staphylococcus aureus (S. aureus) on the skin surface in contrast to expectations. Thus, mild hand cleansers which induce less eczema even with repeated washings are desired. Here, we evaluated the efficacy of a hand cleanser formulated with alkyl ether sulphate (AES), alkyl ether carboxylic acid (AEC) and alkyl glucoside (AG) that contains isopropyl methylphenol (IPMP) on skin symptoms and S. aureus levels. Eczema of the hand and the presence of S. aureus on the skin surface were analysed prior to and following 4 weeks of usage of the hand cleanser. A soap-based hand cleanser with IPMP was used as a reference cleanser. Eczema and cutaneous conditions were evaluated by visual grading, transepidermal water loss (TEWL), stratum corneum moisture-retention ability (MRA) and skin surface pH. The repeated use of the soap-based hand cleanser significantly worsened the hand dryness, scaling and cracks on the tips of the fingers and significantly increased the TEWL and decreased the MRA. In contrast, usage of the test cleanser only induced a significant increase in skin dryness but did not induce skin scaling or cracking and did not increase TEWL or decrease the MRA. Corresponding to these changes in skin symptoms, the presence of S. aureus increased the following use of the reference cleanser but not the test cleanser. There was no significant difference in skin surface pH between the two cleansers. Moreover, the increase in S. aureus was significantly correlated to the worsening of skin dryness and scaling. These results suggest that not only antimicrobial activity but also the mildness, which minimizes cutaneous effects, are important for hand cleansers to prevent the growth of S. aureus. The cleanser formulated with AES, AEC and AG containing IPMP is mild and is effective to promote hand hygiene. © 2016 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

Objective research on tongue manifestation of patients with eczema.

PubMed

Yu, Zhifeng; Zhang, Haifang; Fu, Linjie; Lu, Xiaozuo

2017-07-20

Tongue observation often depends on subjective judgment, it is necessary to establish an objective and quantifiable standard for tongue observation. To discuss the features of tongue manifestation of patients who suffered from eczema with different types and to reveal the clinical significance of the tongue images. Two hundred patients with eczema were recruited and divided into three groups according to the diagnostic criteria. Acute group had 47 patients, subacute group had 82 patients, and chronic group had 71 patients. The computerized tongue image digital analysis device was used to detect tongue parameters. The L*a*b* color model was applied to classify tongue parameters quantitatively. For parameters such as tongue color, tongue shape, color of tongue coating, and thickness or thinness of tongue coating, there was a significant difference among acute group, subacute group and chronic group (P< 0.05). For Lab values of both tongue and tongue coating, there was statistical significance among the above types of eczema (P< 0.05). Tongue images can reflect some features of eczema, and different types of eczema may be related to the changes of tongue images. The computerized tongue image digital analysis device can reflect the tongue characteristics of patients with eczema objectively.

Hands4U: the effectiveness of a multifaceted implementation strategy on behaviour related to the prevention of hand eczema-a randomised controlled trial among healthcare workers.

PubMed

van der Meer, Esther W C; Boot, Cécile R L; Twisk, Jos W R; Coenraads, Pieter Jan; Jungbauer, Frank H W; van der Gulden, Joost W J; Anema, Johannes R

2014-07-01

To investigate the effects of a multifaceted implementation strategy on behaviour, behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to prevent hand eczema. The Hands4U study is a randomised controlled trial. A total of 48 departments (n=1649 workers) were randomly allocated to the multifaceted implementation strategy or the control group (minimal implementation strategy). Within the departments designated to the multifaceted implementation strategy, participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. In addition, working group members were trained to become role models, and an education session was given within the department. Outcome measures were awareness, knowledge, receiving information, behaviour and behavioural determinants. Data were collected at baseline, with a 3- and 6-month follow-up. Statistically significant effects were found after 6 months for awareness (OR 6.30; 95% CI 3.41 to 11.63), knowledge (B 0.74; 95% CI 0.54 to 0.95), receiving information (OR 9.81; 95% CI 5.60 to 17.18), washing hands (B -0.40; 95% -0.51 to -0.29), use of moisturiser (B 0.29; 95% CI 0.20 to 0.38), cotton under gloves (OR 3.94; 95% CI 2.04 to 7.60) and the overall compliance measure (B 0.14; 95% CI 0.02 to 0.26), as a result of the multifaceted implementation strategy. No effects were found for behavioural determinants. The multifaceted implementation strategy can be used in healthcare settings to enhance the implementation of recommendations for the prevention of hand eczema. NTR2812. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Eczema, Atopic Dermatitis, or Atopic Eczema: Analysis of Global Search Engine Trends.

PubMed

Xu, Shuai; Thyssen, Jacob P; Paller, Amy S; Silverberg, Jonathan I

The lack of standardized nomenclature for atopic dermatitis (AD) creates challenges for scientific communication, patient education, and advocacy. We sought to determine the relative popularity of the terms eczema, AD, and atopic eczema (AE) using global search engine volumes. A retrospective analysis of average monthly search volumes from 2014 to 2016 of Google, Bing/Yahoo, and Baidu was performed for eczema, AD, and AE in English and 37 other languages. Google Trends was used to determine the relative search popularity of each term from 2006 to 2016 in English and the top foreign languages, German, Turkish, Russian, and Japanese. Overall, eczema accounted for 1.5 million monthly searches (84%) compared with 247 000 searches for AD (14%) and 44 000 searches for AE (2%). For English language, eczema accounted for 93% of searches compared with 6% for AD and 1% for AE. Search popularity for eczema increased from 2006 to 2016 but remained stable for AD and AE. Given the ambiguity of the term eczema, we recommend the universal use of the next most popular term, AD.

Health hazard evaluation report HETA 85-039-1723, E. L. Smithe Machine Company, Duncansville, Pennsylvania

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bennett, D.E.

1986-08-01

The International Association of Machinists Local 2348 requested an investigation of reported skin rashes and headaches associated with cutting and cooling oils and solvents used in the machine shop. Of 62 employees interviewed, 42 had experienced skin problems occurring on their hands and arms including red skin, dry skin, cracked skin, or itchy skin, related to chemical exposures at the workplace. Xerosis, lichenification, or eczema of the hands and arms were noted on examination of 17 employees of the Lathe Department and 18 of those from the Milling Department. Respiratory and neurological complaints were also found among these employees. Themore » author concluded that the incidence of hand and arm xerosis and eczema in workers in the machining area may be associated with exposure to cutting oils. The author recommends that changes be made to minimize skin exposure and provide adequate ventilation and humidification.« less

Barriers and facilitators in the implementation of recommendations for hand eczema prevention among healthcare workers.

PubMed

van der Meer, Esther W C; van der Gulden, Joost W J; van Dongen, Diana; Boot, Cécile R L; Anema, Johannes R

2015-05-01

Evidence-based recommendations are available for the prevention of hand eczema among healthcare workers. However, the implementation of these recommendations is not always successful. To identify barriers and facilitators in the implementation of recommendations for the prevention of hand eczema among healthcare workers alongside a randomized controlled trial. A qualitative study was performed in which 19 healthcare workers were interviewed. The interview transcripts were open coded and also coded by means of a template by two researchers to identify relevant barriers and facilitators. Most barriers and facilitators reported for the recommendations were found at the level of the innovation (e.g. the recommendations), whereas for the guideline as a whole, multiple levels (socio-political, organization, user, and facilities) were identified. To enhance the implementation of recommendations for the prevention of hand eczema in a healthcare setting, having knowledge about these recommendations seems to be an important first step. In addition, maintaining the attention of the subject, testing the products beforehand and close collaboration with the infection control department might enhance implementation. Furthermore, it is important that the recommendations fit in with the work of the healthcare workers. When the implementation of the recommendations is prepared, these points should be taken into account. © 2015 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.

The ideal moisturizer: a survey of parental expectations and practice in childhood-onset eczema.

PubMed

Hon, Kam-Lun Ellis; Wang, Shuxin Susan; Pong, Nga Hin; Leung, Ting Fan

2013-02-01

We evaluated the moisturizing and bathing practices and preferences of patients with childhood-onset eczema. The attitudes and practice of patients with eczema managed at a pediatric dermatology clinic were evaluated, using children with non-eczematous skin diseases as controls. Disease severity of eczema in the preceding 12 months was evaluated by the Nottingham Eczema Severity Score (NESS). Skin hydration (SH) and transepidermal water loss (TEWL) were assessed. Majority of patients took shower instead of bath and spent 12-13 min in shower. Most eczema patients applied emollients after shower/bath. Air-conditioning use was frequent, and patients with eczema maintained a lower ambient temperature than non-eczema patients (p = 0.001). Most eczema patients reported regular emollient usage (1.8 times/day for mild vs 2.8 times/day for moderate-to-severe eczema, p = 0.001), and acceptability of the current product was good to fair. Parents reported that the current emollients were most often recommended by doctors. Majority of parents/patients with mild eczema thought an ideal emollient needs only to be used twice a day whereas moderate-to-severe patients preferred more frequent usage (p = 0.001), and most of them preferred a non-fragrant, non-herbal white cream. Agreements concerning ideal emollient usage were only "moderate-to-fair" (kappa values <0.61), implying what parents/patients practiced was not the same as what they preferred. This study helps better understand the emolliation practices and preferences of eczema patients. Doctors remain the most important source of recommendation. Majority think an ideal moisturizer is a non-fragrant, non-herbal, white or transparent cream which needs only to be used two to three times per day. Compliance may be enhanced if the recommended moisturizer conforms to the parents/patients preference.

[The role of psychological factors and psychiatric disorders in skin diseases].

PubMed

Kieć-Swierczyńska, Marta; Dudek, Bohdan; Krecisz, Beata; Swierczyńska-Machura, Dominika; Dudek, Wojciech; Garnczarek, Adrianna; Turczyn, Katarzyna

2006-01-01

In this paper, the relation between psychological factors and psychiatric disorders in patients with skin diseases is discussed. On the one hand psychological factors (stress, negative emotions) can influence the generation and aggravation of skin disorders (urticaria, atopic dermatitis, vitiligo), on the other hand psychological disorders can result in some skin diseases (psoriasis, atopic dermatitis). In the majority of cases the quality of life is poorly estimated by patients with skin problems. Psychodermatology is divided into three categories according to the relationship between skin diseases and mental disorders: 1) psychophysiologic disorders caused by skin diseases triggering different emotional states (stress), but not directly combined with mental disorders (psoriasis, eczema); 2) primary psychiatric disorders responsible for self-induced skin disorders (trichotillomania); and 3) secondary psychiatric disorders caused by disfiguring skin (ichthyosis, acne conglobata, vitiligo), which can lead to states of fear, depression or suicidal thoughts.

Lack of association between atopic eczema and the genetic variants of interleukin-4 and the interleukin-4 receptor alpha chain gene: heterogeneity of genetic backgrounds on immunoglobulin E production in atopic eczema patients.

PubMed

Tanaka, K; Sugiura, H; Uehara, M; Hashimoto, Y; Donnelly, C; Montgomery, D S

2001-10-01

The genetic background of atopic eczema might be heterogeneous and there is a possibility that immunoglobulin (Ig)E responsiveness in patients with atopic eczema is controlled separately from the development of atopic eczema. Although both interleukin (IL)-4 and the IL-4 receptor alpha chain have an important role for IgE production and are therefore possible candidate genes for atopy, it has not been clarified whether these genes play any roles in atopic eczema patients who have normal IgE productivity. We aimed to assess whether the polymorphisms of the IL-4 gene and the IL-4 receptor alpha chain gene play any roles in atopic eczema patients, particularly in patients who have normal IgE productivity. We determined the genotype with regard to polymorphisms in the genes for IL-4 and the IL-4 receptor alpha chain (- 589C/T of IL-4; Ile50Val, Ala375Glu and Arg551Gln of IL-4 receptor alpha chain) in patients with atopic eczema using the fluorogenic 5' nuclease assay. IL-4 and the IL-4 receptor alpha chain genotypes were not significantly associated with either total patients with atopic eczema or atopic eczema patients who had normal IgE productivity. The distribution of genotypes of IL-4-589C/T differed by the serum IgE levels in patients with atopic eczema. These results suggest that the polymorphisms in the IL-4 gene and the IL-4 receptor alpha chain gene play no role in the development of atopic eczema in patients who have normal IgE productivity.

Two Cases of Occupational Contact Urticaria Caused by Percutaneous Sensitization to Parvalbumin

PubMed Central

Sano, Akiyo; Yagami, Akiko; Suzuki, Kayoko; Iwata, Yohei; Kobayashi, Tsukane; Arima, Masaru; Kondo, Yasuto; Yoshikawa, Tetsushi; Matsunaga, Kayoko

2015-01-01

Background In recent years, it has been proposed that the primary mechanism for the development of food allergies is percutaneous sensitization. Since 2010, in Japan, the number of immediate-type wheat allergy due to hydrolyzed wheat protein has dramatically increased among those who have been using soap containing hydrolyzed wheat. This incidence supports the hypothesis that food allergens arise through percutaneous sensitization. Clinical Summary A 25-year-old man (case 1) and an 18-year-old girl (case 2) with atopic dermatitis visited our Department because of food allergy and hand eczema. After starting their work with fish, severe itchy eczema appeared on their hands. They subsequently started to experience oral allergic symptoms, intraoral itchiness and dyspnea after eating fish. Specific IgE antibodies were detected for many fishes, and skin prick tests showed positive reactions for a variety of fishes in both cases. Furthermore, the fluorescence intensities of specific IgE antibodies against parvalbumin from various types of fish in microarray immunoassay analysis showed positive reactions. We diagnosed them as contact urticaria caused by percutaneous sensitization to parvalbumin through job-related physical contact with fish. Conclusion The patients' histories and findings indicate the possibility of percutaneous sensitization through occupational exposure to parvalbumin, leading to food allergy. PMID:26464568

Guidelines for diagnosis, prevention and treatment of hand eczema--short version.

PubMed

Diepgen, Thomas L; Andersen, Klaus E; Chosidow, Oliver; Coenraads, Peter Jan; Elsner, Peter; English, John; Fartasch, Manigé; Gimenez-Arnau, Ana; Nixon, Rosemary; Sasseville, Denis; Agner, Tove

2015-01-01

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. © 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Hand eczema and occupational contact allergies in healthcare workers with a focus on rubber additives.

PubMed

Hamnerius, Nils; Svedman, Cecilia; Bergendorff, Ola; Björk, Jonas; Bruze, Magnus; Engfeldt, Malin; Pontén, Ann

2018-06-20

Hand eczema (HE) in healthcare workers (HCWs) is common. Besides wet work, healthcare work also implies exposure to contact allergens. To assess HE and contact allergy related to occupational exposures in HCWs. In a cross-sectional study, 311 HCWs with HE within the preceding 12 months and a control group of 114 HCWs without HE were investigated with the baseline series and a special patch test series based on substances found in the gloves, soaps, alcoholic hand disinfectants and hand creams provided at the hospitals. Contact allergy to rubber additives was significantly more common in HCWs with HE (6%) than in HCWs without HE (1%, P = .02). The corresponding percentages for fragrances were 11% and 3%, respectively (P = .004). Occupational HE was found in 193 of 311 (62%) HCWs. Of these, 22 of 193 (11%) had occupational allergic contact dermatitis, including 17 with glove-related rubber contact allergy. Contact allergy to diphenylguanidine was as common as contact allergy to thiurams. Occupational contact allergy to rubber additives was significantly associated with sick-leave related to HE. Contact allergy to rubber additives in medical gloves is the most common cause of occupational allergic contact dermatitis in HCWs. Aimed patch testing with relevant rubber additives is mandatory when HE in HCWs is investigated. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Development and validation of a questionnaire on 'Satisfaction with dermatological treatment of hand eczema' (DermaSat)

PubMed Central

2010-01-01

Objective To develop a self-administered short questionnaire to assess patient satisfaction with medical treatment for hand eczema (dermatitis) with good psychometric properties. Method The content of the questionnaire was determined on the basis of clinical consultation with groups of patients, from studying the existing instruments, and from discussions with a panel of seven experts. A first draft version containing 38 items organised in six dimensions was tested on a pilot sample of patients to assess its legibility. The extended version was then tested on a sample of 217 patients of both genders enrolled at 18 hospitals representative of the national distribution. The questionnaire was supplied together with the Morisky-Green compliance questionnaire, the health-related quality of life (HRQL) SF-12 questionnaire, and a visual analogue scale (VAS) of perceived health status to assess concurrent validity. The dimensionality was reduced by means of exploratory factor analysis, and reliability was evaluated on the basis of internal consistency and two halves reliability estimates. Item discriminant capability and questionnaire discriminant validity with respect to known groups of patients (by gender, principal diagnosis, age, disease severity and treatment) were also assessed. Results The reduction and validation sample was composed of 54% women and 46% men, of various educational levels with an average age of 43 years (SD = 13.7). Of those who responded, 26% were diagnosed with hyperkeratotic dermatitis of the palms and 27% of the fingertips, and 47% with recurring palmar dyshidrotic eczema. The questionnaire was shortened to a version containing 17 items grouped in six dimensions: effectiveness, convenience, impact on HRQL, medical follow-up, side effects, and general opinion. Cronbach's alpha coefficient reached a value of 0.9. The dimensions showed different degrees of correlation, and the scores had a normal distribution with an average of 58.4 points (SD = 18.01). Treatment satisfaction scores attained correlations between 0.003 and 0.222 with the HRQL measures, and showed higher correlations with the effectiveness (r = 0.41) and tolerability (0.22) measures, but very low correlation with compliance (r = 0.015). Significant differences were observed between some diagnoses and treatments. Conclusions The shortened questionnaire proved to have good psychometric properties, providing excellent reliability, satisfactorily reproducing the proposed structure and supplying evidence of validity. PMID:21054872

Increased risk of lung cancer in patients with eczema: a nationwide cohort study in Taiwan.

PubMed

Juan, Chao-Kuei; Shen, Jui-Lung; Lin, Cheng-Li; Kim, Karen Wang; Chen, Wen-Chi

2016-09-01

The association between lung cancer and eczema remains controversial. Previous studies have yielded conflicting results. This retrospective population-based cohort study is aimed at clarifying the risk of lung cancer associated with eczema. By using the Taiwan National Health Insurance Research Database, we identified 43,719 patients who had been newly diagnosed with eczema in the years 2000 to 2010. The comparison cohort included 87,438 randomly selected, age-matched patients without eczema. The cases of these two cohorts were followed until 2011. The Cox proportional hazard regression model was used to calculate the risk of lung cancer in eczema patients. The database did not contain any information regarding smoking, alcohol consumption, socioeconomic status, or family history. After adjusting for age and comorbidity, the population with eczema had a 2.80-fold greater risk of developing lung cancer compared with the population in the comparison cohort (adjusted hazard ratio 2.80, 95 % confidence interval 2.59-3.03). Eczema patients with comorbid diseases including asthma, chronic obstructive -pulmonary disease, alcoholic liver damage, or diabetes were at a higher risk of lung cancer compared with the non-eczema patients without comorbidity. Eczema is associated with a greater risk for the development of lung cancer. Further studies with more comprehensive information on potential confounders are warranted. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Atopic Dermatitis Anti-IgE Paediatric Trial (ADAPT): the role of anti-IgE in severe paediatric eczema: study protocol for a randomised controlled trial.

PubMed

Chan, Susan; Cornelius, Victoria; Chen, Tao; Radulovic, Suzana; Wan, Mandy; Jahan, Rahi; Lack, Gideon

2017-03-22

The evidence for systemic treatments for severe childhood eczema is limited and largely based on extrapolation of data from adult studies. Current therapies are often immunosuppressant and may be associated with both short- and long-term side effects. There is increasing in vitro and murine-model evidence for the role of IgE in the immunopathogenesis of atopic eczema. The aim of the study is to assess whether anti-IgE treatment (omalizumab) improves eczema, compared to placebo. The Atopic Dermatitis Anti-IgE Paediatric Trial (ADAPT) is a randomised, double-blind, placebo-controlled study assessing the role of anti-IgE in the management of severe paediatric eczema. Children with severe atopic eczema, with an objective SCORing Atopic Dermatitis (SCORAD) score of over 40 will be recruited. These children are candidates for systemic therapy, have failed systemic therapy or have experienced side effects from systemic therapy. Sixty-two patients aged between 4 and 19 years will receive anti-IgE for 6 months. The primary outcome measure will be the validated eczema score, the objective SCORAD at 24 weeks. This study has 90% power to detect a 33% relative reduction in SCORAD between active and placebo groups, with 5% significance. IgE may have a role to play in eczema, particularly in childhood. This forms the basis for the hypothesis that anti-IgE may be an effective treatment in this patient population. This will be the largest study to evaluate the efficacy of anti-IgE (omalizumab) versus placebo in children with severe eczema. The findings will help to clarify the role of anti-IgE as a potential treatment option in patients with severe childhood eczema. European Clinical Trials Database (EudraCT) Number: 2010-020841-29 . Assigned on 14 May 2010. ISRCTN Registry, Identifier: ISRCTN15090567 . Retrospectively assigned on 3 December 2014. ClinicalTrials.gov, Identifier: NCT02300701 . First received 21 November 2014.

Classification and possible bacterial infection in outpatients with eczema and dermatitis in China

PubMed Central

Wang, Xin; Shi, Xiao-Dong; Li, Lin-Feng; Zhou, Ping; Shen, Yi-Wei

2017-01-01

Abstract Little is known about the classification and bacterial infection in outpatients with eczema and dermatitis in China. To investigate the prevalence of eczema and dermatitis in outpatients of dermatology clinics in China, examine classification and proportion of common types of dermatitis and the possible bacterial infection, and analyze the possible related factors. Outpatients with eczema or dermatitis from 39 tertiary hospitals of 15 provinces in mainland China from July 1 to September 30, 2014, were enrolled in this cross-sectional and multicenter study. Among 9393 enrolled outpatients, 636 patients (6.7%) were excluded because of incomplete information. The leading subtypes of dermatitis were unclassified eczema (35.5%), atopic dermatitis (13.4%), irritant dermatitis (9.2%), and widespread eczema (8.7%). Total bacterial infection rate was 52.3%, with widespread eczema, stasis dermatitis, and atopic dermatitis being the leading three (65.7%, 61.8%, and 61.4%, respectively). Clinically very likely bacterial infection has a significant positive correlation with disease duration, history of allergic disease, history of flexion dermatitis, and severe itching. Atopic dermatitis has become a common subtype of dermatitis in China. Secondary bacterial infection is common in all patients with dermatitis, and more attentions should be paid on this issue in other type of dermatitis apart from atopic dermatitis. PMID:28858126

Classification and possible bacterial infection in outpatients with eczema and dermatitis in China: A cross-sectional and multicenter study.

PubMed

Wang, Xin; Shi, Xiao-Dong; Li, Lin-Feng; Zhou, Ping; Shen, Yi-Wei

2017-09-01

Little is known about the classification and bacterial infection in outpatients with eczema and dermatitis in China.To investigate the prevalence of eczema and dermatitis in outpatients of dermatology clinics in China, examine classification and proportion of common types of dermatitis and the possible bacterial infection, and analyze the possible related factors.Outpatients with eczema or dermatitis from 39 tertiary hospitals of 15 provinces in mainland China from July 1 to September 30, 2014, were enrolled in this cross-sectional and multicenter study. Among 9393 enrolled outpatients, 636 patients (6.7%) were excluded because of incomplete information.The leading subtypes of dermatitis were unclassified eczema (35.5%), atopic dermatitis (13.4%), irritant dermatitis (9.2%), and widespread eczema (8.7%). Total bacterial infection rate was 52.3%, with widespread eczema, stasis dermatitis, and atopic dermatitis being the leading three (65.7%, 61.8%, and 61.4%, respectively). Clinically very likely bacterial infection has a significant positive correlation with disease duration, history of allergic disease, history of flexion dermatitis, and severe itching.Atopic dermatitis has become a common subtype of dermatitis in China. Secondary bacterial infection is common in all patients with dermatitis, and more attentions should be paid on this issue in other type of dermatitis apart from atopic dermatitis.

Topical treatment with fresh human milk versus emollient on atopic eczema spots in young children: a small, randomized, split body, controlled, blinded pilot study.

PubMed

Berents, Teresa Løvold; Rønnevig, Jørgen; Søyland, Elisabeth; Gaustad, Peter; Nylander, Gro; Løland, Beate Fossum

2015-05-04

Public health nurses report on effects of fresh human milk as treatment for conjunctivitis, rhinitis and atopic eczema (AE), the latter being highly prevalent in early childhood. Emollients and topical corticosteroids are first line treatment of AE. As many caregivers have steroid phobia, alternative treatment options for mild AE are of interest. The aim of this small pilot study was to assess the potential effects and risks of applying fresh human milk locally on eczema spots in children with AE. This was a split body, controlled, randomized and physician blinded pilot study, of children with AE with two similar contralateral eczema spots having a mother breastfeeding the child or a sibling. Fresh expressed milk and emollient was applied on the intervention spot and emollient alone on the control area, three times a day for four weeks. The severity and area of the eczema spots was evaluated weekly, and samples from milk and the spots were analysed weekly with respect to bacterial colonisation. Of nine patients included, six completed the study. Mean age at inclusion was 18.5 months. The spots examined were localized on the arms, legs or cheeks. The spots were similar in severity, but differed in area. In one patient the eczema ceased after inclusion. In four patients both control and intervention areas increased during the intervention. The relative change in eczema area compared to baseline showed less increase in the intervention spots in two patients, whereas the opposite was observed in three. In four children Staphylococcus aureus was found in their eczema once or more. In three of the 28 human milk samples, Staphylococcus aureus, alfa haemolytic streptococci or coagulase negative staphylococci were detected. Staphylococcus aureus was found once both in human milk and in the eczema spots, no clinical signs of infection were however observed. No secondary infection due to milk application was detected. In this small pilot study, no effect was found on eczema spots treated with topical application of fresh human milk. (ClinicalTrials.gov Identifier, NCT02381028 ).

Cutaneous adverse events (AEs) of anti-programmed cell death (PD)-1 therapy in patients with metastatic melanoma: A single-institution cohort.

PubMed

Hwang, Shelley Ji Eun; Carlos, Giuliana; Wakade, Deepal; Byth, Karen; Kong, Benjamin Y; Chou, Shaun; Carlino, Matteo S; Kefford, Richard; Fernandez-Penas, Pablo

2016-03-01

Anti-programmed cell death (PD)-1 therapy is emerging as the backbone of new standard of care immunotherapy for metastatic melanoma. Immune-related cutaneous events are observed in these patients. We sought to describe cutaneous adverse events observed in patients with metastatic melanoma on anti-PD-1 therapy. We reviewed the clinical and histologic information of all patients treated with single-agent anti-PD-1 therapy for metastatic melanoma at Westmead Hospital, Sydney, Australia, from May 2012 to February 2015. Of the 82 patients included in the study, 34 had dermatology assessments. Forty (49%) developed a form of anti-PD-1-associated cutaneous adverse events. In all, 17% developed lichenoid reactions and eczema, and 15% developed vitiligo. An estimated 25% of patients were expected to develop their first lichenoid reactions within 8.3 months, and eczema and vitiligo within 10.3 months of therapy. These adverse events tend to appear together in patients on anti-PD-1 therapy. The study was from a single center and clinical information was reviewed retrospectively in patients not referred to dermatology. Anti-PD-1 therapy is associated with the development of immune-related cutaneous events. Lichenoid reactions, eczema, and vitiligo are the 3 most prevalent lesions observed in our population. There is a tendency for lichenoid reactions and eczema to occur with vitiligo. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Measurement properties of quality-of-life measurement instruments for infants, children and adolescents with eczema: a systematic review.

PubMed

Heinl, D; Prinsen, C A C; Sach, T; Drucker, A M; Ofenloch, R; Flohr, C; Apfelbacher, C

2017-04-01

Quality of life (QoL) is one of the core outcome domains identified by the Harmonising Outcome Measures for Eczema (HOME) initiative to be assessed in every eczema trial. There is uncertainty about the most appropriate QoL instrument to measure this domain in infants, children and adolescents. To systematically evaluate the measurement properties of existing measurement instruments developed and/or validated for the measurement of QoL in infants, children and adolescents with eczema. A systematic literature search in PubMed and Embase, complemented by a thorough hand search of reference lists, retrieved studies on measurement properties of eczema QoL instruments for infants, children and adolescents. For all eligible studies, we judged the adequacy of the measurement properties and the methodological study quality with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results from different studies were summarized in a best-evidence synthesis and formed the basis to assign four degrees of recommendation. Seventeen articles, three of which were found by hand search, were included. These 17 articles reported on 24 instruments. No instrument can be recommended for use in all eczema trials because none fulfilled all required adequacy criteria. With adequate internal consistency, reliability and hypothesis testing, the U.S. version of the Childhood Atopic Dermatitis Impact Scale (CADIS), a proxy-reported instrument, has the potential to be recommended depending on the results of further validation studies. All other instruments, including all self-reported ones, lacked significant validation data. Currently, no QoL instrument for infants, children and adolescents with eczema can be highly recommended. Future validation research should primarily focus on the CADIS, but also attempt to broaden the evidence base for the validity of self-reported instruments. © 2016 British Association of Dermatologists.

Occupational contact dermatitis to a limonene-based solvent in a histopathology technician.

PubMed

Foti, Caterina; Zambonin, Carlo G; Conserva, Anna; Casulli, Claudia; D'Accolti, Lucia; Angelini, Gianni

2007-02-01

Recently, D-limonene-based solvents are used as a safe alternative to xylene for histological and cytological application to dissolve paraffin. We report the case of a histopathology technician with a recalcitrant hand contact dermatitis strictly related to the use of a limonene-based solvent agent. Patch tests with SIDAPA (Italian Society of Allergological, Professional and Environmental Dermatology) standard series, limonene-based solvent used by the patient and D- and L-limonene (both oxidized and nonoxidized form) and with Giemsa and methylene blue stains were performed. Patch testing gave positive results to oxidized D- and L-limonene. The patient retired from work and promptly improved and healed the hand eczema. Subsequently, the potential occurrence of limonene oxidation products in the incriminated preparation was investigated using gas chromatography-mass spectrometry. While patch test showed positive reaction to oxidized limonene, chemical analysis failed to detect oxidized limonene in the preparations used by the patient. Considering the strict relation between the use of the preparations and the appearance of symptoms, we can assume that oxidized limonene may be produced during the handling of limonene-based products, especially in the presence of oxidants stains, frequently used in histological laboratories.

[Compositae dermatitis].

PubMed

Jovanović, Marina; Poljacki, Mirjana

2003-01-01

Compositae dermatitis is an allergic contact dermatitis caused by plant species of the Compositae family. The first report of a cutaneous reaction to the Chrysanthemum genus was made by Howe JS in 1887. In 1895 Maiden JH reported about skin lesions among men working with Tagetes minuta. Case reports of contact allergic-ragweed dermatitis appeared in the American literature as early as 1919. The North American feverfew--Parthenium Hysterophorus was brought to India from America in 1956 and it caused thousands of cases of so-called parthenium dermatitis. Ragweed and parthenium dermatitis became prototypes for the classic, so-called "airborne" Compositae dermatitis, that affects primarily exposed skin surfaces, and produces a universal erythroderma. The frequency of contact allergy to Compositae in Europe is higher than previously believed. It occurs most frequently in middle-aged and elderly persons, but also in all age groups. During the two past decades a more equal sex ratio has been established. The prevalence varies from 0.7-1.4% in the general population, up to 4.5% among occupationally exposed persons. Compositae allergy is among the top ten contact sensitivities in Europe. In North Europe plants were the cause of 4.4% cases of occupational allergic contact dermatitis. ETIOLOGY AND PATHOGENESIS: Among cultivated Compositae plants, Chrysanthemum is considered to be a major sensitizer in Europe (60%). Among the edible types, it is lettuce--Lactuca sativa and endive Cichorium endivia (20-30%), and wild-growing feverfew--Tanace--tum parthenium (70-90%), tansy--Tanacetum vulgare (54%), and dandelion--Taraxacum officinale (65%). Sesquiterpene lactones are the main sensitizers of the Compositae family. Other components, thiophenes and acetylenes are said to elicit only phytophotodermatitis, but recent studies have demonstrated that some thiophenes and benzofuran derivates possess not only phototoxic activity, but also sensitizing properties. Photosensitivity is present in 22-75% Compositae sensitive individuals. Extracts from Compositae are known to be phototoxic in vitro. Photoreactivity of alpha-methylene-gamma-la-ctone group of sesquiterpene-lactone directed towards the DNA base thymine, thus producing intermolecular 2 + 2 photoadducts (antigen within the cell), was also thought to be related to photosensitivity. Clinical manifestations vary from generalized eczema (20-30%), eczema of hands and face (24%), hand (36-44%), or facial eczema (11-28%). 65% of patients have vesicular hand eczema. Routine patch testing with sesquiterpene lactone mix, aimed testing with Compositae extracts screening mix, Compositae plants, and with their extracts, whereas the treatment of choice is a specific allergen-immunotherapy.

Impact of systemic alitretinoin treatment on skin barrier gene and protein expression in patients with chronic hand eczema.

PubMed

Kumari, V; Timm, K; Kühl, A A; Heine, G; Worm, M

2016-12-01

Chronic hand eczema (CHE) is a common inflammatory skin disease that affects approximately 10% of the population. Systemic alitretinoin has been shown to be effective in patients with CHE who are refractory to topical corticosteroids. To analyse the impact of alitretinoin on the skin barrier genes and protein expression in the skin lesions of patients with CHE. Fifteen patients with CHE were treated with 30 mg daily of alitretinoin for up to 27 weeks. Disease severity was assessed using a clinical score. Skin biopsies from all the patients were evaluated before and after therapy for the expression of Ki-67, various skin barrier genes and thymic stromal lymphopoietin (TSLP) by real-time quantitative polymerase chain reaction and immunohistochemistry. After alitretinoin application, an improvement in the clinical severity of CHE was observed in the majority of patients. Analysis of skin biopsies before treatment showed a significant increase in Ki-67-positive cells in the suprabasal layer and a dysregulated expression of various skin barrier genes, such as claudin 1, loricrin, filaggrin and cytokeratin 10, which were normalized after treatment. TSLP was significantly upregulated in patients with CHE and also normalized after alitretinoin treatment and negatively correlated with filaggrin. Our data indicate that the expression of barrier genes and proteins was normalized following treatment with alitretinoin in patients with CHE. The change in expression levels of these genes correlated with the clinical efficacy, suggesting that alitretinoin exhibits a disease-modifying activity. TSLP is upregulated in CHE and seems to counteract filaggrin expression in the skin. © 2016 British Association of Dermatologists.

The digital eczema centre utrecht.

PubMed

van Os-Medendorp, Harmieke; van Veelen, Carien; Hover, Maaike; Eland-de Kok, Petra; Bruijnzeel-Koomen, Carla; Sonnevelt, Gert-Jan; Mensing, Geert; Pasmans, Suzanne

2010-01-01

The University Medical Centre Utrecht (UMC Utrecht) has developed an eczema portal that combines e-consulting, monitoring and self-management training by a dermatology nurse online for patients and parents of young children with atopic dermatitis (AD). Patient satisfaction with the portal was high. It could be extended to become a Digital Eczema Centre for multidisciplinary collaboration between health-care providers from different locations and the patient. Before starting the construction of the Digital Eczema Centre, the feasibility was examined by carrying out a business case analysis. The purposes, strength and weaknesses showed that the Digital Eczema Centre offered opportunities to improve care for patients with AD. The financial analysis resulted in a medium/best case scenario with a positive result of euro50-240,000 over a period of five years. We expect that the Digital Eczema Centre will increase the accessibility and quality of care. The web-based patient record and the digital chain-of-care promote the involvement of patients, parents and multidisciplinary teams as well as the continuity and coordination of care.

Nummular Eczema of Breast: A Potential Dermatologic Complication after Mastectomy and Subsequent Breast Reconstruction

PubMed Central

Iwahira, Yoshiko; Nagasao, Tomohisa; Shimizu, Yusuke; Kuwata, Kumiko; Tanaka, Yoshio

2015-01-01

Purposes. The present paper reports clinical cases where nummular eczema developed during the course of breast reconstruction by means of implantation and evaluates the occurrence patterns and ratios of this complication. Methods. 1662 patients undergoing breast reconstruction were reviewed. Patients who developed nummular eczema during the treatment were selected, and a survey was conducted on these patients regarding three items: (1) the stage of the treatment at which nummular eczema developed; (2) time required for the lesion to heal; (3) location of the lesion on the reconstructed breast(s). Furthermore, histopathological examination was conducted to elucidate the etiology of the lesion. Results. 48 patients (2.89%) developed nummular eczema. The timing of onset varied among these patients, with lesions developing after the placement of tissue expanders for 22 patients (45.8%); after the tissue expanders were replaced with silicone implants for 12 patients (25%); and after nipple-areola complex reconstruction for 14 patients (29.2%). Nummular eczema developed both in periwound regions (20 cases: 41.7%) and in nonperiwound regions (32 cases: 66.7%). Histopathological examination showed epidermal acanthosis, psoriasiform patterns, and reduction of sebaceous glands. Conclusions. Surgeons should recognize that nummular eczema is a potential complication of breast reconstruction with tissue expanders and silicone implants. PMID:26380109

FOOT ECZEMA: THE ROLE OF PATCH TEST IN DETERMINING THE CAUSATIVE AGENT USING STANDARD SERIES

PubMed Central

Priya, K S; Kamath, Ganesh; Martis, Jacintha; D, Sukumar; Shetty, Narendra J; Bhat, Ramesh M; Kishore, B Nanda

2008-01-01

Foot dermatitis refers to the predominant involvement of feet in the eczematous process. This study is undertaken to determine the clinical pattern and causative agent in foot eczema and to evaluate the role of patch testing in determining the causative agent of foot eczema. Data was collected from 50 patients with foot eczema, who attended the out-patient department. The patch test was performed using Indian standard series. Patch test was positive in 88% of the patients. The most common site affected was the dorsal aspect of the foot (48%) and scaly plaque was the predominant morphological pattern. The highest number of patients (24%) showed positive reactions to mercaptobenzothiazole (MBT) and the lowest (4%) to neomycin sulfate. Rubber and rubber chemicals have been reported worldwide to be the most common sensitizer causing foot eczema. Thus, patch test has a major role in finding out the cause of foot eczema. PMID:19881990

Enhancement of allergic skin wheal responses in patients with atopic eczema/dermatitis syndrome by playing video games or by a frequently ringing mobile phone.

PubMed

Kimata, H

2003-06-01

Playing video games causes physical and psychological stress, including increased heart rate and blood pressure and aggression-related feelings. Use of mobile phones is very popular in Japan, and frequent ringing is a common and intrusive part of Japanese life. Atopic eczema/dermatitis syndrome is often exacerbated by stress. Stress increases serum IgE levels, skews cytokine pattern towards Th2 type, enhances allergen-induced skin wheal responses, and triggers mast cell degranulation via substance P, vasoactive intestinal peptide and nerve growth factor. (1). In the video game study, normal subjects (n = 25), patients with allergic rhinitis (n = 25) or atopic eczema/dermatitis syndrome (n = 25) played a video game (STREET FIGHTER II) for 2 h. Before and after the study, allergen-induced wheal responses, plasma levels of substance P, vasoactive intestinal peptide and nerve growth factor, and in vitro production of total IgE, antihouse dust mite IgE and cytokines were measured. (2). In the mobile phone study, normal subjects (n = 27), patients with allergic rhinitis (n = 27) or atopic eczema/dermatitis syndrome (n = 27) were exposed to 30 incidences of ringing mobile phones during 30 min. Before and after the study, allergen-induced wheal responses, plasma levels of substance P, vasoactive intestinal peptide and nerve growth factor were measured. Playing video games had no effect on the normal subjects or the patients with allergic rhinitis. In contrast, playing video games significantly enhanced allergen-induced skin wheal responses and increased plasma levels of substance P, vasoactive intestinal peptide and nerve growth factors in the patients with atopic eczema/dermatitis syndrome. Moreover, playing video games enhanced in vitro production of total IgE and anti-house dust mite IgE with concomitant increased production of IL-4, IL-10 and IL-13 and decreased production of IFN-gamma and IL-12 in the patients with atopic eczema/dermatitis syndrome. However, exposure to frequently ringing mobile phones significantly enhanced allergen-induced skin wheal responses, plasma levels of substance P, vasoactive intestinal peptide and nerve growth factors in the patients with atopic eczema/dermatitis syndrome, but not in the normal subjects or the patients with allergic rhinitis. Playing video games enhanced allergic responses with a concomitant increased release of substance P, vasoactive intestinal peptide and nerve growth factor, and skewing of the cytokine pattern toward Th2 type in the patients with atopic eczema/dermatitis syndrome. In addition, exposure to frequently ringing mobile phones also enhanced allergic responses with a concomitant increased release of substance P, vasoactive intestinal peptide and nerve growth factor Collectively, high technology causes stress, which in turn may aggravate symptoms of atopic eczema/dermatitis syndrome.

Altered Gut Microbiota Composition Associated with Eczema in Infants.

PubMed

Zheng, Huajun; Liang, Hong; Wang, Yuezhu; Miao, Maohua; Shi, Tao; Yang, Fen; Liu, Enuo; Yuan, Wei; Ji, Zai-Si; Li, De-Kun

2016-01-01

Eczema is frequently the first manifestation of an atopic diathesis and alteration in the diversity of gut microbiota has been reported in infants with eczema. To identify specific bacterial communities associated with eczema, we conducted a case-control study of 50 infants with eczema (cases) and 51 healthy infants (controls). We performed high-throughput sequencing for V3-V4 hypervariable regions of the 16S rRNA genes from the gut fecal material. A total of 12,386 OTUs (operational taxonomic units) at a 97% similarity level were obtained from the two groups, and we observed a difference in taxa abundance, but not the taxonomic composition, of gut microbiota between the two groups. We identified four genera enriched in healthy infants: Bifidobacterium, Megasphaera, Haemophilus and Streptococcus; and five genera enriched in infants with eczema: Escherichia/Shigella, Veillonella, Faecalibacterium, Lachnospiraceae incertae sedis and Clostridium XlVa. Several species, such as Faecalibacterium prausnitzii and Ruminococcus gnavus, that are known to be associated with atopy or inflammation, were found to be significantly enriched in infants with eczema. Higher abundance of Akkermansia muciniphila in eczematous infants might reduce the integrity of intestinal barrier function and therefore increase the risk of developing eczema. On the other hand, Bacteroides fragilis and Streptococcus salivarius, which are known for their anti-inflammatory properties, were less abundant in infants with eczema. The observed differences in genera and species between cases and controls in this study may provide insight into the link between the microbiome and eczema risk.

Altered Gut Microbiota Composition Associated with Eczema in Infants

PubMed Central

Miao, Maohua; Shi, Tao; Yang, Fen; Liu, Enuo; Yuan, Wei; Ji, Zai-Si; Li, De-Kun

2016-01-01

Eczema is frequently the first manifestation of an atopic diathesis and alteration in the diversity of gut microbiota has been reported in infants with eczema. To identify specific bacterial communities associated with eczema, we conducted a case-control study of 50 infants with eczema (cases) and 51 healthy infants (controls). We performed high-throughput sequencing for V3–V4 hypervariable regions of the 16S rRNA genes from the gut fecal material. A total of 12,386 OTUs (operational taxonomic units) at a 97% similarity level were obtained from the two groups, and we observed a difference in taxa abundance, but not the taxonomic composition, of gut microbiota between the two groups. We identified four genera enriched in healthy infants: Bifidobacterium, Megasphaera, Haemophilus and Streptococcus; and five genera enriched in infants with eczema: Escherichia/Shigella, Veillonella, Faecalibacterium, Lachnospiraceae incertae sedis and Clostridium XlVa. Several species, such as Faecalibacterium prausnitzii and Ruminococcus gnavus, that are known to be associated with atopy or inflammation, were found to be significantly enriched in infants with eczema. Higher abundance of Akkermansia muciniphila in eczematous infants might reduce the integrity of intestinal barrier function and therefore increase the risk of developing eczema. On the other hand, Bacteroides fragilis and Streptococcus salivarius, which are known for their anti-inflammatory properties, were less abundant in infants with eczema. The observed differences in genera and species between cases and controls in this study may provide insight into the link between the microbiome and eczema risk. PMID:27812181

Optimal Diet Planning for Eczema Patient Using Integer Programming

NASA Astrophysics Data System (ADS)

Zhen Sheng, Low; Sufahani, Suliadi

2018-04-01

Human diet planning is conducted by choosing appropriate food items that fulfill the nutritional requirements into the diet formulation. This paper discusses the application of integer programming to build the mathematical model of diet planning for eczema patients. The model developed is used to solve the diet problem of eczema patients from young age group. The integer programming is a scientific approach to select suitable food items, which seeks to minimize the costs, under conditions of meeting desired nutrient quantities, avoiding food allergens and getting certain foods into the diet that brings relief to the eczema conditions. This paper illustrates that the integer programming approach able to produce the optimal and feasible solution to deal with the diet problem of eczema patient.

Absorption and retention of nickel from drinking water in relation to food intake and nickel sensitivity.

PubMed

Nielsen, G D; Søderberg, U; Jørgensen, P J; Templeton, D M; Rasmussen, S N; Andersen, K E; Grandjean, P

1999-01-01

Two studies were performed to examine the influence of fasting and food intake on the absorption and retention of nickel added to drinking water and to determine if nickel sensitization played any role in this regard. First, eight nonallergic male volunteers fasted overnight before being given nickel in drinking water (12 micrograms Ni/kg) and, at different time intervals, standardized 1400-kJ portions of scrambled eggs. When nickel was ingested in water 30 min or 1 h prior to the meal, peak nickel concentrations in serum occurred 1 h after the water intake, and the peak was 13-fold higher than the one seen 1 h after simultaneous intake of nickel-containing water and scrambled eggs. In the latter case, a smaller, delayed peak occurred 3 h after the meal. Median urinary nickel excretion half-times varied between 19.9 and 26.7 h. Within 3 days, the amount of nickel excreted corresponded to 2.5% of the nickel ingested when it was mixed into the scrambled eggs. Increasing amounts were excreted as the interval between the water and the meal increased, with 25.8% of the administered dose being excreted when the eggs were served 4 h prior to the nickel-containing drinking water. In the second experiment, a stable nickel isotope, 61Ni, was given in drinking water to 20 nickel-sensitized women and 20 age-matched controls, both groups having vesicular hand eczema of the pompholyx type. Nine of 20 nickel allergic eczema patients experienced aggravation of hand eczema after nickel administration, and three also developed a maculopapular exanthema. No exacerbation was seen in the control group. The course of nickel absorption and excretion in the allergic groups did not differ and was similar to the pattern seen in the first study, although the absorption in the women was less. A sex-related difference in gastric emptying rates may play a role. Thus, food intake and gastric emptying are of substantial significance for the bioavailability of nickel from aqueous solutions. Copyright 1999 Academic Press.

Serum concentrations of metalloproteinase 2, metalloproteinase 9 and granzyme B in contact eczema patients

PubMed Central

Żbikowska-Gotz, Magdalena; Czajkowski, Rafał; Bartuzi, Zbigniew

2013-01-01

Introduction Contact eczema is a common skin condition with complex etiology, variable clinical presentation and lengthy therapy duration. The mechanism of contact eczema is complex, since it is affected by multiple inflammatory mediators. Aim To assess concentrations of metalloproteinase 2 (MMP-2), metalloproteinase 9 (MMP-9) and granzyme B (GzmB) in patients with contact eczema. Material and methods Seventy patients with contact eczema and 30 healthy persons as controls were included in the study. In all subjects, MMP-2, MMP-9 and GzmB were determined using ELISA immunoassay. In study group patients, concentrations were assayed in periods of disease exacerbation and remission. Obtained results were analyzed statistically. Results Mean MMP-2 and GzmB concentrations were found to be significantly higher in the study group than in the control group. Mean MMP-2, MMP-9 and GzmB levels were also statistically significantly higher during skin lesion relapse compared to contact eczema remission periods. Conclusions The presented paper demonstrates that MMP-2, MMP-9 and GzmB are good markers of contact eczema exacerbations. PMID:24278051

Automatic detection and severity measurement of eczema using image processing.

PubMed

Alam, Md Nafiul; Munia, Tamanna Tabassum Khan; Tavakolian, Kouhyar; Vasefi, Fartash; MacKinnon, Nick; Fazel-Rezai, Reza

2016-08-01

Chronic skin diseases like eczema may lead to severe health and financial consequences for patients if not detected and controlled early. Early measurement of disease severity, combined with a recommendation for skin protection and use of appropriate medication can prevent the disease from worsening. Current diagnosis can be costly and time-consuming. In this paper, an automatic eczema detection and severity measurement model are presented using modern image processing and computer algorithm. The system can successfully detect regions of eczema and classify the identified region as mild or severe based on image color and texture feature. Then the model automatically measures skin parameters used in the most common assessment tool called "Eczema Area and Severity Index (EASI)," by computing eczema affected area score, eczema intensity score, and body region score of eczema allowing both patients and physicians to accurately assess the affected skin.

Basal electrical impedance in relation to sodium lauryl sulphate-induced skin reactions--a comparison of patients with eczema and healthy controls.

PubMed

Kuzmina, Natalia; Hagströmer, Lena; Nyrén, Miruna; Emtestam, Lennart

2003-11-01

Identification of subjects at risk for contact dermatitis by screening tests is desirable in order to adjust the preventive measures to individual skin susceptibility. The present study aimed to examine the effects of basic physiological features, such as baseline electrical impedance (IMP) and transepidermal water loss (TEWL), on reactivity to sodium lauryl sulphate (SLS). On the basis of two previous studies, we re-evaluated the experimental irritant skin reactions (50 microL of 2% SLS in large Finn Chambers for 24 h) on the volar forearms of 29 patients with eczema and 19 healthy controls. We found definite differences in the baseline values of IMP, between the patients and the controls. Moreover, patients with eczema showed higher TEWL and lower MIX values on day 3 after exposure to SLS, which may indicate differences in SLS reactivity. After the study, the biophysical parameters of the eczema patients did not return to baseline, which suggests that their skin heals more slowly than that of normal subjects. Our findings indicate that the IMP technique may help to 'detect' chemically vulnerable skin. However, more studies are needed to determine the value of the basal electrical impedance parameters in assessing the risk of developing irritant contact dermatitis.

Core beliefs and psychological distress in patients with psoriasis and atopic eczema attending secondary care: the role of schemas in chronic skin disease.

PubMed

Mizara, A; Papadopoulos, L; McBride, S R

2012-05-01

The role of ingrained cognitive and emotional patterns (schemas) in patients with psoriasis and eczema has not previously been investigated. High levels of psychiatric morbidity and psychological distress observed in these populations suggest the presence of maladaptive schemas and therefore a possible target for future successful psychological intervention. To investigate the presence of early maladaptive schemas (EMS) in patients with psoriasis and eczema and to explore their links with psychological distress. A sample of 185 adults (psoriasis n = 55, atopic eczema n = 54, chronic disease control n = 23, normal control n = 53) completed validated, self-administered questionnaires. Differences were found between dermatology patients and control groups. Patients with psoriasis differed on seven EMS from the normal control group: emotional deprivation (P = 0·011), social isolation (P < 0·001), defectiveness (P < 0·001), failure (P < 0·001), vulnerability to harm (P < 0·001), subjugation (P = 0·009) and emotional inhibition (P = 0·002). They differed from the chronic disease group on vulnerability to harm (P = 0·002) only. Patients with eczema differed from the normal control group on eight EMS: emotional deprivation (P < 0·001), social isolation (P < 0·001), defectiveness (P < 0·001), failure (P < 0·001), dependence (P = 0·010), vulnerability to harm (P = 0·002), subjugation (P = 0·006) and insufficient self-control (P = 0·010). EMS were strongly positively related to psychological distress experienced by dermatology patients. Hierarchical regressions demonstrated two schemas, vulnerability to harm (P < 0·001) and defectiveness (P = 0·029), to be predictive of anxiety, and social isolation (P = 0·012) and vulnerability to harm (P = 0·018) to be predictive of depression, irrespective of age and years of coping for dermatology patients. The findings have important theoretical and clinical implications for psychological management of patients with psoriasis and eczema. Treatment protocols may benefit by targeting schemas. Further studies are needed to investigate the benefits of schema-focused therapy in patients with skin disease. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

[Contact eczema in patients with leg ulcers].

PubMed

Degreef, H; Dooms-Goossens, A; Gladys, K

1986-01-01

Patients with leg ulcers or varicose eczema suffer much more often from contact eczema due to the local application of pharmaceutical preparations than patients suffering from other dermatological problems (even those of eczematous origin). This contact allergy may concern not only the active ingredient but also the excipient, the preservative, or even the perfume. In all cases of leg ulcers, of varicose eczema, but also of badly healed ulcers, epicutaneous tests should be carried out with all the components of the pharmaceutical preparations concerned. Moreover, the pharmaceutical industry really must perfect non-allergenic preparations.

Nurse-led clinics reduce severity of childhood atopic eczema: a review of the literature.

PubMed

Moore, E; Williams, A; Manias, E; Varigos, G

2006-12-01

The increasing prevalence and impact of atopic eczema in children in Western countries such as Australia substantiate the need to evaluate the current management of this illness. It has been well documented that the most important aspects in the management of atopic eczema are to allow adequate time for education and demonstration of treatments. However, current models of healthcare funding restrict the opportunity for patient education during medical consultation times. The contribution of nursing to patient care through nurse-led clinics has significant potential in the management of many common chronic illnesses, although atopic eczema has received minimal attention by researchers to date. To discuss the current clinical management of atopic eczema, and to identify the evidence surrounding the benefits of nurse-led clinics in managing patients with chronic illnesses. Systematic searches were undertaken using the Cochrane Library, MedLine, PUBMed and CINAHL from 1995 to 2005. Manual searches of references of retrieved articles identified two additional key studies from 1990 and 1993 which were also included in the review. In total, 22 relevant publications were identified. These included both primary research and descriptive studies that covered the medical management of eczema, patient education and improved patient outcomes. The evidence emerging from the literature indicates that the current management of eczema through doctor-led clinics could be improved, with doctors often lacking the time to offer sufficient patient education to manage chronic illnesses effectively. The literature supports the efficacy of nurse-led clinics in the management of chronic illnesses. The benefits of nurse-led clinics include increased patient satisfaction, longer consultations resulting in improved patient education and similar health outcomes when compared with care from a doctor. No studies were identified comparing nurse-led and doctor-led clinics in the management of eczema. The most effective way to manage atopic eczema is to provide adequate time for education and demonstration of treatments, which the literature suggests can be achieved through nurse-led clinics. The literature review supports an investigation researching the outcomes of a nurse-led clinic on reducing the severity of eczema in children.

Association between childhood eczema and headaches: An analysis of 19 US population-based studies

PubMed Central

Silverberg, Jonathan I.

2016-01-01

Background Atopic dermatitis (or eczema) is a chronic inflammatory disorder associated with sleep disturbances and quality-of-life impairment. Sleep disturbances have been shown to cause headaches in childhood. However, an association between eczema and headaches is not well established. Objectives We sought to determine whether childhood eczema is associated with increased headaches and whether such association is related to fatigue or sleep disturbance. Methods We analyzed data from 401,002 children and adolescents in 19 US population-based cross-sectional studies from the National Survey of Children’s Health 2003/2004 and 2007/2008 and the National Health Interview Survey 1997–2013. Results In multivariate models controlling for age, sex, race/ethnicity, household income, highest level of education in the family, insurance coverage, number of persons in the household, birthplace in the United States, ever history of asthma, hay fever, and food allergy, eczema was found to be associated with headaches in 14 of 19 studies. In a pooled analysis of all 19 studies, children with eczema compared with those without eczema had a significantly higher prevalence (10.7% [95% CI, 10.3% to 11.0%] vs 5.4% [95% CI, 5.3% to 5.5%]) and odds (1.52 [95% CI, 1.45–1.59]) of headaches. Mild (1.79 [95% CI, 1.07–2.98]) and severe (2.72 [95% CI, 1.33–5.57]) eczema were associated with significantly higher odds of headaches. In particular, eczema associated with atopy, fatigue, excessive daytime sleepiness, insomnia, and only 0 to 3 nights of sufficient sleep had even higher odds of headache than eczema alone. Conclusions Eczema is associated with increased headaches in childhood, particularly in patients with severe disease accompanied by atopy, fatigue, and sleep disturbances. PMID:26329510

Upregulated expression of substance P (SP) and NK1R in eczema and SP-induced mast cell accumulation.

PubMed

Zhan, Mengmeng; Zheng, Wenjiao; Jiang, Qijun; Zhao, Zuotao; Wang, Zhiyun; Wang, Junling; Zhang, Huiyun; He, Shaoheng

2017-08-01

Substance P (SP) was reported to be associated with eczema and acts as a potent skin mast cell secretagogue. However, little is known of its expression in inflammatory cells in eczema and its ability in induction of mast cell accumulation. In the present study, we investigated expression of SP and neurokinin-1 receptor (NK1R) on peripheral blood leukocytes and mast cells from patients with eczema and influence of SP on mast cell accumulation by using flow cytometry analysis, trans-epithelial cell migration assay and mouse peritoneal model. The results showed that plasma SP and IL-17A levels in eczema patients were higher than that in healthy control subject. The percentages of SP+ and NK1R+ expression populations of monocytes, helper T cells, natural killer T cells and basophils in peripheral blood of eczema patients were markedly elevated. It was observed that not only absolute number of mast cells but also SP+ and NK1R+ mast cells are enhanced in the lesion skin of eczema. SP showed a potent chemoattractant action on mast cells as assessed by a mouse peritoneal model and a trans-endothelium cell migration assay. SP-induced mast cell accumulation appears a CD18/CD11a complex, L-selectin and ICAM-1-dependent event which can be blocked by a NK-1R antagonist RP67580. In conclusion, elevated expression of SP in patients with eczema and the ability of SP in induction of mast cell accumulation indicate strongly that SP is a potent proinflammatory mediator, which contributes to the pathogenesis of eczema. Inhibitors of SP and blockers of NK1R are likely useful agents for treatment of eczema.

[Type IV contact allergies in the food processing industry: an update].

PubMed

Bauer, A; Schubert, S; Geier, J; Mahler, V

2018-06-01

The food sector is one of the high-risk areas for occupational irritative and allergic contact eczema. The present work provides an overview of the main allergens as well as sensitization frequencies and risk in various food industry occupations. The literature on type IV sensitization in the food sector is summarized. The relative risk of developing a work-related eczema in food processing is increased by more than 3 times. The comparison group was calculated on the basis of the proportion of documented cases in the IVDK (Informationsverbund Dermatologischer Kliniken) network per 100,000 working persons in relation to the average of the years 2005 and 2010. For this purpose, the average risk of all patients was set as reference to 1. Bakers, pastry chefs, cooks and meat and fish processors are mainly affected. In addition to irritant contact eczema, allergic contact eczema and protein contact dermatitis often occur. Leading haptens (main allergens) are rubber ingredients, but also disinfectants and compositae. Only a few contact allergens are responsible for the majority of job-relevant sensitizations in the food industry.

Cost-effectiveness of oral alitretinoin in patients with severe chronic hand eczema - a long-term analysis from a Swiss perspective

PubMed Central

2010-01-01

Background The impact on patients suffering from chronic hand eczema (CHE) is enormous, as no licensed systemic treatment option with proven efficacy for CHE is available. Alitretinoin is a novel agent which showed high clinical efficacy in patients with severe, refractory CHE. We assessed the cost-effectiveness of alitretinoin for CHE patient treatment from a Swiss third party payer perspective. A further objective of this study was to determine the burden of disease in Switzerland. Methods A long-term Markov cohort simulation model was used to estimate direct medical costs (€) and clinical effectiveness (quality adjusted life years, QALYs) of treating severe CHE patients with alitretinoin. Comparison was against the standard treatment of supportive care (optimised emollient therapy). Information on response rates were derived from a randomized controlled clinical trial. Costs were considered from the perspective of the Swiss health system. Swiss epidemiological data was derived from official Swiss Statistic institutions. Results Annual costs of alitretinoin treatment accounted for €2'212. After a time horizon of 22.4 years, average remaining long-term costs accounted for €42'208 or €38'795 in the alitretinoin and the standard treatment arm, respectively. Compared with the standard therapy, the addition of alitretinoin yielded an average gain of 0.230 QALYs at the end of the simulation. Accordingly, the incremental cost-effectiveness ratio resulted in €14'816/QALY gained. These results were robust to changes in key model assumptions. Conclusion The therapy for CHE patients is currently insufficient. In our long-term model we identified the treatment with alitretinoin as a cost-effective alternative for the therapy of CHE patients in Switzerland. PMID:20579358

Ear piercing, and nickel and cobalt sensitization, in 520 young Swedish men doing compulsory military service.

PubMed

Meijer, C; Bredberg, M; Fischer, T; Widström, L

1995-03-01

Piercing the earlobes has increased in popularity among males in recent years. This habit would be expected to increase the incidence of nickel and cobalt sensitization. Patch testing with nickel sulfate and cobalt chloride was performed in 520 young Swedish men doing compulsory military service. The overall frequency of nickel/cobalt positive tests was 4.2%. The prevalence of nickel/cobalt positive tests was significantly higher (p < 0.05) in 152 men with pierced earlobes (7.9%) than in those 368 with unpierced earlobes (2.7%). A history of hand eczema (7/152 = 4.6%) or other types of eczema (22/152 = 14.5%) in individuals with pierced earlobes was no more common than in those with unpierced earlobes: 24/368 = 6.5% and 51/386 = 13.9%, respectively (n.s.). Hand eczema was no more common in sensitized (1/22 = 4.5%) than in nonsensitized individuals (32/498 = 6.4%) (n.s.).

Measurement properties of adult quality-of-life measurement instruments for eczema: protocol for a systematic review.

PubMed

Apfelbacher, Christian J; Heinl, Daniel; Prinsen, Cecilia A C; Deckert, Stefanie; Chalmers, Joanne; Ofenloch, Robert; Humphreys, Rosemary; Sach, Tracey; Chamlin, Sarah; Schmitt, Jochen

2015-04-16

Eczema is a common chronic or chronically relapsing skin disease that has a substantial impact on quality of life (QoL). By means of a consensus-based process, the Harmonising Outcome Measures in Eczema (HOME) initiative has identified QoL as one of the four core outcome domains to be assessed in all eczema trials (Allergy 67(9):1111-7, 2012). Various measurement instruments exist to measure QoL in adults with eczema, but there is a great variability in both content and quality (for example, reliability and validity) of the instruments used, and it is not always clear if the best instrument is being used. Therefore, the aim of the proposed research is a comprehensive systematic assessment of the measurement properties of the existing measurement instruments that were developed and/or validated for the measurement of patient-reported QoL in adults with eczema. This study is a systematic review of the measurement properties of patient-reported measures of QoL developed and/or validated for adults with eczema. Medline via PubMed and EMBASE will be searched using a selection of relevant search terms. Eligible studies will be primary empirical studies evaluating, describing, or comparing measurement properties of QoL instruments for adult patients with eczema. Eligibility assessment and data abstraction will be performed independently by two reviewers. Evidence tables will be generated for study characteristics, instrument characteristics, measurement properties, and interpretability. The quality of the measurement properties will be assessed using predefined criteria. Methodological quality of studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best evidence synthesis will be undertaken if more than one study has investigated a particular measurement property. The proposed systematic review will produce a comprehensive assessment of measurement properties of existing QoL instruments in adult patients with eczema. We aim to identify one best currently available instrument to measure QoL in eczema patients. PROSPERO CRD42015017138.

Predicting eczema severity beyond childhood.

PubMed

Hon, Kam Lun; Tsang, Yin-Ching K; Poon, Terence Chuen W; Pong, Nga Hin; Kwan, Matthew; Lau, Shirley; Chiu, Yuen-Chun; Wong, Hin-Hei; Leung, Ting-Fan

2016-02-01

We evaluated factors associated with eczema severity in adolescence. Nottingham Eczema Severity Score (NESS), family and personal history of atopy, skin prick test for common food and aeroallergens, highest serum IgE level and eosinophil count were evaluated. Patients with paired NESSs (childhood-NESS is NESS performed at <10 years of age; adolescence-NESS is NESS performed at age >10 years) were further analyzed. Adolescence-NESS (n=383 patients) was associated with eczema onset in infancy, dust mite and food allergen sensitization, dietary avoidance, use of wet wrap, traditional Chinese medicine, immunomodulant (azathioprine or cyclosporine), high IgE level, eosinophil count, but not with family/personal history of atopy. Eighty-two patients had both childhood-NESS and adolescence-NESS (mean follow-up of 6.8 years) showing that adolescence-NESS was associated with childhood- NESS severity grades (P=0.034). Of these patients, 48% remained in the same severity grades, whereas 39% improved, and 13% deteriorated from childhood to adolescence. It is not possible to assure parents that their child can outgrow eczema. In eczema prognosis research, long-term follow-up is warranted.

Pizza makers' contact dermatitis.

PubMed

Lembo, Serena; Lembo, Claudio; Patruno, Cataldo; Balato, Anna; Balato, Nicola; Ayala, Fabio

2014-01-01

Contact eczema to foods, spices, and food additives can occur in occupational and nonoccupational settings in those who grow, handle, prepare, or cook food. Pizza is one of the most eaten foods in every continent, and pizza making is a common work in many countries. We aimed to evaluate the occurrence and the causes of contact dermatitis in pizza makers in Naples. We performed an observational study in 45 pizza makers: all the enrolled subjects had to answer a questionnaire designed to detect personal history of respiratory or cutaneous allergy, atopy; work characteristics and timing were also investigated. Every subject attended the dermatology clinic for a complete skin examination, and when needed, patients were patch tested using the Italian baseline series of haptens integrated with an arbitrary pizza makers series. Our results reported that 13.3% of the enrolled pizza makers (6/45) presented hand eczema, and that 8.9% (4/45) were affected by occupational allergic contact dermatitis. Diallyl disulfide and ammonium persulfate were the responsible substances. Performing patch tests in pizza makers and food handlers affected by hand contact dermatitis is useful. We propose a specific series of haptens for this wide working category.

Face-masks for facial atopic eczema: consider a hydrocolloid dressing.

PubMed

Rademaker, Marius

2013-08-01

Facial involvement of atopic eczema in young children can be difficult to manage. Chronic scratching and rubbing, combined with parental reluctance to use topical corticosteroids on the face, often results in recalcitrant facial eczema. While wet wraps are a useful management option for moderate/severe atopic eczema involving the trunk and limbs they are difficult to use on the face. We describe the use of a face-mask using a widely available adhesive hydrocolloid dressing (DuoDerm extra thin) in three children with recalcitrant facial atopic eczema. Symptomatic control of itch or soreness was obtained within hours and the facial atopic eczema was markedly improved by 7 days. The face-masks were easy to apply, each lasting 1-4 days. One patient had a single adjuvant application of a potent topical corticosteroid under the hydrocolloid dressing. All three patients had long remissions (greater than 3 months) of their facial eczema, although all continued to have significant eczema involving their trunk and limbs. Face-masks made from hydrocolloid dressings, with or without topical corticosteroids, are worth considering in children with recalcitrant facial eczema. © 2012 The Author. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.

Enhanced Expression of IL-18 and IL-18BP in Plasma of Patients with Eczema: Altered Expression of IL-18BP and IL-18 Receptor on Mast Cells.

PubMed

Hu, Yalin; Wang, Junling; Zhang, Huiyun; Xie, Hua; Song, Weiwei; Jiang, Qijun; Zhao, Nan; He, Shaoheng

2017-01-01

IL-18 has been found to be associated with eczema. However, little is known of the role of IL-18 binding protein (BP) and IL-18 receptor (R) in eczema. We therefore investigated the expression of IL-18, IL-18BP, and IL-18R on mast cells by using flow cytometry analysis and mouse eczema model. The results showed that plasma free IL-18 and free IL-18BP levels in eczema patients were higher than those in healthy controls. IL-18 provoked up to 3.1-fold increase in skin mast cells. IL-18 induced also an increase in IL-18BP+ mast cells, but a reduction of IL-18R+ mast cells in mouse eczema skin. It was found that house dust mite allergen Der p1 and egg allergen OVA induced upregulation of the expression of IL-18, IL-18BP, and IL-18R mRNAs in HMC-1 cells following 2 and 16 h incubation. In conclusion, correlation of IL-18 and IL-18BP in eczema plasma suggests an important balance between IL-18 and IL-18BP in eczema. The decrease in molar concentration ratio of plasma IL-18BP/IL-18 and allergen-induced upregulated expression of IL-18 and IL-18R in skin mast cells of the patients with eczema suggests that anti-IL-18 including IL-18BP therapy may be useful for the treatment of eczema.

Enhanced Expression of IL-18 and IL-18BP in Plasma of Patients with Eczema: Altered Expression of IL-18BP and IL-18 Receptor on Mast Cells

PubMed Central

2017-01-01

IL-18 has been found to be associated with eczema. However, little is known of the role of IL-18 binding protein (BP) and IL-18 receptor (R) in eczema. We therefore investigated the expression of IL-18, IL-18BP, and IL-18R on mast cells by using flow cytometry analysis and mouse eczema model. The results showed that plasma free IL-18 and free IL-18BP levels in eczema patients were higher than those in healthy controls. IL-18 provoked up to 3.1-fold increase in skin mast cells. IL-18 induced also an increase in IL-18BP+ mast cells, but a reduction of IL-18R+ mast cells in mouse eczema skin. It was found that house dust mite allergen Der p1 and egg allergen OVA induced upregulation of the expression of IL-18, IL-18BP, and IL-18R mRNAs in HMC-1 cells following 2 and 16 h incubation. In conclusion, correlation of IL-18 and IL-18BP in eczema plasma suggests an important balance between IL-18 and IL-18BP in eczema. The decrease in molar concentration ratio of plasma IL-18BP/IL-18 and allergen-induced upregulated expression of IL-18 and IL-18R in skin mast cells of the patients with eczema suggests that anti-IL-18 including IL-18BP therapy may be useful for the treatment of eczema. PMID:28839348

[Symptoms of anxiety and depression in atopic eczema/dermatitis syndrome].

PubMed

Brzoza, Zenon; Badura-Brzoza, Karina; Nowakowski, Marek; Matysiakiewicz, Jerzy; Rogala, Barbara; Hese, Robert T

2005-01-01

The presence of chronic disease is a risk factor for the development of mood disturbances and panic disorders. They can influence the course of disease and effectiveness of therapy. Depression may be the cause of making light doctor's advice. Anxious patients often aggravate symptoms of the disease. To study symptoms of anxiety and depression in patients suffering from atopic eczema/dermatitis syndrome (ZAZS). Material. We studied 38 patients suffering from adequately controlled moderate ZAZS and 62 volunteers in the control group. Mental status of subjects was assessed by means of State and Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) questionnaires. ZAZS patients demonstrated higher intensity of anxiety (as a trait and as a state) than healthy subjects. Intensity and prevalence of depression in the atopic eczema/ dermatitis syndrome group was higher than in the control group. Patients suffering from atopic/eczema dermatitis syndrome are pre-disposed to anxiety and depression manifestation. Even adequately controlled symptoms of atopic/eczema dermatitis syndrome may be the cause of those disturbances' occurrence.

Skin prick testing in atopic eczema: atopic to what and at what age?

PubMed

Hon, Kam Lun; Wang, Shuxin Susan; Wong, Wing Lam; Poon, Wing Kwan; Mak, Ka Yi; Leung, Ting Fan

2012-05-01

Atopic eczema is a common and distressing disease. This study aimed to review the age-dependent pattern of atopic sensitization to food and aeroallergens in patients with eczema by skin prick testing. The results of skin prick test (SPT), serum IgE, bronchial challenge test, and family history of atopy in eczema patients seen at a pediatric dermatology clinic were reviewed. SPT results were available in 816 eczema patients. In these patients, 90% had atopic sensitization to at least one aeroallergen, 69% to at least one food allergen, and 94% to at least one allergen by SPT. Together with a family history of atopy in parents or siblings and a personal history of airway atopies, 97% and 99.8% of the patients were atopic, respectively. Bronchial hyper-reactivity (BHR) was demonstrated in 44% of 339 patients. Aeroallergen was more prevalent than food allergen sensitization among children older than 10 years. The mites (D. pteronysissnus, D. farinae and Blomia Tropicalis) were the most prevalent allergens regardless of age and BHR, but D. pteronysissnus and D. farinae sensitization were more prevalent among BHR-positive patients. Beef is the least sensitized food protein in all ages. The majority of patients with eczema are atopic to aeroallergens. The mites (D. pteronysissnus, D. farinae and Blomia Tropicalis) are the most prevalent allergens regardless of age and BHR.

Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients' experiences and perceptions.

PubMed

Magin, Parker J; Adams, Jon; Heading, Gaynor S; Pond, Dimity C; Smith, Wayne

2006-06-01

The aim of this study was to explore the use of complementary and alternative medicine (CAM) therapies in patients with acne, psoriasis, or atopic eczema and the attitudes about CAM of these patients. This was a qualitative study, utilizing semistructured interviews and thematic analysis. Patients were recruited from the practices of dermatologists and general practitioners in a noncapital Australian city. Twenty-six (26) interviews were conducted with patients with acne, 29 with psoriasis, and 7 with atopic eczema. Use of CAM therapies was common. Participants tended to value CAM over orthodox therapies because of their preference for natural approaches to their skin diseases and the perceived lesser potential for adverse effects of CAM therapies. Respondents with acne were more confident about the efficacy of CAM than were those with psoriasis or eczema. The resulting sense of control attenuated psychologic sequelae of acne. This was not apparent in psoriasis or eczema. Practitioners should be cognizant of the likely use of CAM and its implications (including the potential for attenuation of psychologic morbidity) in their patients who have skin diseases.

A clinical trial for evaluation of leech application in the management of Vicarcikā (Eczema)

PubMed Central

Shankar, K.M. Pratap; Rao, S. Dattatreya; Umar, Shaik Nafeez; Gopalakrishnaiah, V.

2014-01-01

Background: Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. Eczema is such a skin ailment which cause psychological, social and financial burden on the patient and their families. Management of eczema with antibiotics, antihistamines, steroids etc., are available but even after their use relapses, recurrences and other complications are very common. Aim: The aim of this study was to assess the efficacy of leech application in the management of vicarcikā (Eczema) with standard clinical parameters viz. Eczema Area and Severity Index (EASI) score, SCORing of Atopic Dermatitis (SCORAD) Index and Dermatology Life Quality Index (DLQI). Materials and Methods: An open labeled clinical trial study without control group was conducted with 27 patients having the classical symptoms of vicarcikā (Eczema), selected as per the inclusion and exclusion criteria from outpatient department and inpatient department sections of Shalya Department, S.V. Ayurvedic Hospital, Tirupati. Minimum four sittings of leech application were carried out with 7 days interval. Pre- and post-treatment evaluation of the patient was done with Eczema Area and Severity Index (EASI) score, SCORing of Atopic Dermatitis (SCORAD) Index and Dermatology Life Quality Index (DLQI). Statistical Analysis: Analysis of the data was done with Student's paired t-test. Results: The total EASI score showed considerable reduction up to 54.45% (P < 0.01) and the SCORAD Index significantly reduced by 55% (P < 0.01). The life quality of the patient calculated by DLQI improved significantly by 62.36% (P < 0.01). Conclusion: Leech application gives significant relief for the symptoms of eczema. The life quality of the patient also improved significantly after leech therapy. No adverse reactions were reported during the entire course of study. PMID:25593404

Steroid fears in children with eczema.

PubMed

Hon, Kam-Lun Ellis; Kam, Wai-Yan Christy; Leung, Ting-Fan; Lam, Man-Ching Adrian; Wong, Kin-Yee; Lee, Kwing-Chin Kenneth; Luk, Nai-Ming Tommy; Fok, Tai-Fai; Ng, Pak-Cheung

2006-11-01

Topical glucocorticoids (GCs) are the mainstay of treatment for eczema, but GC phobia and fears are very common among the parents of paediatric patients. To survey the nature and extent of "fears" of GC use, and to evaluate if disease severity is associated with such fears. Patients with eczema managed in the paediatric dermatology outpatient clinic of a university hospital were recruited in this survey. Disease severity and various aspects of belief and practices of GC use were assessed with the Nottingham Eczema Severity Score and a questionnaire. GC "fears" were present in two fifths of informants with non-eczematous skin disease and mild eczema, but three fifths in moderate-to-severe disease. Requests for steroid-sparing medications (such as tacrolimus or pimecrolimus) had been made in nearly 50% of cases with moderate-to-severe eczema, and many parents would wait until eczema had worsened or apply GC only as a last resort to avoid potential side effects. "Fears" were predominantly interpersonal and rarely iatrogenic in nature. Skin problems (in particular skin thinning) and adverse effects on growth were the side effects of GC of most concern. However, fewer than half of the informants had discussed their concerns with doctors. Our results suggest the importance of understanding the nature and extent to which GC fears, regardless of eczema severity, are prevalent so that sound advice can be offered in a timely manner to parents and patients.

Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy.

PubMed

Kimata, Hajime

2006-07-01

Allergic responses are enhanced by stress, whereas they are reduced by laughter in atopic eczema patients. Emotion with tears decreases plasma IL-6 levels in patients with rheumatoid arthritis. Thus, the effect of emotion with tears on allergic responses in patients with atopic eczema was studied. Sixty patients with atopic eczema having latex allergy viewed both the weather information video and the heart-warming movie, Kramer vs. Kramer. Just before and immediately after viewing each video, allergic responses to latex were measured. Viewing the weather information video did not cause emotion with tears in any patients, and it failed to modulate allergic responses. In contrast, viewing Kramer vs. Kramer caused emotion with tears in 44 of 60 patients, and it reduced allergic skin wheal responses to latex and latex-specific IgE production in them. Emotion with tears reduced allergic responses, and it may be useful in the treatment of allergic diseases.

Association between childhood eczema and headaches: An analysis of 19 US population-based studies.

PubMed

Silverberg, Jonathan I

2016-02-01

Atopic dermatitis (or eczema) is a chronic inflammatory disorder associated with sleep disturbances and quality-of-life impairment. Sleep disturbances have been shown to cause headaches in childhood. However, an association between eczema and headaches is not well established. We sought to determine whether childhood eczema is associated with increased headaches and whether such association is related to fatigue or sleep disturbance. We analyzed data from 401,002 children and adolescents in 19 US population-based cross-sectional studies from the National Survey of Children's Health 2003/2004 and 2007/2008 and the National Health Interview Survey 1997-2013. In multivariate models controlling for age, sex, race/ethnicity, household income, highest level of education in the family, insurance coverage, number of persons in the household, birthplace in the United States, ever history of asthma, hay fever, and food allergy, eczema was found to be associated with headaches in 14 of 19 studies. In a pooled analysis of all 19 studies, children with eczema compared with those without eczema had a significantly higher prevalence (10.7% [95% CI, 10.3% to 11.0%] vs 5.4% [95% CI, 5.3% to 5.5%]) and odds (1.52 [95% CI, 1.45-1.59]) of headaches. Mild (1.79 [95% CI, 1.07-2.98]) and severe (2.72 [95% CI, 1.33-5.57]) eczema were associated with significantly higher odds of headaches. In particular, eczema associated with atopy, fatigue, excessive daytime sleepiness, insomnia, and only 0 to 3 nights of sufficient sleep had even higher odds of headache than eczema alone. Eczema is associated with increased headaches in childhood, particularly in patients with severe disease accompanied by atopy, fatigue, and sleep disturbances. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Flexural eczema versus atopic dermatitis.

PubMed

Jacob, Sharon E; Goldenberg, Alina; Nedorost, Susan; Thyssen, Jacob P; Fonacier, Luz; Spiewak, Radoslaw

2015-01-01

Flexural eczema and atopic dermatitis are frequently synonymized. As respiratory atopy is rarely tested for and found in these patients, systematically equating a flexural distribution of dermatitis with atopic dermatitis may too frequently result in misclassified diagnoses and potentially missed opportunity for intervention toward improving patients' symptoms and quality of life. We present a critical review of the available evidence for the atopic dermatitis diagnosis and discuss the similarities between atopic dermatitis and allergic contact dermatitis. Because neither flexural predilection nor atopy is specific for atopic dermatitis, we conclude that the term atopic dermatitis is a misnomer and propose an etymologic reclassification of atopic dermatitis to "atopy-related" dermatitis. Allergic contact dermatitis can induce an atopic dermatitis-like phenotype, and thus, flexural dermatitis cannot be assumed as atopic without further testing. Patch testing should at least be considered in cases of chronic or recurrent eczema regardless of the working diagnosis.

Inappropriate amounts of topical tacrolimus applied on Korean patients with eczema.

PubMed

Jin, Hyunju; Kim, Jeong-Min; Kim, Gun-Wook; Kim, Hoon-Soo; Ko, Hyun-Chang; Kim, Moon-Bum; Kim, Byung-Soo

2017-06-01

The limited efficacy of topical tacrolimus may result from insufficient frequency of application or amount applied in eczema patients. To investigate the frequency of application and amount of use of topical tacrolimus in patients with various types of eczema. The frequency of application and the applied amount of topical tacrolimus were assessed over two weeks. A total of 200 eczema patients completed this study. The average number of applications per day was 1.75 ± 0.53, despite instructions to apply the topical tacrolimus twice daily. With respect to the frequency of application, 147 (73.5%) and 122 (61.0%) of patients followed the prescription in the first and second weeks, respectively. The average amount applied per 2% of total body surface area (TBSA) was 0.54 ± 0.52 g. Only 53 (26.5%) patients applied between 80 and 120% of expected amount of topical tacrolimus. The frequency of application was self-reported, possibly resulting in limited accuracy. Korean patients with eczema tend to apply topical tacrolimus less frequently and in inappropriate amounts. Clear instructions regarding both the frequency and amount of application are needed to improve the therapeutic outcome with treatment with topical tacrolimus.

Serum Vitamin D levels and Vitamin D supplementation do not correlate with the severity of chronic eczema in children.

PubMed

Galli, E; Rocchi, L; Carello, R; Giampietro, P G; Panei, P; Meglio, P

2015-03-01

Eczema is one of the most common chronic inflammatory skin diseases, affecting about 20% of children. The pathogenic mechanisms of eczema are still not fully understood, and current treatment of moderate-severe eczema is often difficult. Recently, it has been suggested that Vitamin D plays a key role in this disease, even if mechanisms are only partially known. The purpose of our study was to assess the 25-Hydroxyvitamin D serum levels in a pediatric population suffering from chronic eczema (IgE-mediated and non-IgE-mediated), and to correlate these phenotypes with the SCORAD severity and selected clinical and biological parameters. Moreover, we aimed to evaluate whether a supplementation of Vitamin D3 could affect the same clinical and laboratory parameters. 89 children with chronic eczema were enrolled in the study. Severity of eczema was assessed with the SCORAD index. Past and present history was taken, and patients were divided into two groups according to the state of sensitization. According to a randomization schedule, the enrolled children were assigned to the following groups: supplementation group, which received a daily oral Vitamin D3 supplementation (2000 IUs) for 3 months; control group which received no supplementation. Vitamin D concentrations in patients with moderate and severe eczema were not statistically different from Vitamin D concentration detected in the serum of patients with mild eczema. Furthermore, we did not find any correlation between Vitamin D levels, total IgEs and SCORAD index, both in the Sensitized and in the Not-Sensitized group. The Vitamin D3 supplementation did not influence the SCORAD severity or the total IgEs concentration. To our knowledge, our study is the first one that shows no correlation between serum levels of Vitamin D, eczema severity and IgE sensitization in a pediatric population suffering from chronic eczema.

A novel molecular disease classifier for psoriasis and eczema.

PubMed

Garzorz-Stark, Natalie; Krause, Linda; Lauffer, Felix; Atenhan, Anne; Thomas, Jenny; Stark, Sebastian P; Franz, Regina; Weidinger, Stephan; Balato, Anna; Mueller, Nikola S; Theis, Fabian J; Ring, Johannes; Schmidt-Weber, Carsten B; Biedermann, Tilo; Eyerich, Stefanie; Eyerich, Kilian

2016-10-01

Novel specific therapies for psoriasis and eczema have been developed, and they mark a new era in the treatment of these complex inflammatory skin diseases. However, within their broad clinical spectrum, psoriasis and eczema phenotypes overlap making an accurate diagnosis impossible in special cases, not to speak about predicting the clinical outcome of an individual patient. Here, we present a novel robust molecular classifier (MC) consisting of NOS2 and CCL27 gene that diagnosed psoriasis and eczema with a sensitivity and specificity of >95% in a cohort of 129 patients suffering from (i) classical forms; (ii) subtypes; and (iii) clinically and histologically indistinct variants of psoriasis and eczema. NOS2 and CCL27 correlated with clinical and histological hallmarks of psoriasis and eczema in a mutually antagonistic way, thus highlighting their biological relevance. In line with this, the MC could be transferred to the level of immunofluorescence stainings for iNOS and CCL27 protein on paraffin-embedded sections, where patients were diagnosed with sensitivity and specificity >88%. Our MC proved superiority over current gold standard methods to distinguish psoriasis and eczema and may therefore build the basis for molecular diagnosis of chronic inflammatory skin diseases required to establish personalized medicine in the field. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelae: results of a qualitative study.

PubMed

Magin, Parker; Adams, Jon; Heading, Gaynor; Pond, Dimity; Smith, Wayne

2008-09-01

Acne, psoriasis and atopic eczema are common diseases and have been consistently associated with adverse psychological sequelae including stigmatization. Being teased on the basis of appearance has been associated with psychiatric morbidity in children and adolescents. The objective of this qualitative study was to explore the experiences of teasing and bullying in patients with acne, psoriasis and eczema, and the role of appearance-related teasing and bullying as mediators of psychological morbidity in these patients. Data collection consisted of 62 in-depth semi-structured interviews with patients with acne, psoriasis or atopic eczema recruited from both specialist dermatology and general practices. Data analysis was cumulative and concurrent throughout the data collection period reflecting a grounded theory approach. Analysis followed the analytic induction method, allowing themes to emerge from the data. Teasing, taunting or bullying was a considerable problem for a significant minority of acne, psoriasis and atopic eczema participants. Themes that emerged were the universally negative nature of the teasing, the use of teasing as an instrument of social exclusion, and as a means of establishing or enforcing power relationships, teasing related to contagion and fear, the emotional and psychological sequelae of teasing and the theme of 'insensate' teasing. For those who had suffered teasing or bullying, this was causally linked in respondents' accounts with psychological sequelae, especially self-consciousness and effects on self-image and self-esteem. Experiences of teasing and bullying were found to have principally occurred during the adolescence of participants and the perpetrators were other adolescents, but there were findings of respondents with psoriasis also having been subjected to ridicule or derogatory remarks by health professionals. Teasing, taunting and bullying may represent an underappreciated source of psychological morbidity in children and adolescents with these common skin diseases.

Particular characteristics of atopic eczema in tropical environments. The Tropical Environment Control for Chronic Eczema and Molecular Assessment (TECCEMA) cohort study*

PubMed Central

Sánchez, Jorge; Sánchez, Andrés; Cardona, Ricardo

2017-01-01

Background Atopic dermatitis is a prevalent health problem in the world. Allergic sensitization is an important risk factor, but the roles of other factors, inherent in tropic region, are unknown. Objective A cohort study was designed in a tropical city to investigate molecular and environmental risk factors for eczema, considering as particular features perennial exposure to mites, poor living conditions and others tropical characteristics. Methods 433 patients were included at baseline and biological samples were collected during 24 months of follow-up. Clinical information was collected using questionnaires (SCORAD, DLQI and a subjective scale) during each clinical assessment. Results The prevalence of atopic eczema was 93%, with similar frequency between children and adults; parents history of eczema and polysensitization to mites, dogs, cats, cockroaches and birds, were risk factors for severe and persistent eczema and allergic comorbidities. Food sensitization was present in 16% of patients but food-induced allergies were scarce. Psychiatric, dental and ocular disorders were the most frequent non-allergic comorbidities. Study limitations selection bias. Conclusion We presented a tropical cohort of patients with eczema and we identified some risk factors for severe and persistent dermatitis. Some patterns of sensitization were associated with severe eczema and respiratory symptoms, and the natural history of "atopic march" is different to that described in some industrialized countries. The collection of biological samples will contribute to the understanding of the gene/environment interactions leading to allergy inception and evolution. PMID:28538875

Particular characteristics of atopic eczema in tropical environments. The Tropical Environment Control for Chronic Eczema and Molecular Assessment (TECCEMA) cohort study.

PubMed

Sánchez, Jorge; Sánchez, Andrés; Cardona, Ricardo

2017-01-01

Atopic dermatitis is a prevalent health problem in the world. Allergic sensitization is an important risk factor, but the roles of other factors, inherent in tropic region, are unknown. A cohort study was designed in a tropical city to investigate molecular and environmental risk factors for eczema, considering as particular features perennial exposure to mites, poor living conditions and others tropical characteristics. 433 patients were included at baseline and biological samples were collected during 24 months of follow-up. Clinical information was collected using questionnaires (SCORAD, DLQI and a subjective scale) during each clinical assessment. The prevalence of atopic eczema was 93%, with similar frequency between children and adults; parents history of eczema and polysensitization to mites, dogs, cats, cockroaches and birds, were risk factors for severe and persistent eczema and allergic comorbidities. Food sensitization was present in 16% of patients but food-induced allergies were scarce. Psychiatric, dental and ocular disorders were the most frequent non-allergic comorbidities. selection bias. We presented a tropical cohort of patients with eczema and we identified some risk factors for severe and persistent dermatitis. Some patterns of sensitization were associated with severe eczema and respiratory symptoms, and the natural history of "atopic march" is different to that described in some industrialized countries. The collection of biological samples will contribute to the understanding of the gene/environment interactions leading to allergy inception and evolution.

The views of children and young people on the use of silk garments for the treatment of eczema: a nested qualitative study within the CLOTHing for the relief of Eczema Symptoms (CLOTHES) randomized controlled trial.

PubMed

Wake, E V; Batchelor, J; Lawton, S; Thomas, K S; Harrison, E F; Cowdell, F C

2018-01-01

Many children suffer with skin diseases but to date most dermatological research has been done 'on' rather than 'with' children; in this study we actively sought the experiences of children and young people. Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects around 20% of children and can impact on the health and wellbeing of children and their families. The role of specialist clothing in the management of AE is poorly understood. The aim of this study, which was nested in a randomized controlled trial, was to qualitatively examine child participants' experiences of using silk garments for the treatment of AE. Eighteen children aged 5-15 years, who took part in the CLOTHing for the relief of Eczema Symptoms (CLOTHES) trial, participated in age-appropriate individual interviews or focus groups. Thematic analysis generated four themes directly related to the silk garments: (i) expectations of the garments; (ii) wearing the garments; (iii) asking if the garments helped; and (iv) thoughts about the garments. The conclusions from this nested qualitative study are that there was some limited improvement in eczema for some children but that the hoped-for 'miracle cure' did not transpire. A mixed picture of knowledge, beliefs and experiences of using the silk garments emerged. Engaging children in the evaluation of the garments provided first-hand nuanced insights that enhanced understanding of the CLOTHES study as a whole. This nested study demonstrates that children can and indeed want to be engaged in dermatological research in meaningful ways that add to our understanding of treatment options. © 2017 British Association of Dermatologists.

Case-control study of eczema in relation to IL4Rα genetic polymorphisms in Japanese women: The Kyushu Okinawa Maternal and Child Health Study.

PubMed

Miyake, Y; Tanaka, K; Arakawa, M

2013-05-01

Epidemiological research on the relationship between single nucleotide polymorphisms (SNPs) in the IL4Rα gene and eczema is sparse. We investigated the associations between IL4Rα SNPs rs1805011, rs1805015 and rs1801275 and risk of eczema in young adult Japanese women. Included were 188 women who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for eczema. Controls were 635 women without eczema according to the ISAAC criteria who also had not been diagnosed with asthma, atopic eczema and/or allergic rhinitis by a doctor. Adjustment was made for age, region of residence, number of children, smoking and education. Under the additive model, SNP rs1805011 was significantly related to eczema: the adjusted OR was 0.55 (95% CI: 0.31-0.99). SNP rs1805015 was significantly associated with eczema in the additive and dominant models: the adjusted ORs were 0.55 (95% CI: 0.30-0.98) and 0.55 (95% CI: 0.30-0.997), respectively. There was no significant association between SNP rs1801275 and eczema. None of the haplotypes were significantly related to eczema. Significant associations between SNPs rs1805011 and rs1805015 and eczema were reported in women who had never smoked, but not in those who had ever smoked; the multiplicative interactions, however, were not significant. This is the first study to demonstrate significant associations between IL4Rα SNPs rs1805011 and rs1805015 and eczema. We do not find evidence for interactions affecting eczema between IL4Rα SNPs and smoking. © 2013 The Authors. Scandinavian Journal of Immunology © 2013 Blackwell Publishing Ltd.

Paediatric eczema and psychosocial morbidity: how does eczema interact with parents' illness beliefs?

PubMed

Walker, C; Papadopoulos, L; Hussein, M

2007-01-01

Thus far there has been relatively little work on children's illness representations regarding eczema and how these relate to parental conceptualizations of their child's psychosocial health. This is important because the challenge of raising a child with a serious illness can affect many facets of a parent's everyday life and the behaviour of parents can be closely related to the health of the child. Two hundred and thirty-two children with eczema, asthma, eczema and asthma, and healthy controls between 7 and 12 years of age and their parents were recruited. Children were administered the Children's Illness Perception Questionnaire. Questionnaires completed by the parents were The Personality Inventory for Children and The Parental Stress Inventory. Parents of children with eczema did not judge their children to have poorer psychosocial health than controls, but parents of children with eczema could not be distinguished between in terms of whether their child was significantly affected by their eczema or not. This work could have important implications for the quality of life of the child and for the parent-child relationship and these implications are considered.

Occupational allergic contact dermatitis from epoxy resin in a golf club repairman.

PubMed

Isaksson, Marléne; Möller, Halvor; Pontén, Ann

2008-01-01

A golfer presented with facial and hand eczema. He had exacerbations of his hand eczema prior to golf tournaments. Being an authorized golf club repairman, he had been working with a two-part glue containing an epoxy resin (ER) based on diglycidyl ether of bisphenol A (DGEBA) and the hardener diethylenetriamine (DETA) for approximately 4 years before he developed any skin problems. He was patch-tested with the standard, which contains an ER based on DGEBA (DGEBA-R), epoxy (containing DETA), and rubber glove series and had positive reactions to DGEBA-R only. Other work materials (a latex glove, a golf glove made of leather, and part of the handle of his own golf club "as is" and in a methyl tert-butyl ether extract) were tested, with negative results. Allergic contact dermatitis from ER affects the skin by direct contact; the dermatitis is usually localized to the hands and forearms. If the face and eyelids are involved, the dermatitis may be due to exposure to airborne hardeners or reactive diluents, exposure to airborne dust from residual monomers, or ectopic allergic reactions. Our repairman had sandpapered an old glued surface, which may have led to possible airborne dust formation, thus explaining the facial eczema. Therefore, a worker with contact allergy to ER may continue working provided the skin is protected from contamination.

Correlations among steroid fear, acceptability, usage frequency, quality of life and disease severity in childhood eczema.

PubMed

Hon, Kam Lun; Tsang, Yin Ching K; Pong, Nga Hin; Luk, David C K; Lee, Vivian W; Woo, Wing Man; Lam, Chak Yiu Justin; Yeung, Yun Ting Eunice; Chau, Yiu Shing Sunny; Chui, Ka Kam Kenneth; Li, Ka Hin Gabriel; Leung, Ting Fan

2015-10-01

Topical corticosteroids (CSs) are the mainstay of treatment for eczema but CS phobia and fears are prevalent and influence therapeutic efficacy. To quantify if CS acceptability and fear affect patients' quality-of-life (QoL). Patients with eczema managed in the pediatric dermatology outpatient clinic of a university hospital were surveyed. Nottingham Eczema Severity Score (NESS) for severity, Children's Dermatology Life Quality Index (CDLQI) for QoL, CS fear, acceptability and reported frequency of CS use were measured with quantified questions. CS fears were prevalent among parents and caregivers of patients with eczema. Fifty-eight percent of parents reported general acceptability of CS as being very good or good, and many applied CS to their child regularly every week. However, >40% of parents reported CS fear "always" or "often", 41% reported that they "always" or "often" apply CS only when eczema got worse, 57% would discuss CS fear with their doctors, 30% would request CS-sparing medications and 14% "always" or "often" use traditional Chinese herbal medicine. Fears were predominantly interpersonal and less often iatrogenic in nature. Skin problems were the most concerned side effects of CS. CS acceptability, frequency of CS usage, CS fear and usage of alternative medications were independent domains in eczema management: CS fears correlated with CDLQI; CS usage frequency correlated with NESS and negatively with parental education; and CS acceptability correlated with parental education. Ordinal logistic regressions showed worse QoL was associated with more CS fear (odds ratio: 1.092 [95% CI: 1.023-1.165], p = 0.008). The extent of CS fears is independent of CS acceptability, but correlates with patients' QoL. Desensitization of parental CS fears should be integral part of eczema education and therapeutics in order to improve therapeutic efficacy and patients' QoL.

Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'.

PubMed

Kantor, R; Thyssen, J P; Paller, A S; Silverberg, J I

2016-10-01

The lack of standardized nomenclature for atopic dermatitis (AD) creates unnecessary confusion for patients, healthcare providers, and researchers. It also negatively impacts accurate communication of research in the scientific literature. We sought to determine the most commonly used terms for AD. A systematic review of the MEDLINE, EMBASE, and LILACS (1945-2016) for the terms AD, atopic eczema (AE), and multiple other eczematous disorders. In MEDLINE, 33 060 were identified, of which 21 299 (64.4%) publications used the term 'AD', 15 510 (46.9%) 'eczema', and only 2471 (7.5%) AE. Most of these publications used the term AD (82.0%) or eczema (70.8%) without additional nomenclature; only 1.2% used AE alone. Few publications used the terminology 'childhood eczema', 'flexural eczema', 'infantile eczema', 'atopic neurodermatitis', or 'Besnier's prurigo'. AD was rarely used until the late 1970s, after which it became the most commonly used of the three terms and continuously increased until 2015. Atopic eczema decreased between 2008 and 2015. Atopic dermatitis was the most commonly used term in studies across almost all publication types, languages, and journals. Atopic dermatitis is the most commonly used term and appears to be increasing in popularity. Given that eczema is a nonspecific term that describes the morphological appearance of several forms of dermatitis, we strongly suggest the use of a more specific term, AD, in publications, healthcare clinician training, and patient education. Support from researchers, reviewers, and editors is key to success. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)

PubMed Central

Chalmers, JR; Schmitt, J; Apfelbacher, C; Dohil, M; Eichenfield, LF; Simpson, EL; Singh, J; Spuls, P; Thomas, KS; Admani, S; Aoki, V; Ardeleanu, M; Barbarot, S; Berger, T; Bergman, JN; Block, J; Borok, N; Burton, T; Chamlin, SL; Deckert, S; DeKlotz, CC; Graff, LB; Hanifin, JM; Hebert, AA; Humphreys, R; Katoh, N; Kisa, RM; Margolis, DJ; Merhand, S; Minnillo, R; Mizutani, H; Nankervis, H; Ohya, Y; Rodgers, P; Schram, ME; Stalder, JF; Svensson, A; Takaoka, R; Teper, A; Tom, WL; von Kobyletzki, L; Weisshaar, E; Zelt, S; Williams, HC

2014-01-01

Summary This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6–7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure. What's already known about this topic? Many different scales have been used to measure eczema, making it difficult to compare trials in meta-analyses and hampering improvements in clinical practice. HOME core outcome measures must pass the OMERACT (Outcome Measures in Rheumatology) filter of truth (validity), discrimination (sensitivity to change and responsiveness) and feasibility (ease of use, costs, time to perform and interpret). It has been previously agreed as part of the consensus process that four domains should be measured by the core outcomes: clinical signs, patient-reported symptoms, long-term control and health-related quality of life. What does this study add? Progress was made towards developing a core outcome set for measuring eczema in clinical trials. The group established the essential items to be included in the outcome measure for the clinical signs of eczema and was able to recommend a scale for the core set. The remaining three domains of patient-reported symptoms, long-term control and health-related quality of life require further work and meetings to determine the core outcome measures. PMID:24980543

Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: clinical validity, reliability and sensitivity to change of the DLQI. The Cavide Research Group.

PubMed

Badia, X; Mascaró, J M; Lozano, R

1999-10-01

The aim of this study was to assess the feasibility, validity, reliability and sensitivity to change of a Spanish version of the Dermatology Life Quality Index (DLQI) in patients with mild to moderate eczema and psoriasis who were treated with topical corticosteroids. The final study sample comprised 237 patients (48% eczema). Discriminant validity was tested by comparing patients' scores with those of a random sample of the general population (n = 100), and convergent validity by analysing correlations between DLQI scores, measures of clinical severity, and domain scores on the Nottingham Health Profile (NHP). Internal consistency and test-retest reliability were tested in clinically stable patients (n = 94), and responsiveness in a clinically unstable group (n = 143) initiating treatment with topical corticosteroids. Patient scores were significantly higher than general population scores (4.3 vs. 0. 27, P < 0.001). Correlations with NHP domains ranged from 0.12 to 0. 32, and there was significant correlation with clinical measures (r = 0.26, P < 0.001). Reliability was good (Cronbach's alpha = 0.83; intraclass correlation coefficient = 0.88), and the instrument proved responsive to change (effect size for the total group of de novo patients = 0.70), though the great majority of changes occurred in items 1 and 2. The NHP Emotional Reactions and Mobility domains were more responsive than some DLQI domains. In clinical trials of treatments for mild to moderate eczema and psoriasis, it is likely that only items 1 and 2 of the DLQI will be needed, and it is probably advisable to include generic instruments alongside the DLQI.

Life quality assessment among patients with atopic eczema.

PubMed

Holm, E A; Wulf, H C; Stegmann, H; Jemec, G B E

2006-04-01

Quantification of quality of life (QoL) related to disease severity is important in patients with atopic eczema (AE), because the assessment provides additional information to the traditional objective clinical scoring systems. To measure health-related QoL (HRQoL) in patients with AE; to analyse discriminant, divergent and convergent validity by examining the association between various QoL methods; and to examine the association between disease severity assessed by an objective Severity Scoring of Atopic Dermatitis (SCORAD) and QoL. HRQoL was assessed at two visits at a 6-monthly interval in 101 patients with AE and 30 controls with one dermatology-specific questionnaire [Dermatology Life Quality Index (DLQI) or Children's DLQI (CDLQI)], one generic instrument (SF-36) and three visual analogue scales (VASs) of severity and pruritus. Objective SCORAD was used to measure disease severity. Patients with AE had significantly lower QoL than healthy controls and the general population. DLQI /CDLQI, pruritus, and patient and investigator overall assessment of eczema severity were significantly (P < 0.0001) and positively correlated with SCORAD, while the generic questionnaire showed only poor correlation. A gender difference was found for the mental component score of SF-36 (P = 0.019). AE has an impact on HRQoL. Patients' mental health, social functioning and role emotional functioning seem to be more affected than physical functioning. A simple VAS score of patients' assessment of disease severity showed the highest and most significant correlations with most of the HRQoL methods used. There is evidence to support the ability of patients with AE to make an accurate determination of their disease severity and QoL.

[Atopic eczema: psychophysiological reactivity with standardized stressors].

PubMed

Münzel, K; Schandry, R

1990-11-01

In 18 atopic eczema patients with active symptomatology and 15 control subjects a comparison of reactivity to psychological stressors was made. The physiological measures were heart rate, peripheral vasomotor response, skin resistance level, spontaneous fluctuations of the skin resistance, and forearm skin temperature. In addition, self-ratings of subjective state, situational anxiety, and social anxiety were assessed. Mental arithmetic performed undisturbed and in distracting conditions, and anticipation of the latter and of having to speak in public served as stressors. The results show higher reaction values of the eczema patients for heart rate, peripheral vasomotor response, fluctuations of skin resistance and subjective tension. A subgroup of patients with extreme skin irritation (itching) reacted with an elevation of skin temperature, in contrast to control subjects and patients with less marked itching, in whom skin temperature dropped slightly. The results suggest that atopic eczema may have a psychophysiological component.

Association between mast cell chymase genotype and atopic eczema: comparison between patients with atopic eczema alone and those with atopic eczema and atopic respiratory disease.

PubMed

Tanaka, K; Sugiura, H; Uehara, M; Sato, H; Hashimoto-Tamaoki, T; Furuyama, J

1999-06-01

It has remained unclear whether genetic background of patients with atopic eczema (AE) alone is identical to that of patients with both AE and atopic respiratory disease. We aimed to assess whether there is a genetic difference between these two groups of AE patients. We determined the genotype with regard to an allelic polymorphism in the gene for mast cell chymase (MCC; a serine protease secreted from mast cells) in 169 AE patients. MCC genotype was significantly associated with pure AE patients who did not have a predisposition to atopic respiratory disease and whose serum IgE concentration was < 500 IU/mL. The distribution of MCC genotypes also differed significantly between the latter patients and those AE patients with bronchial asthma and a serum IgE concentration of > 2000 IU/mL. These results suggest that pure AE is associated with genetic variants of MCC, and that the genetic basis of pure AE differs from that of AE associated with atopic asthma.

Assessment of dietary food and nutrient intake and bone density in children with eczema.

PubMed

Leung, T F; Wang, S S; Kwok, F Yy; Leung, L Ws; Chow, C M; Hon, K L

2017-10-01

Dietary restrictions are common among patients with eczema, and such practice may lead to diminished bone mineral density. This study investigated dietary intake and bone mineral density in Hong Kong Chinese children with eczema. This cross-sectional and observational study was conducted in a university-affiliated teaching hospital in Hong Kong. Chinese children aged below 18 years with physician-diagnosed eczema were recruited from our paediatric allergy and dermatology clinics over a 6-month period in 2012. Subjects with stable asthma and/or allergic rhinitis who were free of eczema and food allergy as well as non-allergic children were recruited from attendants at our out-patient clinics as a reference group. Intake of various foods and nutrients was recorded using a food frequency questionnaire that was analysed using Foodworks Professional software. Bone mineral density at the radius and the tibia was measured by quantitative ultrasound bone sonometry, and urinary cross-linked telopeptides were quantified by immunoassay and corrected for creatinine level. Overall, 114 children with eczema and 60 other children as reference group were recruited. Eczema severity of the patients was classified according to the objective SCORing Atopic Dermatitis score. Males had a higher daily energy intake than females (median, 7570 vs 6736 kJ; P=0.035), but intake of any single food item or nutrient did not differ between them. Compared with the reference group, children with eczema had a higher intake of soybeans and miscellaneous dairy products and lower intake of eggs, beef, and shellfish. Children with eczema also consumed less vitamin D, calcium, and iron. The mean (standard deviation) bone mineral density Z-score of children with eczema and those in the reference group were 0.52 (0.90) and 0.55 (1.12) over the radius (P=0.889), and 0.02 (1.03) and -0.01 (1.13) over the tibia (P=0.886), respectively. Urine telopeptide levels were similar between the groups. Calcium intake was associated with bone mineral density Z-score among children with eczema. Dietary restrictions are common among Chinese children with eczema in Hong Kong, who have a lower calcium, vitamin D, and iron intake. Nonetheless, such practice is not associated with changes to bone mineral density or bone resorptive biomarker.

Pseudoceramide for childhood eczema: does it work?

PubMed

Hon, K L; Wang, Susan S; Lau, Zoe; Lee, H C; Lee, Kenneth K C; Leung, T F; Luk, N M

2011-04-01

Atopic eczema is a chronic relapsing skin disease associated with atopy, and characterised by reduced skin hydration, impaired skin integrity (transepidermal water loss), and poor quality of life. Proper emollient usage is an important facet of its management. This study aimed to establish an approach to evaluate the efficacy of using an emollient over a 4-week period. Prospective observational study. A paediatric dermatology out-patient clinic of a university teaching hospital in Hong Kong. Consecutive new patients aged 5 to 18 years with atopic eczema diagnosed according to Hanifin and Rajka's criteria were recruited from March to August 2009. They or their parents were instructed to liberally apply the test emollient to the flexures and areas affected with eczema, twice daily. Outcome assessments were repeated 2 and 4 weeks later. Skin hydration and transepidermal water loss in the right forearm (2 cm below antecubital flexure), and disease severity (SCORing Atopic Dermatitis index) and Children's Dermatology Life Quality Index. At the end of the study period, a global assessment of treatment was recorded. Thirty-three patients with atopic eczema were recruited and treated with applications of a pseudoceramide-containing cream (Curel, Kao, Japan). The mean age of the patients (16 males and 17 females) was 12 (standard deviation, 4) years. Four weeks following the use of the cream, skin hydration improved significantly and fewer patients were using topical corticosteroids. In these patients, there was no deterioration in transepidermal water loss, eczema severity, or quality of life. The pseudoceramide cream improved skin hydration but not severity or quality of life over a 4-week usage.

Dry skin - self-care

MedlinePlus

... or showers frequently Washing your hands often Some soaps and detergents Skin conditions, such as eczema and ... apply your moisturizer. Avoid skin care products and soaps that contain alcohol, fragrances, dyes, or other chemicals. ...

Psychological profile of the atopic eczema patient.

PubMed

White, A; Horne, D J; Varigos, G A

1990-01-01

A survey of 40 patients with long-standing atopic eczema was carried out to test for the presence of certain psychological traits which had been reported in studies in earlier decades. A series of standardised personality tests was administered to these patients and the results compared with the findings for a normal group for each test. It was demonstrated that atopic eczema patients do have significantly high levels of anxiety and problems in dealing with anger and hostility. Whether such findings make any contribution to understanding the aetiology of this disorder is debatable, but they do have implications for treatment and management, and some of these are discussed.

Decreased natural killer cell activity in atopic eczema.

PubMed Central

Hall, T J; Rycroft, R; Brostoff, J

1985-01-01

We have studied NK cell activity in atopic and non-atopic subjects using a standard 51Cr-release assay and K562 target cells. In atopics (AT) with allergic rhinitis and/or asthma, NK cell activity was similar to that in non-atopic (N) subjects, whilst patients with severe atopic eczema (AE) had depressed NK cell activity compared to AT or N subjects. In addition, circulating T-cell numbers and Con A responsiveness was decreased in AE, although neither parameter was correlated with decreased NK cell activity. However, decreased NK cell activity in atopic eczema was positively correlated with decreased numbers of Fc gamma + lymphocytes (P = 0.01) and decreased effector: target cell binding (P = 0.05), and negatively correlated with increased monocytes in AE (P = 0.09). AE NK cell activity was equally or more sensitive to the inhibitory effects of drugs such as dibutyryl cyclic AMP, prostaglandins (PG) D2,E2 and histamine. The relative percentage increase in NK cell activity by the interferon inducer poly I:C was similar in AE patients and controls. The results suggest that reduced numbers of circulating NK cells and pre-NK cells account for the depressed level of NK cell activity in subjects with severe atopic eczema. PMID:3876984

Patients Presenting with Miliaria While Wearing Flame Resistant Clothing in High Ambient Temperatures: A Case Series

DTIC Science & Technology

2011-09-22

year-old Caucasian woman with a medical history of eczema developed a miliaria-like rash (small red rash with papules) on her inner thighs, knee fossa... eczema developed itchy miliaria-like rash (small red rash with papules) to his inner thighs, bilateral pos- terior calves, and inner elbow (Figure 2...Our patient sought medical attention from the military dermatologist, who diagnosed the rash as eczema and treated it with a cortisone IM injection

Patients Presenting with Miliaria While Wearing Flame Resistant Clothing in High Ambient Temperatures: A Case Series

DTIC Science & Technology

2011-09-22

Case presentation 1 A 23-year-old Caucasian woman with a medical history of eczema developed a miliaria-like rash (small red rash with papules...perspiration. Case presentation 2 A 31-year-old African-American man with a medical history of eczema developed itchy miliaria-like rash (small...military dermatologist, who diagnosed the rash as eczema and treated it with a cortisone IM injection (name and dose unknown). Our patient deployed to

A survey of occupational health in the Royal Norvegian Navy.

PubMed

Moen, Bente E; Koefoed, Vilhelm F; Bondevik, Kristin; Haukenes, Inger

2008-01-01

The aim of this article is to describe possible risk factors in the work environment that can affect the health of staff of the Royal Norwegian Navy (RNoN). The article presents the main results from a subproject related to a major surveillance of the health and work environment in this population. The project was performed as a response to general concerns regarding harmful work environment and negative health effects for these employees. In 2002, a questionnaire was sent out to all the employees in RNoN, and they answered during a period of three months. The overall response rate was 58% (n=2265), 2001 men and 250 women (14 unknown sex). 1581 military employees and 580 civilians participated (104 unknown). Mean age was 38 (range 18-70). Questions about years at work, exposure to chemical, physical and ergonomic hazards were developed for this particular study. Questions about allergy, asthma, hand eczema, hearing loss, cardiovascular disease, diabetes mellitus and cancer were asked. Musculoskeletal disorders were obtained by a standardized instrument. Exposure to noise, heavy lifting, twisted work positions and work close to antennas and communication equipment occurred often in this population. The most commonly reported diseases that might be work related were hand eczema, hearing loss and low back pain. The results indicate the presence of several possible risk factors to health related to the work environment in this population. The project gives a basis for further action regarding the Health Safety and Environment work within RNoN.

Permeability of the small intestine to (/sup 51/Cr)EDTA in children with acute gastroenteritis or eczema

DOE Office of Scientific and Technical Information (OSTI.GOV)

Forget, P.; Sodoyez-Goffaux, F.; Zappitelli, A.

1985-06-01

Increased gut permeability to macromolecules is thought to be an important factor in the development of food hypersensitivity. The latter can develop in the course of acute gastroenteritis and could play a role in infantile eczema. The authors studied gut permeability in 10 normal adults, 11 control children, 7 children with acute gastroenteritis, and 8 patients with infantile eczema, making use of (/sup 51/Cr)EDTA as probe molecule. (/sup 51/Cr)EDTA was given orally (50-100 microCi); 24-h urinary excretion of (/sup 51/Cr)EDTA was measured and expressed as a percentage of the oral dose. Mean and standard error were 2.35 +/- 0.24, 2.51more » +/- 0.21, 9.96 +/- 3.44, and 10.90 +/- 2.05 in normal adults, control children, and gastroenteritis and eczema patients, respectively. Differences between controls and either gastroenteritis (p less than 0.001) or eczema (p less than 0.001) patients are significant. The results support the hypothesis that increased gut permeability could play a role in food hypersensitivity.« less

Knowledge, instruction and behavioural change: building a framework for effective eczema education in clinical practice.

PubMed

Thompson, Deryn Lee; Thompson, Murray John

2014-11-01

A discussion on the reasons educational interventions about eczema, by nurses, are successful, with the subsequent development of a theoretical framework to guide nurses to become effective patient educators. Effective child and parent education is the key to successful self-management of eczema. When diagnosed, children and parents should learn to understand the condition through clear explanations, seeing treatment demonstrations and have ongoing support to learn practical skills to control eczema. Dermatology nurses provide these services, but no one has proposed a framework of the concepts underpinning their successful eczema educational interventions. A discussion paper. A literature search of online databases was undertaken utilizing terms 'eczema OR atopic dermatitis', 'education', 'parent', 'nurs*', 'framework', 'knowledge', motivation', in Scopus, CINAHL, Web of Science, Medline and Pubmed. Limits were English language and 2003-2013. The framework can inform discussion on child and parent education, provide a scaffold for future research and guide non-specialist nurses, internationally, in providing consistent patient education about eczema. Founded on an understanding of knowledge, the framework utilizes essential elements of cognitive psychology and social cognitive theory leading to successful self-management of eczema. This framework may prove useful as a basis for future research in child and parent education, globally, in the healthcare community. A framework has been created to help nurses understand the essential elements of the learning processes at the foundation of effective child and parent education. The framework serves to explain the improved outcomes reported in previous nurse-led eczema educational interventions. © 2014 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Skin problems after a tsunami.

PubMed

Lee, S H; Choi, C P; Eun, H C; Kwon, O S

2006-08-01

On December 26, 2004, the biggest earthquake for 40 years, measuring 9.0 on the Richter scale, triggered a tsunami that pounded the coastal areas of South Asia and East Africa. The effects of the tsunami on skin conditions have not been evaluated. To determine the influence of the tsunami on skin conditions by evaluating the skin problems of patients presenting at hospitals after the tsunami. Between 5 and 25 January 2005, two dermatologists evaluated patients who complained of skin problems at an outpatient clinic and emergency room of a general hospital in Banda Aceh, Aceh Province, Indonesia. The total number of patients that presented during the study period was 235 (131 males and 104 females), and they had a total of 265 skin problems. In terms of age distribution, most subjects were in their fourth decade (23.0%), followed by the third (22.6%) and fifth decade (16.6%). The most prevalent skin problems were infections-infestations (32.5%), followed by eczemas (29.8%) and traumatic skin disorders (29.4%). In males, traumatic skin disorders were most common. The great majority of infection-infestation cases involved superficial fungal infections. Contact dermatitis accounted for three-quarters of eczema cases, and mainly involved the arms (40.0%) and legs (27.1%). The majority of traumatic skin disorders were lacerations, punctures and penetrations, and the feet (44.7%) and hands (18.8%) were most frequently affected. Unhygienic conditions, exposure to a hazardous environment and contact with various objects during and after the tsunami probably increased the prevalence of infections-infestations, traumatic skin disorders and contact dermatitis. To prevent these problems and associated secondary bacterial infections, health-related education and early medical management are required.

Infant-onset eczema in relation to mental health problems at age 10 years: results from a prospective birth cohort study (German Infant Nutrition Intervention plus).

PubMed

Schmitt, Jochen; Apfelbacher, Christian; Chen, Chih-Mei; Romanos, Marcel; Sausenthaler, Stefanie; Koletzko, Sibylle; Bauer, Carl-Peter; Hoffmann, Ute; Krämer, Ursula; Berdel, Dietrich; von Berg, Andrea; Wichmann, H-Erich; Heinrich, Joachim

2010-02-01

Cross-sectional studies suggest an association between eczema and mental health problems, but the temporal relationship is unclear. To assess the association between infant-onset eczema and mental health problems in a prospective study. Between 1995 and 1998, a birth cohort study was recruited and followed until age 10 years. Physician-diagnosed eczema, comorbidities, and a broad set of environmental exposures were assessed at age 1, 2, 3, 4, 6, and 10 years. First, we investigated the association between infant-onset eczema (age 1-2 years) and mental health problems at age 10 years according to the Strengths and Difficulties Questionnaire. Second, we analyzed the likelihood of mental health problems at age 10 years in relation to the course of eczema. A total of 2916 infants were eligible for analysis. Compared with participants never diagnosed as having eczema, children with infant-onset eczema had a significantly increased risk for possible/probable mental health problems (Strengths and Difficulties Questionnaire total score) at age 10 years (odds ratio, 1.49; 95% CI, 1.13-1.96) and for emotional symptoms (odds ratio, 1.62; 95% CI, 1.25-2.09). Eczema limited to infancy predicted a significantly higher risk for conduct problems at age 10 years. The strength of the association between eczema and emotional problems at age 10 years increased with increasing eczema persistence. Infants with eczema are at increased risk for mental health problems at age 10 years. Even if cleared afterward, eczema at age 1 to 2 years may cause persistent emotional and behavioral difficulties. Copyright 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Immunomodulating effect of laser therapy in patients with microbial eczema

NASA Astrophysics Data System (ADS)

Dudchenko, Mycola O.; Denisenko, Olga I.

1999-11-01

While examining 90 patients suffering the microbial eczema (ME), we revealed disorders of the immune system in the majority of them (3/4). It was established that the inclusion of percutaneous laser irradiation of the blood in a course of multimodality treatment of patients with ME caused an immunomodulating action which resulted in an improved ME course in these patients.

Psychiatric comorbidity in adult eczema.

PubMed

Schmitt, J; Romanos, M; Pfennig, A; Leopold, K; Meurer, M

2009-10-01

Atopic eczema (AE) is a common dermatological condition that causes significant problems in everyday life and high levels of illness-related stress in substantial proportions of patients. The extent to which adult AE is associated with clinically relevant psychiatric morbidity is unclear. To investigate the association between adult AE and major psychiatric/psychosomatic disorders. Case-control study utilizing the GKV database Saxony, an interdisciplinary administrative outpatient database from Germany. All patients documented as having AE at least twice within the study period (2003-2004) (n = 3769, mean age 44 years) were individually matched by age and sex to 3769 controls without AE. Logistic regression models were fitted to investigate the relationship of AE with affective, stress-related, behaviour and schizophrenic disorders, considering sociodemographic characteristics, consulting behaviour and allergic comorbidities as potential confounding factors. Eczema was independently associated with affective [adjusted odds ratio (OR) 1.42, 95% confidence interval (CI) 1.13-1.79], stress-related (OR 1.55, 95% CI 1.35-1.77), behaviour (OR 1.52, 95% CI 1.03-2.23) and schizophrenic disorders (OR 2.12, 95% CI 1.22-3.71). For each psychiatric condition the likelihood of being affected significantly increased with each physician visit due to AE, suggesting that the risk of psychiatric comorbidity increases with the severity of AE. This study indicates psychiatric comorbidity of adults with AE. Collaboration between dermatologists and mental health specialists may optimize medical care for a significant subgroup of patients with AE.

Contact allergic dermatitis from melamine formaldehyde resins in a patient with a negative patch-test reaction to formaldehyde.

PubMed

García Gavin, Juan; Loureiro Martinez, Manuel; Fernandez-Redondo, Virginia; Seoane, Maria-José; Toribio, Jaime

2008-01-01

Melamine paper is a basic material used in the furniture industry for home and office interiors. Contact allergic dermatitis from melamine formaldehyde resins (MFRs) should be considered in patients who work on melamine paper impregnation lines. We report a case of a 28-year-old female plywood worker who developed eczema on the dorsal side of her hands and wrists after 2 years of working on the melamine paper impregnation line. She had a relevant positive patch-test reaction to MFR, with a negative reaction to formaldehyde. Contact dermatitis due to MFR is not common, and it is usually related to products that are not fully cured or to close contact with intermediate products on the assembly line. Formaldehyde release from MFR can explain most of the positive responses. To our knowledge, this is the first report of MFR contact allergic dermatitis in a worker on a melamine paper impregnation line.

Remembering childhood atopic dermatitis as an adult: factors that influence recollection.

PubMed

Moberg, C; Meding, B; Stenberg, B; Svensson, A; Lindberg, M

2006-09-01

Atopic dermatitis (AD) is common in the population, and studies have shown that the disease is on the increase. Studies based on hospital records reflect selected populations and may miss less severe cases of AD, and the use of self-reported questionnaires has the drawback of recall bias. To investigate some possible factors influencing recall bias when questionnaires are used to establish the prevalence of childhood eczema in an adult population. A questionnaire regarding past and present eczema was sent to 557 cases (with signs suggesting the diagnosis AD) and 554 matched controls (subjects lacking signs of AD) born during 1960-1969 and identified in school health medical records. Cases and controls were aged 31-42 years at the time of the study and 70.5% returned the questionnaire. Of 403 cases, 29% did not report childhood eczema in the questionnaire. There was a difference between those who did recall their childhood AD (remembering group, RG), and those who did not (forgetful group, FG) in who had documented the diagnostic signs in the school health records. In the RG the signs were reported by both parents and school health personnel in 51% of cases, and in the FG this was true of only 16%. The RG had a higher prevalence of eczema after 15 years of age and of hand eczema. The RG also reported more visits to physicians after the age of 15 years and more time taken as sick leave due to eczema. Several factors influence how well people remember their AD in childhood. These factors include disease activity in adult life, disease severity, and who noticed the eczema in childhood.

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting.

PubMed

Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon; Dohil, Magdalene; Flohr, Carsten; Furue, Masutaka; Gieler, Uwe; Hooft, Lotty; Humphreys, Rosemary; Ishii, Henrique Akira; Katayama, Ichiro; Kouwenhoven, Willem; Langan, Sinéad; Lewis-Jones, Sue; Merhand, Stephanie; Murota, Hiroyuki; Murrell, Dedee F; Nankervis, Helen; Ohya, Yukihiro; Oranje, Arnold; Otsuka, Hiromi; Paul, Carle; Rosenbluth, Yael; Saeki, Hidehisa; Schuttelaar, Marie-Louise; Stalder, Jean-Francois; Svensson, Ake; Takaoka, Roberto; Wahlgren, Carl-Fredrik; Weidinger, Stephan; Wollenberg, Andreas; Williams, Hywel

2012-09-01

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research. © 2012 John Wiley & Sons A/S.

Knowledge, instruction and behavioural change: building a framework for effective eczema education in clinical practice

PubMed Central

Thompson, Deryn Lee; Thompson, Murray John

2014-01-01

Aims A discussion on the reasons educational interventions about eczema, by nurses, are successful, with the subsequent development of a theoretical framework to guide nurses to become effective patient educators. Background Effective child and parent education is the key to successful self-management of eczema. When diagnosed, children and parents should learn to understand the condition through clear explanations, seeing treatment demonstrations and have ongoing support to learn practical skills to control eczema. Dermatology nurses provide these services, but no one has proposed a framework of the concepts underpinning their successful eczema educational interventions. Design A discussion paper. Data Sources A literature search of online databases was undertaken utilizing terms ‘eczema OR atopic dermatitis’, ‘education’, ‘parent’, ‘nurs*’, ‘framework’, ‘knowledge’, motivation’, in Scopus, CINAHL, Web of Science, Medline and Pubmed. Limits were English language and 2003–2013. Implications for Nursing The framework can inform discussion on child and parent education, provide a scaffold for future research and guide non-specialist nurses, internationally, in providing consistent patient education about eczema. Conclusion Founded on an understanding of knowledge, the framework utilizes essential elements of cognitive psychology and social cognitive theory leading to successful self-management of eczema. This framework may prove useful as a basis for future research in child and parent education, globally, in the healthcare community. A framework has been created to help nurses understand the essential elements of the learning processes at the foundation of effective child and parent education. The framework serves to explain the improved outcomes reported in previous nurse-led eczema educational interventions. PMID:25312442

Influence of weather and climate on subjective symptom intensity in atopic eczema

NASA Astrophysics Data System (ADS)

Vocks, E.; Busch, R.; Fröhlich, C.; Borelli, S.; Mayer, H.; Ring, J.

The frequent clinical observation that the course of atopic eczema, a skin disease involving a disturbed cutaneous barrier function, is influenced by climate and weather motivated us to analyse these relationships biometrically. In the Swiss high-mountain area of Davos the intensity of itching experienced by patients with atopic eczema was evaluated and compared to 15 single meteorological variables recorded daily during an entire 7-year observation period. By means of univariate analyses and multiple regressions, itch intensity was found to be correlated with some meteorological variables. A clear-cut inverse correlation exists with air temperature (coefficient of correlation: -0.235, P<0.001), but the effects of water vapour pressure, air pressure and hours of sunshine are less pronounced. The results show that itching in atopic eczema is significantly dependent on meteorological conditions. The data suggest that, in patients with atopic eczema, a certain range of thermo-hygric atmospheric conditions with a balance of heat and water loss on the skin surface is essential for the skin to feel comfortable.

Colonisation with methicillin-resistant Staphylococcus aureus and associated factors among nurses with occupational skin diseases.

PubMed

Brans, Richard; Kolomanski, Katarzyna; Mentzel, Franziska; Vollmer, Ulrike; Kaup, Olaf; John, Swen Malte

2016-10-01

To evaluate the prevalence of colonisation with methicillin-resistant Staphylococcus aureus (MRSA), associated factors and the effectiveness of decolonisation procedures among nurses with occupational skin diseases (OSD). In a retrospective cohort study, the medical records of 319 nurses from Germany who were screened consecutively for MRSA when participating in a tertiary individual prevention programme (TIP) for severe OSD between July 2009 and December 2014 were evaluated. 90.3% of nurses with severe OSD suffered from hand eczema. 43 were colonised with MRSA on admission (13.5%), mainly in the nose (n=35, 81.4%). However, the hands were affected in more than half of the MRSA carriers (n=24, 55.8%). Risk factors for MRSA colonisation were atopic skin diathesis (OR 2.01, 95% CI 1.03 to 3.92, p=0.049) and presence of atopic dermatitis on other body parts than the hands (OR 4.33, 95% CI 2.23 to 8.43, p<0.001). Hand eczema was significantly more severe in MRSA carriers than in non-carriers (OR 1.23, 95% CI 1.10 to 1.37, p<0.001) and showed a higher prevalence of vesicles, erosions or fissures. MRSA eradication was successful in 67.4% after the first attempt. Nurses with OSD have a twofold to threefold higher prevalence of MRSA colonisation than what has been reported for point-prevalence screenings among healthcare workers in Germany. Atopic skin diathesis, atopic dermatitis and severe hand eczema are the main risk factors. Thus, prevention and treatment of OSD could be important elements in reduction of colonisation with MRSA among nurses and transmission to others. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Pimecrolimus Topical

MedlinePlus

Pimecrolimus is used to control the symptoms of eczema (atopic dermatitis; a skin disease that causes the ... treat patients who cannot use other medications for eczema, or whose symptoms were not controlled by other ...

A multi-centre, parallel group superiority trial of silk therapeutic clothing compared to standard care for the management of eczema in children (CLOTHES Trial): study protocol for a randomised controlled trial.

PubMed

Harrison, Eleanor F; Haines, Rachel H; Cowdell, Fiona; Sach, Tracey H; Dean, Taraneh; Pollock, Ian; Burrows, Nigel P; Buckley, Hannah; Batchelor, Jonathan; Williams, Hywel C; Lawton, Sandra; Brown, Sara J; Bradshaw, Lucy E; Ahmed, Amina; Montgomery, Alan A; Mitchell, Eleanor J; Thomas, Kim S

2015-09-02

Eczema is a chronic, itchy skin condition that can have a large impact on the quality of life of patients and their families. People with eczema are often keen to try out non-pharmacological therapies like silk therapeutic garments that could reduce itching or the damage caused by scratching. However, the effectiveness and cost-effectiveness of these garments in the management of eczema has yet to be proven. The CLOTHES Trial will test the hypothesis that 'silk therapeutic garments plus standard eczema care' is superior to 'standard care alone' for children with moderate to severe eczema. Parallel group, observer-blind, pragmatic, multi-centre randomised controlled trial of 6 months' duration. Three hundred children aged 1 to 15 years with moderate to severe eczema will be randomised (1:1) to receive silk therapeutic garments plus standard eczema care, or standard eczema care alone. Primary outcome is eczema severity, as assessed by trained and blinded investigators at 2, 4 and 6 months (using the Eczema Area and Severity Index (EASI)). Secondary outcomes include: patient-reported eczema symptoms (collected weekly for 6 months to capture long-term control); global assessment of severity; quality of life of the child, family and main carer; use of standard eczema treatments (emollients, corticosteroids applied topically, calcineurin inhibitors applied topically and wet wraps); frequency of infections; and cost-effectiveness. The acceptability and durability of the clothing will also be assessed, as will adherence to wearing the garments. A nested qualitative study will assess the views of a subset of children wearing the garments and their parents, and those of healthcare providers and commissioners. Randomisation uses a computer-generated sequence of permuted blocks of randomly varying size, stratified by recruiting hospital and child's age (< 2 years; 2 to 5 years; > 5 years), and concealed using a secure web-based system. The sequence of treatment allocations will remain concealed until randomisation and data collection are complete. Recruitment is taking place from November 2013 to May 2015, and the trial will be completed in 2016. Full details of results will be published in the National Institute for Health Research Journal series. Current Controlled Trials ISRCTN77261365 (registered 11 November 2013).

Family eczema-history in 2-year olds with eczema; a prospective, population-based study. The PACT-study, Norway

PubMed Central

2011-01-01

Background A maternal line of inheritance regarding eczema has been described in several studies, whereas others find associations to both a maternal as well as a paternal line of inheritance. When studying family history of eczema symptoms, cohort studies including siblings are rare. Time point for assessing family eczema-history could be of importance when studying the associations between family eczema-history and children with eczema, as parents with unaffected children may not recall mild symptoms in other siblings or their own disease history. We therefore aimed to study the associations between reported eczema in mother, father and siblings and reported eczema in index child where information on family history was collected at two different ages of index child. Methods Parents/children participating in The Prevention of Allergy among Children in Trondheim (PACT) study were given questionnaires on reported eczema symptoms in mother, father and siblings at 6 weeks and 1 year. When index child was 2 years of age, a detailed questionnaire on different health issues with emphasize on different allergy related disorders were filled in. Results Both maternal and paternal reports on eczema were significantly associated with eczema in index child. Reporting family eczema-history at 1 year (N = 3087), "eczema sibling only" [adjusted odds ratio (aOR) = 3.13 (2.27-4.33)] as well as all other family-groups containing siblings with eczema were strongly associated with eczema 2 years. When family eczema-history was reported at 6 weeks (N = 2657), reporting of "eczema sibling only" was not associated to reported eczema at 2 years in index child [aOR = 1.31 (0.77-2.23)]. Conclusions Having sibling(s) with eczema strengthened the associations between maternal and paternal reports on eczema with eczema in index child only when exposure was reported at 1 year. These findings indicate that results from questionnaires-based studies of family eczema-history depend on whether or not index child has yet developed eczema. Trial registration ISRCTN: ISRCTN28090297 PMID:21599876

Effect of lipid peroxidation, antioxidants, macro minerals and trace elements on eczema.

PubMed

Amin, Mohammad Nurul; Liza, Kaniz Fatema; Sarwar, Md Shahid; Ahmed, Jamiuddin; Adnan, Md Tareek; Chowdhury, Manjurul Islam; Hossain, Mohammad Zahid; Islam, Mohammad Safiqul

2015-09-01

The exact etiology and pathogenesis of eczema are not yet fully understood, although different factors are considered as pathogenic mechanisms in the development of eczema. Our study was designed to determine extent of serum lipid peroxidation, antioxidants, macro minerals and trace elements in patients with eczema, and thereby, find any pathophysiological correlation. The study was conducted as a case-control study with 65 eczema patients as cases and 65 normal healthy individuals as controls. Lipid peroxidation was assessed by measuring the serum level of malondialdehyde (MDA). Antioxidants- vitamin A and E concentration was determined by RP-HPLC method whereas vitamin C was evaluated for serum ascorbic acid by UV spectrophotometric method. Serum macro minerals (Na, K, Ca) and trace elements (Zn, Fe) were determined by Atomic Absorption Spectroscopy (AAS). This study found significantly higher level of MDA (p < 0.001) and lower level of antioxidants (p < 0.05) in patients in comparison to the control subjects. Analysis of serum macro minerals (Na, K and Ca) and trace elements (Zn, Fe) found that the mean values of Na, K, Ca, Zn and Fe were 2771.60 ± 75.64, 66.33 ± 3.03, 48.41 ± 2.50, 0.30 ± 0.02 and 0.29 ± 0.009 mg/L for the patient group and 3284.81 ± 34.51, 162.18 ± 3.72, 87.66 ± 2.10, 0.75 ± 0.06 and 0.87 ± 0.06 mg/L for the control group, accordingly. There was a significant difference for all the minerals between the patients and controls (p < 0.001). This study suggests a strong association between the pathogenesis of eczema with the elevated level of MDA and depleted level of antioxidants, macro minerals, and trace elements.

Relationship between dietary fat and fish intake and the prevalence of atopic eczema in pregnant Japanese females: baseline data from the Osaka Maternal and Child Health Study.

PubMed

Miyake, Yoshihiro; Sasaki, Satoshi; Tanaka, Keiko; Ohya, Yukihiro; Matsunaga, Ichiro; Yoshida, Toshiaki; Hirota, Yoshio; Oda, Hajime

2008-01-01

Dietary factors may be important in the development of atopic eczema. It remains controversial whether n-3 polyunsaturated fatty acid intake is preventive against allergic disorders and whether n-6 polyunsaturated fatty acid intake increases the risk of allergic disorders. The current cross-sectional study examined the association between intake of fatty acids and foods high in fatty acids and the prevalence of atopic eczema. Study subjects were 1002 pregnant Japanese females. Current atopic eczema and atopic eczema after age 18 were defined as present if subjects had been treated with medications at some time in the previous 12 months and after reaching the age of 18, respectively. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Docosahexaenoic acid intake was statistically significantly related to a decreased prevalence of atopic eczema after age 18 and current atopic eczema. Inverse dose-response relationships with regard to consumption of n-3 polyunsaturated fatty acids, eicosapentaenoic acid, and fish and the ratio of n-3 to n-6 polyunsaturated fatty acids with atopic eczema were not observed although these dietary variables in the second tertile were inversely significantly associated with atopic eczema after age 18. Intake of total fat, saturated fatty acids, monounsaturated fatty acids, n-6 polyunsaturated fatty acids, cholesterol, meat, eggs, or dairy products was not related to either of the outcomes for atopic eczema. Docosahexaenoic acid intake may be associated with a reduced prevalence of atopic eczema in pregnant Japanese females.

Bacterial communities living on the skin of eczema patients vary with disease severity | Center for Cancer Research

Cancer.gov

A new study published in Science Translational Medicine reveals that strains of the bacterium Staphylococcus aureus (S. aureus) can dominate the skin of patients with eczema. This discovery could bring clinicians one step closer to understanding possible targets for treatment. Learn more...

Hyper IgE in Childhood Eczema and Risk of Asthma in Chinese Children.

PubMed

Ng, Chantel; Hon, Kam Lun; Kung, Jeng Sum Charmaine; Pong, Nga Hin; Leung, Ting-Fan; Wong, Chun Kwok

2016-06-10

Atopic eczema is a common childhood disease associated with high IgE and eosinophilia. We characterized the clinical features associated with hyper-IgE (defined as IgE > 2000 IU/L) in eczema. Nottingham Eczema Severity Score (NESS), family and personal history of atopy, skin prick test (SPT) for common food and aeroallergens, highest serum IgE ever and eosinophil counts were evaluated in 330 children eczema patients. Childhood-NESS (NESS performed at <10 years of age) and adolescent-NESS (NESS performed at >10 years of age) were further analyzed. IgE correlated with NESS (spearman coefficient 0.35, p < 0.001) and eosinophil percentage (spearman coefficient 0.56, p = 0.001). Compared with IgE ≤ 2000IU/L (n = 167), patients with hyper-IgE (n = 163) were associated with male gender (p = 0.002); paternal atopy (p = 0.026); personal history of atopic rhinitis (p = 0.016); asthma (p < 0.001); dietary avoidance (p < 0.001); use of wet wrap (p < 0.001); traditional Chinese medicine use (TCM, p < 0.001); immunomodulant use (azathioprine or cyclosporine, p < 0.001); skin prick sensitization by dust mites (p < 0.001), cats (p = 0.012), dogs (p = 0.018), food (p = 0.002); eosinophilia (p < 0.001); more severe disease during childhood (p < 0.0001) and during adolescence (p < 0.0001), but not onset age of eczema or maternal atopy. Logistic regression showed that hyper-IgE was associated with personal history of asthma (exp(B) = 5.12, p = 0.002) and eczema severity during childhood and adolescence (p < 0.001). For patients <10 years of age, dust mite sensitization (p = 0.008) was associated with hyper-IgE. For patients >10years of age, food allergen sensitization was associated with hyper-IgE (p = 0.008). Hyper-IgE is independently associated with asthma, more severe atopy and more severe eczema during childhood and adolescence. IgE > 2000 IU/L may be a tool to aid prognostication of this chronic relapsing dermatologic disease and its progression to asthma.

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study.

PubMed

Francis, Nick A; Ridd, Matthew J; Thomas-Jones, Emma; Shepherd, Victoria; Butler, Christopher C; Hood, Kerenza; Huang, Chao; Addison, Katy; Longo, Mirella; Marwick, Charis; Wootton, Mandy; Howe, Robin; Roberts, Amanda; Haq, Mohammed Inaam-ul; Madhok, Vishnu; Sullivan, Frank

2016-03-01

Secondary skin infection is common during eczema exacerbations and many children are treated with antibiotics when this is suspected, although there is little high-quality evidence to justify this practice. To determine the clinical effectiveness of oral and topical antibiotics, in addition to standard treatment with emollients and topical corticosteroids, in children with clinically infected eczema. Multicentre randomised, double-blind, placebo-controlled trial. General practices and dermatology clinics in England, Wales and Scotland. Children (aged 3 months to < 8 years) with a diagnosis of eczema (according to U.K. Working Party definition) and clinical suspicion of infection. (1) Oral flucloxacillin and topical placebo; (2) topical fusidic acid (Fucidin(®), Leo Laboratories Limited) and oral placebo; and (3) oral and topical placebos, all for 1 week. Patient-Orientated Eczema Measure (POEM) at 2 weeks (assessing subjective severity in the week following treatment). We randomised 113 children (36 to oral antibiotic, 37 to topical antibiotic and 40 to placebo), which was fewer than our revised target sample size of 282. A total of 103 (92.0%) children had one or more clinical features suggestive of infection and 78 (69.6%) children had Staphylococcus aureus cultured from a skin swab. Oral and topical antibiotics resulted in a 1.52 [95% confidence interval (CI) -1.35 to 4.40] and 1.49 (95% CI -1.55 to 4.53) increase (worse subjective severity) in POEM score at 2 weeks, relative to placebo and controlling for baseline POEM score. Eczema Area and Severity Index (objective severity) scores were also higher (worse) in the intervention groups, at 0.20 (95% CI -0.12 to 0.52) and 0.42 (95% CI 0.09 to 0.75) for oral and topical antibiotics, respectively, at 2 weeks. Analyses of impact on the family, quality of life, daily symptom scores, and longer-term outcomes were all consistent with the finding of no or limited difference and a trend towards worse outcomes in the intervention groups. Sensitivity analyses, including adjusting for compliance and imputation for missing data, were consistent with the main findings. Our data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community. The CIs around our estimates exclude a meaningful beneficial effect (published minimal clinically important difference for POEM is 3.4). Although most patients in this trial had features suggestive of infection and S. aureus on their skin, participants primarily had mild-moderate eczema and those with signs of more severe infection were often excluded. Clinicians should consider avoiding oral and topical antibiotic use in children with suspected infected eczema in the community who do not have signs of 'severe infection'. Further research should seek to understand how best to encourage the use of topical steroids and limit use of antibiotics in those with eczema flares without signs of severe infection, as well as developing tools to better phenotype eczema flares, in order to better define a population that may benefit from antibiotic treatment. European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2011-003591-37 and Current Controlled Trials ISRCTN96705420. The National Institute for Health Research Health Technology Assessment programme.

Eosinophilic airway disease in a patient with a negative skin prick test, but a positive patch test with platinum salts--implications for medical surveillance.

PubMed

Merget, Rolf; Fartasch, Manigé; Sander, Ingrid; Van Kampen, Vera; Raulf, Monika; Brüning, Thomas

2015-09-01

We present the case of a 52-year-old woman with a topic dermatitis since adolescence who developed work-related hand eczema, cough and runny nose 12 years after she had started working as a laboratory technician at a precious metals refinery. While skin prick test with sodium hexachloroplatinate (SPTPt ) was negative, patch testing with ammonium tetrachloroplatinate was positive after 24, 48, 72, and 96 hr. Inhalation challenge with sodium hexachloroplatinate yielded cough, mild shortness of breath, and a maximal decrease of FEV1 of 8% from baseline 24 hr after the challenge. Significant increases of bronchial hyperresponsiveness, exhaled nitric monoxide and sputum eosinophils were documented after the challenge. We conclude that eosinophilic airway disease due to platinum salts may occur in SPTPt negative subjects. Both, patch testing and inhalation challenge with platinum salts should be considered in SPT negative subjects with occupational exposure to precious metal salts and work-related allergic symptoms. © 2015 Wiley Periodicals, Inc.

[Eczema and food allergy--is there a causal relationship?].

PubMed

Spiewak, Radosław

2013-01-01

In spite of popular beliefs, the relationship between eczema and food allergy still puzzles researchers and clinicians, which in part is due to the variety of mechanisms involved in various types of allergy. One has to realize the differences between hypersensitivity reactions to food proteins (allergens capable of initiating immediate hypersensitivity or immune complex reactions) and low-molecular weight compounds (haptens that may initiate cytotoxic reactions or delayed-type allergy). Hardly doubted is the role of IgE specific to food proteins in anaphylactic reactions and allergic urticaria. The involvement of food protein-specific IgE also is well-documented in protein contact dermatitis, with exposure to offending allergens occurring mainly through direct contact to the skin. In case of oral intake, protein allergens can provoke oral allergy syndrome or allergic reactions of esophageal mucosa, yet after arriving in the stomach they undergo hydrolytic digestion and loose antigenicity. The popular notion "food allergy causes eczema" was challenged by last decade's research suggesting that allergy to food proteins develops secondarily to eczema, and in the later course manifests as anaphylaxis or urticaria, not eczema. On the other hand, somewhat unnoticed remains the wide array of haptens present in food - be it natural components, food additives (dyes, aromas, preservatives, emulsifiers, etc.) or contaminations (e.g. pesticides, veterinary drugs). Haptens can be absorbed already through oral mucosa, they don't undergo digestion and are capable of provoking delayed-type hypersensitivity reactions strongly resembling atopic eczema. Induction of such reactions can be facilitated by cosmetics that frequently contain the same haptens as food.

Associations between home dampness-related exposures and childhood eczema among 13,335 preschool children in Shanghai, China: A cross-sectional study.

PubMed

Cai, Jiao; Liu, Wei; Hu, Yu; Zou, Zhijun; Shen, Li; Huang, Chen

2016-04-01

From April 2011 to April 2012, we conducted a cross-sectional study in Shanghai, China. A total of 13,335 modified ISAAC questionnaires (response rate: 85.3%) were returned by parents or guardians for 4-6 year-old children. Six dampness-related indicators (visible mold spots, visible damp stains, damp bed clothing, water damage, window pane condensation, and moldy odor) were used to evaluate home dampness-related exposures. In the present study, we applied logistic regression model to reveal associations, dose-response relationships, and statistical interaction effects of these dampness-related exposures, with childhood eczema, during lifetime since birth (ever) and in the last 12 months before the questionnaire. The dampness-related indicators were frequently reported in the perinatal and current residences. Prevalences of eczema ever and in the last 12 months were 22.9% and 13.2%, respectively. The dampness-related indicators were robustly associated and dose-response related with increased risk of eczema ever and in the last 12 months in the logistic regression analyses, with adjusted for potential confounders. Specifically, in the perinatal residence, visible mold spots or damp stains could increase 46% (OR, 95% CI: 1.46, 1.29-1.66) odds of childhood eczema (ever); in the current residence, visible mold spots and visible damp stains could increase 34% (1.34, 1.14-1.58) and 38% (1.38, 1.22-1.56) odds of childhood eczema (ever), respectively. Associations were not appreciably different between boys and girls, nor were they different between children with and without parental history of atopy. In conclusion, perinatal and current dampness-related exposures in the residence perhaps are risk factors for childhood eczema. Copyright © 2015 Elsevier Inc. All rights reserved.

Thermoregulation, scratch, itch and sleep deficits in children with eczema.

PubMed

Camfferman, D; Short, M A; Kennedy, J D; Gold, M; Kohler, M; Lushington, K

2016-09-01

Successful sleep onset and maintenance is associated with a reduction in core temperature, facilitated by heat loss at the distal periphery. Problems with initiating and maintaining sleep in children with eczema may relate to impaired thermoregulatory mechanisms, which also contribute to itching and scratching. Our hypothesis was that nocturnal distal skin temperature in eczematous children would be lower than controls, and would also be related to poor sleep quality. We compared overnight polysomnography and distal (finger) and proximal (clavicle) skin temperature in 18 children with eczema and 15 controls (6-16 years). Children with eczema had longer periods of nocturnal wakefulness (mean [SD] = 88.8 [25.8] vs. 44.3 [35.6] min) and lower distal temperatures (34.1 [0.6] °C vs. 34.7 [0.4] °C) than controls, whereas proximal temperature and the distal-proximal gradient were not significantly different. In children with eczema, a higher distal temperature was associated with indicators of poor sleep quality, whereas lower distal temperature was related to more scratching events during sleep. In conclusion, our findings indicate complex interrelationships among eczema, thermoregulation and sleep, and further, that deficits in thermoregulatory mechanisms may contribute to sleep disturbances in children with eczema. Copyright © 2016 Elsevier B.V. All rights reserved.

A Study Comparing the Quality of Life of Patients in the Treatment of Eczema by Pediatric Generalists and Specialists

ClinicalTrials.gov

2018-01-09

Eczema; Dermatitis; Dermatitis, Atopic; Genetic Disease, Inborn; Hypersensitivity; Hypersensitivity, Immediate; Immune System Diseases; Skin Diseases; Skin Diseases, Eczematous; Skin Diseases, Genetic

Home environment and suspected atopic eczema in Japanese infants: the Osaka Maternal and Child Health Study.

PubMed

Miyake, Yoshihiro; Ohya, Yukihiro; Tanaka, Keiko; Yokoyama, Tetsuji; Sasaki, Satoshi; Fukushima, Wakaba; Ohfuji, Satoko; Saito, Kyoko; Kiyohara, Chikako; Hirota, Yoshio

2007-08-01

Atopic eczema is most commonly diagnosed in children under the age of 5 yr. Environmental factors during pregnancy or in early life may confer risk for childhood atopic eczema. The present prospective study examined the relationship of the perinatal home environment and the risk of suspected atopic eczema among Japanese infants under the age of 1. Study subjects were 865 parent-child pairs. The term 'suspected atopic eczema' was used to define an outcome based on our questionnaire at 2-9 months postpartum. Adjustment was made for maternal age, gestation, family income, maternal and paternal education, maternal and paternal history of asthma, atopic eczema, and allergic rhinitis, time of delivery before the second survey, baby's older siblings, baby's sex, and baby's birth weight. A high mite allergen level from maternal bedclothes and mold in the kitchen during pregnancy were significantly associated with an increased risk of suspected atopic eczema. Frequent vacuuming practices during pregnancy and giving the infant a bath or shower at least once a day were significantly inversely related to the risk of suspected atopic eczema. Maternal smoking, maternal use of a synthetic duvet and pillow, carpet use in the living room and maternal bedroom, indoor domestic pets, no ducted heating appliance, and gas use for cooking during pregnancy and household smoking in the same room as the infant, infant's synthetic duvet, carpet use in the infant's room, or vacuuming the infant's room were not related to the risk of suspected atopic eczema. High house dust mite allergen levels and mold in the kitchen during pregnancy may increase the risk of infantile atopic eczema, whereas frequent vacuuming practices during pregnancy and giving the infant a bath or shower at least once a day may protect against infantile atopic eczema.

Case-control study of eczema associated with IL13 genetic polymorphisms in Japanese children.

PubMed

Miyake, Yoshihiro; Kiyohara, Chikako; Koyanagi, Midori; Fujimoto, Takahiro; Shirasawa, Senji; Tanaka, Keiko; Sasaki, Satoshi; Hirota, Yoshio

2011-01-01

Several association studies have investigated the relationships between single nucleotide polymorphisms (SNPs) in the IL13 gene and eczema, with inconsistent results. We conducted a case-control study of the relationship between the polymorphisms of rs1800925 and rs20541 and the risk of eczema in Japanese children aged 3 years. Included were the 209 cases identified based on criteria of the International Study of Asthma and Allergies in Childhood (ISAAC). Controls were 451 children without eczema based on ISAAC questions who had not been diagnosed by a physician as having asthma or atopic eczema. The minor TT genotype of the rs1800925 SNP and the minor AA genotype of the rs20541 SNP were significantly related to an increased risk of eczema: adjusted odds ratio for the TT genotype was 2.78 (95% confidence interval 1.22-6.30) and that for the AA genotype was 2.38 (95% confidence interval 1.35-4.18). Haplotype analyses showed a protective association between the CG haplotype and eczema, whereas the TA haplotype was positively related to the risk of eczema. Perinatal smoking exposure did not interact with genotypes of the IL13 gene in the etiology of eczema. The significant association of the rs20541 SNP with eczema essentially disappeared after additional adjustment for the rs1800925 SNP, whereas a relationship with the rs1800925 SNP remained significant. A common genetic variation in the IL13 gene at the levels of both single SNPs and haplotypes was associated with eczema. However, the significant association with the rs20541 SNP might be ascribed to the rs1800925 SNP. Copyright © 2010 S. Karger AG, Basel.

Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative).

PubMed

Chalmers, J R; Simpson, E; Apfelbacher, C J; Thomas, K S; von Kobyletzki, L; Schmitt, J; Singh, J A; Svensson, Å; Williams, H C; Abuabara, K; Aoki, V; Ardeleanu, M; Awici-Rasmussen, M; Barbarot, S; Berents, T L; Block, J; Bragg, A; Burton, T; Bjerring Clemmensen, K K; Creswell-Melville, A; Dinesen, M; Drucker, A; Eckert, L; Flohr, C; Garg, M; Gerbens, L A A; Graff, A L B; Hanifin, J; Heinl, D; Humphreys, R; Ishii, H A; Kataoka, Y; Leshem, Y A; Marquort, B; Massuel, M-A; Merhand, S; Mizutani, H; Murota, H; Murrell, D F; Nakahara, T; Nasr, I; Nograles, K; Ohya, Y; Osterloh, I; Pander, J; Prinsen, C; Purkins, L; Ridd, M; Sach, T; Schuttelaar, M-L A; Shindo, S; Smirnova, J; Sulzer, A; Synnøve Gjerde, E; Takaoka, R; Vestby Talmo, H; Tauber, M; Torchet, F; Volke, A; Wahlgren, C-F; Weidinger, S; Weisshaar, E; Wollenberg, A; Yamaga, K; Zhao, C Y; Spuls, P I

2016-07-01

This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmö, Sweden on 23-24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient-reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient-reported symptoms were discussed [including the Patient-Oriented SCOring Atopic Dermatitis index, Patient-Oriented Eczema Measure (POEM), Self-Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient-reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms. © 2016 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Texting atopic dermatitis patients to optimize learning and eczema area and severity index scores: A pilot randomized control trial.

PubMed

Singer, Hannah M; Levin, Laura E; Morel, Kimberly D; Garzon, Maria C; Stockwell, Melissa S; Lauren, Christine T

2018-05-02

Atopic dermatitis is a common, chronic, debilitating disease. Poor adherence to treatment is the most important preventable contributor to adverse outcomes. Thus, improving adherence can improve patient outcomes. Text message reminders with embedded condition-specific information have been shown to improve pediatric immunization adherence but have not been assessed in atopic dermatitis. The objective was to assess the effect of daily text messages on Eczema Area Severity Index scores and caregiver knowledge of atopic dermatitis. In this pilot randomized controlled trial, caregivers of children with atopic dermatitis enrolled during their initial appointment with a pediatric dermatologist and randomized 1:1 to standard care or daily text messages with patient education material and treatment reminders. Participants completed a multiple-choice atopic dermatitis knowledge quiz at initial and follow-up visits, and Eczema Area Severity Index scores were assessed. Forty-two patients enrolled, and 30 completed the study: 16 standard care group, 14 text message group. There was no significant difference in Eczema Area Severity Index score between the standard care and text message groups at follow-up, with mean decreases in Eczema Area Severity Index score of 53% and 58%, respectively. Mean score on follow-up atopic dermatitis knowledge quiz was significantly higher in the text message group (84% correct) than in the standard care group (75% correct) (P = .04). This pilot study did not demonstrate a difference in Eczema Area Severity Index scores with text message reminders. The significantly higher follow-up atopic dermatitis quiz score in the text message group indicates that participants read and retained information from text messages. Limitations include small sample size and short duration of follow-up. © 2018 Wiley Periodicals, Inc.

Psychiatric disorders and symptoms severity in preschool children with atopic eczema.

PubMed

Catal, F; Topal, E; Soylu, N; Ozel Ozcan, O; Celiksoy, M H; Babayiğit, A; Karakoç, H T E; Erge, D; Sancak, R

2016-01-01

To compare with a control group the frequency of psychiatric disorders and severity of psychiatric symptoms in preschool children with atopic eczema. The study included children between the ages of 3-5 who were diagnosed to have atopic eczema. The parents of the children with atopic eczema were interviewed in person and were asked to fill in "The Early Childhood Inventory-4" form. This form assesses the psychiatric disorders and symptoms severity in children between the ages of 3-5. The atopic eczema group included 80 patients (38 male, 42 female) with a mean age of 48.4 ± 15.7 months and the control group included 74 patients (41 male, 33 female) with a mean age of 49.9 ± 15.19 months. It was established that 68.8% of the group with atopic eczema received at least one psychiatric diagnosis. Between the psychiatric disorders, ADHD (Odds ratio: 2.57, 95% CI: 1.049-6.298, p=0.035), enuresis and encopresis (Odds ratio: 2.39, 95% CI: 1.121-5.097, p=0.022) and attachment disorder (Odds ratio: 2.03, 95% CI: 1.046-3.953, p=0.035) were found to be significantly higher when compared with the healthy control group. When the groups were compared in terms of psychiatric symptom severity scores calculated by using ECI-4, ADHD severity (p=0.043), conduct disorder severity (p=0.001), anxiety disorders severity (p<0.001), eating disorders severity (p=0.011) and tic disorder severity (p=0.01) were found to be higher in the atopic eczema group. Psychiatric illnesses are frequent in preschool children with atopic eczema. Copyright © 2015 SEICAP. Published by Elsevier Espana. All rights reserved.

Stress in mothers of young children with eczema

PubMed Central

Faught, Jamie; Bierl, Cynthia; Barton, Belinda; Kemp, Andrew

2007-01-01

Objective To assess parental stress levels of mothers of children less than 6 years old with eczema and compare these levels with those reported for other chronic childhood illnesses. Methods Mothers were recruited from hospital‐based out‐patient clinics (55%) or while their child was an in‐patient (45%) for management of eczema. Maternal stress was measured utilising the Parenting Stress Index‐Long Form (PSI) in 33 mothers. The severity of the eczema at the time of interview was documented by the Eczema Area and Severity Index (EASI) score and the Investigators' Global Assessment (IGA) score. Results The children with eczema had a mean age of 2.8 years. Mothers of children aged 5 years or less with eczema exhibited significantly higher total stress scores (mean PSI 259.6, 95% CI 244.9 to 274.3) as compared to mothers of normal children (PSI 222.8, 95% CI 221.4 to 224.2) and children with other chronic disorders such as insulin‐dependent diabetes (PSI 218.1, 95% CI 204.7 to 231.6) and profound deafness (PSI 221.7, 95% CI 206.4 to 237.0). Stress scores in the parental domain (138.2, 95% CI 128.9 to 147.6) did not differ significantly from the scores of parents of children with severe disabilities such as those requiring home enteral feeding (135.2, 95% CI 129.3 to 141.1) and those with Rett syndrome (132.8, 95% CI 125.0 to 140.6). Conclusions Moderate to severe childhood eczema should be regarded as a significant illness in which maternal stress is equivalent to that associated with the care of children with severe developmental and physical problems. PMID:17412743

Ambient Air Pollution, Meteorological Factors and Outpatient Visits for Eczema in Shanghai, China: A Time-Series Analysis.

PubMed

Li, Qiao; Yang, Yingying; Chen, Renjie; Kan, Haidong; Song, Weimin; Tan, Jianguo; Xu, Feng; Xu, Jinhua

2016-11-08

Environmental irritants are important risk factors for skin diseases, but little is known about the influence of environmental factors on eczema incidence. In this time-series study, our objective was to examine the associations of environmental factors with outpatient visits for eczema. Daily outpatient visits between 2007 and 2011 (1826 days) were collected from Huashan Hospital in Shanghai, China. We used an overdispersed generalized additive model to investigate the short-term association between environmental factors and outpatient visits for eczema. Daily outpatient visits for eczema were significantly associated with air pollution and meteorological factors. For example, a 10 μg/m³ increase of 7-day (lag 06) average concentrations of PM 10 (particulate matter no greater than 10 microns), SO₂, NO₂ was associated with 0.81% (95% confidence intervals (CI) 0.39%, 1.22%), 2.22% (95% CI: 1.27%, 3.16%) and 2.31% (95% CI: 1.17%, 3.45%) increase in outpatient visits for eczema, respectively. A 10 °C elevation of temperature on lag 0 day were associated with 8.44% (95% CI: 4.66%, 12.22%) increase in eczema visits, whereas 10 unit decrease of 7-day average relative humidity were associated with 10.86% (95% CI: 8.83%, 12.89%) increase in eczema visits. This study provided clear evidence of ambient air pollution, high temperature and low relative humidity on increasing the incidence of eczema in Shanghai, China.

Bath additives for the treatment of childhood eczema (BATHE): protocol for multicentre parallel group randomised trial.

PubMed

Santer, Miriam; Rumsby, Kate; Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Chorozoglou, Maria; Wood, Wendy; Roberts, Amanda; Thomas, Kim S; Williams, Hywel C; Little, Paul

2015-11-01

Bath emollients are widely prescribed for childhood eczema, yet evidence of their benefits over direct application of emollients is lacking. Objectives To determine the clinical and cost-effectiveness of adding bath emollient to the standard management of eczema in children Pragmatic open 2-armed parallel group randomised controlled trial. General practitioner (GP) practices in England and Wales. Children aged over 12 months and less than 12 years with eczema, excluding inactive or very mild eczema (5 or less on Nottingham Eczema Severity Scale). Children will be randomised to either bath emollients plus standard eczema care or standard eczema care only. Primary outcome is long-term eczema severity, measured by the Patient-Oriented Eczema Measure (POEM) repeated weekly for 16 weeks. Secondary outcomes include: number of eczema exacerbations resulting in healthcare consultations over 1 year; eczema severity over 1 year; disease-specific and generic quality of life; medication use and healthcare resource use; cost-effectiveness. Aiming to detect a mean difference between groups of 2.0 (SD 7.0) in weekly POEM scores over 16 weeks (significance 0.05, power 0.9), allowing for 20% loss to follow-up, gives a total sample size of 423 children. We will use repeated measures analysis of covariance, or a mixed model, to analyse weekly POEM scores. We will control for possible confounders, including baseline eczema severity and child's age. Cost-effectiveness analysis will be carried out from a National Health Service (NHS) perspective. This protocol was approved by Newcastle and North Tyneside 1 NRES committee 14/NE/0098. Follow-up will be completed in 2017. Findings will be disseminated to participants and carers, the public, dermatology and primary care journals, guideline developers and decision-makers. ISRCTN84102309. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Bath additives for the treatment of childhood eczema (BATHE): protocol for multicentre parallel group randomised trial

PubMed Central

Santer, Miriam; Rumsby, Kate; Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Chorozoglou, Maria; Wood, Wendy; Roberts, Amanda; Thomas, Kim S; Williams, Hywel C; Little, Paul

2015-01-01

Introduction Bath emollients are widely prescribed for childhood eczema, yet evidence of their benefits over direct application of emollients is lacking. Objectives To determine the clinical and cost-effectiveness of adding bath emollient to the standard management of eczema in children Methods and analysis Design: Pragmatic open 2-armed parallel group randomised controlled trial. Setting: General practitioner (GP) practices in England and Wales. Participants: Children aged over 12 months and less than 12 years with eczema, excluding inactive or very mild eczema (5 or less on Nottingham Eczema Severity Scale). Interventions: Children will be randomised to either bath emollients plus standard eczema care or standard eczema care only. Outcome measures: Primary outcome is long-term eczema severity, measured by the Patient-Oriented Eczema Measure (POEM) repeated weekly for 16 weeks. Secondary outcomes include: number of eczema exacerbations resulting in healthcare consultations over 1 year; eczema severity over 1 year; disease-specific and generic quality of life; medication use and healthcare resource use; cost-effectiveness. Aiming to detect a mean difference between groups of 2.0 (SD 7.0) in weekly POEM scores over 16 weeks (significance 0.05, power 0.9), allowing for 20% loss to follow-up, gives a total sample size of 423 children. We will use repeated measures analysis of covariance, or a mixed model, to analyse weekly POEM scores. We will control for possible confounders, including baseline eczema severity and child's age. Cost-effectiveness analysis will be carried out from a National Health Service (NHS) perspective. Ethics and dissemination This protocol was approved by Newcastle and North Tyneside 1 NRES committee 14/NE/0098. Follow-up will be completed in 2017. Findings will be disseminated to participants and carers, the public, dermatology and primary care journals, guideline developers and decision-makers. Trial registration number ISRCTN84102309. PMID:26525422

Serum, cheek cell and breast milk fatty acid compositions in infants with atopic and non-atopic eczema.

PubMed

Laitinen, K; Sallinen, J; Linderborg, K; Isolauri, E

2006-02-01

The major theory implicating diet with allergic diseases is associated with altered food consumption and subsequent changes in fatty acid composition. To investigate fatty acid compositions among infants with atopic and non-atopic eczema and healthy infants and to evaluate the expediency of non-invasive cheek cell phospholipid fatty acid composition as a marker in patients with eczema. Diagnosis of eczema in infants was confirmed clinically and by positive (atopic eczema, n=6) or negative (non-atopic eczema, n=6) skin prick testing in comparison with controls (n=19). The fatty acid compositions of infant cheek cell and serum phospholipids and breast milk total lipids were analysed by gas chromatography. The distinction between atopic and non-atopic eczema was manifested in cheek cell phospholipids as linoleic acid (14.69 (13.67-15.53)% of total fatty acids; the median (interquartile range)), the sum of n-6 fatty acids (19.94 (19.06-20.53)%) and the sum of polyunsaturated fatty acids (22.70 (21.31-23.28)%) were higher in infants with atopic eczema compared with non-atopic eczema (12.69 (10.87-13.93); 17.72 (15.63-18.91) and 19.90 (17.64-21.06), respectively; P<0.05) and controls (12.50 (12.16-13.42); 18.19 (17.43-18.70) and 20.32 (19.32-21.03), respectively; P<0.05). Serum phospholipid gamma-linolenic acid was lower in both atopic and non-atopic eczema compared with controls (P<0.05) and additionally eicosapentaenoic acid was higher in atopic eczema compared with controls (P<0.05). These preliminary results suggest differences in fatty acid compositions between the two types of eczema, calling for further evaluation in a larger setting. The two types of eczema may be regulated by different immunological processes, and fatty acids may have a more profound role in the atopic type.

Pre- and post-natal exposure to antibiotics and the development of eczema, recurrent wheezing and atopic sensitization in children up to the age of 4 years.

PubMed

Dom, S; Droste, J H J; Sariachvili, M A; Hagendorens, M M; Oostveen, E; Bridts, C H; Stevens, W J; Wieringa, M H; Weyler, J J

2010-09-01

Little data are available on the relationship between indirect antibiotic exposure of the child in utero or during lactation and allergic diseases. On the other hand, several studies have been conducted on the association with direct post-natal antibiotic exposure, but the results are conflicting. The aim of this study was to investigate pre- and post-natal antibiotic exposure and the subsequent development of eczema, recurrent wheeze and atopic sensitization in children up to the age of 4 years. We conducted an aetiologic study in 773 children based on a prospective birth cohort project in which environmental and health information were collected using questionnaires. Antibiotic exposure was assessed as maternal antibiotic intake during pregnancy and during lactation and as medication intake of the child. The chronology of exposures and outcomes was taken into account during the data processing. At the age of 1 and 4 years, a blood sample was taken for the quantification of specific IgE. Prenatal antibiotic exposure was significantly positively associated with eczema, whereas no association was found with recurrent wheeze and atopic sensitization. We found a positive, although statistically not significant, association between antibiotic exposure through breastfeeding and recurrent wheeze. Neither eczema nor atopic sensitization was significantly associated with antibiotic exposure through breastfeeding. Finally, we observed a negative association between the use of antibiotics in the first year of life and eczema and atopic sensitization, and also between antibiotic use after the first year of life and recurrent wheeze, eczema and atopic sensitization. Indirect exposure to antibiotics (in utero and during lactation) increases the risk for allergic symptoms in children, while direct exposure to antibiotics appears to be protective. The biological mechanisms underlying these findings still need to be elucidated.

Patch test results in patients with allergic contact dermatitis in the Podlasie region

PubMed Central

Bacharewicz, Joanna; Pawłoś, Anna

2013-01-01

Introduction The aim of the study was to provide current data on the incidence of allergy to various contact allergens in patients with allergic contact eczema and the analysis of selected socio-demographic data of the patients. Material and methods The study included 1532 patients (1010 women and 522 men) treated for allergic contact dermatitis at the Department of Dermatology and Venereology and at the Dermatology Outpatient Clinic in Bialystok in 2007–2011. The assessment of selected demographic data and skin lesions was based on the MOAHFLA index, while the results of patch tests were analyzed with modified Baseline European Series consisting of 31 allergens. Results In the group of patients with eczema, 34.1% were men, and 55% of all respondents were people over 40 years of age. The occupational character of skin lesions was found in 22.5%. Most frequently (38.9%) skin lesions were localized on the hands, rarely involved legs (3.98%). Atopic dermatitis was diagnosed in 4.5% of patients. The ten most frequent allergens were: nickel sulfate (24%), cobalt chloride (15.3%), fragrance mix (8.25%), potassium dichromate (6.8%), balsam of Peru (5.5%), neomycin (4.42%), paraphenylenediamine (3.85%), Quatermium-15 (2.1%), detreomycin (1.83%) and budesonide (1.44% of tested patients). Conclusions Frequent allergy to detreomycin indicates the need of patch testing for this allergen of all examined patients with allergic contact dermatitis. The increased frequency of the nickel allergy is a worrying problem and indicates the need for education about the risk factors for nickel allergy development and the implementation of appropriate legal regulations. PMID:24493997

Management of contact dermatitis due to nickel allergy: an update

PubMed Central

Torres, Fernanda; das Graças, Maria; Melo, Mota; Tosti, Antonella

2009-01-01

Nickel is the major cause of allergic contact dermatitis in the general population, both among children and adults, as well as in large occupational groups. This metal is used in numerous industrial and consumer products, including stainless steel, magnets, metal plating, coinage, and special alloys, and is therefore almost impossible to completely avoid in daily life. Nickel contact dermatitis can represent an important morbidity, particularly in patients with chronic hand eczema, which can lead to inability to work, a decrease in quality of life and significant healthcare expenses. Therefore, its management is of great importance. This article reviews diagnostic, preventive and therapeutic strategies in this field. PMID:21436967

Health-related quality of life in adult dermatitis patients stratified by filaggrin genotype.

PubMed

Heede, Nina G; Thyssen, Jacob P; Thuesen, Betina H; Linneberg, Allan; Szecsi, Pal B; Stender, Steen; Johansen, Jeanne D

2017-03-01

Information concerning health-related quality of life (HRQoL) and comorbidities of adult dermatitis patients stratified by loss-of-function mutations in the filaggrin gene (FLG) is limited. To investigate HRQoL, skin symptoms and comorbidities in adult FLG mutation carriers. This cross-sectional study included patients diagnosed with atopic dermatitis and/or hand eczema (n = 520). Patients completed questionnaires about dermatitis, skin symptoms, HRQoL, and comorbidities, including actinic keratosis, and atopic and mental disorders. FLG mutations (R501X, 2282del4, and R2447X) were identified in 16.9% of patients, and were significantly associated not only with atopic dermatitis, but also independently with skin fissures on the fingers and heels, and self-reported actinic keratosis. Although FLG mutations were significantly associated with reduced HRQoL, as measured by use of the Dermatology Life Quality Index (DLQI), no association with self-reported anxiety or depression was identified. Notably, the highest median DLQI score, reflecting greater impairment, was reported by patients with both FLG mutations and atopic dermatitis. Overall, 19.7% of patients with both atopic dermatitis and FLG mutations reported a 'large or extremely large' impact on their lives; this represents twice the prevalence seen in patients with atopic dermatitis and wild-type FLG (9.6%). Patients with both atopic dermatitis and common FLG mutations are more frequently affected by reduced HRQoL. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

What Factors are Important to Patients when Assessing Treatment Response: An International Cross-sectional Survey.

PubMed

von Kobyletzki, Laura B; Thomas, Kim S; Schmitt, Jochen; Chalmers, Joanne R; Deckert, Stefanie; Aoki, Valeria; Weisshaar, Elke; Ojo, Jumoke Ahubelem; Svensson, Åke

2017-01-04

This study investigated the perspective of international patients on individual symptoms of atopic dermatitis (eczema) in determining treatment response. A questionnaire was developed to evaluate the importance of symptoms from the patient's perspective. Patients were asked: "How important are these features in deciding whether or not a treatment is working?", and rated symptoms on a 5-point Likert scale. Patients were approached via Harmonising Outcome Measures for Eczema (HOME) collaborators and self-selected to take part in the on-line survey. Patients from 34 countries (n = 1,111) completed the survey; of these, 423 (38.3%) were parents of children with eczema. Nine items were rated as being "quite important" or "very important" by more than 80% of the respondents: itch, pain/soreness, skin feels hot or inflamed, bleeding, involvement of visible or sensitive body sites, cracks, sleep difficulties, amount of body affected, and weeping/oozing. These results may be of use in determining the face validity of scales from a cross-cultural patients' perspective.

Patient-Oriented Eczema Measure (POEM), a core instrument to measure symptoms in clinical trials: a Harmonising Outcome Measures for Eczema (HOME) statement.

PubMed

Spuls, P I; Gerbens, L A A; Simpson, E; Apfelbacher, C J; Chalmers, J R; Thomas, K S; Prinsen, C A C; von Kobyletzki, L B; Singh, J A; Williams, H C; Schmitt, J

2017-04-01

The Harmonising Outcome Measures for Eczema (HOME) initiative has defined four core outcome domains for a core outcome set (COS) to be measured in all atopic eczema (AE) trials to ensure cross-trial comparison: clinical signs, symptoms, quality of life and long-term control. The aim of this paper is to report on the consensus process that was used to select the core instrument to consistently assess symptoms in all future AE trials. Following the HOME roadmap, two systematic reviews were performed which identified three instruments that had sufficient evidence of validity, reliability and feasibility to be considered for the final COS. At the fourth international HOME meeting, there was broad consensus among all stakeholders that the Patient-Oriented Eczema Measure (POEM) should be used as the core instrument (87·5% agreed, 9·4% unsure, 3·1% disagreed). All relevant stakeholders are encouraged to use POEM as the chosen instrument to measure the core domain of symptoms in all future AE clinical trials. Other instruments of interest can be used in addition to POEM. © 2016 British Association of Dermatologists.

IgE antibodies in relation to prevalence and multimorbidity of eczema, asthma, and rhinitis from birth to adolescence.

PubMed

Ballardini, N; Bergström, A; Wahlgren, C-F; van Hage, M; Hallner, E; Kull, I; Melén, E; Antó, J M; Bousquet, J; Wickman, M

2016-03-01

Eczema, asthma, and rhinitis affect a large proportion of children, but their prevalence varies with age. IgE antibodies are also common in the pediatric population. However, the links between IgE, disease, and trajectories are unclear. To better understand the links between sensitization and disease, we studied IgE sensitization ever in relation to eczema, asthma, and rhinitis, in children followed up to 16 years of age. From the Swedish population-based birth cohort BAMSE, 2607 children were included. Parental reports from six time points between 1 and 16 years were used to identify children with eczema, asthma, and rhinitis. Blood was collected at 4, 8, and 16 years, and sensitization ever was defined as allergen-specific IgE ≥0.35 kUA /l to common food and/or inhalant allergens at any time point. Odds ratios for eczema, asthma, rhinitis, and multimorbidity in relation to sensitization ever were calculated using generalized estimating equations. Fifty-one percent were sensitized at least once up to 16 years. Almost a quarter of ever-sensitized children did not have any disease. After adjustment for potential confounders, sensitization ever was significantly associated with the following: (i) eczema throughout childhood, (ii) multimorbidity of eczema, asthma, and rhinitis from 1 to 16 years (OR for multimorbidity: 5.11, 95% CI: 3.99-6.55), (iii) asthma and rhinitis from 4 to 16 years of age. Specific IgE is strongly associated with eczema and allergic multimorbidity throughout childhood and with asthma and rhinitis from age 4 years. However, 23% of the children with IgE sensitization do not develop any disease in childhood. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Gut microbiome and innate immune response patterns in IgE-associated eczema.

PubMed

West, C E; Rydén, P; Lundin, D; Engstrand, L; Tulic, M K; Prescott, S L

2015-09-01

Gut microbiome patterns have been associated with predisposition to eczema potentially through modulation of innate immune signalling. We examined gut microbiome development in the first year of life in relation to innate immune responses and onset of IgE-associated eczema over the first 2.5 years in predisposed children due to maternal atopy [www.anzctr.org.au, trial ID ACTRN12606000280505]. Microbial composition and diversity were analysed with barcoded 16S rRNA 454 pyrosequencing in stool samples in pregnancy and at ages 1 week, 1 month and 12 months in infants (n = 10) who developed IgE-associated eczema and infants who remained free of any allergic symptoms at 2.5 years of age (n = 10). Microbiome data at 1 week and 1 month were analysed in relation to previously assessed immune responses to TLR 2 and 4 ligands at 6 months of age. The relative abundance of Gram-positive Ruminococcaceae was lower at 1 week of age in infants developing IgE-associated eczema, compared with controls (P = 0.0047). At that age, the relative abundance of Ruminococcus was inversely associated with TLR2 induced IL-6 (-0.567, P = 0.042) and TNF-α (-0.597, P = 0.032); there was also an inverse association between the abundance of Proteobacteria (comprising Gram-negative taxa) and TLR4-induced TNF-α (rs = -0.629, P = 0.024). This relationship persisted at 1 month, with inverse associations between the relative abundance of Enterobacteriaceae (within the Proteobacteria phylum) and TLR4-induced TNF-α (rs = -0.697, P = 0.038) and Enterobacteriaceae and IL-6 (rs = -0.709, P = 0.035). Mothers whose infants developed IgE-associated eczema had lower α-diversity of Bacteroidetes (P = 0.04) although this was not seen later in their infants. At 1 year, α-diversity of Actinobacteria was lower in infants with IgE-associated eczema compared with controls (P = 0.002). Our findings suggest that reduced relative abundance of potentially immunomodulatory gut bacteria is associated with exaggerated inflammatory cytokine responses to TLR-ligands and subsequent development of IgE-associated eczema. © 2015 John Wiley & Sons Ltd.

A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion.

PubMed

Chen, Jennifer K; Jacob, Sharon E; Nedorost, Susan T; Hanifin, Jon M; Simpson, Eric L; Boguniewicz, Mark; Watsky, Kalman L; Lugo-Somolinos, Aida; Hamann, Carsten R; Eberting, Cheryl Lee; Silverberg, Jonathan I; Thyssen, Jacob P

2016-01-01

Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.

Polyvalent type IV sensitizations to multiple fragrances and a skin protection cream in a metal worker.

PubMed

Tanko, Zita; Shab, Arna; Diepgen, Thomas Ludwig; Weisshaar, Elke

2009-06-01

Fragrances are very common in everyday products. A metalworker with chronic hand eczema and previously diagnosed type IV sensitizations to epoxy resin, balsam of Peru, fragrance mix and fragrance mix II was diagnosed with additional type IV sensitizations to geraniol, hydroxycitronellal, lilial, tree moss, oak moss absolute, citral, citronellol, farnesol, Lyral, fragrance mix II and fragrance mix (with sorbitan sesquioleate). In addition, a type IV sensitization to the skin protection cream containing geraniol and citronellol used at the workplace was detected, and deemed occupationally relevant in this case. The patient could have had contact to fragrances through private use of cosmetics and detergents. On the other hand, the fragrance-containing skin protection cream supports occupational exposure. This case report demonstrates that fragrance contact allergy has to be searched for and clarified individually, which requires a thorough history and a detailed analysis of the work place.

Preconceptional and perinatal exposure to traffic-related air pollution and eczema in preschool children.

PubMed

Lu, Chan; Deng, Linjing; Ou, Cuiyun; Yuan, Hong; Chen, Xiang; Deng, Qihong

2017-02-01

Evidence linking prenatal exposure to outdoor air pollution with eczema in early childhood is scare, and the role of components of air pollution and exposure timing remains unclear. We investigated the association between exposure to air pollution during preconceptional and perinatal period and the risk of eczema in preschool children. We conducted a prospective cohort study of 2598 children aged 3-6 years in Changsha, China. The prevalence of eczema was assessed by a standardized health questionnaire administered by the parents. Individual exposures to nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ) and particulate matter with an aerodynamic diameter≤10μm (PM 10 ) during the 4th-6th and 1st-3rd month before pregnancy, entire pregnancy, and three trimesters were estimated by an inverse distance weighted (IDW) method based on concentrations measured at monitoring stations. Association between childhood eczema and exposure to air pollution was examined by logistic regression models in terms of odds ratio (OR) and 95% confidence interval (CI) for an interquartile range (IQR) increase in exposure. Life-time prevalence of eczema in preschool children in Changsha was 28.6%. Childhood eczema was associated with traffic-related air pollutant NO 2 during 3 months before pregnancy and entire pregnancy with adjusted ORs=1.19 (95% CI: 1.04-1.37) and 1.21 (95% CI: 1.03-1.42) respectively. The highest risk of eczema was observed for the 1st trimester exposure to NO 2 [OR=1.26 (95% CI: 1.09-1.46)]. However, no association was detected for SO 2 and PM 10 exposure during any window. High-level exposure to NO 2 during the whole time period significantly increased the effect of NO 2 in all windows on eczema risk as compared with low-level exposure. Sensitivity analysis indicated that the association between both preconceptional and perinatal exposure to NO 2 and childhood eczema was consistent and robust, and this association was modified by some personal, parental hereditary and indoor environmental factors. Our findings support the hypothesis that early childhood eczema is associated with exposure to traffic-related air pollutant during both preconceptional and perinatal period, especially at a high level of exposure. Copyright © 2016 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

The capsaicin cough reflex in eczema patients with respiratory symptoms elicited by perfume.

PubMed

Elberling, Jesper; Dirksen, Asger; Johansen, Jeanne Duus; Mosbech, Holger

2006-03-01

Respiratory symptoms elicited by perfume are common in the population but have unclear pathophysiology. Increased capsaicin cough responsiveness has been associated with the symptoms, but it is unknown whether the site of the symptoms in the airways influences this association. The aim of this study was to investigate the association between the site of airway symptoms elicited by perfume and cough responsiveness to bronchial challenge with capsaicin. 21 eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex- and age-matched case control study. The participants completed a symptom questionnaire and underwent a bronchial challenge with capsaicin. Lower, but not upper, respiratory symptoms elicited by perfume were associated with increased capsaicin cough responsiveness. Having severe symptoms to perfume (n=11) did not relate to the site of the symptoms in the airways and was not associated with increased capsaicin cough responsiveness. In conclusion, respiratory symptoms elicited by perfume may reflect local hyperreactivity related to defensive reflexes in the airways, and measurements of the capsaicin cough reflex are relevant when patients with lower respiratory symptoms related to environmental perfume exposures are investigated.

Mild eczema affects self-perceived health among pre-adolescent girls.

PubMed

Ballardini, Natalia; Östblom, Eva; Wahlgren, Carl-Fredrik; Kull, Inger

2014-05-01

The aim was to assess the impact of eczema on health-related quality of life in the population-based birth cohort BAMSE with 2,756 pre-adolescent children. All answered the following questions on self-perceived health; "How are you feeling?", "How healthy do you consider yourself to be?" and "How happy are you with your life right now?". Children with ongoing eczema answered the "Children's Dermatology Life Quality Index (CDLQI)" questionnaire. In total, 350 (12.7%) of the children had eczema. Girls with eczema reported impaired self-perceived health as evaluated in the 3 questions; adjusted OR 1.72 (95% CI 1.16-2.55), 1.89 (95% CI 1.29-2.76) and 1.69 (95% CI 1.18-2.42). Eczema among boys was not associated with impairment of self-perceived health. The mean CDLQI score was 3.98 (95% CI 3.37-4.58). Since eczema affects up to 20% of pre-adolescent girls, the findings have implications both for health care providers and for society as a whole.

Use of Topical Corticosteroids in Dermatology: An Evidence-based Approach

PubMed Central

Das, Anupam; Panda, Saumya

2017-01-01

Topical corticosteroids (TCs) are the pillars of dermatotherapeutics. These drugs are the “magic molecules,” provided they are used judiciously and appropriately, following a rational prescription. On exhaustive literature search in multiple databases, we found a significant evidence favoring the use of TCs in atopic eczema, localized vitiligo, psoriasis, chronic hand eczema, and localized bullous pemphigoid. However, contrary to conventional wisdom, we did not find any high-level scientific evidence in support of prescribing TCs in cutaneous lichen planus, sarcoidosis, and seborrhoeic dermatitis. Besides, evidence clearly advocates judicious use of mild-to-moderate corticosteroids (if required) in pregnancy and lactation and there is no risk of any fetal abnormality. PMID:28584365

Measurement properties of quality of life measurement instruments for infants, children and adolescents with eczema: protocol for a systematic review.

PubMed

Heinl, Daniel; Prinsen, Cecilia A C; Drucker, Aaron M; Ofenloch, Robert; Humphreys, Rosemary; Sach, Tracey; Flohr, Carsten; Apfelbacher, Christian

2016-02-09

Eczema is a common chronic or chronically relapsing, inflammatory skin disease that exerts a substantial negative impact on quality of life (QoL). The Harmonising Outcome Measures for Eczema (HOME) initiative has used a consensus-based process which identified QoL as one of the four core outcome domains to be assessed in all eczema clinical trials. A number of measurement instruments exist to measure QoL in infants, children, and adolescents with eczema, and there is a great variability in both content and quality of the instruments used. Therefore, the objective of the proposed research is to comprehensively and systematically assess the measurement properties of the existing measurement instruments that were developed and/or validated for the measurement of patient-reported QoL in infants, children, and adolescents with eczema. This study is a systematic review of the measurement properties of patient-reported measures of QoL developed and/or validated for infants, children, and adolescents with eczema. A systematic literature search will be carried out in MEDLINE via PubMed and EMBASE using a selection of relevant search terms. Eligible studies will be primary empirical studies evaluating, describing, or comparing measurement properties of QoL instruments for infants, children, and adolescents with eczema. Two reviewers will independently perform eligibility assessment and data abstraction. Evidence tables will be used to record study characteristics, instrument characteristics, measurement properties, and interpretability. The adequacy of the measurement properties will be assessed using predefined criteria. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist will be used to evaluate the methodological quality of included studies. A best evidence synthesis will be undertaken if more than one study has examined a particular measurement property. The proposed systematic review will yield a comprehensive assessment of measurement properties of existing QoL instruments in infants, children, and adolescents with eczema. The results will serve as a basis to recommend a QoL measurement instrument for infants, one for children, and one for adolescents for use in future clinical trials. PROSPERO CRD42015023483.

IL13 genetic polymorphisms, smoking, and eczema in women: a case-control study in Japan.

PubMed

Miyake, Yoshihiro; Tanaka, Keiko; Arakawa, Masashi

2011-10-21

Several genetic association studies have examined the relationships between single nucleotide polymorphisms (SNPs) in the IL13 gene and eczema, and have provided contradictory results. We investigated the relationship between the IL13 SNPs rs1800925 and rs20541 and the risk of eczema in Japanese young adult women. Included were 188 cases who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for eczema. Control subjects were 1,082 women without eczema according to the ISAAC criteria, who had not been diagnosed with atopic eczema by a doctor and who had no current asthma as defined by the European Community Respiratory Health Survey criteria. Adjustment was made for age, region of residence, number of children, smoking, and education. The minor TT genotype of SNP rs1800925 was significantly associated with an increased risk of eczema in the co-dominant model: the adjusted odds ratio was 2.19 (95% confidence interval: 1.03-4.67). SNP rs20541 was not related to eczema. None of the haplotypes were significantly associated with eczema. Compared with women with the CC or CT genotype of SNP rs1800925 who had never smoked, those with the TT genotype who had ever smoked had a 2.85-fold increased risk of eczema, though the adjusted odds ratio was not statistically significant, and neither multiplicative nor additive interaction was statistically significant. Our findings suggest that the IL13 SNP rs1800925 is significantly associated with eczema in Japanese young adult women. We could not find evidence for an interaction between SNP rs1800925 and smoking with regard to eczema.

IL5RA polymorphisms, smoking and eczema in Japanese women: the Kyushu Okinawa Maternal and Child Health Study.

PubMed

Miyake, Y; Tanaka, K; Arakawa, M

2015-02-01

The present case-control study examined the relationship between IL5RA SNPs and eczema in young adult Japanese women. Cases and control subjects were selected from pregnant women who participated in the baseline survey of the Kyushu Okinawa Maternal and Child Health Study, which is an ongoing prebirth cohort study. Cases comprised 188 women with eczema in the previous 12 months as defined according to the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC), regardless of the presence of a doctor's diagnosis of atopic eczema. Control subjects comprised 1130 women without eczema as defined according to the ISAAC criteria who also had not been diagnosed with atopic eczema by a doctor. Compared with the AA genotype of IL5RA SNP rs17881144, the AT genotype, but not the TT genotype, was significantly associated with a decreased risk of eczema. The ATTAGA haplotype and the GTAGCA haplotype of rs17882210, rs3804797, rs334809, rs9831572, rs6771148 and rs17881144 were significantly associated with an increased risk of eczema. In contrast, the GCTGCA haplotype was significantly related to a decreased risk of eczema. Multiplicative interactions between IL5RA SNPs rs334809 and rs17881144 and smoking with respect to eczema were marginally significant (P = 0.07 and 0.07, respectively). This is the first study to show significant associations between IL5RA SNP rs17881144, the ATTAGA haplotype, the GTAGCA haplotype, and the GCTGCA haplotype and eczema. Smoking may modify the relationships between SNPs rs334809 and rs17881144 and eczema. © 2014 John Wiley & Sons Ltd.

Prenatal Exposure to Butylbenzyl Phthalate and Early Eczema in an Urban Cohort

PubMed Central

Whyatt, Robin M.; Perzanowski, Matthew S.; Calafat, Antonia M.; Perera, Frederica P.; Goldstein, Inge F.; Chen, Qixuan; Rundle, Andrew G.; Miller, Rachel L.

2012-01-01

Background: Recent cross-sectional studies suggest a link between butylbenzyl phthalate (BBzP) in house dust and childhood eczema. Objectives: We aimed to evaluate whether concentrations of monobenzyl phthalate (MBzP), the main BBzP metabolite in urine, during pregnancy are associated prospectively with eczema in young children, and whether this association varies by the child’s sensitization to indoor allergens or serological evidence of any allergies. Methods: MBzP was measured in spot urine samples during the third trimester of pregnancy from 407 African-American and Dominican women residing in New York City in 1999–2006. Repeated questionnaires asked mothers whether their doctor ever said their child had eczema. Child blood samples at 24, 36, and 60 months of age were analyzed for total, anti-cockroach, dust mite, and mouse IgE. Relative risks (RR) were estimated with multivariable modified Poisson regression. Analyses included a multinomial logistic regression model for early- and late-onset eczema versus no eczema through 60 months of age. Results: MBzP was detected in > 99% of samples (geometric mean = 13.6; interquartile range: 5.7–31.1 ng/mL). By 24 months, 30% of children developed eczema, with the proportion higher among African Americans (48%) than among Dominicans (21%) (p < 0.001). An interquartile range increase in log MBzP concentration was associated positively with early-onset eczema (RR = 1.52 for eczema by 24 months; 95% confidence interval: 1.21, 1.91, p = 0.0003, n = 113 reporting eczema/376 total sample), adjusting for urine specific gravity, sex, and race/ethnicity. MBzP was not associated with allergic sensitization, nor did seroatopy modify consistently the MBzP and eczema association. Conclusions: Prenatal exposure to BBzP may influence the risk of developing eczema in early childhood. PMID:22732598

Polymorphisms in the interleukin 13 and GATA binding protein 3 genes and the development of eczema during childhood

PubMed Central

Arshad, S.H.; Karmaus, W.; Kurukulaaratchy, R.; Sadeghnejad, A.; Huebner, M.; Ewart, S.

2009-01-01

Summary Background Atopic eczema is characterized by Th2-dominant immunity with the cytokine interleukin 13 and the transcription factor GATA binding protein 3 playing a critical role. Objectives We assessed the association of polymorphisms in the IL13 and GATA3 genes with childhood eczema. Methods A birth cohort (n = 1456) was established on the Isle of Wight in 1989 and followed at the ages of 1 (n = 1167), 2 (n = 1174), 4 (n = 1218) and 10 years (n = 1373) to determine the prevalence of allergic disease including eczema. At 4 and 10 years, skin prick testing was performed. Whole blood samples (n = 923) were obtained at the 10-year assessment, stored frozen, and genotyped. Five polymorphisms from IL13 and seven from GATA3 were genotyped for this analysis. Repeated measurement analyses were conducted for the occurrence of eczema at ages 1, 2, 4 and 10 years. All analyses were adjusted for maternal and paternal eczema, low birth weight (< 2500 g), breastfeeding ≥ 3 months and age. Results IL13 was not associated with childhood eczema. For GATA3, the single nucleotide polymorphism (SNP) rs2275806 (promoter region) showed an increased odds ratio for atopic eczema independent of whether the comparison group had a positive skin prick test. The SNP rs444762 (intron 3 region) was associated with atopic eczema in comparison with children without eczema. The increased relative risks remained significant after adjustment for multiple testing only for rs2275806 (P < 0Æ05). Conclusions A SNP in GATA3 is associated with atopic eczema. This finding highlights the importance of GATA3 as an immune-modulating gene in atopic eczema. PMID:18410415

IL13 genetic polymorphisms, smoking, and eczema in women: a case-control study in Japan

PubMed Central

2011-01-01

Background Several genetic association studies have examined the relationships between single nucleotide polymorphisms (SNPs) in the IL13 gene and eczema, and have provided contradictory results. We investigated the relationship between the IL13 SNPs rs1800925 and rs20541 and the risk of eczema in Japanese young adult women. Methods Included were 188 cases who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for eczema. Control subjects were 1,082 women without eczema according to the ISAAC criteria, who had not been diagnosed with atopic eczema by a doctor and who had no current asthma as defined by the European Community Respiratory Health Survey criteria. Adjustment was made for age, region of residence, number of children, smoking, and education. Results The minor TT genotype of SNP rs1800925 was significantly associated with an increased risk of eczema in the co-dominant model: the adjusted odds ratio was 2.19 (95% confidence interval: 1.03-4.67). SNP rs20541 was not related to eczema. None of the haplotypes were significantly associated with eczema. Compared with women with the CC or CT genotype of SNP rs1800925 who had never smoked, those with the TT genotype who had ever smoked had a 2.85-fold increased risk of eczema, though the adjusted odds ratio was not statistically significant, and neither multiplicative nor additive interaction was statistically significant. Conclusions Our findings suggest that the IL13 SNP rs1800925 is significantly associated with eczema in Japanese young adult women. We could not find evidence for an interaction between SNP rs1800925 and smoking with regard to eczema. PMID:22013915

Severity of eczema and mental health problems in Japanese schoolchildren: The ToMMo Child Health Study.

PubMed

Kuniyoshi, Yasutaka; Kikuya, Masahiro; Miyashita, Masako; Yamanaka, Chizuru; Ishikuro, Mami; Obara, Taku; Metoki, Hirohito; Nakaya, Naoki; Nagami, Fuji; Tomita, Hiroaki; Hozawa, Atsushi; Tsuji, Ichiro; Kure, Shigeo; Yaegashi, Nobuo; Yamamoto, Masayuki; Kuriyama, Shinichi

2018-04-13

The association between eczema and mental health problems in schoolchildren has been underexplored. We aimed to investigate this association with the validated questionnaires. Of 46,648 invited children, we analyzed 9954 (21.3%) in the 2nd to the 8th grades from the ToMMo Child Health Study conducted in 2014 and 2015, a cross-sectional survey in Miyagi Prefecture, Japan. We defined eczema status as "normal," "mild/moderate," or "severe," based on the presence of persistent flexural eczema and sleep disturbance, according to the International Study of Asthma and Allergies in Childhood (ISAAC) Eczema Symptom Questionnaire. Clinical ranges of Strengths and Difficulties Questionnaire (SDQ) total difficulties scores and four SDQ subcategories of emotional symptoms, conduct problems, hyperactivity/inattention, and peer problems were defined as scores ≥16, ≥5, ≥5, ≥7, and ≥5, respectively. The mean SDQ total difficulties score significantly increased as eczema status worsened (all P ≤ 0.004 for trend). The OR of scores in the clinical range for SDQ total difficulties were 1.51 (95% CI, 1.31-1.74) for mild/moderate eczema and 2.63 (95% CI, 1.91-3.63) for severe eczema (P < 0.001 for trend), adjusted for sex, school grade, current wheeze, and disaster-related factors, using normal eczema as a reference. The association between severity of eczema and four SDQ subcategories showed a similar trend (all P ≤ 0.017 for trend). We found a significant association between severity of eczema and mental health problems. The presence of eczema was associated with four SDQ subcategories. Copyright © 2018 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Recent studies of cutaneous nociception in atopic and non-atopic subjects.

PubMed

Heyer, G R; Hornstein, O P

1999-02-01

Itching reflects a distinct quality of cutaneous nociception elicited by chemical or other stimuli to neuronal receptors at the superficial layers of the skin and muco-cutaneous orifices. Although recent experimental studies of the conduction and perception of itch have yielded deeper insight into the physiology of this sensory quality, little is known about the neuromechanisms involved in pruritus accompanying many inflammatory skin diseases, in particular, in atopic eczema. Previous case-control studies of our research group with patients suffering from atopic eczema (AE) revealed significantly diminished itch perception after iontophoretic application of different doses of histamine as well as substance P (i.c. injected). Further experiments using acetylcholine (ACh, i.c.) clearly demonstrated that ACh elicits pruritus instead of pain in patients with AE. The first part of the present review deals with the results of our most recent case-control studies on histamine-induced itch perception in atopics devoid of eczema as well as in patients with urticaria or psoriasis compared to atopics with or without manifest eczema. We demonstrated that both focal itch and perifocal alloknesis (i.e., itch elicited by a slight mechanical, otherwise non-itching stimulus) were significantly reduced in eczema-free atopics yet were normal in non-atopics suffering from urticaria or psoriasis. In further studies using ACh i.c. injected into the uninvolved skin of patients with AE, lichen ruber, psoriasis, type IV contact eczema, or non-specific nummular eczema (n = 10/each group), all the atopics and 6/10 psoriatics felt itch instead of burning pain, but none of the others did. Different doses of vasoactive intestinal peptide (VIP) i.c. applied to the controls and the atopics with or without eczema did not markedly increase the intensity of nociceptive sensations. However, ACh induced pain in the controls, pure pruritus in the atopics with acute eczema, and a 'mixture' of pain and itch in the atopics just free from eczema. Obviously, the quality of sensations evoked by ACh and VIP depends on the inflammatory or non-inflammatory state of the atopic skin. In a placebo-controlled, double blind study on histamine-induced focal itch and alloknesis with healthy subjects (n = 15) using naltrexone (opioid receptor antagonist) and cetirizine (H1-blocking agent), naltrexone was found to significantly reduce both itching and alloknesis. Cetirizine reduced focal itch but failed to influence the alloknesis phenomenon. The wheal and flare reaction was suppressed only by cetirizine. These different effects point to a mainly CNS-based activity of naltrexone but a peripheral level effect of cetirizine. Due to long-lasting experience with group sport as a supporting adjuvant for inpatients with AE, we evaluated, by clinical, psychometric, and physiological studies, the therapeutic efficacy of controlled physical exercise in addition to otherwise equal anti-eczematous therapy for both voluntary participants and non-participants in sports by performing several case-control studies, one followed-up to 6 months after the patients' discharge from the hospital. Regular moderate exercises neither deteriorated nor impeded the recovery from AE, ameliorated the participants' scratch controlling ability and significantly their depressed emotional mood. The non-participants failed to achieve these aims. Sweating-induced itch was inhibited in almost all participants if simple skin care (clearing by warm shower, ointment) and short-term rest were used by informed patients. In conclusion, there are several indications that itching is elicited in individuals inclined to cutaneous atopy, regardless of their eczematous or just eczema-free state, by a different physiological pathway from that in non-atopic individuals. Therefore, antipruritic agents influencing the centrally altered nociception of atopics are needed and may be expected in near future. (ABSTRACT TRUNCATED)

The eczema risk variant on chromosome 11q13 (rs7927894) in the population-based ALSPAC cohort: a novel susceptibility factor for asthma and hay fever.

PubMed

Marenholz, Ingo; Bauerfeind, Anja; Esparza-Gordillo, Jorge; Kerscher, Tamara; Granell, Raquel; Nickel, Renate; Lau, Susanne; Henderson, John; Lee, Young-Ae

2011-06-15

In a genome-wide association study, a common variant on chromosome 11q13.5 (rs7927894[T]) has been identified as a susceptibility locus for eczema. We aimed to analyze the effect of this risk variant on asthma and hay fever and to determine its impact on the general population level in over 9300 individuals of the prospectively evaluated Avon Longitudinal Study of Parents and Children birth cohort. We demonstrate an association of rs7927894[T] with atopic asthma and with hay fever. The largest effect sizes were found in patients with the combined phenotype atopic asthma plus eczema [odds ratio (OR) = 1.50; 95% confidence interval (CI) 1.20-1.88; P = 3.7 × 10(-4)] and hay fever plus eczema (OR = 1.37; 95% CI 1.15-1.62; P = 3.8 × 10(-4)). We replicated the effects of rs7927894[T] on eczema-associated asthma and hay fever independently in the German GENUFAD (GEnetic studies in NUclear Families with Atopic Dermatitis) study and show that they are significantly larger than the effect observed in eczema. The estimated population attributable risk fractions for eczema, eczema-associated atopic asthma or hay fever were 9.3, 24.9 and 23.5%, respectively. Finally in eczema, we found a synergistic interaction of rs7927894[T] with filaggrin gene (FLG) mutations, which are a major cause of epidermal barrier dysfunction, and replicated the interaction in the German Multicenter Allergy Study birth cohort. The synergistic effect of rs7927894[T] and FLG mutations on eczema risk as well as the association of both variants with eczema-associated atopic asthma and hay fever point to an involvement of rs7927894[T] in a functional pathway that is linked to the barrier defect.

Is Patch Testing with Food Additives Useful in Children with Atopic Eczema?

PubMed

Catli, Gonul; Bostanci, Ilknur; Ozmen, Serap; Dibek Misirlioglu, Emine; Duman, Handan; Ertan, Ulker

2015-01-01

Atopy patch testing is a useful way to determine delayed-type hypersensitivity reactions to foods and aeroallergens. Although food additives have been accused of worsening atopic eczema symptoms, according to recent studies the role of food additives in atopic eczema remains unclear. The purpose of our study was to investigate food additive hypersensitivity in a group of children with atopic eczema by using standardized atopy patch testing and to determine the role of food additive hypersensitivity in atopic eczema. Thirty-four children with atopic eczema and 33 healthy children were enrolled in the study. Children who consumed foods containing additives and did not use either antihistamines or local or systemic corticosteroids for at least 7 days prior to admission were enrolled in the study. All children were subjected to atopy patch testing and after 48 and 72 hours their skin reactions were evaluated by using the guidelines. Positive atopy patch test results were significantly higher in the atopic eczema group. Forty-one percent of the atopic eczema group (n = 14) and 15.2% (n = 5) of the control group had positive atopy patch test results with food additives (p = 0.036) (estimated relative risk 1.68, case odds 0.7, control odds 0.17). Carmine hypersensitivity and the consumption of foods containing carmine, such as gumdrops, salami, and sausage, were significantly higher in the children with atopic eczema. This is the first study investigating hypersensitivity to food additives in children with atopic eczema. Our results indicate that carmine may play a role in atopic eczema. © 2015 Wiley Periodicals, Inc.

Psychological disturbance in atopic eczema: the extent of the problem in school-aged children.

PubMed

Absolon, C M; Cottrell, D; Eldridge, S M; Glover, M T

1997-08-01

Although psychological factors are widely considered to be important in atopic eczema, there have been few controlled studies to assess the extent of disturbance in affected children and the problems experienced by their parents. This study was designed to find out the degree of psychological difficulty experienced by children with atopic eczema, whether their mothers show higher levels of mental distress than a comparison group, and whether the families of children with atopic eczema have less social support than the comparison group. We investigated 30 school-aged children with atopic eczema for psychological problems using the Rutter parent scale and compared them with 30 children with relatively minor skin lesions such as viral warts. Mental distress in mothers was assessed using the General Health Questionnaire. The Family Support Scale was used to get a measure of the social support experienced by the families. We found twice the rate of psychological disturbance in children in the eczema group compared with the control group. This difference was statistically significant for children with moderately severe eczema and severe eczema, but not for children with very mild eczema. Levels of mental distress were no greater in mothers of children with eczema than in parents of the control group and there was no difference in the degree of social support experienced by their families. These findings indicate that school-aged children with moderate and severe atopic eczema are at high risk of developing psychological difficulties, which may have implications for their academic and social development.

Fluctuations in the prevalence of chromate allergy in Denmark and exposure to chrome-tanned leather.

PubMed

Carøe, Caroline; Andersen, Klaus E; Thyssen, Jacob P; Mortz, Charlotte G

2010-12-01

A recent Danish study showed a significant increase in the prevalence of chromate contact allergy after the mid-1990s, probably as a result of exposure to leather products. To reproduce the results by analysing data from the period 1992-2009 at Odense University Hospital, Denmark. The temporal development in the occurrence of chromate contact allergy and assumed causative exposures were investigated. A retrospective analysis of patch test data was performed (n = 8483), and medical charts from patients with chromate allergy (n = 231) were reviewed. Comparisons were made using the χ(2) -test. A test of the reproducibility of the TRUE Test® was also performed. Logistic regression analyses were used to test for associations. No significant changes in the prevalence or exposure sources of chromate allergy during 1992-2009 were identified. Leather shoes (24.4%) were the most frequent exposure sources in chromate allergy, and were mainly registered in women, although the difference between men and women was not significant (P = 0.07). Cement and leather glove exposure occurred significantly more often in men than in women (P = 0.002). Foot dermatitis (40.3%) was the most frequent anatomical location, apart from hand eczema (60.6%). The reproducibility of the TRUE Test® was 93.3%. Apart from hand eczema, the most frequent clinical picture of chromate allergy was foot dermatitis caused by leather shoe exposure. A tendency for an increasing prevalence of chromate contact allergy from 1997 was shown, but no significant change was detectable. © 2010 John Wiley & Sons A/S.

Breast-feeding reduces the risk for childhood eczema.

PubMed

Kull, Inger; Böhme, Maria; Wahlgren, Carl-Fredrik; Nordvall, Lennart; Pershagen, Göran; Wickman, Magnus

2005-09-01

The evidence for a preventive effect of breast-feeding on the development of eczema in childhood remains controversial. To investigate the effect of breast-feeding in various phenotypes of eczema to 4 years. A birth cohort of 4089 children made up the study base. Data on breast-feeding, allergic symptoms, and potential confounders were obtained from questionnaires when the children were 2 months and 1, 2, and 4 years old. At 4 years, blood specific IgE was analyzed. Children with symptoms of eczema and asthma during the period of breast-feeding were excluded in most analyses on risk assessment of eczema and asthma, respectively, to avoid disease-related modification of exposure. Exclusive breast-feeding for >or=4 months reduced the risk for eczema at the age of 4 years (odds ratio [OR], 0.78; 95% CI, 0.63--0.96) irrespective of combination with asthma, sensitization to common allergens, or parental allergic disease. This decreased risk was most evident for children with onset of eczema during the first 2 years persisting to 4 years (OR, 0.59; 95% CI, 0.45--0.77). Among children with early-onset eczema, irrespective of persistency, followed by late onset of asthma or early-onset asthma irrespective of persistency, followed by late-onset eczema to 4 years, a protective effect of breast-feeding was also seen (OR, 0.48; 95% CI, 0.30--0.76). Breast-feeding 4 months or more reduces the risk for eczema and onset of the allergy march to age 4.

Risk factors for work-related eczema and urticaria among vocational students of agriculture.

PubMed

Śpiewak, Radosław; Góra-Florek, Anna; Horoch, Andrzej; Jarosz, Mirosław J; Doryńska, Agnieszka; Golec, Marcin; Dutkiewicz, Jacek

2017-12-23

Farmers are at high risk of occupational skin diseases which may start already during vocational training. This study was aimed at identification of risk factors for work-related skin diseases among vocational students of agriculture. The study involved 440 students (245 males, 195 females aged 17-21 years) in 11 vocational schools which were at least 100 km from each other. The protocol included a physician-managed questionnaire and medical examination, skin prick tests, patch tests, total IgE and Phadiatop. Logistic regression model was used for the identification of relevant risk factors. Work-related dermatoses were diagnosed in 29 study participants (6.6%, 95%CI: 4.3-8.9%): eczema in 22, urticaria in 14, and co-existence of both in 7 students. Significant risk factors for work-related eczema were: history of respiratory allergy (OR=10.10; p<0.001), history of eczema (itchy rash) provoked by wet work and detergents before entering the school (OR=5.85; p<0.001), as well as history of contact dermatitis to metals, rubber or cosmetics prior to inscription (OR=2.84; p=0.016), and family history of any skin disease (OR=2.99; p=0.013). Significant risk factors for work-related urticaria were: history of allergic rhinitis and asthma prior to inscription (OR=7.29; p=0.006), positive skin prick tests to work place allergens (OR=4.65; p=0.002) and to environmental allergens (OR=3.79; p=0.009), and positive Phadiatop test (OR=3.61; p=0.013). Work-related skin diseases are common among vocational students of agriculture. Atopy, past history of asthma, allergic rhinitis, and eczema (either atopic, allergic or irritant) are relevant risk factors for work-related eczema and urticaria in young farmers, along with family history of any skin disease. Positive skin prick tests seem relevant, especially in the case of urticaria. Asking simple, aimed questions during health checks while enrolling students into agricultural schools would suffice to identify students at risk for work-related eczema and urticaria, giving them the chance for selecting a safer profession, and hopefully avoiding an occupational disease in the future.

Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016.

PubMed

Saeki, Hidehisa; Nakahara, Takeshi; Tanaka, Akio; Kabashima, Kenji; Sugaya, Makoto; Murota, Hiroyuki; Ebihara, Tamotsu; Kataoka, Yoko; Aihara, Michiko; Etoh, Takafumi; Katoh, Norito

2016-10-01

Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice. © 2016 Japanese Dermatological Association.

Evaluating Written Patient Information for Eczema in German: Comparing the Reliability of Two Instruments, DISCERN and EQIP

PubMed Central

McCool, Megan E.; Wahl, Josepha; Schlecht, Inga; Apfelbacher, Christian

2015-01-01

Patients actively seek information about how to cope with their health problems, but the quality of the information available varies. A number of instruments have been developed to assess the quality of patient information, primarily though in English. Little is known about the reliability of these instruments when applied to patient information in German. The objective of our study was to investigate and compare the reliability of two validated instruments, DISCERN and EQIP, in order to determine which of these instruments is better suited for a further study pertaining to the quality of information available to German patients with eczema. Two independent raters evaluated a random sample of 20 informational brochures in German. All the brochures addressed eczema as a disorder and/or therapy options and care. Intra-rater and inter-rater reliability were assessed by calculating intra-class correlation coefficients, agreement was tested with weighted kappas, and the correlation of the raters’ scores for each instrument was measured with Pearson’s correlation coefficient. DISCERN demonstrated substantial intra- and inter-rater reliability. It also showed slightly better agreement than EQIP. There was a strong correlation of the raters’ scores for both instruments. The findings of this study support the reliability of both DISCERN and EQIP. However, based on the results of the inter-rater reliability, agreement and correlation analyses, we consider DISCERN to be the more precise tool for our project on patient information concerning the treatment and care of eczema. PMID:26440612

Evaluating Written Patient Information for Eczema in German: Comparing the Reliability of Two Instruments, DISCERN and EQIP.

PubMed

McCool, Megan E; Wahl, Josepha; Schlecht, Inga; Apfelbacher, Christian

2015-01-01

Patients actively seek information about how to cope with their health problems, but the quality of the information available varies. A number of instruments have been developed to assess the quality of patient information, primarily though in English. Little is known about the reliability of these instruments when applied to patient information in German. The objective of our study was to investigate and compare the reliability of two validated instruments, DISCERN and EQIP, in order to determine which of these instruments is better suited for a further study pertaining to the quality of information available to German patients with eczema. Two independent raters evaluated a random sample of 20 informational brochures in German. All the brochures addressed eczema as a disorder and/or therapy options and care. Intra-rater and inter-rater reliability were assessed by calculating intra-class correlation coefficients, agreement was tested with weighted kappas, and the correlation of the raters' scores for each instrument was measured with Pearson's correlation coefficient. DISCERN demonstrated substantial intra- and inter-rater reliability. It also showed slightly better agreement than EQIP. There was a strong correlation of the raters' scores for both instruments. The findings of this study support the reliability of both DISCERN and EQIP. However, based on the results of the inter-rater reliability, agreement and correlation analyses, we consider DISCERN to be the more precise tool for our project on patient information concerning the treatment and care of eczema.

Gradual increase in cutaneous threshold induced by repeated hypnosis of healthy individuals and patients with atopic eczema.

PubMed

Hájek, P; Jakoubek, B; Radil, T

1990-04-01

Gradual increase in cutaneous pain threshold was found in healthy subjects and patients with atopic eczema during repeated hypnotic sessions with specific suggestions. This increase was less in the former than in the latter group. Repeated threshold measurements did not influence the threshold. The analgesic effect outlasted the hypnotic sessions by several months. It could be, however, suddenly reduced by appropriate hypnotic suggestion.

Polyunsaturated fatty acid intake and prevalence of eczema and rhinoconjunctivitis in Japanese children: The Ryukyus Child Health Study

PubMed Central

2011-01-01

Background The recent increase in the prevalence of allergic disorders might be a consequence of increased intake of n-6 polyunsaturated fatty acids (PUFAs) and reduced intake of n-3 PUFAs. The current cross-sectional study examined the association between intake levels and the prevalence of eczema and rhinoconjunctivitis in Japanese children. Methods Subjects were 23,388 schoolchildren aged 6-15 years residing in Okinawa. The presence of eczema and/or rhinoconjunctivitis was determined according to the criteria of the International Study of Asthma and Allergies in Childhood. A brief diet history questionnaire for children and adolescents was administered to acquire information on dietary factors. Adjustment was made for age, sex, residential municipality, number of siblings, smoking in the household, body mass index, paternal and maternal history of allergic diseases, and paternal and maternal educational level. Results The prevalences of eczema and rhinoconjunctivitis in the previous 12 months were 7.0% and 8.0%, respectively. Consumption of PUFAs, n-3 PUFAs, α-linolenic acid, n-6 PUFAs, and linoleic acid was positively associated with the prevalence of eczema: the adjusted odds ratios (ORs) between extreme quintiles (95% confidence intervals [CIs], P for trend) were 1.26 (1.07-1.48, 0.04), 1.31 (1.11-1.54, 0.009), 1.31 (1.12-1.55, 0.003), 1.26 (1.07-1.48, 0.01), and 1.27 (1.08-1.49, 0.01), respectively. Arachidonic acid intake was independently inversely related to eczema: the adjusted OR between extreme quintiles was 0.81 (0.69-0.95, 0.0008). Eczema was not associated with eicosapentaenoic or docosahexaenoic acid intake, or with the ratio of n-3 to n-6 PUFA intake. Only arachidonic acid intake was statistically significantly related to the prevalence of rhinoconjunctivitis, showing a clear inverse linear trend: the adjusted OR between extreme quintiles was 0.86 (0.74-0.997, 0.03). Conclusions Consumption of n-3 and n-6 PUFAs, especially α-linolenic acid and linoleic acid, may be positively associated with eczema. Arachidonic acid intake may be inversely related to eczema and rhinoconjunctivitis. PMID:21599987

Allergic airborne contact dermatitis from essential oils used in aromatherapy.

PubMed

Schaller, M; Korting, H C

1995-03-01

Contact allergy to various essential oils used in aromatherapy was demonstrated on patch testing in a 53-year-old patient suffering from relapsing eczema resistant to therapy on various uncovered parts of the skin, in particular the scalp, neck and hands. Sensitization was due to previous exposure to lavender, jasmine and rosewood. Laurel, eucalyptus and pomerance also produced positive tests, although there was no hint of previous exposure. A diagnosis of allergic airborne contact dermatitis was thus established. On topical and systemic glucocorticoid treatment (peroral methylprednisolone at an initial dose of 60 mg/day) the skin lesions eventually resolved. Due to persistence of the volatile essential oils in the patient's home after a year-long use of aroma lamps, complete renewal of the interior of the patient's flat was considered essential. Due to changing self-medication habits, with increasing orientation to 'natural' modes of treatment, increasing numbers of such sensitizations might be on the horizon.

Jackfruit anaphylaxis in a latex allergic patient.

PubMed

Wongrakpanich, Supakanya; Klaewsongkram, Jettanong; Chantaphakul, Hiroshi; Ruxrungtham, Kiat

2015-03-01

Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens.

Decreased sudomotor function is involved in the formation of atopic eczema in the cubital fossa.

PubMed

Takahashi, Aya; Murota, Hiroyuki; Matsui, Saki; Kijima, Akiko; Kitaba, Shun; Lee, Jeong-Beom; Katayama, Ichiro

2013-12-01

Eczema in the cubital fossa, which is susceptible to sweat, is frequently observed in atopic dermatitis (AD). However, there has been no direct evidence that sweating causes eczema in the cubital fossa. To investigate this issue, axon reflex-mediated sweating volume (AXR) and skin barrier function in the cubital fossa were measured in subjects with AD and in healthy volunteers, and were applied to clinical feature of the cubital fossa. AXR in the cubital fossa decreased in AD subjects; it positively correlated only with water-holding capacity in healthy subjects but not in patients with in AD. Furthermore, AD subjects with lichenoid eczema and either prurigo or papules over the cubital fossa showed extremely decreased AXR. These results suggest that decreased sweating is a major source of water in the stratum corneum, and decreased sudomotor function may be involved in both the cause and aggravation of representative atopic eczema in the cubital fossa.

Standardized Reporting of the Eczema Area and Severity Index (EASI) and the Patient-Oriented Eczema Measure (POEM): A Recommendation by the Harmonising Outcome Measures for Eczema (HOME) Initiative.

PubMed

Grinich, E; Schmitt, J; Küster, D; Spuls, P I; Williams, H C; Chalmers, J R; Thomas, K S; Apfelbacher, C; Prinsen, C A C; Furue, M; Stuart, B; Carter, B; Simpson, E

2018-05-10

Several organizations from multiple fields of medicine are setting standards for clinical research including protocol development, 1 harmonization of outcome reporting, 2 statistical analysis, 3 quality assessment 4 and reporting of findings. 1 Clinical research standardization facilitates the interpretation and synthesis of data, increases the usability of trial results for guideline groups and shared decision-making, and reduces selective outcome reporting bias. The mission of the Harmonising Outcome Measures for Eczema (HOME) initiative is to establish an agreed-upon core set of outcomes to be measured and reported in all clinical trials of atopic dermatitis (AD). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of ‘atopic dermatitis’

PubMed Central

Kantor, R.; Thyssen, J. P.; Paller, A. S.; Silverberg, J. I.

2017-01-01

Background The lack of standardized nomenclature for atopic dermatitis (AD) creates unnecessary confusion for patients, healthcare providers, and researchers. It also negatively impacts accurate communication of research in the scientific literature. We sought to determine the most commonly used terms for AD. Methods A systematic review of the MEDLINE, EMBASE, and LILACS (1945–2016) for the terms AD, atopic eczema (AE), and multiple other eczematous disorders. Results In MEDLINE, 33 060 were identified, of which 21 299 (64.4%) publications used the term ‘AD’, 15 510 (46.9%) ‘eczema’, and only 2471 (7.5%) AE. Most of these publications used the term AD (82.0%) or eczema (70.8%) without additional nomenclature; only 1.2% used AE alone. Few publications used the terminology ‘childhood eczema’, ‘flexural eczema’, ‘infantile eczema’, ‘atopic neurodermatitis’, or ‘Besnier’s prurigo’. AD was rarely used until the late 1970s, after which it became the most commonly used of the three terms and continuously increased until 2015. Atopic eczema decreased between 2008 and 2015. Atopic dermatitis was the most commonly used term in studies across almost all publication types, languages, and journals. Conclusion Atopic dermatitis is the most commonly used term and appears to be increasing in popularity. Given that eczema is a nonspecific term that describes the morphological appearance of several forms of dermatitis, we strongly suggest the use of a more specific term, AD, in publications, healthcare clinician training, and patient education. Support from researchers, reviewers, and editors is key to success. PMID:27392131

Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants.

PubMed

Giwercman, Charlotte; Halkjaer, Liselotte B; Jensen, Signe Marie; Bønnelykke, Klaus; Lauritzen, Lotte; Bisgaard, Hans

2010-04-01

Breast-feeding is recommended for the prevention of eczema, asthma, and allergy, particularly in high-risk families, but recent studies have raised concern that this may not protect children and may even increase the risk. However, disease risk, disease manifestation, lifestyle, and the choice to breast-feed are interrelated, and therefore, analyzing true causal effects presents a number of methodologic challenges. First, to assess the effect from duration of exclusive breast-feeding on the development of eczema and wheezy disorders during the first 2 years of life in a high-risk clinical birth cohort. Second, to assess any influence from the fatty acid composition of mother's milk on the risk from breast-feeding. We studied disease development during the first two years of life of the 411 infants from the Copenhagen Study on Asthma in Childhood (COPSAC) birth cohort, born to mothers with a history of asthma. We analyzed the effect from duration of breast-feeding before disease onset on the disease risk, avoiding the effect from disease-related modification of exposure (inverse causation). Polyunsaturated fatty acids were measured in breast milk. Breast-feeding significantly increased the risk of eczema adjusted for demographics, filaggrin variants, parents' eczema, and pets at home (N = 306; relative risk, 2.09; 95% CI 1.15-3.80; P = .016) but reduced the risk of wheezy episodes (relative risk, 0.67; 95% CI 0.48-0.96; P = .021) and of severe wheezy exacerbation (relative risk, 0.16; 95% CI 0.03-1.01; P = .051). There was no association between the fatty acid composition of mother's milk and the risk of eczema or wheeze. The risk of eczema was increased in infants with increasing duration of breast-feeding. In contrast, the risk of wheezy disorder and severe wheezy exacerbations was reduced. There were no significant effects from the fatty acid composition of the breast milk on risk of eczema or wheezy disorders. Copyright (c) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

The 'holi' dermatoses: annual spate of skin diseases following the spring festival in India.

PubMed

Ghosh, Sudip Kumar; Bandyopadhyay, Debabrata; Chatterjee, Gobinda; Saha, Debabrata

2009-07-01

'Holi' is an annual spring festival celebrated all over India. The central ritual of Holi involves throwing of colors on one another. Playing with toxic industrial dyes often results in various dermatological complaints in a significant number of people immediately following the celebration. To describe patterns of various skin manifestations directly or indirectly related to the use of different colors in the celebration of Holi. Observational clinical study on consecutive patients presenting to a teaching hospital in Kolkata, India. Forty-two patients with a mean age of 24.2 years were studied. Itching was the commonest symptom (25, 59.5%), followed by burning sensation, pain, oozing, and scaling. Eleven patients' symptoms were attributed to activities related to preparation of colors and the removal of colors from the skin surface. Eczematous lesions were the most common pattern (24, 57.1%) followed by erosions, xerosis and scaling, erythema, urticaria, acute nail-fold inflammation, and abrasions. Thirteen (30.9%) patients reported aggravation of preexisting dermatoses (acne, eczema, and paronychia). Secondary pyoderma occurred in 3 (7.1%). Face was the commonest site affected (24, 57.1%), followed by dorsum of the hands, scalp, forearm, palms, arms, and trunk. Ocular complaints in the form of redness, watering, and grittiness occurred in 7 (16.7%) patients. Various forms of cutaneous manifestations, often associated with ocular complaints, occur commonly due to Holi colors. Public awareness and regulatory actions are needed to avoid these preventable conditions.

Few food diets in the treatment of atopic eczema.

PubMed Central

Pike, M G; Carter, C M; Boulton, P; Turner, M W; Soothill, J F; Atherton, D J

1989-01-01

Sixty six children with severe atopic eczema were treated with highly restricted ('few food') diets followed, if they improved, by serial reintroduction of excluded foods. Twenty four patients (36%) improved considerably during the few food phase of the diet. Fifteen of these (23% of the study group) maintained this improvement on dietary treatment, of whom three abandoned the diet after periods ranging from six to 10 months, despite continued benefit, because they found the dietary restrictions too arduous. Thus 12 out of 66 children (18%) with severe eczema experienced prolonged and useful benefit from this dietary manoeuvre. Double blind food challenges performed in 10 patients failed to establish that parental identification of provoking foods is reliable. A search for historical and in vitro predictors of diet responsiveness was unsuccessful in this series. PMID:2624475

Choice of Moisturiser for Eczema Treatment (COMET): feasibility study of a randomised controlled parallel group trial in children recruited from primary care.

PubMed

Ridd, Matthew J; Garfield, Kirsty; Gaunt, Daisy M; Hollinghurst, Sandra; Redmond, Niamh M; Powell, Kingsley; Wilson, Victoria; Guy, Richard H; Ball, Nicola; Shaw, Lindsay; Purdy, Sarah; Metcalfe, Chris

2016-11-16

To determine the feasibility of a randomised controlled trial of 'leave on' emollients for children with eczema. Single-centre, pragmatic, 4-arm, observer-blinded, parallel, randomised feasibility trial. General practices in the UK. Children with eczema aged 1 month to <5 years. Primary outcome-proportion of parents who reported use of the allocated study emollient every day for the duration of follow-up (12 weeks). Other feasibility outcomes-participant recruitment and retention, data collection and completeness and blinding of observers to allocation. Aveeno lotion, Diprobase cream, Doublebase gel, Hydromol ointment. 197 children were recruited-107 by self-referral (mainly via practice mail-outs) and 90 by inconsultation (clinician consenting and randomising) pathways. Participants recruited inconsultation were younger, had more severe Patient-Oriented Eczema Measure scores and were more likely to withdraw than self-referrals. Parents of 20 (10%) of all the randomised participants reported using the allocated emollient daily for 84 days. The use of other non-study emollients was common. Completeness of data collected by parent-held daily diaries and at monthly study visits was good. Daily diaries were liked (81%) but mainly completed on paper rather than via electronic ('app') form. Major costs drivers were general practitioner consultations and eczema-related prescriptions. Observer unblinding was infrequent, and occurred at the baseline or first follow-up visit through accidental disclosure. It is feasible in a primary care setting to recruit and randomise young children with eczema to emollients, follow them up and collect relevant trial data, while keeping observers blinded to their allocation. However, reported use of emollients (study and others) has design implications for future trials. ISRCTN21828118/EudraCT2013-003001-26. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Choice of Moisturiser for Eczema Treatment (COMET): feasibility study of a randomised controlled parallel group trial in children recruited from primary care

PubMed Central

Ridd, Matthew J; Garfield, Kirsty; Gaunt, Daisy M; Redmond, Niamh M; Powell, Kingsley; Wilson, Victoria; Guy, Richard H; Ball, Nicola; Shaw, Lindsay; Purdy, Sarah; Metcalfe, Chris

2016-01-01

Objectives To determine the feasibility of a randomised controlled trial of ‘leave on’ emollients for children with eczema. Design Single-centre, pragmatic, 4-arm, observer-blinded, parallel, randomised feasibility trial. Setting General practices in the UK. Participants Children with eczema aged 1 month to <5 years. Outcome measures Primary outcome—proportion of parents who reported use of the allocated study emollient every day for the duration of follow-up (12 weeks). Other feasibility outcomes—participant recruitment and retention, data collection and completeness and blinding of observers to allocation. Interventions Aveeno lotion, Diprobase cream, Doublebase gel, Hydromol ointment. Results 197 children were recruited—107 by self-referral (mainly via practice mail-outs) and 90 by inconsultation (clinician consenting and randomising) pathways. Participants recruited inconsultation were younger, had more severe Patient-Oriented Eczema Measure scores and were more likely to withdraw than self-referrals. Parents of 20 (10%) of all the randomised participants reported using the allocated emollient daily for 84 days. The use of other non-study emollients was common. Completeness of data collected by parent-held daily diaries and at monthly study visits was good. Daily diaries were liked (81%) but mainly completed on paper rather than via electronic (‘app’) form. Major costs drivers were general practitioner consultations and eczema-related prescriptions. Observer unblinding was infrequent, and occurred at the baseline or first follow-up visit through accidental disclosure. Conclusions It is feasible in a primary care setting to recruit and randomise young children with eczema to emollients, follow them up and collect relevant trial data, while keeping observers blinded to their allocation. However, reported use of emollients (study and others) has design implications for future trials. Trial registration number ISRCTN21828118/EudraCT2013-003001-26. PMID:27852708

Association between the age of solid food introduction and eczema: A systematic review and a meta-analysis.

PubMed

Waidyatillake, N T; Dharmage, S C; Allen, K J; Bowatte, G; Boyle, R J; Burgess, J A; Koplin, J J; Garcia-Larsen, V; Lowe, A J; Lodge, C J

2018-03-23

Eczema is a common childhood ailment responsible for a considerable disease burden. Both timing of introduction to solid food and allergenic food are believed to be related to childhood eczema. Despite the growing body of evidence, the relationship between timing of any solid food introduction (allergenic and/or non-allergenic) and development of eczema has not previously been systematically reviewed. PubMed and EMBASE databases were searched using food and eczema terms. Two authors selected papers according to the inclusion criteria and extracted information on study characteristics and measures of association. Meta-analyses were performed after grouping studies according to the age and type of exposure. A total of 17 papers met the inclusion criteria, reporting results from 16 study populations. Of these, 11 were cohort studies, 2 case-controls, 1 cross-sectional study and 2 randomized controlled trials. Limited meta-analyses were performed due to heterogeneity between studies. Timing of solid food introduction was not associated with eczema. One randomized controlled trial provided weak evidence of an association between early allergenic (around 4 months) food introduction and reduced risk of eczema. The available evidence is currently insufficient to determine whether the timing of introduction of any solid food influences the risk of eczema. © 2018 John Wiley & Sons Ltd.

Environmental Factors Associated with Altered Gut Microbiota in Children with Eczema: A Systematic Review.

PubMed

Chan, Carmen W H; Wong, Rosa S; Law, Patrick T W; Wong, Cho Lee; Tsui, Stephen K W; Tang, Winnie P Y; Sit, Janet W H

2016-07-16

Eczema is a common skin condition that impairs children's daily life activities and quality of life. Previous research shows that gut microbiome composition plays an important role in the development of eczema. The present review summarizes evidence on environmental factors related to altered gut microbiota in children with eczema. We searched Medline, PubMed, Embase, and the Cochrane database of Systematic Reviews through October 2015. The search strategy focused on articles published in peer-reviewed, English-language journals with no publication year limit. Only original studies and review articles that reported environmental factors on gut microbiome specific to eczema were included in this review. We selected six studies (total 1990 participants) for full review and identified that the composition of gut microbiota specific to eczema could be influenced by the following environmental factors: length of gestation, mode of delivery, type of feeding, method of treatment, number of older siblings, and other lifestyle factors. There has been inconsistent empirical evidence as to the modulatory effects of gut microbiota on immunological functions in children with eczema. Further research on the environmental-host-microbial interaction is needed to develop a strong base of knowledge for the development and implementation of prevention strategies and policies for eczema.

TGF-Beta Gene Polymorphisms in Food Allergic versus Non-Food Allergic Eosinophilic Esophagitis

DTIC Science & Technology

2013-10-01

our EE subjects are male, Caucasian, and have another atopic disorder (asthma, allergy, eczema and/or food allergy) (n=142, analysis is ongoing...Rhinitis (%) Eczema (%) 43% 66% 30% Table 3: Food IgE Sensitization Pattern Food Antigen IgE Positive (% patients, 95% CI) (n=122-129) Egg 39

Household environment, lifestyle behaviors, and dietary habits in relation to childhood atopic eczema in Shanghai, China.

PubMed

Cai, Jiao; Liu, Wei; Hu, Yu; Zou, Zhijun; Shen, Li; Huang, Chen

2017-01-01

We aim to investigate associations of the child's individual characteristics, building characteristics, home environmental exposures, family lifestyle behaviors, and dietary habits on childhood eczema during lifetime-ever and in the last year before the survey. During April 2011-April 2012, we conducted a cross-sectional study and collected 13,335 parents-reported questionnaires of 4-6-year-old children from 72 kindergartens in Shanghai, China. Logistic regression model was used to investigate associations. After adjusted for sex, age, family history of atopy, and questionnaire reporter, the factors which were strongly associated (increased odds >30% and p value <0.05) with lifetime-ever eczema included mother employed during pregnancy (adjusted OR 1.33), residence renovated during pregnancy (1.49) and in the child's first year of life (1.31), using laminate (1.58) and solid (1.42) wood as material of floor covering (compared to using cement), residence located in urban district (1.38), and dampness-related exposures in the early residence (mold spots/stains: 1.41; mold odor: 1.41) and in the current residence (water damage: 1.33; damp stains: 1.34; mold spots: 1.32; and windows pane condensation: 1.31). Parental smoking, pet-keeping, and incense-burning had no significant associations with childhood eczema. Similar associations were found for eczema in the last year before the survey. Families with sick children likely changed lifestyle behaviors and dietary habits. Childhood eczema could be influenced by many household environmental and non-environmental factors. Exposures during early lifetime likely have greater impact on childhood eczema than current exposures. Associations of lifestyle behaviors and dietary habits with childhood eczema could be modified by family avoidance behaviors.

Recall bias in childhood atopic diseases among adults in the Odense Adolescence Cohort Study.

PubMed

Mortz, Charlotte G; Andersen, Klaus E; Bindslev-Jensen, Carsten

2015-11-01

Atopic dermatitis (AD) is a common disease in childhood and an important risk factor for the later development of other atopic diseases. Many publications on childhood AD use questionnaires based on information obtained in adulthood, which introduce the possibility of recall bias. In a prospective cohort study, recall bias was evaluated in 1,501 unselected schoolchildren (mean age 14 years) evaluated for the first time in 1995 with a standardized questionnaire combined with a clinical examination and repeated in 2010. The lifetime prevalence of AD was 34.1% including data obtained both during school age and 15 years later, compared with 23.6% including data only from adulthood. The most important factors for remembering having had AD in childhood were: (i) long duration of dermatitis in childhood; (ii) adult hand eczema; and (iii) concomitant atopic disease. Recall bias for childhood AD affected the results of logistic regression on adult hand eczema and is a significant problem in retrospective epidemiological questionnaire studies evaluating previous AD as a risk factor for development of other diseases.

Prevention of hand eczema in the metal-working industry: risk awareness and behaviour of metal worker apprentices.

PubMed

Itschner, L; Hinnen, U; Elsner, P

1996-01-01

In the metal-working industry, occupational hand eczema is very common and often due to contact with cutting fluids. Since it can be avoided by adequate protective measures, prevention plays an important role. However, the effectiveness of prevention depends heavily on the employees' awareness of this health risk. The study aimed to collect information on the attitude of metal worker apprentices towards the risk of occupational skin disorders and skin protection since it is believed that their attitude at the beginning of the education will guide their future risk behaviour. By means of a questionnaire, 79 metal worker apprentices were interviewed about their awareness of dermal risk factors and their risk behaviour at work. The apprentices are very badly informed about skin diseases and skin care. Most of them are not concerned about developing occupational skin problems, and they declared having obtained very little information about this subject. Considering this finding, it seems urgent to intensify health and safety education already at the beginning of the apprenticeship.

Age at onset and persistence of eczema are related to subsequent risk of asthma and hay fever from birth to 18 years of age.

PubMed

Lowe, Adrian J; Angelica, Bianca; Su, John; Lodge, Caroline J; Hill, David J; Erbas, Bircan; Bennett, Catherine M; Gurrin, Lyle C; Axelrad, Christine; Abramson, Michael J; Allen, Katrina J; Dharmage, Shyamali C

2017-06-01

Few studies have simultaneously addressed the importance of age of onset and persistence of eczema for the subsequent development of asthma and hay fever, particularly into early adulthood. A high-risk birth cohort was recruited comprising 620 infants, who were then followed up frequently until 2 years of age, annually from age 3 to 7, then at 12 and 18 years, to document any episodes of eczema, current asthma, and hay fever. The generalized estimation equation technique was used to examine asthma and hay fever outcomes at 6 (n = 325), 12 (n = 248) and 18 (n = 240) years, when there was consistency of associations across the follow-ups. Very early-onset persistent (onset <6 months, still present from 2 to 5 years) eczema was related to current asthma (adjusted OR = 3.2 [95% CI = 1.7-6.1]), as was very early-onset remitting eczema (onset <6 months but not present from 2-5 years, OR = 2.7, 95% CI = 1.0-7.2) and early-onset persistent eczema (onset from 6-24 months, OR = 2.3, 95% CI = 1.2-4.7). Late-onset eczema (commenced from 2-5 years) was associated with increased risk of asthma at 12 years (OR = 3.0, 95% CI=1.1-8.2) but not at age 6 years. Only very early-onset persistent eczema was associated with increased risk of hay fever (aOR = 2.4, 95% CI = 1.4-4.1). Eczema which commences in early infancy and persists into toddler years is strongly associated with asthma, and to a lesser extent hay fever, in high-risk children. If these associations are causal, prevention of early-life eczema might reduce the risk of respiratory allergy. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Oral and Topical Antibiotics for Clinically Infected Eczema in Children: A Pragmatic Randomized Controlled Trial in Ambulatory Care.

PubMed

Francis, Nick A; Ridd, Matthew J; Thomas-Jones, Emma; Butler, Christopher C; Hood, Kerenza; Shepherd, Victoria; Marwick, Charis A; Huang, Chao; Longo, Mirella; Wootton, Mandy; Sullivan, Frank

2017-03-01

Eczema may flare because of bacterial infection, but evidence supporting antibiotic treatment is of low quality. We aimed to determine the effect of oral and topical antibiotics in addition to topical emollient and corticosteroids in children with clinically infected eczema. We employed a 3-arm, blinded, randomized controlled trial in UK ambulatory care. Children with clinical, non-severely infected eczema were randomized to receive oral and topical placebos (control), oral antibiotic (flucloxacillin) and topical placebo, or topical antibiotic (fusidic acid) and oral placebo, for 1 week. We compared Patient Oriented Eczema Measure (POEM) scores at 2 weeks using analysis of covariance (ANCOVA). We randomized 113 children (40 to control, 36 to oral antibiotic, and 37 to topical antibiotic). Mean (SD) baseline Patient Oriented Eczema Measure scores were 13.4 (5.1) for the control group, 14.6 (5.3) for the oral antibiotic group, and 16.9 (5.5) for the topical antibiotic group. At baseline, 104 children (93%) had 1 or more of the following findings: weeping, crusting, pustules, or painful skin. Mean (SD) POEM scores at 2 weeks were 6.2 (6.0) for control, 8.3 (7.3) for the oral antibiotic group, and 9.3 (6.2) for the topical antibiotic group. Controlling for baseline POEM score, neither oral nor topical antibiotics produced a significant difference in mean (95% CI) POEM scores (1.5 [-1.4 to 4.4] and 1.5 [-1.6 to 4.5] respectively). There were no significant differences in adverse effects and no serious adverse events. We found rapid resolution in response to topical steroid and emollient treatment and ruled out a clinically meaningful benefit from the addition of either oral or topical antibiotics. Children seen in ambulatory care with mild clinically infected eczema do not need treatment with antibiotics. © 2017 Annals of Family Medicine, Inc.

Knowledge, Attitude and Advice-Giving Behaviour of Community Pharmacists Regarding Topical Corticosteroids

PubMed Central

Lau, Wing Man

2017-01-01

This study examines the relationship between community pharmacists’ knowledge, attitudes to information provision and self-reported counselling behaviours in relation to topical corticosteroids and adjunct therapy in atopic eczema. A mixed-methods approach was used whereby data from interviews with community pharmacists were used to design a structured questionnaire that a larger sample of community pharmacists completed anonymously. The questionnaire was completed and returned by 105 pharmacists (36% response rate). Pharmacists showed gaps in their knowledge on the use of topical corticosteroids in atopic eczema but had good understanding on the use of emollients. There was a significant correlation between pharmacists’ attitudes to information provision and their self-reported counselling behaviour for most themes except in relation to corticosteroid safety where less advice was given. Improving attitudes to information provision should correlate with increased counselling behaviour. However, for the theme of corticosteroid safety, further studies are needed to examine why in practice pharmacists are not providing patient counselling on this topic even though most agreed this is a topic patients should know about. PMID:28970453

Knowledge, Attitude and Advice-Giving Behaviour of Community Pharmacists Regarding Topical Corticosteroids.

PubMed

Lau, Wing Man; Donyai, Parastou

2017-07-25

This study examines the relationship between community pharmacists' knowledge, attitudes to information provision and self-reported counselling behaviours in relation to topical corticosteroids and adjunct therapy in atopic eczema. A mixed-methods approach was used whereby data from interviews with community pharmacists were used to design a structured questionnaire that a larger sample of community pharmacists completed anonymously. The questionnaire was completed and returned by 105 pharmacists (36% response rate). Pharmacists showed gaps in their knowledge on the use of topical corticosteroids in atopic eczema but had good understanding on the use of emollients. There was a significant correlation between pharmacists' attitudes to information provision and their self-reported counselling behaviour for most themes except in relation to corticosteroid safety where less advice was given. Improving attitudes to information provision should correlate with increased counselling behaviour. However, for the theme of corticosteroid safety, further studies are needed to examine why in practice pharmacists are not providing patient counselling on this topic even though most agreed this is a topic patients should know about.

Atopic Eczema and Stress among Single Parents and Families: An Empirical Study of 96 Mothers.

PubMed

Gieler, Uwe; Schoof, Stefanie; Gieler, Tanja; Scheewe, Sibylle; Schut, Christina; Kupfer, Jörg

2017-01-04

This study investigated the extent to which single mothers of children with atopic eczema experience disease-related stress. A total of 96 mothers were divided into 4 groups: mothers living with a partner, who had or did not have a child with atopic eczema, and single mothers, who had or did not have a child with atopic eczema. The following questionnaires were used to assess psychological burden: Short Stress Questionnaire (Kurzer Fragebogen zur Erfassung von Belastung; KFB), Satisfaction with Life Questionnaire (Fragebogen zur Lebenszufriedenheit; FLZ), General Depression Scale (Allgemeine Depressions-Skala; ADS), and the Questionnaire for Parents of Children with Atopic Eczema (Fragebogen für Eltern von Neurodermitis kranken Kindern; FEN). Single mothers had higher levels of helplessness and aggression due to their child's scratching behaviour than did mothers living with a partner and a child with atopic eczema. Single mothers of children with atopic eczema had the highest scores regarding experienced stress in the family and the lowest scores concerning general life satisfaction. Special care should be provided for single mothers with higher stress, in order to teach them how to deal with the scratching behaviour of their children.

Systematic review of treatments for atopic eczema.

PubMed

Hoare, C; Li Wan Po, A; Williams, H

2000-01-01

Atopic eczema is the commonest inflammatory skin disease of childhood, affecting 15-20% of children in the UK at any one time. Adults make up about one-third of all community cases. Moderate-to-severe atopic eczema can have a profound effect on the quality of life for both sufferers and their families. In addition to the effects of intractable itching, skin damage, soreness, sleep loss and the social stigma of a visible skin disease, other factors such as frequent visits to doctors, special clothing and¿the need to constantly apply messy topical applications all add to the burden of disease. The cause of atopic eczema is unknown, though a genetic pre-disposition and a combination of allergic and non-allergic factors appear to be important in determining disease expression. Treatment of atopic eczema in the UK is characterised by a profusion of treatments aimed at disease control. The evidential basis of these treatments is often unclear. Most people with atopic eczema are managed in primary care where the least research has been done. The objectives of this scoping review are two-fold. To produce an up-to-date coverage 'map' of randomised controlled trials (RCTs) of treatments of atopic eczema. To assist in making treatment recommendations by summarising the available RCT evidence using qualitative and quantitative methods. Data sources included electronic searching of MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register, the Cochrane Skin Group specialised register of trials, hand-searching of atopic eczema conference proceedings, follow-up of references in retrieved articles, contact with leading researchers and requests to relevant pharmaceutical companies. Only RCTs of therapeutic agents used in the prevention and treatment of people with atopic eczema of any age were considered for inclusion. Only studies where a physician diagnosed atopic eczema or atopic dermatitis were included. Data extraction was conducted by two observers onto abstraction forms, with discrepancies resolved by discussion. The quality assessment of retrieved RCTs included an assessment of: a clear description of method and concealment of allocation of randomisation, the degree to which assessors and participants were blinded to the study interventions, and whether all those originally randomised were included in the final main analysis. Where possible, quantitative pooling of similar RCTs was conducted using the Cochrane Collaboration's methods. Where statistical heterogeneity was found, sources of heterogeneity in terms of study participants, formulation or posology of intervention, and use of co-treatments were explored. Where pooling was not deemed to be appropriate, detailed descriptions of the study characteristics and main reported results were presented along with comments on study quality. A total of 1165 possible RCTs were retrieved in hard copy form for further scrutiny. Of these, 893 were excluded from further analysis because of lack of appropriate data. The 272 remaining RCTs of atopic eczema covered at least 47 different interventions, which could be broadly categorised into ten main groups. Quality of reporting was generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only then after considerable data transformation. There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy. There was insufficient evidence to make recommendations on maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin. (ABSTRACT TRUNCATED)

THE ‘HOLI’ DERMATOSES: ANNUAL SPATE OF SKIN DISEASES FOLLOWING THE SPRING FESTIVAL IN INDIA

PubMed Central

Ghosh, Sudip Kumar; Bandyopadhyay, Debabrata; Chatterjee, Gobinda; Saha, Debabrata

2009-01-01

Background: ‘Holi’ is an annual spring festival celebrated all over India. The central ritual of Holi involves throwing of colors on one another. Playing with toxic industrial dyes often results in various dermatological complaints in a significant number of people immediately following the celebration. Aims: To describe patterns of various skin manifestations directly or indirectly related to the use of different colors in the celebration of Holi. Methods: Observational clinical study on consecutive patients presenting to a teaching hospital in Kolkata, India. Results: Forty-two patients with a mean age of 24.2 years were studied. Itching was the commonest symptom (25, 59.5%), followed by burning sensation, pain, oozing, and scaling. Eleven patients’ symptoms were attributed to activities related to preparation of colors and the removal of colors from the skin surface. Eczematous lesions were the most common pattern (24, 57.1%) followed by erosions, xerosis and scaling, erythema, urticaria, acute nail-fold inflammation, and abrasions. Thirteen (30.9%) patients reported aggravation of preexisting dermatoses (acne, eczema, and paronychia). Secondary pyoderma occurred in 3 (7.1%). Face was the commonest site affected (24, 57.1%), followed by dorsum of the hands, scalp, forearm, palms, arms, and trunk. Ocular complaints in the form of redness, watering, and grittiness occurred in 7 (16.7%) patients. Conclusion: Various forms of cutaneous manifestations, often associated with ocular complaints, occur commonly due to Holi colors. Public awareness and regulatory actions are needed to avoid these preventable conditions. PMID:20161854

Prevalence of childhood eczema and food sensitization in the First Nations reserve of Natuashish, Labrador, Canada

PubMed Central

2014-01-01

Background The Mushua Innu of Natuashish, Labrador, Canada seem to have a high rate of childhood eczema. Anecdotally this problem seems to be more common now than 20 years ago. There has been speculation that this could be related to food sensitization that may have arisen coincident with a move away from a traditional Innu diet. We undertook to assess the prevalence and severity of pediatric eczema in Natuashish (population 792), and investigate the level of sensitization to common food antigens. Methods Over a three-month period we performed a population survey of all children in the community from the ages of 2–12 inclusive. The one-year prevalence of eczema was assessed using the United Kingdom Working Party’s diagnostic criteria, and graded on the Nottingham Severity Scale. All children with eczema and twice as many age/sex matched controls were offered complete blood counts, total IgE, and food specific IgE levels for egg white, cow’s milk protein and wheat. Results One hundred and eighty two (95% of the eligible children) were assessed. Of the 182 children examined eczema was diagnosed in 30 (16.5%) - 22 females and 8 males. The majority of children with eczema (20/30) were classified as being in the moderate and severe category. Of the 22 with eczema and 40 controls who consented to venipuncture all but 3 had IgE levels above the lab's reference range. Food specific antibody assays showed that 32, 23, and 5 percent of children with eczema were sensitized to egg, milk, and wheat respectively. None of the controls were sensitized. Conclusions The children of Natuashish, Labrador have a high rate of eczema, much of it graded as moderate or severe. IgE levels were markedly elevated in children with and without eczema, with average values at least ten-fold higher than other populations. There is no evidence of an unusual amount of sensitization to egg, milk or wheat. PMID:24649812

Outdoor environment, ozone, radionuclide-associated aerosols and incidences of infantile eczema in Minsk, Belarus.

PubMed

Belugina, I N; Yagovdik, N Z; Belugina, O S; Belugin, S N

2018-05-06

The early occurrence of atopic dermatitis in infants may be influenced by urban air pollution. The aim of this study was to determine the relationship between incidences of infantile eczema in children under 2 years of age and urban outdoor environmental factors. A 11-year population-based study was conducted in retrospective design. The age/gender-adjusted incidence rates of infantile eczema were determined using the data of outpatient visits. We analysed 1965 cases with atopic dermatitis including infantile eczema in relation to the annual means of outdoor monitoring data from 2005 through 2015 in Minsk. Logistic regression and principal component analysis were performed to determine association between the annual means of air pollutants, meteorological variables and incidences of infantile eczema. Higher mean annual carbon monoxide, ammonia, formaldehyde, lead, particulate matter and ground-level ozone were associated with high incidence rates of infantile eczema both in boys and girls. Higher nitrogen dioxide was associated with high incidence rates of infantile eczema in girls 1-2 years of age and boys 0-2 years of age. There were identified by principal component analysis five combinations of pollutants and meteorological factors. High incidence rates of infantile eczema were associated with the combinations contained higher levels of air pollutants and ultraviolet index, or lower β-activity of the radionuclide-associated aerosols. The higher phenol and formaldehyde levels the higher incidence rates of infantile eczema were observed among boys 0-1 years of age and girls 1-2 years of age. The higher total column ozone with lower lead level was associated with low incidence rates of infantile eczema among boys and girls 1-2 years of age. Urban outdoor air pollutants and their combination with meteorological conditions may impact onset of infantile eczema in both genders. © 2018 European Academy of Dermatology and Venereology.

Breastfeeding and atopic eczema in Japanese infants: The Osaka Maternal and Child Health Study.

PubMed

Miyake, Yoshihiro; Tanaka, Keiko; Sasaki, Satoshi; Kiyohara, Chikako; Ohya, Yukihiro; Fukushima, Wakaba; Yokoyama, Tetsuji; Hirota, Yoshio

2009-05-01

Epidemiological studies associated with breastfeeding have provided conflicting results about whether it is preventive or a risk factor for atopic eczema in children. The current prospective study investigated the relationship between breastfeeding and the risk of atopic eczema in Japan. A birth cohort of 763 infants was followed. The first survey during pregnancy and the second survey between 2 and 9 months postpartum collected information on potential confounding factors and atopic eczema status. Data on breastfeeding and symptoms of atopic eczema were obtained from questionnaires in the third survey from 16 to 24 months postpartum. The following variables were a priori selected as potential confounders: maternal age, maternal and paternal history of asthma, atopic eczema, and allergic rhinitis, indoor domestic pets (cats, dogs, birds, or hamsters), family income, maternal and paternal education, maternal smoking during pregnancy, baby's sex, baby's birth weight, baby's older siblings, household smoking in the same room as the infant, and time of delivery before the third survey. In the third survey, 142 infants (18.6%) were revealed to have developed atopic eczema based on criteria of the International Study of Asthma and Allergies in Childhood. In an overall analysis, neither exclusive nor partial breastfeeding was significantly related to the risk of atopic eczema. After excluding 64 infants identified with suspected atopic eczema in the second survey, both exclusive breastfeeding for 4 months or more and partial breastfeeding for 6 months or more were independently associated with an increased risk of atopic eczema only among infants with no parental history of allergic disorders [multivariate odds ratios were 2.41 (95% confidence interval, 1.10-5.55) and 3.39 (95% confidence interval, 1.20-12.36), respectively]. The authors found that, overall, neither exclusive nor partial breastfeeding had a strong impact on the risk of atopic eczema. However, a parental allergic history may affect the risk.

Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization

PubMed Central

Silverberg, Jonathan I.; Simpson, Eric L.

2015-01-01

Background Atopic dermatitis (AD) is associated with multiple comorbid conditions, such as asthma and food allergy. We sought to determine the impact of eczema severity on the development of these disorders and other non-atopic comorbidities in AD. Methods We used the 2007 National Survey of Children's Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children age 0-17 years. Prevalence and severity of eczema, asthma, hay fever and food allergy, sleep impairment, healthcare utilization, recurrent ear infections, visual and dental problems were determined. Results In general, more severe eczema correlated with poorer overall health, impaired sleep and increased healthcare utilization, including seeing a specialist, compared to children with mild or moderate disease (Rao-Scott Chi-square, P<0.0001). Severe eczema was associated with higher prevalence of comorbid chronic health disorders, including asthma, hay fever and food allergies (P<0.0001). In addition, the severity of eczema was directly related to the severity of the comorbidities. These associations remained significant in multivariate logistic regression models that included age, sex and race/ethnicity. Severe eczema was also associated with recent dental problems, including bleeding gums (P<0.0001), toothache (P=0.0004), but not broken teeth (P=0.04) or tooth decay (P=0.13). Conclusions These data indicate that severe eczema is associated with multiple comorbid chronic health disorders, impaired overall health and increased healthcare utilization. Further, these data suggest that children with eczema are at risk for decreased oral health. Future studies are warranted to verify this novel association. PMID:23773154

Acupuncture and a gluten-free diet relieve urticaria and eczema in a case of undiagnosed dermatitis herpetiformis and atypical or extraintestinal celiac disease: a case report.

PubMed

Ohlsen, Bahia A

2011-12-01

The purpose of this case report is to describe the use of acupuncture and a gluten-free diet (GFD) for urticaria and severe eczema in a patient with undiagnosed dermatitis herpetiformis and atypical or extraintestinal celiac disease. A 48-year-old woman presented with intense urticaria, eczema, worsening heartburn, chronic constipation, headaches, and an intense feeling of heat for 4 months. Results of punch biopsies of the skin lesions and laboratory tests were inconclusive. After the acupuncture sessions reported here ended, human leukocyte antigen blood typing revealed celiac disease and dermatitis herpetiformis-associated human leukocyte antigen DQ-8. Results of an endoscopy and colonoscopy were negative. The patient received 3 acupuncture treatments a week for 12 weeks. The patient's symptoms began in March 2008. She began using topical and oral steroids and felt that her symptoms were not responding. Acupuncture began in July 2008. At the end of the first 12 treatments, during which she was using topical and oral steroids, the urticaria and constipation resolved completely; and she had temporary relief from the heartburn. It is thought that the urticaria and constipation resolved because of the acupuncture as that was the only change. At the end of the second 12 treatments, during which time she had started Optifast, a GFD, the heartburn, headache, and eczema resolved. At the end of the third 12 treatments, all her symptoms remained resolved. Steroid treatment was discontinued after the first 12 treatments. Acupuncture and diet changes appeared to provide relief from the urticaria and eczema of dermatitis herpetiformis beyond that obtained by traditional treatment of a GFD alone.

Advising parents on washing babies' clothes.

PubMed

Scowen, P

1996-01-01

Detergents and other laundry products are generally effective and safe for all the family, but use carefully according to the maker's instructions and keep out of the reach of children. Rinse thoroughly to remove detergent residue from fabrics. If handwashing clothes, dissolve detergent before immersing hands. Wear rubber gloves if possible. Wash, rinse and dry hands thoroughly after contact with detergent. If a baby or parent has eczema, it may be necessary to try different products to see which one the client can tolerate. A non-perfumed, non-enzyme product may be found less irritating.

Hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral®) as allergen: experience from a contact dermatitis unit.

PubMed

Carvalho, Rodrigo; Maio, Paula; Amaro, Cristina; Santos, Raquel; Cardoso, Jorge

2011-09-01

Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC)-Lyral® is a widely used synthetic fragrance found in personal care and household products. It is an aldehyde, lipophilic enough to penetrate the skin and is a frequent cause of contact sensitization. Describe the frequency of contact allergy to HICC in a Contact Dermatitis Unit, after its inclusion in baseline patch test series. A retrospective study including all patients submitted to patch test, from January 2007 to December 2009. Over a 3-year period, 629 consecutive patients were patch tested. The frequency of positive reactions to HICC was 2.7% (17/629). Of the positive patients, 35% (6/17) gave a history of atopy, 58.8% (10/17) had eczema on the face and neck, 23.5% (4/17) on the hands, 23.5% (4/17) in the axillae, 17.6% (3/17) on the trunk and 6% (3/17) had generalized eczema. All patients were patch positive for more than one allergen: all (17/17) positive to fragrance Mix 2 (FM2); 47% of the patients (8/17) positive to fragrance Mix 1 (FM1); and 23.5% of the patients (4/17) positive to Balsam of Peru. In 94% (16/17) of cases, the reaction was judged to be of current relevance. The frequency of positive reactions to HICC of 2.7% found in our population is according to what is described in several European reports, where HICC is still widely used as a fragrance ingredient. In contrast, in North America, the prevalence is lower. All the patients were positive also to FM2. The association found between reactions to FM1 and HICC is also commonly reported and could represent a concomitant sensitization following increased exposure to fragrance allergens. These data confirm the importance of HICC introduction in the baseline patch test series.

Tacrolimus treatment of atopic eczema/dermatitis syndrome.

PubMed

Thestrup-Pedersen, Kristian

2003-10-01

Atopic dermatitis is today the most common chronic disease of children in Europe, the US and Japan. The 'golden standard' of therapy is topical glucocorticosteroids and emollients. The steroids have been on the market for four decades, are efficacious, but only advised for short-term treatment due to their risks of side effects. More than 16,000 persons suffering from atopic dermatitis have been enrolled in clinical studies of tacrolimus. One third of patients with moderate to severe atopic dermatitis experience over 90% improvement in their disease over a 12-week treatment period and up to 70% of patients have over 50% improvement. A 1-year treatment leads to more than 90% improvement in 75% of patients. The most pronounced side effect is a burning sensation occurring in up to 60% of patients. Atopic dermatitis is a chronic skin disease leading to a demand for long-term treatment control. Such treatment options have not previously been available--except for emollients which are not efficacious for controlling skin inflammation. Tacrolimus and pimecrolimus are new treatment options, free from the potential side effects of topical steroids, which are known for their efficacy in short-term treatment. The new treatment modalities prevent the eczema from relapsing and at the same time they control active eczema. The future will see a shift towards the long-term use of tacrolimus which is able to control the skin inflammation and, hopefully, shorten the course of the eczema.

Economic evidence for the prevention and treatment of atopic eczema: a protocol for a systematic review.

PubMed

Sach, Tracey Helen; McManus, Emma; Mcmonagle, Christopher; Levell, Nick

2016-05-27

Eczema, synonymous with atopic eczema or atopic dermatitis, is a chronic skin disease that has a similar impact on health-related quality of life as other chronic diseases. The proposed research aims to provide a comprehensive systematic assessment of the economic evidence base available to inform economic modelling and decision making on interventions to prevent and treat eczema at any stage of the life course. Whilst the Global Resource of Eczema Trials (GREAT) database collects together the effectiveness evidence for eczema, there is currently no such systematic resource on the economics of eczema. It is important to gain an overview of the current state of the art of economic methods in the field of eczema in order to strengthen the economic evidence base further. The proposed study is a systematic review of the economic evidence surrounding interventions for the prevention and treatment of eczema. Relevant search terms will be used to search MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, National Health Service (NHS) Economic Evaluation Database, Health Technology Assessment, Cumulative Index to Nursing and Allied Health Literature, EconLit, Scopus, Cost-Effectiveness Analysis Registry and Web of Science in order to identify relevant evidence. To be eligible for inclusion studies will be primary empirical studies evaluating the cost, utility or full economic evaluation of interventions for preventing or treating eczema. Two reviewers will independently assess studies for eligibility and perform data abstraction. Evidence tables will be produced presenting details of study characteristics, costing methods, outcome methods and quality assessment. The methodological quality of studies will be assessed using accepted checklists. The systematic review is being undertaken to identify the type of economic evidence available, summarise the results of the available economic evidence and critically appraise the quality of economic evidence currently available to inform future economic modelling and resource allocation decisions about interventions to prevent or treat eczema. We aim to use the review to offer guidance about how to gather economic evidence in studies of eczema and/or what further research is necessary in order to inform this. PROSPERO CRD42015024633.

Identifying CpG sites associated with eczema via random forest screening of epigenome-scale DNA methylation.

PubMed

Quraishi, B M; Zhang, H; Everson, T M; Ray, M; Lockett, G A; Holloway, J W; Tetali, S R; Arshad, S H; Kaushal, A; Rezwan, F I; Karmaus, W

2015-01-01

The prevalence of eczema is increasing in industrialized nations. Limited evidence has shown the association of DNA methylation (DNA-M) with eczema. We explored this association at the epigenome-scale to better understand the role of DNA-M. Data from the first generation (F1) of the Isle of Wight (IoW) birth cohort participants and the second generation (F2) were examined in our study. Epigenome-scale DNA methylation of F1 at age 18 years and F2 in cord blood was measured using the Illumina Infinium HumanMethylation450 Beadchip. A total of 307,357 cytosine-phosphate-guanine sites (CpGs) in the F1 generation were screened via recursive random forest (RF) for their potential association with eczema at age 18. Functional enrichment and pathway analysis of resulting genes were carried out using DAVID gene functional classification tool. Log-linear models were performed in F1 to corroborate the identified CpGs. Findings in F1 were further replicated in F2. The recursive RF yielded 140 CpGs, 88 of which showed statistically significant associations with eczema at age 18, corroborated by log-linear models after controlling for false discovery rate (FDR) of 0.05. These CpGs were enriched among many biological pathways, including pathways related to creating transcriptional variety and pathways mechanistically linked to eczema such as cadherins, cell adhesion, gap junctions, tight junctions, melanogenesis, and apoptosis. In the F2 generation, about half of the 83 CpGs identified in F1 showed the same direction of association with eczema risk as in F1, of which two CpGs were significantly associated with eczema risk, cg04850479 of the PROZ gene (risk ratio (RR) = 15.1 in F1, 95 % confidence interval (CI) 1.71, 79.5; RR = 6.82 in F2, 95 % CI 1.52, 30.62) and cg01427769 of the NEU1 gene (RR = 0.13 in F1, 95 % CI 0.03, 0.46; RR = 0.09 in F2, 95 % CI 0.03, 0.36). Via epigenome-scaled analyses using recursive RF followed by log-linear models, we identified 88 CpGs associated with eczema in F1, of which 41 were replicated in F2. Several identified CpGs are located within genes in biological pathways relating to skin barrier integrity, which is central to the pathogenesis of eczema. Novel genes associated with eczema risk were identified (e.g., the PROZ and NEU1 genes).

MULTIPLE CARCINOMATOUS GROWTHS AND SKIN SARCOMA IN A PATIENT WITH CHRONIC ROENTGEN-RAY DERMATOSIS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuta, A.

A case of an extensive chronic roentgen-ray dermatosis on the face of a 68 year old man is reported which developed approximately thirty years after x- ray treatment for sycosis barbae and eczema on the hands. Both fore-arms were amputated six and fourteen years after radiation therapy because of severe destructive lesions. Within the area of this late chronic roentgen-ray dermatosis on the face (forehead, nose, eyelids) gradually eight malignant tumors developed, i.e., four spinocellulars carcinomas, three basalcell carcinomas, and one polymorphocellular sarcoma. All of the tumors, including polymorphocellulars sarcoma, were sparingly excised with optimum therapeutic and cosmetic results andmore » the patient has now for more than two years shown no signs of relapse. There is only an atypic flat spinocellular lesion on the right ala nasi which is uncertain. (auth)« less

Improving Value for Patients with Eczema.

PubMed

Block, Julie

2018-04-01

Chronic diseases now represent a cost majority in the United States health care system. Contributing factors to rising costs include expensive novel and emerging therapies, under-treatment of disease, under-management of comorbidities, and patient dissatisfaction with care results. Critical to identifying replicable improvement methods is a reliable model to measure value. If we understand value within healthcare consumerism to be equal to a patient's health outcome improvement over costs associated with care (Value=Outcomes/Costs), we can use this equation to measure the improvement of value. Research and literature show that patient activation-the skills and confidence that equip patients to become actively engaged in their health care-impact health outcomes, costs, and patient experience. Reaching patient activation through engagement methods including shared decision-making (SDM) lead to improved value of care received. The National Eczema Association (NEA) Shared Decision-Making Resource Center can be a transformative strategy to measure and evaluate value of health care interventions for eczema patients to advance a value-driven health care system in the United States. Through this Resource Center, NEA will measure patient value through their own perceptions using validated PRO instruments and other patient-generated health data. Assessment of this data will reveal findings that can assist researchers in evaluating the impact this care framework on patient-perceived value across other chronic diseases. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases.

PubMed

Bertelsen, Randi J; Brantsæter, Anne Lise; Magnus, Maria C; Haugen, Margaretha; Myhre, Ronny; Jacobsson, Bo; Longnecker, Matthew P; Meltzer, Helle M; London, Stephanie J

2014-01-01

Whether probiotics, which can influence the microbiome, prevent infant eczema or allergic disease remains an open question. Most studies have focused on high-risk infants. We sought to assess whether consumption of probiotic milk products protects against atopic eczema, rhinoconjunctivitis, and asthma in early childhood in a large population-based pregnancy cohort (the Norwegian Mother and Child Cohort study). We examined associations between consumption of probiotic milk products in pregnancy and infancy with questionnaire-reported atopic eczema, rhinoconjunctivitis, and asthma in 40,614 children. Relative risks (RRs) were calculated by using general linear models adjusted for potential confounders. Consumption of probiotic milk in pregnancy was associated with a slightly reduced relative risk (RR) of atopic eczema at 6 months (adjusted RR, 0.94; 95% CI, 0.89-0.99) and of rhinoconjunctivitis between 18 and 36 months (adjusted RR, 0.87; 95% CI, 0.78-0.98) compared with no consumption during pregnancy. Maternal history of allergic disease did not notably influence the associations. When both the mother (during pregnancy) and infant (after 6 months of age) had consumed probiotic milk, the adjusted RR of rhinoconjunctivitis was 0.80 (95% CI, 0.68-0.93) relative to no consumption by either. Probiotic milk consumption was not associated with asthma at 36 months. In this population-based cohort consumption of probiotic milk products was related to a reduced incidence of atopic eczema and rhinoconjunctivitis, but no association was seen for incidence of asthma by 36 months of age. Published by Mosby, Inc.

Effects of Triple P parenting intervention on child health outcomes for childhood asthma and eczema: Randomised controlled trial.

PubMed

Morawska, Alina; Mitchell, Amy E; Burgess, Scott; Fraser, Jennifer

2016-08-01

Childhood chronic health conditions have considerable impact on children. We aimed to test the efficacy of a brief, group-based parenting intervention for improving illness-related child behaviour problems, parents' self-efficacy, quality of life, parents' competence with treatment, and symptom severity. A 2 (intervention vs. care as usual) by 3 (baseline, post-intervention, 6-month follow-up) design was used, with random group assignment. Participants were 107 parents of 2- to 10-year-old children with asthma and/or eczema. Parents completed self-report questionnaires, symptom diaries, and home observations were completed. The intervention comprised two 2-h group discussions based on Triple P. Parents in the intervention group reported (i) fewer eczema-related, but not asthma-related, child behaviour problems; (ii) improved self-efficacy for managing eczema, but not asthma; (iii) better quality of life for parent and family, but not child; (iv) no change in parental treatment competence; (v) reduced symptom severity, particularly for children prescribed corticosteroid-based treatments. Results demonstrate the potential for brief parenting interventions to improve childhood chronic illness management, child health outcomes, and family wellbeing. Effects were stronger for eczema-specific outcomes compared to asthma-specific outcomes. Effects on symptom severity are very promising, and further research examining effects on objective disease severity and treatment adherence is warranted. ACTRN12611000558921. Copyright © 2016 Elsevier Ltd. All rights reserved.

Maternal stress and psychological distress preconception: association with offspring atopic eczema at age 12 months

PubMed Central

El-Heis, S; Crozier, SR; Healy, E; Robinson, SM; Harvey, NC; Cooper, C; Inskip, HM; Baird, J; Godfrey, KM

2017-01-01

Background Perinatal maternal stress and low mood have been linked to offspring atopic eczema. Objectives To examine the relation of maternal stress/mood with atopic eczema in the offspring, focusing particularly on stress/psychological distress preconception. Methods At recruitment in the UK Southampton Women’s Survey, preconception maternal reports of perceived stress in daily living and the effect of stress on health were recorded; in a sub-sample psychological distress was assessed (12-item General Health Questionnaire). Infants were followed up at ages 6 (n=2956) and 12 (n=2872) months and atopic eczema ascertained (based on UK Working Party Criteria for the Definition of Atopic Dermatitis). At 6 months postpartum, mothers were asked if they had experienced symptoms of low mood since childbirth and completed the Edinburgh Post-natal Depression Scale. Results Preconception perceived stress affecting health (OR 1.21 (95%CI 1.08-1.35), p=0.001) and stress in daily living (OR 1.16 (1.03-1.30), p=0.014) were associated with an increased risk of offspring atopic eczema at age 12 months but not at 6 months, robust to adjustment for potentially confounding variables. Findings were similar for maternal psychological distress preconception. Low maternal mood between delivery and 6 months postpartum was associated with an increased risk of infantile atopic eczema at age 12 months, but no significant association between postnatal mood and atopic eczema was seen after taking account of preconception stress. Conclusion & Clinical Relevance Our data provide novel evidence linking maternal stress at preconception to atopic eczema risk, supporting a developmental contribution to the aetiology of atopic eczema and pointing to potentially modifiable influences. PMID:28218994

Genomic insights into the atopic eczema-associated skin commensal yeast Malassezia sympodialis.

PubMed

Gioti, Anastasia; Nystedt, Björn; Li, Wenjun; Xu, Jun; Andersson, Anna; Averette, Anna F; Münch, Karin; Wang, Xuying; Kappauf, Catharine; Kingsbury, Joanne M; Kraak, Bart; Walker, Louise A; Johansson, Henrik J; Holm, Tina; Lehtiö, Janne; Stajich, Jason E; Mieczkowski, Piotr; Kahmann, Regine; Kennell, John C; Cardenas, Maria E; Lundeberg, Joakim; Saunders, Charles W; Boekhout, Teun; Dawson, Thomas L; Munro, Carol A; de Groot, Piet W J; Butler, Geraldine; Heitman, Joseph; Scheynius, Annika

2013-01-22

Malassezia commensal yeasts are associated with a number of skin disorders, such as atopic eczema/dermatitis and dandruff, and they also can cause systemic infections. Here we describe the 7.67-Mbp genome of Malassezia sympodialis, a species associated with atopic eczema, and contrast its genome repertoire with that of Malassezia globosa, associated with dandruff, as well as those of other closely related fungi. Ninety percent of the predicted M. sympodialis protein coding genes were experimentally verified by mass spectrometry at the protein level. We identified a relatively limited number of genes related to lipid biosynthesis, and both species lack the fatty acid synthase gene, in line with the known requirement of these yeasts to assimilate lipids from the host. Malassezia species do not appear to have many cell wall-localized glycosylphosphatidylinositol (GPI) proteins and lack other cell wall proteins previously identified in other fungi. This is surprising given that in other fungi these proteins have been shown to mediate interactions (e.g., adhesion and biofilm formation) with the host. The genome revealed a complex evolutionary history for an allergen of unknown function, Mala s 7, shown to be encoded by a member of an amplified gene family of secreted proteins. Based on genetic and biochemical studies with the basidiomycete human fungal pathogen Cryptococcus neoformans, we characterized the allergen Mala s 6 as the cytoplasmic cyclophilin A. We further present evidence that M. sympodialis may have the capacity to undergo sexual reproduction and present a model for a pseudobipolar mating system that allows limited recombination between two linked MAT loci. Malassezia commensal yeasts are associated with a number of skin disorders. The previously published genome of M. globosa provided some of the first insights into Malassezia biology and its involvement in dandruff. Here, we present the genome of M. sympodialis, frequently isolated from patients with atopic eczema and healthy individuals. We combined comparative genomics with sequencing and functional characterization of specific genes in a population of clinical isolates and in closely related model systems. Our analyses provide insights into the evolution of allergens related to atopic eczema and the evolutionary trajectory of the machinery for sexual reproduction and meiosis. We hypothesize that M. sympodialis may undergo sexual reproduction, which has important implications for the understanding of the life cycle and virulence potential of this medically important yeast. Our findings provide a foundation for the development of genetic and genomic tools to elucidate host-microbe interactions that occur on the skin and to identify potential therapeutic targets.

Skin reactions amongst Greek endodontists: a national questionnaire survey.

PubMed

Zarra, T; Lambrianidis, T

2015-04-01

To investigate amongst Greek endodontists in the past 5 years the prevalence, aetiologic factors, severity and treatment for skin reactions. One hundred and 47 endodontists met the inclusion criteria and were invited to participate in the survey. Participants were asked for personal/professional data, prevalence, aetiologic factors, symptoms, severity and treatment for skin reactions in the past 5 years. The type of gloves used and frequency of hand washing as well as information on history of atopy and eczema were also recorded. Data were analysed using chi-square test and independent samples t-test. The level of significance was set at P = 0.05. The response rate was 84%. Skin reactions were reported by 32.5% of participants. Hands were the body part most frequently affected (66% of cases); glove powder accounted for 73% of skin reactions. Medical care was sought by 28.2% of the affected participants. Endodontists with a history of atopy (P < 0.001) and dermal eczema (P < 0.001) as well as females (P = 0.023) were more likely to report skin reactions. Replacement of powdered latex gloves with powder-free or vinyl/nitrile gloves, avoidance of potential allergens and use of pharmaceutical ointments were adopted by 48.7%, 23.1% and 2.6% of the affected endodontists, respectively, to manage skin reactions. Approximately one-third of participants reported skin reactions. History of atopy and dermal eczema as well as gender was significantly associated with such reactions. The use of powder-free latex gloves instead of powdered ones was the measure most frequently adopted to manage reactions. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Climatic factors are associated with childhood eczema prevalence in US

PubMed Central

Silverberg, Jonathan I.; Hanifin, Jon; Simpson, Eric L.

2013-01-01

Atopic dermatitis (AD, atopic eczema) is driven by a complex relationship between genetic predisposition and environmental exposures. We sought to determine the impact of specific climatic factors on the US prevalence of AD. We used a merged analysis of the 2007 National Survey of Children's Health from a representative sample of 91,642 children age 0–17 years and the 2006–2007 National Climate Data Center and Weather Service measurements of relative humidity (%), indoor heating degree days (HDD), clear sky UV indices ozone levels, and outdoor air temperature. As a proxy for AD, we used an affirmative response to the NSCH survey question asking whether the participant’s child has been given a doctor diagnosis of “eczema or any other kind of skin allergy” in the previous 12 months. In multivariate models controlling for sex, race/ethnicity, age and household income, eczema prevalence was significantly lower with highest-quartile mean annual relative humidity (logistic regression, adjusted odds ratio [95% confidence interval]=0.82 [0.71–0.96], P=0.01) and issued UV index (0.73 [0.64–0.84], P<0.0001), and with two other factors associated with increased UV exposure. Eczema prevalence was decreased with highest-quartile air temperature (0.80 [0.70–0.92], P=0.002), but increased with 3rd–quartile mean annual HDD (1.26 [1.11–1.43], P=0.0003). This study provides evidence of climate influences on the US prevalence of childhood eczema. PMID:23334343

Global skin diseases on Instagram hashtags.

PubMed

Braunberger, Taylor; Mounessa, Jessica; Rudningen, Kyle; Dunnick, Cory A; Dellavalle, Robert P

2017-05-15

Recently named one of the most influential phone applications, Instagram continues to grow in popularity [1]. Instagram consists of images and video posts, making it ideal for education and communication within the visual field of dermatology. In this study, we seek to determine the presence of dermatology-related content with regard to the most common cutaneous diseases of the world. We searched the account types and hashtags associated with the eight most common skin diseases globally as identified by the Global Burden of Disease (GBD) study by Hollenstein et al.: eczema, psoriasis, acne,pruritus, alopecia, decubitus ulcer, urticaria, andscabies [9]. The majority of Instagram accounts included patient experiences (n=73), private accounts(n=52), and disease advocacy and awareness groups(n=20), (total n=221). We further investigated over 2 million skin disease hashtags. The greatest numbersof hashtags were the following: #acne (n = 1,622,626),#alopecia (n = 317,566), and #eczema (n = 196,115). Our results demonstrate that patients interact withone another through Instagram. As social networking platforms become more frequently used as a source of information for patients and patient support, medical professionals must gain awareness of content available through Instagram and consider it as a means to educate the public.

Filaggrin mutations increase allergic airway disease in childhood and adolescence through interactions with eczema and aeroallergen sensitization.

PubMed

Chan, Adrian; Terry, William; Zhang, Hongmei; Karmaus, Wilfried; Ewart, Susan; Holloway, John W; Roberts, Graham; Kurukulaaratchy, Ramesh; Arshad, Syed Hasan

2018-02-01

Filaggrin loss-of-function (FLG-LOF) mutations are an established genetic cause of eczema. These mutations have subsequently been reported to increase the risk of aeroallergen sensitization and allergic airway disease. However, it is unclear whether FLG variants require both eczema and aeroallergen sensitization to influence airway disease development long-term outcomes. To examine the effects of FLG-LOF mutations on allergic airway disease outcomes, with eczema and aeroallergen sensitization as intermediate variables, using the Isle of Wight birth cohort. Study participants were evaluated at ages 1, 2, 4, 10 and 18 years to ascertain the development of allergic diseases (eczema, asthma and allergic rhinitis) and aeroallergen sensitization (determined by skin prick tests). FLG-LOF mutations were genotyped in 1150 subjects. To understand the complex associations between FLG mutations, intermediate variables (eczema and aeroallergen sensitization) and airway disease, path analysis was performed. There were significant total effects of FLG-LOF mutations on both asthma and allergic rhinitis at all ages as well as on aeroallergen sensitization up till 10 years old. In the filaggrin-asthma analysis, a direct effect of FLG-LOF mutations was observed on early childhood eczema (age 1 and 2 years) (relative risk (RR) 2.01, 95% CI: 1.74-2.31, P < .001), and all significant indirect pathways on asthma outcomes passed through eczema at these ages. In contrast, for the filaggrin-rhinitis model, FLG-LOF mutations exerted significant direct effects on early eczema as well as rhinitis at 10 years (RR 1.99; 95% CI: 1.72-2.29, P = .002). FLG-LOF mutations are a significant risk factor for later childhood asthma and rhinitis. However, the pathway to asthma is only through early childhood eczema while a direct effect was observed for childhood rhinitis. © 2017 John Wiley & Sons Ltd.

Endotoxin Exposure and Eczema in the First Year of Life

PubMed Central

Phipatanakul, Wanda; Celedón, Juan C.; Raby, Benjamin A.; Litonjua, Augusto A.; Milton, Donald K.; Sredl, Diane; Weiss, Scott T.; Gold, Diane R.

2005-01-01

Objective Exposure to endotoxin in early life has been proposed as a factor that may protect against the development of allergic diseases such as eczema. The objective of this study was to examine the relation between endotoxin exposure in early life and eczema in the first year of life in children with parental history of asthma or allergies. Methods This study used a prospective birth cohort study of 498 children who had a history of allergy or asthma in at least 1 parent and lived in metropolitan Boston. A subset of 401 living rooms had house dust samples adequate for analysis of endotoxin. Results In multivariate analyses adjusting for gender, income, and season of birth, endotoxin levels in the living room at 2 to 3 months of age was inversely associated with physician- or nurse-diagnosed eczema in the first year of life (odds ratio [OR] for each quartile increment: 0.76; 95% confidence interval [CI]: 0.61–0.96). Exposure to a dog in the home at age 2 to 3 months was also inversely associated with eczema in the first year of life, but the CI widened when endotoxin was included in the multivariate model (OR: 0.54; 95% CI: 0.27–1.09). Other variables associated with eczema in the first year of life included paternal history of eczema (OR: 1.91; 95% CI: 1.03–3.55) and maternal specific immunoglobulin E positivity to ≥1 allergen (OR: 1.61; 95% CI: 1.01–2.56). Conclusions Among children with parental history of asthma or allergies, exposure to high levels of endotoxin in early life may be protective against eczema in the first year of life. In these children, paternal history of eczema and maternal sensitization to at least 1 allergen are associated with an increased risk of eczema in the first year of life. PMID:15231902

[Products for hand hygiene and antisepsis: use by health professionals and relationship with hand eczema].

PubMed

Batalla, A; García-Doval, I; de la Torre, C

2012-04-01

Hand hygiene is the most important measure for the prevention of nosocomial infection. We describe the different products available for hygiene and antisepsis of the hands and the use of these products in daily practice. Hand hygiene products such as soaps and detergents are a cause of irritant dermatitis in health professionals. This irritation is one of the principal factors affecting their use in clinical practice. Alcohol-based products are better tolerated and less irritant than soap and water; irritation should not therefore be a limiting factor in the use of these products and they are to be recommended in place of soap and water. Informative and continued education programs could increase their use. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

Psychiatric Treatment of Eczema: A Controlled Trial

PubMed Central

Brown, D. G.; Bettley, F. R.

1971-01-01

Seventy-two patients with eczema were randomly allotted to one of two treatment groups: A, those receiving dermatological treatment only, and B, those receiving the same dermatological treatment plus psychiatric treatment, limited where possible to four months. Cases were followed up at six-monthly dermatological assessments, 57 (79%) for 18 months. The findings suggest that in the presence of overt emotional disturbance, of new psychological or psychophysiological symptoms preceding the rash by up to a year, and of high motivation for it, brief psychiatric treatment improves the outcome in eczema (the proportion clear at 18 months was about doubled), whereas in their absence such treatment may worsen it, especially in the short term. PMID:5090759

Formulation and clinical evaluation of topical dosage forms of Indian Penny Wort, walnut and turmeric in eczema.

PubMed

Khiljee, Sonia; Rehman, Nisarur; Khiljee, Tanzila; Loebenberg, Raimar; Ahmad, Rao Saeed

2015-11-01

Eczema is characterized by itching, lichenification, scaling, oedema and erythema. Current management strategies include corticosteroids, which are limited due to side effects. Many herbal remedies are used traditionally but unfortunately have not been validated in controlled clinical trials. Three popular traditional treatments of eczema include Indian pennywort, Walnut and Turmeric. In this study three topical formulations (micro emulsion, gel and ointment) were prepared from extracts of Indian pennywort, Walnut and Turmeric. These formulations were monitored for stability for a period of three months. Controlled clinical trials were conducted on 360 eczema patients. Clinical parameters observed were degree of erythema, oedema, scaling, itching and lichenification. Effects of each formulation on these clinical parameters were compared with placebo formulations. Micro emulsion formulations in all cases proved to be more effective in reducing semi quantitative scores of erythema and oedema. Itching was relieved more by gel formulation. The ointment showed more efficacy towards scaling and lichenification. Comparison of the effects of placebo and the specific formulations was performed by chi-square statistics and found to be highly significant. In summary it is concluded that all the formulations could be used as promising source for treatment of eczema.

Probiotics: immunomodulatory properties in allergy and eczema.

PubMed

Drago, L; Toscano, M; Pigatto, P D

2013-10-01

In the last decades the prevalence of allergic diseases and eczema raised significantly, and today they are the most common chronic pathologies affecting children. It has been shown that a functional intestinal mucosa provides a defensive barrier to the host against potential dangerous antigens, regulating the tolerance to them. Some inflammatory diseases of the gut weaken the barrier causing an increase in the mucosa permeability and in antigenic transition. As a consequence, there is an aberrant immune response and the release of pro-inflammatory cytokines further compromises the barrier functionality. It has been demonstrated that a correlation between allergy and eczema onset and the intestinal microflora composition exists, and in particular, it has been showed that some microorganisms are able to influence the immune response. For these reasons it has been hypothesized that probiotics may have a beneficial role in preventing and treating allergies and eczema. However, the benefits of this treatment depend on many factors, such as the bacterial strain, the duration of administration, the pathology, the patient characteristics (age, diet, allergy predisposition). The aim of this work was to review the present knowledge about the use of probiotics in allergic diseases and eczema, highlighting their role in the aforementioned pathologies.

Cupping Therapy May be Harmful for Eczema: A PubMed Search

PubMed Central

Hon, Kam Lun E.; Luk, David Chi Kong; Leong, Kin Fon; Leung, Alexander K. C.

2013-01-01

Eczema is a common childhood atopic condition and treatment is with emollients, topical corticosteroids, and avoidance of possible triggers. S. aureus colonization is a common complication. As there is no immediate cure, many parents seek alternative therapies that claim unproven therapeutic efficacy. We report a girl with long history of treatment noncompliance. After practicing a long period of dietary avoidance and supplementation, the grandparents took her to an alternative medicine practitioner. Following cupping therapy and acupuncture, the child developed blistering and oozing over her back the next day, which rapidly evolved to two large irregular-edge deep ulcers. She was treated with intravenous antibiotics and received multidisciplinary supportive intervention. Using search words of  “cupping,” “eczema,” and “atopic dermatitis,” only two reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports. Childhood eczema is an eminently treatable atopic disease. Extreme alternative therapy seems not to be efficacious and may even be associated with serious undesirable sequelae. Physicians should be aware of various alternative treatment modalities and be prepared to offer evidence-based advice to the patients with eczema and their families. PMID:24282650

"Dermatitis" defined.

PubMed

Smith, Suzanne M; Nedorost, Susan T

2010-01-01

The term "dermatitis" can be defined narrowly or broadly, clinically or histologically. A common and costly condition, dermatitis is underresourced compared to other chronic skin conditions. The lack of a collectively understood definition of dermatitis and its subcategories could be the primary barrier. To investigate how dermatologists define the term "dermatitis" and determine if a consensus on the definition of this term and other related terms exists. A seven-question survey of dermatologists nationwide was conducted. Of respondents (n  =  122), half consider dermatitis to be any inflammation of the skin. Nearly half (47.5%) use the term interchangeably with "eczema." Virtually all (> 96%) endorse the subcategory "atopic" under the terms "dermatitis" and "eczema," but the subcategories "contact," "drug hypersensitivity," and "occupational" are more highly endorsed under the term "dermatitis" than under the term "eczema." Over half (55.7%) personally consider "dermatitis" to have a broad meaning, and even more (62.3%) believe that dermatologists as a whole define the term broadly. There is a lack of consensus among experts in defining dermatitis, eczema, and their related subcategories.

Eczema in early life: Genetics, the skin barrier, and lessons learned from birth cohort studies

PubMed Central

Biagini Myers, Jocelyn M.; Khurana Hershey, Gurjit K.

2010-01-01

Eczema is a chronic inflammatory disorder of the skin that affects up to 30% of children. It often afflicts infants in the first few months of life and can be the first indicator of the atopic march. Recent results from birth cohort studies have uncovered novel information regarding genetic and environmental factors that promote the development of eczema. Birth cohort studies provide an optimal study design to elucidate these associations and prospectively track longitudinal data including exposure assessment and health outcomes from birth into early life and childhood. This is especially relevant for eczema given the age specific emergence of this disease. In this review, we will provide a general overview of pediatric eczema and discuss the important findings in the literature with respect to genetics and environmental exposures, highlighting those derived from birth cohort studies. Additionally, we will review how these relate to the atopic march, the hygiene hypothesis and the integrity of the skin barrier. PMID:20739029

Eek! It's Eczema!

MedlinePlus

... Staying Safe Videos for Educators Search English Español Eczema KidsHealth / For Kids / Eczema What's in this article? ... need to worry. It's just eczema. What Is Eczema? Eczema (say: EK-zeh-ma) is also called ...

TREatment of ATopic eczema (TREAT) Registry Taskforce: protocol for an international Delphi exercise to identify a core set of domains and domain items for national atopic eczema registries.

PubMed

Gerbens, Louise A A; Boyce, Aaron E; Wall, Dmitri; Barbarot, Sebastien; de Booij, Richard J; Deleuran, Mette; Middelkamp-Hup, Maritza A; Roberts, Amanda; Vestergaard, Christian; Weidinger, Stephan; Apfelbacher, Christian J; Irvine, Alan D; Schmitt, Jochen; Williamson, Paula R; Spuls, Phyllis I; Flohr, Carsten

2017-02-27

Patients with moderate-to-severe atopic eczema (AE) often require photo- or systemic immunomodulatory therapies to induce disease remission and maintain long-term control. The current evidence to guide clinical management is small, despite the frequent and often off-label use of these treatments. Registries of patients on photo- and systemic immunomodulatory therapies could fill this gap, and the collection of a core set concerning these therapies in AE will allow direct comparisons across registries as well as data sharing and pooling. Using an eDelphi approach, the international TREatment of ATopic eczema (TREAT) Registry Taskforce aims to seek consensus between key stakeholders internationally on a core set of domains and domain items for AE patient registries with a research focus that collect data of children and adults on photo- and systemic immunomodulatory therapies. Participants from six stakeholder groups will be invited: doctors, nurses, non-clinical researchers, patients, as well as industry and regulatory body representatives. The eDelphi will comprise three sequential online rounds, requesting participants to rate the importance of each proposed domain and domain items. Participants will be able to add domains and domain items to the proposed list in round 1. A final consensus meeting will be held with representatives of each stakeholder group. Identifying a uniform core set of domains and domain items to be captured by AE patient registries will increase the utility of individual registries, and provide greater insight into the effectiveness, safety and cost-effectiveness of photo- and systemic immunomodulatory therapies to guide clinical management across dermatology centres and country borders. Not applicable. This eDelphi study was registered in the Core Outcome Measures for Effectiveness Trials (COMET) database.

Occupational Contact Dermatitis in North American Production Workers Referred for Patch Testing: Retrospective Analysis of Cross-Sectional Data From the North American Contact Dermatitis Group 1998 to 2014.

PubMed

Warshaw, Erin M; Hagen, Solveig L; DeKoven, Joel G; Zug, Kathryn A; Sasseville, Denis; Belsito, Donald V; Zirwas, Matthew J; Fowler, Joseph F; Taylor, James S; Fransway, Anthony F; DeLeo, Vincent A; Marks, James G; Pratt, Melanie D; Maibach, Howard I; Mathias, C G Toby

Little is known about the epidemiology of contact dermatitis in production workers (PWs). The aims of this study were to estimate the prevalence of contact dermatitis and characterize clinically relevant and occupationally related allergens among North American PWs undergoing patch testing. This was a retrospective cross-sectional analysis of North American Contact Dermatitis Group data from 1998 to 2014. Of 39,332 patch-tested patients, 2732 (7.0%) were PWs. Among PWs, most were men (62.4%) and white (83.9%). A history of childhood eczema was uncommon (11.3%). Prevalent occupations included machine operators (27.3%); fabricators, assemblers, and hand-working occupations (16.8%); and precision metalworking occupations (16.1%). The most frequent sites of dermatitis were the hands (53.8%) and arms (29.4%), which were significantly more commonly affected compared with non-PWs (P < 0.0001). Occupationally related skin disease, allergic contact dermatitis, and irritant contact dermatitis were also significantly more common in PWs (49.9% vs 10.6%, 58.9% vs 53.7%, and 32.7% vs 25.7%, respectively; all Ps < 0.0001). Epoxy (15.3%), thiuram mix (8.3%), carba mix (8.1%), formaldehyde (6.3%), and cobalt (5.9%) were the most frequent occupationally related allergens. The top allergen sources included adhesives/glues (16.0%), metalworking fluids/cutting oils (6.8%), and coatings (6.3%). Production workers had a high rate of occupationally related skin disease, as well as irritant and allergic contact dermatitis. Involvement of exposed body areas was common. Frequently identified allergens included adhesives/glues, rubber accelerators, metals, and preservatives.

Allergic contact dermatitis caused by (meth)acrylates in nail cosmetic products in users and nail technicians - a 5-year study.

PubMed

Raposo, Inês; Lobo, Inês; Amaro, Cristina; Lobo, Maria de Lurdes; Melo, Helena; Parente, Joana; Pereira, Teresa; Rocha, Joana; Cunha, Ana P; Baptista, Armando; Serrano, Pedro; Correia, Teresa; Travassos, Ana R; Dias, Margarida; Pereira, Fátima; Gonçalo, Margarida

2017-12-01

The increasing use of long-lasting nail aesthetic products has led to a growing number of cases of allergic contact dermatitis (ACD) caused by (meth)acrylates in recent years. To provide information on ACD caused by (meth)acrylates related to nail cosmetic products. We retrospectively reviewed files of patients with ACD caused by (meth)acrylates related to nail cosmetic products, who were patch tested between January 2011 and December 2015 in 13 departments of dermatology in Portugal. Two-hundred and thirty cases of ACD caused by (meth)acrylates (55 technicians, 56 consumers, and 119 with mixed exposure) had been documented, mostly as chronic hand eczema (93%). The most common sensitizers were: 2-hydroxyethyl methacrylate (HEMA), which was positive in 90% of the tested patients, 2-hydroxypropyl methacrylate (HPMA), which was positive in 64.1%, and ethyleneglycol dimethacrylate, which was positive in 54.5%. HEMA and HPMA were the most frequent positive allergens. HEMA, which identified 90% of cases, can be considered to be a good screening allergen. The high number of cases of ACD caused by (meth)acrylates in nail cosmetic products certainly warrants better preventive measures at the occupational level, and specific regulation in the field of consumer safety. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials.

PubMed

Schmitt, Jochen; Spuls, Phyllis I; Thomas, Kim S; Simpson, Eric; Furue, Masutaka; Deckert, Stefanie; Dohil, Magdalene; Apfelbacher, Christian; Singh, Jasvinder A; Chalmers, Joanne; Williams, Hywel C

2014-10-01

The lack of core outcome sets for atopic eczema (AE) is a major obstacle for advancing evidence-based treatment. The global Harmonising Outcome Measures for Eczema (HOME) initiative has already defined clinical signs, symptoms, quality of life, and long-term control of flares as core outcome domains for AE trials. This article deals with the standardization of measurement instruments to assess clinical signs of AE. To resolve the current lack of standardization of the assessment of clinical signs of AE, we followed a structured process of systematic reviews and international consensus sessions to identify 1 core outcome measurement instrument for assessment of clinical signs in all future AE trials. Systematic reviews indicated that from 16 different instruments identified to assess clinical signs of AE, only the Eczema Area and Severity Index (EASI) and the objective Scoring Atopic Dermatitis (SCORAD) index were identified as extensively validated. The EASI has adequate validity, responsiveness, internal consistency, and intraobserver reliability. The objective SCORAD index has adequate validity, responsiveness, and interobserver reliability but unclear intraobserver reliability to measure clinical signs of AE. In an international consensus study, patients, physicians, nurses, methodologists, and pharmaceutical industry representatives agreed that the EASI is the preferred core instrument to measure clinical signs in all future AE trials. All stakeholders involved in designing, reporting, and using clinical trials on AE are asked to comply with this consensus to enable better evidence-based decision making, clearer scientific communication, and improved patient care. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Viewing a humorous film decreases IgE production by seminal B cells from patients with atopic eczema.

PubMed

Kimata, Hajime

2009-02-01

Sperms induced IgE production by seminal B cells from patients with atopic eczema via interaction of B cells with galectin-3 on sperms. We studied the effect of viewing a humorous film on IgE production by seminal B cells cultured with sperms. Twenty-four male patients with atopic eczema viewed a humorous film (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, semen was collected, and seminal B cells and sperms were purified. Seminal B cells were cultured with sperms and IgE production was measured, while expression of galectin-3 on sperms was assessed. After viewing the humorous film, IgE production by B cells cultured with sperms was significantly decreased. Moreover, expression of galectin-3 on sperms was reduced. Viewing a humorous film reduced galectin-3 expression on sperms, which in turn decreased IgE production by seminal B cells cultured with sperms. These results indicate that viewing a humorous film may be helpful for the study and treatment of local IgE production and allergy in the reproductive tract.

Clinical Characteristics, Treatments, and Prognosis of Atopic Eczema in the Elderly.

PubMed

Tanei, Ryoji

2015-05-18

Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset and clinical course, and associations with immunoglobulin (Ig)E-allergic-status and asthmatic complication were observed. The highest positive-rate and positive-score for serum-specific IgE against Dermatophagoides farinae were 83.8% and 2.65 in patients with IgE-allergic AE, and a lower incidence of lichenified eczema in the elbow and knee folds were observed. In terms of treatments and outcomes, clinical improvement and clinical remission were observed in 80.8% and 36.5% of cases, respectively, using standard treatments and combined therapy with oral corticosteroid in severe cases. As for complications and final prognosis, most elderly AE patients reached the end of life with AE, but patients with IgE-allergic AE showed significantly lower incidences of complications of malignancy and death from malignancy. These results indicate that AE in the elderly represents a new subgroup of AE with specific features.

Clinical Characteristics, Treatments, and Prognosis of Atopic Eczema in the Elderly

PubMed Central

Tanei, Ryoji

2015-01-01

Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset and clinical course, and associations with immunoglobulin (Ig)E-allergic-status and asthmatic complication were observed. The highest positive-rate and positive-score for serum-specific IgE against Dermatophagoides farinae were 83.8% and 2.65 in patients with IgE-allergic AE, and a lower incidence of lichenified eczema in the elbow and knee folds were observed. In terms of treatments and outcomes, clinical improvement and clinical remission were observed in 80.8% and 36.5% of cases, respectively, using standard treatments and combined therapy with oral corticosteroid in severe cases. As for complications and final prognosis, most elderly AE patients reached the end of life with AE, but patients with IgE-allergic AE showed significantly lower incidences of complications of malignancy and death from malignancy. These results indicate that AE in the elderly represents a new subgroup of AE with specific features. PMID:26239460

Deodorants: a clinical provocation study in fragrance-sensitive individuals.

PubMed

Johansen, J D; Rastogi, S C; Bruze, M; Andersen, K E; Frosch, P; Dreier, B; Lepoittevin, J P; White, I; Menné, T

1998-10-01

Deodorants are one of the most marketed types of cosmetics and are frequently reported as a cause of dermatitis, particularly among fragrance-sensitive persons. The aim of this study was to investigate the ability of deodorants, which had previously caused axillary dermatitis in fragrance-mix-sensitive eczema patients, to provoke reactions on repeated open application tests on the upper arm and in the axillae, and to relate the findings to the content of fragrance-mix constituents in those deodorants. 14 eczema patients performed a 7-day use test with 1 or 2 deodorants that had caused a rash within the last 12 months. 2 applications per day were made in the axilla and simultaneously on a 25 cm2 area on the upper arm. A total of 20 deodorants were tested among the 14 patients. Afterwards, the deodorants were subjected to quantitative chemical analysis identifying constituents of the fragrance mix. 12/20 (60%) deodorants elicited eczema on use testing in the axilla. 8/12 deodorants were positive in the axilla on day (D) 7 and 4 both in the axilla and on the upper arm. 2 of the 4 developed a reaction in the axilla before it developed on the upper arm. Chemical analysis revealed that 18/19 deodorants contained between 1 and 6 of the fragrance-mix constituents, on average 3 being found. The mean concentration of fragrance-mix constituents was generally higher in the deodorants causing a positive use test, as compared with those giving a negative reaction, indicating that the differences between the deodorants in terms of elicitation potential were more related to quantitative aspects of allergen content than of a qualitative nature. It is recommended that deodorants are tested in the axilla in the case of a negative use test on the upper arm and a strong clinical suspicion.

Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases

PubMed Central

Bertelsen, Randi J.; Brantsæter, Anne Lise; Magnus, Maria C.; Haugen, Margaretha; Myhre, Ronny; Jacobsson, Bo; Longnecker, Matthew P.; Meltzer, Helle M.; London, Stephanie J.

2013-01-01

Background Whether probiotics, which can influence the microbiome, prevent infant eczema or allergic diseases remains an open question. Most studies have focused on high-risk infants. Objectives To assess whether consumption of probiotic milk products protects against atopic eczema, rhinoconjuctivitis, and asthma in early childhood in a large population-based pregnancy cohort (The Norwegian Mother and Child Cohort Study). Methods We examined associations between consumption of probiotic milk products in pregnancy and infancy with questionnaire-reported atopic eczema, rhinoconjuctivitis, and asthma in 40,614 children. Relative risks (RR) were calculated using general linear models, adjusted for potential confounders. Results Consumption of probiotic milk in pregnancy was associated with a slightly reduced risk [(adjusted RR (aRR)] of atopic eczema at 6 months aRR=0.94 (95% CI: 0.89, 0.99) and of rhinoconjuctivitis between 18 and 36 months, aRR=0.87 (95% CI: 0.78, 0.98) compared with no consumption during pregnancy. Maternal history of allergic disease did not notably influence the associations. When both mother (during pregnancy) and infant (after 6 months of age) had consumed probiotic milk, the adjusted relative risk of rhinoconjunctivitis was aRR=0.80 (95% CI: 0.68, 0.93) relative to no consumption by either. Probiotic milk consumption was not associated with asthma at 36 months. Conclusions In this population-based cohort, consumption of probiotic milk products was related to a reduced incidence of atopic eczema and rhinoconjuctivitis, but no association was seen for incidence of asthma by 36 months of age. PMID:24034345

Changes in Healthcare Spending After Diagnosis of Comorbidities Among Endometriosis Patients: A Difference-in-Differences Analysis.

PubMed

Epstein, Andrew J; Soliman, Ahmed M; Davis, Matthew; Johnson, Scott J; Snabes, Michael C; Surrey, Eric S

2017-11-01

We sought to characterize changes in healthcare spending associated with the onset of 22 endometriosis-related comorbidities. Women aged 18-49 years with endometriosis (N = 180,278) were extracted from 2006-2015 de-identified Clinformatics ® DataMart claims data. For 22 comorbidities, comorbidity patients were identified on the basis of having a first comorbidity diagnosis after their initial endometriosis diagnosis. Controls were identified on the basis of having no comorbidity diagnosis and were matched 1:1 to comorbidity patients on demographics and baseline spending. Total medical and pharmacy spending was measured during 12 months before and after each patient's index date (first comorbidity diagnosis for comorbidity patients, and equal number of days after earliest endometriosis claim for controls). Pre-post spending differences were compared using difference-in-differences linear regression. Total and comorbidity-related cumulative spending per patient for all endometriosis patients were calculated annually for the 5 years following endometriosis diagnosis. The number of endometriosis patients with each comorbidity varied between 121 for endometrial cancer and 16,177 for fatigue. Healthcare spending increased significantly with the onset of eight comorbidities: breast cancer, ovarian cancer, pregnancy complications, systemic lupus erythematosus/rheumatoid arthritis/Sjogren's/multiple sclerosis, infertility, uterine fibroids, ovarian cyst, and headache [p < 0.001 except for headache (p = 0.045)]. Spending decreased significantly for fatigue, cystitis/UTI, and eczema [p < 0.001 except for fatigue (p = 0.048)] and was not statistically different for the other 11 comorbidities. Difference-in-differences estimates were significantly higher for comorbidity patients for all comorbidities except eczema (p ≤ 0.003). Mean 5-year total cumulative spending was $58,191 per endometriosis patient, of which between 11% and 23% was attributable to comorbidity-related medical claims. For all but one of the 22 comorbidities associated with endometriosis, comorbidity onset was associated with a relative increase in total healthcare spending. AbbVie Inc.

Comparative Effectiveness of Homoeopathic vs. Conventional Therapy in Usual Care of Atopic Eczema in Children: Long-Term Medical and Economic Outcomes

PubMed Central

Roll, Stephanie; Reinhold, Thomas; Pach, Daniel; Brinkhaus, Benno; Icke, Katja; Staab, Doris; Jäckel, Tanja; Wegscheider, Karl; Willich, Stefan N.; Witt, Claudia M.

2013-01-01

Background One in five children visiting a homeopathic physician suffers from atopic eczema. Objectives We aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema. Methods In this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional) with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis) at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents’ expectation. Results The adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9–19.5] vs. 14.9 [10.4–19.4], p = 0.741). The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974). Total costs were higher in the homoeopathic versus the conventional group (months 31–36 200.54 Euro [132.33–268.76] vs. 68.86 Euro [9.13–128.58], p = 0.005). Conclusions Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs. PMID:23383019

Less common clinical manifestations of atopic dermatitis: prevalence by age.

PubMed

Julián-Gónzalez, Rolando Elias; Orozco-Covarrubias, Luz; Durán-McKinster, Carola; Palacios-Lopez, Carolina; Ruiz-Maldonado, Ramon; Sáez-de-Ocariz, Marimar

2012-01-01

The common manifestations of atopic dermatitis (AD) appear sequentially with involvement of the cheeks in infancy, flexural extremities in childhood, and hands in adulthood. Although less common clinical manifestations are well described, they have not been the subject of epidemiologic studies to describe their prevalence in specific age groups. This observational, cross-sectional, comparative study included 131 children younger than 18 of both sexes with AD who attended the clinics of the Dermatology Department of the National Institute of Pediatrics in Mexico City. Patients were examined to determine the presence of infrequent clinical manifestations of AD during infancy, preschool and school age, and adolescence and stratified according to sex, age, and number of clinical signs. A chi-square test was used to detect differences according to age and sex. Logistic regression analysis was also performed. The main findings according to age were genital dermatitis and papular-lichenoid dermatitis variant in infants; atopic feet, prurigo-like, nummular pattern, and erythroderma in preschool and school-aged children; and eyelid eczema and nipple dermatitis in adolescents. The risk of development of nipple dermatitis and eyelid eczema increased with age, and the development of genital dermatitis decreased with age. The knowledge of the prevalence of less common clinical manifestations of AD according to age in different populations might be helpful in diagnosing incipient cases of AD. © 2012 Wiley Periodicals, Inc.

Quality of life and psychosocial issues are important outcome measures in eczema treatment.

PubMed

Hon, Kam Lun; Pong, N H; Poon, Terence C W; Chan, Dorothy F Y; Leung, T F; Lai, Kelly Y C; Wing, Y K; Luk, Nai Ming

2015-02-01

Atopic eczema (AE) is a common relapsing inflammatory skin disease in children associated with chronicity and poor quality of life. Many children also display depressive, anxiety and stress symptoms. To investigate the prevalence of depressive, anxiety and stress symptoms, and if these symptoms are associated with disease severity, quality of life and skin biophysiology in childhood AE. Psychological symptoms, eczema severity, quality of life and biophysical skin condition of consecutive adolescents at the pediatric dermatology clinic of a teaching hospital were evaluated with the validated Chinese versions of Depressive, Anxiety, Stress Scales (DASS-42), Beck Depression Inventory (BDI-13), Nottingham Eczema Severity Score (NESS), Children's Dermatology Life Quality Index (CDLQI), transepidermal water loss (TEWL) and stratum corneum skin hydration (SH), respectively. AE patients (n=120) had lower SH, higher TEWL, worse CDLQI and reported higher overall, depressive and stress symptom scores, personal history of atopy, current topical corticosteroid usage and food avoidance than non-AE patients (n=26). Depressive, anxiety and stress symptoms were reported in 21%, 33% and 23% of AE patients, respectively. Multivariate analyses showed that these symptoms were significantly correlated with a poor quality of life (partial correlations of 0.40-0.49; p<0.001). Male patients had more severe disease (higher NESS, p=0.036) and DASS-depressive symptoms (multivariate OR=3.2, p=0.034) than females. Patients who reported current topical steroid usage generally practiced food avoidance (p=0.047), had poor quality of life (p=0.043) but less DASS-depression (multivariate OR=0.354, p=0.043). Only 6% of the 120 AE patients reported prior psychology consultation. Quality of life impairments correlate with disease severity, aberrant skin biophysiology, depression, anxiety and stress symptoms in adolescents with AE. Physicians caring for these patients must evaluate the different but inter-correlated medical, biophysiological and pertinent psychosocial domains. These significant correlations imply that a holistic approach should encompass psychotherapy, behavioral therapy and coping strategies in conjunction with dermatologic therapy.

Indoor risk factors for atopic eczema in school children from East Germany.

PubMed

Schäfer, T; Heinrich, J; Wjst, M; Krause, C; Adam, H; Ring, J; Wichmann, H E

1999-08-01

This study aimed to investigate the relation between environmental influences such as arsenic, cadmium, lead, and mercury, as well as environmental tobacco smoke, pet keeping, and heating systems on the prevalence of atopic eczema. Therefore, a multicenter cross-sectional study of school children aged 5-14 years, including a standardized questionnaire, blood and urine analyses, and a dermatological examination, was undertaken. A cases-control approach was chosen in order to identify relevant risk factors. A total of 2200 school children (response 79.1%) of two areas (Bitterfeld, Hettstedt) polluted by industrial activities and an agricultural control region (Zerbst) of the former German Democratic Republic were examined. Atopic eczema as identified by dermatological examination and history was the outcome variable of interest. Body burden of arsenic and heavy metals and questionnaire data on environmental tobacco smoke exposure, pet keeping, and heating system were investigated as potential risk factors. The overall prevalence of atopic eczema was 2.6%, with higher prevalences in the industrial areas (2.5 and 2.9%) compared to the control area (1.6%, not significant). Bivariate analyses did not reveal statistically significant associations between atopic eczema and tobacco smoke exposure or the body burden of arsenic and heavy metals. According to multiple logistic regression analysis, atopic eczema was significantly more frequent in predisposed families and those who reported keeping guinea pigs (OR=4.37, CI 2.15-8.91), but not other pets, like dogs, cats, and hamsters. In comparison to a distant heating system, a decreased risk was observed in households with central heating system (OR=0.30, CI 0.10-0.90), whereas the presence of a gas heater with an exhaust pipe connection to the wall was associated with a significantly elevated risk for eczema (OR=8.22, CI 2.44-27.66). The heating system and exposure to certain animal allergens are related to the manifestation of atopic eczema. Further studies are needed to clarify how far a causal relationship is reflected by these findings. Copyright 1999 Academic Press.

Protection during production: Problems due to prevention? Nail and skin condition after prolonged wearing of occlusive gloves.

PubMed

Weistenhöfer, Wobbeke; Uter, Wolfgang; Drexler, Hans

2017-01-01

Wearing of occlusive gloves during the whole working shift is considered a risk factor for developing hand eczema, similar to wet work. Moreover, the increased hydration due to glove occlusion may lead to brittle nails. Two hundred and seventy clean room workers, wearing occlusive gloves for prolonged periods, and 135 administrative employees not using gloves were investigated. This included a dermatological examination of the nails and the hands, using the Hand Eczema ScoRe for Occupational Screening (HEROS), measurement of transepidermal water loss (TEWL), and a standardized interview. Of the clean room workers, 39%, mainly women, reported nail problems, mostly brittle nails with onychoschisis. Skin score values showed no significant differences between HEROS values of both groups. TEWL values of exposed subjects were similar to TEWL values of controls 40 min after taking off the occlusive gloves. In a multiple linear regression analysis, male gender and duration of employment in the clean room were associated with a significant increase in TEWL values. The effect of occlusion on TEWL seems to be predominantly transient and not be indicative of a damaged skin barrier. This study confirmed the results of a previous investigation showing no serious adverse effect of wearing of occlusive gloves on skin condition without exposure to additional hazardous substances. However, occlusion leads to softened nails prone to mechanical injury. Therefore, specific prevention instructions are required to pay attention to this side effect of occlusion.

Effects of time and recall of patch test results on quality of life (QoL) after testing. Cross-sectional study analyzing QoL in hand eczema patients 1, 5 and 10 years after patch testing.

PubMed

Jamil, Wasim N; Lindberg, Magnus

2017-08-01

Patch testing can improve health-related quality of life (HRQOL). To study the impact on HRQOL of elapsed time after patch testing (1-10 years), and how the outcome of testing and patients' recall affects HRQOL. The Dermatology Life Quality Index (DLQI) questionnaire was sent to all patients (aged 18-65 years) who were patch tested for suspected contact allergy in 2009, 2005 and 2000 at the Department of Dermatology in Örebro. The response rate was 51% (n = 256). The DLQI score was significantly lower at 10 years after patch testing (mean DLQI = 5.5) than at 1 year (mean DLQI = 7.7). Work was the most impaired aspect. A binary logistic model showed that only time (10 years after testing) was associated with no effect, a light effect or a moderate effect (DLQI < 10) on HRQOL. No such association was seen for patients with negative or positive test results concerning full recall, partial recall or no recall of diagnosed allergens. Although there was an improvement in HRQOL over time, the work aspect remained a major problem. The improvement was not affected by the outcome of testing and patients' recall of test results. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Maternal consumption of dairy products, calcium, and vitamin D during pregnancy and infantile allergic disorders.

PubMed

Miyake, Yoshihiro; Tanaka, Keiko; Okubo, Hitomi; Sasaki, Satoshi; Arakawa, Masashi

2014-07-01

Epidemiologic evidence of the association between maternal intake of dairy foods, calcium, and vitamin D during pregnancy and childhood allergic disorders is inconclusive. To examine the association between maternal intake of dairy foods, calcium, and vitamin D during pregnancy and childhood allergic disorders in Japanese children aged 23 to 29 months. Study participants were 1,354 mother-child pairs. Maternal intake during pregnancy was assessed with a validated diet history questionnaire administered between April 2007 and March 2008. Wheeze and eczema, defined according to criteria of the International Study of Asthma and Allergies in Childhood, and physician-diagnosed asthma and atopic eczema were assessed via a questionnaire completed by mothers. Higher maternal intake of total dairy products during pregnancy was significantly associated with a reduced risk of infantile eczema (adjusted odds ratio [OR] between extreme quartiles, 0.64; 95% confidence interval [CI], 0.42-0.98). Higher maternal intake of cheese during pregnancy was significantly related to a reduced risk of physician-diagnosed infantile asthma (adjusted OR between extreme quartiles, 0.44; 95% CI, 0.18-0.97). Maternal intake levels of yogurt and calcium during pregnancy were significantly inversely associated with physician-diagnosed infantile atopic eczema (adjusted ORs between extreme quartiles, 0.49 and 0.34; 95% CI, 0.20-1.16 and 0.12-0.84; P for trend = .01 and .03, respectively). Maternal intake of vitamin D during pregnancy was significantly positively associated with infantile eczema (adjusted OR between extreme quartiles, 1.63; 95% CI, 1.07-2.51). Higher maternal intake of total dairy products, cheese, yogurt, and calcium during pregnancy may reduce the risk of infantile eczema, physician-diagnosed asthma, physician-diagnosed atopic eczema, and physician-diagnosed atopic eczema, respectively. Higher maternal intake of vitamin D during pregnancy may increase the risk of infantile eczema. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Environmental factors associated with childhood eczema: Findings from a national web-based survey.

PubMed

Sasaki, Mari; Yoshida, Koichi; Adachi, Yuichi; Furukawa, Mayumi; Itazawa, Toshiko; Odajima, Hiroshi; Saito, Hirohisa; Hide, Michihiro; Akasawa, Akira

2016-10-01

Genetic and environmental factors are known to be related to the development of childhood eczema. Our aim was to assess the environmental factors associated with the prevalence of eczema among children using a web-based survey. In June 2012, we conducted a nation-wide web-based survey to identify the prevalence and characteristics of allergic diseases among Japanese children. The prevalence of allergic diseases including eczema was assessed using the International Study of Asthma and Allergies in Childhood core questionnaire. The associations between eczema prevalence and environmental factors, as well as those between background characteristics and comorbid allergic diseases among 6-12 year old children were assessed. A total of 28,348 children were included in the analysis. The prevalence of current eczema was 13.0%. Current eczema was significantly associated with a higher prevalence of wheeze, rhinitis, and food allergy. In multiple logistic regression models, birth during autumn (aOR: 1.18 95%CI: 1.06-1.31) or winter (aOR: 1.21 95%CI: 1.08-1.34), duration of exclusive breastfeeding for at least 6 months (aOR: 1.14 95%CI: 1.06-1.23), and ownership of a pet from infancy (aOR: 2.61 95%CI: 1.68-4.07) were also associated with a higher prevalence of eczema. The prevalence was lower in those with a high annual household income (aOR: 0.90 95%CI: 0.81-0.99) and 2 or more siblings (aOR: 0.86 95%CI: 0.76-0.97). Duration of breastfeeding, season of birth, pet ownership, household income, and the number of siblings were associated with the prevalence of childhood eczema in a nationwide web survey. Copyright © 2016 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

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

PubMed

Gamboni, Sarah E; Allen, Katrina J; Nixon, Rosemary L

2013-05-01

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. © 2012 The Authors. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.

Evaluation of the measurement properties of symptom measurement instruments for atopic eczema: a systematic review.

PubMed

Gerbens, L A A; Prinsen, C A C; Chalmers, J R; Drucker, A M; von Kobyletzki, L B; Limpens, J; Nankervis, H; Svensson, Å; Terwee, C B; Zhang, J; Apfelbacher, C J; Spuls, P I

2017-01-01

Symptoms have been identified as a core outcome domain for atopic eczema (AE) trials. Various instruments exist to measure symptoms in AE, but they vary in quality and there is a lack of standardization between clinical trials. Our objective was to systematically evaluate the quality of the evidence on the measurement properties of AE symptom instruments, thereby informing consensus discussions within the Harmonising Outcome Measures for Eczema (HOME) initiative regarding the most appropriate instruments for the core outcome domain symptoms. Using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and predefined criteria for good measurement properties on identified development and validation studies of AE symptom instruments, a best evidence synthesis was performed to draw an overall conclusion on quality of the instruments and to provide recommendations. Eighteen instruments were identified and evaluated. When the quality and results of the studies were considered, only five of these instruments had sufficient validation data to consider them for the core outcome set for the core outcome domain symptoms. These were the paediatric Itch Severity Scale (ISS), Patient-Oriented Eczema Measure (POEM), Patient-Oriented SCOring Atopic Dermatitis (PO-SCORAD), Self-Administered Eczema Area and Severity Index (SA-EASI) and adapted SA-EASI. ISS (paediatric version), POEM, PO-SCORAD, SA-EASI and adapted SA-EASI are currently the most appropriate instruments and therefore have the potential to be recommended as core symptom instrument in future clinical trials. These findings will be utilized for the development of a core outcome set for AE. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Workplace screening for hand dermatitis: a pilot study.

PubMed

Nichol, K; Copes, R; Spielmann, S; Kersey, K; Eriksson, J; Holness, D L

2016-01-01

Health care workers (HCWs) are at increased risk for developing occupational skin disease (OSD) such as dermatitis primarily due to exposure to wet work. Identification of risk factors and workplace screening can help early detection of OSD to avoid the condition becoming chronic. To determine risk factors and clinical findings for hand dermatitis using a workplace screening tool. Employees at a large teaching hospital in Toronto, Canada, were invited to complete a two-part hand dermatitis screening tool. Part 1 inquired about hand hygiene practices and Part 2 comprised a visual assessment of participants' hands by a health professional and classification as (i) normal, (ii) mild dermatitis or (iii) moderate/severe dermatitis. Risk factors were determined using chi-square and Cochran-Armitage analysis on a dichotomous variable, where Yes represented either a mild or moderate/severe disease classification. There were 183 participants out of 643 eligible employees; response rate 28%. Mild or moderate/severe dermatitis was present in 72% of participants. These employees were more likely to work directly with patients, have worked longer in a health care setting, wash hands and change gloves more frequently, wear gloves for more hours per day, have a history of eczema or dermatitis and report a current rash on the hands or rash in the past 12 months. There was a high percentage of HCWs with dermatitis and risk factors for dermatitis. These findings argue for increased attention to prevention and early identification of hand dermatitis and support further testing of the workplace screening tool. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Therapeutic management of anal eczema: an evidence-based review

PubMed Central

Havlickova, B; Weyandt, G H

2014-01-01

Aim To conduct a systematic review of treatments for anal eczema (AE). Methods We conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted. Results The evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients. Discussion Features of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today. Conclusion This review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared. PMID:24898365

The Effect of Environmentally Friendly Wallpaper and Flooring Material on Indoor Air Quality and Atopic Dermatitis: A Pilot Study

PubMed Central

Na, Jung Im; Byun, Sang Young; Jeong, Mi Young; Park, Kyoung Chan

2014-01-01

Background Formaldehyde (FA) and other volatile organic compounds (VOCs) are considered among the main causes of atopic aggravation. Their main sources include wallpapers, paints, adhesives, and flooring materials. Objective To assess the effects of environmentally friendly wallpaper and flooring material on indoor air quality and atopic dermatitis severity. Methods Thirty patients with atopic dermatitis were enrolled in this study. To improve air quality, the wallpaper and flooring in the homes of the subjects were replaced with plant- or silica-based materials. The indoor air concentration of FA and the total VOCs (TVOCs) were measured before remodeling and 2, 6, and 10 weeks thereafter. Pruritus and the severity of atopic eczema were evaluated by using a questionnaire and the eczema area and severity index (EASI) score before and at 4, 8, and 12 weeks after remodeling. The subjects were instructed to continue their therapy for atopic dermatitis. Results The houses of 24 subjects were remodeled; all subjects completed the study. The concentration of FA in ambient air significantly decreased within 2 weeks after remodeling. The TVOC level showed a decrease at week 2 but increased again at weeks 6 and 10. The reduction of pruritus and EASI score was statistically significant in patients whose baseline EASI score was >3. Conclusion Replacing the wallpaper and flooring of houses with environmentally friendly material reduced FA in ambient air and improved pruritus and the severity of atopic eczema. The improvement of pruritus and eczema was statistically significant in patients whose baseline EASI score was >3. PMID:25473219

Clinical severity correlates with impaired barrier in filaggrin-related eczema.

PubMed

Nemoto-Hasebe, Ikue; Akiyama, Masashi; Nomura, Toshifumi; Sandilands, Aileen; McLean, W H Irwin; Shimizu, Hiroshi

2009-03-01

Mutations in the gene-encoding filaggrin (FLG), a key molecule involved in skin barrier function, have been shown to be a major predisposing factor for atopic dermatitis (AD; eczema). To elucidate the pathomechanisms underlying filaggrin-related AD, we investigated stratum corneum (SC) hydration and transepidermal water loss (TEWL) as parameters of barrier function in AD patients harboring FLG mutations compared to AD patients without any FLG mutation. In filaggrin-related AD, SC hydration was both significantly reduced (P<0.01-0.05) and thicker (P<0.01-0.05) than that in healthy controls. TEWL was demonstrably increased in non-filaggrin AD compared to healthy controls (P<0.01-0.05). The objective score of atopic dermatitis (OSCORAD), a disease clinical severity index, significantly correlated with TEWL (r=0.81, P<0.005), SC hydration (r=-0.65, P<0.05), and SC thickness (r=0.59, P<0.05) in filaggrin-related AD. On the contrary, there was no correlation between these parameters and the OSCORAD in non-filaggrin AD. Furthermore, a significant correlation was obtained between the OSCORAD and specific IgE for house dust (r=0.66, P<0.05), mite allergen (r=0.53, P<0.05), and cat dander (r=0.64, P<0.05) in filaggrin-related AD, but not in non-filaggrin AD. All these data suggest that experimentally demonstrable skin barrier defects due to FLG mutations may play a crucial role in the pathogenesis of AD.

[Dry hands (irritative contact dermatitis) in housewives which is not alleviated on cessation of domestic work: clinical varieties].

PubMed

Grimalt, F; Romaguera, C; Vilaplana, J; Mascaro, J

1988-01-01

There are three types of hand dermatitis in housewives. The most usual are cured when housework is stopped. Another type is that of housewife contact dermatitis which appears on pre-existing endogenous lesions such as dyshidrosis or nummular eczema. The third form is housewife hand contact dermatitis which appears, or coexists with, localized endogenous lesions of the hands. The last two forms are not cured when housework is stopped. In some cases the three forms may coexist or appear one after another. It is not usual for a person suffering from typical flexural atopic dermatitis to present with one of the described three forms of hand dermatitis. Nevertheless, without having some relationship to atopic diathesis no woman could suffer from any of these three forms of dermatitis. In spite of the lack of analytical data, everyday clinical facts (one example being these different forms of housewife hand dermatitis) suggest the need to accept a subgroup of cutaneous atopic diathesis.

Improved emollient use reduces atopic eczema symptoms and is cost neutral in infants: before-and-after evaluation of a multifaceted educational support programme

PubMed Central

2013-01-01

Background Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Support and information about appropriate care may often be inadequate for patients and carers in the community. Methods A multifaceted educational support programme was evaluated as a method of increasing emollient use and reducing atopic eczema in children. Support provided for parents and carers included an educational DVD, online daily diary and telephone helpline. The before and after study included 136 British children and their parents, providing baseline and 12 week follow-up data while receiving the programme. Measures included emollient use, POEM and PEST scores, and cost of care. Results Average emollient use increased by 87.6 g (95% CI: 81.9 to 119.5 g, p = 0.001) from baseline with the change being immediate and persistent. The POEM score reduced on average by 5.38 (95% CI: 4.36 to 6.41, p = 0.001), a 47% reduction from baseline. Similarly the PEST score reduced on average by 0.61 (95% CI: 0.47 to 0.75, p = 0.001), a 48% reduction from baseline. Sleep disturbance was reduced by 1.27 nights per week (95% CI: 0.85 to 1.68, p = 0.001) and parental feeling of control improved by 1.32 points (95% CI: 1.16 to 1.48, p = 0.001). From the NHS perspective, the programme was cost neutral overall within the study period. Conclusion A community-based multifaceted educational support programme greatly increased emollient use, reducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits may accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater feeling of control. PEST, a new simple measure of acute and remitting atopic eczema severity designed to help parents and children to monitor and manage eczema, merits further evaluation. PMID:23679991

Use of a Robotic Sampler (PIPER) for Evaluation of Particulate Matter Exposure and Eczema in Preschoolers.

PubMed

Shah, Lokesh; Mainelis, Gediminas; Ramagopal, Maya; Black, Kathleen; Shalat, Stuart L

2016-02-19

While the association of eczema with asthma is well recognized, little research has focused on the potential role of inhalable exposures and eczema. While indoor air quality is important in the development of respiratory disease as children in the U.S. spend the majority of their time indoors, relatively little research has focused on correlated non-respiratory conditions. This study examined the relationship between particulate matter (PM) exposures in preschool age children and major correlates of asthma, such as wheeze and eczema. Air sampling was carried out using a robotic (PIPER) child-sampling surrogate. This study enrolled 128 participants, 57 male and 71 female children. Ages ranged from 3 to 58 months with the mean age of 29.3 months. A comparison of subjects with and without eczema showed a difference in the natural log (ln) of PM collected from the PIPER air sampling (p = 0.049). PIPER's sampling observed an association between the ln PM concentrations and eczema, but not an association with wheezing history in pre-school children. Our findings are consistent with the hypothesis of the role of the microenvironment in mediating atopic dermatitis, which is one of the predictors of persistent asthma. Our findings also support the use of PIPER in its ability to model and sample the microenvironment of young children.

Contact allergies in haemodialysis patients: a prospective study of 75 patients.

PubMed

Gaudy-Marqueste, C; Jouhet, C; Castelain, M; Brunet, P; Berland, Y; Grob, J J; Richard, M A

2009-02-01

Haemodialysis exposes patients to many potentially sensitizing allergens. The primary objective of this study was to evaluate the prevalence of delayed hypersensitivity in a population of haemodialysis patients. Secondary objectives were to identify the possible risk factors for contact sensitization and to propose a series of skin tests adapted to haemodialysis patients. A prospective monocentric study was carried out in a nonselected population of haemodialysis patients. For each patient, medical history of atopy and allergic contact dermatitis, ongoing treatments (including topical ones), presence of eczema at the site of vascular access for haemodialysis were recorded. Allergological investigation included delayed hypersensitivity tests (European Environmental and Contact Dermatitis Research Group battery, tests GERDA, additional list and a battery of antiseptics and other dialysis-specific allergens) and latex skin prick test. Seventy-five patients (41 men, 34 women, mean age of 65 years old), with a mean 3.8 years under dialysis, were included. Nineteen patients (25%) had at least one positive skin test and 13 (17%) a positive patch test to at least one allergen relative to dialysis process including eight tests to lidocaine-prilocaine cream and three to povidone-iodine. Tests results seemed clinically relevant since nine patients had localized pruritus at the fistula site and six patients active eczema around it. Contact sensitizations are frequent in haemodialysis patients and are linked to vascular access conditioning especially the use of lidocaine-prilocaine cream. Designing a specific test battery could help to diagnose the potential allergens and subsequently to give advice to avoid contact with sensitizing agents.

Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year.

PubMed

Kütting, B; Baumeister, T; Weistenhöfer, W; Pfahlberg, A; Uter, W; Drexler, H

2010-02-01

We recently found a very low adherence to a generally recommended skin protection regimen in a sample of 1355 metalworkers. The present study assessed the effectiveness of skin protection as presently recommended, especially the differential contribution of skin care and skin protection, to the prevention of occupational hand eczema. Methods Of 1355 metalworkers screened, 1020 male volunteers, all fit for work, were recruited for a prospective intervention study with four arms (skin care, skin protection, both combined, and control group, i.e. no recommendation). The study was performed from winter 2006/2007 to spring 2008, following each subject for up for 12 months. Both hands were examined using a quantitative skin score, and a standardized personal interview was performed three times. The change of the objective skin score from baseline to 12 months was used as primary outcome measure. After 12 months 800 subjects were included (78.4% of those recruited). The compliance to follow the randomized measure depended on the recommended measure and ranged from 73.7% to 88.7%. While in the control group a significant deterioration was found, the largest and significant improvement was noted in the group following the generally recommended skin protection programme (skin care + skin protection) followed by skin protection alone as second best. The generally recommended skin protection regimen seems to provide effective prevention of occupational skin disease. Therefore, the compliance to follow the skin protection regimen, especially the use of skin protection, should be enhanced.

Increase in dermcidin-derived peptides in sweat of patients with atopic eczema caused by a humorous video.

PubMed

Kimata, Hajime

2007-01-01

Dermcidin (DCD)-derived peptide is an antimicrobial peptide produced by the sweat glands. However, the levels of DCD-derived peptide in sweat were decreased in patients with atopic eczema (AE). The effect of viewing a humorous video on the levels of DCD-derived peptide was studied. Twenty patients with AE viewed an 87-min humorous video (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, sweat was collected, and the levels of DCD-derived peptide and total protein in sweat were measured. Viewing a humorous video increased the levels of DCD-derived peptide without affecting the levels of total protein in sweat. Viewing a humorous video increased DCD-derived peptide in sweat of patients with AE, and thus, it may be helpful in the treatment of skin infection of AE.

Vulnerability to Allergic Disorder in Families of Children of Behavioral Inhibition

DTIC Science & Technology

1990-10-07

third years of life. The temperamentally inhibited child consistently displays an initial timidity, shyness, and emotional restraint when exposed to...with the uninhibited, children, reported a higher prevalence of atopic allergies, especially hayfever and eczema . Although the exact mechanisms...As Table 1 reveals, more relatives of inhibited, compared with uninhibited, children reported having hayfever, eczema , and frequent stomach cramps

The natural course of eczema from birth to age 7 years and the association with asthma and allergic rhinitis: a population-based birth cohort study.

PubMed

Shen, Chian-Yin; Lin, Ming-Chih; Lin, Heng-Kuei; Lin, Ching-Heng; Fu, Lin-Shien; Fu, Yun-Chin

2013-01-01

Although "atopic march" is a popular concept, the relationship between eczema and subsequent asthma is far from clear. However, some cohort studies have shown the possibility of two different allergic phenotypes in those who present with early eczema in terms of their persistency. We checked the cohort data from 308,849 children born in 2000 in Taiwan, to evaluate the different courses of eczema and their relationships to subsequent asthma and allergic rhinitis (AR) at age 7 years. We examined the age prevalence of eczema, asthma, and AR up to 7 years of age. We grouped all cases according to their course of eczema, as well as wheezing, and determined the rates of asthma and AR at age 7 years. We checked the adjusted risk factors by multiple logistic regression model. We also examined the distributions of wheezing types in different eczema groups. We found the "atopic march" pattern of allergic diseases based on their age prevalence. Early eczema was associated with asthma and AR at the age of 7 years. Those with eczema symptoms persisting after 36 months of age had a higher risk than those with transient eczema. Early wheeze also contributed to asthma and AR later in childhood. In addition, late-onset eczema had a completely different wheeze distribution compared with other groups and also had a higher risk for asthma and AR than transient eczema. In conclusion, different eczema phenotypes could be found in this population-based cohort. This article emphasizes the special attention to the persistency and late-onset eczema in clinical practice.

Association between preschool eczema and medication for attention-deficit/hyperactivity disorder in school age.

PubMed

Johansson, Emma Kristin; Ballardini, Natalia; Kull, Inger; Bergström, Anna; Wahlgren, Carl-Fredrik

2017-02-01

Several studies show an association between eczema and attention-deficit/hyperactivity disorder (ADHD) in childhood, but the mechanisms and time sequence remain unclear. Information on the association between eczema and other disorders involving the central nervous system (CNS) is limited. The aim was to explore whether preschool eczema was associated with ADHD or other CNS-associated disorders requiring pharmacotherapy at school age and to analyze whether eczema at other ages of childhood was associated with medication for ADHD. From a Swedish birth cohort, 3606 children were included in the analyses. At 1, 2, 4, 8, 12, and 16 years of age, their parents answered questionnaires regarding eczema the last year. Information on prescribed medications during school age (10-18 years of age) was derived by record linkage to the Swedish Prescribed Drug Register. A total of 1178 (32.7%) of the children had preschool eczema (eczema at 1, 2, and/or 4 years), and 162 (4.5%) of the children had dispensed ADHD medication at school age. Preschool eczema was not associated with ADHD medication at school age (crude odds ratio 1.16; 95% Confidence Intervals: 0.83-1.61). There was no significant association between preschool eczema and use of antidepressants, migraine drugs, or anti-epileptics at school age. Infantile eczema, school-age eczema, and eczema ever up to 16 years of age were not associated with ADHD medication at school age. In this large birth cohort, there were no significant associations between preschool eczema and medications for ADHD, depression/anxiety/phobia, migraine, or epilepsy at school age. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Why am I so itchy?

PubMed

Clarke, Philip

2004-07-01

Virtually all of us experience an itch at some time. However, for some people, an intense or persistent itch can cause considerable morbidity that often affects the entire family. This article gives an overview of the problem of itch, and discusses the assessment and management of atopic eczema, scabies, lichen planus and dermatitis herpetiformis. A good history will nearly always provide the diagnosis. Examination can then be targeted at finding specific signs. The distribution of rash is important, as is examination of the nails and mouth. Simple but helpful investigations such as microscopy and skin biopsy can be carried out in the consulting room. If a patient presents with a very itchy rash, consider four main possibilities: eczema, scabies, lichen planus and dermatitis herpetiformis, with the first two being the most common. For chronic conditions such as eczema, structured follow up is essential.

Maternal fat consumption during pregnancy and risk of wheeze and eczema in Japanese infants aged 16-24 months: the Osaka Maternal and Child Health Study.

PubMed

Miyake, Y; Sasaki, S; Tanaka, K; Ohfuji, S; Hirota, Y

2009-09-01

One factor capable of modulating antenatal immune responses is diet. This prospective study examined the association between maternal intake of specific types of fatty acids, cholesterol, fish and meat during pregnancy and the risk of wheeze and eczema in the offspring. Subjects were 763 mother-child pairs. Data on maternal intake during pregnancy were assessed with a diet history questionnaire. Data on wheeze and eczema based on criteria of the International Study of Asthma and Allergies in Childhood were obtained from a questionnaire completed by mothers 16-24 months postpartum. Higher maternal intake of alpha-linolenic acid and docosahexaenoic acid during pregnancy was independently associated with a reduced risk of wheeze, but not eczema, in the offspring (adjusted odds ratios (ORs) between extreme quartiles 0.52 (95% CI 0.28 to 0.97) and 0.37 (95% CI 0.15 to 0.91), respectively). Higher maternal intake of n-6 polyunsaturated fatty acids and linoleic acid during pregnancy was independently related to an increased risk of infantile eczema but not wheeze (adjusted ORs 2.25 (95% CI 1.13 to 4.54) and 2.11 (95% CI 1.06 to 4.26), respectively). No significant exposure-response relationships were observed between maternal consumption of total fat, saturated fatty acids, monounsaturated fatty acids, eicosapentaenoic acid, arachidonic acid, cholesterol, meat and fish and the ratio of n-3 to n-6 polyunsaturated fatty acid consumption during pregnancy and infantile wheeze or eczema. Maternal intake of alpha-linolenic acid and docosahexaenoic acid during pregnancy may be preventive against infantile wheeze. Maternal intake of n-6 polyunsaturated fatty acids, especially linoleic acid, during pregnancy may increase the risk of childhood eczema.

Comparative Analysis of Fecal Microbiota in Infants with and without Eczema

PubMed Central

Hong, Pei-Ying; Lee, Bee Wah; Aw, Marion; Shek, Lynette Pei Chi; Yap, Gaik Chin; Chua, Kaw Yan; Liu, Wen-Tso

2010-01-01

Eczema is a chronic form of childhood disorder that is gaining in prevalence in affluent societies. Previous studies hypothesized that the development of eczema is correlated with changes in microbial profile and composition of early life endemic microbiota, but contradictory conclusions were obtained, possibly due to the lack of minimization of apparent non-health related confounders (e.g., age, antibiotic consumption, diet and mode of delivery). In this study, we recruited seven caesarean-delivered and total formula-fed infants, and comparatively examined the early-life endemic microbiota in these infants with and without eczema. Using 16S pyrosequencing, infants' fecal microbiota were observed to comprise Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes as the four main phyla, and the presence and absence of specific populations within these four phyla are primarily mediated by ageing. Quantitative analysis of bacterial targets on a larger sample size (n = 36 at 1, 3, and 12 months of age) revealed that the abundances of Bifidobacterium and Enterobacteriaceae were different among caesarean-delivered infants with and without eczema, and the bacterial targets may be potential biomarkers that can correlate to the health status of these infants. Our overall findings suggest that the minimization of possible confounders is essential prior to comparative evaluation and correlation of fecal microbiota to health status, and that stool samples collected from caesarean-delivered infants at less than 1 year of age may represent a good cohort to study for potential biomarkers that can distinguish infants with eczema from those without. These findings would greatly facilitate future efforts in understanding the possible pathogenesis behind certain bacterial targets, and may lead to a timely intervention that reduces the occurrence of early life eczema and possibly allergic disorders in later life. PMID:20376357

A Novel Glycinate-based Body Wash: Clinical Investigation Into Ultra-mildness, Effective Conditioning, and Improved Consumer Benefits.

PubMed

Regan, Jamie; Mollica, Leonel-Maximo; Ananthapadmanabhan, K P

2013-06-01

To assess the properties of a novel body wash containing the mild surfactant glycinate. Biochemical and clinical assays. Research laboratories and clinical sites in the United States and Canada. Women 18 to 65 years of age (cleansing efficacy); male and female subjects 26 to 63 years of age with mild or moderate dryness and erythema (leg-controlled application test); subjects 5 to 65 years of age with mild-to-moderate eczema (eczema compatibility); and women 18 to 64 years of age (home use). Assessments across studies included colorimetric dye exclusion to assess skin damage potential (corneosurfametry), efficacy of cosmetic product removal from skin, change from baseline in visual dryness, change from baseline in Eczema Area and Severity Index, and self-perceived eczema attributes and self-reported product preference. The glycinate-based cleanser demonstrated mildness to skin components when evaluated in a corneosurfametry assay. Short-term use under exaggerated wash conditions in subjects with dryness scores <3 and erythema scores <2 (both on a 0-6 scale) indicated an initial reduction in visual dryness. In subjects with eczema, normal use resulted in significant improvements (p<0.05) at Week 4 compared with baseline in skin dryness (change from baseline = -0.73), rash (-0.56), itch (-0.927), tightness (-0.585), and all eczema (-0.756). The glycinate-based body wash removed 56 percent of a long-lasting cosmetic foundation from skin compared with less than 30 percent removed by two competitive products tested. The glycinate-based body wash was preferred over a competitive mild cleansing product overall. The patented glycinate-containing body wash demonstrated better product mildness and patient-preferred attributes and clinical benefits.

A lower prevalence of atopy symptoms in children with type 1 diabetes mellitus.

PubMed

Meerwaldt, R; Odink, R J; Landaeta, R; Aarts, F; Brunekreef, B; Gerritsen, J; Van Aalderen, W M C; Hoekstra, M O

2002-02-01

The Th1/Th 2 concept is a model to understand the pathophysiology of certain diseases. Atopic diseases (asthma, eczema and hayfever) are characterized by a chronic inflammatory reaction that is dominated by Th 2 cells, and type 1 diabetes mellitus (DM) is Th1 cell dominated. Because it is known that Th1 and Th 2 cells reciprocally counteract each other, it can be speculated that the prevalence of Th 2-mediated disease is lower in patients with Th1-mediated disease. To compare the prevalence of atopic diseases between children with DM and age-matched controls. Parents of children with DM were requested by Dutch paediatricians to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire on the prevalence of atopic diseases. A control group was derived from a Dutch cross-sectional survey (the ISAAC2 study). We received 555 completed questionnaires, which is estimated to be 25% of the total number of Dutch children with DM. The control group consisted of 777 children. After age-matching, the questionnaires of 188 DM patients were used. Symptoms of asthma, hayfever and eczema were reported less in the group of children with DM compared with the control group (wheeze last year, OR 0.796, 95% CI 0.408-1.554; hayfever symptoms last year, OR 0.642, 95% CI 0.369-1.118; eczema symptoms last year, OR 0.693, 95% CI 0.430-1.115). The lower prevalence of astma, hayfever and eczema symptoms in DM patients compared with age-matched controls, although not statistically significant, is consistent with the Th1/Th 2 concept.

Somatization: the under-recognized factor in nonspecific eczema. The Hordaland Health Study (HUSK).

PubMed

Klokk, M; Stansfeld, S; Overland, S; Wilhelmsen, I; Gotestam, K G; Steinshamn, S; Mykletun, A

2011-03-01

Psychodermatology has focused primarily on depression and anxiety in eczema. Skin symptoms are listed among many others for the ICD-10 diagnosis of somatization disorder. Somatization (unexplained somatic symptoms) is highly prevalent in the general population, but its association with eczema is yet to be empirically investigated. We therefore explored the association between somatization and eczema by examining the extent of somatization in eczema compared with allergic rhinitis, and by examining if eczema was more strongly associated with somatization than with anxiety and depression. Finally, we aimed to examine the relationship between the site of eczema and somatization for individual somatic symptoms and for somatic symptoms as a whole. For this population-based cross-sectional study we employed data from the Hordaland Health Study (HUSK) with 15,225 participants aged 41-48 years. Information on nonspecific eczema, allergic rhinitis, somatization, anxiety, depression and other covariates was obtained by self-report. The association between nonspecific eczema and somatization was strong and followed a dose-response pattern, as did all somatic symptoms in our index of somatization when analysed separately. The association between nonspecific eczema and somatization was stronger than that between rhinitis and somatization, and also the association between nonspecific eczema and anxiety and depression. In multivariate models, somatization accounted for most of the association between nonspecific eczema and anxiety/depression. In contrast, the association between nonspecific eczema and somatization was robust for adjustment for anxiety/depression. Somatization was strongly associated with nonspecific eczema. This applies to a whole range of somatic symptoms constituting the construct of somatization. There is hardly any mention of somatization in leading dermatological journals, in contrast to anxiety and depression which are frequently reported in eczema. We speculate that this under-recognition of somatization in the dermatological literature may correspond to under-recognition of this factor also in clinical practice. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

The associations between personality traits, education, occupation and the occurrence of eczema in adulthood.

PubMed

Cheng, Helen; Treglown, Luke; Montgomery, Scott; Kornilaki, Ekaterina N; Tsivrikos, Dimitrios; Furnham, Adrian

2017-06-01

There were 5834 participants with complete data on parental social class at birth, childhood cognitive ability tests scores at 11 years, educational qualifications at 33 years, the Big Five-Factor personality traits, occupational levels and eczema (measured at age 50 years). Results showed that eczema in childhood, educational achievement and occupational levels were significantly associated with the occurrence of reported eczema in adulthood. Emotionally Stable people (non-neurotic) were less likely to have eczema, but those with high Agreeableness and Openness more likely to have eczema. Childhood cognitive ability was significantly and positively associated with eczema in adulthood.

Eczema

MedlinePlus

... Issues Listen Español Text Size Email Print Share Eczema: How to Help Your Child Avoid the Itch ... also called atopic dermatitis or AD . Who Gets Eczema? Eczema is the most common skin problem treated ...

Eczema

MedlinePlus

Eczema is a term for several different types of skin swelling. Eczema is also called dermatitis. Most types cause dry, ... red, and to swell and itch even more. Eczema is not contagious. The cause is not known. ...

Causes and Triggers

MedlinePlus

... Seborrheic Dermatitis in Children Treatment For Children Eczema & Child Development Tools for School Living Well Resources Eczema and ... Seborrheic Dermatitis in Children Treatment For Children Eczema & Child Development Tools for School Living Well Resources Eczema and ...

[Risks and health problems caused by the use of video terminals].

PubMed

Tamez González, Silvia; Ortiz-Hernández, Luis; Martínez-Alcántara, Susana; Méndez-Ramírez, Ignacio

2003-01-01

To evaluate the association between video display terminal (VDT) use and health hazards, occupational risks, and psychosocial factors, in newspaper workers. A cross-sectional study was conducted in 1998 in a representative sample (n = 68) drawn from a population of 218 VDT operators in Mexico City. Data were collected using a self-administered questionnaire. Data were confirmed by performing physical examinations. The research hypothesis was that both the current and cumulative use of VDT are associated with visual, musculoskeletal system, and skin illnesses, as well as with fatigue and mental or psychosomatic disorders. Occupational health hazards were assessed (visual problems, postural risks, sedentary work, computer mouse use, excessive heat, and overcrowding), as well as psychosocial factors related to work organization (psychological demands, work control, and social support). Prevalence ratios were adjusted for confounding variables like age, sex and schooling. Women were more likely than men to have upper extremity musculoskeletal disorders (MSD), dermatitis, and seborrheic eczema. VDT use was associated with neuro-visual fatigue, upper extremity MSD, dermatitis, and seborrheic eczema. Computer mouse use and postural risks were significantly associated with health problems. Psychosocial factors were mainly associated with mental problems, psychosomatic disorders, and fatigue. Intense use of video screens has been found to cause musculoskeletal disorders of the hand. The diversification of tasks and control of labor processes itself had a protective effect against psychosomatic disorders and pathological fatigue.

Computational analysis of multimorbidity between asthma, eczema and rhinitis

PubMed Central

Aguilar, Daniel; Pinart, Mariona; Koppelman, Gerard H.; Saeys, Yvan; Nawijn, Martijn C.; Postma, Dirkje S.; Akdis, Mübeccel; Auffray, Charles; Ballereau, Stéphane; Benet, Marta; García-Aymerich, Judith; González, Juan Ramón; Guerra, Stefano; Keil, Thomas; Kogevinas, Manolis; Lambrecht, Bart; Lemonnier, Nathanael; Melen, Erik; Sunyer, Jordi; Valenta, Rudolf; Valverde, Sergi; Wickman, Magnus; Bousquet, Jean; Oliva, Baldo; Antó, Josep M.

2017-01-01

Background The mechanisms explaining the co-existence of asthma, eczema and rhinitis (allergic multimorbidity) are largely unknown. We investigated the mechanisms underlying multimorbidity between three main allergic diseases at a molecular level by identifying the proteins and cellular processes that are common to them. Methods An in silico study based on computational analysis of the topology of the protein interaction network was performed in order to characterize the molecular mechanisms of multimorbidity of asthma, eczema and rhinitis. As a first step, proteins associated to either disease were identified using data mining approaches, and their overlap was calculated. Secondly, a functional interaction network was built, allowing to identify cellular pathways involved in allergic multimorbidity. Finally, a network-based algorithm generated a ranked list of newly predicted multimorbidity-associated proteins. Results Asthma, eczema and rhinitis shared a larger number of associated proteins than expected by chance, and their associated proteins exhibited a significant degree of interconnectedness in the interaction network. There were 15 pathways involved in the multimorbidity of asthma, eczema and rhinitis, including IL4 signaling and GATA3-related pathways. A number of proteins potentially associated to these multimorbidity processes were also obtained. Conclusions These results strongly support the existence of an allergic multimorbidity cluster between asthma, eczema and rhinitis, and suggest that type 2 signaling pathways represent a relevant multimorbidity mechanism of allergic diseases. Furthermore, we identified new candidates contributing to multimorbidity that may assist in identifying new targets for multimorbid allergic diseases. PMID:28598986

The relationships between ambient air pollutants and childhood asthma and eczema are modified by emotion and conduct problems.

PubMed

Zhou, Cailiang; Baïz, Nour; Banerjee, Soutrik; Charpin, Denis André; Caillaud, Denis; de Blay, Fréderic; Raherison, Chantal; Lavaud, François; Annesi-Maesano, Isabella

2013-12-01

This study examined the hypothesis that emotion and conduct problems (ECPs) may modify the relationships between ambient air pollutants and childhood asthma and eczema. In the cross-sectional study, 4209 French schoolchildren (aged 10e12 years) were investigated between March 1999 and October 2000. Ambient air pollutants exposures were estimated with dispersion modeling. Health outcomes and ECPs were evaluated by validated questionnaires, completed by the parents. Marginal models were used to analyze the relationships of exposures to ambient air pollutants and/or ECPs to asthma phenotypes and current eczema, adjusting for potential confounders. In our population, interactions were found between ECPs and exposures to ambient air pollutants (benzene, carbon monoxide, nitrogen dioxide, nitrogen oxides, particulate matter with an aerodynamic diameter below 10 mm, volatile organic compounds) (P < .20). In addition, ECPs were related to current wheezing (adjusted prevalence odds ratio [aOR], 2.35; 95% confidence interval [CI], 1.59e3.47), current doctor-diagnosed asthma (aOR, 1.82; 95% CI, 1.25e2.66), and current eczema (aOR, 2.21; 95% CI, 1.61e3.02). Children with ECPs had 1.17e1.51 times higher aORs for the associations between ambient air pollutants and asthma phenotypes and current eczema than those without ECPs. ECPs may modify the relationships between ambient air pollutants and childhood asthma and eczema. 2013 Elsevier Inc. All rights reserved.

Computational analysis of multimorbidity between asthma, eczema and rhinitis.

PubMed

Aguilar, Daniel; Pinart, Mariona; Koppelman, Gerard H; Saeys, Yvan; Nawijn, Martijn C; Postma, Dirkje S; Akdis, Mübeccel; Auffray, Charles; Ballereau, Stéphane; Benet, Marta; García-Aymerich, Judith; González, Juan Ramón; Guerra, Stefano; Keil, Thomas; Kogevinas, Manolis; Lambrecht, Bart; Lemonnier, Nathanael; Melen, Erik; Sunyer, Jordi; Valenta, Rudolf; Valverde, Sergi; Wickman, Magnus; Bousquet, Jean; Oliva, Baldo; Antó, Josep M

2017-01-01

The mechanisms explaining the co-existence of asthma, eczema and rhinitis (allergic multimorbidity) are largely unknown. We investigated the mechanisms underlying multimorbidity between three main allergic diseases at a molecular level by identifying the proteins and cellular processes that are common to them. An in silico study based on computational analysis of the topology of the protein interaction network was performed in order to characterize the molecular mechanisms of multimorbidity of asthma, eczema and rhinitis. As a first step, proteins associated to either disease were identified using data mining approaches, and their overlap was calculated. Secondly, a functional interaction network was built, allowing to identify cellular pathways involved in allergic multimorbidity. Finally, a network-based algorithm generated a ranked list of newly predicted multimorbidity-associated proteins. Asthma, eczema and rhinitis shared a larger number of associated proteins than expected by chance, and their associated proteins exhibited a significant degree of interconnectedness in the interaction network. There were 15 pathways involved in the multimorbidity of asthma, eczema and rhinitis, including IL4 signaling and GATA3-related pathways. A number of proteins potentially associated to these multimorbidity processes were also obtained. These results strongly support the existence of an allergic multimorbidity cluster between asthma, eczema and rhinitis, and suggest that type 2 signaling pathways represent a relevant multimorbidity mechanism of allergic diseases. Furthermore, we identified new candidates contributing to multimorbidity that may assist in identifying new targets for multimorbid allergic diseases.

Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study.

PubMed

Halvorsen, Jon A; Lien, Lars; Dalgard, Florence; Bjertness, Espen; Stern, Robert S

2014-07-01

There are few studies on psychosocial problems in adolescents with eczema. We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning with eczema. A total of 4,744 adolescents (18-19 years) were invited for the study, of whom 3,775 (80%) participated. The overall prevalence of current eczema was 9.7%. Among those with current eczema, 15.5% reported suicidal ideation compared with 9.1% among those without eczema, significantly associated in a multivariate model (odds ratio 1.87, 95% confidence interval 1.31-2.68). In a subgroup analyses, the prevalence of suicidal ideation in those with both eczema and itch was 23.8%, and was significantly associated, compared with those without eczema (3.57, 2.46-5.67). Eczema was associated with mental health problems assessed by the Strength and Difficulties Questionnaire (1.72, 1.21-2.45) and the Hopkins Symptom Checklist 10 (1.63, 1.23-2.16). Five questions assessed social function: feeling attached to family and friends; thriving at school; experiencing bullying; and romantic relationships. Boys with current eczema were less likely to have had romantic relationships (1.93, 1.21-3.08). Eczema in late adolescence is associated with suicidal ideation and mental health problems but rarely with social problems. Our findings point to the importance of addressing mental health issues in adolescents with eczema.

Exposure to outdoor air pollution during trimesters of pregnancy and childhood asthma, allergic rhinitis, and eczema.

PubMed

Deng, Qihong; Lu, Chan; Li, Yuguo; Sundell, Jan; Dan Norbäck

2016-10-01

Mounting evidence suggests that exposure to ambient air pollution is associated with the development of childhood allergic diseases, but the effect of prenatal exposure to air pollution on the risk of childhood asthma and allergy is unclear. We evaluated the association between maternal exposure to outdoor air pollution during different trimesters of pregnancy and incidence of asthma, allergic rhinitis, and eczema in 2598 preschool children aged 3-6 years in China. Children's lifetime incidence of allergic diseases was obtained using questionnaire. Individual exposure to outdoor air pollutants during trimesters of pregnancy was estimated by an inverse distance weighted (IDW) method based on the measured concentrations at monitoring stations. We used multiple logistic regression method to estimate the odds ratio (OR) of asthma, allergic rhinitis, and eczema for per interquartile range (IQR) increase in the exposure to air pollutant in each trimester, which was adjusted for the effect of other air pollutants and its effect in other trimesters by a multi-pollutant/trimester model. Incidence of asthma (6.8%), allergic rhinitis (7.3%), and eczema (28.6%) in children was associated with maternal exposure to traffic-related pollutant NO2 during entire pregnancy with OR (95% confidence interval [CI]) respectively 1.63 (0.99-2.70), 1.69 (1.03-2.77), and 1.37 (1.04-1.80). After adjustment for other pollutants and trimesters, we found the association was significant only in specific trimester: the first trimester for eczema (1.54, 1.14-2.09), the second trimester for asthma (1.72, 1.02-2.97), and the third trimester for allergic rhinitis (1.77, 1.09-2.89). Sensitivity analysis indicated that the trimester sensitive to the development of allergic diseases was stable. Maternal exposure to traffic-related air pollutant NO2 during pregnancy, especially in specific trimesters, is associated with an increased risk of developing asthma, rhinitis, and eczema in children. Our results support the hypothesis that childhood allergic diseases originate in fetal life and are triggered by traffic-related air pollution in sensitive trimesters. Copyright © 2016 Elsevier Inc. All rights reserved.

Skin diseases among elderly patients attending skin clinic at the Regional Dermatology Training Centre, Northern Tanzania: a cross-sectional study.

PubMed

Mponda, Kelvin; Masenga, John

2016-02-22

As global population of the elderly continues to rise, a critical need to provide it with health services, including dermatology, will be significant, especially in developing countries like Tanzania. To adequately meet their dermatologic needs, knowledge of local patterns of skin conditions is vital. This study was aimed to describe the spectrum of skin diseases among elderly patients attending skin clinic at the Regional Dermatology Training Centre (RDTC) in Northern Tanzania. A descriptive hospital based cross-sectional study was conducted between January 2013 and April 2013 at RDTC and included all patients aged 55 years and above who consented to be examined. Diagnoses were clinical, diagnostic tests being done only when necessary. Ethical clearance to conduct the study was granted. A total of 142 patients, age ranges 55-99 years, median age of 67.5 years were seen. Eczemas were the leading disease group (43.7%), with unclassified eczemas (33.9%) predominating. Papulosquamous disorders (15.4%) were second with psoriasis (50%) being the leading disease. Infections (11.3% with fungal infections the leading group representing 5.6% of all diseases), tumours (9.8%: Kaposi's sarcoma 4.2%), vascular disorders 9.1% (lymphedema 4.9%), autoimmune disorders 7.7% (connective tissue diseases 4.9%), vitiligo 4.2%, nutritional diseases 2.1% (pellagra 0.7%), urticaria 0.7% and drug reactions 0.7%. Eczemas are the most common group of disorders among elderly patients presenting at RDTC.

Costs and cost-effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs.

PubMed

Schuttelaar, M L A; Vermeulen, K M; Coenraads, P J

2011-09-01

In a randomized, controlled trial (RCT) on childhood eczema we reported that substituting nurse practitioners (NPs) for dermatologists resulted in similar outcomes of eczema severity and in the quality of life, and higher patient satisfaction. To determine costs and cost-effectiveness of care provided by NPs vs. dermatologists and to compare our results with those in studies from other countries. We estimated the healthcare costs, family costs and the costs in other sectors alongside the RCT. All the costs were linked to quality of life [Infants' Dermatitis Quality of Life Index (IDQOL), Children's Dermatology Life Quality Index (CDLQI)] and to patient satisfaction (Client Satisfaction Questionnaire-8) to determine the incremental cost-effectiveness ratio (ICER). We also examined all the reported studies on the costs of childhood eczema. The mean annual healthcare costs, family costs and costs in other sectors were €658, €302 and €21, respectively, in the NP group and €801, €608 and €0·93, respectively, in the dermatologist group. The ICER in the NP group compared with the dermatologist group indicated €925 and €751 savings per one point less improvement in IDQOL and CDLQI, respectively, and €251 savings per one point more satisfaction in the NP group at 12 months. The mean annual healthcare costs and family costs varied considerably in the six identified studies. Substituting NPs for dermatologists is both cost-saving and cost-effective. The treatment of choice is that provided by the NPs as it is similarly effective to treatment provided by a dermatologist with a higher parent satisfaction. International comparisons are difficult because the types of costs determined, the units and unit prices, and eczema severity all differ between studies. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study.

PubMed

Darsow, U; Laifaoui, J; Kerschenlohr, K; Wollenberg, A; Przybilla, B; Wüthrich, B; Borelli, S; Giusti, F; Seidenari, S; Drzimalla, K; Simon, D; Disch, R; Borelli, S; Devillers, A C A; Oranje, A P; De Raeve, L; Hachem, J-P; Dangoisse, C; Blondeel, A; Song, M; Breuer, K; Wulf, A; Werfel, T; Roul, S; Taieb, A; Bolhaar, S; Bruijnzeel-Koomen, C; Brönnimann, M; Braathen, L R; Didierlaurent, A; André, C; Ring, J

2004-12-01

The atopy patch test (APT) was proposed to evaluate IgE-mediated sensitizations in patients with atopic eczema (AE). The prevalence and agreement with clinical history and specific IgE (sIgE) of positive APT reactions was investigated in six European countries using a standardized method. A total of 314 patients with AE in remission were tested in 12 study centers on clinically uninvolved, non-abraded back skin with 200 index of reactivity (IR)/g of house dust mite Dermatophagoides pteronyssinus, cat dander, grass, and birch pollen allergen extracts with defined major allergen contents in petrolatum. Extracts of egg white, celery and wheat flour with defined protein content were also patch tested. APT values were evaluated at 24, 48, and 72 h according to the European Task Force on Atopic Dermatitis (ETFAD) guidelines. In addition, skin-prick test (SPT) and sIgE and a detailed history on allergen-induced eczema flares were obtained. Previous eczema flares, after contact with specific allergens, were reported in 1% (celery) to 34% (D. pteronyssinus) of patients. The frequency of clear-cut positive APT reactions ranged from 39% with D. pteronyssinus to 9% with celery. All ETFAD intensities occured after 48 and 72 h. Positive SPT (16-57%) and elevated sIgE (19-59%) results were more frequent. Clear-cut positive APT with all SPT and sIgE testing negative was seen in 7% of the patients, whereas a positive APT without SPT or sIgE for the respective allergen was seen in 17% of the patients. APT, SPT and sIgE results showed significant agreement with history for grass pollen and egg white (two-sided Pr > /Z/ < or = 0.01). In addition, SPT and sIgE showed significant agreement with history for the other aeroallergens. With regard to clinical history, the APT had a higher specificity (64-91% depending on the allergen) than SPT (50-85%) or sIgE (52-85%). Positive APT were associated with longer duration of eczema flares and showed regional differences. In 10 non-atopic controls, no positive APT reaction was seen. Aeroallergens and food allergens are able to elicit eczematous skin reactions after epicutaneous application. As no gold standard for aeroallergen provocation in AE exists, the relevance of aeroallergens for AE flares may be evaluated by APT in addition to SPT and sIgE. The data may contribute to the international standardization of the APT.

The Prevalence, Risk Factors and Changes in Symptoms of Self Reported Asthma, Rhinitis and Eczema Among Pregnant Women in Ogbomoso, Nigeria

PubMed Central

Adeyemi, Adewale Samson; Adebayo, Philip Babatunde; Tanimowo, Moses O.; Ayodele, Olugbenga Edward

2015-01-01

Background Allergic disorders have become a major public health concern worldwide. No Nigerian study has examined the epidemiology of allergic diseases among women. Aim To document the prevalence, risk factors and the changes in the symptoms of allergic disorders during pregnancy. Settings and Design Cross-sectional study conducted at the booking and antenatal clinics of LAUTECH Teaching Hospital and Millennium Development Goals (MDG) Clinic of the Comprehensive Health Center, Oja Igbo, Ogbomoso, Nigeria. Materials and Methods Study enrolled 432 women from two public hospitals. Sociodemographic and clinical history were obtained and allergic disorders were diagnosed using ISAAC questionnaires. Results The prevalence of wheezing, eczema and rhinitis in pregnancy are 7.5%, 4.0% and 5.8% respectively. The prevalence of wheezing and eczema was slightly higher among the pregnant in past 12 months. Wheeze worsened in 70% (18/26), improved in 15% (2/26), and stable in 15% (2/26). Eczema worsened in 50% (7/14), improved in 7.1% (1/14) and stable in 42.9% (6/14), while allergic rhinitis worsened in 50% (11/22), improved in 22.7% (5/22) and stabilized in 27.3 % (6/22). In multivariate analysis, the risk of allergic diseases in pregnancy was increase 2 times by low income earning (CI: 1.2 – 2.1, p = 0.002), low level education (OR = 0.6, CI: 0.3 – 0.9, p = 0.011) and by family history of asthma, OR-4.3, CI – 1.3 – 13.9, p = 0.015. Family history of asthma increase the chances of asthma by 18.7 times, CI-2.3 – 152.2, p = 0.006, while the odd of eczema was increased 9.1 times (CI-2.7 – 30.6, p<0.001) and 2.4 times (CI: 1.2 – 4.7, p = 0.008) by second hand home smoking and low-family income respectively. The risk of allergic rhinitis were raised 1.8 times by low family income (CI 1.1 – 2.8, p = 0.013) and 3.9 times by family history of rhinitis (OR = 3.9, CI 1.2 – 12.7, p = 0.024). Conclusion Prevalence of wheezing and eczema are higher in pregnancy probably due to exacerbation induced by pregnancy. Social and genetic factors are important risk factors for allergic disorders in pregnancy. PMID:26500933

Dysbiosis and Staphylococcus aureus colonization drives inflammation in atopic dermatitis

PubMed Central

Kobayashi, Tetsuro; Glatz, Martin; Horiuchi, Keisuke; Kawasaki, Hiroshi; Akiyama, Haruhiko; Kaplan, Daniel H.; Kong, Heidi H.; Amagai, Masayuki; Nagao, Keisuke

2015-01-01

Summary Staphylococcus aureus skin colonization is universal in atopic dermatitis and common in cancer patients treated with epidermal growth factor receptor inhibitors. However, the causal relationship of dysbiosis and eczema has yet to be clarified. Herein, we demonstrate that Adam17fl/flSox9-Cre mice, generated to model ADAM17-deficiency in human, developed eczematous dermatitis with naturally occurring dysbiosis, similar to that observed in atopic dermatitis. Corynebacterium mastitidis, S. aureus, and Corynebacterium bovis sequentially emerged during the onset of eczematous dermatitis, and antibiotic specific for these bacterial species almost completely reversed dysbiosis and eliminated skin inflammation. Whereas S. aureus prominently drove eczema formation, C. bovis induced robust T helper 2 cell responses. Langerhans cells were required for eliciting immune responses against S. aureus inoculation. These results characterize differential contributions of dysbiotic flora during eczema formation, and highlight the microbiota-host immunity axis as a possible target for future therapeutics in eczematous dermatitis. PMID:25902485

'When it goes back to my normal I suppose': a qualitative study using online focus groups to explore perceptions of 'control' among people with eczema and parents of children with eczema in the UK.

PubMed

Howells, Laura M; Chalmers, Joanne R; Cowdell, Fiona; Ratib, Sonia; Santer, Miriam; Thomas, Kim S

2017-11-15

To inform the development of a core outcome set for eczema by engaging with people with eczema and parents of children with eczema to understand their experiences and understanding of the concept 'eczema control'. 37 participants took part in a total of six semi-structured online focus groups held in a typed chatroom with 5-7 participants per group. Three groups involved adults with eczema and three groups involved parents of children with eczema. Framework analysis was used for data analysis. A community-based sample was recruited from across the UK via social media and email. 19 adults aged 17-61 years (15/19 female, 16/19 white) and 18 parents of children with eczema aged 9 months-17 years (9/18 female, 18/19 white). Four main themes were identified:(1) 'Commonalities and differences in the experiences of control': a reduction in symptoms such as itch and sleep loss characterised eczema control, but what level was acceptable differed across participants;(2) 'Eczema control goes beyond the skin': psychological factors, social factors, the constant scratching and the impact on everyday activities are a variety of ways an individual can be impacted;(3) 'Stepping up and down of treatment': participants' stepped-up treatment in response to loss of control, but several factors complicated this behaviour. Control needed to be maintained after stepped-up treatment ended to be acceptable; and (4) 'How to measure control': self-report was generally preferred to allow frequent measurements and to capture unobservable features. Although most thought their eczema needed to be measured frequently, many also felt that this was not always realistic or desirable. 'Eczema control' is a complex experience for people with eczema and parents of children with the condition. These experiences could have important implications on how long-term control should be measured in eczema clinical trials and clinical practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

‘When it goes back to my normal I suppose’: a qualitative study using online focus groups to explore perceptions of ‘control’ among people with eczema and parents of children with eczema in the UK

PubMed Central

Chalmers, Joanne R; Cowdell, Fiona; Ratib, Sonia

2017-01-01

Objective To inform the development of a core outcome set for eczema by engaging with people with eczema and parents of children with eczema to understand their experiences and understanding of the concept ‘eczema control’. Design 37 participants took part in a total of six semi-structured online focus groups held in a typed chatroom with 5–7 participants per group. Three groups involved adults with eczema and three groups involved parents of children with eczema. Framework analysis was used for data analysis. Setting A community-based sample was recruited from across the UK via social media and email. Participants 19 adults aged 17–61 years (15/19 female, 16/19 white) and 18 parents of children with eczema aged 9 months–17 years (9/18 female, 18/19 white). Results Four main themes were identified:(1) ‘Commonalities and differences in the experiences of control’: a reduction in symptoms such as itch and sleep loss characterised eczema control, but what level was acceptable differed across participants;(2) ‘Eczema control goes beyond the skin’: psychological factors, social factors, the constant scratching and the impact on everyday activities are a variety of ways an individual can be impacted;(3) ‘Stepping up and down of treatment’: participants’ stepped-up treatment in response to loss of control, but several factors complicated this behaviour. Control needed to be maintained after stepped-up treatment ended to be acceptable; and (4) ‘How to measure control’: self-report was generally preferred to allow frequent measurements and to capture unobservable features. Although most thought their eczema needed to be measured frequently, many also felt that this was not always realistic or desirable. Conclusions ‘Eczema control’ is a complex experience for people with eczema and parents of children with the condition. These experiences could have important implications on how long-term control should be measured in eczema clinical trials and clinical practice. PMID:29146642

Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema.

PubMed

Lewis-Jones, S

2006-08-01

The misery of living with atopic eczema (syn. dermatitis, AD) cannot be overstated for it may have a profoundly negative effect on the health-related quality of life (HRQoL) of children and their family unit in many cases. As it is one of the commonest chronic relapsing childhood dermatosis (UK lifetime prevalence 16-20% by 20 years), with increasing worldwide prevalence, this has major social and financial implications for individuals, healthcare providers and society as a whole. This review explores the impact of AD on the lives of children and their family units and the use of some of the recently developed HRQoL measures, which have enabled investigation and categorisation of the physical, psychological and psycho-social effects of childhood eczema across all aspects of life. These effects include symptoms of itching and soreness, which cause sleeplessness in over 60%. Sleep deprivation leads to tiredness, mood changes and impaired psychosocial functioning of the child and family, particularly at school and work. Embarrassment, comments, teasing and bullying frequently cause social isolation and may lead to depression or school avoidance. The child's lifestyle is often limited, particularly in respect to clothing, holidays, staying with friends, owning pets, swimming or the ability to play or do sports. Restriction of normal family life, difficulties with complicated treatment regimes and increased work in caring for a child with eczema lead to parental exhaustion and feelings of hopelessness, guilt, anger and depression. The hidden costs involved in eczema management can be significant and have particular impact on lower income families. The impairment of quality of life caused by childhood eczema has been shown to be greater than or equal to other common childhood diseases such as asthma and diabetes, emphasising the importance of eczema as a major chronic childhood disease. HRQoL measures are proving to be valuable tools for use in the clinical setting, as outcome measures for pharmaceutical studies, for health economics and audit purposes. It is therefore recommended that in future, they should be used in conjunction with objective measures of severity, as part of the assessment process of a child with atopic eczema. Lack of information on eczema and treatments heightens parental anxiety. Education of all individuals involved in the care of children with eczema is fundamental in the management of AD and it is essential to provide simple clear, unambiguous information on treatment and disease management in order to reduce the negative impact on HRQoL.

Parental employment, income, education and allergic disorders in children: a prebirth cohort study in Japan.

PubMed

Miyake, Y; Tanaka, K; Sasaki, S; Hirota, Y

2012-06-01

Epidemiological evidence on the relationship between socio-economic status and allergic disorders has been inconsistent. We examined the associations between maternal employment, maternal job type, household income, and paternal and maternal educational levels and the risk of allergic disorders in Japanese children aged 4.5 years. Subjects were 480 mother-child pairs. Definitions of wheeze and eczema symptoms were based on criteria of the International Study of Asthma and Allergies in Childhood. Data on self-reported doctor-diagnosed asthma and atopic eczema were available. Compared with children whose mothers had received less than 13 years of education, those with mothers with ≥15 years of education had a significantly increased risk of wheeze and doctor-diagnosed asthma: the adjusted ORs were respectively 2.41 (95%CI 1.18-5.17) and 2.70 (95%CI 1.03-8.08). Fifteen years or more of paternal education was independently associated with an increased risk of eczema, but not of doctor-diagnosed atopic eczema (adjusted OR 1.89, 95%CI 1.07-3.42). Mother's employment, mother's job type and household income were not related to any of the outcomes. Higher maternal educational level may increase the risk of wheeze and asthma, while higher paternal educational level may increase the risk of eczema.

Reaching clinically relevant outcome measures for new pharmacotherapy and immunotherapy of atopic eczema.

PubMed

Chalmers, Joanne; Deckert, Stefanie; Schmitt, Jochen

2015-06-01

This article describes the core outcome set (COS) for atopic eczema trials. COS describe a minimum set of outcomes to be assessed in a defined situation. COS are required to overcome the current situation of different trials using different endpoints with unclear/insufficient measurement properties resulting in incomparable trials. The global multi-stakeholder Harmonising Outcomes Measures for Eczema initiative developed the Harmonising Outcomes Measures for Eczema roadmap as a generic framework for COS development. Following the establishment of a panel representing all stakeholders, a core set of outcome domains need to be selected based on systematic reviews and consensus methods. Outcome measurement instruments to assess these core domains need to be valid, reliable, and feasible. There is broad global consensus that clinical signs, quality of life, symptoms, and long-term control of flares form the COS for atopic eczema trials. The Eczema Area and Severity Index is recommended to assess clinical signs in atopic eczema trials. Systematic reviews to identify adequate outcome measurement instruments for the other core outcome domains are underway. Clinical signs should be assessed in all atopic eczema trials by at least the Eczema Area and Severity Index. Quality of life, symptoms, and flares should also be assessed in all atopic eczema trials by a valid, reliable, and feasible instrument.

Climate and the prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children

PubMed Central

Weiland, S; Husing, A; Strachan, D; Rzehak, P; Pearce, N

2004-01-01

Aims: To investigate the association between climate and atopic diseases using worldwide data from 146 centres of the International Study of Asthma and Allergies in Childhood (ISAAC). Methods: Between 1992 and 1996, each centre studied random samples of children aged 13–14 and 6–7 years (approx. 3000 per age group and centre) using standardised written and video questionnaires on symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema during the past 12 months. Data on long term climatic conditions in the centres were abstracted from one standardised source, and mixed linear regression models calculated to take the clustering of centres within countries into account. Results: In Western Europe (57 centres in 12 countries), the prevalence of asthma symptoms, assessed by written questionnaire, increased by 2.7% (95% CI 1.0% to 4.5%) with an increase in the estimated annual mean of indoor relative humidity of 10%. Similar associations were seen for the video questionnaire and the younger age group. Altitude and the annual variation of temperature and relative humidity outdoors were negatively associated with asthma symptoms. The prevalence of eczema symptoms correlated with latitude (positively) and mean annual outdoor temperature (negatively). Conclusions: Results suggest that climate may affect the prevalence of asthma and atopic eczema in children. PMID:15208377

Allergic contact dermatitis caused by the blue pigment VINAMON® Blue BX FW - a phthalocyanine blue in a vinyl glove.

PubMed

Weimann, Stefanie; Skudlik, Christoph; John, Swen Malte

2010-10-01

A 44-year-old metalworker suffered from severe hand eczema in spite of treatment with corticosteroid ointments. He had been using protective cotton gloves with blue PVC anti-slip dots on the finger tips. On clinical examination, the backs of both hands were erythematous and thickened while the finger tips showed vesicles. There was a positive patch test reaction to the blue PVC dots of an unworn cotton glove at 72, 96, 120 hours. To identify the causative chemicals, we carried out further patch tests using ingredients of the glove and cupric sulfate. The patient reacted to the blue dye VYNAMON(®) Blue BX FW (PB 15) at two concentrations - 10% at 72 and 96 hours, and 50% at 48 and 72 hours. This dye is a very strong and brilliant blue with red-copper tones and resistant to fire and weathering. The cupric-phthalocyanine complexes are used as pigments in cosmetics (e. g. CI 74160, 74180, 74260). To the best of our knowledge, no allergic reactions to this dye have been described, particularly not in gloves. © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.

Severity and functional disability of patients with occupational contact dermatitis: validation of the German version of the Occupational Contact Dermatitis Disease Severity Index.

PubMed

Ofenloch, Robert F; Diepgen, Thomas L; Popielnicki, Ana; Weisshaar, Elke; Molin, Sonja; Bauer, Andrea; Mahler, Vera; Elsner, Peter; Schmitt, Jochen; Apfelbacher, Christian

2015-02-01

The Occupational Contact Dermatitis Disease Severity Index (ODDI) was designed in Australia to measure severity and functional disability in patients with occupational contact dermatitis (OCD) of the hands. The ODDI was translated into the German language with a linguistic validation process. The psychometric properties of the German version of the ODDI are still unclear. To report the linguistic validation procedure and to perform a psychometric validation by investigating the validity and reliability of the German ODDI version in a sample of patients with OCD. Data were drawn from the baseline assessment (T0) and first follow-up (T1) of the German chronic hand eczema (CHE) registry (CARPE). Spearman correlations of the ODDI with reference measures were computed to assess validity. Cronbach's alpha was calculated as a measure of internal consistency, and the intraclass correlation coefficient (ICC) was calculated to assess retest reliability. The smallest real difference (SRD) and minimal clinically important difference (MCID) were calculated to assess sensitivity to change. Physician Global Assessment (PGA) was used as an anchor for the MCID. Four hundred and twenty-two patients (54.5% female, mean age 45.1 years) were included for analysis. Cronbach's alpha was found to be 0.73. The ICC was 0.79. Correlations between the ODDI total and the Dermatology Life Quality Index (rho = 0.36), and between PGA (rho = 0.48) and patient-assessed disease severity (rho = 0.40), were of moderate strength. The MCID (1.29) was found to be smaller than the SRD (1.87). The German ODDI version is reliable and valid for the measurement of functional impairment and disease severity in patients suffering from OCD. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Filaggrin loss-of-function mutations as a predictor for atopic eczema, allergic sensitization and eczema-associated asthma in Polish children population.

PubMed

Dębińska, Anna; Danielewicz, Hanna; Drabik-Chamerska, Anna; Kalita, Danuta; Boznański, Andrzej

2017-09-01

Loss-of-function mutations in the filaggrin (FLG) gene were identified as a major risk factor for atopic eczema. The aim of the study was to investigate the importance of 4 common FLG null mutations in the susceptibility to atopic eczema and other allergic phenotypes in Polish children population. The FLG mutations were determined in 158 children younger than 2 years of age. All subjects were selected using a detailed questionnaire and blood samples for total and specific IgE measurements were obtained. Cases of atopic eczema were diagnosed according to the criteria of Hanifin and Rajka and skin examination. All FLG mutations were genotyped by real-time PCR assays with a subsequent melting curve analysis using a SimpleProbe® probes. The combined genotype of all 4 mutations (carriage of ≥ 1 FLG mutation) was significantly associated with atopic eczema (p = 0.016). The odds ratio (OR) for individuals carrying 1 of these 4 null mutations was 5.52 (95% CI; 1.11 ÷ 37.12). The significant association between either the combined FLG genotype or 2282del14 deletion and eczema was seen only in the allergic group. The association with asthma was restricted to asthma occurring in the context of eczema (OR, 6.27; 95% CI, 0.89 ÷ 53.56; p = 0.042). Our study confirms the previous findings that FLG mutations are strongly associated with atopic eczema and confer a significant risk of allergic sensitization and asthma in the context of eczema. These results underline the role of the epidermal barrier and filaggrin insufficiency in the pathogenesis of atopic eczema and eczema-associated asthma.

IgE antibodies and urinary trimethylarsine oxide accounted for 1-7% population attributable risks for eczema in adults: USA NHANES 2005-2006.

PubMed

Shiue, Ivy

2015-12-01

Population attributable risks from serum IgE and dust miteallergen concentrations and environmental chemicals for eczema are unclear. Therefore, it was aimed to examine serum IgE and allergen concentrations and environmental chemicals for eczema in adults and to calculate population attributable risks in a national and population-based setting. Data retrieved from the National Health and Nutrition Examination Survey, 2005-2006, was analyzed. Information on demographics and self-reported ever eczema was obtained by household interview. Bloods and urines (sub-sample) were also collected during the interview. Adults aged 20-85 were included. Statistical analyses were using chi-square test, t test, survey-weighted logistic regression modeling, and population attributable risk (PAR) estimation. Of all the included American adults (n = 4979), 310 (6.2%) reported ever eczema. Moreover, more eczema cases were observed in female adults but fewer cases in people born in Mexico. There were no significant associations observed between commonly known biomarkers (including vitamin D) and eczema or between dust mite allergens and eczema. Serum D. Farinae (PAR 1.0%), D. Pteronyssinus (PAR 1.1%), cat (PAR 1.8%), dog (PAR 1.6%), and muse (PAR 3.2%) IgE antibodies were associated with eczema. Adults with ever eczema were found to have higher levels of urinary trimethylarsine oxide concentrations (PAR 7.0%) but not other speciated arsenic concentrations. There were no clear associations between other environmental chemicals including heavy metals, phthalates, phenols, parabens, pesticides, nitrate, perchlorate, polycyclic hydrocarbons and eczema as well. Elimination of environmental risks might help delay or stop eczema up to 7% in the adult population.

Effect of eczema on the association between season of birth and food allergy in Japanese children.

PubMed

Kusunoki, Takashi; Morimoto, Takeshi; Sakuma, Mio; Mukaida, Kumiko; Yasumi, Takahiro; Nishikomori, Ryuta; Heike, Toshio

2013-02-01

Food allergy (FA) in childhood has been shown to be more prevalent in those born in autumn and winter. The mechanisms of this season-of-birth effect remain unclear, although shortage of vitamin D during infancy has been considered one possible mechanism. The purpose of this study was to investigate the effect of eczema on the season-of-birth effect on FA in infancy. A questionnaire survey on the prevalence of allergic diseases was completed by the parents of 14 669 Japanese schoolchildren, aged 7-15 years, in Kyoto City, Japan. Logistic regression models were constructed to compare the prevalence of FA in infancy according to season of birth. Those born in autumn and winter had a significantly higher prevalence of FA in infancy compared to those born in spring and summer in a multivariate model (4.8% vs 3.6%, P = 0.001). The difference, however, was no longer significant when eczema before 6 months was included as either an additional or only confounding factor. The difference among those with and without eczema before 6 months was further analyzed, and it was found that, in both groups, there was no difference between those born in spring and summer and those born in autumn and winter. The season-of-birth effect on FA in infancy was significantly affected by the existence of eczema before 6 months in Japanese children. Eczema before 6 months may be the factor directly related to the season-of-birth effect on FA in infancy. © 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society.

Does urban extent from satellite images relate to symptoms of asthma, rhinoconjunctivitis and eczema in children? A cross-sectional study from ISAAC Phase Three.

PubMed

Pacheco-González, Rosa; Ellwood, Eamon; Exeter, Daniel; Stewart, Alistair W; Asher, Innes

2016-10-01

The relationship between urbanisation and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is not clear, and varying definitions of urban extent have been used. Furthermore, a global analysis has not been undertaken. This study aimed to determine whether the symptom prevalence of asthma, rhinoconjunctivitis and eczema in centres involved in the International Study of Asthma and Allergies in Childhood (ISAAC) were higher in urban than rural centres, using a definition of urban extent as land cover from satellite data. A global map of urban extent from satellite images (MOD500 map) was used to define the urban extent criterion. Maps from the ISAAC centres were digitised and merged with the MOD500 map to describe the urban percentage of each centre. We investigated the association between the symptom prevalence of asthma, rhinoconjunctivitis and eczema and the percentage of urban extent by centre. A weak negative relationship was found between the percentage of urban extent of each ISAAC centre and current wheeze in the 13-14-year age group. This association was not statistically significant after adjusting for region of the world and gross national income. No other relationship was found between urban extent and symptoms of asthma, rhinoconjunctivitis and eczema. In this study, the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema in children were not associated with urbanisation, according to the land cover definition of urban extent from satellite data. Comparable standardised definitions of urbanisation need to be developed so that global comparisons can be made.

Allergic contact dermatitis caused by titanium screws and dental implants.

PubMed

Hosoki, Maki; Nishigawa, Keisuke; Miyamoto, Youji; Ohe, Go; Matsuka, Yoshizo

2016-07-01

Titanium has been considered to be a non-allergenic material. However, several studies have reported cases of metal allergy caused by titanium-containing materials. We describe a 69-year-old male for whom significant pathologic findings around dental implants had never been observed. He exhibited allergic symptoms (eczema) after orthopedic surgery. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. After removal of dental implants, the eczema disappeared completely. Titanium is used not only for medical applications such as plastic surgery and/or dental implants, but also for paints, white pigments, photocatalysts, and various types of everyday goods. Most of the usage of titanium is in the form of titanium dioxide. This rapid expansion of titanium-containing products has increased percutaneous and permucosal exposure of titanium to the population. In general, allergic risk of titanium material is smaller than that of other metal materials. However, we suggest that pre-implant patients should be asked about a history of hypersensitivity reactions to metals, and patch testing should be recommended to patients who have experienced such reactions. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Herbal creams used for atopic eczema in Birmingham, UK illegally contain potent corticosteroids.

PubMed

Ramsay, H M; Goddard, W; Gill, S; Moss, C

2003-12-01

To determine whether "herbal creams" reported as being effective for the treatment of childhood atopic eczema contained corticosteroids. Patients attending the paediatric dermatology clinic at Birmingham Children's Hospital, April 2001 to March 2002, and who reported using "herbal creams" with good effect for atopic eczema were asked to submit the cream for analysis. Hydrocortisone, clobetasone butyrate, betamethasone valerate, and clobetasol propionate were analysed by HPLC. Twenty four creams from 19 patients, median (interquartile range) age 3.82 (0.69-7.98) years were analysed. All five creams labelled Wau Wa and the two labelled Muijiza cream contained clobetasol propionate. Thirteen of 17 unnamed creams contained corticosteroids: clobetasol proprionate (n = 4), clobetasol proprionate + hydrocortisone (n = 1), betamethasone valerate (n = 2), clobetasone butyrate (n = 3), and hydrocortisone (n = 2); there was an unidentified peak in one. Further analysis suggested Wau Wa cream contained approximately 20% proprietary Dermovate Cream in a paraffin base. No parents were aware that the creams contained steroid. The majority of herbal creams analysed illegally contained potent or very potent topical steroids. There is an urgent need for tighter regulation of herbal creams and for increased public education about the potential dangers of alternative therapies.

Associations of maternal and fetal 25-hydroxyvitamin D levels with childhood eczema: The Generation R Study.

PubMed

Gazibara, Tatjana; Elbert, Niels J; den Dekker, Herman T; de Jongste, Johan C; Reiss, Irwin; McGrath, John J; Eyles, Darryl W; Burne, Thomas H; Tiemeier, Henning; Jaddoe, Vincent W V; Pasmans, Suzanne G M A; Duijts, Liesbeth

2016-05-01

Exposure to low levels of vitamin D in fetal life might affect the developing immune system, and subsequently the risk of childhood eczema. We examined whether 25-hydroxyvitamin D levels in mid-gestation and at birth were associated with the risk of eczema until the age of 4 years. In a population-based prospective cohort study of 3019 mothers and their children, maternal blood samples in mid-gestation and umbilical cord blood samples at birth were used to determine 25-hydroxyvitamin D levels (severely deficient <25.0 nmol/l, deficient 25.0-49.9 nmol/l, sufficient 50.0-74.9 nmol/l, optimal ≥75.0 nmol/l). Eczema was prospectively assessed by annual questionnaires until the age of 4 years. Eczema patterns included never, early (age ≤1 year only), late (age >1 year only), and persistent eczema (age ≤ and >1 year). Data were assessed using the generalized estimating equations and multinomial regression models. Compared with the optimal 25-hydroxyvitamin D group, sufficient, deficient, and severely deficient groups of 25-hydroxyvitamin D level in mid-gestation were not associated with the risk of overall eczema (odds ratios [95% confidence interval]: 1.09 [0.82, 1.43], 1.04 [0.87, 1.25], and 0.94 [0.81, 1.10], p-values for trend >0.05), nor with eczema per year or eczema patterns in children up to the age of 4 years. Similarly, we observed no associations of 25-hydroxyvitamin D groups at birth with any eczema outcome. Our results suggest that levels of 25-hydroxyvitamin D in mid-gestation and at birth are not associated with the risk of overall eczema, eczema per year, or eczema patterns among children until the age of 4 years. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

What's new in atopic eczema? An analysis of systematic reviews published in 2007 and 2008. Part 2. Disease prevention and treatment.

PubMed

Williams, H C; Grindlay, D J C

2010-04-01

This review summarizes clinically important findings from systematic reviews indexed in bibliographical databases between August 2007 and August 2008 that dealt with disease prevention (six reviews) and treatment of atopic eczema (seven reviews). Regarding disease prevention, two independent systematic reviews found some clinical trial evidence that ingestion of probiotics by mothers during pregnancy might reduce the incidence of subsequent eczema. Another review failed to find any clear benefit of prebiotics in eczema prevention. Although furry pets are often cited as causing allergic disease, a systematic review of observational studies found no evidence that exposure to cats or dogs at birth increases eczema risk. One very large review of studies of breastfeeding found some evidence of a protective effect on eczema risk, although all the studies were limited by their observational nature. A German group has attempted an overview of eczema prevention studies with a view to informing national guidelines. In terms of eczema treatment, two systematic reviews have confirmed the efficacy of topical tacrolimus ointment. Another review of 31 trials confirms the efficacy of topical pimecrolimus, although many of those trials were vehicle controlled, which limits their clinical utility. A review of 23 studies of desensitization therapy for allergic diseases found some evidence of benefit for eczema, which needs to be explored further. Despite the popularity of antistaphylococcal therapies for eczema, a Cochrane Review of 21 trials failed to show any clear benefit for any of the therapies for infected or clinically noninfected eczema. Another Cochrane Review dealt with dietary exclusions for people with eczema and found little evidence to support any dietary exclusion, apart from avoidance of eggs in infants with suspected egg allergy supported by evidence of sensitization. A review of 13 studies of probiotics for treating established eczema did not show convincing evidence of a clinically worthwhile benefit, an observation that has been substantiated in a subsequent Cochrane Review.

Association Between TSLP Polymorphisms and Eczema in Japanese Women: the Kyushu Okinawa Maternal and Child Health Study.

PubMed

Miyake, Yoshihiro; Hitsumoto, Shinichi; Tanaka, Keiko; Arakawa, Masashi

2015-08-01

We examined the association between thymic stromal lymphopoietin (TSLP) single nucleotide polymorphisms (SNPs) and eczema in young adult Japanese women. Cases were 188 women who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for eczema. Controls were 565 women without eczema according to the ISAAC criteria, who had not been diagnosed with asthma, atopic eczema, and/or allergic rhinitis by a doctor and who had no asthma as defined by the European Community Respiratory Health Survey criteria and no rhinoconjunctivitis according to the ISAAC criteria. Compared with women with the TT genotype of SNP rs1837253, those with the TC or CC genotype had a significantly increased risk of eczema after adjustment for age and smoking, although this association was not significant in crude analysis. There were no relationships between SNP rs3806933 or rs2289276 and eczema. The TC and CC genotypes combined of SNP rs1837253 may be significantly positively associated with eczema.

THE USE OF SILICONES IN DERMATOLOGY

PubMed Central

LeVan, Paul; Sternberg, Thomas H.; Newcomer, Victor D.

1954-01-01

A cosmetically acceptable lotion containing a silicone protectant, a keratolytic, a bacteriocidal agent and antipruritic substances, was clinically tested in 208 persons with various dermatoses. Twenty-four-hour closed patch tests on humans and intradermal tests in laboratory animals indicate the lotion not to be a sensitizer. Subacute and chronic housewives' eczema and contact dermatitis of the hands, uncomplicated “diaper rash,” periaural dermatitis due to excessive moisture, and certain hyperkeratotic dermatoses responded satisfactorily to the use of the lotion. PMID:13190431

IgE sensitization in relation to preschool eczema and filaggrin mutation.

PubMed

Johansson, Emma Kristin; Bergström, Anna; Kull, Inger; Lind, Tomas; Söderhäll, Cilla; van Hage, Marianne; Wickman, Magnus; Ballardini, Natalia; Wahlgren, Carl-Fredrik

2017-12-01

Eczema (atopic dermatitis) is associated with an increased risk of having IgE antibodies. IgE sensitization can occur through an impaired skin barrier. Filaggrin gene (FLG) mutation is associated with eczema and possibly also with IgE sensitization. We sought to explore the longitudinal relation between preschool eczema (PSE), FLG mutation, or both and IgE sensitization in childhood. A total of 3201 children from the BAMSE (Children Allergy Milieu Stockholm Epidemiology) birth cohort recruited from the general population were included. Regular parental questionnaires identified children with eczema. Blood samples were collected at 4, 8, and 16 years of age for analysis of specific IgE. FLG mutation analysis was performed on 1890 of the children. PSE was associated with IgE sensitization to both food allergens and aeroallergens up to age 16 years (overall adjusted odds ratio, 2.30; 95% CI, 2.00-2.66). This association was even stronger among children with persistent PSE. FLG mutation was associated with IgE sensitization to peanut at age 4 years (adjusted odds ratio, 1.88; 95% CI, 1.03-3.44) but not to other allergens up to age 16 years. FLG mutation and PSE were not effect modifiers for the association between IgE sensitization and PSE or FLG mutation, respectively. Sensitized children with PSE were characterized by means of polysensitization, but no other specific IgE sensitization patterns were found. PSE is associated with IgE sensitization to both food allergens and aeroallergens up to 16 years of age. FLG mutation is associated with IgE sensitization to peanut but not to other allergens. Sensitized children with preceding PSE are more often polysensitized. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The pattern of skin diseases in the Qassim region of Saudi Arabia: What the primary care physician should know.

PubMed

Al Shobaili, Hani A

2010-01-01

Epidemiological studies to determine the burden of skin diseases are important for proper health care planning. The purpose of this study was to find the pattern of skin diseases in our patients attending university-affiliated dermatologic clinics in the Qassim region. We conducted a prospective study of all Saudi patients attending the Qassim University Medical College-affiliated dermatology clinics of the Ministry of Health for a period of 12 months from 1 March 2008 to 28 February 2009. The study included 3051 patients comprising 1786 (58.5%) males and 1265 (41.5%) females. Males outnumbered females (P<.05) (male-to-female ratio, 1.4:1). The mean age (standard error of the mean) of the patients was 25.3 (0.27) years. About 71% of the patients were between 5 and 34 years of age. The top five skin diseases were eczema/ dermatitis (19.5%), viral infections (16.6%), pilosebaceous disorders (14.4%), pigmentary lesions (11.2%) and hair disorders (7.6%). The major disorder in males was viral skin infections (20.0%), while eczema/dermatitis (20.7%) constituted the most prevalent skin disease in females. Seasonal variations were recorded in cases of pigmentary lesions, papulosquamous disorders and protozoal infections. Infectious skin diseases, eczema/dermatitis, pilosebaceous disorders, pigmentary lesions and hair disorders ranked as the top five skin diseases. Appropriate training programs for diagnosing and managing common skin diseases should be initiated for primary health care physicians and other general practitioners so as to decrease referrals to dermatology clinics.

The Eczema Education Programme: intervention development and model feasibility.

PubMed

Jackson, K; Ersser, S J; Dennis, H; Farasat, H; More, A

2014-07-01

The systematic support of parents of children with eczema is essential to their effective management; however, we have few models of support. This study examines the rationale, evidence base and development of a large-scale, structured, theory-based, nurse-led intervention, the 'Eczema Education Programme' (EEP), for parents of children with eczema. To outline development of the EEP, model of delivery, determine its feasibility and evaluate this based on service access and parental satisfaction data. Parent-child dyads meeting EEP referral criteria were recruited and demographic information recorded. A questionnaire survey of parental satisfaction was conducted 4 weeks post EEP; parental focus groups at 6 weeks provided comparative qualitative data. Descriptive statistics were derived from the questionnaire data using Predictive Analytics Software (PASW); content analysis was applied to focus group data. A total of 356 parents attended the EEP during the evaluation period. Service access was achieved for those in a challenging population. Both survey data (n = 146 parents, 57%) and focus group data (n = 21) revealed a significant level of parental satisfaction with the programme. It was feasible to provide the EEP as an adjunct to normal clinical care on a large scale, achieving a high level of patient/parent satisfaction and access within an urban area of multiple deprivation and high mobility. The intervention is transferable and the results are generalizable to other ethnically diverse child eczema populations within metropolitan areas in Britain. A multicentre RCT is required to test the effectiveness of this intervention on a larger scale. © 2013 European Academy of Dermatology and Venereology.

Disability Pensions due to Skin Diseases: A Cohort Study in Swedish Construction Workers.

PubMed

Meding, Birgitta; Wrangsjö, Karin; Burdorf, Alex; Järvholm, Bengt

2016-02-01

Disability pensions due to skin diseases in Swedish male construction workers were studied by linking data from pension registers and an occupational health service. Incidence rates of disability pensions for cement workers, painters and plumbers were compared with 2 control groups. A total of 623 disability pensions were granted during 4 decades of follow-up. The main diagnoses were eczema (36%) and psoriasis (49%). Pensions were mostly granted in the age range 55-64 years. Among painters, cement workers and plumbers the incidence rates for disability pensions were 33.3, 24.5 and 20.4 cases/100,000 person-years, respectively, compared with 13.7 and 9.2 cases/100,000 person-years in control groups. Relative risks were highest for eczema, and were notable for psoriasis. Attributable fractions for eczema were 90% in cement workers and painters and 75% in plumbers compared with control groups. Attributable fractions for psoriasis in the occupational groups studied were in the range 54-67%. In conclusion, eczema and psoriasis have a high impact on loss of work ability, as reflected by disability pensions.

Protective role of 6-formylindolo[3,2-b]carbazole (FICZ), an endogenous ligand for arylhydrocarbon receptor, in chronic mite-induced dermatitis.

PubMed

Kiyomatsu-Oda, Mari; Uchi, Hiroshi; Morino-Koga, Saori; Furue, Masutaka

2018-06-01

Chronic eczema such as atopic dermatitis imposes significant socio-econo-psychologic burdens on the affected individuals. In addition to conventional topical treatments, phototherapy is recommended for patients with extensive lesions. Although immunosuppression is believed to explain its primary effectiveness, the underlying mechanisms of phototherapy remain unsolved. Ultraviolet irradiation generates various tryptophan photoproducts including 6-formylindolo[3,2-b]-carbazole (FICZ). FICZ is known to be a potent endogenous agonist for aryl hydrocarbon receptor (AHR); however, the biological role of FICZ in chronic eczema is unknown. To investigate the effect of FICZ on chronic eczema such as atopic dermatitis. We stimulated HaCaT cells and normal human epidermal keratinocytes (NHEKs) with or without FICZ and then performed quantitative reverse transcriptase polymerase chain reaction, immunofluorescence, and siRNA treatment. We used the atopic dermatitis-like NC/Nga murine model and treated the mice for 2 weeks with either Vaseline ® as a control, FICZ ointment, or betamethasone 17-valerate ointment. The dermatitis score, transepidermal water loss, histology, and expression of skin barrier genes and proteins were evaluated. FICZ significantly upregulated the gene expression of filaggrin in both HaCaT cells and NHEKs in an AHR-dependent manner, but did not affect the gene expression of other barrier-related proteins. In addition, FICZ improved the atopic dermatitis-like skin inflammation, clinical scores, and transepidermal water loss in NC/Nga mice compared with those of control mice. On histology, FICZ significantly reduced the epidermal and dermal thickness as well as the number of mast cells. Topical FICZ also significantly reduced the gene expression of Il22. These findings highlight the beneficial role of FICZ-AHR and provide a new strategic basis for developing new drugs for chronic eczema. Copyright © 2018 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.

Irritant contact dermatitis in warehouse employees.

PubMed

Ashworth, J; Rycroft, R J; Waddy, R S; Irvine, D

1993-02-01

A detailed survey of skin complaints amongst 114 airline employees working in a new warehouse revealed 26 cases of skin problems which originated during the 2 1/2 year operation. A clinical survey of broadly the same population confirmed 14 cases from 98 employees as chronic irritant contact dermatitis of the hands. The work involved the reception, unpackaging, inspection, repackaging and dispatch of aircraft parts. The source of the skin irritation was not to be found in the work itself. Rather, the presence among the employees of two severe cases of non-occupational eczema, combined with the idea that incoming aircraft parts from foreign countries might be 'dirty' in some way, had caused a heightened perception of a risk of skin disease, and the frequency of hand washing had increased as a result. Over-frequent hand washing in a few employees had resulted in precisely what the warehouse staff had been trying to avoid.

Dubowitz syndrome: review of 141 cases including 36 previously unreported patients.

PubMed

Tsukahara, M; Opitz, J M

1996-05-03

We review clinical information on 141 individuals with Dubowitz syndrome, 105 reported since 1965, and 36 previously unreported. We define the Dubowitz syndrome phenotype on the basis of clinical descriptions. The facial appearance is characteristic and present in most patients with Dubowitz syndrome. The phenotypic spectrum is quite variable and ranges from normal growth and head circumference with mild psychomotor retardation and lack of eczema to a condition of severe growth retardation, mental retardation, microcephaly, and eczema. Overall, the condition may involve the cutaneous, ocular, dental, digestive, musculoskeletal, urogenital, cardiovascular, neurological, hematological, and immune systems. Characteristic behavior patterns which have not been cited previously are present in our cases; most patients are hyperactive, shy, hate crowds, and like music, rhythm, and vibrations from music speakers, tape recorders, or transmitted through floors. Dubowitz syndrome is an autosomal recessive disorder with possibly increased frequency of parental consanguinity. Heterogeneity cannot be excluded at this time.

Cement-Induced Chromate Occupational Allergic Contact Dermatitis.

PubMed

Kridin, Khalaf; Bergman, Reuven; Khamaisi, Mogher; Zelber-Sagi, Shira; Weltfriend, Sara

2016-01-01

Hexavalent chromium in cement is a common cause of occupational allergic contact dermatitis (OACD). Analysis of patch test data during 1999 to 2013 was done. Patients with cement-induced chromate OACD filled the Dermatology Life Quality Index, graded 1 to 5. Of 4846 consecutive patients who were patch tested, 146 (3%) were chromate-sensitive. Of 46 (31.5%) who presented with chromate OACD, 27 (59%) had cement-induced chromate OACD. The proportion of chromate-sensitive patients with clinically relevant cement exposure increased from 7.7% in 2002 to 2004 to 28.7% in 2011 to 2013 (P = 0.04). The median age of presentation was younger than for other chromate-sensitive patients (32 vs 42 years). Hand eczema (88.9%) was the most frequent clinical presentation. Of the 27 with cement-induced chromate OACD, 21 (77.8%) had ongoing dermatitis at the time of the review. Although 14/27 (51.9%) changed their occupation to avoid exposure to cement, symptoms persisted in 9/14 (64.3%). Prolonged exposure to cement before development of symptoms was associated with chronicity. All the symptomatic patients experienced at least a moderate effect on their quality of life (grade 3 or higher on the Dermatology Life Quality Index). We recommend the adoption of the European legislation in Israel, to reduce the prevalence of chromate OACD from cement.

Eczema Is Associated with Childhood Speech Disorder: A Retrospective Analysis from the National Survey of Children's Health and the National Health Interview Survey.

PubMed

Strom, Mark A; Silverberg, Jonathan I

2016-01-01

To determine if eczema is associated with an increased risk of a speech disorder. We analyzed data on 354,416 children and adolescents from 19 US population-based cohorts: the 2003-2004 and 2007-2008 National Survey of Children's Health and 1997-2013 National Health Interview Survey, each prospective, questionnaire-based cohorts. In multivariate survey logistic regression models adjusting for sociodemographics and comorbid allergic disease, eczema was significantly associated with higher odds of speech disorder in 12 of 19 cohorts (P < .05). The pooled prevalence of speech disorder in children with eczema was 4.7% (95% CI 4.5%-5.0%) compared with 2.2% (95% CI 2.2%-2.3%) in children without eczema. In pooled multivariate analysis, eczema was associated with increased odds of speech disorder (aOR [95% CI] 1.81 [1.57-2.05], P < .001). In a single study assessing eczema severity, mild (1.36 [1.02-1.81], P = .03) and severe eczema (3.56 [1.70-7.48], P < .001) were associated with higher odds of speech disorder. History of eczema was associated with moderate (2.35 [1.34-4.10], P = .003) and severe (2.28 [1.11-4.72], P = .03) speech disorder. Finally, significant interactions were found, such that children with both eczema and attention deficit disorder with or without hyperactivity or sleep disturbance had vastly increased risk of speech disorders than either by itself. Pediatric eczema may be associated with increased risk of speech disorder. Further, prospective studies are needed to characterize the exact nature of this association. Copyright © 2016 Elsevier Inc. All rights reserved.

Eczema Is Associated with Childhood Speech Disorder: A Retrospective Analysis from the National Survey of Children’s Health and the National Health Interview Survey

PubMed Central

Strom, Mark A.; Silverberg, Jonathan I.

2016-01-01

Objective To determine if eczema is associated with an increased risk of a speech disorder. Study design We analyzed data on 354 416 children and adolescents from 19 US population-based cohorts: the 2003–2004 and 2007–2008 National Survey of Children’s Health and 1997–2013 National Health Interview Survey, each prospective, questionnaire-based cohorts. Results In multivariate survey logistic regression models adjusting for sociodemographics and comorbid allergic disease, eczema was significantly associated with higher odds of speech disorder in 12 of 19 cohorts (P < .05). The pooled prevalence of speech disorder in children with eczema was 4.7% (95% CI 4.5%–5.0%) compared with 2.2% (95% CI 2.2%–2.3%) in children without eczema. In pooled multivariate analysis, eczema was associated with increased odds of speech disorder (aOR [95% CI] 1.81 [1.57–2.05], P < .001). In a single study assessing eczema severity, mild (1.36 [1.02–1.81], P = .03) and severe eczema (3.56 [1.70–7.48], P < .001) were associated with higher odds of speech disorder. History of eczema was associated with moderate (2.35 [1.34–4.10], P = .003) and severe (2.28 [1.11–4.72], P = .03) speech disorder. Finally, significant interactions were found, such that children with both eczema and attention deficit disorder with or without hyperactivity or sleep disturbance had vastly increased risk of speech disorders than either by itself. Conclusions Pediatric eczema may be associated with increased risk of speech disorder. Further, prospective studies are needed to characterize the exact nature of this association. PMID:26520915

Do early-life exposures explain why more advantaged children get eczema? Findings from the U.K. Millennium Cohort Study.

PubMed

Taylor-Robinson, D C; Williams, H; Pearce, A; Law, C; Hope, S

2016-03-01

Atopic dermatitis (eczema) in childhood is socially patterned, with higher incidence in more advantaged populations. However, it is unclear what factors explain the social differences. To identify early-life risk factors for eczema, and to explore how early-life risk factors explain any differences in eczema. We estimated odds ratios (ORs) for ever having had eczema by age 5 years in 14 499 children from the U.K. Millennium Cohort Study (MCS), with a focus on maternal, antenatal and early-life risk factors and socioeconomic circumstances (SECs). Risk factors were explored to assess whether they attenuated associations between SECs and eczema. Overall 35·1% of children had ever had eczema by age 5 years. Children of mothers with degree-level qualifications vs. no educational qualifications were more likely to have eczema (OR 1·52, 95% confidence interval 1·31-1·76), and there was a gradient across the socioeconomic spectrum. Maternal atopy, breastfeeding (1-6 weeks and ≥ 6 months), introduction of solids under 4 months or cow's milk under 9 months, antibiotic exposure in the first year of life and grime exposure were associated with an increased odds of having eczema. Female sex, Pakistani and Bangladeshi ethnicity, smoking during pregnancy, exposure to environmental tobacco smoke and having more siblings were associated with reduced odds for eczema. Controlling for maternal, antenatal and early-life characteristics (particularly maternal smoking during pregnancy, breastfeeding and number of siblings) reduced the OR for eczema to 1·26 (95% confidence interval 1·03-1·50) in the group with the highest educational qualifications compared with the least. In a representative U.K. child cohort, eczema was more common in more advantaged children. This was explained partially by early-life factors including not smoking during pregnancy, breastfeeding and having fewer siblings. © 2015 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Interplay of Filaggrin Loss-of-Function Variants, Allergic Sensitization, and Eczema in a Longitudinal Study Covering Infancy to 18 Years of Age

PubMed Central

Ziyab, Ali H.; Karmaus, Wilfried; Yousefi, Mitra; Ewart, Susan; Schauberger, Eric; Holloway, John W.; Zhang, Hongmei; Arshad, Syed Hasan

2012-01-01

Background Immune specific genes as well as genes regulating the formation of skin barrier are major determinants for eczema manifestation. There is a debate as to whether allergic sensitization and filaggrin gene (FLG) variants lead to eczema or FLG variants and eczema increase the risk of allergic sensitization. To investigate the time-order between eczema and allergic sensitization with respect to FLG variants, data from a large prospective study covering infancy to late adolescence were analyzed. Methodology/Principal Findings Repeated measurements of eczema and allergic sensitization (documented by skin prick tests) at ages 1, 2, 4, 10, and 18 years were ascertained in the Isle of Wight birth cohort (n = 1,456). Three transition periods were analyzed: age 1-or-2 to 4, 4 to 10, and 10 to 18 years. FLG variants were genotyped in 1,150 participants. Over the three transition periods, in temporal sequence analyses of initially eczema-free participants, the combined effect of FLG variants and allergic sensitization showed a 2.92-fold (95% CI: 1.47–5.77) increased risk ratio (RR) of eczema in subsequent examinations. This overall risk was more pronounced at a younger age (transition period 1-or-2 to 4, RR = 6.47, 95% CI: 1.96–21.33). In contrast, FLG variants in combination with eczema showed a weaker, but significant, risk ratio for subsequent allergic sensitization only up to 10 years of age. Conclusions/Significance Taking the time order into account, this prospective study demonstrates for the first time, that a combination of FLG variants and allergic sensitization increased the risk of eczema in subsequent years. Also FLG variants interacted with eczema and increased the risk of subsequent allergic sensitization, which, was limited to the younger age. Hence, early restoration of defective skin barrier could prevent allergic sensitization and subsequently reduce the risk of eczema development. PMID:22403702

Developmental Profiles of Eczema, Wheeze, and Rhinitis: Two Population-Based Birth Cohort Studies

PubMed Central

2014-01-01

Background The term “atopic march” has been used to imply a natural progression of a cascade of symptoms from eczema to asthma and rhinitis through childhood. We hypothesize that this expression does not adequately describe the natural history of eczema, wheeze, and rhinitis during childhood. We propose that this paradigm arose from cross-sectional analyses of longitudinal studies, and may reflect a population pattern that may not predominate at the individual level. Methods and Findings Data from 9,801 children in two population-based birth cohorts were used to determine individual profiles of eczema, wheeze, and rhinitis and whether the manifestations of these symptoms followed an atopic march pattern. Children were assessed at ages 1, 3, 5, 8, and 11 y. We used Bayesian machine learning methods to identify distinct latent classes based on individual profiles of eczema, wheeze, and rhinitis. This approach allowed us to identify groups of children with similar patterns of eczema, wheeze, and rhinitis over time. Using a latent disease profile model, the data were best described by eight latent classes: no disease (51.3%), atopic march (3.1%), persistent eczema and wheeze (2.7%), persistent eczema with later-onset rhinitis (4.7%), persistent wheeze with later-onset rhinitis (5.7%), transient wheeze (7.7%), eczema only (15.3%), and rhinitis only (9.6%). When latent variable modelling was carried out separately for the two cohorts, similar results were obtained. Highly concordant patterns of sensitisation were associated with different profiles of eczema, rhinitis, and wheeze. The main limitation of this study was the difference in wording of the questions used to ascertain the presence of eczema, wheeze, and rhinitis in the two cohorts. Conclusions The developmental profiles of eczema, wheeze, and rhinitis are heterogeneous; only a small proportion of children (∼7% of those with symptoms) follow trajectory profiles resembling the atopic march. Please see later in the article for the Editors' Summary PMID:25335105

Association of variants in innate immune genes with asthma and eczema

PubMed Central

Sharma, Sunita; Poon, Audrey; Himes, Blanca E.; Lasky-Su, Jessica; Sordillo, Joanne E.; Belanger, Kathleen; Milton, Donald K.; Bracken, Michael B.; Triche, Elizabeth W.; Leaderer, Brian P.; Gold, Diane R.; Litonjua, Augusto A.

2012-01-01

Background The innate immune pathway is important in the pathogenesis of asthma and eczema. However, only a few variants in these genes have been associated with either disease. We investigate the association between polymorphisms of genes in the innate immune pathway with childhood asthma and eczema. In addition, we compare individual associations with those discovered using a multivariate approach. Methods Using a novel method, case control based association testing (C2BAT), 569 single nucleotide polymorphisms (SNPs) in 44 innate immune genes were tested for association with asthma and eczema in children from the Boston Home Allergens and Asthma Study and the Connecticut Childhood Asthma Study. The screening algorithm was used to identify the top SNPs associated with asthma and eczema. We next investigated the interaction of innate immune variants with asthma and eczema risk using Bayesian networks. Results After correction for multiple comparisons, 7 SNPs in 6 genes (CARD25, TGFB1, LY96, ACAA1, DEFB1, and IFNG) were associated with asthma (adjusted p-value<0.02), while 5 SNPs in 3 different genes (CD80, STAT4, and IRAKI) were significantly associated with eczema (adjusted p-value < 0.02). None of these SNPs were associated with both asthma and eczema. Bayesian network analysis identified 4 SNPs that were predictive of asthma and 10 SNPs that predicted eczema. Of the genes identified using Bayesian networks, only CD80 was associated with eczema in the single-SNP study. Using novel methodology that allows for screening and replication in the same population, we have identified associations of innate immune genes with asthma and eczema. Bayesian network analysis suggests that additional SNPs influence disease susceptibility via SNP interactions. Conclusion Our findings suggest that innate immune genes contribute to the pathogenesis of asthma and eczema, and that these diseases likely have different genetic determinants. PMID:22192168

Dyshidrotic eczema associated with the use of IVIg

PubMed Central

Kotan, Dilcan; Erdem, Teoman; Acar, Bilgehan Atilgan; Boluk, Ayhan

2013-01-01

Intravenous immunoglobulin (IVIg) treatment is highly effective for autoimmune diseases including myasthenia gravis. Recovery is observed at approximately. 75% of myasthenia gravis patients through IVIg treatment. As a result of many clinical studies, the recommended dose is determined as 0.4 g/kg for 5 days (maximum total dose at 2 g/kg body weight). If an additional immunomodulatory treatment is not administered, IVIg maintenance treatment is needed mostly. However, some side effects may inhibit long-term treatment. For this reason, it is important to know the effect profile well and when the treatment should be discontinued. A female myasthenia gravis patient case is presented here, where dyshidrotic eczema has occurred after the second dose of  intravenous Ig medication and whose treatment is despite further IVIg therapy. PMID:23417935

[Hand for the dermatologist].

PubMed

Cribier, B

2010-11-01

Through its anatomical, topographical, and functional distinctiveness, more than all other parts of the body, the hand is the interface between humans and their environment. All types of stimulus produce cutaneous signs in the hands, notably cold, light, pressure, contact, etc. Exposure to light makes it the region where photodermatosis is expressed, but also a particular site for cutaneous carcinogenesis. The countless chemical substances that the hand encounters can create specific or particular diseases in this location (irritative dermitis, contact eczema, hyperkeratosis, atrophy, etc.). The hand is also the site of infectious dermatosis transmission (erysipeloid, orf, mycobacteriosis, etc.), sometimes exotic (chromomycosis, histoplasmosis), and the site of plant penetration (protothecosis or more commonly thorns and splinters). The complexity of its vascularization and its many bones, joints, and tendons explain why it is a preferred area for signs of systemic diseases (diverse forms of lupus, dermatomyositis, inflammatory rheumatism, etc.). The nail unit alone shows innumerable signs of exogenic diseases, but also reflects certain internal diseases localized here with often characteristic signs. Here more than anywhere else, dermatology opens out to all of medicine. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Maternal B vitamin intake during pregnancy and wheeze and eczema in Japanese infants aged 16-24 months: the Osaka Maternal and Child Health Study.

PubMed

Miyake, Yoshihiro; Sasaki, Satoshi; Tanaka, Keiko; Hirota, Yoshio

2011-02-01

It is uncertain whether B group vitamins are risk or preventive factors for allergic disorders. We prospectively investigated the association between maternal intake of folate and vitamins B(12) , B(6) , and B(2) during pregnancy and the risk of wheeze and eczema in the infants aged 16-24 months. Subjects were 763 Japanese mother-child pairs. Data on maternal intake during pregnancy were assessed with a diet history questionnaire (DHQ). Symptoms of wheeze and eczema were based on criteria of the International Study of Asthma and Allergies in Childhood. Among 763 infants, 169 (22.1%) and 142 (18.6%) had symptoms of wheeze and eczema, respectively. There were no evident relationships between maternal consumption of folate, vitamin B(12) , vitamin B(6) , and vitamin B(2) during pregnancy and the risk of wheeze or eczema in the offspring after adjustment for maternal age, gestation at baseline, residential municipality at baseline, family income, maternal and paternal education, maternal and paternal history of asthma, atopic eczema, and allergic rhinitis, changes in maternal diet in the previous 1 month, season when data at baseline were collected, maternal smoking during pregnancy, baby's older siblings, baby's sex, baby's birth weight, household smoking in the same room as the infant, breastfeeding duration, age at which solid foods were introduced, age of infant at the third survey, and maternal intake of docosahexaenoic acid, n-6 polyunsaturated fatty acids, vitamin D, calcium, vitamin E, and β-carotene during pregnancy. Further investigation is warranted to draw conclusions as to the question of whether maternal B vitamin intake during pregnancy is related to the risk of childhood allergic disorders. © 2010 John Wiley & Sons A/S.

Fetal growth trajectory and risk for eczema in a Saudi population.

PubMed

AlMakoshi, Amel; Ellahi, Awaiss; Sallout, Bala; Devereux, Graham; Turner, Steve

2015-12-01

Recent studies in Western cohorts have identified associations between increasing fetal abdominal circumference (AC) during mid-pregnancy and increased risk for eczema and atopy. We sought to replicate these findings in a Saudi population where antenatal environmental exposures are different compared with Western countries. A Saudi birth cohort was recruited to relate maternal dietary intake and fetal growth to wheeze, eczema, and rhinitis in the first 2 yrs. Fetal size was determined from routine ultrasound scan measurements in the second and third trimesters and birthweight was noted. Parent-reported outcomes during the first 2 yrs were acquired by telephone-administered questionnaire. There were 1076 mothers recruited. AC was determined in 562 for the second, in 632 for the third, and in 281 for both second and third trimesters. A history of eczema was determined in 814 children at 2 yrs of age. There was an inverse relationship between change in abdominal circumference between the second and third trimesters for eczema (OR 0.66 per z score increase in AC [95% CI 0.49, 0.89]), and the quartile with the greatest faltering growth were at increased risk compared with other groups (p ≤ 0.045). Change in fetal size between the third trimester and birth was not associated with altered eczema risk. There were no associations between fetal growth and wheeze at the age of 2 yrs. Our findings contrast observations made in Western populations but nonetheless suggest that factors associated with changing fetal growth trajectory in the second half of pregnancy are also relevant to atopy development on the global setting. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Contact Eczema Caused by True Teak (Tectona Grandis)

PubMed Central

Krogh, H. K.

1962-01-01

An epidemiological study of occupational contact eczema in a furniture factory is presented. The localization, distribution, and clinical features of the skin lesions were characteristic of contact eczema caused by a sensitizing or irritating dust. True teak—Tectona grandis—was the cause of the skin condition. That teak is a fairly potent sensitizer and also contains primary irritants is fully confirmed by the present study. About half the employees who were heavily exposed to teak dust suffered from eczema and/or severe itching. Only 8% of those with slight exposure to teak dust experienced skin symptoms. Patch tests with native teak dust moistened with water were applied on 10 “controls” and 112 workers who were exposed to teak in various working procedures. Moistened teak dust produced toxic reactions in 20·5%, while native teak dust did not have primary irritant effects and was, therefore, considered to be the substance of choice for patch testing; 18·7% of the workers showed an allergic skin reaction to native teak dust. The diagnosis of allergic contact eczema was made in 12·5%, and 6·2% were considered to have latent allergy. Primary irritant (contact) eczema was considered to be present in four individuals who had experienced acute, transitory, eczematous eruptions during the hot part of the summer when they perspired freely. In these cases the patch test to native teak dust was negative. Desensitization or “hardening” was observed in four workers. In most cases the skin lesions were not severe enough to cause sickness absence. The cause of the relatively high percentage of sensitization to teak among the workers in the factory is discussed. The importance of suitable prophylactic measures is stressed. PMID:14459786

Enzyme replacement therapy in a patient with Fabry disease and the development of IgE antibodies against agalsidase beta but not agalsidase alpha.

PubMed

Tanaka, Akemi; Takeda, Taisuke; Hoshina, Takao; Fukai, Kazuyoshi; Yamano, Tsunekazu

2010-12-01

Fabry disease is an X-linked inherited lysosomal storage disorder caused by an inborn deficiency of the enzyme α-galactosidase A. Enzyme replacement therapy (ERT) with agalsidase alpha or beta isozymes is an effective treatment. Cross-reactivity of immunoglobulin G (IgG) antibodies with agalsidase alpha and beta has been reported, but no such reaction has been recorded for IgE antibodies. We present the case of a patient with Fabry disease who developed antiagalsidase beta IgE antibodies without cross-reactivity to agalsidase alpha. A 17-year-old boy with Fabry disease had suffered from severe atopic dermatitis since infancy, and he complained for several years of peripheral pain during the summer months and when exercising. Fabry disease was confirmed by family history and a positive enzyme test, and ERT was commenced. Following infusion of agalsidase beta (1.0 mg/kg), the patient complained of a high temperature in his hands and feet, and purulent eczema developed. The infusion dose was reduced to 0.2 mg/kg, but the hyperthermia did not change, although its duration decreased. After three infusions, eosinophilia developed (9.4%; 573 cells/μl blood) and remained unresolved after four infusions with agalsidase beta. Treatment with this enzyme was discontinued, and agalsidase alpha (0.2 mg/kg) started. This produced immediate resolution of the eosinophilia, which has been maintained during follow-up. In conclusion, this patient developed IgE antibodies against agalsidase beta, which demonstrated no cross-reactivity to agalsidase alpha. These findings emphasize the importance of analyzing IgE antibodies against both enzymes when patients exhibit severe infusion-related events.

Water exposure--challenging differences between occupations.

PubMed

Meding, Birgitta; Anveden Berglind, Ingegärd; Alderling, Magnus; Lindahl, Gunborg; Wrangsjö, Karin

2016-01-01

Few studies have compared water exposure between different occupations in the general population. To investigate and compare the extent of occupational water exposure, with a focus on service, healthcare and production occupations previously classified as involving a high risk for hand eczema. In two public health surveys (2006 and 2010), a validated question regarding occupational water exposure was answered by 18 342 and 15,736 gainfully employed individuals, respectively. Exposure for ≥ 0.5 h/day was reported by 17.5% and 16.3% (p = 0.020) for the respective years, and exposure for > 2 h/day by 7.8% and 7.7% (p = 0.73). Exposure in women was almost twice as high as in men for both years (p ≤ 0.001) and exposure levels (p < 0.001). Exposure for > 2 h/day was more common in high-risk occupations in service and healthcare than in non-high-risk occupations [prevalence proportion ratios of 16.7 (95%CI: 14.0-20.0) and 8.3 (95%CI: 6.9-9.9), respectively]. Exposure was highest in service occupations, where 44.6% reported exposure for > 2 h/day in 2010, and kitchen work, cleaning and hairdressing dominated. In healthcare, the corresponding figure was 22.0%. Challenging differences in water exposure between occupational groups were found, and extensive water exposure was reported in a number of occupations previously classified as involving a high risk for hand eczema. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Review of Medicinal Remedies on Hand Eczema Based on Iranian Traditional Medicine: A Narrative Review Article

PubMed Central

MANSOURI, Parvin; KHADEMI, Aleme; PAHLEVAN, Daryoush; MEMARIANI, Zahra; ALIASL, Jale; SHIRBEIGII, Laila

2016-01-01

Background: Hand Eczema (HE) is a dermatological disorder with frequent relapses and multiple causes such as atopic, allergic and irritant contact dermatitis. The management is complex because of the wide range of different pathogenesis. Efficacy of some of available treatments is not well established and it can affect patients’ quality of life significantly. Methods: Reports on HE such as diagnosis, pathophysiology, pharmacological and nonpharmacological therapy that described in medieval Iranian medicine, were gathered and analyzed from selected medical and pharmaceutical textbooks of Iranian Traditional Medicine (ITM). The search of databases such as PubMed, EMBASE/Excerpta Medica, Science direct, Scopus, Google scholar, Web of science, Sid, Iran medex, Irandoc, was performed to reconfirm the efficacy of ITM remedies in conventional medicine from 1980-Jan-1 to 2015-Dec-30. Results: According to their opinion, HE is highly associated with liver function. This disorder was categorized into two main types as wet and dry ones. Most Iranian textbook explained signs of HE, as excessive skin itching, redness, burning and dryness. Treatments recommended by Iranian scientists were lifestyle modification, dietary intervention and performing the rules of prevention as well as herbal therapy and special manipulations. Conclusion: Iranian practitioners believed that, six essential principles, diet therapy and medicinal plants have high impact on treatment of HE. These remedies based on Iranian scholar’s experiences might be useful for further studies to the management of HE. PMID:27928524

Occurrence and prognosis of hand eczema in the car industry: results from the PACO follow-up study (PACO II).

PubMed

Apfelbacher, Christian J; Radulescu, Magda; Diepgen, Thomas L; Funke, Ulrich

2008-06-01

Only a few epidemiological studies on hand eczema (HE) in the metalworking industry have been conducted, and no study has attempted a long-term follow-up. In the Prospective Audi Cohort (PACO) II follow-up study, we aimed to estimate burden and prognosis of HE in a car industry setting (follow-up > 10 years). Eligible participants were individuals who had been examined in the original PACO study (1990-1998) and had been followed through until the end of their apprenticeship (n = 1909). Participants were interviewed and underwent dermatological examination. An exposure assessment was carried out according to a pre-defined algorithm. The follow-up rate was 78.3% (1494/1909). Mean follow-up time was 13.3 [standard deviation 1.3] years. The period prevalence of HE in the follow-up period was 21.0% [95% confidence interval (CI) 19.0-23.1%], yielding a cumulative incidence of 29.3% (95% CI 26.9-31.6%) in the entire study period. HE persisted after the end of apprenticeship in 40.0% (95% CI 33.3-46.7%) of subjects who had had HE during apprenticeship (n = 205). 18.0% (95% CI 15.9-20.1%) developed HE in the follow-up period (n = 1289). Around 30% of subjects were affected by HE at least once during the study period. HE persisted in 40% of the participants affected during apprenticeship.

Dysbiosis and Staphylococcus aureus Colonization Drives Inflammation in Atopic Dermatitis.

PubMed

Kobayashi, Tetsuro; Glatz, Martin; Horiuchi, Keisuke; Kawasaki, Hiroshi; Akiyama, Haruhiko; Kaplan, Daniel H; Kong, Heidi H; Amagai, Masayuki; Nagao, Keisuke

2015-04-21

Staphylococcus aureus skin colonization is universal in atopic dermatitis and common in cancer patients treated with epidermal growth factor receptor inhibitors. However, the causal relationship of dysbiosis and eczema has yet to be clarified. Herein, we demonstrate that Adam17(fl/fl)Sox9-(Cre) mice, generated to model ADAM17-deficiency in human, developed eczematous dermatitis with naturally occurring dysbiosis, similar to that observed in atopic dermatitis. Corynebacterium mastitidis, S. aureus, and Corynebacterium bovis sequentially emerged during the onset of eczematous dermatitis, and antibiotics specific for these bacterial species almost completely reversed dysbiosis and eliminated skin inflammation. Whereas S. aureus prominently drove eczema formation, C. bovis induced robust T helper 2 cell responses. Langerhans cells were required for eliciting immune responses against S. aureus inoculation. These results characterize differential contributions of dysbiotic flora during eczema formation, and highlight the microbiota-host immunity axis as a possible target for future therapeutics in eczematous dermatitis. Copyright © 2015 Elsevier Inc. All rights reserved.

Eczema, Sleep, and Behavior in Children

PubMed Central

Camfferman, Danny; Kennedy, J. Declan; Gold, Michael; Martin, A. James; Winwood, Peter; Lushington, Kurt

2010-01-01

Introduction: There is a general consensus that sleep disruption in children causes daytime behavioral deficits. It is unclear if sleep disruption in children with eczema has similar effects particularly after controlling for known comorbid disorders such as asthma and rhinitis. Methods: Parents of children (6-16 y) with eczema (n = 77) and healthy controls (n = 30) completed a validated omnibus questionnaire which included the Sleep Disturbance Scale for Children, Conners Parent Rating Scale-Revised (S), Child Health Questionnaire, Children's Dermatology Life Quality Index, and additional items assessing eczema, asthma, rhinitis, and demographics. Results: Compared to controls, children with eczema had a greater number of sleep problems with a greater percentage in the clinical range, lower quality of life, and higher levels of ADHD and oppositional behavior. They also had elevated rhinitis and asthma severity scores. Importantly, structural equation modelling revealed that the effect of eczema on the behavioral variables of Hyperactivity, ADHD Index, and Oppositional Behaviors were mediated through sleep with no direct effect of eczema on these behaviors. The comorbid atopic disorders of rhinitis and asthma also had independent effects on behavior mediated through their effects on sleep. Conclusions: The present findings suggest that the daytime behaviors seen in children with eczema are mediated independently by the effects of eczema, asthma, and rhinitis on sleep quality. These findings highlight the importance of sleep in eczematous children and its role in regulating daytime behavior. Citation: Camfferman D; Kennedy JD; Gold M; Martin AJ; Winwood P; Lushington K. Eczema, sleep, and behavior in children. J Clin Sleep Med 2010;6(6):581-588. PMID:21206547

Efficacy and tolerability of pale sulfonated shale oil cream 4% in the treatment of mild to moderate atopic eczema in children: a multicentre, randomized vehicle-controlled trial.

PubMed

Korting, H C; Schöllmann, C; Cholcha, W; Wolff, L

2010-10-01

Reports on controlled trials on the efficacy and tolerability of sulfonated shale oils in atopic eczema are not available so far. The aim of this study was to investigate whether topically applied, specially prepared pale sulfonated shale oil (PSSO) cream is capable of improving symptoms/signs of mild to moderate atopic eczema in children more efficaciously than a corresponding vehicle cream. A total of 99 children suffering from mild to moderate atopic eczema were enrolled in this multicentre, randomized, vehicle-controlled study. Verum or vehicle cream was applied to the affected skin area three times a day over 4 weeks. As the primary outcome parameter served the reduction of the total score after 4 weeks of treatment, compared with the initial examination. Secondary outcome parameters were addressed as well. Tolerability was judged by investigators and patients/parents, and adverse events were documented. After 4 weeks of treatment, the total score declined from 13.4 ± 3.7 to 4.5 ± 7.4 score points in the verum group and from 13.0 ± 3.1 to 11.7 ± 8.6 score points in the vehicle group (P < 0.0001). The superiority of verum regarding total score was already apparent after a treatment period of 1 week (reduction by 5.6 ± 4.3 vs. 1.3 ± 5.9 score points; P < 0.0001). Tolerability was found superior at the end of the treatment in the verum when compared with the control group--both by investigators (P < 0.0001) and patients/parents (P = 0.0051). Pale sulfonated shale oil cream 4% is capable to treat mild to moderate atopic eczema in children more efficaciously than vehicle and is well tolerated. PSSO thus represents a valuable addition to our therapeutic armamentarium. PSSO should be considered in particular when valid alternatives for topical glucocorticoids are sought for. © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

Childhood eczema: disease of the advantaged?

PubMed Central

Williams, H. C.; Strachan, D. P.; Hay, R. J.

1994-01-01

OBJECTIVE--To determine whether the increased prevalence of childhood eczema in advantaged socioeconomic groups is due to increased parental reporting. DESIGN--Comparison of parental reports of eczema with visible eczema recorded by medical officers during a detailed physical examination. SETTING--National birth cohort study. SUBJECTS--8279 children from England, Wales, and Scotland born during 3-9 March 1958 and followed up at the ages of 7, 11, and 16. MAIN OUTCOME MEASURES--Prevalence of eczema according to parental report compared with medical officer's examination at the ages of 7, 11, and 16. RESULTS--Prevalence of both reported and examined eczema increased with rising social class at the ages of 7, 11, and 16 years. The point prevalence of examined eczema at age 7 was 4.8%, 3.6%, 3.6%, 2.4%, 2.2%, and 2.4% in social classes I, II, III non-manual, III manual, IV, and V respectively (chi 2 value for linear trend 12.6, P < 0.001). This trend persisted after adjustment for potential confounders such as region and family size and was not present for examined psoriasis or acne. CONCLUSIONS--Eczema is more prevalent among British schoolchildren in social classes I and II than those in lower classes. Exposures associated with social class are probably at least as important as genetic factors in the expression of childhood eczema. PMID:8173454

Vitamin D and the Development of Atopic Eczema

PubMed Central

Palmer, Debra J.

2015-01-01

A “vitamin D hypothesis” has been proposed to explain the increased prevalence of eczema in regions with higher latitude. This review focuses on the current available evidence with regard to the possible effect of vitamin D on the development of atopic eczema. Observational studies have indicated a link between vitamin D status and eczema outcomes, including lower serum vitamin D levels associated with increased incidence and severity of eczema symptoms. Vitamin D is known to have a regulatory influence on both the immune system and skin barrier function, both critical in the pathogenesis of eczema. However heterogeneous results have been found in studies to date investigating the effect of vitamin D status during pregnancy and infancy on the prevention of eczema outcomes. Well-designed, adequately powered, randomised controlled trials are needed. The study design of any new intervention trials should measure vitamin D levels at multiple time points during the intervention, ultraviolet (UV) radiation exposure via the use of individual UV dosimeters, and investigate the role of individual genetic polymorphisms. In conclusion, the current available evidence does not allow firm conclusions to be made on whether vitamin D status affects the development of atopic eczema. PMID:26239464

Atopic and Non-atopic Eczema.

PubMed

Rożalski, Michał; Rudnicka, Lidia; Samochocki, Zbigniew

2016-06-01

Atopic dermatitis is a common term used in the medical literature, but according to The Nomenclature Review Committee Of The World Allergy Organization the name which should be used is eczema. Eczema is divided into two subtypes: atopic and non-atopic. These subtypes differ in the level of total immunoglobulin E (IgE) in serum, response to allergens in skin prick tests, and detection of specific IgE antibodies. Non-atopic eczema is characterized by a low level of total IgE, negative skin prick tests, and undetectable specific IgE antibodies. It is estimated that 10-45% cases of eczema are non-atopic ones. In recent studies, other features differentiating these two subtypes have been identified, such as female predominance in non-atopic eczema. A more severe course, damage of the epidermal barrier, predominance of Th2 (T helper cells 2) response, and a lower positive reaction to metal patch tests are the characteristics of the atopic subtype. In our opinion, new diagnostic criteria taking into account the non-atopic subtype of eczema need to be established.

Cutaneous protothecosis - Case report*

PubMed Central

da Silva, Pâmela Craveiro Gomes; Silva, Sabrina Beirão da Costa e; Lima, Ricardo Barbosa; D'Acri, Antonio Macedo; Lupi, Omar; Martins, Carlos José

2013-01-01

Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation test. The finding of morula-like spherules is characteristic of Prototheca sp. Its rarity and non-specific clinical aspect may difficult the disease diagnosis. We report a case of a diabetic patient, in chronic use of systemic corticosteroids, that developed a skin lesion after trauma to the right leg. PMID:24346914

Cutaneous protothecosis--case report.

PubMed

Silva, Pâmela Craveiro Gomes da; Costa e Silva, Sabrina Beirão da; Lima, Ricardo Barbosa; D'Acri, Antonio Macedo; Lupi, Omar; Martins, Carlos José

2013-01-01

Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation test. The finding of morula-like spherules is characteristic of Prototheca sp. Its rarity and non-specific clinical aspect may difficult the disease diagnosis. We report a case of a diabetic patient, in chronic use of systemic corticosteroids, that developed a skin lesion after trauma to the right leg.

Effectiveness of occlusive bedding in the treatment of atopic dermatitis--a placebo-controlled trial of 12 months' duration.

PubMed

Holm, L; Bengtsson, A; van Hage-Hamsten, M; Ohman, S; Scheynius, A

2001-02-01

Several studies on avoidance of house-dust-mite (HDM) and cat allergens have been carried out, most of them in asthmatic patients and only a few in patients with atopic dermatitis (AD). No study so far has focused on which subgroup of AD patients benefits from avoidance measures. Forty adult patients with AD completed the 12-month avoidance study. They were divided into an active treatment (n = 22) and a placebo (n = 18) group. Active treatment comprised use of polyurethane-coated cotton encasings for bedding, and placebo use of cotton covers. Patients came for regular checkups during the 12-month period, when eczema severity was assessed and blood samples were analyzed for total IgE, HDM- and cat-specific IgE and soluble CD30 (sCD30) in serum. Dust samples were collected from mattresses before treatment and after 3, 6, and 12 months, and analyzed for content of HDM and cat allergen. Eczema severity decreased significantly in both groups (P < 0.001), with a more pronounced decrease in patients with active covers. The HDM exposure decreased significantly in the active treatment group (P < 0.001), and the levels of HDM-specific IgE were reduced (P<0.05). Exposure to cat allergens was unchanged in the active treatment group but decreased, albeit not significantly (P=0.19), in the placebo group. sCD30 levels were significantly reduced in both groups (P<0.001). Patients not sensitized to HDM allergens benefited from the bedcovers as much as sensitized patients. Occlusive bedding significantly reduced HDM exposure in bed (P<0.001) and eczema severity, and sCD30 levels decreased significantly (P<0.001). Patients not sensitized to HDM and not exposed to HDM allergens benefited equally from use of the bedcovers, a result which could be due to a reduction of other important allergens, superantigens, or irritants in bed. We therefore recommend the use of bedcovers as part of treatment for AD.

Effects of Three Anesthetic Regimens on Bioengineering Methods Conducted on Ventral Abdominal Skin of Weanling Swine

DTIC Science & Technology

2004-01-01

would be required to keep the animals relatively motionless in this position would likely exert undue emotional stress on the animals that could, in...34). The positive relationship of TEWL to skin temperature in psoriasis and eczema is different from that obtained in normal skin and can be...temperature in psoriasis and eczema . J Invest Dermatol 1975; 64(5):313-315. 36. Bircher AJ. Laser Doppler measurement of skin blood flux: variation and

[Pili trianguli et canaliculi. A case report of uncombable hair in relation to atopic eczema and tooth anomalies].

PubMed

Beringer, K; Botzi, C; Hemmer, W; Focke, M; Götz, M; Jarisch, R

2000-04-01

We report on a child with pili trianguli et canaliculi. This hair shaft abnormality belongs to a heterogeneous group of diseases which are included under the synonym uncombable hair. The diagnosis was confirmed by scanning electron microscopy, revealing hair shafts with a characteristic longitudinal groove. In addition the girl suffered from atopic eczema and tooth anomalies. Our findings suggest that this disorder could represent a tricho-odontal subtype of ectodermal dysplasia.

The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries.

PubMed

Dalgard, Florence J; Gieler, Uwe; Tomas-Aragones, Lucia; Lien, Lars; Poot, Francoise; Jemec, Gregor B E; Misery, Laurent; Szabo, Csanad; Linder, Dennis; Sampogna, Francesca; Evers, Andrea W M; Halvorsen, Jon Anders; Balieva, Flora; Szepietowski, Jacek; Romanov, Dmitry; Marron, Servando E; Altunay, Ilknur K; Finlay, Andrew Y; Salek, Sam S; Kupfer, Jörg

2015-04-01

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants--3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67-3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68-2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33-2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries

PubMed Central

Dalgard, Florence J; Gieler, Uwe; Tomas-Aragones, Lucia; Lien, Lars; Poot, Francoise; Jemec, Gregor B E; Misery, Laurent; Szabo, Csanad; Linder, Dennis; Sampogna, Francesca; Evers, Andrea W M; Halvorsen, Jon Anders; Balieva, Flora; Szepietowski, Jacek; Romanov, Dmitry; Marron, Servando E; Altunay, Ilknur K; Finlay, Andrew Y; Salek, Sam S; Kupfer, Jörg

2015-01-01

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants––3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67–3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68–2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33–2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications. PMID:25521458

Multicentre study of fragrance allergy in Hungary. Immediate and late type reactions.

PubMed

Temesvári, Erzsébet; Németh, Ilona; Baló-Banga, Mátyás J; Husz, Sándor; Kohánka, Valéria; Somos, Zsuzsa; Judák, Rita; Remenyik, E V A; Szegedi, Andrea; Nebenführer, László; Mészáros, Csilla; Horváth, Attila

2002-06-01

The authors followed the frequency of fragrance contact sensitization in Hungary in a multicentre study in the years 1998 and 1999. A total of 3,604 patients were tested with fragrance mix (FM), and positive reactions were observed in 294 (8.2%). In 160 FM hypersensitive patients, the study was continued with patch testing of the mix constituents (cinnamic alcohol, cinnamic aldehyde, eugenol, amyl cinnamic aldehyde, hydroxycitronellal, geraniol, isoeugenol, oak moss absolute). Of the patients tested, 70.6% produced positive reactions to the constituents. FM contact sensitization was mainly observed in female patients (74.4%). The incidence of contact urticaria in FM hypersensitive patients was 6.1%. Simultaneous patch test trials of other environmental contact allergens, in both early and late evaluations, mainly confirmed hypersensitivity reactions to balsams. Female dominance of hypersensitivity reactions observed during testing the individual components of the mix was striking (82.4%). In positive skin reactions, cinnamic alcohol, isoeugenol and oak moss provoked skin symptoms most frequently. We also tested the 104 patients who produced negative reactions to FM with the constituent individual allergens, with 11.9% positive incidence. The clinical symptoms of the patients were above all manifest in the form of contact eczema, located on the hands, face, eyelids and axillae. With this study, the authors, members of the Hungarian Contact Dermatitis Research Group, call attention to one of the most frequent allergens in the environment.

House dust mite reduction and avoidance measures for treating eczema.

PubMed

Nankervis, Helen; Pynn, Emma V; Boyle, Robert J; Rushton, Lesley; Williams, Hywel C; Hewson, Deanne M; Platts-Mills, Thomas

2015-01-19

Eczema is an inflammatory skin disease that tends to involve skin creases, such as the folds of the elbows or knees; it is an intensely itchy skin condition, which can relapse and remit over time. As many as a third of people with eczema who have a positive test for allergy to house dust mite have reported worsening of eczema or respiratory symptoms when exposed to dust. To assess the effects of all house dust mite reduction and avoidance measures for the treatment of eczema. We searched the following databases up to 14 August 2014: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 8), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), and the GREAT database. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant studies. We handsearched abstracts from international eczema and allergy meetings. Randomised controlled trials (RCTs) of any of the house dust mite reduction and avoidance measures for the treatment of eczema, which included participants of any age diagnosed by a clinician with eczema as defined by the World Allergy Organization. We included all non-pharmacological and pharmacological interventions that sought to reduce or avoid exposure to house dust mite and their allergenic faeces. The comparators were any active treatment, no treatment, placebo, or standard care only. Two authors independently checked the titles and abstracts identified, and there were no disagreements. We contacted authors of included studies for additional information. We assessed the risk of bias using Cochrane methodology. We included seven studies of 324 adults and children with eczema. Overall, the included studies had a high risk of bias. Four of the seven trials tested interventions with multiple components, and three tested a single intervention. Two of the seven trials included only children, four included children and adults, and one included only adults. Interventions to reduce or avoid exposure to house dust mite included covers for mattresses and bedding, increased or high-quality vacuuming of carpets and mattresses, and sprays that kill house dust mites.Four studies assessed our first primary outcome of 'Clinician-assessed eczema severity using a named scale'. Of these, one study (n = 20) did not show any significant short-term benefit from allergen impermeable polyurethane mattress encasings and acaricide spray versus allergen permeable cotton mattress encasings and placebo acaricide spray. One study (n = 60) found a modest statistically significant benefit in the Six Area, Six Sign Atopic Dermatitis (SASSAD) scale over six months (mean difference of 4.2 (95% confidence interval 1.7 to 6.7), P = 0.008) in favour of a mite impermeable bedding system combined with benzyltannate spray and high-filtration vacuuming versus mite permeable cotton encasings, water with a trace of alcohol spray, and a low-filtration vacuum cleaner. The third study (n = 41) did not compare the change in severity of eczema between the two treatment groups. The fourth study (n = 86) reported no evidence of a difference between the treatment groups.With regard to the secondary outcomes 'Participant- or caregiver-assessed global eczema severity score' and the 'Amount and frequency of topical treatment required', one study (n = 20) assessed these outcomes with similar results being reported for these outcomes in both groups. Four studies (n = 159) assessed 'Sensitivity to house dust mite allergen using a marker'; there was no clear evidence of a difference in sensitivity levels reported between treatments in any of the four trials.None of the seven included studies assessed our second primary outcome 'Participant- or caregiver-assessed eczema-related quality of life using a named instrument' or the secondary outcome of 'Adverse effects'.We were unable to combine any of our results because of variability in the interventions and paucity of data. We were unable to determine clear implications to inform clinical practice from the very low-quality evidence currently available. The modest treatment responses reported were in people with atopic eczema, specifically with sensitivity to one or more aeroallergens. Thus, their use in the eczema population as a whole is unknown. High-quality long-term trials of single, easy-to-administer house dust mite reduction or avoidance measures are worth pursuing.

Eczema and cardiovascular risk factors in 2 US adult population studies.

PubMed

Silverberg, Jonathan I; Greenland, Philip

2015-03-01

Eczema is associated with high rates of sleep disturbance and quality-of-life impairment. These factors might have a negative impact on psychosocial development and behavior and could increase cardiovascular risk. We sought to determine whether adults with eczema have increased cardiovascular risk factors. We analyzed data for 27,157 and 34,525 adults aged 18 to 85 years from the 2010 and 2012 National Health Interview Survey. Adults with eczema had higher odds of ever smoking 100 cigarettes in their lifetime (survey logistic regression; adjusted odds ratio [aOR], 1.32; 95% CI, 1.18-1.47) and current smoking history (aOR, 1.28; 95% CI, 1.12-1.45), with significantly younger age of onset (survey linear regression; adjusted β, -0.58; 95% CI, -0.95 to -0.21). Eczema was also associated with greater odds of ever drinking 12 or more alcoholic beverages annually (aOR, 1.16; 95% CI, 1.03-1.31), including current intake of moderate (aOR, 1.33; 95% CI, 1.09-1.62) and heavier (aOR, 1.58; 95% CI, 1.23-2.03) amounts. Adults with a history of eczema had lower odds of daily vigorous activity (aOR, 0.79; 95% CI, 0.63-0.99) and lower frequency of vigorous activity in the past week (adjusted β, -0.46; 95% CI, -0.72 to -0.21) than did adults without a history of eczema. Those with eczema had a higher body mass index than did those without eczema (adjusted β, 0.86; 95% CI, 0.37-1.36), particularly a body mass index of 35 or more (aOR, 1.54; 95% CI, 1.16-2.05), and higher odds of hypertension (aOR, 1.48; 95% CI, 1.18-1.85), hypertension on 2 visits (aOR, 1.56; 1.22-1.99), and lifetime prediabetes (aOR, 1.71; 95% CI, 1.19-2.45). Finally, there were significant interactions between eczema and sleep disturbances such that eczema associated with fatigue, daytime sleepiness, or insomnia was associated with even higher odds of obesity, hypertension, hypertension on 2 visits, prediabetes, diabetes, and high cholesterol than eczema alone. We found that eczema in adults is a marker for cardiovascular risk, emphasizing the importance of behavioral modification and perhaps more aggressive interventions to better manage eczema. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Treatment of infants with atopic eczema with pimecrolimus cream 1% improves parents' quality of life: a multicenter, randomized trial.

PubMed

Staab, Doris; Kaufmann, Roland; Bräutigam, Matthias; Wahn, Ulrich

2005-09-01

Atopic eczema begins primarily in infancy or early childhood, and sleep loss due to night-time pruritus can have a considerable impact on patients' and parents' quality of life (QoL). In this study, infants (n = 196) with mild to severe atopic eczema were randomized 2:1, double-blind, to receive either pimecrolimus cream 1% (Elidel, Novartis Pharma, Nürnberg, Germany) or the corresponding vehicle bid for 4 wk, followed by a 12 wk, open-label phase and a 4 wk, treatment-free, follow-up period. The parents' QoL was measured at baseline and at the end of the double-blind phase, using the questionnaire 'QoL in Parents of Children with Atopic Dermatitis' (PQoL-AD), thus data presented here refer to the initial 4-wk treatment phase only. After 4 wk of double-blind treatment, an increase in the mean percentage change from baseline in eczema area and severity index of 71.5% was observed with pimecrolimus, compared with 19.4% with vehicle. The increase in efficacy was paralleled by the following mean percentage changes from baseline in the five domains of the questionnaire in pimecrolimus and vehicle, respectively: psychosomatic well-being: 14.6% vs. 6.2%; effects on social life: 6.7% vs. 2.3%; confidence in medical treatment: 10.0% vs. 3.7%; emotional coping: 16.1% vs. 6.5%; acceptance of disease: 19.6% vs. 7.0%. Analysis (ancova) of the dependent variable difference from baseline and the covariate baseline value revealed values of p < 0.05 for all five domains, despite the very short duration of the study. It is concluded that improvements in atopic eczema in infants achieved by treatment with pimecrolimus have a significant beneficial effect on the QoL of parents.

Dermatology on instagram.

PubMed

Karimkhani, Chante; Connett, Jessica; Boyers, Lindsay; Quest, Tyler; Dellavalle, Robert P

2014-07-15

The novel photo-sharing social networking platform, Instagram, has an impressive following of 75 million daily users, with a predominantly younger and female demographic. This study investigated the presence of dermatology-related content on Instagram. The most popular professional dermatological organizations, dermatology journals, and dermatology related patient advocate groups on Facebook and Twitter, determined from a prior study, were searched for established profiles on Instagram. In addition, dermatology-related terms (i.e. dermatology, dermatologist, alopecia, eczema, melanoma, psoriasis, and skin cancer) and dermatology-related hashtags (i.e. #dermatology, #dermatologist, #melanoma, #acne, #psoriasis, and #alopecia) were searched. None of the top ten dermatological journals or professional dermatological organizations were found on Instagram. Although only one of the top ten patient advocate groups related to dermatology conditions, Melanoma Research Foundation, had an Instagram presence, there were many private offices, cosmetic products, and some patient advocacy groups. This novel social networking platform could grant dermatology journals and other professional organizations a unique opportunity to reach younger demographic populations, particularly women, with the potential for true educational and life-changing impact.

Pre- and Postnatal Smoking Exposure and Risk of Atopic Eczema in Young Japanese Children: A Prospective Prebirth Cohort Study.

PubMed

Tanaka, Keiko; Miyake, Yoshihiro; Furukawa, Shinya; Arakawa, Masashi

2017-07-01

Epidemiological evidence regarding the effect of perinatal smoking exposure on atopic eczema in children continues to be inconclusive. The aim of this prospective prebirth cohort study was to investigate the association between prenatal smoking exposure and postnatal living with household smokers and the risk of atopic eczema in Japanese children aged 23 to 29 months. Study subjects were 1354 Japanese mother-child pairs. Information on the variables under study was obtained through questionnaires which were completed by mothers, first prior to delivery, then shortly after birth and subsequently around 4, 12, and 24 months after delivery. Eczema in the last 12 months was defined according to the criteria of the International Study of Asthma and Allergies in Childhood. Physician-diagnosed atopic eczema was considered present if reported by mothers. Compared with no perinatal smoking exposure, prenatal smoking exposure only was associated with an increased risk of physician-diagnosed atopic eczema (adjusted odds ratio = 7.11, 95% confidence interval: 1.43 to 27.8). Postnatal living with at least one household smoker only was not associated with the risk of physician-diagnosed atopic eczema; neither was the combination of both prenatal smoking exposure and postnatal living with at least one household smoker. No association was observed between perinatal smoking exposure status and the risk of eczema as defined according to the International Study of Asthma and Allergies in Childhood criteria. Our findings suggest that maternal smoking during pregnancy may increase the risk of atopic eczema in young children. In the present prebirth cohort study, we assessed the independent and additive effects of pre- and postnatal exposure to tobacco smoking on atopic eczema in children. Compared with no perinatal smoking exposure, prenatal smoking exposure only was significantly associated with an increased risk of atopic eczema. Postnatal smoking exposure only was not associated with the risk of atopic eczema; neither was the combination of both pre- and postnatal smoking exposure. This is the first epidemiological study to show a positive association between prenatal smoking exposure only and the risk of atopic eczema. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Parents' and carers' views about emollients for childhood eczema: qualitative interview study

PubMed Central

Muller, I; Yardley, L; Lewis-Jones, S; Ersser, S; Little, P

2016-01-01

Objective Leave-on emollients form the mainstay of eczema treatment, but adherence is poor. We aimed to explore parents’/carers' views on effectiveness and acceptability of leave-on emollients for childhood eczema through secondary analysis of data from 2 qualitative data sets. Setting Study 1 recruited through mail-out from 6 general practices in southern England. Study 2 recruited from a feasibility trial of an intervention to support eczema self-care in 31 practices in the same area. Participants Study 1 included 28 interviews with carers of children aged ≤5 years with eczema. Study 2 included 26 interviews with carers of children aged ≤5 years with eczema. Methods Interviews followed semistructured guides: study 1 explored carers' understandings around eczema treatments in order to develop a web-based self-care support intervention; study 2 explored carers' understandings of eczema and eczema treatments after using the intervention. Interviews were carried out face to face or by telephone, audio-recorded and transcribed. Secondary analysis of data from both studies focused on views and experiences of emollient use. Data were analysed using an inductive thematic approach facilitated by NVivo V.10 software. Results In study 1, most participants felt emollients improved eczema but held mixed views about long-term use to prevent flare-ups. In study 2, where carers had used the web-based intervention, all participants held positive views about long-term emollient use. In both studies, participants expressed a range of preferences about emollient ‘thickness’; some felt that ‘thick’ emollients (ointments) were most effective, while others found these difficult to use. Carers described a process of ‘trial and error’, trying emollients suggested by professionals, friends and family, or bought over-the-counter. Carers expressed a need for understanding differences between products and their effective use. Conclusions Providing a rationale for long-term emollient use and choice of emollients could help improve adherence and help families gain more rapid control of eczema. PMID:27543590

Expression of the filaggrin gene in umbilical cord blood predicts eczema risk in infancy: A birth cohort study.

PubMed

Ziyab, A H; Ewart, S; Lockett, G A; Zhang, H; Arshad, H; Holloway, J W; Karmaus, W

2017-09-01

Filaggrin gene (FLG) expression, particularly in the skin, has been linked to the development of the skin barrier and is associated with eczema risk. However, knowledge as to whether FLG expression in umbilical cord blood (UCB) is associated with eczema development and prediction is lacking. This study sought to assess whether FLG expression in UCB associates with and predicts the development of eczema in infancy. Infants enrolled in a birth cohort study (n=94) were assessed for eczema at ages 3, 6, and 12 months. Five probes measuring FLG transcripts expression in UCB were available from genomewide gene expression profiling. FLG genetic variants R501X, 2282del4, and S3247X were genotyped. Associations were assessed using Poisson regression with robust variance estimation. Area under the curve (AUC), describing the discriminatory/predictive performance of fitted models, was estimated from logistic regression. Increased level of FLG expression measured by probe A_24_P51322 was associated with reduced risk of eczema during the first year of life (RR=0.60, 95% CI: 0.38-0.95). In contrast, increased level of FLG antisense transcripts measured by probe A_21_P0014075 was associated with increased risk of eczema (RR=2.02, 95% CI: 1.10-3.72). In prediction models including FLG expression, FLG genetic variants, and sex, discrimination between children who will and will not develop eczema at 3 months of age was high (AUC: 0.91, 95% CI: 0.84-0.98). This study demonstrated, for the first time, that FLG expression in UCB is associated with eczema development in infancy. Moreover, our analysis provided prediction models that were capable of discriminating, to a great extent, between those who will and will not develop eczema in infancy. Therefore, early identification of infants at increased risk of developing eczema is possible and such high-risk newborns may benefit from early stratification and intervention. © 2017 John Wiley & Sons Ltd.

Varicella infection is not associated with increasing prevalence of eczema: a U.S. population-based study.

PubMed

Li, J C; Silverberg, J I

2015-11-01

Chickenpox infection early in childhood has previously been shown to protect against the development of childhood eczema in line with the hygiene hypothesis. In 1995, the American Academy of Pediatrics recommended routine vaccination against varicella zoster virus in the United States. Subsequently, rates of chickenpox infection have dramatically decreased in childhood. We sought to understand the impact of declining rates of chickenpox infection on the prevalence of eczema. We analysed data from 207 007 children in the 1997-2013 National Health Interview Survey. One-year prevalence of eczema and 'ever had' history of chickenpox were analysed. Associations between chickenpox infection and eczema were tested using survey-weighted logistic regression. The impact of chickenpox on trends of eczema prevalence was tested using survey logistic regression and generalized linear models. Children with a history of chickenpox compared with those without chickenpox had a lower prevalence [survey-weighted logistic regression (95% confidence interval, CI)] of eczema [8·8% (8·5-9·0%) vs. 10·6% (10·4-10·8%)]. In pooled multivariate models controlling for age, sex, race/ethnicity, household income, highest level of household education, insurance coverage, U.S. birthplace and family size, eczema was inversely associated with chickenpox [adjusted odds ratio (95% CI), 0·90 (0·86-0·94), P < 0·001]. The prevalence of eczema significantly increased over time (Tukey post-hoc test, P < 0·001 for comparisons of survey years 2001-13 vs. 1997-2000, 2008-13 vs. 2001-04 and 2008-13 vs. 2005-07). In multivariate generalized linear models, the odds of eczema was not associated with chickenpox in 2001-13 (P ≥ 0·06). These findings suggest that lower rates of chickenpox infection secondary to widespread vaccination against varicella zoster virus are not contributing to higher rates of childhood eczema in the U.S. © 2015 British Association of Dermatologists.

Maternal hookworm modifies risk factors for childhood eczema: results from a birth cohort in Uganda

PubMed Central

Mpairwe, Harriet; Ndibazza, Juliet; Webb, Emily L; Nampijja, Margaret; Muhangi, Lawrence; Apule, Barbara; Lule, Swaib; Akurut, Hellen; Kizito, Dennison; Kakande, Mohammed; Jones, Frances M; Fitzsimmons, Colin M; Muwanga, Moses; Rodrigues, Laura C; Dunne, David W; Elliott, Alison M

2014-01-01

Background Worms may protect against allergy. Early-life worm exposure may be critical, but this has not been fully investigated. Objectives To investigate whether worms in pregnancy and in early childhood are associated with childhood eczema incidence. Methods The Entebbe Mother and Baby Study, an anthelminthic treatment trial, enrolled pregnant women between 2003 and 2005 in Uganda. Mothers were investigated for worms during pregnancy and children annually. Eczema was doctor-diagnosed from birth to age five years. A planned observational analysis was conducted within the trial cohort to investigate associations between worms and eczema. Results Data for 2345 live-born children were analysed. Hookworm was the most prevalent maternal worm (45%). Childhood worms were less prevalent. Eczema incidence was 4.68/100 person-years. Maternal hookworm was associated with reduced eczema incidence [adjusted hazard ratio (95% confidence interval), p-value: 0.71(0.51–0.99), 0.04] and modified effects of known risk factors for eczema: Dermatophagoides-specific IgE in children was positively associated with eczema incidence if the mother had no hookworm [2.72(1.11–6.63), 0.03], but not if the mother had hookworm [0.41(0.10–1.69), 0.22], interaction p-value = 0.03. Similar interactions were seen for maternal history of eczema {[2.87(1.31–6.27, 0.008) vs. [0.73(0.23–2.30), 0.60], interaction p-value = 0.05}, female gender {[1.82(1.22–2.73), 0.004 vs. [0.96(0.60–1.53), 0.87], interaction p-value = 0.04} and allergen-specific IgE. ChildhoodTrichuris trichiura and hookworm were inversely associated with eczema. Conclusions Maternal hookworm modifies effects of known risk factors for eczema. Mechanisms by which early-life worm exposures influence allergy need investigation. Worms or worm products, and intervention during pregnancy have potential for primary prevention of allergy. PMID:25171741

Association between breastfeeding and eczema during childhood and adolescence: A cohort study.

PubMed

Wang, Jingying; Ramette, Alban; Jurca, Maja; Goutaki, Myrofora; Beardsmore, Caroline S; Kuehni, Claudia E

2017-01-01

Breastfeeding is said to protect children from eczema (atopic dermatitis), but the available evidence is conflicting and subject to the influences of parental atopy and reverse causation (when mothers extended duration of breastfeeding because their children had eczema). In the prospective, population-based Leicester Respiratory Cohort study, we assessed duration of breastfeeding in children aged 1-4 years. Prevalence of eczema was determined by questionnaire surveys that were repeated until the children were 17 years old. We investigated the association between having been breastfed and current eczema using generalized estimating equations, adjusting for potential confounders, and tested for effect modification by parental atopy. We also assessed the association between having been breastfed and incident eczema at ages 2, 4, and 6 years using multivariable logistic regression. Among the 5,676 children in the study, 2,284 (40%) had never been breastfed, while 1,610 (28%), 705 (12%), and 1,077 (19%) had been breastfed for 0-3, 4-6, and >6 months, respectively. Prevalence of current eczema decreased from 36% in 1-year-olds to 18% in children aged 10-17 years. Breastfeeding was not associated with current eczema. Compared with children who had never been breastfed, the adjusted odds ratios for current eczema at any age were 1.02 (95% confidence interval 0.90-1.15) for children who had been breastfed for 0-3 months, 0.97 (0.82-1.13) for children breastfed for 4-6 months, and 0.98 (0.85-1.14) for children breastfed for >6 months. There was no strong evidence for an effect modification by parental atopy (p-value for interaction term was 0.061) and no association between having been breastfed and incident eczema later in childhood. This population-based cohort study found no evidence for protection of breastfeeding against childhood eczema at any age, from infancy through adolescence.

Association between breastfeeding and eczema during childhood and adolescence: A cohort study

PubMed Central

Ramette, Alban; Jurca, Maja; Goutaki, Myrofora; Beardsmore, Caroline S.; Kuehni, Claudia E.

2017-01-01

Background Breastfeeding is said to protect children from eczema (atopic dermatitis), but the available evidence is conflicting and subject to the influences of parental atopy and reverse causation (when mothers extended duration of breastfeeding because their children had eczema). Methods In the prospective, population-based Leicester Respiratory Cohort study, we assessed duration of breastfeeding in children aged 1–4 years. Prevalence of eczema was determined by questionnaire surveys that were repeated until the children were 17 years old. We investigated the association between having been breastfed and current eczema using generalized estimating equations, adjusting for potential confounders, and tested for effect modification by parental atopy. We also assessed the association between having been breastfed and incident eczema at ages 2, 4, and 6 years using multivariable logistic regression. Results Among the 5,676 children in the study, 2,284 (40%) had never been breastfed, while 1,610 (28%), 705 (12%), and 1,077 (19%) had been breastfed for 0–3, 4–6, and >6 months, respectively. Prevalence of current eczema decreased from 36% in 1-year-olds to 18% in children aged 10–17 years. Breastfeeding was not associated with current eczema. Compared with children who had never been breastfed, the adjusted odds ratios for current eczema at any age were 1.02 (95% confidence interval 0.90–1.15) for children who had been breastfed for 0–3 months, 0.97 (0.82–1.13) for children breastfed for 4–6 months, and 0.98 (0.85–1.14) for children breastfed for >6 months. There was no strong evidence for an effect modification by parental atopy (p-value for interaction term was 0.061) and no association between having been breastfed and incident eczema later in childhood. Conclusions This population-based cohort study found no evidence for protection of breastfeeding against childhood eczema at any age, from infancy through adolescence. PMID:28945812

A multicentre randomised controlled trial and economic evaluation of ion-exchange water softeners for the treatment of eczema in children: the Softened Water Eczema Trial (SWET).

PubMed

Thomas, K S; Koller, K; Dean, T; O'Leary, C J; Sach, T H; Frost, A; Pallett, I; Crook, A M; Meredith, S; Nunn, A J; Burrows, N; Pollock, I; Graham-Brown, R; O'Toole, E; Potter, D; Williams, H C

2011-02-01

To determine whether installation of an ion-exchange water softener in the home could improve atopic eczema in children and, if so, to establish its likely cost and cost-effectiveness. An observer-blind, parallel-group randomised controlled trial of 12 weeks duration followed by a 4-week observational period. Eczema was assessed by research nurses blinded to intervention at baseline, 4 weeks, 12 weeks and 16 weeks. The primary outcome was analysed as intent-to-treat, using the randomised allocation rather than actual treatment received. A secondary per-protocol analysis excluded participants who failed to receive their allocated treatment and who were deemed to be protocol violators. Secondary and primary care referral centres in England (UK) serving a variety of ethnic and social groups and including children living in both urban and periurban homes. Three hundred and thirty-six children (aged 6 months to 16 years) with moderate/severe atopic eczema, living in homes in England supplied by hard water (≥ 200 mg/l calcium carbonate). Participants were randomised to either installation of an ion-exchange water softener plus usual eczema care (group A) for 12 weeks or usual eczema care alone (group B) for 12 weeks. This was followed by a 4-week observational period, during which water softeners were switched off/removed from group A homes and installed in group B homes. Standard procedure was to soften all water in the home, but to provide mains (hard) water at a faucet-style tap in the kitchen for drinking and cooking. Participants were therefore exposed to softened water for bathing and washing of clothes, but continued to drink mains (hard) water. Usual care was defined as any treatment that the child was currently using in order to control his or her eczema. New treatment regimens used during the trial period were documented. Primary outcome was the difference between group A and group B in mean change in disease severity at 12 weeks compared with baseline, as measured using the Six Area, Six Sign Atopic Dermatitis (SASSAD) score. This is an objective severity scale completed by blinded observers (research nurses) unaware of the allocated intervention. Secondary outcomes included use of topical medications, night-time movement, patient-reported eczema severity and a number of quality of life measures. A planned subgroup analysis was conducted, based on participants with at least one mutation in the gene encoding filaggrin (a protein in the skin thought to be important for normal skin barrier function). Target recruitment was achieved (n = 336). The analysed population included 323 children who had complete data. The mean change in primary outcome (SASSAD) at 12 weeks was -5.0 [standard deviation (SD) 8.8] for the water softener group (group A) and -5.7 (SD 9.8) for the usual care group (group B) [mean difference 0.66, 95% confidence interval (CI) -1.37 to 2.69, p = 0.53]. The per-protocol analysis supported the main analysis, and there was no evidence that the treatment effect varied between children with and without mutations in the filaggrin gene. No between-group differences were found in the three secondary outcomes that were assessed blindly (use of topical medications; night-time movement; proportion showing reasonable, good or excellent improvement). Small, but statistically significant, differences in favour of the water softener were found in three of the secondary outcomes that were assessed by participants [Patient-Oriented Eczema Measure (POEM); well-controlled weeks (WCWs); Dermatitis Family Index (DFI)]. The results of the economic evaluation, and the uncertainty surrounding them, suggest that ion-exchange water softeners are unlikely to be a cost-effective intervention for children with atopic eczema from an NHS perspective. Water softeners provided no additional benefit to usual care in this study population. Small, but statistically significant, differences were found in some secondary outcomes as reported by parents, but it is likely that such improvements were the result of response bias. Whether or not the wider benefits of installing a water softener in the home are sufficient to justify the purchase of a softener is something for individual householders to consider on a case-by-case basis. This trial demonstrated overwhelming demand for non-pharmacological interventions for the treatment of eczema, and this is something that should be considered when prioritising future research in the field. Current Controlled Trials ISRCTN71423189. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 15, No. 8. See the HTA programme website for further project information. Results of this trial are also published at www.plosmedicine.org.

Children and adolescents living with atopic eczema: an interpretive phenomenological study with Chinese mothers.

PubMed

Cheung, Winnie K H; Lee, Regina L T

2012-10-01

This article is a report on a phenomenological study of Chinese mothers' experiences of caring for their children who were living with atopic eczema. A mother's attitude and personality may have a direct influence on her child's adherence to treatment for atopic eczema. Thus, good communication between healthcare professionals and the mother is essential. Treatment and care should also be culturally appropriate. Using an interpretive phenomenological method, 14 interviews were conducted in Hong Kong, China from September 2007 to August 2008, with nine mothers caring for their children who were living with atopic eczema. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis. Mothers' coping patterns involved persistently dealing with enduring demands and seeking alternative therapies that were aimed at curing the disease. Four themes finally emerged from the data: (1) dealing with extra mothering, (2) giving up their life, (3) becoming an expert and (4) living with blame and worry. Mothers' coping patterns involved persistently finding ways to relieve their children's suffering with the aim of curing the disease and dealing with their own emotions related to the frustration resulting from giving up their life and living with blame and worry. The study findings provide nurses with an empathic insight into mothers' feelings and the enduring demands of caring for children with atopic eczema, and help nurses to develop culturally sensitive interventions, reinforce positive coping strategies, increase family function and improve health outcomes. © 2011 Blackwell Publishing Ltd.

Prevalence, severity and risk factors of asthma, rhinitis and eczema in a large group of Chinese schoolchildren.

PubMed

Song, Ning; Shamssain, Mohammed; Mohammed, Shamssain; Zhang, Jin; Wu, Jianling; Fu, Chunling; Hao, Shuting; Guan, Jitao; Yan, Xixin

2014-04-01

There is a lack of information on the prevalence, severity and risk factors of asthma, rhinitis and eczema in Chinese children. To establish baseline data for a major longitudinal study of factors affecting asthma, rhinitis and eczema in a large group of children from the industrialized city of Shijiazhuang, China. We used the International Study of Asthma and Allergies in Childhood questionnaire and studied 10 338 children, ages 6-18, from Shijiazhuang. The prevalence of childhood asthma, rhinitis and eczema is 1.2%, 13.5% and 11.8%, respectively. Boys had higher prevalence of these conditions than girls and younger children had higher prevalence of asthma and eczema but lower prevalence of rhinitis than older children. Breastfed children had lower prevalence of asthma and rhinitis, but not eczema, than non-breastfed children. Overweight children had higher prevalence of asthma and rhinitis than those who were not overweight. Children exposed to paternal smoking had higher prevalence of rhinitis and eczema than those not exposed; children exposed to pets had higher prevalence of asthma and rhinitis than those not exposed. The prevalence of asthma in this study group is low, but the prevalence of rhinitis is high, and could be considered a major public health problem. The prevalence of asthma, rhinitis and eczema is generally higher in boys and younger children generally have higher prevalence of asthma and eczema but lower prevalence of rhinitis. Exposure to pets is a risk factor for rhinitis, being overweight is a risk factor for asthma and rhinitis, and exposure to parental smoking is a risk factor for asthma, rhinitis and eczema in these children.

Atopic and nonatopic eczema in adolescence: is there a difference?

PubMed

Johansson, E K; Ballardini, N; Bergström, A; Kull, I; Wahlgren, C-F

2015-10-01

There is limited information on clinical manifestations of atopic eczema (AE) and non-AE in teenagers. To describe the characteristics of adolescent eczema in the general population and to identify potential differences between AE and non-AE in teenagers. Overall, 3108 teenagers were included from the population-based BAMSE cohort and 2529 of these teenagers provided blood samples for analysis of specific IgE. At age 16 years, the teenagers answered questionnaires regarding the symptoms of eczema, asthma and rhinitis for the previous year. The prevalence of eczema in adolescence was 9·6% (n = 297). More girls than boys had eczema (12·5% vs. 6·5%; P < 0·001). The age at onset was usually within the first 2 years of life (48·8%), but onset in adolescence was also common (25·6%). Eczema was mild in 72·7% of cases, moderate in 16·8% and severe in 10·4%. Body folds were most frequently affected (73·4%). More than half of the teenagers with eczema had AE (59%). The teenagers with AE had more severe and more chronic eczema. Onset in infancy was most common in AE and onset in adolescence was most common in non-AE. There were no major differences in location or seasonal variance between AE and non-AE in adolescence. AE is more common than non-AE among teenagers. More than one in four teenagers with eczema has moderate-to-severe disease. Onset in adolescence is common, especially for non-AE. AE in adolescence has an earlier onset and is more chronic and more severe than non-AE. © 2015 British Association of Dermatologists.

Treatment policy for psoriasis and eczema: a survey among dermatologists in the Netherlands and Belgian Flanders.

PubMed

Roelofzen, Judith H J; Aben, Katja K H; Khawar, Ali J M; Van de Kerkhof, Peter C M; Kiemeney, Lambertus A L M; Van Der Valk, Pieter G M

2007-01-01

Today, many therapies are available for the treatment of psoriasis and eczema. One of the oldest topical therapies is coal tar. Coal tar has been used for decades, but over the past years, the use of coal tar has decreased for several reasons, including the supposed carcinogenicity of coal tar. We investigated the current and past treatment policies for psoriasis and eczema with special emphasis on the use of tar products; a postal survey was conducted among all dermatologists in two European countries: the Netherlands (n = 360) and the Flemish speaking part of Belgium (Flanders) (n = 328). This study was conducted as part of the ongoing LATER-study ("Late effects of coal tar treatment in eczema and psoriasis; the Radboud study"). All practising dermatologists received a questionnaire. Dermatologists were asked to describe their treatment policies in mild/moderate psoriasis, severe psoriasis, mild/moderate eczema and severe eczema. The response rate to the questionnaire was 62.5% for the Dutch dermatologists and 45.7% for the Flemish dermatologists. Almost all dermatologists prescribe topical corticosteroids. In eczema, most of the dermatologists prescribe the recently introduced calcineurin inhibitors (95%). Coal tar is a second choice topical therapy. Dutch dermatologists mainly use tar in the treatment of eczema (72% vs. 48% in Flanders), whereas in Flanders, tar is mainly prescribed in psoriasis (60% vs. 41% in Holland). Flemish dermatologists very frequently prescribe PUVA in psoriasis (93% vs. 63%). Topical treatment, especially topical corticosteroids, is the mainstay in psoriasis and eczema. Coal tar still is an important (second choice) therapy for the topical treatment of psoriasis and eczema, but its use varies from country to country. Despite the carcinogenicity of PUVA, this photochemotherapy is frequently prescribed by dermatologists, mainly in Flanders.

Racial and ethnic differences in health care utilization for childhood eczema: An analysis of the 2001-2013 Medical Expenditure Panel Surveys.

PubMed

Fischer, Alexander H; Shin, Daniel B; Margolis, David J; Takeshita, Junko

2017-12-01

Eczema is a common chronic inflammatory disease of the skin. Studies suggest differences in disease prevalence and severity by race/ethnicity. Our knowledge of health care utilization for eczema among different racial/ethnic groups remains limited. To evaluate health care utilization for childhood eczema among different racial/ethnic groups in the United States. We performed a cohort study of non-Hispanic white (reference), non-Hispanic black, and Hispanic white individuals under the age of 18 years with caregiver-reported eczema (N = 2043) pooled from the 2-year longitudinal cohorts of the 2001-2013 Medical Expenditure Panel Surveys. Health care utilization outcomes were evaluated over the 2-year follow-up period by race/ethnicity using multivariable regression. Among all children with eczema, non-Hispanic blacks were less likely than whites to report an ambulatory visit for eczema (adjusted odds ratio [OR adj ] 0.69; 95% confidence interval [CI] 0.51-0.92). Among those with ≥1 ambulatory visit for eczema, non-Hispanic blacks reported more visits (adjusted incidence rate ratio [IRR adj ] 1.68; 95% CI 1.10-2.55) and prescriptions (IRR adj 1.22; 95% CI 1.01-1.46) than whites and were more likely than whites to report a dermatology visit (OR adj 1.82; 95% CI 1.06-3.14) for eczema. We used caregiver- or self-reported data. Our findings suggest disparities in health care utilization for eczema among non-Hispanic black children despite utilization patterns suggestive of more severe disease. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Persistent Food Allergy and Food Allergy Coexistent with Eczema Is Associated with Reduced Growth in the First 4 Years of Life.

PubMed

Beck, Cara; Koplin, Jennifer; Dharmage, Shyamali; Wake, Melissa; Gurrin, Lyle; McWilliam, Vicki; Tang, Mimi; Sun, Cong; Foskey, Rebecca; Allen, Katrina J

2016-01-01

Food allergy has been associated with lower weight and height in cross-sectional studies in children; however, this has not been investigated in longitudinal studies to explore growth over time, and previous studies have not accounted for coexisting eczema. The objective of this study was to examine the association of IgE-mediated food allergy and eczema with anthropometric measures at 1 and 4 years of age. In the HealthNuts population-based cohort, infants recruited at age 1 year underwent a skin prick test to egg, peanut, and sesame; those sensitized had oral food challenges. Food challenges repeated at 4 years determined food allergy persistence or resolution. Eczema was defined as parent report of eczema diagnosis. Parent-reported weight and height and child health record data were used to calculate age- and sex-adjusted percentiles from World Health Organization charts. Multivariable linear regression models were fitted to examine the effect of food allergy and eczema on weight and height controlling for potential confounders. Children with both food allergy and eczema at age 1 had lower percentiles for mean weight (51.3 vs 58.3 percentile, P = .001) and height (48.4 vs 53.4, P = .028) at age 1 compared with those with neither condition. There was no difference for children with only food allergy or eczema at age 1. By age 4, children with persistent food allergy and persistent eczema, but not those with resolved food allergy, were still shorter and lighter. Children with both food allergy and eczema were shorter and lighter throughout early childhood, with more pronounced differences in those with persistent food allergy. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Factors accounting for the association between anxiety and depression, and eczema: the Hordaland health study (HUSK)

PubMed Central

2010-01-01

Background The association between anxiety and depression, and eczema is well known in the literature, but factors underlying this association remain unclear. Low levels of omega-3 fatty acids and female gender have been found to be associated with both depression and eczema. Somatization and health anxiety are known to be associated with anxiety and depression, further, somatization symptoms and health anxiety have also been found in several dermatological conditions. Accordingly, omega-3 fatty acid supplement, female gender, somatization and health anxiety are possible contributing factors in the association between anxiety and depression, and eczema. The aim of the study is to examine the relevance of proposed contributing factors for the association between anxiety and depression, and eczema, including, omega-3 fatty acid supplement, female gender, health anxiety and somatization. Methods Anxiety and depression was measured in the general population (n = 15715) employing the Hospital Anxiety and Depression Scale (HADS). Information on eczema, female gender, omega-3 fatty acid supplement, health anxiety and somatization was obtained by self-report. Results Somatization and health anxiety accounted for more than half of the association between anxiety/depression, and eczema, while the other factors examined were of minor relevance for the association of interest. Conclusions We found no support for female gender and omega-3 fatty acid supplement as contributing factors in the association between anxiety/depression, and eczema. Somatization and health anxiety accounted for about half of the association between anxiety/depression, and eczema, somatization contributed most. The association between anxiety/depression, and eczema was insignificant after adjustment for somatization and health anxiety. Biological mechanisms underlying the mediating effect of somatization are yet to be revealed. PMID:20412596

Eczema exacerbation and food atopy beyond infancy: how should we advise Chinese parents about dietary history, eczema severity, and skin prick testing?

PubMed

Hon, Kam-Lun Ellis; Leung, Ting-Fan; Lam, Man-Ching Adrian; Wong, Kin-Yee; Chow, Chung-Mo; Ko, Wai-San Fanny; Fok, Tai-Fai; Leung, Alexander K C

2007-01-01

Issues related to empirical dietary restriction are important, but they have been inadequately studied among children with atopic dermatitis (AD). To evaluate whether any association exists between food atopy, food avoidance, and AD severity, investigators in the present study reviewed all skin prick tests (SPTs) performed between January 2005 and April 2006 at a pediatric dermatology clinic and correlated findings with history of food avoidance and eczema severity. Only 13% of 114 children with AD had a positive SPT for beef. The most commonly sensitized foods were egg yolk (53%), egg white (42%), shrimp (35%), peanuts (31%), and crab (29%). Disease severity was not associated with prevalence of sensitization to these foods. The investigators concluded that immediate immunoglobulin E reaction to beef, as suggested by positive SPT findings, is unlikely to occur in most children with AD. SPT information may be useful in reassuring parents about the unlikelihood of a severe and immediate reaction to beef. As for other foods, it is sensible to advise parents about specific avoidance strategies only in more severely affected children with a definite history of eczema exacerbation by specific food allergens.

Allergic Skin Conditions

MedlinePlus

... most common types are atopic dermatitis (often called eczema) and contact dermatitis. Atopic Dermatitis (Eczema) Eczema is a chronic ... contact with your skin, they may cause a rash called contact dermatitis. There are two kinds of contact dermatitis: ...

Differential effects of two probiotics on the risks of eczema and atopy associated with single nucleotide polymorphisms to Toll-like receptors.

PubMed

Marlow, Gareth; Han, Dug Yeo; Wickens, Kristin; Stanley, Thorsten; Crane, Julian; Mitchell, Edwin A; Dekker, James; Barthow, Christine; Fitzharris, Penny; Ferguson, Lynnette R; Morgan, Angharad R

2015-05-01

There is strong evidence to support a genetic predisposition to eczema and more recently studies have suggested that probiotics might be used to prevent eczema by modifying the expression of putative allergy-associated genes. The aim of this present study was to investigate whether two probiotics, Lactobacillus rhamnosus HN001 (HN001) and Bifidobacterium animalis subsp. lactis HN019 (HN019), can modify the known genetic predisposition to eczema conferred by genetic variation in the Toll-like receptor (TLR) genes in a high-risk infant population. We selected 54 SNPs in the Toll-like receptor genes. These SNPs were analysed in 331 children of sole European ancestry as part of a double-blind, randomized, placebo-controlled trial examining the effects of HN001 and HN019 supplementation on eczema development and atopic sensitization. The data showed that 26 TLR SNPs interacted with HN001 resulting in a significantly reduced risk of eczema, 18 for eczema severity as defined by SCORAD ≥ 10 and 20 for atopic sensitization compared to placebo. There were only two SNPs that interacted with HN019 resulting in a reduced risk of eczema, eczema severity or atopy. This is the first study to show that the negative impact of specific TLR genotypes may be positively affected by probiotic supplementation. HN001 exhibits a much stronger effect than HN019 in this respect. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Quality of life in patients with allergic contact dermatitis.

PubMed

Kadyk, Deana L; McCarter, Kevin; Achen, Fritz; Belsito, Donald V

2003-12-01

Allergic contact dermatitis (ACD), a common dermatological disorder, often results in ongoing disease and disability. However, relatively little has been published quantifying the quality of life (QoL) of patients with ACD. This study was conducted to investigate the impact of ACD on QoL and explore prognostic factors that influence outcomes. A total of 428 subjects with ACD were, at varying times after diagnosis, mailed a QoL questionnaire modified from Skindex-16 to include an additional 5 items pertaining to occupational impact. The QoL scores were correlated with subject demographics, disease characteristics, and management techniques to ascertain factors that impact QoL in subjects with ACD. The response rate was 35%, with 149 subjects returning the postal survey. Responders reported being bothered most by itching, skin irritation, and persistence of the condition. Of the four scales included in the QoL questionnaire, the emotions scale had the worst composite QoL score, followed by symptoms, functioning, and occupational impact. Patients with ACD of the face were significantly more bothered by the appearance of their skin. Hand involvement and occupationally related ACD were associated with worse QoL scores within the occupational impact and functioning scales. Subjects that had changed jobs because of ACD had more severe QoL impairment than any other group analyzed, with significantly worse scores on 17 of the 21 QoL items. A history of atopic eczema seemed to impart improved outcomes on patients with ACD, and these subjects were less worried about being fired from their jobs. Subjects diagnosed by patch testing more than 36 months after disease onset seemed to have worse QoL scores than those diagnosed earlier in the natural history of the disease. Patients diagnosed by patch testing within the last 6 months had the worst QoL scores, while the best outcomes were reported in subjects patch tested 6 to 12 months ago. A slight decline in QoL was observed 12 months after patch testing, but scores did not diminish back to the level seen immediately after diagnosis. ACD has an appreciable effect on QoL, especially when it affects the hands, the face, or is occupationally related. Of the four scales included in our study, the emotions scale suffered the greatest effect. Emotional impact is therefore an important measure of QoL in ACD patients. Outcomes in patients with ACD were improved by early diagnosis and subjects enjoyed their best QoL at 6 to 12 months after patch testing. However, individuals who elected to change jobs because of their skin condition reported significantly worse QoL than those who retained their current positions.

Overview of Reviews The prevention of eczema in infants and children: an overview of Cochrane and non-Cochrane reviews

PubMed Central

Foisy, Michelle; Boyle, Robert J.; Chalmers, Joanne R.; Simpson, Eric L.; Williams, Hywel C.

2012-01-01

Background Eczema is the most common inflammatory skin disease of childhood, characterized by an itchy red rash that usually involves the face and skin folds. There is currently no curative treatment for eczema, so the reduction of eczema incidence through disease prevention is a desirable goal. Potential interventions for preventing eczema include exclusive breastfeeding, hydrolysed protein formulas and soy formulas when bottle feeding, maternal antigen avoidance, omega oil supplementation, prebiotics and probiotics. Objectives This overview of reviews aims to present the current body of data from Cochrane and non-Cochrane reviews to provide the most up-to-date evidence on the efficacy and safety of interventions to prevent eczema in infants and children at different risk levels for developing allergic disease. Methods Our pool of Cochrane and non-Cochrane reviews came from the 2010 United Kingdom National Health Service (NHS) Evidence Skin Disorders Annual Evidence Updates Mapping Exercise on Atopic Eczema. This group used a comprehensive search strategy last conducted in August 2010 to identify all systematic reviews on eczema prevention. We identified all reviews that met our pre-specified inclusion criteria, and data were extracted, analysed, compiled into tables and synthesized using quantitative and qualitative methods. Main results Seven systematic reviews containing 39 relevant trials with 11 897 participants were included in this overview. Overall, there was no clear evidence that any of the main interventions reviewed reduced eczema incidence. In subgroup analyses of infants at high risk of allergic disease, an observational study found that exclusive breastfeeding for at least six months compared with introduction of solids at three to six months decreased the incidence of eczema by 60% (risk ratio (RR): 0.40; 95% confidence interval (CI): 0.21, 0.78), and a randomized controlled trial found that prebiotics compared with no prebiotics decreased incidence by 58% (RR: 0.42; 95% CI: 0.21, 0.84). However, each of these findings was based on the results of a single small trial, and no intervention reduced eczema incidence beyond the first two years of life. Although we pre-specified incidence of atopic eczema (i.e. eczema associated with immunoglobulin E (IgE) sensitization) as a primary outcome, data on whether participants diagnosed with eczema were truly atopic were largely lacking from systematic reviews. Similarly, data on atopy, measured using skin prick tests or specific IgE tests to allergens, were not reported in many reviews. No interventions were found to decrease atopy when reported. Adverse events data were generally lacking, but data from a trial of probiotics versus no probiotics showed significantly more spitting up in the first one (RR: 1.88; 95% CI: 1.03, 3.45) and two (RR: 1.69; 95% CI: 1.02, 2.80) months of life, but no overall increase in risk of gastrointestinal symptoms in the first year. Authors’ conclusions Although there is currently no clear evidence showing that any of the interventions examined in this overview prevent eczema in participants not selected for risk of allergic disease, there is some evidence that exclusive breastfeeding for at least six months and prebiotics might reduce eczema incidence in high-risk participants. However, these conclusions are based on limited evidence with methodological shortcomings. Future research on prevention of eczema is needed and should examine different types of hydrolysed formulas, prebiotics and probiotics, as well as enhancement of the skin barrier and other novel approaches in infants at different risk levels for developing allergic disease. PMID:22822349

Prevalence and Severity of Asthma, Rhinitis, and Atopic Eczema in 13- to 14-Year-Old Schoolchildren from Southern Brazil

PubMed Central

2006-01-01

The objective of this study was to investigate the prevalence and severity of asthma, rhinitis, and atopic eczema in schoolchildren from southern Brazil. A cross-sectional study was carried out with the International Study of Asthma and Allergies in Childhood phase III written questionnaire. The questionnaire was self-applied by 2,948 randomly selected schoolchildren aged 13 to 14 years. The lifetime prevalence rates of symptoms were as follows: wheezing, 40.8%; rhinitis, 40.7%; eczema, 13.6%; self-reported asthma, 14.6%; rhinitis, 31.4%; eczema, 13.4%. Rhinitis was reported by 55% of adolescents with current asthma (60% females vs 46.9% males). Girls 13 to 14 years of age had higher prevalence rates of asthma, rhinitis, and eczema than boys had. Atopic eczema was reported by 42.7% of girls and 31.4% of boys with asthma. The prevalence rates were statistically significant for symptoms of asthma, rhinitis, and atopic eczema in females. However, there were no statistically significant differences between the sexes in regard to reported asthma and bronchospasm induced by exercise. PMID:20529214

Cupping in dermatology: a critical review and update.

PubMed

Soliman, Yssra; Hamed, Nouran; Khachemoune, Amor

2018-06-01

Cupping is an ancient procedure that has been practiced for thousands of years. It has been used to treat a variety of medical conditions, including dermatological ones. Cupping has been described in the literature for the treatment of conditions such as acne and eczema. The procedure is fundamentally divided into dry cupping and wet cupping; however, there have been many modern adaptations. Adverse events related to the procedure have been reported in the literature and should be considered by patients. However, cupping has a promising role in helping manage dermatological conditions.

Allergies associated with body piercing and tattoos: a report of the Allergy Vigilance Network.

PubMed

Dron, P; Lafourcade, M P; Leprince, F; Nonotte-Varly, C; Van Der Brempt, X; Banoun, L; Sullerot, I; This-Vaissette, C; Parisot, L; Moneret-Vautrin, D A

2007-06-01

Body piercing and tattooing are increasingly common. As well as the risk of infection and scarring, allergic reactions are also reported. This is the first multi-centre study to assess the frequency of consultations for allergy. Of the 138 allergologists who answered our two questionnaires, 7.9% reported allergic reactions associated with body piercing and 18.9% identified allergies associated with temporary henna-based tattoos. Contact eczema, rhinitis and urticaria were related to nickel allergy. Contact eczema, generalized eczema, pruritus and edema were caused by tattoos. In 20 out of 28 cases, sensitization to para-phenylenediamine (PPD) was observed. The authors review the literature, underscoring the risk of serious allergy to PPD, the need for long-term monitoring of the risk of skin lymphocytoma, the difficulties met during treatment and the necessity of regulating tattooing and body piercing practices.

Recurrent wheezing is associated with intestinal protozoan infections in Warao Amerindian children in Venezuela: a cross-sectional survey.

PubMed

Overeem, Marcella M A; Verhagen, Lilly M; Hermans, Peter W M; del Nogal, Berenice; Sánchez, Adriana Márquez; Acevedo, Natacha Martinez; Murga, Rosalicia Ramirez; Roelfsema, Jeroen; Pinelli, Elena; de Waard, Jacobus H

2014-05-29

While in developed countries the prevalence of allergic diseases is rising, inflammatory diseases are relatively uncommon in rural developing areas. High prevalence rates of helminth and protozoan infections are commonly found in children living in rural settings and several studies suggest an inverse association between helminth infections and allergies. No studies investigating the relationship between parasitic infections and atopic diseases in rural children of developing countries under the age of 2 years have been published so far. We performed a cross-sectional survey to investigate the association of helminth and protozoan infections and malnutrition with recurrent wheezing and atopic eczema in Warao Amerindian children in Venezuela. From August to November 2012, 229 children aged 0 to 2 years residing in the Orinoco Delta in Venezuela were enrolled. Data were collected through standardized questionnaires and physical examination, including inspection of the skin and anthropometric measurements. A stool sample was requested from all participants and detection of different parasites was performed using microscopy and real time polymerase chain reaction (PCR). We observed high prevalence rates of atopic eczema and recurrent wheezing, respectively 19% and 23%. The prevalence of helminth infections was 26% and the prevalence of protozoan infections was 59%. Atopic eczema and recurrent wheezing were more frequently observed in stunted compared with non-stunted children in multivariable analysis (OR 4.3, 95% CI 1.3 - 13.6, p = 0.015 and OR 4.5, 95% CI 0.97 - 21.2, p = 0.055). Furthermore, recurrent wheezing was significantly more often observed in children with protozoan infections than in children without protozoan infections (OR 6.7, 95% CI 1.5 - 30.5). High prevalence rates of atopic eczema and recurrent wheezing in Warao Amerindian children under 2 years of age were related to stunting and intestinal protozoan infections respectively. Helminth infections were not significantly associated with either atopic eczema or recurrent wheezing.

Recurrent wheezing is associated with intestinal protozoan infections in Warao Amerindian children in Venezuela: a cross-sectional survey

PubMed Central

2014-01-01

Background While in developed countries the prevalence of allergic diseases is rising, inflammatory diseases are relatively uncommon in rural developing areas. High prevalence rates of helminth and protozoan infections are commonly found in children living in rural settings and several studies suggest an inverse association between helminth infections and allergies. No studies investigating the relationship between parasitic infections and atopic diseases in rural children of developing countries under the age of 2 years have been published so far. We performed a cross-sectional survey to investigate the association of helminth and protozoan infections and malnutrition with recurrent wheezing and atopic eczema in Warao Amerindian children in Venezuela. Methods From August to November 2012, 229 children aged 0 to 2 years residing in the Orinoco Delta in Venezuela were enrolled. Data were collected through standardized questionnaires and physical examination, including inspection of the skin and anthropometric measurements. A stool sample was requested from all participants and detection of different parasites was performed using microscopy and real time polymerase chain reaction (PCR). Results We observed high prevalence rates of atopic eczema and recurrent wheezing, respectively 19% and 23%. The prevalence of helminth infections was 26% and the prevalence of protozoan infections was 59%. Atopic eczema and recurrent wheezing were more frequently observed in stunted compared with non-stunted children in multivariable analysis (OR 4.3, 95% CI 1.3 – 13.6, p = 0.015 and OR 4.5, 95% CI 0.97 – 21.2, p = 0.055). Furthermore, recurrent wheezing was significantly more often observed in children with protozoan infections than in children without protozoan infections (OR 6.7, 95% CI 1.5 – 30.5). Conclusions High prevalence rates of atopic eczema and recurrent wheezing in Warao Amerindian children under 2 years of age were related to stunting and intestinal protozoan infections respectively. Helminth infections were not significantly associated with either atopic eczema or recurrent wheezing. PMID:24885094

Management of Psoriasis with a XemaTop Topical Compounded Formula: A Case Report.

PubMed

Jones, Nat; Carvalho, Maria; Branvold-Herr, Andrea

2017-01-01

Skin conditions such as psoriasis and eczema negatively impact the patient's quality of life; the primary goal of topical treatments is to minimize the disease-specific symptoms. This case report discusses the management of two refractory psoriasis skin lesions in an adult male using a topical compounded formula. The psoriasis symptoms were assessed quantitatively using two validated research instruments, the Psoriasis Symptom Inventory, and an adapted Numeric Rating Scale. A qualitative assessment was also performed by evaluating the digital photographs taken by the patient during the course of treatment. The compounded formula containing zinc pyrithione, clobetasol propionate, and cyanocobalamin in the Professional Compounding Centers of America's proprietary base PCCA XemaTop, applied topically for three weeks, significantly reduced the patient's self-reported psoriasis symptoms and improved his overall condition by 81.2%. This successful case report is important evidence for healthcare professionals when considering new, innovative topical compounded formulas for managing skin conditions such as psoriasis and eczema. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

Expert panel on practice patterns in the management of cow's milk protein allergy and associated economic burden of disease on health service in Turkey.

PubMed

Sekerel, Bulent Enis; Seyhun, Oznur

2017-09-01

To evaluate practice patterns in the management of cow's milk protein allergy (CMPA) and associated economic burden of disease on health service in Turkey. This study was based on experts' views on the practice patterns in management of CMPA manifesting with either proctocolitis or eczema symptoms and, thereby, aimed to estimate economic burden of CMPA. Practice patterns were determined via patient flow charts developed by experts using the modified Delphi method for CMPA presented with proctocolitis and eczema. Per patient total 2-year direct medical costs were calculated, including cost items of physician visits, laboratory tests, and treatment. According to the consensus opinion of experts, 2-year total direct medical cost from a payer perspective and societal perspective was calculated to be $US2,116.05 and $US2,435.84, respectively, in an infant with CMPA presenting with proctocolitis symptoms, and $US4,001.65 and $US4,828.90, respectively, in an infant with CMPA presenting with eczema symptoms. Clinical nutrition was the primary cost driver that accounted for 89-92% of 2-year total direct medical costs, while the highest total direct medical cost estimated from a payer perspective and societal perspective was noted for the management of an exclusively formula-fed infant presenting either with proctocolitis ($US3,743.85 and $US4,025.63, respectively) or eczema ($US6,854.10 and $US7,917.30, respectively). The first line use of amino acid based formula (AAF) was associated with total direct cost increment $US1,848.08 and $US3,444.52 in the case of proctocolitis and eczema, respectively. Certain limitations to this study should be considered. First, being focused only on direct costs, the lack of data on indirect costs or intangible costs of illness seems to be a major limitation of the present study, which likely results in a downward bias in the estimates of the economic cost of CMPA. Second, given the limited number of studies concerning epidemiology and practice patterns in CMPA in Turkey, use of expert clinical opinion of the panel members rather than real-life data on practice patterns that were used to identify direct medical costs might raise a concern with the validity and reliability of the data. Also, while this was a three-step study with six experts included in the first stage (developing local guidelines for diagnosis, treatment, and follow-up of infants with CMPA in Turkey) and 410 pediatricians included in the second stage (a cross-sectional questionnaire-survey to determine pediatricians' awareness and practice of CMPA in infants and children), only four members were included in the present Delphi panel, which allows a limited discussion. Third, lack of sensitivity analyses and exclusion of indirect costs and costs related to alterations in quality of life, behavior of infants, and general well-being of infants and their parents from the cost-analysis seems to be another limitation that may have caused under-estimation of relative cost-effectiveness of the formulae. Fourth, calculation of costs per local guidelines rather than real-life practice patterns is another limitation that, otherwise, would extend the knowledge achieved in the current study. Notwithstanding these limitations, the present expert panel provided practice patterns in the management of CMPA and an estimate of the associated costs, depending on the symptom profile at initial admission for the first time in Turkey. In conclusion, in providing the first health economic data on CMPA in Turkey, the findings revealed that CMPA imposes a substantial burden on the Turkish healthcare system from both a payer perspective and societal perspective, and indicated clinical nutrition as a primary cost driver. Management of infants presenting with eczema, exclusively formula-fed infants, and first line use of AAF were associated with higher estimates for 2-year direct medical costs.

Associations of childhood eczema severity: A US population based study

PubMed Central

Silverberg, Jonathan I.; Simpson, Eric L.

2014-01-01

Little is known about predictors of eczema severity in the US population. We sought to determine the distribution and associations of childhood eczema severity in the US. We analyzed data from the 2007 National Survey of Children's Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children (0-17yr). The prevalence of childhood eczema was 12.97% (95% confidence interval [95% CI]=12.42–13.53); 67.0% (95% CI: 64.8–69.2) had mild, 26.0% (95% CI: 23.9–28.1) moderate and 7.0% (95% CI: 5.8–8.3) severe disease. There was significant statewide-variation of the distribution of eczema severity (Rao-Scott chi square, P=0.004), with highest rates of severe disease in Northeastern and Midwestern states. In univariate models, eczema severity was increased with older age, African-American and Hispanic race/ethnicity, lower household income, oldest child in the family, home with a single mother, lower paternal/maternal education level, maternal general health, maternal/paternal emotional health, dilapidated housing and garbage on the streets. In multivariate survey logistic regression models using stepwise and backward selection, moderate–severe eczema was associated with older age, lower household income and fair or poor maternal health, but inversely associated with birthplace outside the US. These data indicate that environmental and/or lifestyle factors play an important role in eczema severity. PMID:24819283

Complementary and alternative medicines and childhood eczema: a US population-based study.

PubMed

Silverberg, Jonathan I; Lee-Wong, Mary; Silverberg, Nanette B

2014-01-01

The prevalence of complementary and alternative medicine (CAM) use in US children with eczema is unknown. Furthermore, it is unknown whether CAM use in the United States is associated with higher eczema prevalence. We sought to determine the eczema prevalence in association with CAM usage. We analyzed data from the 2007 National Health Interview Survey that included a nationally representative sample of 9417 children ages 0 to 17 years. Overall, 46.9% (95% confidence interval, 45.6%-48.2%) of children in the United States used 1 or more CAM, of which 0.99% (0.28%-1.71%) used CAM specifically to treat their eczema, including herbal therapy (0.46%), vitamins (0.33%), Ayurveda (0.28%), naturopathy (0.24%), homeopathy (0.20%), and traditional healing (0.12%). Several CAMs used for other purposes were associated with increased eczema prevalence, including herbal therapy (survey logistic regression; adjusted odds ratio [95% confidence interval], 2.07 [1.40-3.06]), vitamins (1.45 [1.21-1.74]), homeopathic therapy (2.94 [1.43-6.00]), movement techniques (3.66 [1.62-8.30]), and diet (2.24 [1.10-4.58]), particularly vegan diet (2.53 [1.17-5.51]). In conclusion, multiple CAMs are commonly used for the treatment of eczema in US children. However, some CAMs may actually be harmful to the skin and be associated with higher eczema prevalence in the United States.

Associations of gestational and early life exposures to ambient air pollution with childhood atopic eczema in Shanghai, China.

PubMed

Liu, Wei; Cai, Jiao; Huang, Chen; Hu, Yu; Fu, Qingyan; Zou, Zhijun; Sun, Chanjuan; Shen, Li; Wang, Xueying; Pan, Jun; Huang, Yanmin; Chang, Jing; Zhao, Zhuohui; Sun, Yuexia; Sundell, Jan

2016-12-01

Whether ambient air pollution is associated with childhood atopic eczema is controversial. In this paper, we selected 3358 preschool children who had not altered residences since pregnancy from a cross-sectional study during 2011-2012 in Shanghai, China, and obtained parent-reported data regarding childhood atopic eczema using an improved ISAAC questionnaire. We recorded daily concentrations of SO 2 , NO 2 , and PM 10 throughout the child's lifetime (2006-2012), and calculated period-averaged concentrations for each district where the child lived to represent the child's exposure levels of these pollutants during different periods. In the multiple logistic regression analyses adjusted for potential confounders as well as for the other pollutants in the same periods, childhood atopic eczema was significantly associated with increments of NO 2 in the approximate interquartile range (20μg/m 3 ) during gestational period (adjusted OR, 95% CI for eczema lifetime-ever: 1.80, 1.29-2.49; for eczema in the year prior to the survey: 2.32, 1.57-3.43) and during the first year of life (2.00, 1.40-2.84; 2.16, 1.43-3.28). Exposure to elevated NO 2 in the first two years, three years and total lifetime, as well as exposure to mixtures containing NO 2 in each of these periods, were consistently associated with increased likelihood of childhood eczema. The highest odds ratios were found between exposure to a mixture of SO 2 and NO 2 during total lifetime (increment: 35μg/m 3 ) and childhood eczema (adjusted OR, 95% CI: 2.80, 1.75-4.48; 3.50, 1.98-6.19). No significant associations were found between childhood eczema and ambient SO 2 and PM 10 individually or in mixtures. This study indicates that gestational and lifetime exposures to ambient NO 2 are risk factors for atopic eczema in childhood. Exposure to ambient SO 2 and PM 10 may enhance the effect of NO 2 exposure on childhood eczema. Copyright © 2016 Elsevier B.V. All rights reserved.

Parents' and carers' views about emollients for childhood eczema: qualitative interview study.

PubMed

Santer, M; Muller, I; Yardley, L; Lewis-Jones, S; Ersser, S; Little, P

2016-08-19

Leave-on emollients form the mainstay of eczema treatment, but adherence is poor. We aimed to explore parents'/carers' views on effectiveness and acceptability of leave-on emollients for childhood eczema through secondary analysis of data from 2 qualitative data sets. Study 1 recruited through mail-out from 6 general practices in southern England. Study 2 recruited from a feasibility trial of an intervention to support eczema self-care in 31 practices in the same area. Study 1 included 28 interviews with carers of children aged ≤5 years with eczema. Study 2 included 26 interviews with carers of children aged ≤5 years with eczema. Interviews followed semistructured guides: study 1 explored carers' understandings around eczema treatments in order to develop a web-based self-care support intervention; study 2 explored carers' understandings of eczema and eczema treatments after using the intervention. Interviews were carried out face to face or by telephone, audio-recorded and transcribed. Secondary analysis of data from both studies focused on views and experiences of emollient use. Data were analysed using an inductive thematic approach facilitated by NVivo V.10 software. In study 1, most participants felt emollients improved eczema but held mixed views about long-term use to prevent flare-ups. In study 2, where carers had used the web-based intervention, all participants held positive views about long-term emollient use. In both studies, participants expressed a range of preferences about emollient 'thickness'; some felt that 'thick' emollients (ointments) were most effective, while others found these difficult to use. Carers described a process of 'trial and error', trying emollients suggested by professionals, friends and family, or bought over-the-counter. Carers expressed a need for understanding differences between products and their effective use. Providing a rationale for long-term emollient use and choice of emollients could help improve adherence and help families gain more rapid control of eczema. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effect of n-3 long chain polyunsaturated fatty acid supplementation in pregnancy on infants’ allergies in first year of life: randomised controlled trial

PubMed Central

Palmer, D J; Sullivan, T; Gold, M S; Prescott, S L; Heddle, R; Gibson, R A

2012-01-01

Objective To determine whether dietary n-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation of pregnant women with a fetus at high risk of allergic disease reduces immunoglobulin E associated eczema or food allergy at 1 year of age. Design Follow-up of infants at high hereditary risk of allergic disease in the Docosahexaenoic Acid to Optimise Mother Infant Outcome (DOMInO) randomised controlled trial. Setting Adelaide, South Australia. Participants 706 infants at high hereditary risk of developing allergic disease whose mothers were participating in the DOMInO trial. Interventions The intervention group (n=368) was randomly allocated to receive fish oil capsules (providing 900 mg of n-3 LCPUFA daily) from 21 weeks’ gestation until birth; the control group (n=338) received matched vegetable oil capsules without n-3 LCPUFA. Main outcome measure Immunoglobulin E associated allergic disease (eczema or food allergy with sensitisation) at 1 year of age. Results No differences were seen in the overall percentage of infants with immunoglobulin E associated allergic disease between the n-3 LCPUFA and control groups (32/368 (9%) v 43/338 (13%); unadjusted relative risk 0.68, 95% confidence interval 0.43 to 1.05, P=0.08; adjusted relative risk 0.70, 0.45 to 1.09, P=0.12), although the percentage of infants diagnosed as having atopic eczema (that is, eczema with associated sensitisation) was lower in the n-3 LCPUFA group (26/368 (7%) v 39/338 (12%); unadjusted relative risk 0.61, 0.38 to 0.98, P=0.04; adjusted relative risk 0.64, 0.40 to 1.02, P=0.06). Fewer infants were sensitised to egg in the n-3 LCPUFA group (34/368 (9%) v 52/338 (15%); unadjusted relative risk 0.61, 0.40 to 0.91, P=0.02; adjusted relative risk 0.62, 0.41 to 0.93, P=0.02), but no difference between groups in immunoglobulin E associated food allergy was seen. Conclusion n-3 LCPUFA supplementation in pregnancy did not reduce the overall incidence of immunoglobulin E associated allergies in the first year of life, although atopic eczema and egg sensitisation were lower. Longer term follow-up is needed to determine if supplementation has an effect on respiratory allergic diseases and aeroallergen sensitisation in childhood. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12610000735055 (DOMInO trial: ACTRN12605000569606). PMID:22294737

Association of pollution and climate with atopic eczema in US children.

PubMed

Kathuria, P; Silverberg, J I

2016-08-01

We sought to determine the relationship between childhood eczema, climate, and environmental pollutants. We analyzed data from the 2007-2008 National Survey of Children's Health including a representative sample of 91,642 children age 0-17 years and the 2006-2007 Environmental Protection Agency measurements of carbon monoxide (CO), nitrate (NO3 ), nitrogen dioxide (NO2 ), organic carbon (OC), sulfate (SO3 ), sulfur dioxide (SO2 ), particulate matter ≤2.5 μm (PM-2.5) and <10 μm (PM-10), and tropospheric ozone levels, and the National Climate Data Center measurements of relative humidity (%), issued UV index, outdoor air temperature, and precipitation levels. In multivariate survey logistic regression models controlling for age, sex, race/ethnicity, household income, US birthplace, and history of moving to a new location, eczema was associated with higher mean annual NO2 (p = 0.008), SO2 (p = 0.006), SO3 (p = 0.0002), arsenic (p = 0.0007), nickel (p = 0.0002), lead (p = 0.03), vanadium (p < 0.0001), and zinc (p = 0.003), but lower NO3 (p = 0.002), OC (p = 0.03), PM-2.5 (p = 0.006), cadmium (p < 0.0001), copper (p = 0.004), and potassium (p < 0.0001). In contrast, moderate-severe eczema was associated with higher NO3 (p = 0.03), OC (p = 0.008) and PM-2.5 (p = 0.01), copper (p = 0.04), lead (p = 0.008), and zinc (p = 0.01), but lower CO (p = 0.03). Principal component analysis was used and identified 4 combinations of pollutants and climate factors occurring in the USA, of which 1 was associated with higher prevalence and two were associated with lower prevalences of eczema (p < 0.05). Pollutants in conjunction with climate factors may differentially impact eczema prevalence and severity, some with apparent harmful effects. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Occupational peri-ocular contact dermatitis due to sensitization against black rubber components of a microscope.

PubMed

Kuijpers, D I M; Hillen, F; Frank, J A

2006-08-01

A 24-year-old female working in the Department of Pathology of a University Hospital developed an acute peri-ocular eczema clearly being related to her daily work at the microscope. Patch testing revealed delayed type hypersensitivity against the black rubber mix, N-isopropyl-N'-phenyl paraphenylenediamine, N-cyclohexyl-N'-phenyl paraphenylenediamine and the rubber ring situated on the ocular of the respective microscope. This is the first report, to our knowledge, on peri-orbital allergic contact eczema because of sensitization with rubber components of a microscope.

Eczema (For Parents)

MedlinePlus

... the skin to become scaly and inflamed), and contact dermatitis (caused by direct skin contact with an irritating substance, such as a metal, ... How Do I Get Rid of Eczema Scars? Eczema Impetigo View more About Us Contact Us Partners Editorial Policy Permissions Guidelines Privacy Policy & ...

East Indian Sandalwood Oil Is a Phosphodiesterase Inhibitor: A New Therapeutic Option in the Treatment of Inflammatory Skin Disease.

PubMed

Sharma, Manju; Levenson, Corey; Browning, John C; Becker, Emily M; Clements, Ian; Castella, Paul; Cox, Michael E

2018-01-01

Cyclic adenosine monophosphate phosphodiesterases (PDEs) regulate pro-inflammatory cytokine production. One isoform, PDE4, is overactive in chronic relapsing inflammatory skin diseases: psoriasis and eczema/atopic dermatitis, and in several cancers. East Indian sandalwood oil (EISO) has significant anti-inflammatory properties. Here, we report that 75% of pediatric eczema/atopic dermatitis patients treated with topical EISO formulations achieved a >50% reduction in their Eczema Area and Severity Index score. EISO treatment of a psoriasis model reduced PDE4 expression and reversed histopathology. EISO directly inhibited PDE enzymatic activity in vitro . In lipopolysaccharide-stimulated human dermal fibroblast, BEAS-2B, A549, and THP-1 cells, EISO suppressed total cellular PDE activity, PDE4, and 7 transcript levels, nuclear factor kappa B (NF-κB) activation, and pro-inflammatory cytokines/chemokine production. These results suggest that EISO anti-inflammatory activity is mediated through suppressing PDE activity, thus facilitating cAMP-regulated inhibition of NF-κB and indicate EISO as an attractive natural therapeutic for chronic and acute inflammatory disorders.

East Indian Sandalwood Oil Is a Phosphodiesterase Inhibitor: A New Therapeutic Option in the Treatment of Inflammatory Skin Disease

PubMed Central

Sharma, Manju; Levenson, Corey; Browning, John C.; Becker, Emily M.; Clements, Ian; Castella, Paul; Cox, Michael E.

2018-01-01

Cyclic adenosine monophosphate phosphodiesterases (PDEs) regulate pro-inflammatory cytokine production. One isoform, PDE4, is overactive in chronic relapsing inflammatory skin diseases: psoriasis and eczema/atopic dermatitis, and in several cancers. East Indian sandalwood oil (EISO) has significant anti-inflammatory properties. Here, we report that 75% of pediatric eczema/atopic dermatitis patients treated with topical EISO formulations achieved a >50% reduction in their Eczema Area and Severity Index score. EISO treatment of a psoriasis model reduced PDE4 expression and reversed histopathology. EISO directly inhibited PDE enzymatic activity in vitro. In lipopolysaccharide-stimulated human dermal fibroblast, BEAS-2B, A549, and THP-1 cells, EISO suppressed total cellular PDE activity, PDE4, and 7 transcript levels, nuclear factor kappa B (NF-κB) activation, and pro-inflammatory cytokines/chemokine production. These results suggest that EISO anti-inflammatory activity is mediated through suppressing PDE activity, thus facilitating cAMP-regulated inhibition of NF-κB and indicate EISO as an attractive natural therapeutic for chronic and acute inflammatory disorders. PMID:29593534

Prenatal Exposure to Phthalates and the Development of Eczema Phenotypes in Male Children: Results from the EDEN Mother-Child Cohort Study.

PubMed

Soomro, Munawar Hussain; Baiz, Nour; Philippat, Claire; Vernet, Celine; Siroux, Valerie; Nichole Maesano, Cara; Sanyal, Shreosi; Slama, Remy; Bornehag, Carl-Gustaf; Annesi-Maesano, Isabella

2018-02-02

Contradictory results exist regarding the importance of early-life exposure to phthalates for development of childhood eczema. We evaluated the association between maternal urinary concentrations of phthalate metabolites between the 24th and 28th week of gestation and occurrence of eczema in their sons up to 5 y of age, according to allergic sensitization as assessed by total immunoglobulin E (IgE) in a subsample of individuals. Data on health outcomes and background factors were collected using five standardized annual questionnaires completed by parents at the children's ages of 1-5 y, and their associations with phthalate metabolite urinary concentrations were assessed in 604 mother-son pairs with adjusted multiple logistic regression and Cox's survival model. Several eczema phenotypes were considered. Atopic status was assessed at 5 y of age in 293 boys through total IgE assessment. At 5 y of age, the prevalence of ever eczema was 30.4%. Metabolites of di-isobutyl phthalate (DiBP) and di-isononyl phthalate (DiNP) were positively associated with early-onset (0-24 mo of age) eczema (15.7%) and late-onset (24-60 mo of age) eczema (14.7%). Applying the Cox's model showed a significant association of occurrence of eczema in the first 5 y of life with DiBP and DiNP metabolites. Among IgE-sensitized boys, metabolites of di- n -butyl phthalate (DBP) and DiBP were significantly associated with ever eczema {hazard ratio (HR)=1.67 [95% confidence interval (CI): 1.10, 2.54], p =0.01 and HR=1.87 (95% CI: 1.01, 3.48), p =0.04, respectively}. Occurrence of eczema in early childhood may be influenced by prenatal exposure to certain phthalates in boys. Further investigations are needed to confirm this observation. https://doi.org/10.1289/EHP1829.

Cost-effectiveness of Maintenance Treatment with a Barrier-strengthening Moisturizing Cream in Patients with Atopic Dermatitis in Finland, Norway and Sweden.

PubMed

Norrlid, Hanna; Hjalte, Frida; Lundqvist, Adam; Svensson, Åke; Tennvall, Gunnel Ragnarson

2016-02-01

Atopic dermatitis is a chronic skin disorder with high prevalence, especially in the Nordic countries. Effective maintenance therapy during symptom-free episodes may prolong the time to eczema relapse according to a previously published clinical trial. The present study evaluates the cost-effectiveness of a barrier-strengthening moisturizer containing 5% urea, compared with a moisturizer with no active ingredients during eczema-free periods. A health economic microsimulation model, based on efficacy data from the randomized clinical trial, analysed the cost-effectiveness of the barrier-strengthening treatment in Finland, Norway and Sweden. The barrier-strengthening moisturizer was cost-saving compared with the moisturizer with no active ingredients in all 3 countries. The result was confirmed in all but one sensitivity analysis. In conclusion, the barrier-strengthening moisturizer is cost-effective as maintenance therapy for patients with atopic dermatitis compared with a moisturizer with no active ingredients.

Treatment of Recurrent Eczematous External Otitis with Honey Eardrops: A Proof-of-Concept Study.

PubMed

Henatsch, Darius; Nabuurs, Cindy H; van de Goor, Rens M; Wolffs, Petra F; Stokroos, Robert J

2017-10-01

Eczematous external otitis is a chronic inflammatory disease and often difficult to treat. Our objective was to investigate the clinical effect and in vitro antibacterial potential of medical honey eardrops as treatment of eczematous external otitis. In a prospective study, 15 patients diagnosed with recurrent eczematous external otitis were treated with medical honey eardrops for 2 weeks. The following clinical outcomes were evaluated: visual analog scale of ear complaints, score of eczema, and eradication of bacterial infection. Furthermore, the antibacterial effect of honey eardrops against different bacterial strains was tested in vitro. Treatment resulted in less discomfort and itching and decreased signs of eczema, with high patient satisfaction and without adverse reactions. Honey eardrops showed a strong in vitro inhibitory activity against all tested strains but did not eradicate Staphylococcus aureus infection in vivo. The results of this preliminary study indicate a possible role of honey eardrops in eczematous ear disease.

[Establishment of novel biomarkers for Personalized medication for atopic dermatitis].

PubMed

Ohta, Shoichiro; Taniguchi, Kazuto; Arima, Kazuhiko; Suzuki, Shoichi; Shiraishi, Hiroshi; Masuoka, Miho; Izuhara, Kenji

2013-03-01

To diagnose atopic dermatitis (AD), an appearance of eczema examined by experienced dermatologists is required. Therefore, biomarkers to diagnose AD or to reflect the severity of AD would be of a great use for non-specialists in the clinic or hospitals. We can apply such a biomarker for realization of personalized medicine for AD in the future. Interleukin-4 (IL-4) and IL-13 have been known to play important roles in the pathogenesis of allergic diseases including AD. In addition to these, we previously identified SCCA1, SCCA2, and periostin as IL-4/IL-13-inducible genes. We recently established ELISA systems to measure serum levels of SCCA1, SCCA2, and periostin and evaluated their usefulness in the treatment of AD patients. Serum SCCA1 and SCCA2 are up-regulated in AD patients and can distinguish AD patients from non-atopic controls, and their serum levels reflect eczema grades. Periostin concentration is also elevated in the serum of AD patients. These results demonstrate that SCCA1, SCCA2, and periostin might be promising biomarkers for personalized medicine in allergic diseases including AD.

The spectrum of skin diseases in a black population in Durban, KwaZulu-Natal, South Africa.

PubMed

Dlova, Ncoza C; Mankahla, Avumile; Madala, Nomandla; Grobler, Anneke; Tsoka-Gwegweni, Joyce; Hift, Richard J

2015-03-01

Precise knowledge of the prevalence and spectrum of skin diseases in a population allows for effective planning for provision of dermatology services and distribution of resources. There are no published data on the epidemiology of skin disorders in Durban, KwaZulu-Natal. We investigated the prevalence of skin diseases in black African patients attending a predominantly black private healthcare facility and profiled the patients. Clinical charts of all black African patients seen between January 2003 and December 2010 in a private practice in Durban were reviewed. The diseases seen were described and the prevalence calculated. A total of 6664 patient charts were reviewed. The five most common conditions were acne, eczemas, dyschromias, infections, and hair disorders. These data agree with reports from other parts of the world. Selection bias was presented by a single private practice, thus data may not be fully representative of our population. Acne, eczemas, dyschromias, infections, and hair disorders are, in that order, the five most common disorders encountered. © 2014 The International Society of Dermatology.

Clinical profile and quality of life of patients with occupational contact dermatitis from New Delhi, India.

PubMed

Bhatia, Riti; Sharma, Vinod K; Ramam, M; Sethuraman, Gomathy; Yadav, Chander P

2015-09-01

Data regarding occupational contact dermatitis (OCD) and its effect on quality of life (QOL) in India are limited. To evaluate patients with OCD and record the outcome of treatment. All patients with OCD were evaluated for severity of disease (by the use of physician global assessment) and its effect on QOL (by use of the Dermatology Life Quality Index) questionnaire) at the first visit and after 3 months of treatment. Among 117 patients with OCD, hand eczema was present in 81.2%. Positive patch test reactions were found in 76%. The most common allergens were Parthenium hysterophorus and potassium dichromate. The most frequent diagnosis was occupational allergic contact dermatitis (OACD) (57%), caused by farming and construction work, followed by occupational irritant contact dermatitis (OICD) (24%), caused by wet work. Severe psychosocial distress was recorded in 62.5% of patients. After 3 months of treatment, 83% improved significantly, and 54% had improvement in QOL. Farmers were most frequently affected, followed by construction workers and housewives. OACD was found at a higher frequency than OICD. The most frequent allergens were Parthenium hysterophorus in farmers, potassium dichromate in construction workers, and vegetables in housewives. OCD has a significant impact on QOL. Patch testing, in addition to standard treatment, improves the outcome considerably. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Skin diseases in rural Yucatan, Mexico.

PubMed

Paek, So Yeon; Koriakos, Angie; Saxton-Daniels, Stephanie; Pandya, Amit G

2012-07-01

There are no known reports of the frequency of skin diseases endemic to rural Yucatan, Mexico. The aim of this study was to report the prevalence of dermatologic conditions in rural villages in that region. We conducted a retrospective descriptive study of all cases of skin disease diagnosed by a team of American board-certified dermatologists during consultations in January 2009, August 2009, and June 2010, in the state of Yucatan, Mexico. Traveling clinics were held in eight different rural locations. Age, sex, and diagnosis, according to history and physical examination, were recorded for each patient. A total of 1071 cases of skin disease were seen in 858 patients. The frequency of parasitic, viral, and fungal infections was 34.5%. Dermatitis and eczema (24.6%) were the next most prevalent conditions, followed by disorders of skin appendages (12.2%), photosensitivity disorders (5.4%), papulosquamous disorders (3.2%), urticaria and erythema (1.5%), bacterial infections of the skin and subcutaneous tissue (1.2%), and neoplastic disorders (2.1%). The most frequently seen single diagnoses were viral warts (12.2%), scabies (8.7%), acne (7.4%), dermatophytosis (6.8%), contact dermatitis (3.5%), and nummular eczema (3.5%). Infectious diseases, acne, and eczemas are the most common skin disorders seen in dermatology clinics in rural Yucatan, Mexico. Our findings may be useful in the development of public health initiatives targeting rural communities in this region. © 2012 The International Society of Dermatology.

Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness

PubMed Central

Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Rumsby, Kate; Chorozoglou, Maria; Becque, Taeko; Roberts, Amanda; Liddiard, Lyn; Nollett, Claire; Hooper, Julie; Prude, Martina; Wood, Wendy; Thomas, Kim S; Thomas-Jones, Emma; Williams, Hywel C; Little, Paul

2018-01-01

Abstract Objectives To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children. Design Pragmatic randomised open label superiority trial with two parallel groups. Setting 96 general practices in Wales and western and southern England. Participants 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded. Interventions Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants. Main outcome measures The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed. Results 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score over the 16 week period was 7.5 (SD. 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group (95% confidence interval −0.27 to 1.10), below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects. Conclusions This trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes. Trial registration Current Controlled Trials ISRCTN84102309. PMID:29724749

Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness.

PubMed

Santer, Miriam; Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Rumsby, Kate; Chorozoglou, Maria; Becque, Taeko; Roberts, Amanda; Liddiard, Lyn; Nollett, Claire; Hooper, Julie; Prude, Martina; Wood, Wendy; Thomas, Kim S; Thomas-Jones, Emma; Williams, Hywel C; Little, Paul

2018-05-03

To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children. Pragmatic randomised open label superiority trial with two parallel groups. 96 general practices in Wales and western and southern England. 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded. Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants. The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed. 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score over the 16 week period was 7.5 (SD. 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group (95% confidence interval -0.27 to 1.10), below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects. This trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes. Current Controlled Trials ISRCTN84102309. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Effects of infant feeding practice on eczema during early childhood in Shanghai, Hohhot, and Fuzhou].

PubMed

Zheng, X Q; Zhu, G W; Zheng, Z Q; Yang, Y; Gong, C D; Deng, S S; Wu, Q L; Peng, Y M

2016-12-02

Objective: To estimate the prevalence of eczema in early childhood and effect of infant feeding practice on eczema by different regions of China with diverse climate and dietary patterns. Method: A questionnaire survey was conducted from June 2012 to October 2012 in Shanghai, Hohhot, and Fuzhou. The parent or guardian of the children aged between 2.5 to 3.5 years attending routine health visit in the chosen communities were invited to complete a modified questionnaire of the International Study of Asthma and Allergy in Childhood (ISAAC). Logistic regression model was used to analyze of the family history of allergy, duration of breastfeeding, timing of introduction of complementary foods and other potential confounders. Result: A total of 2 242 children were interviewed, 750 from Shanghai, 716 from Hohhot, and 776 from Fuzhou. The prevalence of eczema in early childhood was significantly different among Shanghai (16.9%, 95% CI 16.87-16.93), Hohhot (34.5%, 95% CI 34.46-34.54)and Fuzhou (44.3%, 95% CI 44.26-44.34). The difference was statistically significant between 3 groups (χ 2 =72.05, P <0.05). Introducing complementary food after the age of 6 months was associated with a decreased risk for eczema when compared to introduction between 4 to 6 months(odds ratio (OR) 0.58, 95% CI 0.41-0.81) in Fuzhou, while there was no significant association between timing of introduction of complementary foods and eczema in Shanghai and Hohhot. Conclusion: The prevalence of eczema during early childhood is various among three cities. The relationship between timing of introduction of complementary foods and eczema in Fuzhou is different from that in Shanghai and Hohhot. The role of climate and dietary patterns on prevalence of eczema needs further studies.

Genetic variation in small proline rich protein 2B as a predictor for asthma among children with eczema

PubMed Central

Epstein, Tolly G.; LeMasters, Grace K.; Bernstein, David I.; Ericksen, Mark B.; Martin, Lisa J.; Ryan, Patrick H.; Biagini Myers, Jocelyn M.; Butsch Kovacic, Melinda S.; Lindsey, Mark A.; He, Hua; Reponen, Tiina; Villareal, Manuel S.; Lockey, James E.; Bernstein, Cheryl K.; Khurana Hershey, Gurjit K.

2013-01-01

Background Small proline rich protein 2B (SPRR2B) is a skin and lung epithelial protein associated with allergic inflammation in mice that has not been evaluated in human atopic diseases. Objective To determine whether single-nucleotide polymorphisms (SNPs) in SPRR2B are associated with childhood eczema and with the phenotype of childhood eczema combined with asthma. Methods Genotyping for SPRR2B and filaggrin (FLG) was performed in 2 independent populations: the Cincinnati Childhood Allergy & Air Pollution Study (CCAAPS; N = 762; birth-age, 4 years) and the Greater Cincinnati Pediatric Clinical Repository (GCPCR;N = 1152; ages 5–10 years). Eczema and eczema plus asthma were clinical outcomes based on parental report and clinician’s diagnosis. Genetic analyses were restricted to whites and adjusted for sex in both cohorts and adjusted for environmental covariates in CCAAPS. Results Variants in SPRR2B were not significantly associated with eczema in either cohort after Bonferroni adjustment. Children from both cohorts with the CC genotype of the SPRR2B rs6693927 SNP were at 4 times the risk for eczema plus asthma (adjusted odds ratio, 4.1; 95% confidence interval, 1.5– 10.9; P = .005 in CCAAPS; and adjusted odds ratio, 4.0; 95% confidence interval, 1.8 –9.1; P <.001 in the GCPCR), however. SNPs in SPRR2B were not in strong linkage disequilibrium with the R501X and del2282 FLG mutations, and these findings were independent of FLG. Conclusions An SNP in SPRR2B was predictive of asthma among white children with eczema from 2 independent populations. SPRR2B polymorphisms may serve as important predictive markers for the combined eczema plus asthma phenotype. PMID:22374195

Role of environmental exposures and filaggrin mutations on associations of ethnic origin with risk of childhood eczema. The Generation R Study.

PubMed

Elbert, Niels J; Duijts, Liesbeth; den Dekker, Herman T; Jaddoe, Vincent W V; Sonnenschein-van der Voort, Agnes M M; de Jongste, Johan C; Pasmans, Suzanne G M A

2016-09-01

The prevalence of childhood eczema varies considerably between ethnic groups. However, data from longitudinal studies remain scarce. We examined the associations of ethnic origin with the development of eczema from birth until the age of 4 years, and whether known environmental and genetic risk factors explain these associations. This study was performed in a multiethnic population-based prospective cohort among 5,082 children. Ethnic origin was based on the parents' country of birth. Data on physician-diagnosed eczema were obtained by annual questionnaires. Information on environmental risk factors was mostly obtained by questionnaires. Filaggrin (FLG) mutations (2282del4, R2447X, R501X, and S3247X) were genotyped for 3,096 children. We used generalized estimating equation models to examine the associations of ethnic origin with the longitudinal odds of eczema at 6 months and 1, 2, 3, and 4 years of age overall and independently. Compared with Dutch children, Cape Verdean, Dutch Antillean, Surinamese-Creole, and Surinamese-Hindustani children had overall increased risks of eczema (OR (95%-CI): 1.53 (1.15, 2.03), 1.60 (1.21, 2.12), 1.95 (1.56, 2.44), and 2.06 (1.65, 2.57), respectively). Effect estimates for the associations of Cape Verdean and Dutch Antillean origin with eczema became non-significant after adjustment for genetic risk factors or both environmental and genetic risk factors, respectively. Surinamese-Creole and Surinamese-Hindustani children remained to have increased risks of eczema. Cape Verdean, Dutch Antillean, Surinamese-Creole, and Surinamese-Hindustani children had increased risks of eczema in the first 4 years of life. Environmental and genetic risk factors partly weakened these associations. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

DNA methylation of the filaggrin gene adds to the risk of eczema associated with loss-of-function variants

PubMed Central

Ziyab, A. H.; Karmaus, W.; Holloway, J. W.; Zhang, H.; Ewart, S.; Arshad, S. H.

2012-01-01

Background Loss-of-function variants within the filaggrin gene (FLG) are associated with a dysfunctional skin barrier that contributes to the development of eczema. Epigenetic modifications, such as DNA methylation, are genetic regulatory mechanisms that modulate gene expression without changing the DAN sequence. Objectives To investigate whether genetic variants and adjacent differential DNA methylation within the FLG gene synergistically act on the development of eczema. Methods A subsample (n = 245, only females aged 18 years) of the Isle of Wight birth cohort participants (n = 1,456) had available information for FLG variants R501X, 2282del4, and S3247X and DNA methylation levels for 10 CpG sites within the FLG gene. Log-binomial regression was used to estimate the risk ratios (RRs) of eczema associated with FLG variants at different methylation levels. Results The period prevalence of eczema was 15.2% at age 18 years and 9.0% of participants were carriers (heterozygous) of FLG variants. Of the 10 CpG sites spanning the genomic region of FLG, methylation levels of CpG site ‘cg07548383’ showed a significant interaction with FLG sequence variants on the risk for eczema. At 86% methylation level, filaggrin haploinsufficient individuals had 5.48-fold increased risk of eczema when compared to those with wild type FLG genotype (p-value = 0.0008). Conclusions Our novel results indicated that the association between FLG loss-of-function variants and eczema is modulated by DNA methylation. Simultaneously assessing the joint effect of genetic and epigenetic factors within the FLG gene further highlights the importance of this genomic region for eczema manifestation. PMID:23003573

Epidemiology and Comorbidity in Children with Psoriasis and Atopic Eczema.

PubMed

Augustin, Matthias; Radtke, Marc A; Glaeske, Gerd; Reich, Kristian; Christophers, Enno; Schaefer, Ines; Jacobi, Arnd

2015-01-01

First studies have shown that juvenile psoriasis is associated with an increased prevalence of comorbidity. We carried out a data analysis to characterise the profiles of comorbidity in children with psoriasis and atopic eczema. Prevalence data were derived from the database of a German statutory health insurance company according to ICD-10 codes L40 (psoriasis) and L20 (atopic eczema) of children up to 18 years insured in 2009. Data sets included 1.64 million persons and 293,181 children. 1,313 children = 0.45% (0.42-0.47) had a diagnosis of psoriasis and 30,354 = 10.35% (10.24-10.47) had a diagnosis of atopic eczema. Obesity, hyperlipidaemia, arterial hypertension and diabetes were more often diagnosed in children with psoriasis in comparison to all children without psoriasis and to those with atopic eczema. Children with psoriasis and atopic eczema show different and specific patterns of comorbidity which should be detected early and treated adequately. © 2015 S. Karger AG, Basel.

EMB6/481: Evidence-Based Patient Education on the Web: Methods and studies for determining consumers' needs

PubMed Central

Eysenbach, G; Fartasch, D; Diepgen, TL

1999-01-01

Introduction On the Internet, thousands of medical Web sites aim to educate consumers in the field of health. The quality of the educational material for patients varies greatly and is rarely "evidence-based" - not only in terms of the scientific accuracy but also in terms of sometimes questionable appropriateness for the target group. Material boring the reader with facts already known to him/her and failing to address common questions or misunderstandings will most likely fail to reach its aims. Conventional studies to determine the information needs of patients and their relatives are expensive and difficult to conduct. At our dermatology portal site we conducted two separate studies using two different approaches to determine the "needs" of the consumers by using both most commonly used "feedback channels" the Internet has to offer: Emails and Web forms. Methods In the first study, we systematically reviewed 209 unsolicited emails we received from consumers in response to our dermatology Web site, analyzing their contents in respect to previous contacts with live physicians, disease duration, level of frustration expressed in the e-mails, and type of information sought. In another study, we developed a web-based questionnaire as a "pre-test" to determine the knowledge level of patients visiting a patient education site on atopic eczema. The "pre-test" is a form-based "quiz", users are asked to voluntarily complete this questionnaire before entering the information system. The quiz contains 24 statements about atopic eczema, which the user should mark as "true" or "untrue". Once completed, answers are stored in a database and the system generates a dynamic, customized page for the user with explanations and hyperlinks to the respective Web pages which contain further information about the respective items. Results Analysis of the 209 emails revealed that many dermatologic patients surfing the Internet and requesting tele-advice have a chronic disease (81%) and seek a second opinion. Seventeen percent express frustration about previous encounters with live physicians. 40% of all e-mails could have been answered by a librarian. In at least 5 instances patients attempt self-diagnosis. Analysis of 1010 responses to the quiz, entered within 5 months (27.2.-27.7.98), revealed some common misunderstandings among patients with atopic eczema, for example that it is a psychosomatic disease or "disease of the nerves", that a special diet is principally required and that AE is an allergy (which is an especially common misunderstanding among parents!). Discussion The studies demonstrate how easy, fast and cost-effectively the information needs of patients and consumers can be determined using interactive venues on the Internet and give some insights into the motivation of consumers to consult the Internet.

Maternal intake of Natto, a Japan's traditional fermented soybean food, during pregnancy and the risk of eczema in Japanese babies.

PubMed

Ozawa, Naoko; Shimojo, Naoki; Suzuki, Yoichi; Ochiai, Shingo; Nakano, Taiji; Morita, Yoshinori; Inoue, Yuzaburo; Arima, Takayasu; Suzuki, Shuichi; Kohno, Yoichi

2014-06-01

There are reports that the maternal diet during pregnancy may affect development of babies' eczema. We sought to investigate the association between the maternal diet during pregnancy and the risk of eczema in infancy in Japan. A birth cohort was set up at 2 hospitals in Chiba city. Dietary habits concerning fish, butter, margarine, yogurt and natto during pregnancy was obtained from mothers just after delivery. The intake frequencies of these foods were classified into four groups: 1) daily, 2) 2-3 times a week, 3) once a week and 4) once a month or less. Diagnosis of eczema at 6 months of age was made by the presence of an itchy rash that persisted more than two months. Valid data on 650 mother-baby pairs were obtained. No relationship between frequencies of the maternal intake of fish, margarine and yogurt during pregnancy and the onset rate of the babies' eczema were observed. For butter consumption, the incidence of babies' eczema was significantly higher in the group with daily intake than in those with an intake 2-3 times a week or less (p = 0.044). For natto, incidence of babies' eczema was significantly lower in the group with everyday intake than those eating it 2-3 times a week or less (p = 0.020). High frequency intake of natto during pregnancy possibly reduces the incidence of eczema in children at 6 months of age.

Opposing Effects of Cat and Dog Ownership and Allergic Sensitization on Eczema in an Atopic Birth Cohort

PubMed Central

Epstein, Tolly G.; Bernstein, David I.; Levin, Linda; Khurana Hershey, Gurjit K.; Ryan, Patrick H.; Reponen, Tiina; Villareal, Manuel; Lockey, James E.; LeMasters, Grace K.

2016-01-01

Objective To examine risk factors for eczema at age 4 years. Study design Beginning at age one, infants of atopic parents (n=636) had annual clinical evaluations and skin prick tests (SPTs) to 15 aeroallergens, and milk and egg. Parents completed validated surveys on eczema and environmental exposures. House dust samples were evaluated for allergens and endotoxin. Eczema was defined as a parental report of scratching, and redness, “raised bumps,” or dry skin/scaling for 6 of the last 12 months. Results At age four, 90 children (16%) had eczema. Not having a dog prior to age one and being dog SPT+ at ages one, two, and/or three conferred a four-fold higher risk for eczema at age four (aOR=3.9 [1.6–9.2]; p=0.002). Among dog owners, however, dog SPT+ was not associated with significantly increased risk (aOR 1.3 [0.3–6.8]; p=0.8). Among children with cats prior to age one, cat SPT+ conferred significantly increased risk for eczema (aOR= 13.3 [3.1–57.9]; p<0.001). Among non-cat owners, cat SPT+ was not associated with increased risk (aOR=1.1 [0.5–2.7]; p=0.8). Conclusion Dog ownership significantly reduced the risk for eczema at age four among dog sensitized children, and cat ownership combined with cat sensitization significantly increased the risk. PMID:20884006

Opposing effects of cat and dog ownership and allergic sensitization on eczema in an atopic birth cohort.

PubMed

Epstein, Tolly G; Bernstein, David I; Levin, Linda; Khurana Hershey, Gurjit K; Ryan, Patrick H; Reponen, Tiina; Villareal, Manuel; Lockey, James E; Lemasters, Grace K

2011-02-01

To examine risk factors for eczema at age 4 years. Beginning at 1 year of age, infants of atopic parents (n = 636) had annual clinical evaluations and skin prick tests (SPTs) to 15 aeroallergens and milk and egg. Parents completed validated surveys on eczema and environmental exposures. House dust samples were evaluated for allergens and endotoxin. Eczema was defined as a parental report of scratching, and redness, "raised bumps," or dry skin/scaling for 6 of the last 12 months. At age 4 years, a total of 90 children (14%) had eczema. Not having a dog before 1 year of age and being dog SPT+ at 1, 2, or 3 years of age conferred a 4-fold higher risk for eczema at age 4 years (adjusted odds ratio [aOR] = 3.9 [1.6-9.2]; P = .002). Among dog owners, however, dog SPT+ was not associated with significantly increased risk (aOR 1.3 [0.3-6.8]; P = .8). Among children with cats before 1 year of age, cat SPT+ conferred significantly increased risk for eczema (aOR = 13.3 [3.1-57.9]; P < .001). Among non-cat owners, cat SPT+ was not associated with increased risk (aOR = 1.1 [0.5-2.7]; P = .8). Dog ownership significantly reduced the risk for eczema at age 4 years among dog-sensitized children, cat ownership combined with cat sensitization significantly increased the risk. Copyright © 2011 Mosby, Inc. All rights reserved.

OCCUPATIONAL DERMATITIS DUE TO SENSITIZATION TO SODIUM AND CALCIUM URANYL CARBONATES (in French)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thiers, H.; Chanial, G.; Rivoire, J.

1961-01-01

BS>A report on a rare type of occupational dermatitis from sensitization to Na and Ca uranates observed in two workers in the Guegnon uranium-processing plandt is presented. In both patients there was no history of personal or family allergies. The dermatitis was especially evident on the fingers and presented characteristics not reported previously: the skin was dry and wrinkled with small periangualar fissures. Small nodules 2--3 mm, appearing as centers of hyperkeratosis encased in the skin, appeared on the sides and under surface of fingers. The nails were grooved and peeling at the edges. Also, at the base of themore » fingers and over the hand hyperkeritosic eczema of a common type was seen. These lessons were filled with pus. Skin tests confirmed their sensitization to 2% solutions of Na and Ca uranates; otherwise these patients appeared to be completely normal. A survey of working conditions showed that there was no possibility of their dermatitis resulting from radioactivity. That excessive radiation was not involved in the pathogenesis of these lesions was attested to by their normal blood pictures. The manifestations of the lesions indicated their definite allergic origin. Both patients recovered eventually and, after occupying other positions in the plant, have had no recrudescence of the lesions. (BBB)« less

Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort

PubMed Central

2012-01-01

Background This study aimed to estimate the association between eczema in early childhood and the onset of asthma and rhinitis later in life in children. Methods A total of 3,124 children aged 1–2 years were included in the Dampness in Building and Health (DBH) study in the year 2000, and followed up 5 years later by a parental questionnaire based on an International Study of Asthma and Allergies in Childhood protocol. The association between eczema in early childhood and the incidence of asthma and rhinitis later in life was estimated by univariable and multivariable logistic regression modelling. Results The prevalence of eczema in children aged 1–2 years was 17.6% at baseline. Children with eczema had a 3-fold increased odds of developing asthma (adjusted odds ratio [aOR], 3.07; 95% confidence interval (CI) 1.79–5.27), and a nearly 3-fold increased odds of developing rhinitis (aOR, 2.63; 1.85–3.73) at follow-up compared with children without eczema, adjusted for age, sex, parental allergic disease, parental smoking, length of breastfeeding, site of living, polyvinylchloride flooring material, and concomitant allergic disease. When eczema was divided into subgroups, moderate to severe eczema (aOR, 3.56; 1.62–7.83 and aOR, 3.87; 2.37–6.33, respectively), early onset of eczema (aOR, 3.44; 1.94–6.09 and aOR, 4.05; 2.82–5.81; respectively), and persistence of eczema (aOR, 5.16; 2.62–10.18 and aOR, 4.00; 2.53–6.22, respectively) further increased the odds of developing asthma and rhinitis. Further independent risk factors increasing the odds of developing asthma were a parental history of allergic disease (aOR, 1.83; 1.29–2.60) and a period of breast feeding shorter than 6 months (aOR, 1.57; 1.03–2.39). The incidence of rhinitis was increased for parental history of allergic disease (aOR, 2.00; 1.59–2.51) and polyvinylchloride flooring (aOR, 1.60; 1.02–2.51). Conclusion Eczema in infancy is associated with development of asthma and rhinitis during the following 5-year period, and eczema is one of the strongest risk factors. Early identification is valuable for prediction of the atopic march. PMID:22839963

Specific allergen immunotherapy for the treatment of atopic eczema: a Cochrane systematic review.

PubMed

Tam, H H; Calderon, M A; Manikam, L; Nankervis, H; Núñez, I G; Williams, H C; Durham, S R; Boyle, R J

2016-09-01

Specific allergen immunotherapy (SIT) is an effective allergy treatment, but it is unclear whether SIT is effective for atopic eczema (AE). We undertook a systematic review to assess SIT efficacy and safety for treating AE. We searched databases, ongoing clinical trials registers, and conference proceedings up to July 2015. Randomized controlled trials (RCTs) of SIT using standardized allergen extracts, compared with placebo/control, for treating AE in patients with allergic sensitization were eligible. We identified 12 eligible trials with 733 participants. Interventions included subcutaneous (six trials), sublingual (four trials), oral or intradermal SIT in children/adults allergic to house dust mite (10 trials), grass pollen or other inhalants. Risk of bias was moderate, with high loss to follow-up and nonblinding as the main concerns. For our primary outcomes, three studies (208 participants) reported no significant difference - patient-reported global disease severity improvement RR 0.75 (95% CI 0.45, 1.26); and eczema symptoms mean difference -0.74 on a 20-point scale (95% CI -1.98, 0.50). Two studies (85 participants) reported a significant difference - SIT improved global disease severity RR 2.85 (95% CI 1.02, 7.96); and itch mean difference -4.20 on a 10-point scale (95% CI -3.69, -4.71). Meta-analysis was limited due to extreme statistical heterogeneity. For some secondary outcomes, meta-analyses showed benefits for SIT, for example investigator-rated improvement in eczema severity RR 1.48 (95% CI 1.16, 1.88; six trials, 262 participants). We found no evidence of adverse effects. The overall quality of evidence was low. We found no consistent evidence that SIT is effective for treating AE, but due to the low quality of evidence further research is needed to establish whether SIT has a role in AE treatment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Temperature-controlled laminar airflow (TLA) device in the treatment of children with severe atopic eczema: Open-label, proof-of-concept study.

PubMed

Gore, C; Gore, R B; Fontanella, S; Haider, S; Custovic, A

2018-05-01

Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression. To evaluate the effect of the temperature-controlled laminar airflow (TLA) treatment in children/adolescents with severe AE. We recruited 15 children aged 2-16 years with long-standing, severe AE and sensitization to ≥1 perennial inhalant allergen. Run-in period of 6-10 weeks (3 visits) was followed by 12-month treatment with overnight TLA (Airsonett ® , Sweden). The primary outcome was eczema severity (SCORAD-Index and Investigator Global Assessment-IGA). Secondary outcomes included child/family dermatology quality of life and family impact questionnaires (CDQLI, FDQLI, DFI), patient-oriented eczema measure (POEM), medication requirements and healthcare contacts. The study is registered as ISRCTN65865773. There was a significant reduction in AE severity ascertained by SCORAD and IGA during the 12-month intervention period (P < .001). SCORAD was reduced from a median of 34.9 [interquartile range 28.75-45.15] at Baseline to 17.2 [12.95-32.3] at the final visit, and IGA improved significantly from 4 [3-4] to 2 [1-3]. We observed a significant improvement in FDQLI (16.0 [12.25-19.0] to 12 [8-18], P = .023) and DFI (P = .011), but not CDQLI or POEM. Compared to 6-month period prior to enrolment, there was a significant reduction at six months after the start of the intervention in potent topical corticosteroids (P = .033). The exploratory cluster analysis revealed two strongly divergent patterns of response, with 9 patients classified as responders, and 6 as non-responders. Addition of TLA device to standard pharmacological treatment may be an effective add-on to the management of difficult-to-control AE. © 2018 John Wiley & Sons Ltd.

TREatment of ATopic eczema (TREAT) Registry Taskforce: An international Delphi exercise to identify a core set of domains and domain items for national atopic eczema photo- and systemic therapy registries.

PubMed

Gerbens, L A A; Apfelbacher, C J; Irvine, A D; Barbarot, S; de Booij, R J; Boyce, A E; Deleuran, M; Eichenfield, L F; Hof, M H; Middelkamp-Hup, M A; Roberts, A; Schmitt, J; Vestergaard, C; Wall, D; Weidinger, S; Williamson, P R; Flohr, C; Spuls, P I

2018-05-15

Evidence of immunomodulatory therapies to guide clinical management for atopic eczema (AE) is scarce, despite frequent and often off-label use. Patient registries provide valuable evidence for the effects of treatments under real world conditions which can inform treatment guidelines, give the opportunity for health economic evaluation and the evaluation of quality of care, as well as pharmacogenetic and -dynamic research which cannot be adequately addressed in clinical trials. The TREatment of ATopic eczema (TREAT) Registry Taskforce aims to seek international consensus on a core set of domains and items ('what to measure') for AE research registries, using a Delphi approach. Participants from six stakeholder groups were included: doctors, nurses, non-clinical researchers, patients, industry and regulatory body representatives. The eDelphi comprised 3 sequential online rounds, requesting participants to rate the importance of each proposed domain item. Participants could add domain items to the proposed list in round 1. A final consensus meeting was held to ratify the core set. 479 participants from 36 countries accessed the eDelphi platform, of whom 86%, 79% and 74% completed rounds 1, 2, and 3 respectively. At the face-to-face consensus meeting attended by 42 participants the final core set was established containing 19 domains with 69 domain items (49 baseline and 20 follow-up items). This core set of domains and items to be captured by national AE systemic therapy registries will standardise data collection and thereby allow direct comparability across registries and facilitate data pooling between countries. Ultimately, it will provide greater insight into the effectiveness, safety and cost-effectiveness of photo- and systemic immunomodulatory therapies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Diversity of the gut microbiota and eczema in early life.

PubMed

Forno, Erick; Onderdonk, Andrew B; McCracken, John; Litonjua, Augusto A; Laskey, Daniel; Delaney, Mary L; Dubois, Andrea M; Gold, Diane R; Ryan, Louise M; Weiss, Scott T; Celedón, Juan C

2008-09-22

A modest number of prospective studies of the composition of the intestinal microbiota and eczema in early life have yielded conflicting results. To examine the relationship between the bacterial diversity of the gut and the development of eczema in early life by methods other than stool culture. Fecal samples were collected from 21 infants at 1 and 4 months of life. Nine infants were diagnosed with eczema by the age of 6 months (cases) and 12 infants were not (controls). After conducting denaturating gradient gel electrophoresis (DGGE) of stool samples, we compared the microbial diversity of cases and controls using the number of electrophoretic bands and the Shannon index of diversity (H') as indicators. Control subjects had significantly greater fecal microbial diversity than children with eczema at ages 1 (mean H' for controls = 0.75 vs. 0.53 for cases, P = 0.01) and 4 months (mean H' for controls = 0.92 vs. 0.59 for cases, P = 0.02). The increase in diversity from 1 to 4 months of age was significant in controls (P = 0.04) but not in children who developed eczema by 6 months of age (P = 0.32). Our findings suggest that reduced microbial diversity is associated with the development of eczema in early life.

No high level evidence to support the use of oral H1 antihistamines as monotherapy for eczema: a summary of a Cochrane systematic review

PubMed Central

2014-01-01

Background The most important symptom as well as one of the major diagnostic criteria for eczema is itch. Although oral antihistamines continue to be prescribed for people with eczema, it is unclear if they are effective and safe in relieving itch and skin lesions. We sought to evaluate the available evidence on effectiveness of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. Methods Searches included 10 databases and trial registers as well as conference proceedings (January 2014). Randomised controlled trials that assessed the effects of oral H1 antihistamines as monotherapy in children and adults with eczema were included. Results Our searches retrieved 757 references, but no randomised controlled trial met our inclusion criteria. Most studies allowed concomitant treatments, making the assessment of the individual effects of oral H1 antihistamines impossible. Conclusions There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. A further review of studies that assesses the effects of oral H1 antihistamines as ‘add-on’ therapy together with concomitant treatments is warranted to determine the beneficial effects of this group of medications in the treatment of eczema. PMID:24625301

Quality of life and emotional state in chronic skin disease.

PubMed

Pärna, Ene; Aluoja, Anu; Kingo, Külli

2015-03-01

The aim of this study was to evaluate the associations between chronic inflammatory skin conditions and patients' emotional state and quality of life. The following self-rated questionnaires were used: Emotional State Questionnaire, a self-report scale assessing depression and anxiety symptoms; Dermatology Life Quality Index (DLQI); and RAND-36, a measure of health-related quality of life. The study group comprised 40 patients with psoriasis, 40 with eczema, 40 with acne, 15 with seborrhoeic dermatitis and 40 healthy controls. Patients with chronic skin diseases had lower DLQI and lower RAND-36 physical functioning scores, more perceived physical limitations and pain, and lower emotional well-being and general health ratings compared with the control group. In conclusion, chronic skin diseases are associated with symptoms of emotional distress, in particular insomnia and general anxiety.

Mapping Systematic Reviews on Atopic Eczema—An Essential Resource for Dermatology Professionals and Researchers

PubMed Central

Futamura, Masaki; Thomas, Kim S.; Grindlay, Douglas J. C.; Doney, Elizabeth J.; Torley, Donna; Williams, Hywel C.

2013-01-01

Background Many research studies have been published on atopic eczema and these are often summarised in systematic reviews (SRs). Identifying SRs can be time-consuming for health professionals, and researchers. In order to facilitate the identification of important research, we have compiled an on-line resource that includes all relevant eczema reviews published since 2000. Methods SRs were searched for in MEDLINE (Ovid), EMBASE (Ovid), PubMed, the Cochrane Database of Systematic Reviews, DARE and NHS Evidence. Selected SRs were assessed against the pre-defined eligibility criteria and relevant articles were grouped by treatment category for the included interventions. All identified systematic reviews are included in the Global Resource of EczemA Trials (GREAT) database (www.greatdatabase.org.uk) and key clinical messages are summarised here. Results A total of 128 SRs reviews were identified, including three clinical guidelines. Of these, 46 (36%) were found in the Cochrane Library. No single database contained all of the SRs found. The number of SRs published per year has increased substantially over the last thirteen years, and reviews were published in a variety of clinical journals. Of the 128 SRs, 1 (1%) was on mechanism, 37 (29%) were on epidemiology, 40 (31%) were on eczema prevention, 29 (23%) were on topical treatments, 31 (24%) were on systemic treatments, and 24 (19%) were on other treatments. All SRs included searches of MEDLINE in their search methods. One hundred six SRs (83%) searched more than one electronic database. There were no language restrictions reported in the search methods of 52 of the SRs (41%). Conclusions This mapping of atopic eczema reviews is a valuable resource. It will help healthcare practitioners, guideline writers, information specialists, and researchers to quickly identify relevant up-to-date evidence in the field for improving patient care. PMID:23505516

Efficacy and Safety of Dupilumab in Patients ≥12 to <18 Years of Age, With Moderate-to-Severe Atopic Dermatitis

ClinicalTrials.gov

2017-12-18

Moderate-to-Severe Atopic Dermatitis; Dermatitis, Dermatitis Atopic; Eczema, Skin Diseases, Skin; Diseases Genetic, Genetic; Diseases Inborn, Skin; Disease, Eczematous Skin; Hypersensitivity, Immediate; Hypersensitivity, Immune System Diseases; Dermatitis, Atopic

Filaggrin haploinsufficiency is highly penetrant and is associated with increased severity of eczema: further delineation of the skin phenotype in a prospective epidemiological study of 792 school children

PubMed Central

Brown, SJ; Relton, CL; Liao, H; Zhao, Y; Sandilands, A; McLean, WHI; Cordell, HJ; Reynolds, NJ

2009-01-01

Background Null mutations within the filaggrin gene (FLG) cause ichthyosis vulgaris and are associated with atopic eczema. However, the dermatological features of filaggrin haploinsufficiency have not been clearly defined. Objectives This study investigated the genotype–phenotype association between detailed skin phenotype and FLG genotype data in a population-based cohort of children. Methods Children (n= 792) aged 7–9 years were examined by a dermatologist. Features of ichthyosis vulgaris, atopic eczema and xerosis were recorded and eczema severity graded using the Three Item Severity score. Each child was genotyped for the six most prevalent FLG null mutations (R501X, 2282del4, R2447X, S3247X, 3702delG, 3673delC). Fisher’s exact test was used to compare genotype frequencies in phenotype groups; logistic regression analysis was used to estimate odds ratios and penetrance of the FLG null genotype and a permutation test performed to investigate eczema severity in different genotype groups. Results Ten children in this cohort had ichthyosis vulgaris, of whom five had mild–moderate eczema. The penetrance of FLG null mutations with respect to flexural eczema was 55·6% in individuals with two mutations, 16·3% in individuals with one mutation and 14·2% in wild-type individuals. Summating skin features known to be associated with FLG null mutations (ichthyosis, keratosis pilaris, palmar hyperlinearity and flexural eczema) showed a penetrance of 100% in children with two FLG mutations, 87·8% in children with one FLG mutation and 46·5% in wild-type individuals (P< 0·0001, Fisher exact test). FLG null mutations were associated with more severe eczema (P= 0·0042) but the mean difference was only 1–2 points in severity score. Three distinct patterns of palmar hyperlinearity were observed and these are reported for the first time. Conclusions Filaggrin haploinsufficiency appears to be highly penetrant when all relevant skin features are included in the analysis. FLG null mutations are associated with more severe eczema, but the effect size is small in a population setting. PMID:19681860

Staphylococcus aureus clonal dynamics and virulence factors in children with atopic dermatitis.

PubMed

Lomholt, Hans; Andersen, Klaus Ejner; Kilian, Mogens

2005-11-01

A prospective cohort study was undertaken to determine the clonal dynamics of Staphylococcus aureus colonization and infection during 1 y in children with atopic dermatitis, and to correlate specific clones, accessory gene regulator (agr) groups, and production of virulence factors with eczema activity. Eleven children were examined every 6 wk with swaps taken from active eczema, anterior nose, axillae and perineum, and scoring of eczema activity by severity scoring of atopic dermatitis (SCORAD). Individual S. aureus clonal types were identified and examined for production of superantigens, toxins, and were assigned to agr groups. S. aureus colonization patterns ranged from rare colonization over transient colonization to persistent colonization by a single clone or a dynamic exchange of up to five clones. Production of no single virulence factor including superantigens and toxins was significantly associated with exacerbation of eczema. In four children there was a shift between visits in agr group of colonizing clones. These shifts were associated with an increased SCORAD value of 19 (SE = 7, p = 0.009). Change of clones belonging to the same agr group was not associated with a higher SCORAD value. In 11 of 12 cases with two different clones co-colonizing a child the clones belonged to the same agr group. In conclusion, this limited group of children with atopic dermatitis showed highly variable colonization patterns of S. aureus, and communication between strains by use of agr encoded octa peptides appeared to be active in vivo. Increased severity of eczema was related to a change in agr group and may have been because of inflammation triggered by the takeover of an antigenically different clone, as agr groups represent ancient phylogenetic lineages.

Preconceptional, prenatal and postnatal exposure to outdoor and indoor environmental factors on allergic diseases/symptoms in preschool children.

PubMed

Deng, Qihong; Lu, Chan; Ou, Cuiyun; Chen, Lv; Yuan, Hong

2016-06-01

Environmental factors have been found to be associated with allergic diseases, but it is unclear which environmental factor during which exposure window causes what kind of allergic diseases. We investigated association between exposure to some predominant outdoor and indoor environmental factors during preconceptional, prenatal, and postnatal periods and allergic diseases/symptoms in 2598 children in China. Children's lifetime incidence of allergic diseases and current prevalence of allergic symptoms and exposure to indoor new furniture/redecoration and mold/dampness was surveyed by a questionnaire. Exposure to outdoor air pollutants was estimated by the concentrations measured at air quality monitoring stations. Multiple logistic regression model was used to evaluate the associations between outdoor air pollutants and indoor environmental factors and allergic diseases (asthma, allergic rhinitis, and eczema) and symptoms (wheezing, night cough, and rhinitis-like). We found that preconceptional, prenatal, and postnatal exposure to outdoor industrial and traffic air pollutants were significantly associated with increase in the risk of childhood asthma, and also positively associated with allergic rhinitis and eczema. However, we cannot distinguish the effect of outdoor air pollutants and exposure windows because of their high correlations. New furniture was associated with eczema and allergic rhinitis during postnatal exposure, but redecoration associated with asthma and eczema during prenatal exposure. Indoor visible mold/damp stains was significant for eczema during prenatal exposure and asthma during postnatal exposure respectively, but window condensation was significant for all childhood allergic diseases during both prenatal and postnatal exposures. Allergic symptoms in children were found to be associated with exposure to indoor factors only. Associations between outdoor air pollutants and indoor environmental factors and childhood allergic diseases/symptoms were divergent and related to the timing of exposure. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shared genetic origin of asthma, hay fever and eczema elucidates allergic disease biology.

PubMed

Ferreira, Manuel A; Vonk, Judith M; Baurecht, Hansjörg; Marenholz, Ingo; Tian, Chao; Hoffman, Joshua D; Helmer, Quinta; Tillander, Annika; Ullemar, Vilhelmina; van Dongen, Jenny; Lu, Yi; Rüschendorf, Franz; Esparza-Gordillo, Jorge; Medway, Chris W; Mountjoy, Edward; Burrows, Kimberley; Hummel, Oliver; Grosche, Sarah; Brumpton, Ben M; Witte, John S; Hottenga, Jouke-Jan; Willemsen, Gonneke; Zheng, Jie; Rodríguez, Elke; Hotze, Melanie; Franke, Andre; Revez, Joana A; Beesley, Jonathan; Matheson, Melanie C; Dharmage, Shyamali C; Bain, Lisa M; Fritsche, Lars G; Gabrielsen, Maiken E; Balliu, Brunilda; Nielsen, Jonas B; Zhou, Wei; Hveem, Kristian; Langhammer, Arnulf; Holmen, Oddgeir L; Løset, Mari; Abecasis, Gonçalo R; Willer, Cristen J; Arnold, Andreas; Homuth, Georg; Schmidt, Carsten O; Thompson, Philip J; Martin, Nicholas G; Duffy, David L; Novak, Natalija; Schulz, Holger; Karrasch, Stefan; Gieger, Christian; Strauch, Konstantin; Melles, Ronald B; Hinds, David A; Hübner, Norbert; Weidinger, Stephan; Magnusson, Patrik K E; Jansen, Rick; Jorgenson, Eric; Lee, Young-Ae; Boomsma, Dorret I; Almqvist, Catarina; Karlsson, Robert; Koppelman, Gerard H; Paternoster, Lavinia

2017-12-01

Asthma, hay fever (or allergic rhinitis) and eczema (or atopic dermatitis) often coexist in the same individuals, partly because of a shared genetic origin. To identify shared risk variants, we performed a genome-wide association study (GWAS; n = 360,838) of a broad allergic disease phenotype that considers the presence of any one of these three diseases. We identified 136 independent risk variants (P < 3 × 10 -8 ), including 73 not previously reported, which implicate 132 nearby genes in allergic disease pathophysiology. Disease-specific effects were detected for only six variants, confirming that most represent shared risk factors. Tissue-specific heritability and biological process enrichment analyses suggest that shared risk variants influence lymphocyte-mediated immunity. Six target genes provide an opportunity for drug repositioning, while for 36 genes CpG methylation was found to influence transcription independently of genetic effects. Asthma, hay fever and eczema partly coexist because they share many genetic risk variants that dysregulate the expression of immune-related genes.

Shared genetic origin of asthma, hay fever and eczema elucidates allergic disease biology

PubMed Central

Esparza-Gordillo, Jorge; Medway, Chris W; Mountjoy, Edward; Burrows, Kimberley; Hummel, Oliver; Grosche, Sarah; Brumpton, Ben M; Witte, John S; Hottenga, Jouke-Jan; Willemsen, Gonneke; Zheng, Jie; Rodríguez, Elke; Hotze, Melanie; Franke, Andre; Revez, Joana A; Beesley, Jonathan; Matheson, Melanie C; Dharmage, Shyamali C; Bain, Lisa M; Fritsche, Lars G; Gabrielsen, Maiken E; Balliu, Brunilda; Nielsen, Jonas B; Zhou, Wei; Hveem, Kristian; Langhammer, Arnulf; Holmen, Oddgeir L; Løset, Mari; Abecasis, Gonçalo R; Willer, Cristen J; Arnold, Andreas; Homuth, Georg; Schmidt, Carsten O; Thompson, Philip J; Martin, Nicholas G; Duffy, David L; Novak, Natalija; Schulz, Holger; Karrasch, Stefan; Gieger, Christian; Strauch, Konstantin; Melles, Ronald B; Hinds, David A; Hübner, Norbert; Weidinger, Stephan; Magnusson, Patrik KE; Jansen, Rick; Jorgenson, Eric; Lee, Young-Ae; Boomsma, Dorret I; Almqvist, Catarina; Karlsson, Robert; Koppelman, Gerard H; Paternoster, Lavinia

2017-01-01

Asthma, hay fever (or allergic rhinitis) and eczema (or atopic dermatitis) often coexist in the same individuals1, partly because of a shared genetic origin2–4. To identify shared risk variants, we performed a genome-wide association study (GWAS, n=360,838) of a broad allergic disease phenotype that considers the presence of any one of these three diseases. We identified 136 independent risk variants (P<3x10-8), including 73 not previously reported, which implicate 132 nearby genes in allergic disease pathophysiology. Disease-specific effects were detected for only six variants, confirming that most represent shared risk factors. Tissue-specific heritability and biological process enrichment analyses suggest that shared risk variants influence lymphocyte-mediated immunity. Six target genes provide an opportunity for drug repositioning, while for 36 genes CpG methylation was found to influence transcription independently of genetic effects. Asthma, hay fever and eczema partly coexist because they share many genetic risk variants that dysregulate the expression of immune-related genes. PMID:29083406

'Patient's delay'--analysis of the preclinical phase of occupational dermatoses.

PubMed

Rusca, C; Hinnen, U; Elsner, P

1997-01-01

In order to cure diseases effectively it is important that they are detected in their early stages so that medical precautions can be taken. With job-related disorders it is conceivable that anxiety concerning the workplace, as well as other factors of a demanding nature, may lead to a further delay of diagnosis and treatment. The study was carried out for the purpose of gathering information about the patients' reactions in the preclinical phase of job-related eczema. 79 patients suffering from a job-related skin disease were questioned. The patients were divided up into groups according to their respective delay and the results evaluated in line with the method of logistic regression. The average delay was 8.6 months. Fear of losing their job was mentioned by most participants as the reason for the postponement of seeking medical care. People with a long delay were mainly men, senior and Swiss citizens, those with a higher education and those with a longer professional training. Patient delay in occupational dermatology highly depends on the support of employers and on the counseling of workers on job-related skin disease and their insurance protection.

[Research on Kathon CG in cosmetic and personal hygiene products].

PubMed

Vezia, V; Renacco, E; Castelain, P Y; Caperan, A; Lanza, M; Pastor, J

1990-09-01

Kathon is an anti-microbial agent that is used as a preservative in cosmetics and bodily hygiene products. At the recommended levels of usage Kathon is innocuous and has a recognised efficacy. Nevertheless, following reappearance of contact allergic eczemas due to cosmetics and bodily hygiene products different authors have reported increase in sensitisation to it. We have met the same problems in the Service de Dermatology++ of the Hospital Sainte Marguerite at Marseille and we wished to make a deeper examination of the question and to ascertain whether the current cosmetics contained Kathon CG. For this we have developed a technique of liquid chromatography and tested 44 creams. Eight contained Kathon CG, of which 2 were responsible for contact eczema in patients.

Atopic eczema and the filaggrin story.

PubMed

Brown, Sara J; Irvine, Alan D

2008-06-01

The discovery that null mutations in the filaggrin gene (FLG) are associated with atopic eczema represents the single most significant breakthrough in understanding the genetic basis of this complex disorder. The association has been replicated in multiple independent studies during the past 2 years with the use of various methodologies, from populations in Europe, the United States, and Japan. Filaggrin plays a key role in epidermal barrier function, and its association with atopic eczema emphasizes the importance of barrier dysfunction in eczema pathogenesis. This review aims to summarize the current state of knowledge regarding the role of FLG mutations in ichthyosis vulgaris, atopic eczema, and other skin disorders, with an emphasis on potential clinical applications. Further research is needed to clarify the precise role of filaggrin in skin and systemic atopic disease, to pave the way for novel therapeutic interventions.

Maternal meat and fat consumption during pregnancy and suspected atopic eczema in Japanese infants aged 3-4 months: the Osaka Maternal and Child Health Study.

PubMed

Saito, Kyoko; Yokoyama, Tetsuji; Miyake, Yoshihiro; Sasaki, Satoshi; Tanaka, Keiko; Ohya, Yukihiro; Hirota, Yoshio

2010-02-01

Interest has increased in the possibility that maternal dietary intake during pregnancy might influence the development of allergic disorders in children. The present prospective study examined the association of maternal intake of selected foods high in fatty acids and specific types of fatty acids during pregnancy with the risk of suspected atopic eczema among Japanese infants aged 3-4 months. Subjects were 771 mother-child pairs. Information on maternal dietary intake during pregnancy was assessed with a validated self-administered diet history questionnaire. The term 'suspected atopic eczema' was used to define an outcome based on results of our questionnaire completed by mothers 3-4 months postpartum. The risk of suspected atopic eczema was 8.4% (n = 65). Higher maternal intake of meat during pregnancy was significantly associated with an increased risk of suspected atopic eczema in the offspring: the multivariate odds ratio (OR) for the highest vs. lowest quartile was 2.59 [95% confidence interval (CI): 1.15-6.17, p for trend = 0.01]. The positive association was strengthened when the definition of the outcome was confined to a definite physician's diagnosis of atopic eczema (n = 35): the multivariate OR between extreme quartiles was 3.53 (95% CI: 1.19-12.23, p for trend = 0.02). No material exposure-response relationships were observed between maternal intake of eggs, dairy products, fish, total fat, saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, alpha-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n-6 polyunsaturated fatty acids, linoleic acid, arachidonic acid and cholesterol and the ratio of n-3 to n-6 polyunsaturated fatty acid consumption and the risk of suspected atopic eczema. Higher maternal meat intake may increase the risk of infantile atopic eczema, whereas we found no evidence that maternal intake of fish and n-3 polyunsaturated fatty acids are preventive against infantile atopic eczema. (c) 2009 John Wiley & Sons A/S

Lifetime prevalence of childhood eczema and the effect of indoor environmental factors: Analysis in Hispanic and non-Hispanic white children

PubMed Central

Kim, Hyo-Bin; Zhou, Hui; Kim, Jeong Hee; Habre, Rima; Bastain, Theresa M.

2016-01-01

Background: The prevalence of eczema varies markedly across the globe. It is unclear whether the geographic variation is due to race and/or ethnic differences, environmental exposures, or genetic factors. Objective: We investigated the effects of ethnicity and environmental exposures on eczema in Hispanic white and non-Hispanic white children who participated in the Southern California Children's Health Study. Methods: We performed a cross-sectional study with sociodemographic predictors and environmental exposures among Hispanic white and non-Hispanic white children ages 4–8 years enrolled in the Children's Health Study, 2002–2003. Results: Eczema prevalence differed by ethnicity: Hispanic whites showed lower prevalence (13.8%) compared with non-Hispanic whites (20.2%), and adjustment for sociodemographic factors did not account for the ethnic difference (odds ratio [OR] 0.79 [95% confidence interval {CI}, 0.65–0.95]). Parental history of allergic disease had a larger effect in Hispanic whites than in non-Hispanic whites (p for interaction = 0.005). High maternal education level (OR 1.46 [95% CI, 1.14–1.87]), parental history of allergic disease (OR 2.21 [95% CI, 1.78–2.76]), and maternal smoking during pregnancy (OR 1.44 [95% CI, 1.06–1.95]) increased the risk of eczema. Indoor environmental factors (e.g., mold, water damage, humidifier use) increased the risk of eczema in non-Hispanic whites independent of a parental history of allergic disease, but, in Hispanic whites, increased risks were observed, primarily in children without a parental history of allergic disease. Conclusion: Hispanic white children in southern California had a lower prevalence of eczema than non-Hispanic whites, and this ethnic difference was not accounted for by sociodemographic differences. The effects of a parental history of allergic disease and indoor environmental exposures on eczema varied by ethnicity, which indicated that the etiology of eczema may differ in Hispanic whites and in non-Hispanic whites. PMID:26831849

Timing of eczema onset and risk of food allergy at 3 years of age: A hospital-based prospective birth cohort study.

PubMed

Shoda, Tetsuo; Futamura, Masaki; Yang, Limin; Yamamoto-Hanada, Kiwako; Narita, Masami; Saito, Hirohisa; Ohya, Yukihiro

2016-11-01

Although recent studies suggest that eczema in early childhood is important in the development of food allergy, the importance of the timing of eczema onset has not been fully clarified. This study aim to identify an association between the timing of eczema onset and development of food allergy in a prospective birth cohort study. Data were obtained from the Tokyo Children's Health, Illness and Development (T-CHILD) study, which is a hospital-based birth cohort study currently in progress in Japan. A total of 1550 children were born to the recruited women. Outcome data for children were collected from questionnaires completed at 6 months, 1 and 3 years of age. Association between the timing of eczema onset and development of food allergy was estimated by logistic regression analyses. All analysis were performed using SPSS software with a two-sided 5% significance level. Eczema in the first year of life was a significant risk factor in multivariate analysis (aOR 3.90, 95% CI 2.34-6.52, p<0.001). In each age (by month) stratum, infants with onset of eczema within the first 1-2 months after birth had the highest risk of food allergy at 3 years of age (aOR 6.61, 95% CI 3.27-13.34, p<0.001). Infants with early eczema onset (especially within the first 1-4 months after birth) were found to have an increased risk of developing food allergy at 3 years of age. Our findings may contribute to a better understanding of the timing of eczema onset as a potentially modifiable risk factor and to defining those who may need to be on guard for food allergy. Copyright © 2016 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

Lifetime prevalence of childhood eczema and the effect of indoor environmental factors: Analysis in Hispanic and non-Hispanic white children.

PubMed

Kim, Hyo-Bin; Zhou, Hui; Kim, Jeong Hee; Habre, Rima; Bastain, Theresa M; Gilliland, Frank D

2016-01-01

The prevalence of eczema varies markedly across the globe. It is unclear whether the geographic variation is due to race and/or ethnic differences, environmental exposures, or genetic factors. We investigated the effects of ethnicity and environmental exposures on eczema in Hispanic white and non-Hispanic white children who participated in the Southern California Children's Health Study. We performed a cross-sectional study with sociodemographic predictors and environmental exposures among Hispanic white and non-Hispanic white children ages 4-8 years enrolled in the Children's Health Study, 2002-2003. Eczema prevalence differed by ethnicity: Hispanic whites showed lower prevalence (13.8%) compared with non-Hispanic whites (20.2%), and adjustment for sociodemographic factors did not account for the ethnic difference (odds ratio [OR] 0.79 [95% confidence interval {CI}, 0.65-0.95]). Parental history of allergic disease had a larger effect in Hispanic whites than in non-Hispanic whites (p for interaction = 0.005). High maternal education level (OR 1.46 [95% CI, 1.14-1.87]), parental history of allergic disease (OR 2.21 [95% CI, 1.78-2.76]), and maternal smoking during pregnancy (OR 1.44 [95% CI, 1.06-1.95]) increased the risk of eczema. Indoor environmental factors (e.g., mold, water damage, humidifier use) increased the risk of eczema in non-Hispanic whites independent of a parental history of allergic disease, but, in Hispanic whites, increased risks were observed, primarily in children without a parental history of allergic disease. Hispanic white children in southern California had a lower prevalence of eczema than non-Hispanic whites, and this ethnic difference was not accounted for by sociodemographic differences. The effects of a parental history of allergic disease and indoor environmental exposures on eczema varied by ethnicity, which indicated that the etiology of eczema may differ in Hispanic whites and in non-Hispanic whites.

Infant feeding patterns and eczema in children in the first 6 years of life.

PubMed

Soto-Ramírez, N; Kar, S; Zhang, H; Karmaus, W

2017-10-01

Modes of infant feeding such as direct and indirect breastfeeding, and formula feeding, and their combinations may play a role in child health. The aim was to investigate which feeding patterns in the first 6 months pose risks of eczema/skin allergy in children up to 6 years compared to direct breastfeeding for at least 3 months. The Infant Feeding Practices Study II in the United States and its 6-year follow-up provided data on feeding modes in infancy and doctor's diagnosed eczema/skin allergy in the first 6 years of life (1387 infants), based on parental reports. Different feeding patterns were identified. Log-linear models were used to estimate prevalence ratios (PRs) of feeding patterns for doctor's diagnosed eczema/skin allergy in the first 6 years of life, adjusting for confounders. Compared to "direct breastfeeding for at least 3 months" (DBF3m), the combination of "direct feeding at the breast (DBF), pumping and feeding breast milk (BM), and formula (FF) in the first months" (DBF/BM/FF) showed a statistically significant higher risk of eczema/skin allergy in the first 6 years of life (PR = 1.46), adjusting for confounders. DBF combined with BM for the first 3 months followed by mixed feeding also had an increased risk (PR = 1.26), although not statistically significant. Formula feeding introduced since birth had no effect on eczema. Among the confounders, paternal eczema and race/ethnicity (Hispanic vs White) were associated with a higher risk of eczema/skin allergy. Mixed infant feeding may carry a higher risk of eczema/skin allergy compared to direct feeding at the breast. The recent epidemic of pumping and feeding in the United States and the use of mixed infant feeding modes requires additional studies to provide appropriate and renewed assessments of the risks of feeding modes for the future development of allergies. © 2017 John Wiley & Sons Ltd.

Prenatal Omega-3 Supplementation and Eczema Risk among Offspring at Age 36 Months.

PubMed

Berman, D; Clinton, C; Limb, R; Somers, E C; Romero, V; Mozurkewich, E

2016-01-01

Long-term follow-up was completed in 84 mother-infant pairs of 118 women who completed a randomized controlled trial of prenatal supplementation with EPA- or DHA-rich fish oil or soy oil placebo. The goal of this study was to determine whether prenatal omega-3 fatty acid supplementation protects offspring against development of early childhood allergies. Assessment of childhood allergic/atopic disease among offspring at age 36 months was performed by maternal interview using the National Health Interview Survey (NHIS) questions for childhood digestive allergies, wheezing, eczema or skin allergy, and respiratory allergy. Multiple logistic regressions examined the association between prenatal supplementation and childhood outcomes, adjusted for covariates. Eczema was reported in 26/84 (31%) of offspring at age 36 months, and was significantly more prevalent in the omega-3 supplementation groups vs. placebo: EPA 13/31 (41.9%); DHA 10/26 (38.5%); placebo 3/27 (11.1%), p=0.019. Compared to placebo, EPA and DHA were associated with ≥5 times risk of offspring eczema [odds ratios (ORs): EPA 5.8 (95% CI 1.4-23.3); DHA 5.0 (95% CI 1.2-21.0)]. After adjusting for other potential risk factors (race, birth weight, vaginal/Cesarean delivery, and maternal eczema) the magnitudes of association for omega-3 supplementation increased: EPA OR 8.1 (95% CI 1.4-45.6); DHA OR 9.6 (95% CI 1.6-58.5). Maternal eczema was also significantly associated with offspring eczema in the adjusted model: OR 10.8 (95% CI 2.1-54.3). Contrary to our hypothesis, acids supplementation compared to soy oil was associated with a substantial increase in risk of childhood eczema. This association was not observed on childhood respiratory or digestive outcomes. It is unclear if these findings were driven by unfavorable effects of omega-3s, or whether there may have been unanticipated protective effects of the soy-based placebo with regards to eczema.

Pediatric access to dermatologists: Medicaid versus private insurance.

PubMed

Chaudhry, Sofia B; Armbrecht, Eric S; Shin, Yoon; Matula, Sarah; Caffrey, Charles; Varade, Reena; Jones, Lisa; Siegfried, Elaine

2013-05-01

There is disparity in access to outpatient care for Medicaid beneficiaries. This inequity disproportionately impacts children. Access for children with skin disease may be especially limited. We sought to compare access to dermatologists for new pediatric patients insured by Medicaid versus a private plan. We surveyed 13 metropolitan markets by conducting secret-shopper scripted telephone calls to dermatology providers listed by Medicaid health plans. Paired calls, differing by insurance type, were made to each office on the same day, portraying a parent requesting a new appointment for a child with eczema. We called the offices of 723 Medicaid-listed providers. Final analysis included 471 dermatologists practicing general dermatology. Of these, an average of 44% refused a new Medicaid-insured pediatric patient. The average wait time for an appointment did not significantly vary between insurance types. Assuming that dermatologists not listed as Medicaid providers do not see Medicaid-insured children, our data indicate that pediatric Medicaid acceptance rates ranged from 6% to 64% by market, with an overall market size-weighted average acceptance rate of 19%. Relative reimbursement levels for Medicaid-insured patients did not correlate with acceptance rates. Although the most current health plan directories were used to create calling lists, these are dynamic. The sample sizes of confirmed appointments were in part limited by a lack of referral letters and/or health plan identification numbers. Only confirmed appointments were used to calculate average wait times. Access to dermatologists is limited for Medicaid-insured children with eczema. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Sleep and neurocognitive functioning in children with eczema.

PubMed

Camfferman, Danny; Kennedy, J Declan; Gold, Michael; Simpson, Carol; Lushington, Kurt

2013-08-01

Sleep disruption in childhood is associated with clearly defined deficits in neurocognition and behaviour. Childhood eczema is also a potent cause of sleep disruption though it is unknown whether it too results in neurocognitive deficits. To test this hypothesis, neurocognitive (WISC-IV), parental-reported sleep quality (Sleep Disturbance Scale of Children (SDSC)) and overnight polysomnographic (PSG) data were collected in 21 children with eczema and 20 healthy controls (age range 6-16 years). Children with eczema had worse sleep quality on both PSG (notably increased nocturnal wakefulness, a higher number of stage shifts and a longer latency to REM onset) and parental report. In addition, they demonstrated significant neurocognitive deficits (especially verbal comprehension, perceptual reasoning and to a lesser extent working memory) with a composite Full Scale IQ 16 points lower than controls. Parental reported sleep problems but not PSG parameters were correlated with reduced neurocognitive performance. However, hierarchical regression analyses revealed that eczema status was predictive while sleep fragmentation (parental or PSG) was not predictive of neurocognitive performance. As this is the first study to systematically examine neurocognitive functioning in children with eczema and given the finding of significant deficits it merits replication especially given the prevalence of the condition. The unanswered question is whether these cognitive deficits normalise with effective eczema treatment and if this is mediated by improvements in sleep architecture. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Difficulties in avoiding exposure to allergens in cosmetics.

PubMed

Noiesen, Eline; Munk, Martin D; Larsen, Kristian; Johansen, Jeanne Duus; Agner, Tove

2007-08-01

The aim of the study is to describe the ability of patients with allergic contact dermatitis to avoid exposure to allergens in cosmetics. The study is a questionnaire survey among 382 patients with contact allergy to preservatives and fragrances, included from 3 dermatological clinics. The questionnaire included questions about the level of difficulty in reading labels of ingredients on cosmetics and about patients' strategies to avoid substances they were allergic to. It also included questions about eczema severity as well as about educational level. 46% of the patients found it difficult or extremely difficult to read the ingredient labelling of cosmetics, and this finding was significantly related to low educational level. Patients allergic to formaldehyde and methyldibromo glutaronitrile experienced the worst difficulties, while patients with fragrance allergy found ingredient label reading easier than patients with preservative allergy. Reading of ingredient labels is a major problem for patients with contact allergy to allergens in consumer products. It is a general problem for all patients and not restricted to a small group with multiple allergies.

Combined effects of prenatal medication use and delivery type are associated with eczema at age 2 years.

PubMed

Wegienka, G; Havstad, S; Zoratti, E M; Kim, H; Ownby, D R; Johnson, C C

2015-03-01

Separately, prenatal antibiotics and Caesarian delivery have been found to be associated with increased risk of allergic diseases. It is not clear whether these factors may modify the effect of each other. To assess whether the associations between delivery types and eczema, sensitization and total IgE at age 2 years were modified by maternal use of prenatal medications. Prenatal charts of women enrolled in the WHEALS birth cohort were reviewed for delivery mode and medications prescribed and administered throughout their entire pregnancy, including systemic antibiotics and vaginally applied antifungal medications. The associations between the delivery mode and select medications and, eczema, sensitization (≥ 1 of 10 allergen-specific IgE ≥ 0.35 IU/mL) and total IgE at age 2 years were assessed. There was a lower risk of eczema among vaginally vs. c-section born children (relative risk adjusted for race = aRR = 0.77, 95% CI 0.56, 1.05). Although not statistically significantly different, this association was stronger among the subset of children born vaginally to a mother who did not use systemic antibiotics or vaginal antifungal medications (aRR = 0.69, 95% CI 0.44, 1.08) compared to those born vaginally to mothers who used systemic antibiotics or vaginal antifungals (aRR = 0.81, 95% CI 0.57, 1.14). A protective association between vaginal birth and sensitization (aRR = 0.86, 95% CI 0.72, 1.03) was similar for those children born vaginally to a mother who did not (aRR = 0.87, 95% CI 0.69, 1.10) and who did (RR = 0.85, 95% CI 0.70, 1.04) use systemic antibiotics or vaginal antifungal medications. There were no associations with total IgE. Children born vaginally had lower risk of eczema and sensitization compared with those born via c-section; however, the protective association with eczema may be slightly weakened when mothers took systemic antibiotics or vaginally applied medications during pregnancy. © 2014 John Wiley & Sons Ltd.

Prevalence and factors linked to atopic eczema in 10- and 11-year-old schoolchildren. Isaac 2 in Almeria, Spain.

PubMed

Batlles Garrido, J; Torres-Borrego, J; Bonillo Perales, A; Rubí Ruiz, T; González Jiménez, Y; Momblán De Cabo, J; Aguirre Rodríguez, J; Jiménez Liria, R; Losilla Maldonado, A; Daza Torres, M

2010-01-01

Atopic eczema affects 5-10% of the Spanish paediatric population, and has increased in frequency over the last few decades, probably due to changes in the environment and lifestyle. Phase II of the ISAAC (International Study of Asthma and Allergies in Childhood) uses a standardised methodology to establish the prevalence of allergic disorders and factors linked to them in each centre. To assess the prevalence and severity of atopic eczema, and to establish factors linked to atopic eczema in 10-11 year-old school children in the city of Almeria (South-East coast of Spain). An ecological study was carried out as part of ISAAC II, using homologated questionnaires and allergic tests in 1143 schoolchildren. Statistic association was assessed by means of chi(2) test, and then logistic regression analysis was performed with the most significant variables from the univariant analysis. The prevalence of atopic eczema was 11.4%. The risk factors found in the multiple logistic regression analysis were: personal antecedents of severe asthma (OR 19 CI 95% 1.35-266) and severe rhinitis (OR 7.7 CI 95% 1.79-33), fungi in bedroom during the first year of life (OR 4.2 CI 95% 1.17-15.1) and atopic eczema in one parent (OR 5.2 CI 95% 2.69-10.1). The prevalence of atopic eczema is similar to that found in other studies within ISAAC Phase I. The most important risk factors for atopic eczema are family and personal history of other atopic diseases and the presence of fungi in the home. Copyright 2009 SEICAP. Published by Elsevier Espana. All rights reserved.

A Randomised Controlled Trial of Ion-Exchange Water Softeners for the Treatment of Eczema in Children

PubMed Central

Thomas, Kim S.; Dean, Tara; O'Leary, Caroline; Sach, Tracey H.; Koller, Karin; Frost, Anthony; Williams, Hywel C.

2011-01-01

Background Epidemiological studies and anecdotal reports suggest a possible link between household use of hard water and atopic eczema. We sought to test whether installation of an ion-exchange water softener in the home can improve eczema in children. Methods and Findings This was an observer-blind randomised trial involving 336 children (aged 6 months to 16 years) with moderate/severe atopic eczema. All lived in hard water areas (≥200 mg/l calcium carbonate). Participants were randomised to either installation of an ion-exchange water softener plus usual eczema care, or usual eczema care alone. The primary outcome was change in eczema severity (Six Area Six Sign Atopic Dermatitis Score, SASSAD) at 12 weeks, measured by research nurses who were blinded to treatment allocation. Analysis was based on the intent-to-treat population. Eczema severity improved for both groups during the trial. The mean change in SASSAD at 12 weeks was −5.0 (20% improvement) for the water softener group and −5.7 (22% improvement) for the usual care group (mean difference 0.66, 95% confidence interval −1.37 to 2.69, p = 0.53). No between-group differences were noted in the use of topical corticosteroids or calcineurin inhibitors. Conclusions Water softeners provided no additional benefit to usual care in this study population. Small but statistically significant differences were found in some secondary outcomes as reported by parents, but it is likely that such improvements were the result of response bias, since participants were aware of their treatment allocation. A detailed report for this trial is also available at http://www.hta.ac.uk. Trial registration Current Controlled Trials ISRCTN71423189 Please see later in the article for the Editors' Summary PMID:21358807

Variants of the FADS1 FADS2 Gene Cluster, Blood Levels of Polyunsaturated Fatty Acids and Eczema in Children within the First 2 Years of Life

PubMed Central

Rzehak, Peter; Thijs, Carel; Standl, Marie; Mommers, Monique; Glaser, Claudia; Jansen, Eugène; Klopp, Norman; Koppelman, Gerard H.; Singmann, Paula; Postma, Dirkje S.; Sausenthaler, Stefanie; Dagnelie, Pieter C.; van den Brandt, Piet A.; Koletzko, Berthold; Heinrich, Joachim

2010-01-01

Background Association of genetic-variants in the FADS1-FADS2-gene-cluster with fatty-acid-composition in blood of adult-populations is well established. We analyze this genetic-association in two children-cohort-studies. In addition, the association between variants in the FADS-gene-cluster and blood-fatty-acid-composition with eczema was studied. Methods and Principal Findings Data of two population-based-birth-cohorts in the Netherlands and Germany (KOALA, LISA) were pooled (n = 879) and analyzed by (logistic) regression regarding the mutual influence of single-nucleotide-polymorphisms (SNPs) in the FADS-gene-cluster (rs174545, rs174546, rs174556, rs174561, rs3834458), on polyunsaturated fatty acids (PUFA) in blood and parent-reported eczema until the age of 2 years. All SNPs were highly significantly associated with all PUFAs except for alpha-linolenic-acid and eicosapentaenoic-acid, also after correction for multiple-testing. All tested SNPs showed associations with eczema in the LISA-study, but not in the KOALA-study. None of the PUFAs was significantly associated with eczema neither in the pooled nor in the analyses stratified by study-cohort. Conclusions and Significance PUFA-composition in young children's blood is under strong control of the FADS-gene-cluster. Inconsistent results were found for a link between these genetic-variants with eczema. PUFA in blood was not associated with eczema. Thus the hypothesis of an inflammatory-link between PUFA and eczema by the metabolic-pathway of LC-PUFAs as precursors for inflammatory prostaglandins and leukotrienes could not be confirmed by these data. PMID:20948998

‘You don't know which bits to believe’: qualitative study exploring carers’ experiences of seeking information on the internet about childhood eczema

PubMed Central

Santer, Miriam; Muller, Ingrid; Yardley, Lucy; Burgess, Hana; Ersser, Steven J; Lewis-Jones, Sue; Little, Paul

2015-01-01

Objective We sought to explore parents and carers’ experiences of searching for information about childhood eczema on the internet. Design A qualitative interview study was carried out among carers of children aged 5 years or less with a recorded diagnosis of eczema. The main focus of the study was to explore carers’ beliefs and understandings around eczema and its treatment. As part of this, we explored experiences of formal and informal information seeking about childhood eczema. Transcripts of interviews were analysed thematically. Setting Participants were recruited from six general practices in South West England. Participants Interviews were carried out with 31 parents from 28 families. Results Experiences of searching for eczema information on the internet varied widely. A few interviewees were able to navigate through the internet and find the specific information they were looking for (for instance about treatments their child had been prescribed), but more found searching for eczema information online to be a bewildering experience. Some could find no information of relevance to them, whereas others found the volume of different information sources overwhelming. Some said that they were unsure how to evaluate online information or that they were wary of commercial interests behind some information sources. Interviewees said that they would welcome more signposting towards high quality information from their healthcare providers. Conclusions We found very mixed experiences of seeking eczema information on the internet; but many participants in this study found this to be frustrating and confusing. Healthcare professionals and healthcare systems have a role to play in helping people with long-term health conditions and their carers find reliable online information to support them with self-care. PMID:25854963

Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus.

PubMed

Schmitt, J; Chen, C-M; Apfelbacher, C; Romanos, M; Lehmann, I; Herbarth, O; Schaaf, B; Kraemer, U; von Berg, A; Wichmann, H-E; Heinrich, J

2011-03-01

Cross-sectional studies suggest an association between eczema and mental health problems, possibly modified by sleeping problems, but prospective evidence is missing. We aimed to prospectively investigate the relationship between infant eczema (within first 2 years of age), infant sleeping problems (within first 2 years of age), and the risk of mental health problems at 10 years of age. Between 1997 and 1999, a population-based birth cohort was recruited in Munich, Leipzig, Wesel, and Bad Honnef, Germany, and followed until 10 years of age. Physician-diagnosed eczema, parent-reported sleeping problems, and known environmental risk factors for atopy were regularly assessed until 10 years of age. Mental health was measured using the Strengths and Difficulties Questionnaire (parent version) at 10 years of age. We applied logistic regression modeling adjusting for environmental and lifestyle factors, allergic comorbidity, and family history of eczema. From the original cohort of 3097 neonates, 1658 (54%) were followed until age 10, while 1578 (51%) were eligible for analysis. In the fully adjusted model, children with infant eczema were at increased risk of hyperactivity/inattention at 10 years of age [odds ratio (OR) 1.78; 95% confidence interval (95% CI) 1.02-3.09]. Infant eczema with concurrent sleeping problems predicted emotional problems [OR 2.63; 95% confidence interval (95% CI) 1.20-5.76] and conduct problems (OR 3.03; 95% CI 1.01-9.12) at 10 years of age. Infant eczema with concurrent sleeping problems appears to be a risk factor for the development of mental health problems. © 2010 John Wiley & Sons A/S.

Children and adolescents' health-related quality of life in relation to eczema, asthma and hay fever: results from a population-based cross-sectional study.

PubMed

Matterne, Uwe; Schmitt, Jochen; Diepgen, Thomas L; Apfelbacher, Christian

2011-10-01

Several studies have looked at the relationship between childhood atopic disease and health-related quality of life (HRQoL), but existing research is limited by selected populations, small samples or lack to consider each of the three atopic conditions simultaneously. Impact of 4-week and 12-month occurrences of the three conditions on HRQoL were analysed by the use of complex sample general linear models alone and adjusted for the other atopic conditions, sociodemographics and mental health in a population-based sample (n = 6,518) of children and adolescents aged 11-17. In univariate analyses, total HRQoL was significantly impacted by eczema and hay fever but not asthma with stronger effects for 4-week occurrence. In multivariate analyses, 12-month occurrence of hay fever and 4-week occurrence of eczema and hay fever significantly impacted on total HRQoL. Although most of the variance in HRQoL was explained by mental health, independent effects of the atopic conditions remained. Atopic conditions impact HRQoL over and above mental health. When analysing the relationship between atopic conditions and HRQoL, it is important to consider more immediate versus less immediate effects of the conditions. Extent of impairment and the domains affected appear to vary when different time intervals are used.

Tinea incognito in Korea and its risk factors: nine-year multicenter survey.

PubMed

Kim, Won-Jeong; Kim, Tae-Wook; Mun, Je-Ho; Song, Margaret; Kim, Hoon-Soo; Ko, Hyun-Chang; Kim, Byung-Soo; Park, Chun Wook; Lee, Seok-Jong; Lee, Mu Hyoung; Lee, Kyu Suk; Kye, Young Chul; Suh, Kee Suck; Chung, Hyun; Lee, Ai Young; Kim, Ki Ho; Lee, Sook Kyung; Park, Kyoung Chan; Lee, Jun Young; Choi, Jee Ho; Lee, Eun-So; Lee, Kwang Hoon; Choi, Eung Ho; Seo, Jong Keun; Choi, Gwang Seong; Park, Hai Jin; Yun, Seok Kweon; Seo, Seong Jun; Yoon, Tae Young; Kim, Kwang Ho; Yu, Hee Joon; Ro, Young Suck; Kim, Moon-Bum

2013-01-01

Tinea incognito (TI) is a dermatophytic infection which has lost its typical clinical appearance because of improper use of steroids or calcineurin inhibitors. The incidence of TI is increasing nowadays. We conducted retrospective review on 283 patients with TI from 25 dermatology training hospitals in Korea from 2002-2010 to investigate the demographical, clinical, and mycological characteristics of TI, and to determine the associated risk factors. More than half (59.3%) patients were previously treated by non-dermatologists or self-treated. The mean duration of TI was 15.0 ± 25.3 months. The most common clinical manifestations were eczema-like lesion, psoriasis-like, and lupus erythematosus-like lesion. The trunk and face were frequently involved, and 91 patients (32.2%) also had coexisting fungal infections. Among 67 isolated strains, Trichophyton rubrum was the most frequently detected (73.1%). This is the largest study of TI reported to date and the first investigational report concerning TI in Korea. We suggest that doctors should consider TI when a patient has intractable eczema-like lesions accompanied by tinea pedis/unguium. Furthermore, there should be a policy change, which would make over-the-counter high-potency topical steroids less accessible in some countries, including Korea.

Eczema and sleep and its relationship to daytime functioning in children.

PubMed

Camfferman, Danny; Kennedy, John D; Gold, Michael; Martin, Alfred J; Lushington, Kurt

2010-12-01

Chronic childhood eczema has significant morbidity characterised by physical discomfort, emotional distress, reduced child and family quality-of-life and, of particular note, disturbed sleep characterised by frequent and prolonged arousals. Sleep disturbance affects up to 60% of children with eczema, increasing to 83% during exacerbation. Even when in clinical remission, children with eczema demonstrate more sleep disturbance than healthy children. Notably, disturbed sleep in otherwise healthy children is associated with behavioural and neurocognitive deficits. Preliminary evidence suggests that disturbed sleep in children with eczema is also associated with behavioural deficits while the impact on neuropsychological functioning remains unexplored. In conclusion, a disease which affects up to 20% of children in some countries and may produce long-term behavioural and neurocognitive deficits merits further evaluation using standardised tests of sleep, behaviour and neurocognition. Copyright © 2010 Elsevier Ltd. All rights reserved.

Flares in childhood eczema.

PubMed

Langan, S M

2009-01-01

Eczema is a major public health problem affecting children worldwide. Few studies have directly assessed triggers for disease flares. This paper presents evidence from a published systematic review and a prospective cohort study looking at flare factors in eczema. This systematic review suggested that foodstuffs in selected groups, dust exposure, unfamiliar pets, seasonal variation, stress, and irritants may be important in eczema flares. We performed a prospective cohort study that focused on environmental factors and identified associations between exposure to nylon clothing, dust, unfamiliar pets, sweating, shampoo, and eczema flares. Results from this study also demonstrated some new key findings. First, the effect of shampoo was found to increase in cold weather, and second, combinations of environmental factors were associated with disease exacerbation, supporting a multiple component disease model. This information is likely to be useful to families and may lead to the ability to reduce disease flares in the future.

A systematic approach to systemic contact dermatitis and symmetric drug-related intertriginous and flexural exanthema (SDRIFE): a closer look at these conditions and an approach to intertriginous eruptions.

PubMed

Winnicki, Monika; Shear, Neil H

2011-06-01

Systemic contact dermatitis is a condition that occurs when an individual sensitized to a contact allergen is exposed to that same allergen or a cross-reacting molecule through a systemic route. Systemic exposure to allergens can include transcutaneous, transmucosal, oral, intravenous, intramuscular, and inhalational routes. Baboon syndrome is perhaps the most recognizable form of systemic contact dermatitis, presenting with diffuse, well demarcated erythema of the buttocks, upper inner thighs, and axillae. Other forms of systemic contact dermatitis include dermatitis at sites of previous exposure to the allergen such as at a previous site of dermatitis or at sites of previous positive patch tests, dyshidrotic hand eczema, flexural dermatitis, exanthematous rash, erythroderma, and vasculitis-like lesions. The most common causes of systemic contact dermatitis consist of three groups of allergens: (i) metals including mercury, nickel, and gold; (ii) medications including aminoglycoside antibacterials, corticosteroids, and aminophylline; and (iii) plants and herbal products including the Compositae and Anacardiaceae plant families and Balsam of Peru. Baboon syndrome caused by systemic medications without a known history of previous cutaneous sensitization in the patient has been termed drug-related baboon syndrome (DRBS) or symmetric drug-related intertriginous and flexural exanthema (SDRIFE). Criteria for SDRIFE include exposure to systemic drug at first or repeated dose, erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal area, involvement of at least one other intertriginous localization, symmetry of affected areas, and absence of systemic toxicity. The most common causes are aminopenicillins, β-lactam antibacterials, and certain chemotherapeutic agents, though the list of etiologic agents continues to grow. Baboon syndrome and SDRIFE should be strongly considered in a patient presenting with a symmetric intertriginous eruption involving multiple body folds. With the knowledge of the most frequent causes of these conditions, a detailed history and review of exposures will guide the clinician in the search for the most likely etiologic agent.

Novel unconventional therapeutic approaches to atopic eczema.

PubMed

Worm, M; Henz, B M

2000-01-01

Atopic eczema is a chronic, recurrent, multifactorial skin disease, and, accordingly, there are numerous therapeutic options for its symptomatic treatment. Conventional medications are however often unsatisfactory for many patients because of adverse effects on long-term use. For this reason, patients often readily welcome unconventional therapeutic approaches. We present here a selected number of such treatment modalities, namely gamma-linolenic acid, Chinese herbal tea, diets eliminating allergens, pseudoallergens, metal salts and sodium, and bioresonance. When stringent scientific criteria are applied in the evaluation of such study results, none of the reviewed alternative treatments provides unequivocal, convincing evidence of its efficacy, even when double-blind, placebo-controlled studies are available. With Chinese herbal tea, potentially serious adverse effects should be considered as well. Any new type of unconventional therapy should thus be thoroughly evaluated and shown to be equal or superior to conventional treatments with regard to both efficacy and tolerability before it is recommended for use in clinical practice. Copyright 2000 S. Karger AG, Basel.

HLA-C expression pattern is spatially different between psoriasis and eczema skin lesions.

PubMed

Carlén, Lina; Sakuraba, Kazuko; Ståhle, Mona; Sánchez, Fabio

2007-02-01

Interactions between genetic and environmental factors underlie the immune dysregulation and keratinocyte abnormalities that characterize psoriasis. Among known psoriasis susceptibility loci (PSORS), PSORS1 on chromosome 6 has the strongest association to disease. Altered expression of some PSORS1 candidate genes has been reported but little is known about HLA-C expression in psoriasis. This study compared expression of major histocompatibility complex class Ia and HLA-C in psoriasis, allergic contact eczema, and normal skin. Although HLA-C was abundant in protein extracts from both eczema and psoriasis, a consistent and intriguing difference in the expression pattern was observed; strong immunoreactivity in the basal cell layer, polarized towards the basement membrane in psoriasis, whereas in eczema lesions HLA-C immunostaining was present mostly in suprabasal cells. Inflammatory cells in the dermis were strongly stained in both diseases. Normal skin epithelium showed less intense but similar HLA-C staining as eczema lesions. HLA class Ia expression overall resembled that of HLA-C in all samples. The distinct HLA-C expression patterns in psoriasis and eczema suggest a functional role in the specific psoriasis immune response and not only a general feature of inflammation.

Meta-analysis identifies seven susceptibility loci involved in the atopic march.

PubMed

Marenholz, Ingo; Esparza-Gordillo, Jorge; Rüschendorf, Franz; Bauerfeind, Anja; Strachan, David P; Spycher, Ben D; Baurecht, Hansjörg; Margaritte-Jeannin, Patricia; Sääf, Annika; Kerkhof, Marjan; Ege, Markus; Baltic, Svetlana; Matheson, Melanie C; Li, Jin; Michel, Sven; Ang, Wei Q; McArdle, Wendy; Arnold, Andreas; Homuth, Georg; Demenais, Florence; Bouzigon, Emmanuelle; Söderhäll, Cilla; Pershagen, Göran; de Jongste, Johan C; Postma, Dirkje S; Braun-Fahrländer, Charlotte; Horak, Elisabeth; Ogorodova, Ludmila M; Puzyrev, Valery P; Bragina, Elena Yu; Hudson, Thomas J; Morin, Charles; Duffy, David L; Marks, Guy B; Robertson, Colin F; Montgomery, Grant W; Musk, Bill; Thompson, Philip J; Martin, Nicholas G; James, Alan; Sleiman, Patrick; Toskala, Elina; Rodriguez, Elke; Fölster-Holst, Regina; Franke, Andre; Lieb, Wolfgang; Gieger, Christian; Heinzmann, Andrea; Rietschel, Ernst; Keil, Thomas; Cichon, Sven; Nöthen, Markus M; Pennell, Craig E; Sly, Peter D; Schmidt, Carsten O; Matanovic, Anja; Schneider, Valentin; Heinig, Matthias; Hübner, Norbert; Holt, Patrick G; Lau, Susanne; Kabesch, Michael; Weidinger, Stefan; Hakonarson, Hakon; Ferreira, Manuel A R; Laprise, Catherine; Freidin, Maxim B; Genuneit, Jon; Koppelman, Gerard H; Melén, Erik; Dizier, Marie-Hélène; Henderson, A John; Lee, Young Ae

2015-11-06

Eczema often precedes the development of asthma in a disease course called the 'atopic march'. To unravel the genes underlying this characteristic pattern of allergic disease, we conduct a multi-stage genome-wide association study on infantile eczema followed by childhood asthma in 12 populations including 2,428 cases and 17,034 controls. Here we report two novel loci specific for the combined eczema plus asthma phenotype, which are associated with allergic disease for the first time; rs9357733 located in EFHC1 on chromosome 6p12.3 (OR 1.27; P=2.1 × 10(-8)) and rs993226 between TMTC2 and SLC6A15 on chromosome 12q21.3 (OR 1.58; P=5.3 × 10(-9)). Additional susceptibility loci identified at genome-wide significance are FLG (1q21.3), IL4/KIF3A (5q31.1), AP5B1/OVOL1 (11q13.1), C11orf30/LRRC32 (11q13.5) and IKZF3 (17q21). We show that predominantly eczema loci increase the risk for the atopic march. Our findings suggest that eczema may play an important role in the development of asthma after eczema.

[Prevention of atopic eczema. Evidence based guidelines].

PubMed

Schäfer, T

2005-03-01

With an estimated prevalence of 12% for preschool children and 3% for adults, atopic eczema is a serious public health problem. This disease severely jeopardizes quality of life and is associated with considerable costs. Since there is still no causal therapy, primary and secondary prevention are especially important. Here the evidence basis for recommendations on prevention of atopic eczema is discussed on the basis of the first evidence-based consensus guideline (S3) on allergy prevention. This recommends that babies should be breastfed exclusively for at least 4 months and exposure to passive smoking be avoided even during pregnancy; restriction of the maternal diet during pregnancy has no influence, though during breastfeeding it can lower the incidence of eczema among babies at risk. Thereby this measure should be balanced with potential consequences of malnutrition. There seems to be a positive correlation between keeping small rodents (rabbits, guinea pigs), and possibly cats, and the occurrence of atopic eczema, while keeping dogs has no effect or even a protective effect. Avoidance of an unfavorable indoor climate is probably also helpful in preventing eczema. There is no evidence to support deviating from the current recommendations of the standing committee for vaccination.

Supporting Self-Care for Families of Children With Eczema With a Web-Based Intervention Plus Health Care Professional Support: Pilot Randomized Controlled Trial

PubMed Central

Muller, Ingrid; Yardley, Lucy; Burgess, Hana; Selinger, Hannah; Stuart, Beth L; Little, Paul

2014-01-01

Background Childhood eczema, or childhood atopic dermatitis, causes significant distress to children and their families through sleep disturbance and itch. The main cause of treatment failure is nonuse of prescribed treatments. Objective The objective of this study was to develop and test a Web-based intervention to support families of children with eczema, and to explore whether support from a health care professional (HCP) is necessary to engage participants with the intervention. Methods We followed the PRECEDE-PROCEED model: regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this. LifeGuide software was used to write the intervention website. Carers of children with eczema were invited through primary care mail-out and randomized to 3 groups: (1) website only, (2) website plus HCP support, or (3) usual care. Patient-Oriented Eczema Measure (POEM) scores were measured online by carer report at baseline and at 12 weeks. Qualitative interviews were carried out with 13 HCPs (primarily practice nurses) and 26 participants to explore their experiences of taking part in the study. Results A total of 143 carers were recruited through 31 practices. We found a decrease of ≥2 in follow-up compared with baseline POEM score in 23 of 42 (55%) participants in the website only group, 16 of 49 (33%) in the usual care group, and 18 of 47 (38%) in the website plus HCP group. Website use data showed that 75 of 93 (81%) participants allocated to the website groups completed the core modules, but less than half used other key components (videos: 35%; regular text reminders: 39%). There were no consistent differences in website use between the website only or the website plus HCP groups. Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in. However, HCPs reported productive consultations and that they found it helpful to use the website in consultations, while observing that some participants seemed to need more support than others. Qualitative interviews with participants suggested that HCP support was valued highly only by a minority, generally those who were less confident in their management of eczema or less confident using the Internet. Conclusions Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible. Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema. In this study population, HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 98560867; http://www.controlled-trials.com/ISRCTN98560867 (Archived by WebCite at http://www.webcitation.org/6NcxvMtgN). PMID:24594972

Supporting self-care for families of children with eczema with a Web-based intervention plus health care professional support: pilot randomized controlled trial.

PubMed

Santer, Miriam; Muller, Ingrid; Yardley, Lucy; Burgess, Hana; Selinger, Hannah; Stuart, Beth L; Little, Paul

2014-03-04

Childhood eczema, or childhood atopic dermatitis, causes significant distress to children and their families through sleep disturbance and itch. The main cause of treatment failure is nonuse of prescribed treatments. The objective of this study was to develop and test a Web-based intervention to support families of children with eczema, and to explore whether support from a health care professional (HCP) is necessary to engage participants with the intervention. We followed the PRECEDE-PROCEED model: regular emollient use was the target behavior we were seeking to promote and we identified potential techniques to influence this. LifeGuide software was used to write the intervention website. Carers of children with eczema were invited through primary care mail-out and randomized to 3 groups: (1) website only, (2) website plus HCP support, or (3) usual care. Patient-Oriented Eczema Measure (POEM) scores were measured online by carer report at baseline and at 12 weeks. Qualitative interviews were carried out with 13 HCPs (primarily practice nurses) and 26 participants to explore their experiences of taking part in the study. A total of 143 carers were recruited through 31 practices. We found a decrease of ≥2 in follow-up compared with baseline POEM score in 23 of 42 (55%) participants in the website only group, 16 of 49 (33%) in the usual care group, and 18 of 47 (38%) in the website plus HCP group. Website use data showed that 75 of 93 (81%) participants allocated to the website groups completed the core modules, but less than half used other key components (videos: 35%; regular text reminders: 39%). There were no consistent differences in website use between the website only or the website plus HCP groups. Qualitative feedback showed that most HCPs had initial concerns about providing support for eczema self-care because this was not a condition that they felt expert in. However, HCPs reported productive consultations and that they found it helpful to use the website in consultations, while observing that some participants seemed to need more support than others. Qualitative interviews with participants suggested that HCP support was valued highly only by a minority, generally those who were less confident in their management of eczema or less confident using the Internet. Our pilot trial demonstrated the potential for greater improvements in POEM scores in both website intervention groups and that a full-scale trial is feasible. Such a trial would quantify the effectiveness and cost-effectiveness of this intervention to determine whether it should be widely promoted to families of children with newly diagnosed eczema. In this study population, HCP support was not strongly valued by participants and did not lead to better outcomes or website use than use of the Web-based intervention alone. International Standard Randomized Controlled Trial Number (ISRCTN): 98560867; http://www.controlled-trials.com/ISRCTN98560867 (Archived by WebCite at http://www.webcitation.org/6NcxvMtgN).

Relevance of inhalant and food allergens to the etiology and management of patients with atopic dermatitis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Platts-Mills, T.A.; Mitchell, E.B.; Rowntree, S.

Patients with atopic dermatitis have IgE antibodies to common environmental antigens, both foods and inhalants. Such antibodies are probably relevant and exposure to the corresponding antigens can give rise to eczema. Nevertheless, the mechanisms involved and the role of other etiologies, e.g. contact reactions, remain to be elucidated. Patients with atopic dermatitis should have comprehensive evaluations to determine the role of environmental antigens.

Related Medical Conditions

MedlinePlus

... age of 5 years... Airborne allergens (e.g., pollen) may contribute to eczema flares in older children ... the nose. Most commonly associated with allergies to pollen, dust, and/or furred animals, its symptoms include ...

Herpesviruses and the microbiome.

PubMed

Dreyfus, David H

2013-12-01

The focus of this article will be to examine the role of common herpesviruses as a component of the microbiome of atopic patients and to review clinical observations suggesting that atopic patients might be predisposed to more severe and atypical herpes-related illness because their immune response is biased toward a TH2 cytokine profile. Human populations are infected with 8 herpesviruses, including herpes simplex virus HSV1 and HSV2 (also termed HHV1 and HHV2), varicella zoster virus (VZV or HHV3), EBV (HHV4), cytomegalovirus (HHV5), HHV6, HHV7, and Kaposi sarcoma-associated herpesvirus (termed KSV or HHV8). Herpesviruses are highly adapted to lifelong infection of their human hosts and thus can be considered a component of the human "microbiome" in addition to their role in illness triggered by primary infection. HSV1 and HSV2 infection and reactivation can present with more severe cutaneous symptoms termed eczema herpeticum in the atopic population, similar to the more severe eczema vaccinatum, and drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is associated with reactivation of HSV6 and possibly other herpesviruses in both atopic and nonatopic patients. In this review evidence is reviewed that primary infection with herpesviruses may have an atypical presentation in the atopic patient and conversely that childhood infection might alter the atopic phenotype. Reactivation of latent herpesviruses can directly alter host cytokine profiles through viral expression of cytokine-like proteins, such as IL-10 (EBV) or IL-6 (cytomegalovirus and HHV8), viral encoded and secreted siRNA and microRNAs, and modulation of expression of host transcription pathways, such as nuclear factor κB. Physicians caring for allergic and atopic populations should be aware of common and uncommon presentations of herpes-related disease in atopic patients to provide accurate diagnosis and avoid unnecessary laboratory testing or incorrect diagnosis of other conditions, such as drug allergy or autoimmune disease. Antiviral therapy and vaccines should be administered promptly when indicated clinically. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Interactive effect of STAT6 and IL13 gene polymorphisms on eczema status: results from a longitudinal and a cross-sectional study

PubMed Central

2013-01-01

Background Eczema is a prevalent skin disease that is mainly characterized by systemic deviation of immune response and defective epidermal barrier. Th2 cytokines, such as IL-13 and transcription factor STAT6 are key elements in the inflammatory response that characterize allergic disorders, including eczema. Previous genetic association studies showed inconsistent results for the association of single nucleotide polymorphisms (SNPs) with eczema. Our aim was to investigate whether SNPs in IL13 and STAT6 genes, which share a biological pathway, have an interactive effect on eczema risk. Methods Data from two independent population-based studies were analyzed, namely the Isle of Wight birth cohort study (IOW; n = 1,456) and for the purpose of replication the Swansea PAPA (Poblogaeth Asthma Prifysgol Abertawe; n = 1,445) cross-sectional study. Log-binomial regressions were applied to (i) account for the interaction between IL13 (rs20541) and STAT6 (rs1059513) polymorphisms and (ii) estimate the combined effect, in terms of risk ratios (RRs), of both risk factors on the risk of eczema. Results Under a dominant genetic model, the interaction term [IL13 (rs20541) × STAT6 (rs1059513)] was statistically significant in both studies (IOW: adjusted Pinteraction = 0.046; PAPA: Pinteraction = 0.037). The assessment of the combined effect associated with having risk genotypes in both SNPs yielded a 1.52-fold increased risk of eczema in the IOW study (95% confidence interval (CI): 1.05 – 2.20; P = 0.028) and a 2.01-fold higher risk of eczema (95% CI: 1.29 – 3.12; P = 0.002) in the PAPA study population. Conclusions Our study adds to the current knowledge of genetic susceptibility by demonstrating for the first time an interactive effect between SNPs in IL13 (rs20541) and STAT6 (rs1059513) on the occurrence of eczema in two independent samples. Findings of this report further support the emerging evidence that points toward the existence of genetic effects that occur via complex networks involving gene-gene interactions (epistasis). PMID:23815671

Prenatal Omega-3 Supplementation and Eczema Risk among Offspring at Age 36 Months

PubMed Central

Berman, D; Clinton, C; Limb, R; Somers, EC; Romero, V; Mozurkewich, E

2017-01-01

Background Long-term follow-up was completed in 84 mother-infant pairs of 118 women who completed a randomized controlled trial of prenatal supplementation with EPA- or DHA-rich fish oil or soy oil placebo. The goal of this study was to determine whether prenatal omega-3 fatty acid supplementation protects offspring against development of early childhood allergies. Methods and Findings Assessment of childhood allergic/atopic disease among offspring at age 36 months was performed by maternal interview using the National Health Interview Survey (NHIS) questions for childhood digestive allergies, wheezing, eczema or skin allergy, and respiratory allergy. Multiple logistic regressions examined the association between prenatal supplementation and childhood outcomes, adjusted for covariates. Eczema was reported in 26/84 (31%) of offspring at age 36 months, and was significantly more prevalent in the omega-3 supplementation groups vs. placebo: EPA 13/31 (41.9%); DHA 10/26 (38.5%); placebo 3/27 (11.1%), p=0.019. Compared to placebo, EPA and DHA were associated with ≥5 times risk of offspring eczema [odds ratios (ORs): EPA 5.8 (95% CI 1.4–23.3); DHA 5.0 (95% CI 1.2–21.0)]. After adjusting for other potential risk factors (race, birth weight, vaginal/Cesarean delivery, and maternal eczema) the magnitudes of association for omega-3 supplementation increased: EPA OR 8.1 (95% CI 1.4–45.6); DHA OR 9.6 (95% CI 1.6–58.5). Maternal eczema was also significantly associated with offspring eczema in the adjusted model: OR 10.8 (95% CI 2.1–54.3) Conclusion Contrary to our hypothesis, acids supplementation compared to soy oil was associated with a substantial increase in risk of childhood eczema. This association was not observed on childhood respiratory or digestive outcomes. It is unclear if these findings were driven by unfavorable effects of omega-3s, or whether there may have been unanticipated protective effects of the soy-based placebo with regards to eczema. PMID:28649675

Identifying the heterogeneity of young adult rhinitis through cluster analysis in the Isle of Wight birth cohort.

PubMed

Kurukulaaratchy, Ramesh J; Zhang, Hongmei; Patil, Veeresh; Raza, Abid; Karmaus, Wilfried; Ewart, Susan; Arshad, S Hasan

2015-01-01

Rhinitis affects many young adults and often shows comorbidity with asthma. We hypothesized that young adult rhinitis, like asthma, exhibits clinical heterogeneity identifiable by means of cluster analysis. Participants in the Isle of Wight birth cohort (n = 1456) were assessed at 1, 2, 4, 10, and 18 years of age. Cluster analysis was performed on those with rhinitis at age 18 years (n = 468) by using 13 variables defining clinical characteristics. Four clusters were identified. Patients in cluster 1 (n = 128 [27.4%]; ie, moderate childhood-onset rhinitis) had high atopy and eczema prevalence and high total IgE levels but low asthma prevalence. They showed the best lung function at 18 years of age, with normal fraction of exhaled nitric oxide (Feno), low bronchial hyperresponsiveness (BHR), and low bronchodilator reversibility (BDR) but high rhinitis symptoms and treatment. Patients in cluster 2 (n = 199 [42.5%]; ie, mild-adolescence-onset female rhinitis) had the lowest prevalence of comorbid atopy, asthma, and eczema. They had normal lung function and low BHR, BDR, Feno values, and total IgE levels plus low rhinitis symptoms, severity, and treatment. Patients in cluster 3 (n = 59 [12.6%]; ie, severe earliest-onset rhinitis with asthma) had the youngest rhinitis onset plus the highest comorbid asthma (of simultaneous onset) and atopy. They showed the most obstructed lung function with high BHR, BDR, and Feno values plus high rhinitis symptoms, severity, and treatment. Patient 4 in cluster 4 (n = 82 [17.5%]; ie, moderate childhood-onset male rhinitis with asthma) had high atopy, intermediate asthma, and low eczema. They had impaired lung function with high Feno values and total IgE levels but intermediate BHR and BDR. They had moderate rhinitis symptoms. Clinically distinctive adolescent rhinitis clusters are apparent with varying sex and asthma associations plus differing rhinitis severity and treatment needs. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial.

PubMed

Thomas, Kim S; Bradshaw, Lucy E; Sach, Tracey H; Cowdell, Fiona; Batchelor, Jonathan M; Lawton, Sandra; Harrison, Eleanor F; Haines, Rachel H; Ahmed, Amina; Dean, Taraneh; Burrows, Nigel P; Pollock, Ian; Buckley, Hannah K; Williams, Hywel C; Llewellyn, Joanne; Crang, Clare; Grundy, Jane D; Guiness, Juliet; Gribbin, Andrew; Wake, Eileen V; Mitchell, Eleanor J; Brown, Sara J; Montgomery, Alan A

2017-04-01

Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects the quality of life of children and their families. The role of specialist clothing in the management of AE is poorly understood. To assess the effectiveness and cost-effectiveness of silk garments for the management of AE in children with moderate to severe disease. Parallel-group, observer-blind, randomised controlled trial of 6 months' duration, followed by a 2-month observational period. A nested qualitative study evaluated the beliefs of trial participants, health-care professionals and health-care commissioners about the use of silk garments for AE. Secondary care and the community in five UK centres. Children aged 1-15 years with moderate or severe AE. Participants were randomised (1 : 1 using online randomisation) to standard care or standard care plus 100% silk garments made from antimicrobially protected knitted sericin-free silk [DermaSilk TM (AlPreTec Srl, San Donà di Piave, Italy) or DreamSkin TM (DreamSkin Health Ltd, Hatfield, UK)]. Three sets of garments were supplied per participant, to be worn for up to 6 months (day and night). At 6 months the standard care group received the garments to use for the remaining 2-month observational period. Primary outcome - AE severity using the Eczema Area and Severity Index (EASI) assessed at 2, 4 and 6 months, by nurses blinded to treatment allocation. EASI scores were log-transformed for analysis. Secondary outcomes - patient-reported eczema symptoms (Patient Oriented Eczema Measure); global assessment of severity (Investigator Global Assessment); quality of life of the child (Atopic Dermatitis Quality of Life, Child Health Utility - 9 Dimensions), family (Dermatitis Family Impact Questionnaire) and main carer (EuroQoL-5 Dimensions-3 Levels); use of standard eczema treatments (e.g. emollients, topical corticosteroids); and cost-effectiveness. The acceptability and durability of the clothing, and adherence to wearing the garments, were assessed by parental/carer self-report. Safety outcomes - number of skin infections and hospitalisations for AE. A total of 300 children were randomised (26 November 2013 to 5 May 2015): 42% female, 79% white, mean age 5 years. The primary analysis included 282 out of 300 (94%) children ( n  = 141 in each group). Garments were worn for at least 50% of the time by 82% of participants. Geometric mean EASI scores at baseline, 2, 4 and 6 months were 8.4, 6.6, 6.0, 5.4 for standard care and 9.2, 6.4, 5.8, 5.4 for silk clothing, respectively. There was no evidence of difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age and centre (ratio of geometric means 0.95, 95% confidence interval 0.85 to 1.07; p  = 0.43). This confidence interval is equivalent to a difference of -1.5 to 0.5 in the original EASI scale units. Skin infections occurred in 39 out of 141 (28%) and 36 out of 142 (25%) participants for standard care and silk clothing groups, respectively. The incremental cost per QALY of silk garments for children with moderate to severe eczema was £56,811 from a NHS perspective in the base case. Sensitivity analyses supported the finding that silk garments do not appear to be cost-effective within currently accepted thresholds. Knowledge of treatment allocation may have affected behaviour and outcome reporting for some of the patient-reported outcomes. The addition of silk garments to standard AE care is unlikely to improve AE severity, or to be cost-effective compared with standard care alone, for children with moderate or severe AE. This trial adds to the evidence base to guide clinical decision-making. Non-pharmacological interventions for the management of AE remain a research priority among patients. Current Controlled Trials ISRCTN77261365. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 16. See the NIHR Journals Library website for further project information.

Managing atopic eczema in childhood: the health visitor and school nurse role.

PubMed

Robinson, Jean

2008-06-01

Atopic eczema affects up to 20% of children in the UK. It is a disease of varying severity, and health visitors and school nurses have a vital role in educating and supporting children and their parents and carers in its management. Diagnosis and assessment needs to consider atopic eczema severity, effect on quality of life and contributing trigger factors. Treatment should be tailored to the individual child and should include education on emollient therapy, the use of topical corticosteroids and other measures. A case study is included to highlight practical issues and the support of the child and family in coping with atopic eczema at home and in school.

Experimental eczema. 12 effects of x-rays in experimental eczema (combined injury) (in French)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Adatto, R.

1961-01-01

Contact dermatitis was induced in guinea pig nipples by local application of 2,4-dinitrochlorobenzene after previous sensitization. No effect of x irradiation on the histologic aspects of the developing dermatitis could be detected when doses of 800 or 1600 r were given 2 to 16 days after sensitization or repeated 100-r doses were given. Although a 800-r dose had no detectable effect on epithelium, it was found to alter the eczematous reaction when given 72 hr before the eliciting application of dinitrocitlorobenzene in sensitized animals. Eczematous epithelium in irradiated skin showed swelling of cells, indistinct cell boundaries, diminished numbers of nuclei,more » and fewer mitoses blocked by colchicine; none of these changes was produced by eczema alone. The changes in epidermis induced by irradiation with 800 r before eliciting eczema resembled those produced by much higher x-ray doses (2400 r), indicating that eczema augments the cellular changes induced by irradiation.« less

Meta-analysis identifies seven susceptibility loci involved in the atopic march

PubMed Central

Marenholz, Ingo; Esparza-Gordillo, Jorge; Rüschendorf, Franz; Bauerfeind, Anja; Strachan, David P.; Spycher, Ben D.; Baurecht, Hansjörg; Margaritte-Jeannin, Patricia; Sääf, Annika; Kerkhof, Marjan; Ege, Markus; Baltic, Svetlana; Matheson, Melanie C.; Li, Jin; Michel, Sven; Ang, Wei Q.; McArdle, Wendy; Arnold, Andreas; Homuth, Georg; Demenais, Florence; Bouzigon, Emmanuelle; Söderhäll, Cilla; Pershagen, Göran; de Jongste, Johan C.; Postma, Dirkje S.; Braun-Fahrländer, Charlotte; Horak, Elisabeth; Ogorodova, Ludmila M.; Puzyrev, Valery P.; Bragina, Elena Yu; Hudson, Thomas J.; Morin, Charles; Duffy, David L.; Marks, Guy B.; Robertson, Colin F.; Montgomery, Grant W.; Musk, Bill; Thompson, Philip J.; Martin, Nicholas G.; James, Alan; Sleiman, Patrick; Toskala, Elina; Rodriguez, Elke; Fölster-Holst, Regina; Franke, Andre; Lieb, Wolfgang; Gieger, Christian; Heinzmann, Andrea; Rietschel, Ernst; Keil, Thomas; Cichon, Sven; Nöthen, Markus M.; Pennell, Craig E.; Sly, Peter D.; Schmidt, Carsten O.; Matanovic, Anja; Schneider, Valentin; Heinig, Matthias; Hübner, Norbert; Holt, Patrick G.; Lau, Susanne; Kabesch, Michael; Weidinger, Stefan; Hakonarson, Hakon; Ferreira, Manuel A. R.; Laprise, Catherine; Freidin, Maxim B.; Genuneit, Jon; Koppelman, Gerard H.; Melén, Erik; Dizier, Marie- Hélène; Henderson, A John; Lee, Young Ae

2015-01-01

Eczema often precedes the development of asthma in a disease course called the ‘atopic march'. To unravel the genes underlying this characteristic pattern of allergic disease, we conduct a multi-stage genome-wide association study on infantile eczema followed by childhood asthma in 12 populations including 2,428 cases and 17,034 controls. Here we report two novel loci specific for the combined eczema plus asthma phenotype, which are associated with allergic disease for the first time; rs9357733 located in EFHC1 on chromosome 6p12.3 (OR 1.27; P=2.1 × 10−8) and rs993226 between TMTC2 and SLC6A15 on chromosome 12q21.3 (OR 1.58; P=5.3 × 10−9). Additional susceptibility loci identified at genome-wide significance are FLG (1q21.3), IL4/KIF3A (5q31.1), AP5B1/OVOL1 (11q13.1), C11orf30/LRRC32 (11q13.5) and IKZF3 (17q21). We show that predominantly eczema loci increase the risk for the atopic march. Our findings suggest that eczema may play an important role in the development of asthma after eczema. PMID:26542096

Self-reported seafood intake and atopy in Japanese school-aged children.

PubMed

Kunitsugu, Ichiro; Okuda, Masayuki; Murakami, Natsuko; Hashimoto, Michio; Yamanishi, Rintaro; Bando, Noriko; Sasaki, Satoshi; Terao, Junji; Sugiyama, Shinichi; Hobara, Tatsuya

2012-04-01

The effects of fish consumption and n-3 poly-unsaturated fatty acid (PUFA) levels on atopic disorders are inconsistent in previous reports, but few studies have investigated the effects of both fish and n-3 PUFA. The aim of the present study was to investigate whether erythrocyte fatty acids and the consumption of fish are associated with atopic diseases in pre- and early adolescents. A total of 135 students with eczema, 136 students with asthma, and 137 healthy control students were selected from fifth and eighth grades in Shunan, Japan. Atopic disorders and dietary intake were evaluated with questionnaires, and total serum IgE was measured using an enzyme-linked immunosorbent assay. In addition, erythrocyte membrane levels of PUFA were assessed via gas chromatography. Total IgE was significantly elevated in the atopic subjects (P < 0.001). The intake of fatty and dried fish or seafood was significantly associated with eczema (odds ratios of the highest quartiles: 0.46, 95% confidence interval (95%CI): 0.22-0.94; 0.34, 95%CI: 0.16-0.71, respectively). Additionally, only erythrocyte eicosapentaenoic acid (EPA) level had a negative association with eczema (P= 0.048). For asthma, the effect of fish consumption was not significant. Fish consumption was related to a low prevalence of eczema, but not asthma in Japanese pre- and early adolescents. EPA may be involved in this mechanism. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

Effect of childhood eczema and asthma on parental sleep and well-being: a prospective comparative study.

PubMed

Moore, K; David, T J; Murray, C S; Child, F; Arkwright, P D

2006-03-01

The psychological impact of childhood atopic eczema on parents and carers is poorly quantified. Objectives To compare the impact of caring for a child with atopic eczema vs. asthma on parents' sleep and well-being. Ninety-two parents of 55 children who had moderate to severe atopic eczema or asthma took part in this prospective, questionnaire-based study. It was conducted at regional eczema and asthma outpatient clinics within a U.K. tertiary paediatric hospital. The main outcome measures were the number and duration of parents' sleep disturbances, as well as their anxiety and depression scores. Mothers caring for children with atopic eczema lost a median of 39 min of sleep per night and fathers lost 45 min sleep per night. This compared with a median of 0 min sleep lost by parents who had children with asthma (P < 0.001). These differences were independent of the age of the children, and whether the child came from a single-parent or two-parent family. There was a direct correlation between the severity of sleep disturbance and the level of maternal anxiety (rho = 0.58; P = 0.002) and depression (rho = 0.73; P < 0.001), as well as the level of paternal anxiety (rho = 0.59; P = 0.01). Compared with looking after a child with chronic asthma, caring for a child with chronic atopic eczema was associated with greater parental sleep disturbances. Disruption to parental sleep correlated with anxiety levels and, in the case of mothers, depression scores.

Immune-modulatory genomic properties differentiate gut microbiota of infants with and without eczema.

PubMed

Oh, Seungdae; Yap, Gaik Chin; Hong, Pei-Ying; Huang, Chiung-Hui; Aw, Marion M; Shek, Lynette Pei-Chi; Liu, Wen-Tso; Lee, Bee Wah

2017-01-01

Gut microbiota play an important role in human immunological processes, potentially affecting allergic diseases such as eczema. The diversity and structure of gut microbiota in infants with eczema have been previously documented. This study aims to evaluate by comparative metagenomics differences in genetic content in gut microbiota of infants with eczema and their matched controls. Stools were collected at the age of one month old from twelve infants from an at risk birth cohort in a case control manner. Clinical follow up for atopic outcomes were carried out at the age of 12 and 24 months. Microbial genomic DNA were extracted from stool samples and used for shotgun sequencing. Comparative metagenomic analysis showed that immune-regulatory TCAAGCTTGA motifs were significantly enriched in the six healthy controls (C) communities compared to the six eczema subjects (E), with many encoded by Bifidobacterium (38% of the total motifs in the C communities). Draft genomes of five Bifidobacterium species populations (B. longum, B. bifidum, B. breve, B. dentium, and B. pseudocatenulatum) were recovered from metagenomic datasets. The B. longum BFN-121-2 genome encoded more TCAAGCTTGA motifs (4.2 copies per one million genome sequence) than other Bifidobacterium genomes. Additionally, the communities in the stool of controls (C) were also significantly enriched in functions associated with tetrapyrrole biosynthesis compared to those of eczema (E). Our results show distinct immune-modulatory genomic properties of gut microbiota in infants associated with eczema and provide new insights into potential role of gut microbiota in affecting human immune homeostasis.

Immune-modulatory genomic properties differentiate gut microbiota of infants with and without eczema

PubMed Central

Oh, Seungdae; Yap, Gaik Chin; Hong, Pei-Ying; Huang, Chiung-Hui; Aw, Marion M.; Shek, Lynette Pei-Chi; Liu, Wen-Tso; Lee, Bee Wah

2017-01-01

Gut microbiota play an important role in human immunological processes, potentially affecting allergic diseases such as eczema. The diversity and structure of gut microbiota in infants with eczema have been previously documented. This study aims to evaluate by comparative metagenomics differences in genetic content in gut microbiota of infants with eczema and their matched controls. Stools were collected at the age of one month old from twelve infants from an at risk birth cohort in a case control manner. Clinical follow up for atopic outcomes were carried out at the age of 12 and 24 months. Microbial genomic DNA were extracted from stool samples and used for shotgun sequencing. Comparative metagenomic analysis showed that immune-regulatory TCAAGCTTGA motifs were significantly enriched in the six healthy controls (C) communities compared to the six eczema subjects (E), with many encoded by Bifidobacterium (38% of the total motifs in the C communities). Draft genomes of five Bifidobacterium species populations (B. longum, B. bifidum, B. breve, B. dentium, and B. pseudocatenulatum) were recovered from metagenomic datasets. The B. longum BFN-121-2 genome encoded more TCAAGCTTGA motifs (4.2 copies per one million genome sequence) than other Bifidobacterium genomes. Additionally, the communities in the stool of controls (C) were also significantly enriched in functions associated with tetrapyrrole biosynthesis compared to those of eczema (E). Our results show distinct immune-modulatory genomic properties of gut microbiota in infants associated with eczema and provide new insights into potential role of gut microbiota in affecting human immune homeostasis. PMID:29049378

[Contact allergies in musicians].

PubMed

Gasenzer, E R; Neugebauer, E A M

2012-12-01

During the last years, the problem of allergic diseases has increased. Allergies are errant immune responses to a normally harmless substance. In musicians the allergic contact dermatitis to exotic woods is a special problem. Exotic rosewood contains new flavonoids, which trigger an allergic reaction after permanent contact with the instrument. High quality woodwind instruments such as baroque flute or clarinets are made in ebony or palisander because of its great sound. Today instruments for non-professional players are also made in these exotic materials and non-professionals may have the risk to develop contact dermatitis, too. Brass-player has the risk of an allergic reaction to the different metals contained in the metal sheets of modern flutes and brass instruments. Specially nickel and brass alloys are used to product flute tubes or brass instruments. Special problem arises in children: patients who are allergic to plants or foods have a high risk to develop contact dermatitis. Parents don't know the materials of low-priced instruments for beginners. Often unknown cheap woods from exotic areas are used. Low-priced brass instruments contain high amount of brass and other cheap metals. Physicians should advice musician-patients or parents about the risks of the different materials and look for the reason of eczema on mouth, face, or hands. © Georg Thieme Verlag KG Stuttgart · New York.

Alcohol Intake During Pregnancy and Offspring's Atopic Eczema Risk.

PubMed

Wada, Keiko; Konishi, Kie; Tamura, Takashi; Shiraki, Makoto; Iwasa, Shinichi; Nagata, Chisato

2016-05-01

Although alcohol consumption has been suggested to have an effect on the immune system, it is unknown whether alcohol consumption has a role in developing allergic diseases. We aimed to examine the associations of total alcohol intake during pregnancy with the risks of childhood asthma and atopic eczema in a birth cohort in Japan. Pregnant women were recruited at a maternal clinic from May 2000 to October 2001. The children who were born to these mothers were followed until November 2007. Total alcohol intake, including alcohol as a cooking ingredient, was assessed using 5-day dietary records. Mother reports of physician-diagnosed asthma and atopic eczema were annually obtained from the questionnaires. Asthma assessed by the American Thoracic Society Division of Lung Diseases questionnaire and atopic eczema assessed by International Study of Asthma and Allergies in Childhood questions were also obtained in 2007. A total of 350 children participated in the follow-up survey. Maternal total alcohol intake during pregnancy was associated with increased risks of atopic eczema before age 3. The positive association with atopic eczema was also observed when it was defined as before age 5. In the high versus the low tertile of maternal total alcohol intake, the estimated hazard ratios (HRs) of child's eczema were 1.90 (95% CI: 0.96 to 3.76) before age 3 and 1.74 (95% CI: 0.93 to 3.24) before age 5, respectively. The estimated HRs of child's asthma before age 3 was 1.61 (95% CI: 0.70 to 3.69) in the high versus the low of maternal total alcohol intake and 2.11 (95% CI: 0.93 to 4.81) among children having drinking mothers versus nondrinking mothers in pregnancy, although maternal alcohol intake during pregnancy was not significantly associated with the risk of asthma before age 5. Alcohol consumption during pregnancy might have an effect on developing atopic eczema in offspring. Copyright © 2016 by the Research Society on Alcoholism.

Utilization of Preventive Health Care in Adults and Children With Eczema

PubMed Central

Strom, Mark A.; Silverberg, Jonathan I.

2017-01-01

Introduction Chronic disease is a barrier to delivery of preventive health care and health maintenance. However, health behaviors of adults and children with eczema, a chronic skin disorder, have not been examined. This study examined associations of eczema with vaccination, disease screening, health maintenance, and healthcare utilization. Methods This study investigated 34,613 adults and 13,298 children from the 2012 National Health Interview Survey, a prospective questionnaire-based study. Data were analyzed between August 2014 and January 2015. Results Adult eczema was associated with higher odds of vaccination for tetanus (OR [95% CI]= 1.37 [1.22, 1.54]); influenza (1.23 [1.10, 1.37]); hepatitis A (1.21 [1.04, 1.41]) and B (1.21 [1.07, 1.35]); human papilloma virus (1.66 [1.32, 2.08]); and pneumonia (1.35 [1.19, 1.54]), but not herpes zoster virus (1.07 [0.87, 1.31]). Adult eczema was associated with increased measurement of blood glucose (1.29 [1.16, 1.44]); cholesterol (1.19 [1.06, 1.34]); blood pressure (1.84 [1.56, 2.08]); and HIV infection (1.50 [1.34, 1.70]), but not Pap smears (1.11 [0.95, 1.30]); colon cancer screening (p=0.17); or mammograms (p=0.63). Adults with eczema were more likely to interact with general doctors, mid-level providers, mental health professionals, eye doctors, podiatrists, chiropractors, therapists, obstetrician/gynecologists, and other specialists (p≤0.01). Childhood eczema was associated with higher rates of vaccination for influenza (p<0.0002); well child checkups (p=0.002); and interaction with most types of healthcare providers (p≤0.01). Many associations remained significant in multivariate models controlling for sociodemographics and healthcare interaction frequency. Conclusions Eczema in adults and children is associated with greater utilization of preventive health care and health maintenance, but not cancer screening. PMID:26547540

Utilization of Preventive Health Care in Adults and Children With Eczema.

PubMed

Strom, Mark A; Silverberg, Jonathan I

2016-02-01

Chronic disease is a barrier to delivery of preventive health care and health maintenance. However, health behaviors of adults and children with eczema, a chronic skin disorder, have not been examined. This study examined associations of eczema with vaccination, disease screening, health maintenance, and healthcare utilization. This study investigated 34,613 adults and 13,298 children from the 2012 National Health Interview Survey, a prospective questionnaire-based study. Data were analyzed between August 2014 and January 2015. Adult eczema was associated with higher odds of vaccination for tetanus (OR [95% CI]=1.37 [1.22, 1.54]); influenza (1.23 [1.10, 1.37]); hepatitis A (1.21 [1.04, 1.41]) and B (1.21 [1.07, 1.35]); human papilloma virus (1.66 [1.32, 2.08]); and pneumonia (1.35 [1.19, 1.54]), but not herpes zoster virus (1.07 [0.87, 1.31]). Adult eczema was associated with increased measurement of blood glucose (1.29 [1.16, 1.44]); cholesterol (1.19 [1.06, 1.34]); blood pressure (1.84 [1.56, 2.08]); and HIV infection (1.50 [1.34, 1.70]), but not Pap smears (1.11 [0.95, 1.30]); colon cancer screening (p=0.17); or mammograms (p=0.63). Adults with eczema were more likely to interact with general doctors, mid-level providers, mental health professionals, eye doctors, podiatrists, chiropractors, therapists, obstetrician/gynecologists, and other specialists (p≤0.01). Childhood eczema was associated with higher rates of vaccination for influenza (p<0.0002); well child checkups (p=0.002); and interaction with most types of healthcare providers (p≤0.01). Many associations remained significant in multivariate models controlling for sociodemographics and healthcare interaction frequency. Eczema in adults and children is associated with greater utilization of preventive health care and health maintenance, but not cancer screening. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

High breast milk IL-1β level is associated with reduced risk of childhood eczema.

PubMed

Jepsen, A A; Chawes, B L; Carson, C G; Schoos, A-M M; Thysen, A H; Waage, J; Brix, S; Bisgaard, H

2016-10-01

We recently demonstrated a dual effect of breastfeeding with increased risk of eczema and decreased risk of wheezing in early childhood by increasing breastfeeding length. We hypothesize that immune mediators in breast milk could explain such association either through a direct effect or as a surrogate marker of maternal immune constitution. To investigate the possible association between cytokine and chemokine levels in breast milk and development of eczema and recurrent wheeze during early childhood. Levels of 19 pro-inflammatory and immunoregulatory cytokines and chemokines were measured in 223 breast milk samples from mothers in the Copenhagen Prospective Study on Asthma in Childhood2000 (COPSAC) high-risk birth cohort. Eczema and recurrent wheeze at the age of 0-3 years were prospectively diagnosed by COPSAC physicians adherent to predefined validated algorithms. Association analyses were performed by Cox regression adjusting for potential confounding factors and by multivariable principal component analysis. Increased IL-1β in breast milk (≥ 0.7 pg/mL) was associated with more than a halved risk of eczema before age three (aHR = 0.41; 95% CI = 0.24-0.68; P < 0.001), which remained significant after false discovery rate adjustment (P = 0.008). The principal component analysis confirmed that a mediator pattern dominated by high levels of IL-1β, IL-17A, and CCL17 and low levels of CXCL1 and TSLP in breast milk protected against eczema (aHR = 0.82; 95% CI = 0.68-0.98; P = 0.03). No associations were observed for recurrent wheeze. Elevated breast milk IL-1β level was associated with decreased risk of early childhood eczema suggesting either a direct protective effect of IL-1β or IL-1b acting as a proxy for a healthy maternal immune system protecting high-risk offspring from eczema. © 2016 John Wiley & Sons Ltd.