Pub Date : 2005-11-01DOI: 10.1080/03658340510012426
Thomas Bieber
Atopic dermatitis (AD) is a chronic inflammatory skin disease which develops on a complex genetic background, the so-called atopic diathesis. AD is in most, but not all, patients characterized by the presence of elevated total serum IgE levels. However, a subgroup of atopic patients exhibits normal IgE levels and mechanisms contributing to the so-called ‘intrinsic’ or ‘non-allergic’ form have been the matter of intensive research work in the last years. These forms have been particularly studied in the context of AD, which has also led to a new nomenclature. Moreover, we now have increasing evidence for the putative role of autoimmune phenomena in the complex pathophysiology of AD. Mainly adult patients exhibit specific IgE directed against self proteins of epidermal origin. Therefore
{"title":"Putative mechanisms underlying chronicity in atopic eczema.","authors":"Thomas Bieber","doi":"10.1080/03658340510012426","DOIUrl":"https://doi.org/10.1080/03658340510012426","url":null,"abstract":"Atopic dermatitis (AD) is a chronic inflammatory skin disease which develops on a complex genetic background, the so-called atopic diathesis. AD is in most, but not all, patients characterized by the presence of elevated total serum IgE levels. However, a subgroup of atopic patients exhibits normal IgE levels and mechanisms contributing to the so-called ‘intrinsic’ or ‘non-allergic’ form have been the matter of intensive research work in the last years. These forms have been particularly studied in the context of AD, which has also led to a new nomenclature. Moreover, we now have increasing evidence for the putative role of autoimmune phenomena in the complex pathophysiology of AD. Mainly adult patients exhibit specific IgE directed against self proteins of epidermal origin. Therefore","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"7-10"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510012444
Alain Taïeb
An allergy workup is done in many children with atopic dermatitis but its pratical benefit on disease management remains largely unproven. This paper emphasizes the need of a global assessment of the young patient, including compliance to previous treatments and disease severity. Allergy testing should be considered as a second line option, integrated to global management. True food allergy is found in one third of patients with moderate/severe disease, and avoidance diets in such patients help reducing topical corticosteroids consumption. Apart a better delineation of the indication of the tests, there is a need to make allergy workups simplier, and a better standardization of tests is needed.
{"title":"Allergy workup: when and how for the child with atopic dermatitis?","authors":"Alain Taïeb","doi":"10.1080/03658340510012444","DOIUrl":"https://doi.org/10.1080/03658340510012444","url":null,"abstract":"An allergy workup is done in many children with atopic dermatitis but its pratical benefit on disease management remains largely unproven. This paper emphasizes the need of a global assessment of the young patient, including compliance to previous treatments and disease severity. Allergy testing should be considered as a second line option, integrated to global management. True food allergy is found in one third of patients with moderate/severe disease, and avoidance diets in such patients help reducing topical corticosteroids consumption. Apart a better delineation of the indication of the tests, there is a need to make allergy workups simplier, and a better standardization of tests is needed.","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"16-20"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012444","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510012453
Kim Fleischer Michaelsen
This article focuses on several aspects as follows; the relationship between permeability of the gastrointestinal tract and atopic eczema, probiotics and eczema, probiotics and the immune system in the gastrointestinal tract, breastfeeding and immunomodulation, and the relation between breastfeeding and the development of atopic eczema. It is concluded that there is evidence that some probiotic strains seem to be beneficial in the treatment of atopic eczema. GUT MUCOSAL BARRIER AND ATOPIC ECZEMA The gut mucosal barrier of patients with atopic eczema is impaired. In an in vitro study Majamaa & Isolauri (1) studied the absorption of horseradish peroxidase (HRP) through the gut mucosal barrier. Small intestinal biopsies were studied in Ussing chambers, measuring the absorption of both intact and degraded HRP. Compared with controls, absorption in patients with atopic eczema is increased. There are also several studies showing increased intestinal permeability in patients with bronchial asthma. Benard et al. (2) studied the urinary excretion of Cr EDTA, a recognized method of monitoring intestinal absorption, in asthmatics, in patients with chronic obstructive airways disease and in controls. There were significant differences between the asthmatics and the other two groups in respect of increased intestinal permeability. There was no significant difference in intestinal permeability between patients with allergic and non-allergic asthma, and the intestinal permeability was not correlated with the severity of asthma as measured by FEV1.
{"title":"Probiotics, breastfeeding and atopic eczema.","authors":"Kim Fleischer Michaelsen","doi":"10.1080/03658340510012453","DOIUrl":"https://doi.org/10.1080/03658340510012453","url":null,"abstract":"This article focuses on several aspects as follows; the relationship between permeability of the gastrointestinal tract and atopic eczema, probiotics and eczema, probiotics and the immune system in the gastrointestinal tract, breastfeeding and immunomodulation, and the relation between breastfeeding and the development of atopic eczema. It is concluded that there is evidence that some probiotic strains seem to be beneficial in the treatment of atopic eczema. GUT MUCOSAL BARRIER AND ATOPIC ECZEMA The gut mucosal barrier of patients with atopic eczema is impaired. In an in vitro study Majamaa & Isolauri (1) studied the absorption of horseradish peroxidase (HRP) through the gut mucosal barrier. Small intestinal biopsies were studied in Ussing chambers, measuring the absorption of both intact and degraded HRP. Compared with controls, absorption in patients with atopic eczema is increased. There are also several studies showing increased intestinal permeability in patients with bronchial asthma. Benard et al. (2) studied the urinary excretion of Cr EDTA, a recognized method of monitoring intestinal absorption, in asthmatics, in patients with chronic obstructive airways disease and in controls. There were significant differences between the asthmatics and the other two groups in respect of increased intestinal permeability. There was no significant difference in intestinal permeability between patients with allergic and non-allergic asthma, and the intestinal permeability was not correlated with the severity of asthma as measured by FEV1.","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"21-4"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510046807
Richard Langley
One of the recent developments is to treat the disease very early in its development, exactly as is being done in asthma. The aim is to evaluate whether it is possible to modify the disease with long-term management. Can flare-ups be prevented? Is it possible to prevent the ‘atopic march’? The typical progress of a patient with atopic dermatitis (AD) was documented by Kissling & Wuthrich (1). They documented the development of eczema in 106 patients from the infantile phase, through childhood and adolescence into adulthood. The majority of patients experienced recurrent cycles of flare-ups, each of which was controlled by steroids. This recurrent cycle of events is distressing to parents who are also concerned about the ‘atopic march’ (2). Atopic eczema is in most cases the first manifestation of atopic disposition; eczema in childhood, compounded by food allergy, leading to asthma and long-term rhinitis. The general approach to treating AD is to treat relapses/flare-ups and when controlled to withdraw active treatment and use emollients (until the next flare-up). A recent trial has investigated whether continued application of a steroid can prevent or delay the cycle of relapses and treatment. Berth-Jones et al. (3) conducted a randomized vehicle (emollient) controlled trial in patients aged 12–65 with moderate to severe disease, to determine whether fluticasone propionate (at two strengths of 0.05% and 0.005%) can prevent relapses. There was a 1-month stabilization phase, followed by maintenance treatment of both ‘healed’ skin and new areas. The primary end point of the study was the time to relapse. A significant (pv0.001) prolongation of remission with application of fluticasone propionate 0.05% was seen. Significant benefit was also seen with fluticasone propionate 0.005%, but the benefit and statistical significance was reduced (p50.01). NEW THERAPEUTIC STATEGIES AND TARGETS
{"title":"New therapeutic targets in atopic eczema.","authors":"Richard Langley","doi":"10.1080/03658340510046807","DOIUrl":"https://doi.org/10.1080/03658340510046807","url":null,"abstract":"One of the recent developments is to treat the disease very early in its development, exactly as is being done in asthma. The aim is to evaluate whether it is possible to modify the disease with long-term management. Can flare-ups be prevented? Is it possible to prevent the ‘atopic march’? The typical progress of a patient with atopic dermatitis (AD) was documented by Kissling & Wuthrich (1). They documented the development of eczema in 106 patients from the infantile phase, through childhood and adolescence into adulthood. The majority of patients experienced recurrent cycles of flare-ups, each of which was controlled by steroids. This recurrent cycle of events is distressing to parents who are also concerned about the ‘atopic march’ (2). Atopic eczema is in most cases the first manifestation of atopic disposition; eczema in childhood, compounded by food allergy, leading to asthma and long-term rhinitis. The general approach to treating AD is to treat relapses/flare-ups and when controlled to withdraw active treatment and use emollients (until the next flare-up). A recent trial has investigated whether continued application of a steroid can prevent or delay the cycle of relapses and treatment. Berth-Jones et al. (3) conducted a randomized vehicle (emollient) controlled trial in patients aged 12–65 with moderate to severe disease, to determine whether fluticasone propionate (at two strengths of 0.05% and 0.005%) can prevent relapses. There was a 1-month stabilization phase, followed by maintenance treatment of both ‘healed’ skin and new areas. The primary end point of the study was the time to relapse. A significant (pv0.001) prolongation of remission with application of fluticasone propionate 0.05% was seen. Significant benefit was also seen with fluticasone propionate 0.005%, but the benefit and statistical significance was reduced (p50.01). NEW THERAPEUTIC STATEGIES AND TARGETS","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"25-7"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510046807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510012480
Kristian Thestrup-Pedersen
Adult atopic eczema is often chronic and with moderate to severe disease activity commonly complicated with Staphylococcus aureus infection. The ‘gold standard’ therapy is emollients in combination with topical steroids whose potency depends on the location of the eczema. A combination of a steroid and an antibiotic has shown its efficacy in infected eczema. If long-term control is needed the calcineurin inhibitors, pimecrolimus and tacrolimus, have shown their efficacy. Another option is the use of UV light, where narrowband UVB seems most beneficial. Only rarely is systemic immunosuppressive treatment necessary. It is important to discuss treatment strategies with the patients to secure long-term control of the eczema.
{"title":"Treatment strategies and compliance for the adult patient with atopic eczema.","authors":"Kristian Thestrup-Pedersen","doi":"10.1080/03658340510012480","DOIUrl":"https://doi.org/10.1080/03658340510012480","url":null,"abstract":"Adult atopic eczema is often chronic and with moderate to severe disease activity commonly complicated with Staphylococcus aureus infection. The ‘gold standard’ therapy is emollients in combination with topical steroids whose potency depends on the location of the eczema. A combination of a steroid and an antibiotic has shown its efficacy in infected eczema. If long-term control is needed the calcineurin inhibitors, pimecrolimus and tacrolimus, have shown their efficacy. Another option is the use of UV light, where narrowband UVB seems most beneficial. Only rarely is systemic immunosuppressive treatment necessary. It is important to discuss treatment strategies with the patients to secure long-term control of the eczema.","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"36-40"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012480","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atopic eczema - new insights in the definition, diagnostics and disease management. Proceedings of a LEO eczema workshop. November 2003. Copenhagen, Denmark.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"7-48"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25934614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510012435
Donald Leung
There is now considerable evidence that colonization or infection with Staphylococcus aureus is an exacerbating factor in atopic dermatitis (AD) (1). Numerous studies have shown that the superantigens produced by staphylococci and streptococci are implicated in the pathogenesis of various inflammatory skin diseases. The skin lesions of patients with AD predominantly contain infiltrating T cells and monocyte/macrophages which can be activated by superantigenic toxins from these microbes. This review focuses on two specific aspects of the involvement of S. aureus in AD. These are mechanisms by which superantigens can induce skin inflammation and impair the response of the inflammatory process to corticosteroids, and the inability of the innate immune system in atopic skin to counteract staphylococcal skin colonization and infection.
{"title":"Superantigens, steroid insensitivity and innate immunity in atopic eczema.","authors":"Donald Leung","doi":"10.1080/03658340510012435","DOIUrl":"https://doi.org/10.1080/03658340510012435","url":null,"abstract":"There is now considerable evidence that colonization or infection with Staphylococcus aureus is an exacerbating factor in atopic dermatitis (AD) (1). Numerous studies have shown that the superantigens produced by staphylococci and streptococci are implicated in the pathogenesis of various inflammatory skin diseases. The skin lesions of patients with AD predominantly contain infiltrating T cells and monocyte/macrophages which can be activated by superantigenic toxins from these microbes. This review focuses on two specific aspects of the involvement of S. aureus in AD. These are mechanisms by which superantigens can induce skin inflammation and impair the response of the inflammatory process to corticosteroids, and the inability of the innate immune system in atopic skin to counteract staphylococcal skin colonization and infection.","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"11-5"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510012471
Tove Agner
Atopic eczema is a chronic disease with a severe impact on quality of life, and compliance is important for the course of the disease. During the last decade educational programmes have been increasingly popular, but only few randomized controlled trials evaluating the effect of educational programmes and eczema schools exist. These studies, however, indicate a high participant satisfaction and a positive influence on compliance.
{"title":"Compliance among patients with atopic eczema.","authors":"Tove Agner","doi":"10.1080/03658340510012471","DOIUrl":"https://doi.org/10.1080/03658340510012471","url":null,"abstract":"Atopic eczema is a chronic disease with a severe impact on quality of life, and compliance is important for the course of the disease. During the last decade educational programmes have been increasingly popular, but only few randomized controlled trials evaluating the effect of educational programmes and eczema schools exist. These studies, however, indicate a high participant satisfaction and a positive influence on compliance.","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"33-5"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012471","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510012462
John McFadden
The controversy concerning the sensitizing potential of a common agent to which there is contact sensitivity, dinitrochlorobenzene, has been reassessed by Rees et al. (1). Dose-response relationships for contact sensitization and elicitation at three different concentrations of dinitrochlorobenzene were determined for 22 patients with minimal atopic eczema compared to 27 non-atopic healthy control subjects. Atopic patients were significantly less responsive, with smaller reactions at all challenge doses and exhibited flatter challenge doseresponse curves than did healthy controls. This is in keeping with the classic cytokine route of sensitization, which indicates that atopics should be less prone to sensitization under experimental conditions.
{"title":"Contact allergic reactions in patients with atopic eczema.","authors":"John McFadden","doi":"10.1080/03658340510012462","DOIUrl":"https://doi.org/10.1080/03658340510012462","url":null,"abstract":"The controversy concerning the sensitizing potential of a common agent to which there is contact sensitivity, dinitrochlorobenzene, has been reassessed by Rees et al. (1). Dose-response relationships for contact sensitization and elicitation at three different concentrations of dinitrochlorobenzene were determined for 22 patients with minimal atopic eczema compared to 27 non-atopic healthy control subjects. Atopic patients were significantly less responsive, with smaller reactions at all challenge doses and exhibited flatter challenge doseresponse curves than did healthy controls. This is in keeping with the classic cytokine route of sensitization, which indicates that atopics should be less prone to sensitization under experimental conditions.","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-11-01DOI: 10.1080/03658340510012499
Thomas Diepgen
Atopic dermatitis (AD) is the most common inflammatory dermatosis affecting children and its management is associated with significant economic costs (1, 2). Most epidemiological studies indicate an increase in allergic asthma, rhinitis and AD. Recent European studies indicate a lifetime prevalence of AD in 15–20% of subjects, with a 4–12% point prevalence. In addition, other research suggests that the overall incidence of other atopic conditions may be increasing. Recent developments concerning the overall incidence are reviewed. The results from large prospective studies evaluating job-related risk factors for hand eczema are discussed, in relation to occupational counselling.
{"title":"Epidemiology and job-related problems for the eczema patient.","authors":"Thomas Diepgen","doi":"10.1080/03658340510012499","DOIUrl":"https://doi.org/10.1080/03658340510012499","url":null,"abstract":"Atopic dermatitis (AD) is the most common inflammatory dermatosis affecting children and its management is associated with significant economic costs (1, 2). Most epidemiological studies indicate an increase in allergic asthma, rhinitis and AD. Recent European studies indicate a lifetime prevalence of AD in 15–20% of subjects, with a 4–12% point prevalence. In addition, other research suggests that the overall incidence of other atopic conditions may be increasing. Recent developments concerning the overall incidence are reviewed. The results from large prospective studies evaluating job-related risk factors for hand eczema are discussed, in relation to occupational counselling.","PeriodicalId":6960,"journal":{"name":"Acta dermato-venereologica. Supplementum","volume":" 215","pages":"41-4"},"PeriodicalIF":0.0,"publicationDate":"2005-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/03658340510012499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25730419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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