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Atopic Dermatitis (atopic + dermatitis)
Kinds of Atopic Dermatitis Terms modified by Atopic Dermatitis Selected AbstractsEXTENSIVE PITYRIASIS ALBA IN A CHILD WITH ATOPIC DERMATITISPEDIATRIC DERMATOLOGY, Issue 3 2004KAMALDEEP SANDHU M.D. No abstract is available for this article. [source] Lesson from performing SCORADs in children with atopic dermatitis: Subjective symptoms do not correlate well with disease extent or intensityINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006K. L. E. Hon MBBS Background, Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. It is not known how well these symptoms correlate with the extent and intensity of eczematous involvement. We evaluated whether: (i) the level of sleep loss correlates with pruritus and (ii) the level of pruritus correlates with the extent or severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. Method, Patients with AD younger than 18 years old were recruited from the pediatric dermatology clinic of a university teaching hospital, and AD severity was evaluated by the SCORAD index. Results, One hundred and eighty-two Chinese children with AD (107 boys and 75 girls) [mean (SD) age of 9.6 (4.2) years] were recruited. Their mean (SD) overall SCORAD was 30.1 (19.2). Sleep loss was strongly correlated with pruritus (r = 0.57, P < 0.001). However, the two subjective symptoms were only weakly correlated with the objective signs (extent and intensity) of AD. The correlations between pruritus and extent and intensity were 0.42 (P < 0.001) and 0.38 (P < 0.001), respectively, and the correlations between sleep loss and extent and intensity were 0.38 (P < 0.001) and 0.34 (P < 0.001), respectively. Conclusion, We speculate that the lack of a better correlation was either because pruritus and sleep loss as reported by parents were imprecise, or that mechanisms other than disease extent or severity are responsible for the pathogenesis of these subjective symptoms. [source] Treatment-Resistant Atopic DermatitisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2001Gilbert L. Wergowske MD No abstract is available for this article. [source] Serum concentration of macrophage-derived chemokine may be a useful inflammatory marker for assessing severity of atopic dermatitis in infants and young childrenPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 4 2003Ting Fan Leung Chemokines are responsible for the trafficking of leukocytes to sites of inflammation. Serum chemokine levels were previously shown to be increased in adult patients with atopic dermatitis (AD). We tested whether serum concentrations of chemokines, including macrophage-derived chemokine (MDC), thymus and activation-regulated chemokine (TARC), eotaxin (EOX), interferon gamma inducible protein 10 (IP-10) and monocyte chemotactic protein 1 (MCP-1), are useful inflammatory markers for assessing AD severity in infants and young children. To investigate this, we assessed the severity of AD clinically using the SCORing Atopic Dermatitis (SCORAD) index system. Serum chemokine concentrations were determined by sandwich enzyme immunoassay. Twenty AD patients with a median age of 2.1 years [interquartile range (IQR): 0.6,4.2] were recruited. Their SCORAD score was 23.5 (12.5,33.5). Serum concentrations of MDC, TARC, EOX, IP-10 and MCP-1 were 2551 (1978,3935), 1469 (1125,3070), 68 (57,85), 126 (101,226) and 518 (419,614) pg/ml, respectively. Serum MDC levels correlated with SCORAD (r =,0.608, p = 0.004) and its extent (r =,0.629, p = 0.003) and intensity (r =,0.557, p = 0.011) components. Serum TARC concentration showed weaker correlation with extent (r =,0.474, p = 0.035) and intensity (r =,0.465, p = 0.039) of skin involvement but not SCORAD. The median serum levels of MDC (3131 vs. 2394 pg/ml; p = 0.031) and EOX (80 vs. 61 pg/ml; p = 0.046) were also higher in children with moderate as compared with mild AD. The other chemokines did not correlate with AD severity. In conclusion, our results suggest that serum MDC concentration may be a useful inflammatory marker for assessing AD severity in infants and young children. [source] The Safety and Efficacy of Tacrolimus Ointment in Pediatric Patients with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 5 2010Alexandra D. McCollum M.D. It is a chronic disorder, characterized by intermittent flares and phases of remission. Treatment regimens often require multiple therapies. These can vary between patients, and in an individual patient, depending on the state of disease. The traditional treatment for AD flares is topical corticosteroids, which are fast acting and effective for relief of symptoms, but may cause adverse effects, including those resulting from systemic absorption, particularly in children. Topical calcineurin inhibitors (TCIs) are alternative treatments for AD. Tacrolimus ointment, a TCI, is approved for patients aged 2 years and older. Multiple studies have shown that tacrolimus is effective for short-term relief of symptoms in pediatric patients with AD. Long-term trials have demonstrated that the effectiveness of tacrolimus is maintained for up to 4 years in children. Additional studies have revealed that long-term intermittent use of tacrolimus as part of maintenance therapy can prevent AD flares. Tacrolimus has a low potential for systemic accumulation, and analysis of long-term studies indicates that it has a good safety profile. Treatment with tacrolimus, alone or in combination with topical corticosteroids for acute flares, may be a useful option for long-term management of AD in pediatric patients. [source] Protein Losing Enteropathy in Severe Atopic Dermatitis in an Exclusively Breast-Fed InfantPEDIATRIC DERMATOLOGY, Issue 5 2009JIN-BOK HWANG M.D. Protein losing enteropathy was confirmed by fecal ,1 -antitrypsin clearance test and imaged successfully by 99mTc-human serum albumin scintigraphy. The present case highlights that protein losing enteropathy in severe infantile atopic dermatitis is being a topic of concern and also an issue even in exclusive breast feeding patients. [source] Three Years of Italian Experience of an Educational Program for Parents of Young Children Affected by Atopic Dermatitis: Improving Knowledge Produces Lower Anxiety Levels in Parents of Children with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 1 2009Giampaolo Ricci M.D. As atopic dermatitis affects 10% of the pediatric population, pediatricians and dermatologists spend much time on the treatment of this disease, which requires a multidisciplinary approach. To improve the quality of life of children and families affected by atopic dermatitis we have offered an educational program to the parents of young children affected by the disease. The program consists of six meetings at weekly intervals involving a pediatric allergist, a dermatologist, and a psychologist. Our experience has been positive. This type of program may help to improve the quality of life of families with children affected by atopic dermatitis. Lower levels of anxiety were observed among parents at the end of the program. We believe that educational programs of this type, in association with conventional treatment, can be useful in the long term management of the disease. They may be considered to improve the quality of life of the family and children and to create more interaction and compliance between physicians, parents, and children. [source] The Socioeconomic Impact of Atopic Dermatitis in the United States: A Systematic ReviewPEDIATRIC DERMATOLOGY, Issue 1 2008Anthony J. Mancini M.D. A search was performed using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the International Agency for Health Technology Assessment (INAHTA) database, and the Cochrane Library. All abstracts were reviewed for the following criteria: original cost data, studies performed in the United States, and English language. The search yielded 418 papers. Fifty-nine papers were reviewed in detail, and four studies were found that met the inclusion criteria. These cost-identification analyses estimated the cost of atopic dermatitis heterogeneously and could not be compared directly. National cost estimates ranged widely, from $364 million to $3.8 billion US dollars per year. The cost of atopic dermatitis is significant and will likely increase in proportion to increasing disease prevalence. Measurement of the cost of atopic dermatitis in the United States has been limited to direct cost-identification analyses, with few studies measuring the indirect cost of disease. [source] Effect of Desonide Hydrogel 0.05% on the Hypothalamic-Pituitary-Adrenal Axis in Pediatric Subjects with Moderate to Severe Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 3 2007Lawrence F. Eichenfield M.D. A recent formulation advance has enabled the development of desonide 0.05% into a novel moisturizing aqueous gel (hydrogel) that is free of alcohol and surfactants. This multicenter, open-label study evaluated the hypothalamic-pituitary-adrenal axis suppression potential, tolerability, and efficacy of this new Class VI topical steroid formulation in pediatric subjects with moderate-to-severe atopic dermatitis (mean body surface area = 51%). Forty children, aged 6 months to 6 years were enrolled and treated twice daily for 4 weeks. Desonide hydrogel 0.05% was well tolerated and no treatment-related adverse events were reported. No suppression of adrenal function was observed in subjects who completed the study without protocol violations related to cosyntropin administration or cortisol testing (n = 34). Of the subjects who completed the study with complications in cortisol testing (n = 3), there was one subject (1/37 = 3%) who had a low poststimulation cortisol level at week 4. Efficacy was demonstrated by marked improvement in overall disease state and in the signs and symptoms of atopic dermatitis. This study validates the systemic safety of a novel desonide hydrogel formulation in young pediatric patients and confirms the longstanding tolerability and efficacy profile of desonide. [source] Unnecessary Milk Elimination Diets in Children with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 1 2007J.L. Sinagra M.D. We investigated the percentage of children allergic to cow's milk compared with the rate of milk exclusion diets in a group of patients with atopic dermatitis. We enrolled 206 children (79 girls, 127 boys), mean age 45.8 (4,68) months, affected by atopic dermatitis into our study. All children underwent radioallergosorbent test for casein, alpha-lactalbumin and beta-lactoglobulin, prick test, atopy patch test, and oral provocation test. Children were followed up at 1, 3, 6, and 12 months. Of the 206 patients, 20 were excluded from statistical analysis, leaving 186. Forty-five (24.2%) were on a milk elimination diet and 141 on a normal diet. Four patients on the milk-free diet (8.9%), accounting for 2.2% of all patients, were found to be allergic. In the others, milk reintroduction did not cause the disease to worsen during the follow-up period. No children on a normal diet were found to be allergic. Our results demonstrated an actual prevalence of cow's milk allergy in patients on milk elimination diets (4%) to be significantly lower than the number of patients prescribed such diets (24.2%),confirming that this measure is being applied excessively. [source] Pigmentary Changes and Atopic Dermatitis in a Patient with Seckel SyndromePEDIATRIC DERMATOLOGY, Issue 1 2007Amy Brackeen M.D. This syndrome has been described with associated disorders of orthopedic, neurologic, hematologic, cardiac, and ocular systems; however, only a few reports mention dermatologic involvement. We describe a 5-year-old girl with classic Seckel syndrome who presented with moderately severe atopic dermatitis and diffuse hypopigmented macules and papules. [source] Evaluation of Adrenal Suppression of a Lipid Enhanced, Topical Emollient Cream Formulation of Hydrocortisone Butyrate 0.1% in Treating Children with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 1 2007Lawrence Eichenfield M.D. In the pediatric population however, the potential impact of adrenal suppression is always an important safety concern. Twenty boys and girls, 5,12 years of age, with normal adrenal function and a history of atopic dermatitis were maximally treated three times daily with a lipid-rich, moisturizing formulation of hydrocortisone butyrate 0.1% for up to 4 weeks. At the conclusion of the 4-week treatment period, cosyntropin injection stimulation testing showed no evidence of adrenal suppression. In addition, the therapy was noted to be highly efficacious, with a clinical success rate of 80% (Physician Global Score of (0) clear or (1) almost clear). No local side effects associated with prolonged use of topical corticosteroids were reported. In summary, this study supports the contention that this lipid-rich, moisturizing formulation of hydrocortisone butyrate 0.1% was a well-tolerated and beneficial treatment for atopic dermatitis, demonstrating no adrenal suppression in the pediatric population aged 5,12 years. The relevance of these findings for children below 5 years of age, because of difference in body mass/surface area ratios, remains to be determined. [source] Low Systemic Absorption and Good Tolerability of Pimecrolimus, Administered as 1% Cream (Elidel®) in Infants with Atopic Dermatitis , A Multicenter, 3-Week, Open-Label StudyPEDIATRIC DERMATOLOGY, Issue 5 2005Doris Staab M.D. Here we evaluate pimecrolimus blood concentrations and tolerability to pimecrolimus cream 1% in 22 infants below 2 years of age with atopic dermatitis (10,92% body surface area affected at baseline). Efficacy was assessed as a secondary objective. Pimecrolimus cream 1% was applied twice daily for 3 weeks. Blood concentrations were low, typically (96% of total 100 concentrations measured) below 2 ng/mL, the majority (71%) remaining below 0.5 ng/mL. The highest concentration observed was 2.26 ng/mL. At steady state, there was no indication of accumulation. Pimecrolimus was well tolerated locally and systemically, with no serious adverse events recorded. Most adverse events recorded (35 in 17/22 patients) were typical of the young pediatric population studied, of mild to moderate severity, and not considered to be study-medication related, with the exception of four local adverse effects limited to the site of cream application. No clinically relevant change was observed in physical examination, vital signs, or laboratory safety parameters. A rapid onset of therapeutic effect was observed within the first four days of treatment. Pimecrolimus cream 1% is well tolerated in infants 3 to 23 months of age treated for 3 weeks, and results in minimal systemic exposure. [source] Serum Concentration of IL-18 Correlates with Disease Extent in Young Children with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 6 2004Kam Lun Ellis Hon F.A.A.P. Previous studies have suggested that IL-18 may be an inflammatory marker for atopic dermatitis (AD). The purpose of our study was to test whether the serum concentration of IL-18 is a useful inflammatory marker for assessing AD severity in young children. Nineteen AD patients with a median age of 2.2 years (interquartile range 0.7,4.6 years) were recruited. The severity of AD was clinically determined using the Scoring Atopic Dermatitis (SCORAD) index. Their SCORAD score was 23.9 (range 18.6,34.8). Serum IL-18 levels were determined by sandwich enzyme immunoassay. The median serum concentration of IL-18 was 394 pg/ml (interquartile range 204,612 pg/ml). Serum IL-18 levels correlated with SCORAD scores (r = 0.502, p = 0.029) and their extent component (r = 0.633, p = 0.004). When compared with mild disease with low SCORAD scores, the serum concentration in moderate to severe disease was significantly higher (p = 0.014). We concluded that serum IL-18 concentration is elevated in young children with AD. It may be a useful inflammatory marker that correlates with the extent component of AD in particular, and differentiates mild disease from more severe disease when used for assessing AD severity in young children. [source] Time Spent on Treatment of Atopic Dermatitis: A New Method of Measuring Pediatric Morbidity?PEDIATRIC DERMATOLOGY, Issue 6 2004Elisabeth A. Holm M.D. The TSOT (min/day) was studied in a group of 42 children with atopic dermatitis (AD) (16 girls and 26 boys; mean age 7.07 years). The TSOT included time spent on all types of topical treatment, on extra cleaning, and on visits to doctors. Objective Scoring Atopic Dermatitis (SCORAD) assessment was performed at each visit. A significant correlation was found between TSOT and SCORAD scores for all visits (p < 0.0001). There was no correlation between TSOT and age or sex or between TSOT/SCORAD and age (p < 0.08). For the 65 visits (by 42 children), TSOT/SCORAD ranged from 0.08 min/point to 28.67 min/point. Older children (10,15 years of age) had a lower TSOT/SCORAD ratio compared to younger children (1,5 years of age). Our data suggest that TSOT in itself may be a useful measure of morbidity among pediatric AD patients. It is speculated that patients with a very high TSOT/SCORAD rate or a very low rate have coping problems and would therefore be suitable candidates for intensified efforts in programs such as "eczema schools." [source] Validation of a Self-Administered Questionnaire in Chinese in the Assessment of Eczema SeverityPEDIATRIC DERMATOLOGY, Issue 6 2003Kam Lun Hon F.A.A.P. Each parent or patient filled out a questionnaire in Chinese based on the NESS. A physician then repeated the NESS independently. Finally, the severity of AD was evaluated according to the Scoring Atopic Dermatitis (SCORAD) scale. The NESSs, severity grades, and SCORAD were analyzed for agreement and correlation. The severity grading agreed with the physician's grading in 38 of 52 parents (73%) and in 16 of 18 children (89%) who self-evaluated the severity of their AD. The weighted kappa (95% confidence interval [CI]) for parents with children less than 10 years old, parents with children ,10 years old, and patients who self-evaluated their AD were 0.79 (0.66,0.91), 0.85 (0.69,1.00), and 0.74 (0.36,1.00), respectively. The R2 for the NESS by parents, the NESS by patients, and the SCORAD scores was 42.1%, 47.5%, and 49.8%, respectively. When compared with the parents, the older children who self-evaluated their AD showed a better correlation of the NESS with the SCORAD index. The self-administered questionnaire appears to be useful in assessing AD severity in Chinese children. [source] Palmar-Plantar Keratoderma of Unna Thost Associated with Atopic Dermatitis: An Underrecognized Entity?PEDIATRIC DERMATOLOGY, Issue 3 2003Teck-Hiong Loh All had typical features of PPKUT with diffuse, yellowish thickening on the palms and soles with a well-defined erythematous rim of demarcation on the sides associated with palmar-plantar hyperhidrosis. The changes were obvious since birth or arose during early life, and were persistent. We believe that the association between the two disorders is not coincidental but an underrecognized entity that may shed light on the underlying pathogenesis of these two conditions. [source] The Family Impact of Atopic Dermatitis in Children: The Role of the Parent CaregiverPEDIATRIC DERMATOLOGY, Issue 1 2003Rajesh Balkrishnan Ph.D. We conducted a cross-sectional, exploratory analysis of how parent caregivers are affected by their child's AD, and how certain parent caregiver characteristics and perceptions affect the family impact of this condition. Parent caregivers of children with AD (n = 49) were administered a survey to collect detailed data on socioeconomic status, health perceptions, and caregiving issues. Family impact of the child's AD was measured using a modified AD Family Impact Scale. Multiple regression analyses revealed that three major factors associated with the parent caregiver were correlated with large increases in the family impact scores: 1) perception that the child's condition is severe (13%, p < 0.01), 2) high use of nonmedical services for child's condition (21%, p < 0.01), and 3) financial concern about the child's condition (18%, p < 0.01). These preliminary data indicate distinct characteristics of the parent caregiver that are associated with higher family impact of AD in children. These parent caregiver factors may be important in identifying suitable audiences and areas for education for optimal management of children's AD. [source] The Natural History of Sensitizations to Food and Aeroallergens in Atopic Dermatitis: A 4-Year Follow-UpPEDIATRIC DERMATOLOGY, Issue 4 2000Annalisa Patrizi M.D. Generally the dermatitis disappears during the first years of life, but it is often followed by the appearance of allergic respiratory diseases (ARDs). Our aim was to establish the risk factors for developing an ARD in children with AD. We followed up for 4 years 78 children (51 boys, 27 girls) with mild (26%), moderate (48%), and severe (26%) AD (clinical score proposed by Rajka and Langeland). In all the patients IgE serum levels were checked and skin prick tests (SPTs) were performed at the first examination. The SPTs were repeated in 68 children at the end of the study. The children with severe AD had significantly higher IgE serum levels than those with mild or moderate AD. SPTs at the first observation were positive in 47% of cases, mostly in patients with severe AD, with a prevalence of food allergens, particularly in younger patients. At the second observation, SPTs were positive in 65% of cases, including 100% of children with severe AD. Inhalants were the most common allergens. An ARD appeared in 38% of all patients: in 75% of those with severe AD and in 54% of those with a positive first SPT. Allergic screening should be carried out at an early age, especially in severe AD, since SPT positivity to food allergens, associated with severe clinical AD symptoms and a high IgE serum level, identifies those children ages 0,3 years at high risk of development of ARD. [source] Development and validation of the psychosomatic scale for atopic dermatitis in adultsTHE JOURNAL OF DERMATOLOGY, Issue 7 2006Tetsuya ANDO ABSTRACT Psychosocial factors play an important role in the course of adult atopic dermatitis (AD). Nevertheless, AD patients are rarely treated for their psychosomatic concerns. The purpose of the present study was to develop and validate a brief self-rating scale for adult AD in order to aid dermatologists in evaluating psychosocial factors during the course of AD. A preliminary scale assessing stress-induced exacerbation, the secondary psychosocial burden, and attitude toward treatment was developed and administered to 187 AD patients (82 male, 105 female, aged 28.4 ± 7.8, 13,61). Severity of skin lesions and improvement with standard dermatological treatment were assessed by both the dermatologist and the participant. Measures of anxiety and depression were also determined. In addition, psychosomatic evaluations were made according to the Psychosomatic Diagnostic Criteria for AD. Factor analysis resulted in the development of a 12-item scale (The Psychosomatic Scale for Atopic Dermatitis; PSS-AD) consisting of three factors: (i) exacerbation triggered by stress; (ii) disturbances due to AD; and (iii) ineffective control. Internal consistency indicated by Cronbach's alpha coefficient was 0.86 for the entire measure, 0.82 for (i), 0.81 for (ii), and 0.77 for (iii), verifying the acceptable reliability of PSS-AD. Patients with psychosomatic problems had higher PSS-AD scores than those without. PSS-AD scores were positively associated with the severity of the skin lesions, anxiety and depression. The scores were negatively associated with improvement during dermatological treatments. In conclusion, PSS-AD is a simple and reliable measure of the psychosomatic pathology of adult AD patients. It may be useful in dermatological practice for screening patients who would benefit from psychological or psychiatric interventions. [source] Eczema workshops reduce severity of childhood atopic eczemaAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 2 2009Elizabeth J Moore ABSTRACT An intervention study was conducted to assess the effectiveness of a nurse-led eczema workshop in reducing the severity of atopic eczema in infants, children and adolescents. Ninety-nine new patients referred to the Dermatology Department of The Royal Children's Hospital in Melbourne, Australia, for the management of atopic eczema were randomized to receive care from an eczema workshop or a dermatologist-led clinic. Patients were followed-up 4 weeks after the intervention. The primary outcome was the severity of eczema as determined by scores obtained using the Scoring of Atopic Dermatitis (SCORAD) index at a 4-week follow-up visit. The secondary outcome was a comparison of treatments used in both clinics. At the 4-week review the mean improvement in SCORAD was significantly greater in those patients attending the eczema workshop than those attending the dermatologist-led clinic (,9.93, 95% confidence interval ,14.57 to ,5.29, P < 0.001). Significantly more patients from the eczema workshop improved from moderate severity eczema at baseline to mild at review. There was greater adherence to eczema management in the eczema workshop compared with the dermatologist-led clinic. In this study, patients attending the eczema workshop had a greater improvement in eczema severity thanpatients attending a dermatologist-led clinic, supporting collaborative models of service provision. [source] Assessment of atopic eczema: clinical scoring and noninvasive measurementsBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2007E.A. Holm Summary Background, Clinical scoring systems are widely used in clinical trials of atopic eczema (AE), while noninvasive methods are more often used for research purposes. Positive correlations between the two types of methods may be used in support of the validity of both in a clinical context. Few studies are available of the association between clinical scores and instrumental assessment of disease severity obtained with noninvasive instruments. Objectives, To compare clinical scores in AE with biometric data in AE. Methods, Transepidermal water loss, stratum corneum hydration, erythema, scaling and subepidermal oedema were measured. ,Scoring of Atopic Dermatitis (SCORAD)', ,Eczema Area and Severity Index (EASI)' and ,Atopic Dermatitis Severity Index (ADSI)' were used for clinical scores. Two assessments at 6-month intervals at the antecubital fossa, dorsal forearm and popliteal fossa in 101 patients with AE and 30 controls were carried out. Results, Significant correlations were found within the clinical scores (P < 0·0001 and r = 0·85,0·91) and between instruments and clinical scores (P < 0·0001 and r = 0·61,0·79). Conclusions, The various instruments and clinical scores showed internal agreement and noninvasive methods correlated significantly with the three different clinical scorings systems. This observation suggests that both methods provide data of clinical (scores) and biological (instrumental measures) relevance, and may be useful in future studies of AE. It is speculated that combined measures including scores and selected instruments may be particularly useful. [source] Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterpartsBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2002M.A. Ben-Gashir SummaryBackground The prevalence of atopic dermatitis (AD) has been shown to be higher in London-born black Caribbean children than in their white counterparts, but little is known about the severity of the disease. Objectives To carry out a longitudinal survey to investigate potential risk factors for AD severity in children. We report our findings in relation to differences in disease severity between white and black children and the effect of inclusion and exclusion of erythema scores on this comparison. Methods The recruited children were identified by their general practitioners (GPs) as having presented with AD, and the U.K. diagnostic criteria for AD were used to verify the diagnosis. Interview and clinical examination of children took place up to four times, 6 months apart. Each time, the same observer assessed AD severity using the SCORAD (SCORe Atopic Dermatitis) index. Potential risk factors and confounders were evaluated with a five-page questionnaire. Non-parametric tests were used for statistical analysis and the study participant remained the unit of the analysis. Results In total, 137 children (82 urban and 55 rural) were recruited, and each seen up to four times. This gave 380 observations (69% of an expected 548). The urban population contained 42 (51%) white children, 26 (32%) black children and 14 (17%) from other races. The rural population was entirely white. The 14 children from other races were completely excluded from the statistical analysis. The black children were all born in the U.K. On crude analysis, children with black skin showed a non-significantly lower risk of severe disease when compared with white children (odds ratio, OR 0·84; 95% confidence interval, CI 0·4,1·76; P = 0·65), while a highly significantly increased risk was found after adjusting for erythema score (OR 5·93; 95% CI 1·94,18·12; P = 0·002). The difference remained significant even after controlling for other potential confounders. Conclusions Black children with AD are about six times more at risk of having severe AD than their white counterparts. GPs and dermatologists should note that erythema can be a misleading indicator of severity in black children. Difficulties of assessment due to skin pigmentation might mean that severe cases are not being detected and appropriately treated. [source] Clinical effects of kestose, a prebiotic oligosaccharide, on the treatment of atopic dermatitis in infantsCLINICAL & EXPERIMENTAL ALLERGY, Issue 9 2009R. Shibata Summary Background Oligosaccharides may have beneficial properties of the prevention of atopic dermatitis (AD). Kestose, a fructo-oligosaccharide, stimulates the activity of bifidobacteria. Objective To assess the clinical effect of kestose on the treatment of AD in infants. Methods A randomized, double-blind, placebo-controlled trial was carried out using 15 and 14 infants with AD in the kestose group and placebo groups, respectively. One to 2 g kestose and maltose were administered to the subjects in the kestose and placebo groups, respectively, everyday for 12 weeks. Clinical evaluations of AD using Severity Scoring of Atopic Dermatitis (SCORAD) and the enumeration of bifidobacteria in the feces using real-time PCR were performed at Weeks 0, 6, and 12. Results The medians of the SCORAD score were significantly lower in the kestose group than in the placebo group on both Week 6 (25.3 vs. 36.4; P=0.004) and Week 12 (19.5 vs. 37.5; P<0.001). No significant correlation was found between the improvement of the SCORAD score and the count of bifidobacteria. Conclusion Kestose was found to exert a beneficial effect on the clinical symptoms in infants with AD. The mechanism how does kestose improve the symptoms of AD remains to be elucidated. [source] The immune system in healthy adults and patients with atopic dermatitis seems to be affected differently by a probiotic interventionCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2008A. Roessler (nee Klein) Summary Background Probiotic bacteria are proposed to alleviate atopic dermatitis (AD) in infants. There are few indications about the effect of probiotics on AD in adults. Objective The purpose of this study was to elucidate the influence of a probiotic drink containing a combination of the probiotics Lactobacillus paracasei Lpc-37, Lactobacillus acidophilus 74-2 and Bifidobacterium animalis subsp. lactis DGCC 420 (B. lactis 420) in healthy volunteers and in patients with AD on clinical and immunological parameters and their detection in feces. Methods A double-blind, placebo-controlled, randomized cross-over study was conducted in 15 healthy adults and 15 patients with AD. The probiotic product or placebo was given over 8 weeks. A 2-week washout period was interconnected before the intervention was crossed. At the end of each period, blood and stool samples were collected. In patients, the severity of AD was evaluated using the Scoring of Atopic Dermatitis (SCORAD). Results L. paracasei and B. lactis were recovered in high numbers in feces after supplementation, whereas L. acidophilus marginally increased. In patients, the SCORAD tended to decrease by 15.5% (P=0.081). Major lymphocyte subsets were not affected by the probiotic intervention. However, CD57+ increased significantly (P=0.034) in healthy subjects after probiotic intake and was not changed in patients, whereas CD4+CD54+ decreased significantly (P=0.031) in patients with AD and remained uninfluenced in healthy subjects. The expression of CD4+CD25+ T cells was similar in healthy subjects and AD patients. The phagocytic activity of monocytes and granulocytes was significantly increased in healthy subjects after probiotic intervention (P=0.014). Conclusion L. paracasei Lpc-37 and B. lactis 420 are able to colonize the intestine transiently. This study reveals that the probiotics differently modulate peripheral immune parameters in healthy subjects and patients with AD. [source] Is the effect of probiotics on atopic dermatitis confined to food sensitized children?CLINICAL & EXPERIMENTAL ALLERGY, Issue 5 2006D. Sistek Summary Background Probiotics have previously been shown to reduce the severity of atopic dermatitis (AD) in infants and children. Objective To examine the effect of two probiotics (Lactobacillus rhamnosus and Bifidobacteria lactis) on established AD in children. Subjects and methods Atopic children with current dermatitis received 2 × 1010 colony forming units/g of probiotic (n=29) or placebo (n=30). Both were given daily as a powder mixed with food or water. SCORing Atopic Dermatitis (SCORAD; developed by the European Task Force on Atopic Dermatitis) a measure of the extent and severity of AD, was assessed at baseline, 2 and 12 weeks after starting treatment and 4 weeks after treatment was discontinued. Results SCORAD geometric mean score at baseline was 26.0 (21.9,30.8) in the probiotic group and 35.1 (28.9,42.8) in the placebo group (P=0.02). After adjustment for these between-group baseline differences there was no significant improvement in AD at 12 weeks, SCORAD geometric mean ratio: 0.80 (95% confidence level (CI) 0.62,1.04, P=0.10). Among the food sensitized children, there was an improvement in those treated with probiotics, SCORAD geometric mean ratio: 0.73 (95% CI 0.54,1.00, P=0.047). Conclusion In this study a combination of Lactobacillus rhamnosus and Bifidobacteria lactis improved AD only in food sensitized children. [source] Natural course of sensitization to cow's milk and hen's egg in childhood atopic dermatitis: ETACTM Study GroupCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2002A. Wolkerstorfer Background Sensitization to food allergens has been implicated in the pathogenesis of atopic diseases, in particular atopic dermatitis (AD). The aim of the present paper is to investigate the natural course of sensitization to egg and to cow's milk and its relationship with the severity of AD. Methods The placebo intention-to-treat population of the ETACTM (Early Treatment of the Atopic Child) study consisted of 397 children with AD aged 12,24 months (mean±,SD: 17.2 ± 4.1 months) who were followed for 18 months. All children were examined for objective SCORing Atopic Dermatitis (SCORAD) and specific IgE amongst other, to egg and to cow's milk at inclusion and after 3, 12 and 18 months. Fifteen patients were excluded from this analysis due to major protocol violations thus leaving 382 patients in the analysed population. Results Sensitization to egg and to cow's milk was more common in atopic children with severe AD at all time-points. At inclusion, children sensitized to both egg and to cow's milk had the most severe AD (Kruskall-Wallis test P = 0.007). The degree of sensitization expressed in RAST classes was significantly related to the severity of AD. Furthermore, children sensitized to egg or to cow's milk at inclusion had a higher risk of persistence of AD (84% and 67%, respectively, vs. 57% in those not sensitized) and a higher objective SCORAD after 18 months follow-up. Conclusion We found an association between severity of AD and sensitization to egg or to cow's milk. Moreover, sensitization to egg, and to a lesser extent cow's milk, indicates a worse outcome of AD in terms of persistence and severity of the disease. [source] A randomized double-blind controlled trial to compare a triclosan-containing emollient with vehicle for the treatment of atopic dermatitisCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2010W. P. Tan Summary The use of topical antiseptics in the treatment of atopic dermatitis (AD) has previously been explored. However, no triclosan-containing leave-on emollient has been evaluated previously, to our knowledge. The aims of this study were to assess the safety and efficacy of an emollient containing triclosan compared with the emollient alone (vehicle) for the treatment of AD. Eligible patients with mild to moderate AD were randomized to receive either the study cream or vehicle. All patients also received a low-potency corticosteroid cream to use during the treatment phase of the study if necessary. Patients were assessed for severity according to the SCORing Atopic Dermatitis (SCORAD) Index, amount of corticosteroid used, patient assessment of cream, and adverse events (AEs). In total, 60 patients received either the study cream or vehicle, and an intention-to-treat analysis was performed. At day 14, there was a significant decrease in SCORAD from baseline for the study cream compared with vehicle (P < 0.05). At day 27, although there was an improved mean reduction from baseline, this was no longer significant (P > 0.05). Only four patients had mild treatment-related AEs. The mean total amount of topical steroid applied by the patients using the study was significantly lower than that used by controls (P = 0.40). Triclosan-containing leave-on emollient was safe and highly acceptable to patients. However, the overall benefit on day 27 was not significant. Nevertheless, the amount of topical steroid used by patients was significantly less with the study cream than with the vehicle, thus further studies are needed to confirm its steroid-sparing effect. [source] A pilot study on the use of wet wraps in infants with moderate atopic eczemaCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 4 2004P. E. Beattie Summary Wet wrap therapy (WWT) is a well-established treatment for severe atopic dermatitis (AD). However little evidence exists to justify widespread use in the community for less severe eczema. We compared the efficacy of WWT with a standard regime of hydrocortisone, to control moderate AD in children. We carried out a single-observer, randomized, controlled pilot study in 19 children under 5 years of age, with AD of 30% or more body surface area, using only 1% hydrocortisone (HC) prior to the study. Group one applied HC once in the morning for 2 weeks, with wet wraps twice daily for week 1, but only at night for week 2. Group two applied HC twice daily without wet wraps. Both applied emollient twice daily and as necessary. The primary outcome measure was the Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score, and the secondary outcome measures were the Infants Dermatology Quality of Life Index (IDQOL), the Dermatitis Family Impact (DFI) score and the weight of topical steroids and emollients used. Over the 2-week active therapy period the mean fall in SASSAD was 8 [95% confidence interval (CI), ,18 to +2; P = 0.11] more in the non-WWT group, the median change in the IDQOL was 2 for Group one and 7 for Group two (95% CI for difference, ,10 to +3; P = 0.24) and the median change in DFI score was 2 for Group one and 5 for Group two (95% CI for difference, ,14 to +2; P = 0.42). This small study has shown that conventional therapy with HC and emollients alone is as effective as WWT for infants with moderately severe, widespread AD, and provides weak evidence to suggest that it may be more effective. We would not advocate routine use of WWT for moderate eczema without further evaluation. [source] Pediatric atopic dermatitis: should we treat it differently?DERMATOLOGIC THERAPY, Issue 2 2006Robert Sidbury ABSTRACT:, Atopic dermatitis is an extremely common childhood skin disease that can have far-reaching impact on patients and families. Pediatric patients, particularly infants, pose special concerns for parents and providers, and equal emphasis must be placed on both nonpharmacologic and prescription interventions. Concerns for adverse effects of prescription therapies and a universal parental fear of an undetected allergy are hallmarks of pediatric atopic dermatitis care. The purpose of the present study is to highlight important educational and therapeutic strategies designed to optimally care for this patient population. [source] | |||||||||||||||||||||||||||||||