Control Of Eczema Research Articles

Sophora flavescens-Angelica sinensis in the treatment of eczema by inhibiting TLR4/MyD88/NF-κB pathway

Ethnopharmacological relevanceSophora flavescens Ait.-Angelica sinensis(Oliv.) Diels drug pairing (SA) is a transformed drug pairing from Shengui pill, a traditional Chinese medicine prescription in the ninth volume of Traditional Chinese Medicine classic “Gu Jin Yi Jian”, which is famous for clearing heat, moistening dryness, and promoting blood circulation. It is commonly used in the treatment of eczema, a skin condition that causes itching and inflammation. Despite its widespread use, there is still limited research on the mechanism of how SA treats eczema. This paper aims to fill this gap by conducting animal experiments to uncover the mechanism behind SA's therapeutic effects on eczema. Our findings provide a solid foundation for the clinical use of this TCM prescription. Aim of the studyThe basic purpose of this study is to clarify the therapeutic mechanism of Sophora flavescens-Angelica sinensis (SA) in the treatment and control of eczema. Materials and methodsThe chemical compositions of SA were analyzed using HPLC-Q-Orbitrap-MS. In vivo, a mouse model of eczema was created, and the serum levels of TNF-α and IL-1β were quantified using an enzyme-linked immunosorbent assay (ELISA). Hematoxylin and eosin (HE) staining was performed to assess the pathological state of the mouse skin, and immunohistochemical technique (IHC) was employed to estimate the contents of TNF-α, TLR4, and NF-κB semi-quantitatively. The expression levels of TLR4, MyD88, and NF-κB mRNA were determined through real-time quantitative polymerase chain reaction (qRT-PCR). Western Blotting was utilized to identify the protein levels of TLR4, MyD88, and NF-κB in mouse skin tissue. ResultsSA identified 18 active chemicals, some of which were shown in vivo to inhibit the TLR4/MyD88/NF-κB signaling pathway while reducing serum levels of TNF-α and IL-1β, making them ideal agents for the treatment of eczema. ConclusionsSA's anti-inflammatory properties are attributed to its ability to reduce serum levels of TNF-α and IL-1β, likewise inhibit the TLR4/MyD88/NF-κB signaling pathway.

Translated article] Spanish Version of the RECAP Questionnaire to Assess Control of Atopic Eczema: Translation, Cultural Adaptation, Validation, and Correlations With Other Patient-Reported Outcome Measures

BackgroundThe 7-item RECAP (Recap of Atopic Eczema) questionnaire is used to assess the control of different degrees of eczema severity in patients of all ages. Long-term control of eczema is one of the 4 core outcome domains to be assessed in clinical trials of eczema therapies. After the RECAP was developed in the United Kingdom, it was translated into Chinese, German, Dutch, and French. ObjectivesTo produce a validated Spanish version of the RECAP questionnaire and, secondarily, to test its content validity in a group of Spanish patients with atopic eczema. Material and methodsIn a 7-step process we produced 2 forward translations and 1 back translation of the RECAP questionnaire. Experts then held two meetings to reach consensus and draft a Spanish version of the questionnaire. Fifteen adult patients with atopic eczema were interviewed to evaluate the comprehensibility, comprehensiveness, and relevance of the drafted items. These patients also completed the Atopic Dermatitis Control Tool (ADCT), the Dermatology Life Quality Index (DLQI), and the Patient-Oriented Eczema Measure (POEM). Stata software (version 16) was then used to explore the correlations between the patients’ scores on these tools and the RECAP. ResultsThe patients found the Spanish version of the RECAP to be comprehensible and easy to answer. We observed a strong correlation between results on the Spanish RECAP and the ADCT, and highly significant correlations between the RECAP and the DLQI and POEM tools. ConclusionsThe culturally adapted Spanish version of the RECAP is linguistically equivalent to the original version of the questionnaire. RECAP scores correlate highly with other patient-reported outcome measures.

TL1A control of eczema and psoriasis

Abstract Psoriasis is a Th17-induced dermatitis, characterized by epidermal thickening. Psoriasis increases the risk of developing arthritis and cardiovascular-related morbidities, hence the need to stop its progression early. Why the disease is patchy, and what activates the keratinocytes in the psoriatic plaques driving a Th17-type inflammation, remain unknown. Chronic exposure to imiquimod (IMQ) drives psoriasis in mice reminiscent of human disease. We have preliminary data implicating the TNFSF (tumor necrosis factor superfamily) member TL1A (tumor necrosis factor-like cytokine 1A) in psoriasis. Our loss of function studies show that the genetic deletion of TL1A receptor, protects from IMQ-induced psoriasis. Further, TL1A is known to be enriched in the psoriatic lesions and serum of psoriatic patients. These findings suggest that TL1A may play a central role in the development and maintenance of psoriasis. Therefore, targeting TL1A could be beneficial to treat Psoriasis.

Traducción, adaptación transcultural, correlación con otros PRO y validación del cuestionario RECAP sobre el grado de control de la dermatitis atópica

BackgroundThe 7-item RECAP (Recap of Atopic Eczema) questionnaire is used to assess the control of different degrees of eczema severity in patients of all ages. Long-term control of eczema is one of the 4 core outcome domains to be assessed in clinical trials of eczema therapies. After the RECAP was developed in the United Kingdom, it was translated into Chinese, German, Dutch, and French. ObjectivesTo produce a validated Spanish version of the RECAP questionnaire and, secondarily, to test its content validity in a group of Spanish patients with atopic eczema. Material and methodsIn a 7-step process we produced 2forward translations and 1back translation of the RECAP questionnaire. Experts then held two meetings to reach consensus and draft a Spanish version of the questionnaire. Fifteen adult patients with atopic eczema were interviewed to evaluate the comprehensibility, comprehensiveness, and relevance of the drafted items. These patients also completed the Atopic Dermatitis Control Tool (ADCT), the Dermatology Life Quality Index (DLQI), and the Patient-Oriented Eczema Measure (POEM). Stata software (version 16) was then used to explore the correlations between the patients’ scores on these tools and the RECAP. ResultsThe patients found the Spanish version of the RECAP to be comprehensible and easy to answer. We observed a strong correlation between results on the Spanish RECAP and the ADCT, and highly significant correlations between the RECAP and the DLQI and POEM tools. ConclusionsThe culturally adapted Spanish version of the RECAP is linguistically equivalent to the original version of the questionnaire. RECAP scores correlate highly with other patient-reported outcome measures.

Prevalence and influencing risk factors of eczema among preschool children in Urumqi city: a cross-sectional survey

BackgroundEczema is a chronic inflammatory disease associated with impaired quality of life. We identified indoor environmental risk factors, to provide strong evidence for the prevention and control of eczema in preschool children.MethodsUsing a cross-sectional study with stratified random cluster sampling, we conducted a self-administered questionnaire survey among 8153 parents of children aged 2–8 years in 60 kindergartens in six districts of Urumqi city during August 2019.ResultsAmong 8153 preschool children, 12.0% of the children have been diagnosed with eczema. Multivariate logistic regression analysis showed that caesarean section (odds ratio [OR] = 1.18, 95% confidence interval [CI]: 1.03–1.36), being an only child (OR = 1.36, 95% CI: 1.18–1.57), presence of mould or moisture in the mother’s home before pregnancy (OR = 1.53, 95% CI: 1.17–2.00), presence of flies or mosquitoes in the dwelling currently (OR = 1.31, 95% CI: 1.10–1.55), pets kept in the child’s home currently (OR = 1.23, 95% CI: 1.01–1.51), presence of pets during child’s first year (OR = 1.45, 95% CI: 1.14–1.85), and family history of eczema (OR = 3.53, 95% CI: 2.98–4.19) are the risk factors for the development of eczema, whereas ethnicity other than the Han Chinese (OR = 0.77, 95% CI: 0.61–0.96) is a protective factor for eczema.ConclusionPreschool children in Urumqi are at a high risk of eczema, particularly those of the Han Chinese ethnicity. Parents should be attentive to the indoor living environment of children and take actions to reduce indoor humidity, pest control and elimination, and avoid raising pets to reduce the risk of development of eczema in children.

What instruments should we add to our toolbox for measuring the severity and control of eczema?

What instruments should we add to our toolbox for measuring the severity and control of eczema?

Measurement properties of patient-reported outcome measures for eczema control: a systematic review.

Atopic eczema (herein referred to as 'eczema') is a skin disease characterized by remitting and relapsing symptoms. The Harmonising Outcome Measures for Eczema (HOME) initiative was developed to establish a core outcome set (COS) for eczema to be measured for all future eczema trials. The core outcome set for atopic eczema clinical trials includes the domain for patient-reported eczema control, but a review of the validation of available eczema control instruments was lacking. We aimed to review the literature and systematically assess the measurement properties of validated patient-reported outcome instruments that capture eczema control. PubMed and Ovid EMBASE were searched up to 24 January 2020 for any study that reported on PROM instrument development or validation. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria were used to assess the quality of eligible studies. We screened 12036 titles and abstracts and 58 full texts. A total of 12 papers were included, reporting on seven PROMS. These were assessed with respect to development, reliability, construct validity and responsiveness. Two instruments, Recap of Atopic Eczema (RECAP) and the Atopic Dermatitis Control Tool (ADCT), have been developed and validated to a sufficient standard to support their recommendation as patient-reported outcome instruments for measuring control of atopic eczema as part of the HOME Core Outcome Set.

The German RECAP questionnaire: linguistic validation and cognitive debriefing in German adults with self-reported atopic eczema and parents of affected children

BackgroundRecap of atopic eczema (RECAP) is a patient-reported outcome measure (PROM) assessing eczema control. Long-term control of eczema is one of the four core outcome domains for atopic eczema trials. This instrument has been recently developed in the UK.ObjectiveThis study aimed to translate the English RECAP into German and test its content validity in a German population with self-reported atopic eczema.MethodsA six-step procedure including two forward and one backward translations, two consensus decisions and an expert review was performed to obtain a German version of RECAP. We conducted semi-standardized cognitive interviews with adults with atopic eczema (n = 7) and parents having children affected by this disease (n = 5). A “think-aloud” method was used and aspects of comprehensibility, comprehensiveness and relevance according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria were examined. Interviews were coded using qualitative content analysis.ResultsNo particular linguistic problems were encountered during forward-backward translation. Minor wording changes were made as required. The title was adjusted to a more familiar German term of the disease (which is ‘Neurodermitis’). The recall period was rephrased from ‘over the last week’ to ‘over the last seven days’ since there was a different cultural understanding of the time frame. Regarding content validity, the items of the German RECAP were considered to be comprehensible, comprehensive and relevant for the participants and parents of affected children. The participants understood the instruction and considered the one-week recall period and the response options as appropriate.ConclusionsA German version of RECAP that is linguistically equivalent to the original version is now available but further assessment of its measurement properties is needed.

Defining and measuring 'eczema control': an international qualitative study to explore the views of those living with and treating atopic eczema.

BackgroundAtopic eczema (also known as eczema) is a chronic, inflammatory skin condition that often afflicts patients’ health and well‐being. The Harmonising Outcome Measures for Eczema (HOME) initiative recommends that ‘long‐term control of eczema’ is measured in all clinical trials 3 months or longer in duration. However, little has been published on what eczema control means to those living with or treating atopic eczema.ObjectivesTo (i) develop understanding of what eczema control means to patients, carers and clinicians and (ii) explore the feasibility and acceptability of different ways of measuring eczema control in the long term.MethodsOnline focus groups explored patients/carers experiences in the UK, the United States, the Netherlands, France, Sweden and Japan, and an international online survey gathered views of clinicians. The framework method was used to analyse the focus groups, and thematic analysis was used to analyse survey data. All findings were integrated into a theoretical framework to create overarching themes that cut across these diverse groups.ResultsEight focus groups with patients (16 years+) and eight groups with carers of children took place (N = 97). Sixty‐two people took part in the survey. Eczema control was described as a multifaceted construct involving changes in disease activity, the treatment and management of the condition and psychological, social and physical functioning. Patient/carer measurement allows personal accounts and frequent measurement, whilst clinician measurement was deemed less subjective. The burden on patients/carers and issues for analysing and interpreting data should be considered.ConclusionsThis study formed the basis of judging the content validity and feasibility of measurement instruments/methods to assess control of eczema in clinical trials. This online approach to an international qualitative study is an example of how core outcome set developers with limited resources can engage with multiple stakeholder groups on an international basis to inform consensus meeting discussions.

Abstracts of the 10th George Rajka International Symposium on Atopic Dermatitis, 11-13 April 2018, Utrecht, the Netherlands

The Harmonising Outcome Measures for Eczema (HOME) initiative is a multidisciplinary, evidence-based international group developing a core outcome set for atopic eczema trials. HOME has previously recommended four essential domains to be measured; signs, symptoms, quality of life and long-term control, with Eczema Area and Severity Index (EASI) and Patient-Oriented Eczema Measure (POEM) as the instruments to measures signs and symptoms, respectively. The aim of the current study was to define the domain of long-term control, and achieve consensus on what instrument(s) should be used to measure it. Two qualitative studies were conducted by the long-term control working group: online focus groups involving patients and carers, and an online qualitative survey of the HOME membership. These were analysed thematically and combined to provide evidence on what long-term control of atopic eczema means to patients, carers and clinicians. A face-to-face consensus meeting (HOME V) was held on 12-14 June 2017 in Nantes, France, involving moderated small interactive groups and whole-group discussions with anonymous voting. The HOME roadmap and COSMIN and COMET guidelines on outcome measurement instrument selection were followed. Discussions and voting on the definition of long-term control and the face validity and feasibility of different ways of measuring long-term control were informed by these two international qualitative studies and other published evidence (systematic reviews and validation studies). Focus groups involving 99 patients and carers were conducted in the U.K., the U.S.A., the Netherlands, France, Sweden and Japan. The HOME survey included 62 responses, mainly clinicians, representing 16 countries. Patients, carers and clinicians considered long-term control to involve several related concepts: level of disease activity, impact on daily life, and treatment required (such as reducing treatment or using only maintenance treatment). Issues highlighted to consider when measuring long-term control included capturing the perspective of patients, carers and clini-cians, burden of data collection, interpretability and including an objective assessment. The consensus meeting in Nantes was attended by 81 participants from 13 countries. There was consensus (91% of participants voted in favour) that the long-term-control domain consists of repeated measures of the agreed core domains [clinician-reported signs, patient-reported symptoms (including itch intensity) and quality of life] plus a patient global assessment. Pending further discussions, the existing recommended instruments for signs and symptoms (EASI and POEM) should be used. HOME recommends that long-term control of atopic eczema is captured in trials by repeated measures of the existing core domains plus a patient global assessment. Further work is required on the timing of assessments and to determine the patient global assessment instrument.

The Prevalence of Hand Eczema and Its Determinants Among Female Hairdressers: A Cross-Sectional Survey

Introduction:Female hairdressers are exposed to various chemicals in their occupation which may lead to skin problems such as hand eczema.This study aimed to determine the one-year prevalence of hand eczema and its risk factors in a sample of Northwest Iranian female hairdressers in 2015.Methods:This study was a cross-sectional investigation in which 385 female hairdressers and 385 women from general population were selected as case and control, respectively.The prevalence of one-year hand eczema was obtained by Nordic occupationl skin questionnaireusing face-to-face interview. Data were analyzed using descriptive and inferential statistics (chi-square, independent t-test and logistic regression in SPSS software version 19).Results:The mean and standard deviation of age and work experience of hairdressers were 33.16 ± 7.2 and 8.72 ± 5.7 years, respectively.The prevalence of one-year hand eczema in hairdressers and control group were 27.8% (95%CI=23.22 -32.22) and 13.2% (95%CI=9.02-15.58), respectively. The Odds Ratio (OR) for hand eczema in the hairdressers was 2.52 (95%CI=1.72-3.64), compared to the control group as the reference. Using logistic regression analysis smoking habit [OR=3.44 (95%CI=1.73-6.85)],age less than 30 years [OR=1.76 (95%CI=1.04-2.96)] and working experience less than10 years [OR=3.14 (95%CI=1.63-6.04)]were independent risk factors for reporting one-year prevalence of hand eczemaConclusion:Female hairdressers were more likely to be at risk of developing hand eczema compared to general population. Smoking habit, younger age, and less work experience were the significant risk factors of hand eczema in hairdressers. Occupational health interventions should consider these factors in the control of hand eczema in hairdressers.

Soaps and cleansers for atopic eczema, friends or foes? What every South African paediatrician should know about their pH

Background . Knowledge of the pH level of soaps and cleansers used by patients with atopic eczema and sensitive skin is crucial, as high-alkalinity products are irritants and impair the normal skin barrier, so interfering with the adequate control of atopic eczema. Objectives. The aim of this study was to assess the pH of various bar soaps and cleansers that are usually recommended and used by patients with atopic diseases and dry, sensitive skin in South Africa. Methods . Forty-nine commercial soap bars and cleansers were randomly selected for pH analysis. The samples were prepared as 8% emulsions in tap water. Nine undiluted liquid facial cleansers were also evaluated. Deionised water was used as a negative control. The pH of each emulsion or liquid cleanser was recorded in duplicate using a Metrohm pH meter model 827 (Metrohm, Herisau, Switzerland). Results . Of the 49 samples analysed, 34 (69.4%) were alkaline with a pH ranging from 9.3 - 10.7. Two samples (4.1%) were within the acceptable range of (5.4 - 5.9), and 2 samples (4.1%) had pH levels of below 5. In total, 5 samples (10.2 %) had a pH of 4 - 6. Conclusion. The majority of soaps and cleansers analysed in this study were alkaline, with only 2 falling in the acceptable pH range of 5.4 - 5.9 and 5 within the pH range of 4 - 6, thus raising concerns regarding the optimal management of atopic eczema patients.

Parents' and carers' views about emollients for childhood eczema: qualitative interview study

ObjectiveLeave-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...

Effect of pasture sward mix on Pithomyces chartarum spore counts in New Zealand

ABSTRACTA set of 18 × 0.5 ha paddocks at the DairyNZ research farm in Hamilton made up from three replicates of six sward mixes had pasture collected weekly from 31 January 2012 to 9 May 2012 and spore counts of Pithomyces chartarum were determined. Low diversity (LD) meant that the paddock was sown with a single grass species (tall fescue, high sugar cultivar, ryegrass) and white clover. High diversity (HD) meant that the paddock was sown with a single grass species and white clover plus prairie grass, chicory, plantain and lucerne. The study aims were to assess the benefit of diversity and sward type in the control of facial eczema. There was no difference in spore counts over time between high diversity and low diversity pastures (P = 0.43). Both tall fescue paddocks (LD and HD) showed a lower spore count over time in comparison with low diversity ryegrass (P = 0.055 and 0.05).

Use of Staphylococcus aureus Phage Lysate Staphage Lysate (SPL)® for the Control of Recurrent Pyoderma Eczema in Dogs with Atopic Dermatitis

Background: Recurrent staphylococcal infections are frequent in dogs with atopic dermatitis (AD). Many factors seem to contribute to making bacterial pyoderma refractory to treatment. Short-term systemic antibiotic therapy is effective for the treatment of acute symptoms, and may, along with pulsatile therapy, contribute to the long-term control of the disease. However, microbial resistance has become a growing and alarming problem. The aim of this study was to evaluate whether the use of Staphylococcus aureus Phage Lysate Staphage Lysate (SPL)®, can minimize the symptoms of recurrent pyoderma and increase the interval between acute atopic manifestations in dogs.Materials, Methods & Results: Thirteen dogs with a history of Canine Atopic Dematitis (CAD) and recurrent bacterial pyoderma received SPL at increasing intervals for 23 weeks. The contents of an intact pustule of each dog was collected and submitted to microbiological analysis. Systemic antibiotic therapy was established for the first 4-6 weeks of SPL protocol, based on the antibiotic sensitivity tests. The animals included in the study underwent a therapeutic protocol receiving shots of 0.5 mL of SPL subcutaneously (SC) twice a week for the first 12 weeks; 1.0 mL of SPL (SC) once a week for four weeks; 1.0 mL of SPL (SC) once every 15 days; 1.0 mL of SPL (SC) after a three-week interval from the last dose on week 20, until final observation at week 26, with no application. The animals underwent clinical examination every week and the evaluation of pruritus was used according Rybnicek et al. During the therapeutic protocol with SPL, a significant decline in the pruritus was observed in the treated dogs (P < 0.05). In week 1, the mean pruritus index was 7.33 on the Rybnicek scale; in weeks 12 and 23, the mean indices were 2.41 and 1.91. An effectiveness of 83.33% for the control of pruritus along with regression of the lesions was observed.Discussion: Before treatment, the selected animals presented worsening of the pruritus during the pyoderma eczema episodes (pruritic), resulting in the emergence of a vicious cycle where the pruritus induced the appearance of new lesions, requiring the use of antibiotics for a long period. During the therapeutic protocol with SPL, a significant decline in the pruritus was observed in the treated dogs. The control of pruritus associated with pyoderma eczema of the dogs in this study before the vaccination protocol with SPL was satisfactory when they were subjected to antibiotic therapy; however, after suspending therapy, the bacterial infections recurred, on average, after 2-4 weeks. On the other hand, with the use of SPL, the animals were recurrence-free until the end of the experimental protocol. This was attributed to the antibiotic therapy administered at the beginning of the protocol, as this led to a regression of the bacterial pyoderma and involution of the lesions. However, after suspending antibiotics, it was observed that, by the end of the study, 83.33% of the dogs still had a low level of pruritus, few or no lesions, which were considered acceptable to most owners. At this moment none of these patients needed to be subjected to antibiotic treatment. The sums of the scores for the dogs on weeks 1, 12, and 23 were 53.33, 4.41, and 3.5, respectively, indicating significant improvements of the lesions, showing that the proposed protocol with SPL was able to prevent new episodes of pyoderma.

Refractory urticaria,bradycardia and contact eczema in patient with nickel hypersensitivity after atrial septal defect occluder implantation.A case report.

Event Abstract Back to Event Refractory urticaria,bradycardia and contact eczema in patient with nickel hypersensitivity after atrial septal defect occluder implantation.A case report. Kaddy J. Beltran1*, CARLOS E. OLMOS1 and Catalina Gomez1 1 Cayre IPS, Cundinamarca, Colombia Rationale Metal hypersensitivity is a frequent cause of contact eczema and a potential risk in the use of medical advices usually made with nickel, cobalt and chromium for the eventual sistemic reaction that this metals can cause. Case report A 31 year-old woman with history of eczema and pruritus with contact of jewerly,was implanted a atrial septal defect occluder in may of 2014, without immediately postprocedure reactions but 72 hours after the patient complains of intense pruritus.heaves and eczema in her back, neck and chest and progresive chest discomfort and dyspnea.The attendat phisician consider a probably reaction for nickel and start loratadin, ASA and clopidogrel. Two weeks after the reaction, the patient persists with the cutaneous and increase the cardiac simptoms,even in repose and with syncope episodes; after multiple studies the cardiologist found a persistent bradycardia de novo wich was attributed to metal hypersensitivity ,so it increase ASA and clopidogrel and refers to allergologist service: we did skin patch test that was positive to nickel and cobalt and started fexofenadin,topic steroid and topic calcineurin inhibitors achieving partial skin responsive but persist with bradycardia and chest dyscomfort. Then the patient was assesed by cardiology and cardiac surgery who founded a giant atrial septum aneurysm involves de amplatzer so she wasn´t candidate to removal by eventual life-threatening, which requires continuing pharmacological treatment included montelukast and cardiac rehabilitation with partial control of hives and eczema but persistent bradycardia without new syncope episodes. Conclusions Nickel hypersensitivity is reported in 15-17% of population and is the most frequent cause of contact dermatitis.The use of medical advices with metal components suppose a risk that has been assesed in different studies and specifically in atrial septal defect occluder finding that 2% of this patients had effects atributable to nickel allergy like hives, chest pain, migraine and pericardial effusion; that was described 48 hours to 30 days after de implantation of the advice and resolved with use of antihistamines,antiplatelet y anticoagulant for 30 to 60 days with total resolution and without relapse after discontinuation. We just found one case report of a similar case who doesn´t improve with farmacological therapy and need to removed the amplatzer with total resolution of the symptoms. In this case we present a clinical and therapeutical challenge about the severity of the symptoms and the imposibility of removal the device, thus it was necessary adjust the pharmacological protocol and stablish a multidsclipinary staff for her management and follow up.

Atopic Dirty Neck or Acquired Atopic Hyperpigmentation? An Epidemiological and Clinical Study from the National Skin Centre in Singapore

Background: ‘Atopic dirty neck' is a poorly understood acquired hyperpigmentation in patients with atopic dermatitis (AD). Objective: To report a single-centre experience with synthesis of this entity's features. Methods: All patients with AD with dirty neck seen over a 5-month period at the National Skin Centre were invited to participate. Results: Out of 544 AD patients examined, 78 (14.3%) had acquired pigmentation of the neck. The majority had moderate-to-severe underlying eczema. Histopathology showed increased epidermal melanin and dermal melanophages, a thickened basement membrane and a dense superficial perivascular infiltrate. Conclusion: Acquired atopic hyperpigmentation has a high prevalence, particularly in adolescent Asian males. Clinico-pathological correlation suggests it results from both frictional melanosis and post-inflammatory hyperpigmentation. The rippled appearance and the onset in adolescence are probably due to accentuation of the juxta-clavicular beaded lines. Optimal control of eczema may improve and potentially prevent the development, which is of importance considering the psychosocial impact of the condition.

Zoonotic Disease Pathogens in Fish Used for Pedicure

Zoonotic Disease Pathogens in Fish Used for Pedicure

Could good eczema care prevent development of other atopic conditions?

The ‘atopic march’ describes the progression from eczema to other atopic conditions, mainly asthma and allergic rhinitis, and there has been a sharp rise in prevalence of all these conditions over the past few decades. Recent research suggests that changes in the skin barrier in early life are central to the development of atopy and there is gathering evidence to suggest that control or prevention of eczema in infancy may prevent future development of other atopic conditions. Genetic research has shed light on the susceptibility of some individuals to develop atopic conditions through defects in genes involved in skin barrier function. Several studies have demonstrated an increased risk of developing eczema in individuals with defects in the filaggrin gene, which is present in up to 10% of western European populations.1 Filaggrin is one of a number of structural proteins of the epidermis which contribute to maintaining an effective skin barrier. Mutations in the filaggrin gene result in loss of skin barrier function and the presence of atopic diseases, particularly eczema and asthma. Filaggrin gene defects are associated with an increased risk of developing asthma in individuals with eczema, but not those without eczema and, interestingly, filaggrin is not expressed in bronchial mucosa. Therefore, in individuals with filaggrin mutations, it seems that the breakdown in skin barrier plays a role in the development of asthma.2 It is hypothesised that lack of skin barrier function allows exposure to allergens through the skin and that the atopic march arises due to subsequent migration of sensitised T cells to the airways and nose. Mice models have shown that filaggrin mutations lead to increased uptake of …

A history of facial eczema (pithomycotoxicosis) research

Facial eczema (pithomycotoxicosis), a photosensitisation of ruminants grazing pasture, has been known in New Zealand for over 100 years, but its cause, a toxin produced by a largely saprophytic fungus, Pithomyces chartarum, growing on litter at the base of pasture and sporing profusely under warm moist conditions in late summer and autumn, was found only 50 years ago. As the fungus spores it produces the toxin sporidesmin which, when eaten by sheep, cattle, goats or deer, causes liver injury with inflammation and blockage of bile ducts. Phylloerythrin, a photodynamic breakdown product of chlorophyll, is no longer excreted but circulates in the blood, causing lesions of unpigmented skin when the affected animal is exposed to sunlight. Lesions do not appear until at least a week after sporidesmin has been ingested, and this lag period delayed discovery of the causative agent, first thought to have been an abnormal metabolite of rapidly growing ryegrass. However, before the role of P. chartarum was discovered, the pathology of the disease had been described, toxic extracts had been made from herbage mown from pastures associated with facial eczema outbreaks, and the weather conditions preceding outbreaks had been defined. When the causative agent was identified, cultures of P. chartarum on artificial media produced sporidesmin for chemical characterisation and animal dosing trials. Control of facial eczema in the field was first by avoiding toxic pasture, detected by P. chartarum spore counts on herbage, later by reducing P. chartarum pasture populations by spray application of substituted thiabendazole fungicides, and later still by protecting animals with oral doses of zinc at close to toxic levels. Sheep vary widely in their sensitivity to sporidesmin, either under field conditions in facial eczema outbreaks or when dosed orally with sporidesmin, and breeding resistant animals by selection after sporidesmin challenge is the best long‐term control method at present. Whilst facial eczema outbreaks have been most severe in New Zealand, the disease has been reported from an increasing number of countries with warm temperate climates in which ruminants are intensively grazed on pasture. The great majority of New Zealand isolates of P. chartarum produce sporidesmin, but varying proportions of those in other countries do not.