Cases Of Eczema Research Articles

Associations of prenatal organophosphate esters exposure with risk of eczema in early childhood, mediating role of gut microbiota.

Few epidemiological evidence has focused on the impact of organophosphate esters (OPEs) and the risk of eczema, and underlying role of gut microbiota. Based on the Shanghai Maternal-Child Pairs Cohort, a nested case-control study including 332 eczema cases and 332 controls was conducted. Umbilical cord blood and stools were collected for OPEs detection and gut microbiota sequencing, separately. Eczema cases were identified using the International Study of Asthma and Allergies in Childhood core questionnaire and clinical diagnosis. The environmental risk score (ERS) for OPEs was developed to quantify OPEs burden. Conditional logistic regression models, multivariate analysis by linear models, negative-binomial hurdle regression, and mediation analysis were employed. Tris(2-butoxyethyl) phosphate (TBP), tris (2-butoxy ethyl) phosphate (TBEP), 2-ethylhexyl diphenyl phosphate (EHDPP), and tris(1,3-dichloro-2-propyl) phosphate (TDCPP) had detection rates > 50 %, with median concentrations ranged from 0.11 to 2.71 μg/L. TBP (OR=1.12, 95 %CI: 1.01, 1.25), TDCPP (OR=1.32, 95 %CI: 1.09, 1.59), and ERS (OR=6.44, 95 %CI: 3.47, 11.94) were associated with elevated risk of eczema. OPEs exposure was correlated with increased alpha diversity and the abundance of several pathogenic bacteria, such as Klebsiella. Negative associations were observed between OPEs exposure and the abundances of Lachnospiraceae genera. Additionally, a positive correlation was identified between alpha diversity and the risk of eczema during childhood. Alpha diversity indices and Lachnospiraceae serve as significant mediators in this relationship. Results of this study indicate that prenatal exposure to OPEs is linked to an elevated risk of eczema and gut microbiota dysbiosis, potentially contributing to immunotoxicity of OPEs during early life.

FC16 Blood mass cytometry reveals Type 1 cytokine expression in blood of patients with paradoxical eczema secondary to biologics for psoriasis

Abstract Biologics targeting the tumour necrosis factor (TNF) and interleukin (IL)-17/23 axis are effective treatments for psoriasis but can result in cutaneous adverse events. The pathogenesis of paradoxical eczema, a phenotype resembling atopic eczema occurring after biologic initiation for psoriasis, is unknown. This study aimed to explore the systemic disease signature of paradoxical eczema occurring in psoriasis patients treated with biologics. Peripheral blood mononuclear cells (PBMCs) from three patients with paradoxical eczema (two on adalimumab, one on guselkumab), six matched psoriasis controls receiving biologics and five healthy volunteers were subjected to staining for surface markers and eight intracellular cytokines: granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon alpha (IFNa), interferon gamma (IFNg), IL-4, IL-10, IL-13, IL-17a, TNF. Prior to staining, PBMCs from each donor were either stimulated with phorbol 12-myristate 13-acetate/ionomycin or left unstimulated. Mass cytometry was used to compare cell-type abundance and cell-type (cluster)-specific cytokine expression. After data cleaning, there were 8 613 686 live singlets which were clustered using FlowSOM and manually annotated based on canonical marker expression. There was lower abundance (false discovery rate adjusted P < 0.1) of the CD4 natural killer T (NKT) (logFC −5.17), CD8 NKT (logFC −4.16) and CD8 mucosal-associated invariant T (MAIT)/NKT (logFC −2.76) clusters in paradoxical eczema cases relative to psoriasis controls; the findings were similar for stimulated cells. Compared with healthy controls, cases had a lower abundance (adjusted P < 0.1) of the CD8 MAIT/NKT (logFC −4.17) and CD56dim NK (logFC −2.64) clusters. TNF expression was higher across most unstimulated cell clusters in cases than controls (36 out of 41 clusters), with 18 reaching statistical significance (adjusted P < 0.1) including CD4 T cells, CD8 T cells, gdT cells, B cells and NK cells. IFN-γ was more highly expressed in 21 case clusters encompassing CD4 T cells, CD8 T cells, gdT cells, B cells, monocytes and NK cells. In cases relative to controls, IFN-α was more highly expressed in the double-negative B (IgD− CD27−), Naive B, CD4 Naive, CD8 Naive and CD4+CD8+ Naive T-cell clusters; there was a lower expression in CD14 (classical) monocytes. There were few differences in GM-CSF, IL-4, IL-10, IL-13 and IL-17A expression between group clusters. On stimulation, there were no differences between case and control cytokine expression. These findings suggest that the systemic signature of paradoxical eczema is characterized by Type 1 inflammation and a reduced systemic cytolytic/NKT signature. Further work is required to establish the disease signature in skin and identify if Type 1 inflammation is the primary pathophysiological process in paradoxical eczema or a reactive phenomenon.

Risk factors and associations with atopic diseases in the pediatric population in Qatar.

Asthma is a common noncommunicable disease with public health implications due to the rising number of cases among the pediatric population in Qatar. The objective of the current study is to explore possible risk factors and associations in relation to pediatric asthma, allergic rhinitis, and eczema cases in Qatar. Using the Global Asthma Network questionnaires, this study sampled 2646 children, of which 1210 were aged 6-7 years and 1436 were aged 13-14 years in addition to 3831 adult parents or guardians. The STROBE guidelines were used to ensure the reporting of this cross-sectional study. Univariate and multivariate logistic regression were used to produce the odds ratio for the various risk factors and associated factors, respectively. Multiple associations and risk factors for each of the three diseases were reported. Based on the outcome of a multivariate logistic regression, being born in Qatar was the only risk factor present across all three diseases. Being male, wheezing ever, wheezing after exercise, and having eczema were other risk factors reported for asthma. Being in the older age group, wheezing ever, and having hay fever were other risk factors reported for allergic rhinitis. The study concluded that further evaluation into associated and risk factors for asthma, allergic rhinitis, and eczema is warranted in the future.

Association between fine particulate matter and eczema: A cross-sectional study of the All of Us Research Program and the Center for Air, Climate, and Energy Solutions.

The prevalence of eczema has increased with industrialization. Industrial practices generate ambient air pollution, including fine particulate matter of diameter ≤ 2.5μm (PM2.5). Studies investigating the relationship between PM2.5 and eczema in the US are scarce. The objective of this study was to determine the risk of eczema with PM2.5 exposure in a diverse national cohort of American adults. In this cross-sectional study, eczema cases in the All of Us Research Program were linked via three-digit zip code to average annual PM2.5 concentrations from the Center for Air, Climate, and Energy Solutions. Eczema cases and controls were compared using Pearson's χ2 test for categorical variables and one-way analysis of variance for continuous variables. The relationship between PM2.5 and eczema was assessed via logistic regression adjusting for demographic factors, smoking, and atopic comorbidities. Individuals with eczema (n = 12,695) lived in areas with significantly higher PM2.5 concentrations than did individuals without eczema (n = 274,127) (0.83 x 10 μg/m3 v. 0.81 x 10 μg/m3, P < .001). PM2.5 concentration was significantly associated with eczema in univariable analysis (odds ratio 1.97, 95% confidence interval 1.77-2.19, P < .001), and in multivariable analyses, both controlling for demographics and smoking status (odds ratio 2.21, 95% confidence interval 1.98-2.47, P < .001) and with the addition of atopic comorbidities (odds ratio 2.38, 95% confidence interval 2.12-2.67, P < .001). The odds of eczema increased with greater PM2.5 concentration in this large, diverse, adult American cohort. Ambient air pollution is an environmental hazard that influences inflammatory skin disease, suggesting possible targeted interventions.

Dupilumab for Chronic Hand Eczema: A Systematic Review and Meta-Analysis.

Chronic hand eczema (CHE) is a distressing and pervasive dermatologic condition, and effective treatment can be challenging. The novel IL-4/13 inhibitor dupilumab has shown clinical efficacy for atopic dermatitis (AD) and is being studied for CHE. PubMed database was searched for terms dupilumab and chronic hand eczema/dermatitis, including CHE subtypes (dyshidrotic, hyperkeratotic, allergic, contact, atopic, occupational, vesicular). Twenty-two study publications met inclusion and exclusion criteria for evaluation. Two multicenter prospective studies, one randomized controlled trial, two prospective observational studies, one retrospective study, nine case series, and seven case reports were included in the analysis with 374 total patients. Any partial response or complete resolution of CHE occurred in 80.3% of patients treated with dupilumab within 4-16 weeks of treatment. The patient response tended to increase throughout the duration of these studies for a significant percentage of patients, and for many it lasted beyond the study duration. Significant improvement in hand eczema severity scores and quality-of-life scores were noted. Efficacy was reported in over half of the cases of hyperkeratotic hand eczema; however, efficacy was decreased compared with relatively high consistent efficacy in other CHE subtypes such as dyshidrotic, vesicular, atopic, and contact CHE. Patients with current or previous AD had increased improvement scores compared to those without. The most common adverse effects were conjunctivitis (9.9%), herpes viral infection (1.4%), and facial erythema/dermatitis (1.3%). Dupilumab shows therapeutic efficacy in treating CHE. Further randomized controlled studies of dupilumab use in CHE subtypes are needed.

A Study Correlating the Dermoscopic Diagnosis with Histopathology in Inflammatory Papulosquamous Dermatoses

ABSTRACT Background: The dermoscope is a noninvasive diagnostic tool, which of late has been found useful in corroborating a clinical diagnosis, thus averting the need for a skin biopsy. Aim: To study the dermoscopic patterns of inflammatory papulosquamous dermatoses and correlate them with the histopathological diagnosis. Methods: All patients diagnosed clinically with inflammatory papulosquamous dermatoses were recruited in this cross-sectional study after obtaining informed consent and with due consideration of the inclusion and exclusion criteria. A brief history taking and examination was done, followed by a dermoscopic examination of the lesion. Skin biopsy was taken from the same site as that of dermoscopy. Findings obtained from both modalities were tabulated and assessed to establish a diagnosis. The dermoscopic and histopathological diagnosis were compared to elucidate the specificity and sensitivity of the dermoscopic findings. Results: This study showed that among a total of 100 cases, 94.1% of cases of psoriasis, 86.7% of cases of eczema, 69% cases of LP, 60% of cases of DLE, and 82.3% of other cases showed a positive correlation between dermoscopy and histopathology, with an overall correlation of 82%. A ”P” value of 0.03 was obtained, indicating a significant correlation between the two modalities. Conclusion: Dermoscopy, a diagnostic tool, can provide vital clues in the diagnosis of various dermatoses as it highlights subtle surface features, which in turn can give valuable information about the underlying pathological process to the treating physician. This study shows that dermoscopy is valuable for differentiating various inflammatory papulosquamous dermatoses and can reduce the frequency of unnecessary biopsies.

Patch testing with Indian standard series of 20 allergens in 125 patients of chronic dermatitis and dermatoses

Objectives: Patch testing is generally done in cases of allergic contact dermatitis to find the offending allergen/s. It has been less reported in patients clinically presenting as non-eczematous contact reactions such as lichen planus, lichenoid eruption, lichen planus pigmentosus and facial melanosis overlap. In addition, it may give clues to the sensitizers leading to chronic, recurring dermatitis and overlap of dermatoses in the form of systemic contact dermatitis. The aim of the present study was to identify the sensitizer/s with patch testing in patients presenting with non-eczematous contact reactions as well as chronic, relapsing dermatitis and overlap of dermatoses. Material and Methods: In the present study, patch testing was done using the Indian standard series in 125 cases presenting clinically as lichen planus, lichen planus pigmentosus, facial melanosis, cheilitis, mucosal lichen planus and vulvar dermatitis, in addition to cases of chronic and recurrent dermatitis such as nummular eczema, lichenoid eruption, pompholyx, photo aggravated dermatitis, air borne contact and hand and feet dermatitis. Results: The tests were positive in 102 (81.6%) patients, negative in 16, doubtful in 3 and invalid in 4 patients. Positive results were found in 100% cases of photo aggravated dermatitis and chronic dermatitis of hands/feet dermatitis and 76% cases of facial melanosis and lichen planus pigmentosus overlap, 88.9% cases of nummular eczema, 81.8% cases of lichenoid eruption, 75% cases of lichen planus, 57% cases of atopic eczema, 66.6% cases of pompholyx, and 100% of mucosal lichen planus. Test for nickel was positive in 40 (32%) cases, parthenium in 37 (29.6%), cobalt in 23 (18.4%), fragrance in 19 (15.2%), paraphenylenediamine in 17 (13.6%), paraben in 9 (7.2%) and neomycin in 5 (4%) cases, either alone or in combination. In the present study, in addition to eczematous dermatoses, non-eczematous conditions such as lichen planus, lichenoid eruption, lichen planus pigmentosus and facial melanosis also showed positive results on patch testing. Conclusion: Patch testing should be considered in patients presenting with chronic and recurrent dermatitis and overlap of more than one type of dermatoses. Identification and elimination of culprit allergens can help in achieving long term remission in these chronic conditions.

Laser-Induced Koebner-Related Skin Reactions: A Clinical Overview.

The Koebner phenomenon (KP), also known as the isomorphic response, describes the process by which new lesions that are clinically and histologically identical to a patient's existing skin disease develop following trauma. Many skin diseases exhibit this characteristic, with variations that include possible, questionable, and pseudo-Koebner reactions, with the latter category occurring due to infectious agents seeding at a trauma site. Laser application, a type of controlled skin injury used for improving cutaneous lesions and skin rejuvenation, is also considered a form of trauma. This raises the question of whether controlled thermal injury can be regarded as a type of mechanical trauma capable of producing Koebner-related reactions. We conducted a literature review of cases or studies to identify laser-induced dermatoses that correspond to Koebner-related or pathergy reaction categories. As a whole, we identified nine case reports on true KPs, two cases on possible KPs, seventeen cases on laser-induced questionable KPs comprising cases of vasculitis, eczema or Meyerson reactions, and eruptive squamous atypia cases (ESA) as well as two pseudo-Koebner cases involving wart occurrences at laser application sites. Laser-induced Koebner reactions highlight several aspects of the KP. Firstly, the type of mechanical damage influences disease promotion, as different lasers are associated with different KPs. For example, hair removal lasers are linked with true and questionable KPs such as vasculitis while resurfacing lasers were found to be more connected with ESA occurrence. Secondly, the laser target is significant, with vascular laser application for port-wine stains tending to result in eczematous reactions, while hair follicle destruction can frequently lead to true KPs. Thirdly, the number of sessions matters; true KPs and eruptive squamous atypia questionable KPs typically appear after one to two sessions, whereas eczematous reactions require more sessions (at least four). Additionally, skin phototype is crucial, with darker phototypes showing a higher KP frequency as laser treatment for hypertrichosis relies on melanin absorption in the hair bulge or bulb for follicle destruction, as chromophore competes with the abundant melanin in the epidermis. Further research with larger-scale studies into trauma-specific Koebner reactions is vital for refining treatment protocols, minimizing post-laser adverse effects, and improving dermatological care outcomes.

Effect of Virechana Karma Along with Japapatryadi Tail Local Application and Amritadi Kwath Orally in the Management of Vicharchika

In the present case report, a 58-year-old man consulted in the Outpatient department of Dayanand Ayurvedic College, Jalandhar. The complaint of the patient was recurrent skin rashes with redness, skin oedema, itching, flaking and discolouration in the skin. By examining the signs and symptoms, the patient was diagnosed with Eczema (Vicharchika), Shodhana and Shaman Chikitsa was given under the treatment of Vicharchika[1]. Vicharchika, according to Ayurveda, is a Raktapradoshaja Vyaadhi with the involvement of Tridoshas, and it is Kapha in predominance[2]. The patient was given Virechana Karma along with the local application of Japapatryadi tail and Amritadi kwath orally for a period of 2 months. After that, the condition of the patient was assessed on the basis of signs and symptoms of Vicharchika, which were cured after taking the treatment. This study shows that the cases of eczema (Vicharchika) can be successfully managed with Virechana Karma followed by Japapatryadi tail locally and Amritadi kwath given orally.

Efficacy of Combination Therapy with External Human Epidermal Growth Factor and Ebastin in 60 Cases of Eczema

Objective: The primary aim of this research endeavor was to meticulously evaluate the efficacy and safety profile of integrating external human epidermal growth factor (EGF) with ebastine in the therapeutic management of eczema, Methods: A comprehensive cohort comprising sixty patients clinically diagnosed with eczema and admitted to our esteemed medical facility during the period spanning from June 2020 to June 2022 was meticulously curated for this investigation. Employing a rigorous randomized allocation procedure, the recruited patients were stratified into two distinct groups: the control group and the study group. The control group, serving as the comparative benchmark, underwent treatment with conventional ebastine therapy, whereas the study group was subjected to a novel therapeutic regimen encompassing the combined administration of external human epidermal growth factor and ebastine. Throughout the study duration, each patient&amp;apos;s response to treatment was diligently monitored and meticulously documented. Results: Upon comprehensive analysis of the treatment outcomes, it was unequivocally evident that the therapeutic regimen involving the concomitant administration of external human epidermal growth factor and ebastine yielded markedly superior outcomes in comparison to the conventional ebastine monotherapy. Specifically, the study group exhibited an impressively high effective rate of 96.7%, which starkly contrasted with the comparatively modest effective rate of 73.3% observed in the control group (P &amp;lt; 0.05). Moreover, the incidence of adverse reactions in the study group was notably lower, standing at 13.3%, as opposed to the substantially higher incidence rate of 46.7% documented in the control group (P &amp;lt; 0.05). These compelling findings underscore the profound therapeutic potential and favorable safety profile associated with the innovative combination therapy. Conclusions: In light of the compelling evidence gleaned from this meticulously conducted study, it can be unequivocally concluded that the integration of external human epidermal growth factor with ebastine holds immense promise as a novel therapeutic strategy for the effective management of eczema. These findings advocate for the wider adoption and integration of this innovative therapeutic approach into mainstream clinical practice, thereby signifying a pivotal advancement in the armamentarium against this debilitating dermatological ailment.

Dyshidrotic eczema: clinical and epidemiological features and therapy tactics

Introduction. Dyshidrotic eczema is a clinical type of chronic eczema, the clinical picture of which is characterized by itchy vesicular or bullous rashes localized on the skin of the palms and/or soles, a tendency to long-term chronic and recurrent course, the development of complications and resistance to therapy. Despite its prevalence and impact on quality of life, treatment of dyshidrotic eczema may be ineffective due to its polyetiology, chronic and recurrent course, and the lack of well-organized randomized controlled studies on the pathogenetic therapy of dyshidrotic eczema.Aim. Conduct an analysis of available sources devoted to the study of dyshidrotic eczema. Provide a description of clinical cases of dyshidrotic eczema and experience with external therapy.Results. The proportion of dyshidrotic eczema among other types of eczema varies from 6 to 31.8%. More than 80% of patients note a negative impact of dyshidrotic eczema on the quality of life. Conducted studies demonstrate a variety of factors predisposing to the onset, among which genetic predisposition, atopy and contact allergy are the main ones. Possible triggers include medications, insolation, humidity, and mycotic sensitization. Dyshidrotic eczema is a long-term and recurrent process with a risk of developing infectious complications. Staphylococcus aureus, Corynebacterium, Streptococcus and Micrococcus are detected in dyshidrotic eczema foci, which must be taken into account in combination therapy. The article presents clinical examples of successful treatment of dyshidrotic eczema localized on the skin of the hands with an external preparation containing a combination of 0.05% betamethasone dipropionate, 0.1% gentamicin sulfate and 1% clotrimazole.Conclusions. Dyshidrotic eczema is a common condition and affects quality of life. Proper diagnosis is essential for effective and efficient treatment. External therapy with the inclusion of a cream (ointment) containing a combination of 0.05% betamethasone dipropionate, 0.1% gentamicin sulfate and 1% clotrimazole gives better results and increases satisfaction with the treatment of patients with dyshidrotic eczema.

几例猪湿疹病例诊断与防治体会

几例猪湿疹病例诊断与防治体会

Efficacy of a New Alcohol-Free Organic Acid-Based Hand Sanitizer against Foodborne Pathogens.

In light of the global health crisis triggered by the COVID-19 pandemic, numerous experts have deemed the utilization of hand sanitizers imperative as a precautionary measure against the virus. Consequently, the demand for hand sanitizers has experienced a substantial surge. Since the beginning of 2020, the utilization of alcohol-free hand sanitizers has been increasingly favored due to the potential risks associated with alcohol poisoning, flammability, as well as the adverse effects on skin lipid dissolution, dehydration, and sebum reduction, which can lead to severe cases of eczema and norovirus infections. In this study, we developed an aqueous hand sanitizer that does not contain alcohol. The sanitizer consists of naturally occurring, food-grade organic acids, including lactic, citric, and azelaic acids. Additionally, food-grade ammonium sulfate and a small amount of povidone-iodine (PVPI) were included in the formulation to create a synergistic and potent antibacterial effect. The effectiveness of the hand sanitizer was evaluated against four common foodborne pathogens, namely Clostridium botulinum, Escherichia coli, Listeria monocytogenes, and Staphylococcus aureus, via in vitro testing. The organic acids exhibited a synergistic inhibitory function, resulting in a 3-log reduction in CFU/mL. Furthermore, the presence of povidone-iodine and ammonium sulfate enhanced their antibacterial effect, leading to a 4-log reduction in CFU/mL. The hand sanitizer solution remained stable even after 60 days of storage. During this period, the detection of additional triiodide (I3-) ions occurred, which have the ability to release broad-spectrum molecular iodine upon penetrating the cell walls. This alcohol-free hand sanitizer may offer extended protection and is anticipated to be gentle on the skin. This is attributed to the presence of citric and lactic acids, which possess cosmetic properties that soften and smoothen the skin, along with antioxidant properties.

Development of the early-life gut microbiome and associations with eczema in a prospective Chinese cohort.

The first few years of life is a key period for the development of the gut microbiome. However, our current understanding of this topic is largely biased toward Western populations. In this study, we characterized the development and determinants of the gut microbiome in a prospective cohort of 112 term Chinese children by sequencing 713 stool samples collected at nine time points from birth to 3 years of age using 16S rRNA gene sequencing. We revealed alterations in the composition and alpha and beta diversities of the gut microbiota across the first 3 years of life. We identified mode of delivery, feeding mode, and intrapartum antibiotics as the major determinants of the early-life gut microbiome, the effects of all of which persisted up to 12 months. Importantly, by conducting a nested case-control study, we showed that alterations in the infant gut microbiota precede the development of eczema. Interestingly, we identified a depletion of Bacteroides and an enrichment of Clostridium sensu stricto 1 in the gut microbiome of infants with eczema at 1 year old. The same patterns were also observed in C-section-born infants within the same time frames, suggesting a role of the gut microbiota in previously reported associations between C-section and increased risk of eczema. Our study has revealed important associations between the gut microbiome and eczema in infancy and has established the basis for potential prevention/treatment of eczema via modulation of the gut microbiota. IMPORTANCE Eczema is a major allergic disease in children, which is particularly prevalent in Chinese children during their first year of life. In this study, we showed that alterations in the infant gut microbiota precede the development of eczema in a prospective Chinese cohort. In particular, we discovered enrichments of the genera Clostridium sensu stricto 1 and Finegoldia in the cases at 3 and 1 month of age, respectively, which may represent potential targets for intervention to prevent eczema. Besides, we identified a depletion of Bacteroides from 1 to 6 months of age and an enrichment of Clostridium sensu stricto 1 at 3 months in the eczema cases, patterns also observed in C-section-born infants within the same time frames, providing first evidence to support a role of the gut microbiota in previously reported associations between C-section and increased risk of eczema in infancy.

Observed Causal Relationship Between Eczema and Inflammatory Bowel Diseases

Over the past 27 years in my functional medicine clinical practice, I have had 10 or more patients present with chronic and acute cases of eczema. After taking a thorough history, ordering blood tests and food intolerance panels, all of them were positive for signs and symptoms of intestinal permeability and positive IgA markers to predominantly; gliadin, agglutinins and casein, as well as a plethora of other food proteins, due to the nature of molecular mimicry. After placing patients on an antigen free food plan for 3-6 months, prescribing demulcent herbals, L-glutamine, anti-inflammatory supplements, and counseling them on stress reducing strategies, there was a resolution of the eczema and a healing of the intestinal lining. There is a misconception in traditional allopathic medicine that the problem resides at the dermis, where the symptomatology is observed and expressed. However, the skin is just a reflection and extension of the inflammatory cascade occurring at the intestinal lining which leads to the erosion of the tight junctions of the microvilli, which causes intestinal permeability [1,2]. These erosions open the door to undigested proteins which end up in the enteric blood vessels, subsequently triggering white blood cells to tag these proteins with antibodies. These proteins are almost identical to body tissues (molecular mimicry) , leading to autoimmune reactivity. Eczema is a direct expression of this immune system response and loss of oral and self-tolerance. The road to healing the tight junctions begins with an elimination food plan that excludes all the proteins which have become antigens. I have found it necessary to prescribe demulcent herbs such as; slippery elm, aloe vera gel, marshmallow root, deglycyrrhizinated licorice, rhubarb, immunoglobulin compounds, turmeric, vitamin D3/K2, glutathione, resveratrol and omega 3’s, as well as counseling patients on stress reduction strategies, given that production of high levels of cortisol and norepinephrine contribute to erosion of tight junctions [3]. The more a patient unburdens their body from causative factors, the faster the transformation and quicker the necessary scaffolding is built, to provide significant symptom relief and restoration of functional physiological processes that render a vital healthy human being, who is capable of developing immune and chemical tolerance to living in this “modern” hectic world. We live in a world where we spend 80% of our daily lives running from the “tyrannical lion(ness)” inside our busy monkey minds. In “flight or fight mode”, we are running tons of adrenaline epinephrine, norepinephrine, putting out fires, disasters, unknowns, daily to-do lists, answering phone calls, typing on the computer, driving around freeways, and encountering angry, impatient beings along the way. We are also near-constantly bombarded by lights, sounds, smells, EMF’s, microwaves, 4G and now the 5G radiation grid, toxins, infections, and stressors of all kinds [4]. Taking time to counter these daunting and relentless “flight or fight” drivers is imperative if we are to survive as beings and as a collective species. Stimulating your parasympathetic nervous system is a MUST when leading patients towards successful restoration of health and wellness.

Integrated proteomics and genomics analysis of paradoxical eczema in psoriasis patients treated with biologics

Few studies have explored the immunology and genetic risk of paradoxical eczema occurring as an adverse event of biologic therapy in patients with psoriasis. We sought to describe the systemic inflammatory signature of paradoxical eczema using proteomics and explore whether this is genetically mediated. This study used the Olink Target 96 Inflammation panel on 256 serum samples from 71 patients with psoriasis and paradoxical eczema, and 75 controls with psoriasis to identify differentially expressed proteins and enriched gene sets. Case samples from 1 or more time points (T1 prebiologic, T2 postbiologic, and T3 postparadoxical eczema) were matched 1:1 with control samples. Genes contributing to enriched gene sets were selected, and functional single nucleotide polymorphisms used to create polygenic risk scores in a genotyped cohort of 88 paradoxical eczema cases and 3124 psoriasis controls. STAMBP expression was lower in cases at T1 than in controls (log-fold change: -0.44; adjusted P= .022); no other proteins reached statistical significance at equivalent time points. Eleven gene sets including cytokine and chemokine pathways were enriched in cases at T2 and 10 at T3. Of the 39 proteins contributing to enriched gene sets, the majority are associated with the atopic dermatitis serum proteome. Apolygenic risk score including 38 functional single nucleotide polymorphisms linked to enriched gene sets was associated with paradoxical eczema (adjusted P= .046). The paradoxical eczema systemic inflammatory proteome trends toward atopic dermatitis at a gene-set level and is detectable before onset of the phenotype. This signature could be genetically determined.

P38 Integrating proteomics and genomics to investigate the mechanisms of paradoxical eczema developing in patients with psoriasis treated with biologics: a UK multicentre, longitudinal, cohort study

Abstract Few studies have explored the immunology and genetic risk of paradoxical eczema occurring in patients with psoriasis treated with biologics. This study aims to describe the systemic inflammatory signature of paradoxical eczema using proteomics and explore whether it is genetically mediated. Participants were adults treated with biologics for plaque psoriasis, who were corecruited to the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) and Biomarkers of Systemic Treatment Outcomes in Psoriasis (BSTOP) studies. To identify differentially expressed proteins and enriched gene sets, we used the Olink Target 96 Inflammation panel on 256 serum samples from BSTOP for 71 cases with paradoxical eczema and 75 controls. Paradoxical eczema was defined as eczema, atopic eczema or atopic dermatitis occurring during biologic exposure. Case samples across three time points [T1: prebiologic (n = 42); T2, postbiologic (n = 45); T3, postparadoxical eczema (n = 41)] were matched 1 : 1 with control samples. Case samples at T2 and T3 were taken during exposure to the same biologic that caused paradoxical eczema. Genes contributing to proteomic signatures were selected, and single-nucleotide polymorphisms (SNPs) that were nonsynonymous or associated with significant expression quantitative trait loci were used to create polygenic risk scores (PRS) in a genotyped cohort of 88 paradoxical eczema cases and 3124 psoriasis controls. Signal transducing adapter molecule 1-binding protein expression was lower in cases at T1 than in controls (log-fold change −0.44, adjusted P = 0.022); no other proteins achieved statistical significance at equivalent time points. Eleven gene sets, including cytokine and chemokine pathways, were enriched in cases at T2 and 10 at T3. Of the 39 proteins contributing to enriched gene sets, 21 are elevated in the sera of patients with atopic dermatitis. A PRS including 38 SNPs linked to enriched gene sets was associated with paradoxical eczema (adjusted P = 0.046). We subdivided the SNPs into those linked to specific gene sets, such as chemokine, cytokine and interleukin (IL)-10 signalling, to generate 10 partitioned PRS. Seven were associated with paradoxical eczema (adjusted P &amp;lt; 0.05). These SNPs do not map to known atopic loci. The paradoxical eczema systemic inflammatory proteome trends toward atopic dermatitis at a gene set level and is detectable before the onset of the phenotype. This signature may be mediated genetically by SNPs associated with these gene sets. Further studies are needed to explore the role of specific pathways (such as IL-10 signalling) in paradoxical eczema and define the inflammatory profile in the skin.

Exploring genetic associations between allergic diseases and indicators of COVID-19 using mendelian randomization

We carried out a bidirectional Mendelian randomization (MR) including cases ofeczema (N= 218,792), asthma (N= 462,933), and allergic rhinitis (N= 112,583). COVID-19 susceptibility (N= 1,683,768), COVID-19 hospitalization (N= 1,887,658), and COVID-19 severe respiratory symptom (N= 1,388,342) were sampled from GWAS database. The MR analysis was primarily based on inverse variance weighted (IVW), supplemented by several other algorithms. In the bidirectional MR analysis, eczema was negatively associated with COVID-19 susceptibility (odds ratio (OR) IVW= 0.92; p= 0.031) and COVID-19 hospitalization (ORIVW= 0.81, p= 0.010); asthma was negatively associated with COVID-19 susceptibility (ORIVW= 0.65, p= 0.005) and COVID-19 severe respiratory symptom (ORIVW= 0.20, p= 0.001). No significant association was found between allergic rhinitis and COVID-19 susceptibility (ORIVW= 0.80, p= 0.174), COVID-19 hospitalization (ORIVW= 0.71, p= 0.207), or COVID-19 severe respiratory symptom (ORIVW= 0.56; p= 0.167). The reverse MR analysis showed no potential reverse causal association. Our findings provided new evidence that allergic diseases might be associated with different risks of COVID-19 susceptibility, hospitalization, and severe respiratory symptom.

Nine cases of chronic hand and foot eczema treated with baricitinib.

Chronic hand and foot eczema (CHFE) is a common inflammatory disorder that generally lasts for over 3 months. If it is intractable to topical agents, systemic immunomodulators can be considered; however, they are not suitable for long-term management because of their adverse effects. Baricitinib is an oral Janus kinase inhibitor that has been approved for the treatment of moderate-to-severe atopic dermatitis. However, its effect on CHFE has rarely been described. Herein, we report nine cases of recalcitrant CHFE that were treated with baricitinib after an inadequate response to low-dose ciclosporin. All patients had more than moderate improvement within 2-8 weeks without serious adverse effects.

Long-term clinical efficacy and safety of ixekizumab for psoriatic patients: a single-center experience.

While clinical trials provide invaluable evidence, real-world data can offer further insight on the efficacy and safety of biologic drugs. This report aims to analyze the long-term efficacy and safety of ixekizumab in real-world clinical practice in our facility. Patients with a diagnosis of psoriasis and who started treatment with ixekizumab were included in this retrospective study and followed for 156 weeks. The severity of cutaneous manifestations was evaluated using the PASI score at several time points and clinical efficacy was evaluated using PASI 75, -90 and -100 responses. Not only PASI 75, but also PASI 90 and 100 responses showed a favorable outcome after treatment with ixekizumab. Responses at week 12 were sustained through the following three years in the majority of patients. No statistically significant difference was found between bio-naive and bio-switch patients and weight and disease duration had no impact on the efficacy of the drug. Ixekizumab had a favorable safety profile, as we observed no major adverse events. Two cases of eczema were observed and led to drug discontinuation. This study confirms the efficacy and safety of ixekizumab in real-world clinical practice.