Severe Cases Of Atopic Dermatitis Research Articles

Therapeutic effects of full spectrum light on the development of atopic dermatitis-like lesions in NC/Nga mice.

Full spectrum light (FSL) includes UVA, visible light and infrared light. Many studies have investigated the application of FSL in severe cases of atopic dermatitis (AD) in humans; however, FSL has not yet been studied in an animal model. The purpose of this study was to evaluate the therapeutic effects of FSL on AD-like skin lesions using NC/Nga mice, with the aim of mitigating itching and attenuating the expression of adhesion molecules. We examined the effects of FSL on mite allergen-treated NC/Nga mice by assessing skin symptom severity, ear thickness, serum IgE levels, and the cytokine expression. We examined the histology of lesions using hematoxylin-eosin, toluidine blue and immunohistochemical staining. Our findings suggest that FSL phototherapy exerts positive therapeutic effects on Dermatophagoides farinae (Df)-induced AD-like skin lesions in NC/Nga mice by reducing IgE levels, thus promoting recovery of the skin barrier. The mechanisms by which FSL phototherapy exerts its effects may also involve the inhibition of scratching behavior, reduction of IL-6 levels and reductions in adhesion molecule expression. The present study indicates that FSL phototherapy inhibits the development of AD in NC/Nga mice by suppressing cytokine, chemokine and adhesion molecule expression, and thus, could potentially be useful in treating AD.

Atopic dermatitis with CD30-positive anaplastic large cell lymphoma

The association between long-term severe atopic dermatitis (AD) and lymphoma is a matter of debate. However, a substantial number of cases of severe AD with CD30+ anaplastic large cell lymphoma (ALCL) have been reported.We present the case of a 39-year-old female patient with long-term AD whose ALCL became systemic and nearly took a fatal course. She had been diagnosed with AD in early childhood and had been suffering from it ever since. Her disease severity had been mild and she was treated with [...]

Detoxification Combining Fasting with Fluid Therapy for Refractory Cases of Severe Atopic Dermatitis

To introduce and determine the clinical benefits of a detoxification program that combines fasting with fluid therapy for refractory cases of severe atopic dermatitis (AD), we performed a retrospective chart review of inpatients with AD from March 2010 to February 2012 at the Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine in the Kyung Hee Medical Center. Patients were treated with the detoxification program, which combined fasting with fluid therapy, and herbal medicine, herbal wet wrap dressings, or acupuncture treatment when clinically necessary. The primary outcome was the SCORAD total index. The secondary outcome was the pruritus visual analogue scale (VAS) score in SCORAD as evaluated by a trained dermatology specialist. Among the 130 inpatients that have done detoxification, 7 patients met the inclusion criteria. The mean total SCORAD scores significantly decreased from 64.67 ± 11.72 to 26.26 ± 11.01 (P = 0.018) after the detoxification program. There was also a significant decrease in VAS score for pruritus from 8.00 ± 1.16 to 2.57 ± 0.98 (P = 0.016) between admission and discharge. We suggest that fasting with fluid therapy as a complementary and alternative treatment method may provide some benefits for patients with refractory cases of severe atopic dermatitis.

Modern aspects of phototherapy for atopic dermatitis.

Phototherapy has still great importance in the treatment of atopic dermatitis, though costs, compliance, and long-term risks narrow its relevance. In spite of its long history, up to now, the therapeutic regimes are mostly empirical. Narrowband UVB und UVA1 are the most frequently applied regimens in atopic dermatitis with proven efficacy. However, even for these modalities randomized prospective and controlled studies are still pending. Advances in photoimmunology and molecular biology had demonstrated that phototherapy targets inflammatory cells, alters cytokine production, and has a significant antimicrobial effect within atopic skin. This paper summarizes the current literature on the different regimes of phototherapy and also discusses therapeutic modalities like photochemotherapy and extracorporeal photopheresis. These more complex regimes should be restricted to severe cases of atopic dermatitis, which are refractory to topical treatment.

Intravenous Immunoglobulin to Treat Severe Atopic Dermatitis in Children: A Case Series

Severe cases of atopic dermatitis (AD) may require systemic immunosuppression to achieve disease control. Unfortunately, some cases continue to be refractory to management or develop unacceptable adverse effects. There are limited reports of the use of intravenous immunoglobulin (IVIg) in the treatment of severe AD, but results are inconsistent. In a retrospective study, we report 10 children with severe AD refractory to systemic immunosuppression and maximal topical therapy who were treated using IVIg. The children received monthly IVIg for an average of 24 months. This resulted in a significant improvement in symptoms, with fewer infection-related exacerbations and hospitalizations, allowing systemic immunosuppression to be tapered. The effect was associated with a significant decrease in serum immunoglobulin E and was sustained after cessation of IVIg in 50% of cases. No significant side effects attributable to the IVIg infusions were noted. In this cohort of children with severe AD and recurrent cutaneous infections, IVIg provided an effective treatment with minimal side effects and significant benefits in school attendance and quality of life.

Adherence must always be considered: Is everolimus really ineffective as a treatment for atopic dermatitis?

This issue of the Journal of Dermatological Treatment includes the presentation of two very interesting cases of severe atopic dermatitis treated with everolimus, a rapamycin-derived immunosuppressive agent (1). Everolimus is effective as a psoriasis treatment, and its mechanism of action (inhibiting T cell function) seems promising as a basis for treating atopic dermatitis as well.

배독요법을 통한 아토피환자 2례에 대한 임싱적 고찰

Objectives : This study is desinged in order to evaluate the Poison extraction method for the Atopic dermatitis. Methods : The authors observed the two cases of Atopic dermatitis patients who previously used steroid-based ointment. for treating the Poison Extraction Method. Conclusions : 1. In case 1, the patient with mild case of Atopic dermatitis in face is treated with the Poison extraction method. Rash symptoms intensed for first few days. As sweating appeared in the local area from the seventh day, all the symptoms was disappeared rapidly. No recurrence was found. 2. In case 2, the patient with severe case of Atopic dermatitis in whole body is treated with the Poison extraction method. The symptoms intensed after two months and all the symptoms of itchiness, rash, scaly letter dissapeared in the third and fourth months. No recurrence was found. 3. In both cases of mild and severe cases of Atopic dermatitis. all the symptoms were disappeared and no recurrence was found with the Poison Extraction Method.

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

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

Therapeutic and prophylactic effects of PUVA photochemotherapy on atopic dermatitis‐like lesions in NC/Nga mice

Psoralens and ultraviolet A radiation (PUVA) photochemotherapy has been used for severe cases of atopic dermatitis (AD). To understand the mechanisms of action is important for the choice of treatments. AD-like lesions can be induced experimentally in NC/Nga mice. To evaluate clinically and histologically the therapeutic and prophylactic effects of PUVA on AD-like dermatitis using NC/Nga mice. PUVA therapy was performed with intraperitoneal injection of 4 mg/kg of 8-methoxypsoralen (8-MOP) and 4 J/cm(2)-UVA irradiation before and after development of AD-like lesions in NC/Nga mice which had been maintained in a conventional room (Conv-NC/Nga mice). Clinical skin conditions were evaluated periodically by a clinical severity score defined. Lesions were histologically examined in haematoxylin-eosin or toluidine blue-stained sections. Plasma levels of total IgE were measured at various time points. In Conv-NC/Nga mice infested with mite, AD-like lesions started to develop at 8 week of age and thereafter increased in severity score. PUVA therapy at lower does than minimal phototoxic dose suppressed the development of dermatitis and was also therapeutically effective against established lesions. Proliferation of dermal mast cells in AD-like lesions was suppressed, but IgE hyperproduction was not changed after PUVA. These observations suggest that PUVA photochemotherapy reveals not only therapeutic but also prophylactic effects on human AD.

Cyclosporin A in the treatment of severe atopic dermatitis and palmoplantar pustulosis

Background/Aims: Cyclosporin A is useful in the treatment of psoriasis, atopic dermatitis and other dermatoses. The aim of this long-term study was to investigate the usefulness of cyclosporin A in the treatment of severe and therapy-resistant atopic dermatitis and also in pahnoplantar pustulosis.Methods: This study was performed in two series, one of 18 patients with severe atopic dermatitis, the other one of 36 patients with palmar or palmoplantar pustulosis. In both series the schedule of treatment consisted of four consecutive stages: in the first stage the patients received cyclosporin A 2.5 mg/kg per day for 3 months; in the second stage 2 mg/kg per day for 6 months; in the third stage 1.2 mg/kg per day also for 6 months; and in the fourth stage the doses were the same as in the third but on alternate days. The fifth stage was a follow-up period, 9 months for patients without recurrences until then and 3 months if there was any recurrence or if the patient had relapsed in an earlier stage.Results: This regimen of treatment was effective in 91.6% of cases of palmoplantar pustulosis and in 73.7% of cases of severe atopic dermatitis. Side-effects, when present, were slight.Conclusion: A low dose treatment regimen of CyA is both efficient and has very few side effects.

Suppressive effect of ultraviolet (UVB and PUVA) radiation on superantigen production by Staphylococcus aureus

It is well known that Staphylococcus aureus ( S. aureus) proliferates on the moist skin lesion of atopic dermatitis. Reduction of bacteria colonization from skin lesions by antibiotics has been reported to be effective for the treatment of atopic dermatitis. S. aureus produces superantigens which can activate T cells and possibly enhance the inflammatory reaction. Photo(chemo)therapy has been successfully used for the treatment of severe cases of atopic dermatitis. We have previously reported that photo(chemo)therapy had bacteriostatic effect on S. aureus. Now we examined the effect of UVB and psoralen plus UVA (PUVA) on superantigen production from S. aureus. We isolated S. aureus from six atopic dermatitis patients. S. aureus was irradiated in vitro with UVB (0, 5, 10 mJ/cm 2) or PUVA (0.001% psoralen plus 0, 5, 10 mJ/cm 2 UVA) and incubated 4 h with 100 strokes per min. After incubation, the amounts of superantigens in the supernatant were measured using ELISA kit. The production of superantigens decreased in an ultraviolet dose-dependent manner. The suppressive effects of UV radiation on superantigen production may be involved in the therapeutic efficacy of photo(chemo)therapy for atopic dermatitis.

STUDIES ON THE RELATION BETWEEN ATOPIC DERMATITIS IN CHILDREN AND ZINC

The role of zinc in the production of atopic dermatitis (AD) was studied, and no significant differences were observed in Zn levels among patients of both AD and bronchial asthma (BA), patients with BA alone, and healthy control group.In our comparative studies, no significant differences in IgE levels were observed between patients with serum Zn≥80μg/dl and those with levels<80mμg/dl.However, most of severe cases of AD were found among patients with Zn blood level than 80μg/dl. In some cases, dermatological symptom disappeared when Zn was administrated orally. Moreover, in the comparative studies on Zn levels in hair the levels were significantly lower (p<0.01) in the AD group than in the healthy control group.These results suggest that Zn may play some role in pathogenesis of AD.

Phototherapy of eczema.

Several studies have shown a beneficial effect of ultraviolet radiation on eczema, especially atopic dermatitis. The action spectrum lies at higher wavelengths compared with psoriasis. UVAB seems to be superior to UVB and best suited for mild to moderate cases. From a carcinogenic point of view, the therapy seems safe and the doses are low compared with UVB treatment of psoriasis. UVA-1 therapy seems to be a promising new alternative, especially for more severe cases. High-dose regimens work well but the hazards are not yet fully elucidated. The very high dosage regimens should be reserved for very resistant cases where lower doses have been tried but proven inadequate. PUVA is also very effective, but due to the long-term hazards it should be reserved for the most severe cases of atopic dermatitis.

Hypoalbuminemia, oliguria and peripheral cyanosis in an infant with severe atopic dermatitis.

A six-month old male infant with severe atopic dermatitis was admitted with hypoalbuminemia, oliguria and cyanosis of the extremities. There was marked edema and generalized eczema with foul, yellowish exudates. The patient's major clinical manifestations were attributed to the loss of albumin through the skin. Although atopic dermatitis is a common disease in children, here we want to show that systemic disturbances may arise from such condition, describe the total care given the patient, and emphasize the wholistic approach in managing cases of severe atopic dermatitis. Intensive treatment was instituted and the patient was discharged after three weeks and remained in a stable condition.

Gamma-interferon therapy for severe cases of atopic dermatitis of the adult type.

Recombinant gamma interferon (IFN-gamma) was employed to treat adult-type atopic dermatitis. Eight cases received subcutaneous injections of 500,000 JRU of IFN-gamma for 8 weeks. They responded relatively well to this treatment; however, the overall response to the treatment was not significantly better than that to conventional therapy in the control group. There was no significant suppression of itch or erythema. Swelling was reduced at the 8th week in the treatment group. Frequency of flushing attacks on the face was reduced and disappeared within four weeks in 6 of these patients; however, a similar reduction of frequency was observed in the control group. Papular and lichenified lesions on the trunk and extremities responded significantly to the treatment later than 5 weeks after its initiation. Serum IgE level was not affected by the treatment. Seven had the same level of serum IgE before and after the treatment. The serum cytokine level in the treated patients was also unaltered. Therefore, although IFN-gamma treatment has some benefit in the treatment of severe cases of atopic dermatitis, it should be applied to limited cases because of its high cost.

Interleukin 2 therapy in severe atopic dermatitis

Interleukin 2 (IL-2) at a dose of 10,000 to 20,000 U/kg/q 8 hr was given for 9-12 days to six patients with cases of severe atopic dermatitis (AD) which were refractory to conventional therapy. After IL-2 therapy, the clinical symptoms and signs of eczema including pruritus, scratching, papulovesicles, and lichenification were much improved, but all of them recurred 2-6 weeks after stopping treatment. Adverse reactions were similar to those reported previously, but all of them subsided after discontinuation of therapy. Laboratory findings showed decreased T-cell subsets, especially CD4+ cells, and increased IL-2R+ (CD25) cells, but there was no significant change in serum IL-2, serum IgE, or in vitro IgE production. Immunopathological studies of the skin biopsies showed decreased mononuclear-cell infiltration, depletion of CD4+ cells, and enhanced expression of CD25 and HLA-DR antigens. As lymphokine-activated killer (LAK)-cell activity against cultured fibroblasts was similar in patients with AD and in normals and CD1+ Langerhans cells were not decreased after IL-2 therapy, we speculate that the depletion of helper/inducer CD4+ cells and hence abrogation of the exaggerated antigen processing and cellular activation in diseased skin are the explanation for the transient efficacy of IL-2 in the treatment of atopic dermatitis.

Blood eosinophilia in atopic dermatitis

Blood eosinophil levels were examined in 200 (100 mild and 100 severe) patients with atopic dermatitis. Eosinophil levels roughly correlated with disease severity. However, the pattern of eosinophilia was not homogeneous. Very high eosinophil counts were common in severe cases of atopic dermatitis who had a personal or family history of respiratory atopy, while normal or moderately elevated eosinophil values were obtained in severe cases of 'pure' atopic dermatitis who had neither personal nor family history of respiratory atopy. It is suggested that disease severity and personal or family history of respiratory atopy are important factors in determining high blood eosinophil levels in atopic dermatitis.