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Abstract: Background/Objectives: Atopic dermatitis is a common, chronic, debilitating disease. Poor adherence to treatment is the most important preventable contributor to adverse outcomes. Thus, improving adherence can improve patient outcomes. Text message reminders with embedded condition‐specific information have been shown to improve pediatric immunization adherence but have not been assessed in atopic dermatitis. The objective was to assess the effect of daily text messages on Eczema Area Severity Index scores and caregiver knowledge of atopic dermatitis. Methods: In this pilot randomized controlled trial, caregivers of children with atopic dermatitis enrolled during their initial appointment with a pediatric dermatologist and randomized 1:1 to standard care or daily text messages with patient education material and treatment reminders. Participants completed a multiple‐choice atopic dermatitis knowledge quiz at initial and follow‐up visits, and Eczema Area Severity Index scores were assessed. Results: Forty‐two patients enrolled, and 30 completed the study: 16 standard care group, 14 text message group. There was no significant difference in Eczema Area Severity Index score between the standard care and text message groups at follow‐up, with mean decreases in Eczema Area Severity Index score of 53% and 58%, respectively. Mean score on follow‐up atopic dermatitis knowledge quiz was significantly higher in the text message group (84% correct) than in the standard care group (75% correct) (P = .04). Conclusion: This pilot study did not demonstrate a difference in Eczema Area Severity Index scores with text message reminders. The significantly higher follow‐up atopic dermatitis quiz score in the text message group indicates that participants read and retained information from text messages. Limitations include small sample size and short duration of follow‐up. [ABSTRACT FROM AUTHOR]

Abstract: Background: Therapeutic patient education is a continuous, systematic, patient‐centered learning process to help patients and their families acquire and maintain the skills they need to manage their lives with a chronic disease. It has been proven effective in increasing treatment adherence and improving quality of life for patients with atopic dermatitis (AD) in Western countries. We introduce the first multicenter, randomized controlled clinical trial of therapeutic patient education in Chinese children with AD. Objectives: To evaluate the effects of therapeutic patient education on the severity of AD, quality of life, and understanding and successful use of emollients in Chinese children with eczema. Methods: We recruited 580 children, ages 2‐14 years, with moderate to severe AD from six hospitals in China. Participants were randomized (1:1) to an intervention (n = 293) or control (n = 249) group. In addition to the severity of AD, data on quality of life and a questionnaire on family and patient knowledge of emollients were evaluated at the 6‐month follow‐up. Results: On study completion, we found that the intervention group showed a significantly greater reduction in mean SCORing Atopic Dermatitis (P < .001) and Infant's Dermatology Life Quality Index (P = .030) scores than the control group. In addition, knowledge about the use of emollients improved significantly in the intervention group. There was no significant difference between groups in Children's Dermatology Life Quality Index scores. Conclusions: The first randomized controlled trial of a therapeutic patient education program in China had positive long‐term effects on decreasing eczema severity and improvement of quality of life in children 2‐4 years of age with AD, as well as in promoting greater understanding of the use of emollients. [ABSTRACT FROM AUTHOR]

Background/Objectives Emollients are part of the standard treatment for atopic dermatitis ( AD), although there is limited evidence that regular use of emollients as management therapy reduces the frequency of flares and corticosteroid consumption. The objective of this study was to evaluate the benefit of emollient use in the management of mild to moderate AD in children by assessing the ability of two different emollients (particularly V0034 CR) to prevent flares and to reduce the use of corticosteroids. Methods In this randomized, open-label study, patients with a current flare were treated with a potent topical corticosteroid. After flare resolution, patients were centrally randomized to V0034 CR emollient, reference emollient, or no emollient (1:1:1 ratio) for 12 weeks. New flares were medically assessed before being treated with a moderately potent corticosteroid. Results A total of 335 children 2 to 6 years of age were randomized. At 12 weeks, the percentage of patients with one or more flares was statistically significantly lower with V0034 CR (35.1%) than without emollient (67.6%; p < 0.001). Fewer patients treated with V0034 CR required any corticosteroids or immunosuppressants (23.6%) than patients with no emollient (43.3%) at 12 weeks. The difference was significant at all time points (p = 0.002). Patients treated with emollients had a longer time to first flare, fewer flares, higher complete remission rates, less corticosteroid consumption, lower Investigator Global Assessment scores, and lower Scoring Atopic Dermatitis scores than those who were not. V0034 CR was well tolerated, with no specific safety concerns. Conclusion Regular emollient use in children with mild to moderate AD reduces flares and corticosteroid consumption. [ABSTRACT FROM AUTHOR]

The skin of children with atopic dermatitis ( AD) is colonized with Staphylococcus aureus more frequently than that of their peers. We investigated the prevalence of skin and nares colonization by S. aureus in children with AD, the virulence genes of the isolates, and their association with allergy, AD severity, and serum vitamin D (25( OH)D). This was an observational, cross-sectional study in a sample of children diagnosed with AD in two settings in Spain. The samples were collected in 2012. Swabs from affected skin and nares were taken for microbiologic culture. The prevalence of S. aureus and presence of 17 staphylococcal virulence genes were studied using polymerase chain reaction. A total of 114 patients with a mean age of 5.7 ± 4.1 (range 3 mos to 14 yrs) were included in the study. Swabs were taken from the skin of 113 individuals with AD and from the nares of 85; 28.3% had S. aureus on the skin, which was significantly associated with positive allergen-specific immunoglobulin E antibodies and higher Scoring Atopic Dermatitis (SCORAD) scores in the multivariate analysis. The presence of virulence factors tsst-1, eta, cna, aur, and sec in cutaneous S. aureus isolates was associated with lower serum levels of 25( OH)D. S. aureus on nasal swabs correlated with its presence on the skin and was associated with lower 25( OH)D levels. In conclusion, S. aureus colonization is associated with allergy and severity in AD, whereas certain virulence genes are associated with lower serum 25( OH)D levels. [ABSTRACT FROM AUTHOR]

Atopic dermatitis ( AD) and ichthyosis vulgaris ( IV) are two common disorders of epidermal homeostasis resulting in dry skin. The profilaggrin gene, located on chromosome 1q22, encodes a keratin filament aggregating protein (filaggrin) that is essential to forming the epidermal barrier and maintaining hydration. Null mutations in filaggrin have been found to underlie IV and are common in patients with AD, but the minority of African Americans with AD or IV show these mutations in filaggrin. We have selectively studied African Americans with both AD and IV to maximize the possibility of finding filaggrin null mutations in this population. DNA was collected using buccal swabs from 18 African American children with both AD and IV and 17 African American controls without either of these diseases. Purified genomic DNA was amplified using polymerase chain reaction from three regions of the filaggrin gene, exon 3, including R501X, 2282del4, E2554X, R2447X, 1249insG, R826X, 2767insT, and E2422X. Of the African American children with both AD and IV, 22.2% were heterozygous for filaggrin null mutations. Out of the control group, one carried a null mutation and was later discovered to have a history of asthma. Null mutations found in this population included R501X ( n = 1), 2282del4 ( n = 2), and R826X ( n = 2, including the control patient). Our data demonstrate a prevalence of filaggrin mutations in the African American population that exceeds previously published data, although the overall prevalence is still lower than in other populations. It is likely that factors other than known FLG mutations are involved in African American patients. [ABSTRACT FROM AUTHOR]

Improving skin barrier function and moisturizing without irritation are important components of managing patients with atopic dermatitis. This study evaluated the safety and tolerability of a body wash and moisturizer regimen for infants and toddlers with atopic dermatitis. This was an open-label study involving 56 children (3-36 months old) with a history of atopic dermatitis. The skin care regimen (Cetaphil Restoraderm Skin Restoring Body Wash and Cetaphil Restoraderm Skin Restoring Moisturizer; Galderma Laboratories, L.P.) was used at least once daily, but no more than twice daily, for 4 weeks. The primary variable of interest was the worst postbaseline scores for local tolerability (expressed as success or failure) using a 4-point scale for each component (erythema, edema, scaling and dryness, rash, and signs of discomfort upon application). Assessments of moisture content of the stratum corneum and transepidermal water loss were also performed. Fifty-three children completed the study. The percentage of subjects with no erythema increased from 33.9% to 50.0% by Week 4. The percentage of subjects with no scaling or dryness increased from 58.9% to 85.2% at Week 4. A statistically significant increase in corneometry from baseline (p < 0.001) and a statistically significant decrease in transepidermal water loss (p = .009) were observed. The body wash and moisturizer regimen was safe and well tolerated and improved hydration and skin barrier function in infants and toddlers as young as 3 months of age with a history of atopic dermatitis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We sought to describe the clinical outcomes of eight pediatric patients diagnosed with atopic dermatitis (AD) and hypogammaglobulinemia through retrospective review of medical records. All patients presented with severe facial AD. The mean and median ages of diagnosis of hypogammaglobulinemia were 6.2 months and 6.5 months, respectively, with a mean immunoglobulin G (IgG) level of 156 mg/dL. Seven of the eight patients identified in our search demonstrated simultaneous improvement in AD and serum IgG levels within 2 years of initial presentation, suggesting a diagnosis of transient hypogammaglobulinemia. The remaining patient demonstrated normalization by age 6, but no IgG levels had been measured between initial presentation and age 6. The five patients who were tested for specific antibody response to tetanus and Haemophilus influenzae type b vaccination all produced protective responses. All eight patients initially presented with high serum IgE levels. On initial evaluation, three patients had leukocytosis (white blood cell count >18,000 cells/μL), and six had peripheral blood eosinophilia. Three patients outgrew their AD by age 5, and five had clinically good to excellent control of their AD at their last visit, coincident with normalization of IgG levels. Although severe AD and immunoglobulin deficiency may rarely be associated with complex immunodeficiency disorders, our observations suggest that, with careful immunologic monitoring and diligent skin care, most children who present with severe AD and hypogammaglobulinemia exhibit improvement in dermatitis and serum IgG levels within 2 years of onset without major complications. [ABSTRACT FROM AUTHOR]

We present 5 cases of eczema herpeticum in patients with severe recalcitrant atopic dermatitis to illustrate the range of possible clinical findings and supporting laboratory data that can obscure the diagnosis and complicate treatment. Major issues include: the need for aggressive laboratory evaluation (molecular diagnostics, viral cultures, skin biopsy, serology); the possibility of recurrent or chronic infection; the value of empiric antiviral therapy; the possibility of infection with thymidine-kinase resistant strains; and the importance of achieving control over the dermatitis with nonmyelosuppressive immunomodulating agents such as intravenous immunoglobulin or interferon gamma for dermatitis that requires systemic treatment. [ABSTRACT FROM AUTHOR]

Given the increasing rate of community-acquired methicillin resistant Staphylococcus aureus skin infections in the population, such infections might be concurrently increasing in patients with atopic dermatitis. This study assessed current and prior rates of community-acquired methicillin resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus skin and soft tissue infections in children with atopic dermatitis compared to the general pediatric population. Other antibiotic sensitivity and resistance patterns, including clindamycin-inducible resistance, were also identified. Retrospective study of all skin and soft tissue isolates were positive for Staphylococcus aureus during two distinct 1-year periods, obtained by the outpatient services and the emergency department at Rady Children's Hospital, the major regional pediatric health center in San Diego, California. Of the Staphylococcus aureus isolates obtained from January to December 2000, none from atopic dermatitis patients were methicillin resistant Staphylococcus aureus, while 4.2% of those obtained from the general outpatient pediatric population showed methicillin resistance. In the period from June 2007 to May 2008, 11 of 78 isolates (14.1%) from children with atopic dermatitis were methicillin resistant Staphylococcus aureus. This was significantly lower than the rate of increase noted in the general pediatric population (658 of 1482, or 44.4%, in 2007/2008, p < 0.05). Clindamycin-inducible resistance was noted in 1.9% of the isolates in the general population; all six tested isolates from atopic patients lacked clindamycin-inducible resistance. In this study, children with atopic dermatitis had a much lower rate of community-acquired methicillin resistant Staphylococcus aureus infection compared to the general outpatient pediatric population. Clindamycin-inducible resistance was very low in both groups. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is the most common skin disease in children, and its prevalence is increasing. It is a chronic disorder, characterized by intermittent flares and phases of remission. Treatment regimens often require multiple therapies. These can vary between patients, and in an individual patient, depending on the state of disease. The traditional treatment for AD flares is topical corticosteroids, which are fast acting and effective for relief of symptoms, but may cause adverse effects, including those resulting from systemic absorption, particularly in children. Topical calcineurin inhibitors (TCIs) are alternative treatments for AD. Tacrolimus ointment, a TCI, is approved for patients aged 2 years and older. Multiple studies have shown that tacrolimus is effective for short-term relief of symptoms in pediatric patients with AD. Long-term trials have demonstrated that the effectiveness of tacrolimus is maintained for up to 4 years in children. Additional studies have revealed that long-term intermittent use of tacrolimus as part of maintenance therapy can prevent AD flares. Tacrolimus has a low potential for systemic accumulation, and analysis of long-term studies indicates that it has a good safety profile. Treatment with tacrolimus, alone or in combination with topical corticosteroids for acute flares, may be a useful option for long-term management of AD in pediatric patients. [ABSTRACT FROM AUTHOR]

The true prevalence of allergic contact dermatitis (ACD) in children remains unknown. Our aim was to compare the results of patch tests in children with suspected ACD between two different periods of time and identify possible changes in emerging allergens. We compared contact allergens, gender, age distribution, and personal history of atopic dermatitis (AD), in correlation with the positivity of patch tests, between two equal periods of time (232 children tested during 1980–1993, period A, and 255 children during 1994–2007, period B) in the same region and in the same institution. Patch test positivity was 47.8% in period A, and 60% in period B (p = 0.083). The most common allergens in period A were: nickel sulfate (16.3%), cobalt chloride (8.6%), fragrance mix (7.3%), potassium dichromate (4.3%), and thimerosal only (1.7%). In period B, the allergen distribution was as follows: nickel sulfate (21.56%), thimerosal (18.03%), cobalt chloride (12.9%), potassium dichromate (9.4%), and fragrance mix (4.7%). Girls were more likely to have a positive patch test compared with boys, with reactions in 53% of girls and 39% of boys in period A (p = 0.003), and 61% of girls and 58% of boys in period B (p = 0.691). Twenty-nine per cent of patients with positive results had a personal history of AD in period A and 44% in period B (p = 0.015). Differences in the positivity of allergens between different time periods reflect changes in habits, of allergens exposure or preventive measures. [ABSTRACT FROM AUTHOR]

Patient education has been regarded as having a key role in the self-management of atopic eczema. However, the relationship between the educational interventions and clinical outcomes including severity of eczema, quality of life, and family impact has not been rigorously examined. The purpose of this longitudinal randomized controlled study was to evaluate the impact of an intensive education program with a focus on dermatology and immunology designed for parents and children diagnosed with atopic eczema. The intention of this study was not to change treatment regimes prescribed by the patient's physician. The Scoring Atopic Dermatitis rating system was used for assessment of disease impact, and the impact on quality of life was quantified by using the Children's Dermatology Life Quality Index, Infants’ Dermatology Quality of Life Index, and Dermatitis Family Impact. A total of 61 pediatric patients (0–16 years) diagnosed with atopic eczema from the metropolitan area of Adelaide were randomized to either the control or intervention group. Results of the study showed that the intervention group had a significant improvement in the scoring atopic dermatitis measure when compared to the control group at week 4 and week 12. Quality of life measures did not significantly improve with decreased severity of eczema except in the group of children aged 5–16 years which, despite small numbers, showed a significant improvement in quality of life scores. These findings suggest that education provides an important role in decreasing the severity of eczema. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is a common disease of increasing prevalence. Affected individuals must cope with a significant psychosocial burden, in addition to dealing with the medical aspects of the disease. Furthermore, because this is primarily a disease of childhood, family members, especially parents, are also affected by the condition. Individuals and family members are burdened with time-consuming treatment regimens for the disease, as well as dietary and household changes. The financial impact of atopic dermatitis on families can also be great. Moreover, the cost to society is significant, with estimates ranging from less than$100 to more than$2000 per patient per year. It is estimated that the direct cost of atopic dermatitis in the United States alone is almost$1 billion per year. Reducing the onus of this disease must take into account the full breadth of its burden. Targeting parents and caregivers with education and psychosocial support can decrease family and personal burden, which in turn may decrease the cost of treating the condition because of better medical, psychosocial, and family outcomes. [ABSTRACT FROM AUTHOR]

The results from three online surveys of dermatologists, allergists and immunologists, and primary care physicians (PCPs) regarding routine bathing frequency recommendations for children with atopic dermatitis (AD) are presented. The results suggest that PCPs approach bathing frequency differently than specialists, with PCPs recommending daily bathing less than 50% of the time and specialists recommending daily bathing more than 50% of the time. Because there is lack of consensus, studies are needed to evaluate whether bathing frequency makes a clinical difference in the treatment of pediatric AD. [ABSTRACT FROM AUTHOR]

The frequency and significance of minor clinical features for the diagnosis of atopic dermatitis (AD) were evaluated in different agerelated subgroups of 100 children (up to 12 yrs) with AD and an equal number of controls. Additional features studied were infraauricular fissuring, diffuse scaling of the scalp, and Hertoghe sign. Features found to be nonspecific were ichthyosis, nipple eczema, cheilitis, keratoconus, anterior subcapsular cataract, pityriasis alba, anterior neck folds, and food intolerance. Other minor features were of variable significance in different age groups. Seasonal variation of AD was observed in 44% of patients, with worsening during winter in 29% and in summer in 15%. Of the additional features, diffuse scaling of the scalp and infraauricular fissuring were significant, but Hertoghe sign was not. It was therefore concluded that minor clinical features for the diagnosis of AD need modification, with deletion of some of the present features and addition of newer ones. [ABSTRACT FROM AUTHOR]

We conducted a prospective open study of immediate- and delayed-type contact hypersensitivity to food and other allergens in 33 children with atopic dermatitis (AD). The design of the study was exploratory and not randomized. Various methods for detecting immediate-type hypersensitivity were compared. Thirty-three children age 5 to 15 years with persistent AD were initially enrolled, but 3 dropped out. Nine patients had positive reactions to foods in the patch-scratch test, four had positive reactions in the skin application food test, and five had positive reactions to foods in the prick tests. Positive reactions to foods were observed in only three patients on the delayed-type patch tests. In all tests, but especially the patch-scratch and prick tests, positive reactions to food allergens were observed without clinically related symptoms. None of these tests gave ideal results. Twenty (67%) of the 30 children had positive reactions to inhalants in prick testing. Fourteen showed positive patch-test reactions with the European standard series (True Test). The most positive reactions were to nickel (9 patients), cobalt, and balsam of Peru. Restrictive measures led to evident improvement of AD only in some children. The results of this study illustrate that food allergy plays only a limited role in patients with AD age 5 to 15 years. We could not conclude which of the tests would predict which children might benefit from dietary manipulation. [ABSTRACT FROM AUTHOR]

The article presents abstracts of various articles on dermatology. In one of the article "The Effect of Washing on the Thickness of the Stratum Corneum in Norman and Atopic Individuals," it was examined that the thickness of the stratum corneum and epidermis in healthy individuals and the normal appearing skin of patients with chronic atopic dermatitis. The authors speculate that because the probable impairment of barrier function of the skin could lead to worsening of atopic dermatitis washing of atopic skin should be kept to a minimum. In another article it was discussed that Tuberousclerosis is inherited as an autosomal dominant trait. The earliest sign of this neurocutaneous syndrome in children is circumscribed, hypopigemented lesions known as ash-leaf macules.

We report seven patients with facial lichen striatus along the lines of Blaschko who presented to our pediatric dermatology unit between 2003 and 2009. The mean age of diagnosis was 4.6 years (range 2.5-9 years). Three of the cases were associated with atopic dermatitis, and one case presented with vitiligo. In the six patients for whom we have follow-up, all lesions resolved without pigmentary changes in an average of 11 months. This case series describes the distribution, presentation, and natural history of lichen striatus along facial lines of Blaschko. From our experience, clinical diagnosis and monitoring without biopsy is a reasonable approach to the management of uncomplicated lichen striatus, particularly when the face is involved. [ABSTRACT FROM AUTHOR]

A 7-year-old girl suffering from atopic dermatitis developed multiple lesions of Kaposi's sarcoma, which could not be categorized under any one of the four known types of Kaposi's sarcoma (classic, human immunodeficiency virus-associated, endemic, or iatrogenic). We propose that atopic dermatitis may cause susceptibility to human herpes virus 8 infection, which is related to the pathogenesis of Kaposi's sarcoma. [ABSTRACT FROM AUTHOR]

The article presents information on extracutaneous manifestations of atopic dermatitis (AD). Atopic dermatitis is a multisystem disease that at times can be difficult to diagnosis. The diagnostic criteria have only recently been standardized. The ectodermal origin of the epidermis and of many eye structures explains the frequent associations observed in AD. A variable percentage of patients up to 50 percent may have palpebral or ocular diseases. Although no precise correlation between the severity of the dermatitis and eye changes exists, the frequency of these abnormalities suggests that eye examinations can be performed in the diagnostic screening of atopic patients.

Cyclosporine A (CyA) is a systemic therapy used to control severe atopic dermatitis ( AD) in children, but its use may be associated with serious side effects. Intermittent short-course therapy has been used to minimize these risks without the loss of clinical benefits. We conducted a 20-week study using intermittent short-course CyA therapy in five patients with severe AD and a Scoring Atopic Dermatitis ( SCORAD) score >40. The result was a reduction in the cumulative dose of CyA and serum CyA level, which allows for a longer duration of CyA treatment and decreases the risk of relapse in patients with severe AD. [ABSTRACT FROM AUTHOR]

Coxsackie eruptions concentrated in areas of atopic dermatitis, a phenomenon termed 'eczema coxsackium,' has been well described in the literature but, to our knowledge, the concentration of coxsackie viral lesions to areas of ichthyosis has not been reported. This case describes a rare presentation of coxsackie viral lesions concentrated in areas of epidermolytic ichthyosis in a 3-year-old boy. [ABSTRACT FROM AUTHOR]

This report details the case of an 11-year-old boy with a history of atopic dermatitis who developed a widespread dermatitis 1 month after receiving a laptop for Christmas. Allergic contact dermatitis to nickel in the laptop was determined as the cause. [ABSTRACT FROM AUTHOR]

Some differences in behavioral characteristics have been attributed to atopic dermatitis (AD). In this study, AD patients compared with healthy toddlers had significantly higher scores in perceptual sensitivity and high pleasure in an early childhood behavior questionnaire (ECBQ). They tended to be more energetic and impulsive, and also showed more excitement when subjected to novel stimuli. [ABSTRACT FROM AUTHOR]

Skin prick tests were performed in 12 children with atopic eczema before and after 2 weeks of treatment with topical mometasone furoate and tacrolimus. Both treatments significantly suppressed the allergen wheal size. Mometasone furoate reduced the histamine wheal size as well. Skin prick testing in children treated with topical glucocorticoids or tacrolimus is associated with a risk of false-negative test results. [ABSTRACT FROM AUTHOR]

Comments on the frequency and significance of minor clinical features in various age-related subgroups of atopic dermatitis in children. Clinical delineation of atopic dermatitis in 1935; Evaluation of the diagnostic significance of minor clinical features in atopic dermatitis in 1985; Obstacles in delineating atopic dermatitis in infancy.