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Background: Azathioprine is frequently used in severe eczema. It is converted in the liver into active metabolites, including 6-thioguanine nucleotide (6-TGN) and methylated 6-methylmercaptopurine (6-MMP). In the past, the therapeutic potential of azathioprine may have not been fully utilized. Recent investigations on inflammatory bowel disease have led to a better understanding of azathioprine metabolism and optimizing treatment. Objective: To investigate whether measuring thiopurine metabolites in circulation can improve the effectiveness and safety of azathioprine treatment in patients with atopic dermatitis and/or chronic hand/foot eczema. Methods: Azathioprine metabolite levels were measured in eczema patients during maintenance treatment (Part I) and dose escalation (Part II). Clinical effectiveness, hepatotoxicity, and bone marrow suppression were analyzed and TPMT genotype was assessed. Results: A wide variation in metabolite levels in all dose groups was observed. In Part I (32 patients), there were no significant differences in 6-TGN levels between clinical responders and non-responders (p = .806). No hepatoxicity or myelotoxicity was observed. In Part II, all 6-TGN and 6-MMP levels increased during dose escalation. Hypermethylation was observed in 2/8 patients. Conclusion: For individual eczema patients treated with azathioprine, routinely measuring 6-TGN and 6-MMP can be helpful in optimizing azathioprine dose, improving clinical effectiveness, and preventing side effects. [ABSTRACT FROM AUTHOR]

Purpose: This is a review of emerging targeted, systemic therapies for atopic dermatitis (AD). The information presented aims to provide dermatologists with updated therapeutic options, stimulate academic interest, and spark future research. Material and methods: Extensive search of ClinicalTrials.gov, the National Eczema Association, and PubMed was performed for clinical trials examining the effect of emerging targeted, systemic therapies in patients with AD. Results were included if they demonstrated efficacy in reversing AD symptoms. Studies that did not demonstrate clinical benefit were excluded. Results: A number of emerging systemic agents targeting specific mediators involved in the pathogenesis of AD were found. These targets include IL-4, IL-13, IgE, B-cells, IL-5, IL-31, JAK-STAT, SYK, IL-6, PDE-4, IL-12, IL-17, IL-23, IL-22, H4R, NKR1, κOR, TSLP, PPAR-γ, and DGLA. Treatment of AD patients with these therapies has, in many cases, led to statistically significant improvements in clinical severity scores and patient-reported outcomes. Conclusions: While multiple agents have demonstrated efficacy, only dupilumab is currently approved for adults with AD. Large-scale, randomized, placebo-controlled, double-blind trials, especially in children, are needed. As we enter the dawn of targeted therapy for AD, a comprehensive clinical trial registry is needed to facilitate data pooling and comparison among international registries. [ABSTRACT FROM AUTHOR]

Background:Patients tend to apply topical medications less frequently, in improper amounts. Not only frequency but also application amount may influence treatment outcome. However, studies on relationship between application amount and objective treatment outcome have rarely been conducted. Objective:To assess efficacy of topical agent according to application amount in adult patients, using the finger-tip unit method. Methods:The efficacy of 0.1% topical tacrolimus in adult patients with localised atopic dermatitis was assessed using EASI, TIS, IGA, and PGA scores at baseline, follow-up. Adherence in amount was evaluated after 2 weeks of treatment using the ratio of the actual amount applied to the expected amount applied (A/E). Results:Twenty-seven patients (20.93%) used topical tacrolimus in proper amounts (A/E: 0.8–1.2). However, 86 patients (66.67%) underused topical tacrolimus; 16 (12.40%) patients overused topical tacrolimus. Decreases in EASI scores between baseline and 2 weeks of follow-up in each group (under-amount, proper amount, over-amount) were 1.64, 4.65 and 4.21, respectively. Treatment efficacy increased in accordance with application amount. Further, TIS, IGA, PGA, VAS for Itch and DLQI scores improved concomitantly, exhibiting similar tendencies. Conclusion:Application amount of topical agent is important in increasing treatment efficacy in adult patients with atopic dermatitis. [ABSTRACT FROM PUBLISHER]

Purpose:A study was conducted with a new topical panthenol-containing emollient (NTP-CE) to investigate the efficacy and safety of a 3-month maintenance treatment in infants and children with stabilized mild atopic dermatitis (AD). Methods:After the stabilization phase (up to 2 months) using a corticosteroid-free topical medical device, 108 subjects (aged 2–49 months) with a SCORing AD (SCORAD) on the target area of <5, were randomized to receive NTP-CE (N = 52) or reference emollient (N = 56) twice-daily for ∼3 months. SCORAD scores, occurrence of flares, and tolerability were assessed at regular intervals. Results:In both groups, local SCORAD decreased during the study with a mean change from baseline (=end of stabilization phase) of −1.2 ± 1.3 (NTP-CE) and −1.0 ± 1.9. Kaplan–Meier analysis provided success rates (i.e. proportion of subjects without flares at study end) of 96 and 77% for the NTP-CE and reference group, respectively (p=.083, log-rank test). Mean time to flare-up was 47 days (range: 29–65) in the NTP CE group and 50 days (6–100). Study products were well tolerated. Conclusions:Our results indicate that NTP-CE is efficacious and safe when used for maintenance treatment of mild childhood AD. [ABSTRACT FROM AUTHOR]

Background:Topical corticosteroids (TCS) are key to managing chronic inflammatory dermatoses (CID). Parents/patients cite TCS phobia as an impediment to treatment adherence. Family/friends and the Internet are a source of misinformation on TCS which can negatively impact perceptions of TCS safety. Purpose:To assess information from family/friends and the Internet, as related to and reported by patients/parents using long-term TCS. Methods:A multicenter cross-sectional survey of patients (aged >18 years) and parents of patients (aged <18 years) with a history of CID requiring long-term (≥1 month) TCS use assessing messages about TCS received from family/friends and the Internet. Results:A total of 123 patients and 78 parents completed the survey (n = 201). Parents/patients were more likely to be informed by the Internet “[having] my [child’s] skin condition means that [I/he/she] will need to use topical corticosteroids” (p < .001) and that “inflamed skin conditions will improve with the topical corticosteroids” (p = .007). Family/friends were more likely to recommend parents/patients “try non-prescription creams/ointments before resorting to the use of prescription topical corticosteroids” (p = .014). Conclusions:High rates of messages about TCS “risk” from family/friends and the Internet may affect patient/parent understanding about TCS safety. This may contribute to treatment non-adherence. [ABSTRACT FROM AUTHOR]

Background:Atopic dermatitis, a chronic inflammatory disease, has a lifetime prevalence of 10–20%. Atopic dermatitis reduces quality of life, primarily due to pruritus. Interleukin-31 and its target receptor are newly discovered entities that are involved in pruritus. Purpose:To summarize the current understanding of interleukin-31 and its role in atopic dermatitis, potential therapeutic interventions and future prospects. Methods:A systematic review was designed to identify articles related to interleukin-31 and its role in pruritus. Predefined queries containing interleukin-31 and related key terms were searched with no past date restriction, through 31 August 2016, using MEDLINE, Cochrane Controlled Trials Register, ClinicalTrials.gov and the International Clinical Trials Registry Platform Search Portal database. Results:Of 151 identified articles, 61 met eligibility criteria. Interleukin-31 receptors are expressed constitutively on the surface of keratinocytes, eosinophils and small diameter neurons. Overexpression of interleukin-31, independent of mast cells and lymphocytes, induces clinical and histological features consistent with atopic dermatitis. In addition, overexpression of interleukin-31 causes reversible alopecia. Human monoclonal interleukin-31 antagonist, CIM331, decreased pruritus in phase-I and phase-II clinical trials. Conclusions:Interleukin-31 plays an important role in atopic dermatitis and alopecia. Inhibiting this pathway may provide an alternative to antihistamines for the pruritus of atopic dermatitis. [ABSTRACT FROM AUTHOR]

There is a lack of reports focusing on the course of atopic dermatitis (AD) with respect to its evolution and association with other allergic diseases and parameters. This study gives the review of results concerning the evaluation of different parameters in patients suffering from AD older than 14 years of age. This study evaluates the occurrence of food allergy, food intolerance, inhalant allergy, occurrence of asthma bronchiale, allergic rhinitis, peripheral blood eosinophilia, family history of atopy, onset of AD and the severity of AD according to the SCORAD index. [ABSTRACT FROM AUTHOR]

Background:Natural moisturizing factor (NMF) is used as genotypic and phenotypic biomarker in diagnostics. This study is a side-to-side comparison of two different methods to determine NMF in atopic dermatitis patients: Raman microspectroscopy and stratum corneum tape stripping followed by HPLC. Results:Measured NMF values were significantly correlated (R2 = .61;p < .0001), both methods demonstrated a concentration-depth dependence of NMF and reduced NMF levels in the carriers of filaggrin null mutations. Good agreement between measurements of left and right arms indicated robustness and good reproducibility of both methods. Conclusions:Both methods showed comparable performance, choice of method will rather be influenced by practical consideration. [ABSTRACT FROM PUBLISHER]

Background:The limited efficacy of topical tacrolimus may result from insufficient frequency of application or amount applied in eczema patients. Objective:To investigate the frequency of application and amount of use of topical tacrolimus in patients with various types of eczema. Methods:The frequency of application and the applied amount of topical tacrolimus were assessed over two weeks. Results:A total of 200 eczema patients completed this study. The average number of applications per day was 1.75 ± 0.53, despite instructions to apply the topical tacrolimus twice daily. With respect to the frequency of application, 147 (73.5%) and 122 (61.0%) of patients followed the prescription in the first and second weeks, respectively. The average amount applied per 2% of total body surface area (TBSA) was 0.54 ± 0.52 g. Only 53 (26.5%) patients applied between 80 and 120% of expected amount of topical tacrolimus. Limitations:The frequency of application was self-reported, possibly resulting in limited accuracy. Conclusion:Korean patients with eczema tend to apply topical tacrolimus less frequently and in inappropriate amounts. Clear instructions regarding both the frequency and amount of application are needed to improve the therapeutic outcome with treatment with topical tacrolimus. [ABSTRACT FROM PUBLISHER]

The aim of this study is the evaluation of the specificity and sensitivity of the skin prick tests (SPTs), specific IgE and atopy patch tests (APTs) in atopic dermatitis patients suffering from food allergy. A total of 301 patients were examined, complete dermatological and allergological examination was performed in all patients. The food allergy was confirmed to peanuts in 62 patients (20%), to egg in 16 patients (5%), to soy in 9 patients (3%), to wheat in 12 patients (4%) and to cow milk in 6 patients (2%). The specificity of SPT, specific IgE and APT is considered as good; the sensitivity of APT is low. The positive results in isolation cannot confirm the food allergy; however, together with other diagnostic methods, such as clinical history and open exposure test, these tests are valuable tool in examination of food allergy. [ABSTRACT FROM AUTHOR]

Aim: The evaluation of the importance of atopy patch tests in patients suffering from food allergy to egg’s white and yolk, peanuts, soy, cow’s milk and wheat.Methods: 240 patients were examined. Complete dermatological and allergological examination was performed in all patients including specific IgE, skin prick test, atopy patch test and the challenges tests.Results: The specificity of atopy patch tests is for soy 96%, for egg 95%, for wheat 95%, for peanuts 99% and for milk 99%. The sensitivity of atopy patch tests is for soy 62%, for egg 35.7%, for wheat 16.7%, for peanuts 20.8% and for milk 50%.Conclusion: The specificity of atopy patch tests may be considered good; regarding the sensitivity, the high percentage of false negative results should make us believe that these tests are not conclusive. [ABSTRACT FROM AUTHOR]

The aim of our study is to evaluate the count of eosinophils in peripheral blood in atopic dermatitis (AD) patients over 14 years of age and to compare it with the occurrence of food hypersensitivity (FH) reactions. Complete allergological and dermatological examination was performed in 212 patients included in the study (90 men, 122 women, average age 26.7 years, average SCORAD 32.9). According to our results, in AD patients the difference in count of eosinophils in patients with and without FH reactions is not statistically significant. When evaluating the occurrence of FH reactions to single foods, the count of eosinophils is significantly higher only in patients suffering from reactions to carrot. [ABSTRACT FROM AUTHOR]

Introduction: Phosphodiesterase type 4 (PDE4) inhibition is a well-known anti-inflammatory mechanism. However, the clinical use of PDE4 inhibitors has been compromised by the occurrence of mechanism-associated adverse reactions, which often limit the maximum tolerated dose. To minimize systemic exposure, a topically active PDE4 inhibitor with low transdermal bioavailability could be clinically useful. The purpose of this study was to evaluate the efficacy of a novel topical PDE4 inhibitor, E6005, in patients with atopic dermatitis.Methods: This randomized, investigator-blinded, vehicle-controlled, multiple ascending dose study included 40 adult male patients with atopic dermatitis, who were randomly assigned to 10 days of treatment with either E6005 ointment (0.01, 0.03, 0.1 or 0.2%) or vehicle ointment.Results: Of 81 patients screened, 40 who had typical lesions on their posterior trunk were randomized into the study. One patient receiving 0.03% E6005 treatment discontinued because of acute gout and one receiving vehicle treatment discontinued because of progression of atopic dermatitis. The targeted lesion severity scores decreased in a concentration-dependent manner in patients treated with E6005. This drop was significant in the 0.2% E6005 ointment treatment group (mean percent change: −54.30%,p = 0.007).Conclusion: E6005 ointment showed anti-inflammatory efficacy in adult patients with atopic dermatitis. [ABSTRACT FROM AUTHOR]

The aim of our study is to evaluate the count of eosinophils in peripheral blood in atopic dermatitis (AD) patients older than 14 years of age and to compare it with the occurrence of some other atopic diseases and parameters. One hundred and seventy-two patients were included in the study. According to our results, in AD patients with asthma bronchiale, rhinitis, food allergy, positive family history about atopy, with permanent skin lesions, with total IgE above 200 IU/ml, with the onset of AD under 5 years of age and in patients suffering from moderate or severe form of AD, the count of eosinophils is higher than the normal level of eosinophils. The normal count of eosinophils is recorded in patients suffering from mild form of AD and in patients suffering from food sensitization. [ABSTRACT FROM AUTHOR]

Aim of study: This work was performed to evaluate the level of IL-4, and to clarify the role of IL-4 gene polymorphism at position cytosine –590-to-thyamine (C-590T), IL-4Rα gene polymorphism at position adenine +4679-to-guanine (A+4679G) [isoleucine-50-valine (I50V)] and STAT6 gene polymorphism at position guanine 2964-to-adenine (G2964A) in Saudi children with non-atopic dermatitis (non-AD) and atopic dermatitis (AD) to identify their role in the pathogenesis of these diseases. Subjects and methods: This study included 150 children: 50 healthy children as controls, 50 with non-AD, and 50 with AD. They were subjected to full clinical examination, complete blood picture, skin prick test, and determination of serum interleukin-4 (IL-4) and total immunoglobulin-E (IgE) levels. Detection of interleukin-4 gene (C-590T), interleukin-4 receptor alpha gene (A+4679G) (I50V), and STAT6 gene (G2964A) polymorphisms were performed by PCR-based restriction fragment length polymorphism (PCR-RFLP). Results: There was a significant (P< 0.01) association between genotype and allele frequencies of IL-4Rα (A+4679G) (I50V) polymorphism in the AD group (but not non-AD group). Moreover, there was a significant association between genotype and allele frequencies of the STAT6 (G2946A) polymorphism in the non-AD (P< 0.05) and AD (P< 0.01) groups. On the other hand, there was no significant association between genotype and allele frequencies of the (C-590T) polymorphism in the non-AD group and AD group. There was a significant (P< 0.001) higher total IgE level in patients compared to the controls. Moreover, the mean values of total IgE were significantly different among the different allelic variants of (C-590T), (I50V), (G2964A) polymorphisms of IL-4, IL-4Rα, and STAT6 genes, respectively, in all the studied groups. On the other hand, there was no significant difference of serum IL-4 levels among all the studied patients, or among the different allelic variants of (C-590T), (I50V), (G2964A) polymorphisms of IL-4, IL-4Rα, and STAT6 genes, respectively. Conclusion: IL-4Rα gene (I50V) and STAT6 gene (G2964) polymorphisms may play a role in development of eczema; however, the IL-4 gene polymorphism (C-590T) had no relationship with susceptibility to the disease among Saudi children. [ABSTRACT FROM PUBLISHER]

A few reports demonstrate the relationship between food allergy in atopic dermatitis patients and other allergic diseases and parameters. The objective of this study is to evaluate if some food allergens has the relationship to the occurrence of other atopic diseases and parameters. The following parameters were examined: food allergy to wheat flour, cow milk, egg, peanuts and soy; the occurrence of asthma bronchiale and rhinitis; duration of atopic dermatitis; family history; pollen allergy and onset of atopic dermatitis. The statistical evaluation of the relations among food allergy and monitored parameters was performed. Two hundred and seventy two patients were examined (87 men, 185 women). In general, atopic dermatitis patients with confirmed food allergy suffer significantly more often from rhinitis, asthma bronchiale, persistent eczematic lesions and pollen allergy and have positive data about atopy in their family history. Peanuts, soy and wheat are of great importance. [ABSTRACT FROM AUTHOR]

Only few population-based data exist on the association of food hypersensitivity reactions and atopic diseases. The objective of this study was to evaluate the dependence between the occurrence of food hypersensitivity reactions and other atopic diseases and parameters. Complete dermatological and allergological examination was performed. Statistical evaluation of the relations between the occurrence of food hypersensitivity reactions and the occurrence of asthma bronchiale, rhinitis, duration of atopic dermatitis, family history and onset of atopic dermatitis was performed. Two hundred and thirty-five patients were examined – 75 men and 160 women, average age 26.2 years (SD = 9.5). Patients suffering from food hypersensitivity reactions, in general, suffer significantly more often from rhinitis and from persistent eczematic lesions; the dependence was confirmed in patients with hypersensitivity reactions to nuts, kiwi, fishes and apple. Atopic march was confirmed in patients suffering from atopic dermatitis and from food hypersensitivity reactions. [ABSTRACT FROM PUBLISHER]

Atopic dermatitis is associated with food allergies. The aim of this study is to evaluate soy allergy in patients suffering from atopic dermatitis. Altogether 228 persons were included; specific IgE, skin prick tests, atopy patch tests, challenge tests with soy and history of soy allergy were evaluated. Soy allergy was confirmed in eight patients (3.5%, in four patients with worsening of atopic dermatitis, in four patients with oral allergy syndrome), sensitisation to soy was found in another 47 patients (20%) with no clinical manifestation after soy ingestion. Dependence was confirmed statistically between soy allergy and pollen allergy and soy sensitivity and pollen allergy. About 20% of patients suffering from atopic dermatitis are sensitised to soy. Clinical symptoms of soy allergy occur only in 3.5% of patients suffering from atopic dermatitis. [ABSTRACT FROM AUTHOR]

Background: Pruritus ani (PA) is defined as intense chronic itching affecting perianal skin. Objective: We aimed to determine the efficacy of topical tacrolimus treatment in atopic dermatitis (AD) patients who have PA. Methods: The study included 32 patients with AD who were suffering PA. Patients were randomized into two groups. In total, 16 patients used 0.03% tacrolimus ointment and 16 patients used vaseline as placebo. All groups applied topical treatments to their perianal area twice daily for 4 weeks. The treatments were then reversed for 4 weeks after a 2 weeks wash out period. Results: In total, 32 patients with AD who had refractory anal itching were enrolled in this study. None of the patients had obtained successful results with previous treatments. There was a statistically significant decrease in the recorded EASI, DLQI and itching scores for the tacrolimus group compared to the placebo group at weeks 4 and 6 of treatment ( p < 0.05). Conclusion: Topical tacrolimus treatment was well tolerated and effective in controlling persistent PA in AD patients. [ABSTRACT FROM AUTHOR]

The effects of particulate pollutants on lung function in children with atopic dermatitis (AD) remain to be determined. The authors investigated the short-term effects of ambient particles on peak expiratory flow rate (PEFR) in 84 children with and without AD. Daily particulates less than 10, 2.5, and 1 μm (PM10, PM2.5, and PM1) and number concentrations of submicron particles were measured. The authors observed elevated levels of PM10, PM2.5, and PM1, and accumulation-mode particles were associated with decreased PEFR in children with AD. The PEFR decrements were −2.89 L/min (95% confidence interval [CI], −4.93 to −0.89) for an interquartile-range increase of previous-day PM10, −2.79 L/min (95% CI, −4.89 to −0.69) for PM2.5, and −2.71 L/min (95% CI, −4.81 to −0.61) for PM1. These results suggest that ambient fine particles may affect the pulmonary function in children with AD. The respiratory health of children with atopic skin disorders renders them more vulnerable to ambient particles than healthy subjects. [ABSTRACT FROM AUTHOR]

Multiple treatment modalities, including topical and systemic corticosteroid and phototherapy, have been used in treatment of patients with atopic dermatitis. However, long-term corticosteroid therapy may have various adverse effects. The purpose of this study was to investigate the therapeutic efficacy and safety of bath therapy using green tea extracts for treatment of patients with atopic dermatitis. A total of four patients with atopic dermatitis were enrolled in this study. A Malassezia multiplex detection kit was used in performance of multiplex PCR on clinical isolates, which confirmed Malassezia sympodialis. Subjects underwent treatment with bath therapy using green tea extracts three times per wk for a period of 4 wk. Assessment using the scoring atopic dermatitis (SCORAD) index, the visual analogue scale for pruritus, and transepidermal water loss was performed weekly. Laboratory tests were performed before and after treatment. All patients showed marked improvement on the mean SCORAD and visual analogue scale, and a significant decrease in the mean values of serum eosinophil counts was observed after treatment. Bath therapy with green tea extract is an effective, safe, and nonsteroidal therapy for treatment of patients with atopic dermatitis associated with Malassezia syinpodialis. [ABSTRACT FROM AUTHOR]

Background: Percutaneous absorption of topically applied 0.05% clobetasol propionate (CLO) can be assessed indirectly by measuring cortisol levels. A direct way is to measure systemic levels of topically applied CLO. Methods: Serum concentrations of CLO were measured by liquid chromatography-tandem mass spectrometry (LC/MS/MS), and were related to serum cortisol levels in 25 patients with an exacerbation of atopic dermatitis (AD) before and after the first day of treatment with 0.05% CLO in hospital. The body surface area (BSA) affected by AD was measured. Results: Before the start of 0.05% CLO treatment, normal cortisol levels were measured (0.47 ± 0.18 μmol/l) and CLO concentrations could not be detected. After the first day of treatment, cortisol levels decreased to 0.04 ± 0.05 μmol/l. Serum concentrations of CLO could be detected in all patients (0.112-4.504 ng/ml). Levels did not differ between patients who had received two applications versus one application of 0.05% CLO. There was no correlation between the affected BSA and serum concentrations of CLO. Conclusion: Serum levels of CLO can be measured by LC/MS/MS. When prescribing 0.05% CLO, one must bear in mind that, even after an application of 20-30 g, CLO is systemically available and potent enough to induce adrenal gland suppression. [ABSTRACT FROM AUTHOR]

Parthenium hysterophorus is the leading cause of airborne contact dermatitis, a type IV hypersensitivity reaction in India. Though there are reports of it causing type-I hypersensitivity in atopic individuals in the form of allergic rhinitis and asthma, there is very little information on its role in pathogenesis of atopic dermatitis (AD), another predominately type I hypersensitivity. In the present study, we evaluated the presence of immediate hypersensitivity to P. hysterophorus in patients with AD and evaluated the in vitro immunological response of P. hysterophorus SPT positive AD patients to stimulation with P hysterophorus allergen . In 70 patients (age 15-45 years) with AD and 70 healthy controls, who were patch test negative to P. hysterophorus, immediate hypersensitivity to P hysterophorus was determined by skin prick test (SPT). In SPT positive patients with AD and SPT negative controls, the absolute eosinophil count (AEC), the total serum IgE and Parthenium specific IgE were determined and PBMC proliferation assay to Parthenium pollen using tritiated thymidine incorporation was done. The IL-4, IL-10, IL-2 and IFN-γ from stimulated PBMCs culture supernatant was also quantified using sandwich ELISA in both groups of patients. Twenty-five (35.7%%) of 70 patients with AD had a positive SPT to Parthenium, compared to 3 (4.3%%) of controls . The mean AEC, the mean total IgE and Parthenium specific IgE were significantly elevated in SPT positive AD patients vis-à-vis SPT negative controls. Similarly in the Parthenium specific PBMCs proliferation assay, the stimulation index as well as the Th2 cytokine (IL-4 and IL-10) profile were significantly elevated in SPT positive AD patients vis-à-vis SPT negative controls but there was no difference in the Th1 cytokine (IL-2 and IFN-γ) profile. Our study suggests that a third of patients with AD demonstrated a type I hypersensitivity to P. hysterophorus with a Th2 biased cytokine profile (IL-4 and IL-10) in culture supernatant of Parthenium stimulated PBMCs in these patients. [ABSTRACT FROM AUTHOR]

Aim. The evaluation of the occurrence of peanut allergy in adolescent and adult patients suffering from atopic dermatitis. Methods. Altogether 175 persons suffering from atopic dermatitis were included in the study. A diagnostic work-up for food allergy to peanuts was performed (specific IgE, skin prick tests, atopy patch tests, history), and the patients were also examined for pollen allergy containing Bet v 1 and Bet v 2 allergens. Results. Allergic reactions to peanuts were recorded in 23% of patients, and another 16% of patients were sensitised to peanuts. A dependency between the occurrence of pollen allergy with Bet v 1 and Bet v 2 allergens and the results of the examination for peanut allergy is confirmed in our study. Conclusion. One-fifth of patients with atopic dermatitis suffer from peanut allergy; the most common symptom is oral allergy syndrome. [ABSTRACT FROM PUBLISHER]

Background. House dust mites (HDMs) are important causes of persistent allergic diseases, such as asthma and rhinitis. Various types of mites are found in the house dust of many countries, including Israel. Objective. To evaluate the prevalence of sensitization to various HDMs in patients with perennial allergic rhinitis and asthma Methods. Sensitization of 117 patients with persistent rhinitis who attended the Allergy and Asthma Center in Tel Aviv (Israel) was evaluated by a skin prick test (SPT) using standardized allergenic extracts. The tested mites were Dermatophagoides farinae (DF), Dermatophagoides pteronyssinus (DP), Lepidoglyphus destructor (LD), Blomia tropicalis (BT), Tyrophagus putrescentiae (TP), Acarus siro (AS), Glycyphagus domesticus (GD), Blomia kulagini (BK), and Tetranychus urticae (TU). Results. Most patients ( n = 95, 81%) had a positive SPT to at least one mite extract. The three most frequent positive reactions were to DF (78%), DP (75%), and, unexpectedly, BT (77%). The correlation between DF and DP sensitization was higher than the correlation between DF or DP to BT ( r = .78 versus r = .60, p < .05). Six patients had positive skin reactions to at least one mite species other than DF, DP or BT, mainly LD ( n = 2, 2.1%) and BK ( n = 4, 3.8%). Conclusions. The findings of this study identified the most ubiquitous mites to which Israeli patients with allergic rhinitis were sensitized and indicated the importance of BT as an allergen. Extracts of these mites may provide a more accurate diagnosis and effective treatment of respiratory diseases due to mite allergy in Israel and probably in other countries with similar climes. [ABSTRACT FROM AUTHOR]

Quantitative questionnaire-based research has suggested a considerable effect of skin disease on the sexual life of sufferers. In this study, we explored the effects of acne, psoriasis and atopic eczema upon sexual functioning and sexual relationships in the context of a wider exploration of the psychological sequelae of these diseases. We employed a qualitative methodology employing in-depth semi-structured interviews and involving thematic analysis and constant comparison. Participants were patients with currently active acne, psoriasis or atopic eczema. Purposive sampling aimed to obtain a sample reflecting a wide range of participant characteristics including skin disease severity, age, sex, and care by general practitioner or dermatologist. Sixty-two semi-structured interviews were conducted. Acne had adverse effects on participants' self-perceived sexual attractiveness and self-confidence, as did psoriasis and eczema. But psoriasis and eczema also had marked effects on sexual well-being and on capacity for intimacy. These were related to issues of self-esteem and sexual self-image and were often pervasive, resulting in marked behavioural avoidance of intimate situations and continuing effects on sexual well-being even in long-established sexual relationships. Effects of psoriasis and eczema on sexual well-being and sexual relationships were mediated more by appearance and texture of non-genital skin than by involvement of genital skin. We conclude that, while recognising the distressing effects of acne on self-perceived sexual attractiveness, clinicians should be especially aware of the capacity of psoriasis and eczema to profoundly affect patients' psychological and sexual well-being. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of tacrolimus ointment 0.1% and pimecrolimus cream 1% in adult patients with moderate to very severe atopic dermatitis (AD). Methods: A total of 281 patients (141 treated with tacrolimus and 140 treated with pimecrolimus) were randomized to a multicenter, investigator-blinded, 6-week study. Results: Tacrolimus-treated patients had significantly greater improvements in the Eczema Area Severity Index score compared with pimecrolimus-treated patients (mean percent reduction from baseline to study end: 57% vs 39%, respectively; p = 0.0002). Treatment success was also significantly greater among the tacrolimus-treated patients compared with pimecrolimus-treated patients (40% vs 22% at study end; p = 0.001), as was the improvement in percentage of total body surface area affected (a reduction of 49% vs 34% at study end; p = 0.01). Both treatment groups had similar improvements in patient assessment of itch. There were no significant differences in the incidences of adverse events, including application-site burning and application-site pruritus, the two most commonly reported adverse events. Significantly more pimecrolimus-treated patients than tacrolimus-treated patients withdrew from the study due to lack of efficacy (10 vs 1, p = 0.005). Conclusion: Tacrolimus ointment is more effective than pimecrolimus cream in adults with moderate to very severe AD. Both agents have a similar safety profile. [ABSTRACT FROM AUTHOR]

Background: Pimecrolimus cream 1% (Elidel ® ), a non‐steroid inhibitor of inflammatory cytokines, is effective in the treatment of atopic dermatitis, without corticosteroid‐related side effects such as skin atrophy. It is indicated for twice‐daily application. More frequent applications might be expected either to enhance efficacy or increase toxicity. This study compared the safety, efficacy and systemic absorption of pimecrolimus administered twice daily (recommended dose) and four times daily early in the treatment of patients with moderate to severe atopic dermatitis. Methods: Adolescent and adult patients with moderate to severe atopic dermatitis were randomly assigned to a twice daily (BID) treatment group ( n = 24) or a four times daily (QID) group ( n = 25). During days 1–7, patients in the QID group applied pimecrolimus four times daily, and patients in the BID group applied pimecrolimus twice daily plus vehicle equivalent twice daily. During days 8–21, all patients were required to use pimecrolimus twice daily and had the option to use up to two further daily treatments (pimecrolimus in the QID group and vehicle equivalent in the BID group). Blood sampling occurred 2, 4, and 6 hours after the first morning application on days 1 and 5 and then prior to the first morning application on days 8 and 15, and any time on day 22. Results: Only 3 (12%) QID patients and 4 (17%) BID patients reported adverse events (primarily mild, transient application‐site burning) with no significant difference between treatment groups in the frequency, type, or severity of adverse events. The median daily number of applications in the QID group during days 8–21 when two additional doses were optional remained at four. Pimecrolimus blood levels from a subgroup of 22 patients showed no difference in systemic exposure between the two dosing regimens. All but three (one in the QID group, two in the BID group) patients had blood levels below the limit of quantification; the highest single blood level of pimecrolimus measured in any patient was 1.37 ng/ml (QID group). Both the QID and BID regimens improved the signs and symptoms of atopic dermatitis similarly as measured by improvements in pruritus severity score, Investigator's Global Assessment, Eczema Area and Severity Index, percentage of body surface area affected, and patient's self‐assessment of disease control. Conclusions: The data suggest that increasing pimecrolimus application from twice daily to four times daily to treat moderate to severe atopic dermatitis for up to 3 weeks does not alter the safety profile nor does it increase the efficacy of treatment. Systemic absorption of pimecrolimus applied BID and QID is minimal and is not different between dosing regimens. Patients and physicians familiar with the potential hazards of overuse of topical corticosteroids should be reassured that if pimecrolimus is applied at twice the recommended BID dose for short periods of time, there is no effect on safety, tolerability, or systemic absorption. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This randomized, double-blind, multi-centre study compared the long-term safety and tolerability of pimecrolimus cream 1% and topical corticosteroids (TCS) in 658 adults with moderate-severe atopic dermatitis (AD). METHODS: Patients applied either pimecrolimus or TCS (i.e. 0.1% triamcinolone acetonide cream and/or 1% hydrocortisone acetate cream) twice daily to all affected areas until complete clearance or for up to 1 year. The study was approved by the institutional review board or ethics committee at each centre. RESULTS: A majority of patients treated with either pimecrolimus or TCS used the drug on a continuous basis over 1 year. In patients who had >30% of the body surface involved by AD, the incidence rate of all skin infections was significantly lower in the pimecrolimus group than in the TCS group (95% CI of the treatment difference: -25.3% to -3.4%). The most frequent application site reaction was burning (25.9% of patients on pimecrolimus and 10.9% on TCS), which was transient and mild-moderate in most cases. Three TCS-treated patients reported skin striae. There were no treatment-related serious or clinically significant systemic adverse events. Efficacy was better in patients on continuous TCS therapy, although patients completing the study were similarly well-controlled in both groups. About 42% of the pimecrolimus-treated patients were maintained for 1 year without TCS. CONCLUSION: Pimecrolimus demonstrated a favourable safety profile when used to treat adult patients with moderate-severe AD for up to 1 year. A significant proportion of patients could be maintained without TCS for a year. [ABSTRACT FROM AUTHOR]

A correction to the article "Recovery of platelet factor 4 (PF-4) and betathromboglobulin (beta-TG) plasma concentrations during remission in patients suffering from atopic dermatitis" that was published in the November 2010 issue is presented.