Search

Hintergrund Der Zusammenhang zwischen atopischer Dermatitis (AD) und allergischer Kontaktdermatitis ist nach wie vor nicht abschliesend geklart. Studien ergeben sehr unterschiedliche Resultate; sie reichen vom Fehlen jeglichen Zusammenhangs bis hin zu einer vermehrten Sensibilisierung auf multiple Allergene. Konsistente Assoziationen mit bestimmten Allergenen wurden jedoch bisher nicht gefunden. ZIEL: Wir haben eine grose Kohorte von Patienten, stratifiziert nach atopischer Hautdiathese gemas dem Erlanger Atopiescore (EAS), unabhangig von einer aktiven Hauterkrankung, durch Epikutantests untersucht. Methoden Retrospektive Multicenter-Datenanalyse aus funf dermatologischen Zentren in Deutschland mit 4.509 Patienten. Die Patienten wurden nach dem EAS eingeteilt in eine Gruppe ohne atopische Hautdiathese (n = 2.165) und eine mit atopischer Hautdiathese (n = 1.743). Ergebnisse In der Gruppe mit atopischer Hautdiathese zeigten signifikant mehr Personen mindestens eine positive Epikutantest-Reaktion in der Standardreihe als in der Gruppe ohne atopische Hautdiathese (49,1 % vs. 38,3 %). In der logistischen Regressionsanalyse war die atopische Hautdiathese mit einem signifikant erhohten Sensibilisierungsrisiko gegen Methylchloroisothiazolinon/Methylisothiazolinon (OR 2.383) und Methylisothiazolinon (OR 1.891), Thiuram-Mix (OR 1.614) sowie Nickel (OR 1.530), Kobalt (OR 1.683) und Chrom (OR 2.089) assoziiert. Schlussfolgerungen Die atopische Hautdiathese zeigte sich als der wichtigste intrinsische Risikofaktor fur eine Kontaktsensibilisierung gegen einige spezifische Antigene. Eine fruhere oder derzeit bestehende AD erwies sich als weniger relevante Grose.

Summary Background The association of atopic dermatitis (AD) and allergic contact dermatitis has been a matter of considerable uncertainty. Study results range from lack of any association to increased sensitization for multiple allergens, but fail to identify consistent allergen associations. Objective We studied a large patch test cohort of patients stratified by their atopic skin diathesis using the Erlangen Atopy Score (EAS), independent of active skin disease. Methods Retrospective multi‐center data analysis from five departments of dermatology in Germany with 4,509 patients. Patients were grouped as “no atopic skin diathesis” (n = 2,165) and “atopic skin diathesis” (n = 1,743), according to EAS. Results Significantly more individuals with atopic skin diathesis showed at least one positive patch test reaction to the baseline series compared to individuals without atopic skin diathesis (49.1 % vs. 38.3 %). In logistic regression analyses, atopic skin diathesis was associated with a significantly higher risk of sensitization to methylchloroisothiazolinone/methylisothiazolinone (OR 2.383) and methylisothiazolinone (OR 1.891), thiuram mix (OR 1.614), as well as nickel (OR 1.530), cobalt (OR 1.683), and chromium (OR 2.089). Conclusions Atopic skin diathesis proved to be the most important intrinsic risk factor for contact sensitization to few, specific allergens. Past or present AD was a less relevant variable.

Given that local elevated protease activity (EPA) has been implicated in impaired wound healing, a prospective single-center study was conducted to assess protease activity in various wound types.Protease activity was determined using an easy-to-use test system (Woundchek Protease Status Test Kit; Systagenix, Gatwick, United Kingdom) in 160 wounds in 143 patients. The assay detects the combined activity of inflammatory proteases, mainly matrix metalloproteinases 8 and 9 and human neutrophil elastase.Local EPA was detected in 29 of 153 validly tested wounds (18.95%). No difference was detected between acute and chronic wounds, regardless of associated or causative conditions, with the sole exception of surgical wounds. Surgical wounds showed EPA significantly less frequently than nonsurgical wounds. Among nonsurgical wounds, EPA was detected more frequently in acute compared with chronic wounds. Wounds with signs of unimpeded healing (granulation or epithelialization) showed EPA less often than wounds covered with necrotic tissue or a fibrin layer. However, 14% of wounds with epithelialization or granulation exhibited EPA potentially impeding wound healing. Wounds treated with moisture-retentive wound dressings showed EPA significantly less frequently compared with wounds bandaged with dressings with less moisture-retentive properties. Remarkably, none of the wounds treated with collagen/oxidized regenerated cellulose/silver, which is a protease-modulating dressing, showed EPA.To the study authors' knowledge, this is the largest study assessing EPA in various wound types. The convenient applicability of the test system provides a basis for future studies assessing the pathophysiologic relevance of EPA. In some unsuspicious wounds, early detection of EPA might precede impaired healing and prompt protease-modulating treatment before failure to heal becomes apparent.

Background: Palmoplantar pustulosis (PPP) is arecalcitrant chronic inflammatory skin disease. Datarelevant for the medical care of patients with PPP arescarce. Thus, the aim of this work was to investigatethe disease burden, clinical characteristics, andcomorbidity of PPP patients in Germany. Patientsand Methods: PPP patients were examined in a crosssectionalstudy at seven specialized psoriasis centersin Germany. Results: Of the 172 included patients withPPP, 79.1% were female and 69.8% were smokers.In addition, 25.0% suffered from psoriasis vulgaris,28.2% had documented psoriatic arthritis, and 30.2%had a family history of psoriasis. In 77 patients themean Dermatology Life Quality Index (DLQI) was 12.2± 7.7 (mean ± SD). The mean Psoriasis PalmoplantarPustulosis Area and Severity Index (PPPASI) was 12.6 ±8.6. Mean body mass index was above average at 27.1± 5.5. The PPP patients had previously received anaverage of 2.6 ± 2.1 different anti-psoriatic systemicdrugs or UV-therapies. The systemic drugs that hadbeen used most frequently were corticosteroids in40.1% of patients, followed by acitretin (37.8%), andmethotrexate (27.9%). The PPPASI was 13.4 ± 8.9 inpatients without current systemic therapy and 10.4 ±7.9 in patients with systemic therapy. Conclusion: ManyPPP patients had a concomitant diagnosis of psoriasisvulgaris and/or psoriatic arthritis or had a familyhistory of psoriasis. Despite the fact that many of thepatients were using anti-psoriatic therapies, there wasstill a high burden of disease within this PPP cohort.This insufficient control of symptoms demonstratesthe urgent need for new PPP treatments.