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Background Skin infections related to disrupted antimicrobial defence are a common problem in atopic dermatitis ( AD). Altered levels of antimicrobial peptides, including human β-defensin (h BD)-2, have been reported in AD skin, and a link to impaired barrier function has been suggested. Objectives To study h BD-2 in relation to skin barrier function in patients with AD and controls, and to study h BD-2 in relation to disease severity. Methods Twenty-five patients with AD and 11 controls were enrolled. h BD-2 peptide concentration was determined in stratum corneum samples collected by a minimally invasive tape-stripping method. Disease severity was assessed by SCORing Atopic Dermatitis ( SCORAD), and skin barrier function was evaluated by measurement of transepidermal water loss ( TEWL) and skin p H. Patients with AD were characterized according to filaggrin mutations. Results h BD-2 concentrations in the stratum corneum were found to differ between lesional and nonlesional AD skin and controls, with the highest values in lesional skin ( P < 0·001). SCORAD and TEWL were significantly increased in participants with measureable h BD-2 ( P < 0·018 and P < 0·007, respectively). Significant correlations between h BD-2 in lesional skin, and TEWL and SCORAD were observed ( R = 0·55 and R = 0·44, respectively). No correlations with skin p H were found. h BD-2 was not found to relate to filaggrin mutations. Conclusions A significant correlation was found between h BD-2, disturbed skin barrier function and disease severity. The minimally invasive skin sample technique enables evaluation of the stratum corneum and its proteins over time and provides the possibility of relating these findings to treatment, infections and physiological variations. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Is skin exposure to water mainly occupational or nonoccupational? A population-based study."

The barrier function of the skin is dependent on an optimal composition of the stratum corneum lipids, exemplified by the altered lipid profile in patients with atopic eczema (AE). Differences in the global prevalence of AE point to the environment as an important factor in AE. Studies on filaggrin point to a genetic aspect in AE. The influence of environment and genes needs to be explored. To investigate possible differences in stratum corneum lipids between different healthy ethnicities living in the same environment. Healthy participants without any major skin diseases were enrolled in the study. Twenty-five participants of Asian origin (Asians), 18 of African origin (Africans) and 28 of Danish origin (white-skinned), all students at universities in the Copenhagen area of Denmark, had the ceramide profile of their stratum corneum examined using the cyanoacrylate method and analysed using high-performance thin layer chromatography. For the ceramide/cholesterol ratio we found statistically significant differences between groups, with Asians having the highest ratio ( P < 0·001 as compared with both white-skinned individuals and Africans), white-skinned individuals having intermediate values, and Africans having the lowest values. No statistically significant differences were found between any of the ceramide subgroups. We found different ceramide/cholesterol ratios in comparable groups of different ethnicity, pointing to unknown genetic differences. [ABSTRACT FROM AUTHOR]

To cite this article: Jungersted JM, Scheer H, Mempel M, Baurecht H, Cifuentes L, Høgh JK, Hellgren LI, Jemec GBE, Agner T, Weidinger S. Stratum corneum lipids, skin barrier function and filaggrin mutations in patients with atopic eczema. Allergy 2010; 65: 911–918. Background: Prior to the discovery of filaggrin ( FLG) mutations, evidence for an impaired skin barrier in atopic dermatitis (AD) has been documented, and changes in ceramide profile, altered skin pH and increased trans-epidermal water loss (TEWL) in patients with AD have been reported. Until now, no studies have analysed stratum corneum (SC) lipids combined with skin barrier parameters in subjects of known FLG genotype. Methods: A cohort of 49 German individuals genotyped for the most common FLG mutations (R501X, 2282del4) had SC samples taken for lipid analysis by high-performance thin layer chromatography. In addition, TEWL, erythema, skin hydration and pH were measured. In 27 of the 49 individuals, a 24-h irritation patch test with sodium lauryl sulphate was performed. For the analysis, both the AD group and the control group were stratified by FLG mutation status ( FLGmut/ FLGwt). Results: In the FLGmut AD group, significantly lower levels of ceramide 4 and significantly higher levels of ceramide 7 were observed when compared to both healthy control groups. However, ceramide 7 levels also significantly differed between FLGwt AD and FLGwt controls, as did ceramide 1 levels. No significant differences were observed for ceramide 2, 3, 5 and 6. FLGmut individuals had significantly higher skin pH values than individuals not carrying FLG mutations. Patients with AD with FLG mutations had significantly higher erythema compared to patients with AD without FLG mutations. Conclusion: Our results confirm previous observations of altered ceramide levels in AD, which however appear to show no clear relationship with FLG mutations. [ABSTRACT FROM AUTHOR]

Background Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis. Objectives To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis. Methods Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6-month follow up using a self-administered photographic guide. Additional information was obtained by self-administered questionnaires. Results Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1·5–8·0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1–8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1·11 [95% confidence interval (CI) 1·02–1·21] per month of patient delay and by 1·05 (95% CI 1·00–1·10) per month of healthcare delay. Conclusions A poorer prognosis of hand eczema was associated with longer delay before medical attention. [ABSTRACT FROM AUTHOR]

Background The role of bacterial infections in hand eczema (HE) remains to be assessed. Objectives To determine the prevalence of Staphylococcus aureus in patients with HE compared with controls, and to relate presence of S. aureus, subtypes and toxin production to severity of HE. Methods Bacterial swabs were taken at three different visits from the hand and nose in 50 patients with HE and 50 controls. Staphylococcus aureus was subtyped by spa typing and assigned to clonal complexes (CCs), and isolates were tested for exotoxin-producing S. aureus strains. The Hand Eczema Severity Index was used for severity assessment. Results Staphylococcus aureus was found on the hands in 24 patients with HE and four controls ( P < 0·001), and presence of S. aureus was found to be related to increased severity of the eczema ( P < 0·001). Patients carried identical S. aureus types on the hands and in the nose in all cases, and between visits in 90% of cases. Ten different CC types were identified, no association with severity was found, and toxin-producing strains were not found more frequently in patients with HE than in controls. Conclusions Staphylococcus aureus was present on hands in almost half of all patients with HE, and was significantly related to severity of the disease. This association indicates that S. aureus could be an important cofactor for persistence of HE. [ABSTRACT FROM AUTHOR]

Un bambino di 4 mesi presenta una dermatite grave con infezioni recidivanti. L'esame istologico mostra vacuolizzazione delle cellule basali e flogosi della giunzione dermo-epidermica. Gli esami portano alla diagnosi di immunodeficienza combinata grave e la dermatite viene addebitata a una reazione da trapianto contro l'ospite da cellule materne. Il bambino vede guarire la sua dermatite 4 mesi dopo trapianto di midollo allogenico. [ABSTRACT FROM AUTHOR]

Background Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. Objectives In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. Methods Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. Results At baseline, 60·3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36·1% at follow-up. The mean HECSI value decreased from 19·9 points at baseline to 11·2 points at follow-up ( P < 0·001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age ( P < 0·001), atopic dermatitis ( P = 0·01) and ≥ 1 positive patch test ( P < 0·001). Being an unskilled worker was a predictor for a poor prognosis at follow-up ( P = 0·04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease ( P = 0·02) and a poor prognosis ( P = 0·04). Conclusions Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers. [ABSTRACT FROM AUTHOR]

Background Staphylococcus aureus in atopic skin has been associated with exacerbation of eczema. Objectives To investigate a possible association between neonatal colonization with S. aureus and the risk of atopic dermatitis (AD) during the first 3 years of life. Materials and methods The study participants were 356 children born of mothers with asthma from the Copenhagen Prospective Study on Asthma in Childhood. Swabs from the vestibulum nasi and the perineum were cultured at 1 month and 1 year, from acute eczema, and from parents (vestibulum nasi and pharynx). AD development and severity were monitored prospectively. Results Of the neonates, 5·3% had positive swabs for S. aureus cultured from the vestibulum nasi (51·3%) and/or the perineum (11·3%). Forty-two per cent developed AD, but without association between colonization with S. aureus at 1 month of age and risk of developing AD at 3 years of age. There was a 70% concordance for S. aureus carriage between neonates and parents. At 1 year of age 11·3% children had swabs positive for S. aureus. Fourteen per cent of children tested at the 1-year visit developed AD after the visit but before 3 years of age, but again, there was no association between colonization with S. aureus and the risk of AD. In children seen at acute visits the severity of AD measured by scoring of atopic dermatitis (SCORAD) was significantly higher in children with a positive culture for S. aureus in lesions. Conclusions Colonization with S. aureus at 1 month of age is not associated with an increased risk of developing AD during the first 3 years of life. [ABSTRACT FROM AUTHOR]

Background Hand eczema is a long-lasting disease with a high prevalence in the background population. The disease has severe, negative effects on quality of life and sometimes on social status. Epidemiological studies have identified risk factors for onset and prognosis, but treatment of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system for hand eczema is needed. Objectives The present study attempts to characterize subdiagnoses of hand eczema with respect to basic demographics, medical history and morphology. Methods Clinical data from 416 patients with hand eczema from 10 European patch test clinics were assessed. Results A classification system for hand eczema is proposed. Conclusions It is suggested that this classification be used in clinical work and in clinical trials. [ABSTRACT FROM AUTHOR]

Background The filaggrin protein is a key component of stratum corneum and homo- or heterozygotes for the filaggrin variant alleles R501X and 2282del4 have varying degrees of impaired skin barrier. The variant alleles have repeatedly been shown to be associated with atopic dermatitis. Any possible association with hand eczema or contact allergy are unexplored. Objectives To explore associations between the variant alleles, hand eczema, contact allergy and atopic dermatitis. Methods In total, 183 adult individuals participated in a clinical examination of the hands, patch testing and filaggrin genotyping. Children without any evidence of atopic dermatitis from the Copenhagen Prospective Study on Asthma in Childhood (COPSAC) study were used as controls. The χ2 test was used for comparison of allele frequencies. Results The majority (73%) had hand eczema, 25% had contact allergy and 14% had a diagnosis of atopic dermatitis. The association between atopic dermatitis and the filaggrin variant alleles was confirmed (odds ratio 3·5, P = 0·015). Allele frequencies in individuals with hand eczema or contact allergy were not statistically significantly increased. Conclusion There is no association between the variant alleles and hand eczema or contact allergy. [ABSTRACT FROM AUTHOR]

Background Population-based studies on the incidence of hand eczema are sparse. Objectives The aim of this prospective follow-up study was to determine the incidence rate of hand eczema in a population-based twin cohort. Secondly, the role of genetic factors and other potential risk factors for hand eczema was investigated. Methods A questionnaire on self-reported hand eczema was answered by 5610 and 4128 twin individuals in 1996 and 2005, respectively. Data were analysed in a Poisson regression analysis. Results The crude incidence rate was 8·8 cases per 1000 person-years (95% confidence interval, [CI] 7·7–9·9). Incidence rate ratios (IRRs) dependent on the co-twin’s hand eczema status revealed a significant, doubled risk for monozygotic twin individuals with a co-twin affected by hand eczema, compared with dizygotic twin individuals with a co-twin affected by hand eczema (IRR 2·4, 95% CI 1·4–4·1). Also, significantly increased IRRs were found for positive patch test, atopic dermatitis, and wet work. Conclusions Hand eczema is still a frequent disease and genetic factors are confirmed important risk factors. Positive patch test, atopic dermatitis and wet work were associated with an increased risk, whereas no association with age, sex, smoking or alcohol was found. [ABSTRACT FROM AUTHOR]

Background Previous studies show that use of complementary and alternative medicine (CAM) is frequent among dermatological patients in general and that the use of CAM is linked to disease severity and duration. Objectives To investigate factors influencing the use of CAM and visits to alternative practitioners among patients with allergic contact dermatitis. Methods The study was a postal questionnaire survey among 485 patients with allergic contact dermatitis to fragrances and preservatives in consumer products. The questionnaire included questions about use of conventional treatment, use of CAM and visits to alternative therapists. It also included questions about eczema severity and duration as well as social factors. The patients were recruited from one dermatological clinic in the capital city area and two clinics in smaller cities. Results The response rate was 79%. Forty per cent of respondents were users of CAM, predominantly in combination with conventional treatment, and 29% had visited an alternative practitioner. Women were found to be significantly more frequent users of CAM and visitors to alternative practitioners than men, and patients from urban/rural districts reported more frequent use of CAM than patients from the capital city area. Frequent eczema eruptions, hand eczema, long duration of disease and work-related problems were positively associated with use of CAM and/or visits to alternative practitioners. Conclusions The typical CAM user is female, lives in a rural district or town (not the capital area), has long disease duration and often work-related problems. Overall, the use of CAM is not an alternative to conventional treatment, but is a supplement. [ABSTRACT FROM AUTHOR]

Background The benefit of alcohol-based disinfectant used on normal skin has been debated. Objectives The objective of the present study was to compare the effects of repeated exposure to an alcohol-based disinfectant, a detergent and an alcohol-based disinfectant/detergent alternately for 10 days, including noninvasive measurements in the evaluation. Skin reactivity in irritated skin after a 4-week interval was also evaluated. Materials and methods Detergent, disinfectant and alternate disinfectant and detergent were applied twice daily every 10 min for 1 h to the ventral upper arms and forearms of 17 healthy volunteers. A control area was included. After 4 weeks an SLS patch was applied to each area. Irritant reactions were quantified with a visual score recording and measurements of transepidermal water loss (TEWL) and skin colour were performed on days 1, 5, 11, 38 and 40. Results On day 5 the detergent caused a higher visual score than either disinfectant applied alone or alternate disinfectant and detergent, P < 0·05. On day 11 detergent and alternate disinfectant and detergent caused a higher score than disinfectant, P < 0·05. An increased irritant response for detergent compared with disinfectant alone and alternate disinfectant and detergent was confirmed by TEWL evaluations on days 5 and 11, P < 0·001, while no significant difference was found by colour measurement. After 4 weeks, when evaluated by colour measurement, significantly less response to the SLS patch was found on the disinfectant-treated area compared with the control area and detergent area, and a similar trend was found for TEWL, although it was not statistically significant. Conclusion Alcohol-based disinfectant caused less visible skin irritation and less skin barrier disruption than the use of detergent. The alternate use of detergent and disinfectant caused less irritation than the use of detergent, and a possible interaction between the two irritants was not indicated. After 4 weeks there was a tendency for decreased skin reactivity in the skin areas which had 4 weeks previously been exposed to disinfectant. [ABSTRACT FROM AUTHOR]

Severity assessment of occupational hand eczema (OHE) is important not only in clinical settings but also in research. Questionnaires with self-rated assessment of severity may be an attractive tool for assessing severity because of their cost efficiency in comparison with expensive clinical examinations. To evaluate the relation between self-rated severity and severity assessment based on standardized medical certificates issued by dermatologists in a population of patients with OHE. Between October 2001 and November 2002 (58 weeks) we identified all new cases of recognized OHE from the Danish National Board of Industrial Injuries (DNBII) registry. Each patient was examined by a dermatologist, who issued a standardized medical certificate. The severity assessment in the DNBII registry was based on this medical certificate, which comprised information on morphology and extent of eczema, and frequency of eruptions. All participants received a self-administered questionnaire and were asked to classify severity of their OHE on a visual analogue scale from 0 to 10. The relation between DNBII-assessed and self-rated severity was illustrated by a receiver operating characteristic analysis. Of 758 patients included in the study, 621 returned the questionnaire and 602 (79%) provided information on self-rated severity. The proportion of severe cases was significantly higher among patients' assessments compared with the rating by the DNBII. Almost 18% were categorized as severe cases by the DNBII while 40% of patients had assessed themselves as having severe eczema. The optimal cut-off point had a sensitivity and specificity of self-rated severity according to the DNBII assessment of 65% and 66%, respectively. The positive predictive value was 29% and the negative predictive value was 90%. The low positive predictive value suggests major differences in the criteria for self-rated severity vs. DNBII-rated severity. We recommend researchers to include ratings from both patients and physicians in future investigations of severity. The methods may address different aspects of OHE. [ABSTRACT FROM AUTHOR]

There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE).To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE.Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient.ICC for total HECSI score was 0·79 at the first assessment and 0·84 at the second assessment. ICC for intraobserver agreement was 0·90.Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered. [ABSTRACT FROM AUTHOR]

Epidemiological studies indicate that occupational hand eczema (OHE) often is associated with persistent dermatitis and prolonged sick leave, which may lead to unemployment. Previous studies suggest that OHE caused by allergic contact dermatitis and atopic dermatitis (AD) carries the worst prognosis.To evaluate and compare the severity and consequences of recognized OHE in different diagnostic and subdiagnostic groups.Between October 2001 and November 2002, all new cases of recognized OHE were identified from the Danish National Board of Industrial Injuries Registry (758 cases). Severity was graded from 0 to 2 depending on the intensity of skin response and the frequency of relapse. To supplement the information from the Registry, we surveyed the study population using a postal questionnaire which included questions about disease duration, sick leave, current occupation and loss of job.The overall response rate to the questionnaire was 82%. We observed substantially greater severity among those with occupational irritant contact dermatitis (ICD) and AD than for any other diagnoses. Age above 50 years was also associated with increased severity of OHE. Prolonged sick leave due to OHE was reported by 19·9% and was associated with AD and severe OHE. We found a higher proportion of prolonged sick leave among those in food-related occupations (27·2%) compared with those in wet occupations (20·1%) and other occupations (16·5%). Twenty-three per cent reported that they had lost their job at least once during the past 12 months due to OHE. The only strong association with loss of job was food-related occupations.Occupational ICD and AD appear to be strongly associated with severity of OHE. AD and severity of OHE were independently associated with prolonged sick leave. Having a food-related occupation appears to be associated with increased risk of loss of job. [ABSTRACT FROM AUTHOR]

The rapidly increasing level of contact allergy to methyldibromoglutaronitrile (MDBGN) in Europe is of concern. In April 2003, the EU Commission prohibited the use of MDBGN in leave-on cosmetic products, such as creams and lotions, until a level of safe use can be defined. Industry risk assessment has indicated that such a safe level could be 50–100 p.p.m.To determine whether 50 p.p.m. or 100 p.p.m. could be tolerated by MDBGN-sensitized individuals, and to evaluate if the risk for elicitation of MDBGN allergy is higher for a leave-on product with a high lipid content than for a product with a low lipid content.Eighteen volunteers with contact allergy to MDBGN and 10 healthy controls were exposed to repeated open application tests (ROATs) with two moisturizers with a high and a low lipid content, respectively, both containing MDBGN at a concentration of 50 p.p.m. The ROATs were performed on the left and the right side of the neck for 14 days, or until a positive reaction was seen. If a positive reaction did not develop within the first 14 days, two analogous moisturizers containing 100 p.p.m. MDBGN were applied for a further 14 days. Clinical assessments were done on days 2, 3, 7, 14, 21 and 28 or when a reaction developed.Eleven of 18 (61%) subjects developed dermatitis on the test area, of whom 10 developed a positive reaction to the 50 p.p.m. moisturizer, seven having a positive reaction on day 2 or 3. Reactions to the low-lipid moisturizer were the more frequent. All participants used more of the low-lipid moisturizer than the high-lipid moisturizer. The controls all had negative ROATs.Even 50 p.p.m. cannot be regarded as a safe concentration for use and the prohibition of MDBGN is scientifically well founded. [ABSTRACT FROM AUTHOR]

A population-based twin study has recently shown that genetic factors are of significance for hand eczema. To characterize further a sample of this twin material with regard to contact allergy, atopic dermatitis and wet work. In total, 1076 individual twins were examined clinically and patch tested. The diagnosis of atopic dermatitis was based on the U.K. Working Party criteria. The decision concerning wet work was based on the individual job description, taking into account the later introduced definition of at least 2 h of water exposure daily. The data were analysed by a newly developed statistical method which makes it possible to analyse the individual risk factor and at the same time discriminate between genetic and environmental factors. The statistical analysis confirmed atopic dermatitis as an important risk factor for hand eczema. Contact allergy was also confirmed as a significant risk factor for hand eczema, and the risk was related to strength (+ to + + +) of contact allergy. The results indicated that the high frequency of hand eczema in women in comparison with men was caused by environmental and not genetic factors. Aggregation of hand eczema within twin pairs was only to a minor degree explained by atopic dermatitis and nickel allergy (or other contact allergies). We suggest that a hitherto unrecognized genetic risk factor for hand eczema independent of atopic dermatitis and contact allergy is probably of importance for the development of irritant contact dermatitis on the hands. [ABSTRACT FROM AUTHOR]

Severe facial and scalp dermatitis following the use of permanent hair dyes has been reported in several cases. Para -phenylenediamine (PPD) is known as a potent contact allergen, and PPD is allowed in hair dye at a concentration of 6%. Hair dye reactions are usually diagnosed by the patients themselves, and adverse reactions to hair dye may not necessarily be recorded by the health care system, unless the reactions are especially severe. Based on this assumption, we suspected that hair dye dermatitis was occurring more frequently than reported in the literature. Consumer complaint-based data were obtained by advertising for persons with adverse reactions to hair dye. Among those responding to the advertisement, 55 cases of severe, acute allergic contact dermatitis were identified. The main symptoms were severe oedema of the face, scalp and ears, and clinically this was often mistaken for angio-oedema. The 55 cases comprised a total of 75 visits to the health service and 5 admissions to hospital. 18 persons had sick leave, which supports the impression of very severe dermatitis reactions. 60% were treated with antihistamine, while 52% were treated with corticosteroids. 29% of the cases were patch tested and all were found positive to PPD. Our data presented here clearly show that PPD and its derivatives in hair dye at the present concentrations presents a significant health risk for the population. Furthermore, the severe acute allergic skin reactions are often misdiagnosed in the health care system. The frequency of allergic contact dermatitis resulting from hair dye is likely to be underestimated. New methods to survey the frequency of adverse reactions should be considered. [ABSTRACT FROM AUTHOR]

Evaluates the effect of implementing an evidence-based skin care program for wet-work employees as part of an occupational health and safety management system. Evaluation of behavior and skin symptoms; Basis of the recommendations in the skin care program; Risk factor for the development of hand eczema.

The preservatives imidazolidinyl urea (IMID, Germall 115) and diazolidinyl urea (DU, Germall II) are commonly used in cosmetic products and are well-known sensitizers. The aim of the present study was to establish the optimal patch test concentration in hydrophilic dried-in vehicle (TRUE Test) for IMID and DU. 181 patients were included in the study. Of these, 150 were patients referred for patch testing, 12 were patients with known allergy to IMID and 19 were patients with known allergy to DU. 76 consecutive patients and the 12 IMID-allergic patients were patch tested with a dilution series IMID (0 to 600 μg/cm2), formaldehyde (180 μg/cm2) and DU (200 μg/cm2). 74 consecutive patients and the 19 DU-allergic patients were patch tested with a dilution series of DU (0 to 600 μg/cm2), formaldehyde (180 μg/cm) and IMID (200 μg/cm2). A positive dose-response relationship was found. The number of doubtful reactions decreased with increasing test concentrations. No late reactions were observed. A patch test concentration in hydrophilic dried-in vehicle (TRUE Test) of 600 μg/cm2 was found to be adequate and safe for both IMID and DU. [ABSTRACT FROM AUTHOR]

The authors' focuses a study related to the treatment atopic dermatitis (AD) with drug azathioprine. Topics include evaluation of efficacy and safety of azathioprine in patients with AD, placebo-controlled trials and randomized controlled trial for the same and adverse effects of azathioprine. Other topics include establishing a hierarchy of immunomodulatory treatment and causes for discontinuation of azathioprine. It highlights characteristics of immunosuppressant in patient with AD.