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Notes: Atopic dermatitis (AD), or atopic eczema, is the most common, chronic inflammatory disease among children in industrialized countries. We still lack knowledge of its pathophysiology and in particular the role of allergy as both an eliciting factor for disease expression and for disease activity. This article describes the clinical symptoms of the disease and its qualitatively different aspects. AD cannot be understood as being induced by one factor only, e.g. allergy, and this is important when planning treatment strategies. It is also important to realize the very wide range of disease intensity: from subclinical, or latent AD, in which only a few symptoms are present and thus which prevents a clear diagnosis of AD, to its most severe forms including erythroderma. It's unknown aetiology, the wide range in symptomatology, and the fluctuating course (including the many eliciting factors) form the background for our diagnostic and therapeutic difficulties of atopic eczema. AD is prevalent in childhood, but the atopic trait continues, not only for later respiratory allergies, but also for skin diseases in adulthood (such as AD itself or the frequent irritant contact dermatitis of the hands). A child with an acute and first attack of AD is therefore a challenge to the child, its parents and – certainly − to the doctor. However, after stressing the chronicity of the disease, it is equally important to assure the parents that this disease is, in most cases, controllable through correct treatment and that it has a good prognosis: It is not a ‘life sentence’, but a controllable disease in an otherwise healthy child.

Notes: Background Liarozole is an inhibitor of the metabolism of all-trans-retinoic acid. Systemic administration increases tissue levels of this endogenous retinoid and has been reported to improve psoriasis in an open, uncontrolled study. Objectives A multicentre, double-blind, placebo-controlled, dose-ranging study was therefore undertaken to determine the lowest effective oral dose of liarozole in the treatment of psoriasis vulgaris. Patients/methods Adult male and postmenopausal female patients requiring systemic treatment for psoriasis were randomized to receive placebo or liarozole at total daily doses of 50 mg, 75 mg or 150 mg for 12 weeks. The daily doses were each divided into two equal (morning and evening) doses. Response was assessed using an eight-point global scale to assess improvement and by monitoring the Psoriasis Area and Severity Index (PASI). The primary end-point was the proportion of subjects in each treatment group demonstrating ‘marked improvement’ or better as assessed on the eight-point scale. The tolerability of the treatment was assessed by recording mucocutaneous effects of retinoids and all adverse events. Biochemical and haematological monitoring were also performed. Results One hundred and thirty-nine subjects were randomized (118 male and 21 female) and 116 completed the study. A marked improvement or better response was observed in 6% of subjects on placebo, 18% on liarozole 50 mg, 11% on 75 mg and 38% on 150 mg. Only in the 150-mg group was the response rate significantly different to placebo (P 〈 0·001). Over the treatment period the mean PASI changed from 15·9 to 15·4 on placebo, from 17·4 to 13·8 on liarozole 50 mg, from 17·5 to 14·5 on 75 mg and from 15·8 to 8·8 on 150 mg. Again, only in the group receiving 150 mg was the response significantly better than placebo (P 〈 0·001). Liarozole was generally well tolerated. Mucocutaneous retinoid effects were generally infrequent and mild. Five subjects were withdrawn from treatment as a result of adverse events that may have been treatment related. These events were abnormalities of liver enzymes in two cases, an episode of erythema multiforme (in a patient receiving placebo), an allergic reaction in one and a rash accompanied by deterioration of the psoriasis in another. There was mild elevation of triglycerides in the groups receiving liarozole 75 mg and 150 mg daily. In males, the serum luteinizing hormone and testosterone levels rose significantly in all the active treatment groups. Conclusions The data confirm that liarozole is an effective treatment for psoriasis and indicate that the lowest effective dose is 75 mg twice daily. The drug seems generally to be well tolerated.

Notes: Chronic hand eczema can be incapacitating, and there is little knowledge of the efficacy and safety of long-term treatment with topical corticosteroids. We compared the efficacy and safety of two different schedules for the treatment of chronic hand eczema with a potent topical corticosteroid, mometasone furoate. In a prospective, open, randomized trial, 120 patients with chronic hand eczema were treated daily with mometasone furoate fatty cream until the dermatitis cleared or for a maximum of 9 weeks. Those who cleared were randomized to treatment for up to 36 weeks with mometasone furoate on Sunday, Tuesday and Thursday (group A), mometasone furoate on Saturday and Sunday (group B) or no further corticosteroid treatment (group C). In the event of relapse, patients were permitted daily treatment with mometasone furoate for 3 weeks on two separate occasions. For 50 of 106 randomized patients, daily treatment for 3 weeks controlled their dermatitis; 29 needed 6 weeks and 27 needed 9 weeks of treatment. During the maintenance phase, 29 of 35 (83%) in group A, 25 of 37 (68%) in group B and nine of 34 (26%) in group C had no recurrences (P = 0.001, χ2-test). Side-effects were minimal. It is concluded that long-term, intermittent treatment of chronic hand eczema with mometasone furoate fatty cream is effective and safe.

Notes: Abstract:  In view of the central pathogenic importance of leukocyte extravasation in inflammatory skin diseases, therapeutic interference with this – surprisingly complex – process is clearly a promising new approach for treating these dermatoses. Despite some disappointments during the clinical use of these agents and despite their crippling price tag, the recent incorporation of biologicals that target defined molecular controls of leukocyte extravasation into dermatological and rheumatological practise, consequently, has greatly enriched our therapeutic options for battling major, chronic, inflammatory dermatoses such as psoriasis. However, the – as yet unresolved and still rather controversially discussed – critical question is: Which of the multiple steps that control leukocyte extravasation in the human system really offer the most promising, most pragmatic, and safest molecular targets for therapeutic intervention for which disease entity? The current debate intends to stimulate public and rational debate of this crucial issue, beyond the evident commercial interests that are touched by whatever stand one takes.

Notes: Dry skin and eczema only seldomly occur in workers in the Danish fish-processing industry (FPI) during work, when their fingers and palms have a low skin surface temperature, low transepidermal water loss (TEWL), and a high capacitance. However, shortly after work, when the skin temperature has become normal, TEWL levels increase to above normal, and capacitance decreases to below normal, followed by the development of dry skin or chapping, which subsequently revert to normal over a period of hours. These observations suggest that workers in the FPI may have a delect in skin barrier function, which is, however, masked by a low skin temperature, resulting in misleadingly low TEWL levels during work. To test this hypothesis, we disrupted the permeability barrier in hairless mice with topical acetone, and exposed the treated skin to ice for 3–5h. Although TEWL rates immediately after cold exposure were low, suggesting normal barrier recovery, TEWL increased to levels slightly above pre-cold exposure levels (i.e. levels just after the barrier was disrupted with acetone) when the skin temperature reverted to normal (≥ 15min). The changes in TEWL were paralleled by equivalent changes in percutaneous penetration of the electron-dense tracer lanthanum nitrate. This indicates that cold masks a defective barrier, and inhibits barrierrepair. After a few hours at ambient temperatures, normal barrier recovery was observed. Electron microscopy revealed empty or partially empty lamellar bodies during the first 30 min post-cold exposure. After 1 h the majority of nascent LBs displayed normal morphology. Moreover, histochemical studies showed a delayed reappearance of stratum corneum intercellular lipids following cold exposure. These results demonstrate that cold exposure prevents barrier recovery after acetone disruption, and provide an explanation for the occupatonal dermatosis observed in the fish-processing industry and related occupations.

Notes: The aim of the present study was to evaluate the influence of individual explanatory factors, such is sex, age, atopy, test time and presence of diseased skin, on clinical patch lest results, by application of multivariate statistical analysis. The study population was 2l66 consecutive patients patch tested with the standard series of the International Contact Dermatitis Research Group (ICDRG) by members of the Danish Contact Dermatitis Group (DCDG) over a period of ft months. Fur the 8 test allergens most often found positive (nickel, fragrance-mix, cobalt, chromate. balsam of Peru, carba-mix, colophony, and formaldehyde). one or more individual factors were of significance for the risk of being sensitized, except for chromate and formaldehyde it is concluded that patch test results can be compared only after stratification of the material or by multivariate analysis.

Notes: 11 widely used nickel alloys were investigated with respect to corrosion stability and reactivity in nickel-sensitive individuals. Alloys with a nickel release in synthetic sweat exceeding 1 μg/cm2/week gave a strong patch test reaction in nickel-sensitive persons; those with a release below 0.5 μg/cm2/week showed weak reactivity with one exception. Nickel allergy is a health problem. It may be minimized by using nickel alloys with a corrosion level below 0.5 μg/cm2/week. Action should be taken by dermatologists, industry and authorities to solve this neglected problem.

Notes: Nine adult patients suffering from severe atopic dermatitis (AD) and increased total serum IgE were treated with recombinant human interferon-alpha 2A (Roferon-AR; IFN-α-2A) 3 × 106 units daily for 21 d to study the effect upon serum IgE, basophil histamine release (HR), eosinophil-derived proteins in serum, and clinical symptoms. The skin disease was so severe that all patients needed topical treatment with glucocorticosteroid cream. Changes were not observed in total serum IgE or in eosinophil-derived proteins, the latter being increased in six of nine patients. A significant reduction in basophil HR was found in six of nine patients after anti-IgE and concanavalin A (Con A) stimulation, but not after A23187 stimulation. The clinical skin score was reduced in eight of nine patients at the end of therapy, but disease activity returned to pretreatment levels within 3 weeks despite continued topical treatment. rIFN-α-2A was well tolerated with few clinical side-effects, and all patients completed the study. The short-term therapy using IFN-α-2A neither brought a sustained clinical remission nor reduced total serum IgE or eosinophil-derived proteins. However, a significant reduction in IgE-receptor-mediated basophil HR was observed in six of nine patients.