Elevated serum levels of soluble CD30 in patients with atopic dermatitis (AD)

The immunopathology of AD is still unclear, but evidence for an immune response polarized towards Th2 activity has been provided. The CD30 molecule belongs to the tumour necrosis factor (TNF) receptor family and is expressed on activated T cells with a sustained expression in Th2 cells. This molecule also exists in a soluble form (sCD30). Elevated serum levels of sCD30 have been found in patients with Hodgkin's disease, chronic hepatitis B infection and HIV infection. Studies were undertaken to compare the serum levels of sCD30 in patients with AD (n=49) and healthy non-atopic controls (n=94). The presence of sCD30 was analysed with ELISA. A significantly higher concentration of sCD30 was noted in AD patients, median sCD30 level 29 U/ml (range 1-708 U/ml), compared with healthy non-atopic controls (P<0.001), where the median level was 11 U/ml with a range of 1-1042 U/ml. No correlation was found between sCD30 levels and total serum IgE, or between the AD patients' SCORAD values and concentration of sCD30. sCD30 levels were also analysed in 20 AD patients, which during ketoconazole treatment had improved their clinical scores and reduced their serum IgE and eosinophil cationic protein levels. However, no significant decrease in sCD30 levels was noted after treatment. The results show that patients with AD have elevated levels of sCD30, but without correlation to total serum IgE or disease activity.     

In vivo formation of prostaglandin E1 and prostaglandin E2 in atopic dermatitis

The authors present the young man case who had undergone 6 months long antibiotic therapy first, than has been operated because of growing nose obstruction with bloody pus secretion. Diagnostic difficulties were responsible for diagnosis and undertaking treatment. Fulminant course of disease resulted in death of patient in the course of immunosupression therapy.     

Expression of CD30 on T helper cells in the inflammatory infiltrate of acute atopic dermatitis but not of allergic contact dermatitis

The CD30 molecule has been proposed as a marker for a subset of CD4+CD45RO+ (memory) T cells with potent B cell helper activity producing IL-5 and IFN-gamma and as a specific marker for Th2 cells. Recently, an association has been demonstrated between elevated serum levels of soluble CD30, which is shed by CD30+ cells in vitro and in vivo, and atopic dermatitis but not respiratory atopic disorders or allergic contact dermatitis. We studied the expression of CD30 in the inflammatory infiltrate of atopic dermatitis compared with that of allergic contact dermatitis, with special regard to skin disease activity (acute vs subacute/ chronic). Biopsies were obtained from 16 patients suffering from atopic dermatitis (acute n = 6, subacute/ chronic n = 10), from 7 patients with acute allergic contact dermatitis and from 5 positive patch-test reactions. Paraffin-embedded as well as snap-frozen material was stained with anti-CD30 and anti-CD45RO mAbs according to standard procedures. Double-staining procedures for CD30CD3, CD30CD4, CD30CD45RO and CD30CD68 were also performed. Abundant CD45RO+ cells were detected both in atopic dermatitis and in allergic contact dermatitis lesions. We found scattered CD30+ cells in only one of six formalin-fixed paraffin-embedded acute atopic dermatitis biopsies, but in all of the respective snap-frozen specimens, possibly because CD30 expression on atopic dermatitis infiltrating cells is weak and sensitive to formalin fixation and paraffin embedding. CD30CD3 and CD30CD4 double staining identified CD30+ cells to be helper T lymphocytes. No significant CD30 expression (either in paraffin-embedded or in frozen material) could be found in subacute/chronic atopic dermatitis lesions or in any of the specimens of allergic contact dermatitis. The results suggest a specific regulatory function of CD30+ T cells in acute atopic dermatitis. With respect to the view that CD30 is a marker for Th2 cells, our observations confirm previous findings that Th2 cells predominate in the infiltrate particularly of acute atopic dermatitis. CD30 expression in acute atopic dermatitis but not in acute allergic contact dermatitis might be helpful in the histological differentiation of these disorders and in the further characterization of atopy patch testing.     

New concepts in atopic dermatitis

Allergic bronchopulmonary aspergillosis (ABPA) occurs in 1-2% of patients with asthma and in 10% of patients with cystic fibrosis. We introduce the acronym "ARTEPICS" in this review article on ABPA to facilitate its diagnosis: A: Asthma; R: Roentgenographic infiltrates; T: Tests for Aspergillus fumigatus (Af) positive in the skin; E: Eosinophilia; P: Precipitating antibody to Af; I: IgE in serum elevated; C: Central bronchiectasis; and S: Serum specific IgE-Af and IgG-Af elevated (ARTEPICS).     

Impression cytology in atopic dermatitis

PURPOSE: This study aimed to describe the ocular surface disorder in patients with atopic dermatitis (AD). DESIGN: A prospective case-controlled study. PARTICIPANTS: A total of 44 patients with active AD seen at Kobe University School of Medicine, Department of Ophthalmology, during 1994 through 1996 and 22 normal control subjects were studied. INTERVENTION: The subjects underwent routine ophthalmic examinations, tear film break-up time (BUT), Schirmer test, and conjunctival impression cytology. MAIN OUTCOME MEASURES: Patients and control subjects were compared for tear function parameters, goblet cell density, and conjunctival squamous metaplasia grade. The relation of duration and recurrences of AD to the ocular surface disorder also was looked for. RESULTS: The duration of atopic disease ranged from 18 to 32 years (mean, 22.8 years). The average for exacerbations was 4.5 times. Chronic allergic conjunctivitis with superficial punctate keratitis was the most frequent clinical presentation. The BUT and Schirmer test values were significantly lower in patients with AD compared with those of the control subjects. Impression cytology showed goblet cell loss and conjunctival squamous metaplasia, both of which related to the number of recurrences of AD rather than the duration of disease. Facial atopy and allergic keratoconjunctivitis (AKC) related to the metaplasia of the ocular surface (P < 0.001). Patients with reduced goblet cell density also showed low BUT levels (P < 0.001). CONCLUSION: Ocular surface disorder of AD characterized by goblet cell loss and conjunctival squamous metaplasia seemed to evolve independently of the duration of disease but worsen with increased number of flare-ups. Direct epithelial damage by the allergic reaction, disorder of tear quality, and quantity may be important in the genesis of the atopic ocular surface disease.     

Elimination protocols in atopic dermatitis

Both dacryocystography and dacryoscintigraphy are well established in the evaluation of stenoses of the lacrimal drainage system. They provide limited information about the ductal anatomy itself and about periductal structures. MR imaging was evaluated for its capability to directly visualize the lacrimal drainage system in detail and simultaneously provide functional characterization of dacryostenosis. SUBJECTS AND METHODS: Twenty-seven lacrimal drainage systems of 23 patients suffering from epiphora were examined in an MR unit before and after conjunctival and intravenous application of Gd-DTPA using a surface coil. RESULTS: Dacryostenosis was found in 23 of 27 lacrimal systems. Stenoses were localized to the canalicular (n = 3), saccular (n = 8), and ductal (n = 12) level, and were classified as stenosis or occlusion. CONCLUSION: MR imaging with conjunctival contrast application allows within one examination both detailed morphological and functional assessment of the lacrimal drainage system with depiction of surrounding structures. Limitations arise mainly from demands on technical and patient-related preconditions.     

Immunopathologic disorders in atopic dermatitis

The atopic dermatitis is a multifactorial inheritable disease, in which pathogenesis in addition to environmental factors (climate, allergens, clothing) genetically determined multiplex metabolic differences (arachidonic acids, essential fatty acids) and immunologic alterations play an important role. Within immunologic findings the disturbances of balance in Th1 and Th2 subclasses, the increased degranulation activity of mast cells and the increased antigen presentation activity of Langerhans cells can be stressed. The clinical immunological alterations shown in the diseases, the increased production of IgE and so the type I. allergic reactions (urticaria, gastrointestinal manifestation of food allergy, allergic rhinitis, asthma bronchiale), the difference of cellular immunity of the skin can be explained by the above mentioned main immunological changes. In understanding of immunological origin of atopic dermatitis the IgE receptors expressed on the surface of Langerhans cells (connecting the immediate and delayed type of immune response) mean significant help.     

Abnormal vascular reactions in atopic dermatitis

Vascular reactions to mechanical stroking, topical application of nicotinic acid ester, and methacholine chloride were examined in both the normal and abnormal skin of 100 patients with atopic dermatitis and 20 patients with allergic contact dermatitis. White dermographism, nicotinic acid blanching, and delayed blanch with methacholine consistently occurred in areas of skin with eczematous change of patients with atopic dermatitis and those with allergic contact dermatitis. Normal skin of atopic patients did not show the abnormal vascular reactions. It is suggested that white dermographism, nicotinic acid blanching, and delayed blanch with methacholine seen in atopic dermatitis are secondary phenomena that give no definite information concerning the diagnosis of this disease.     

Immunomodulation in the treatment of atopic dermatitis

In the submitted review the authors present information on possibilities of immunomodulating treatment of atopic dermatitis. Immunosuppressive treatment comprises systemic corticosteroid administration (possibly combined with cytostatic immunosuppressive preparations), cyclosporin A and phototherapy. Immunopotentiating treatment of AD makes use mainly of modulating preparations with the nature of physiological substances close to the immune system, substances obtained from natural biological sources (thymic hormones) or in recent years more frequently substances of recombinant origin (interferons, interleukins). The use of immunopotentiating drugs of chemical origin (synthetic substances) is used less frequently in AD. The use of intravenous immunoglobulin preparations for severe forms of atopic dermatitis is only just starting.     

Flucloxacillin in the treatment of atopic dermatitis

Although colonization of atopic dermatitis by Staphylococcus aureus is universal and bacterial infection is common, it is not known whether antibiotic therapy is helpful in eczematous children who do not have any signs suggestive of bacterial infection. Fifty children aged 1-16 years with atopic dermatitis took part in a randomized double-blind placebo-controlled study of 4 weeks treatment with oral flucloxacillin, with an 8-week follow-up period. The change in the mean of the log10 of the counts/cm2 of S. aureus after 4 weeks of treatment was significantly different for patients receiving treatment, compared with the change for those receiving the placebo (P = 0.008). However, the difference in the change at 14 days after stopping treatment was not significant (P = 0.32). Methicillin-resistant strains of S. aureus were cultured from five children during or after treatment. Flucloxacillin did not improve the symptoms or clinical appearance of atopic dermatitis and only temporarily changed skin colonization by S. aureus.     

Anxiety and atopic dermatitis.

Reports that 45 Ss with atopic dermatitis had significantly higher A-State and A-Trait anxiety (measured by the State-Trait Anxiety Inventory) than 45 Ss with pityriasis rosea (a nonitchy skin disease) or 45 normal control Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infraorbital crease and atopic dermatitis

Chronic ectopic pregnancy is an uncommon form of tubal pregnancy manifested as a pelvic mass with minimal symptoms and a low or absent titer of human chorionic gonadotropin. For this reason, most of the reported cases have been diagnosed only after explorative laparotomy. The value of Doppler ultrasonography for preoperative diagnosis of this entity has not yet been established. We report on a 36-year-old patient who was admitted for intermittent right lower quadrant abdominal pain of 3 months' duration, and a right adnexal mass found on pelvic examination. On Doppler ultrasonography, a right complex adnexal mass was demonstrated, characterized by extensive external vascularization, aberrant vessels and arteriovenous shunting, but with no internal blood flow. Explorative laparotomy revealed a right tubal mass adherent to the omentum, and covered by numerous enlarged and tortuous blood vessels originating in the omentum. Pathological examination of the mass revealed a chronic ectopic pregnancy. The possible contribution of Doppler-specific characteristics for the diagnosis of chronic ectopic pregnancy is described and discussed.     

Promoting health in children with atopic dermatitis

Atopic dermatitis (AD), or eczema, can be a very challenging disease to manage. The etiology of the disease is not completely understood, and its incidence has risen in the past 10 years to more than 10% of the population. AD is characterized primarily by intense itching and the development of papules, scaly lesions, fissures, and crusting. The onset occurs primarily in childhood, and much of the disease management is conducted by the family. Patients and their families often experience multiple recurrences and exacerbations, repeated attempts at cures and treatments, lowered self-esteem of the child, impaired growth and development of the child, loss of sleep, discipline problems, and multiple clinic and emergency department visits for exacerbations. Management primarily consists of prevention (i.e., good daily skin care and management of environmental trigger factors such as infection, irritants, emotional stress, and allergens). These children and their families need education and the support of health care professionals. This article outlines specific techniques to help parents and children manage AD at home and minimize exacerbations.     

Clinical course of atopic dermatitis in Japanese patients

To determine which diagnoses in the emergency department (ED), apart from battering injuries, were more common among women who were living in physically abusive relationships than among women who were not, a study was conducted in 10 hospital-based EDs in two cities serving inner city, urban, and suburban populations. A total of 9,057 women between the ages of 19 and 65 years presenting to the EDs were eligible for the study. Medical records were reviewed, and a written questionnaire was used. The questionnaire was completed by 4,501 (73% of those asked, 59% of those eligible, and 50% of those presenting). Two hundred sixty-six (5.9%) were currently in a physically abusive relationship but not in the ED for battering injuries, and 3,969 (88.2%) were not currently in a physically abusive relationship. An additional 266 (5.9%) were positive, probable, or suggestive for battering injuries and excluded from diagnosis comparisons. Women in physically abusive relationships were more likely to be diagnosed with urinary tract infections, neck pain, vaginitis, foot wound, suicide attempt, and finger fracture. However, these represented only 19.8% of diagnoses in this group. The use of this knowledge alone to predict the presence of intimate violence in individual patients in the ED will not identify the majority of women at risk. These results suggest the use of routine inquiry for abuse in all women.     

Candida albicans sensitization in patients with atopic bronchial asthma and atopic dermatitis

Candida albicans, a component of normal human microflora, can induce synthesis of specific IgE-antibodies in patients with atopic bronchial asthma and atopic dermatitis. The study included 25 patients with atopic dermatitis sensitized to C.albicans and 23 patients with atopic dermatitis non-sensitized to C.albicans. The sensitization was determined by the skin test and enzyme immunoassay. The patients had the history of atopic dermatitis exacerbation after taking food containing baking yeasts. Atopic dermatitis with sensitization to C.albicans is characterized by severe course correlating with the following indices: high total IgE (r = 0.6), level of IgE antibodies to C.albicans (r = 0.6), level of serum IgG (r = 0.46) and IgA (r = 0.33). Contrary to adults, children with sensitization to C.albicans had decreased relative number of CD4+, CD8+ and CD72+ of lymphocyte subpopulations. Thus, sensitization to C.albicans manifests in severe atopic dermatitis which in children is often associated with immune deficiency.     

Circulating skin-homing T cells in atopic dermatitis. Selective up-regulation of HLA-DR, interleukin-2R, and CD30 and decrease after combined UV-A and UV-B phototherapy

BACKGROUND: As the cutaneous lymphocyte-associated antigen appears to detect circulating T cells that migrate to the skin in atopic dermatitis but not T cells that migrate to mucosal sites in allergic asthma and rhinitis, we investigated T-cell activation markers and CD30 on the cutaneous lymphocyte-associated antigen-positive circulating T-cell subset in atopic dermatitis to see whether these markers are different from those in normal controls and related to disease activity. DESIGN: Open study. SETTING: University referral center. PATIENTS: Twelve patients with atopic dermatitis and 12 healthy controls. INTERVENTION: Combined UV-A and UV-B treatment for 2 months. MAIN OUTCOMES MEASURES: Percentage of circulating cutaneous lymphocyte-associated antigen-positive T cells that express HLA-DR, interleukin-2 receptor, CD69, CD71, and CD30 (triple-color flow cytometric analysis). Clinical score, Dermatology Life Quality Index, pruritus score, and consumption of topical corticosteroids were determined. RESULTS: Increased relative numbers of cutaneous lymphocyte-associated antigen-positive T cells expressing HLA-DR, interleukin-2 receptor, and CD30 were found in patients with atopic dermatitis before treatment. Treatment with UV-A and UV-B was associated with clinical improvement and a decrease of levels of HLA-DR, interleukin-2 receptor, and CD30 in cutaneous lymphocyte-associated antigen-positive T cells. HLA-DR on cutaneous lymphocyte-associated antigen-positive T cells correlated significantly with the clinical score. CONCLUSION: Expression of HLA-DR and interleukin-2 receptor is a sensitive marker of disease activity in atopic dermatitis. Apart from giving information on disease activity in atopic dermatitis, the availability of skin-seeking T cells in the blood offers the opportunity to obtain further information on T cells that may have effector function in the skin.