British Journal of Dermatology

Nettis, E.; Colanardi, M.C.; Soccio, A.L.; Marcandrea, M.; Pinto, L.; Ferrannini, A.; Tursi, A.; Vacca, A.

doi: 10.1111/j.1365-2133.2006.07738.xpmid: 17493066

SummaryBackground Natural rubber latex (NRL) allergy is a worldwide problem. Although prevention is sufficient to reduce sensitization, prolonged avoidance is needed to prevent resensitization or adverse reactions on re‐exposure.Objectives This double‐blind, placebo‐controlled study was conducted to determine the efficacy of sublingual immunotherapy (SLIT) with latex.Methods Forty patients with NRL allergy were enrolled. At diagnosis, 30 presented urticaria and 10 asthma. Patients were evaluated on their clinical history and an allergological assessment: skin prick test with latex extract, serum‐specific IgE and provocation tests. Patients were subdivided by complaint (asthma or urticaria), and randomized to receive SLIT with latex extract (ALK‐Abelló, Lainate, Milan, Italy) or placebo.Results The evaluable population consisted of 35 patients, 18 treated with SLIT and 17 with placebo. The results show that 12 months of SLIT improved the symptoms score and reduced the medication score in all subjects. The subjective evaluation was corroborated by improved bronchial and glove provocation test results. The latex‐specific IgE levels increased slightly in the SLIT group, and skin sensitization was reduced at the end of the trial in all the patients treated with SLIT. The immunotherapy was not complicated by any severe adverse reactions.Conclusions This is the first double‐blind, placebo‐controlled evaluation of the efficacy of SLIT with latex extract conducted in adult patients allergic to NRL. SLIT with latex can be proposed for subjects with latex allergy, especially those for whom complete avoidance of latex exposure may be very difficult or even impossible. More studies are needed to evaluate the efficacy of SLIT in the treatment of subjects with latex allergy who are sensitized to inhalant allergens.

Bailey, J.N.R.; Waite, A.E.; Clayton, W.J.; Rustin, M.H.A.

doi: 10.1111/j.1365-2133.2006.07714.xpmid: 17263819

SummaryBackground Keloid scars are formed by over‐activity of fibroblasts producing collagen and they cause significant morbidity both from their appearance and from their symptoms. Existing treatments are often unsatisfactory. Topical mitomycin C is known to inhibit fibroblast proliferation.Objectives To determine whether application of mitomycin C to the base of shave‐removed keloids would prevent their recurrence.Methods Ten patients had all or part of their keloid shave‐removed. After haemostasis topical mitomycin C 1 mg mL−1 was applied for 3 min. This application was repeated after 3 weeks. The keloids were photographed before treatment and the patients were reviewed every 2 months for a total of 6 months when a final photograph of the keloid site was taken. The patients and the Clinical Trials Unit staff scored the outcome on a linear analogue scale of 0–10, where 0 = disappointed and 10 = delighted. The pretreatment and 6‐month post‐treatment photographs were also assessed by two dermatologists who were not involved in the clinical trial.Results Four of the 10 patients were delighted with the outcome of treatment and only one was disappointed. On average there was an 80% satisfied outcome.Conclusions This new treatment of keloids has been shown to be effective in the majority of patients but further studies are required to confirm this benefit.

Keogh‐Brown, M.R.; Fordham, R.J.; Thomas, K.S.; Bachmann, M.O.; Holland, R.C.; Avery, A.J.; Armstrong, S.J.; Chalmers, J.R.; Howe, A.; Rodgers, S.; Williams, H.C.; Harvey, I.

doi: 10.1111/j.1365-2133.2007.07768.x

Wolkewitz, M.; Rothenbacher, D.; Löw, M.; Stegmaier, C.; Ziegler, H.; Radulescu, M.; Brenner, H.; Diepgen, T.L.

doi: 10.1111/j.1365-2133.2006.07659.xpmid: 17493067

SummaryBackground Prevalence studies of atopic diseases such as atopic dermatitis (AD), hay fever and allergic asthma have mostly been performed in children. Studies in the adult population are still rare.Objectives We estimated the lifetime prevalence of different atopic diseases in an elderly population in Saarland, Germany. Additionally we investigated the association between atopic diseases and sociodemographic factors including age, gender, duration of school education (as a proxy measure of socioeconomic status), family history, and size of place of residence.Methods This study was conducted between June 2000 and December 2002 in the State of Saarland, Germany. Participants aged 50–75 years (n = 9961) were recruited by their general practitioner in the context of a general health screening examination. All filled out a standardized questionnaire and reported whether a physician had ever diagnosed an atopic disease (hay fever, AD or asthma).Results Overall, 9949 subjects (mean age 62 years, 45% men) were included in this analysis. The lifetime prevalence of reported AD, hay fever and asthma was 4·3%, 8·3% and 5·5%, respectively. Lifetime prevalence of AD and asthma among women, and lifetime prevalence of hay fever among both genders, strongly decreased with age. Duration of school education (≤ 9 years, 10–11 years, > 11 years) was strongly associated with AD (3·7%, 5·7%, 6·8%; P trend < 0·0001) and hay fever (7·2%, 11·2%, 12·8%; P trend < 0·0001), but only tentatively with asthma.Conclusions The lifetime prevalence of AD is considerably lower in the elderly compared with the prevalence reported among younger adults in recent studies. Adults with a longer duration of school education appeared to have a higher risk for atopic diseases.

Harris, J.M.; Williams, H.C.; White, C.; Moffat, S.; Mills, P.; Newman Taylor, A.J.; Cullinan, P.

doi: 10.1111/j.1365-2133.2006.07710.xpmid: 17263823

SummaryBackground The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent‐reported, doctor‐diagnosed eczema by age 2 years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen.Objectives To extend the exposure–response analysis of allergen exposure and eczema outcomes measured up to age 8 years, and to investigate the role of other genetic and environmental determinants.Methods A total of 593 children (92·4% of those eligible) born to all newly pregnant women attending one of three general practitioner surgeries in Ashford, Kent, were followed from birth to age 8 years. Concentrations of house dust mite and cat allergen were measured in dust samples collected from the home at 8 weeks after birth. The risk of subsequent eczema as defined by the U.K. diagnostic criteria was determined according to different levels (quintiles) of allergen exposure at birth.Results By age 8 years, 150 (25·3%) children had met the diagnostic criteria for eczema at least once. Visible flexural dermatitis was recorded at least once for 129 (28·0%). As in other studies, parental allergic history was positively associated with most eczema outcomes, as were higher maternal education and less crowded homes. No clear linear associations between early exposure to house dust mite or cat allergen were found, regardless of the definition of eczema used. The risk of eczema appeared to increase for the three lowest quintiles of house dust mite allergen exposure (odds ratio, OR 1·37 for third quintile compared with first), and then to fall for the two highest quintiles (OR 0·66 and 0·71) even after controlling for confounding factors.Conclusions The lack of any clear exposure–disease relationship between allergens in early life and subsequent eczema argues against allergen exposure being a major factor causing eczema. If the lower levels of eczema at higher levels of house dust mite are confirmed, then interventions aimed at reducing house dust mite in early infancy could paradoxically increase the risk of subsequent eczema.

Boralevi, F.; Léauté‐Labrèze, C.; Lepreux, S.; Barbarot, S.; Mazereeuw‐Hautier, J.; Eschard, C.; Taïeb, A.; ,

doi: 10.1111/j.1365-2133.2006.07741.xpmid: 17493068

SummaryBackground Idiopathic facial aseptic granuloma (IFAG) was recently described in a single‐centre retrospective study as a skin condition that occurs specifically in childhood.Objectives To improve our epidemiological, clinical and pathological knowledge on IFAG, to search for an infectious aetiology, and to assess therapeutic recommendations.Methods Children presenting with one or several acquired nodules on the face, lasting for at least 1 month, with no evidence of any other recognizable clinical entity such as infantile acne, pilomatrixoma, furuncle, tumour or vascular malformation, were enrolled in a prospective multicentre study from June 2001 to June 2004, involving the main French paediatric dermatology outpatient units. We recorded clinical details about the nodule and its duration, ultrasound study pattern, cultures for bacteria and mycobacteria, and Bartonella henselae and Afipia felis antibody testing.Results Thirty children (17 boys and 13 girls, mean age 3·8 years) were enrolled. Ultrasound studies revealed a solid well‐demarcated hypoechoic lesion without calcium deposit. Cultures for bacteria were negative in 70% of cases. Cultures for mycobacteria and cat scratch disease serologies were negative. Antibiotic therapy was ineffective; the lesion healed spontaneously with a mean duration of 11 months. Histological examination, performed in five cases, showed a chronic dermal lymphohistiocytic granuloma with numerous foreign body‐type giant cells.Conclusions IFAG is characterized by a painless facial nodule, presenting as a single lesion localized on the cheek, with a prolonged course but spontaneous healing. Oral or local antibiotics are usually ineffective. Regarding the pathophysiology, our study rules out a primary infectious disease, and allows considering IFAG either as a granulomatous process appearing around an embryological residue or as a manifestation to include in the spectrum of granulomatous rosacea in childhood.

Mahé, E.; Girszyn, N.; Hadj‐Rabia, S.; Bodemer, C.; Hamel‐Teillac, D.; De Prost, Y.

doi: 10.1111/j.1365-2133.2007.07782.xpmid: 17493069

SummaryBackground Subcutaneous fat necrosis (SFN) of the newborn is a rare acute transient hypodermatitis that develops within the first weeks of life in term infants. It often follows a difficult delivery. Prognosis is generally good except for the development of hypercalcaemia in severe cases. Only several case reports or small patients series have been published.Objectives To evaluate risk factors, complications and outcomes of SFN in 16 consecutive patients seen from 1996 to 2002 in our Department of Paediatric Dermatology.Methods On a case‐report form created for the study, we recorded putative risk factors concerning the mother, pregnancy and delivery, clinical aspects of SFN, and early and late outcomes. The study was conducted in two stages: the first was a retrospective analysis of the observations and the second analysed data collected on children and their parents during a new consultation (n = 10).Results All the children were born at term. Lesions appeared a mean of 4 days after delivery. Three‐quarters of the children had diffuse SFN. Risk factors identified were newborn failure to thrive (12/16), forceps delivery (7/16), maternal high blood pressure (3/10) and/or diabetes (2/10), and newborn cardiac surgery (1/16). Putative novel risk factors were macrosomia (7/16), exposure to active (4/10) or passive (3/10) smoking during pregnancy, putative or known maternal, paternal or newborn risk factors for thrombosis (5/10), and dyslipidaemia (2/10). Complications were hypercalcaemia (9/16), pain (4/16), dyslipidaemia (1/16), renal insufficiency (1/16) and late subcutaneous atrophy (6/6).Conclusions This study on 16 newborns with SFN provides new information. Familial or newborn risk factors for thrombosis are frequent. Macrosomia, familial dyslipidaemia and smoking should be evaluated. The main complications identified were severe pain, hypercalcaemia and subcutaneous atrophy.

Faurschou, A.; Wulf, H.C.

doi: 10.1111/j.1365-2133.2006.07684.xpmid: 17493070

SummaryBackground The declared sun protection factor (SPF) is based on the use of a sunscreen layer of 2 mg cm−2. However, only around a quarter (0·5 mg cm−2) of this amount is applied by sunbathers. Theoretical calculations have suggested that the effective SPF is related to sunscreen quantity in an exponential way but this was not confirmed in vitro and has not been studied in vivo.Objectives To investigate the relation between SPF and sunscreen amount in vivo.Subjects and methods On the backs of 20 healthy volunteers, five areas of 34 cm2 each were marked. One area was phototested to determine the ultraviolet (UV) sensitivity. Four areas were treated with a sunscreen SPF 4 in different amounts: 0·5, 1, 2 and 4 mg cm−2. Thirty minutes after sunscreen application a phototest was conducted on each area. The effective SPF was calculated 22–26 h after irradiation using the UV dose needed to produce just perceptible erythema (minimal erythema dose) on protected and unprotected skin.Results In all areas the mean SPF was significantly different from an SPF of 1 (no protection) (P ≤ 0·0001) and the SPFs of the areas with the various amounts of sunscreen differed significantly from each other (P ≤ 0·0008). The relation between the sunscreen amount applied and the SPF provided was most likely to follow exponential growth (r2 = 0·903).Conclusions This study indicates that the relation between SPF and sunscreen quantity follows exponential growth. Application of 1 mg cm−2 or 0·5 mg cm−2 makes the SPF fall as the square or fourth root, respectively, and 4 mg cm−2 results in an almost squared SPF.

Nakashima, T.; Sato, E.; Niwano, Y.; Kohno, M.; Muraoka, W.; Oda, T.

doi: 10.1111/j.1365-2133.2006.07655.xpmid: 17493071

SummaryBackground Reactive oxygen species (ROS) released from inflammatory cells constitute one of the critical causative factors in inflammatory skin diseases such as seborrhoeic dermatitis and atopic dermatitis.Objectives To investigate inhibitory effects of ketoconazole (KCZ) and ciclopiroxolamine (CPO), both of which have been used for the treatment of seborrhoeic dermatitis, on ROS released from inflammatory cells.Methods The methyl‐Cypridina‐luciferin analogue‐dependent chemiluminescence method was employed for the detection of ROS production by phorbol 12‐myristate 13‐acetate (PMA)‐stimulated inflammatory cells. Moreover, the radical scavenging activities of both agents were examined by using a hypoxanthine–xanthine oxidase system and the stable radical 1,1‐diphenyl‐2‐picrylhydrazyl (DPPH). NADPH oxidase activity was determined in particulate (membrane) fractions prepared from PMA‐stimulated RAW 264·7 cells, a macrophage‐like cell line.Results Both of these antifungal agents inhibited PMA‐stimulated ROS production. However, only CPO significantly scavenged both ROS generated by the hypoxanthine–xanthine oxidase system and DPPH, and the scavenging activity of CPO seemed to act on ROS other than superoxide anions. Although KCZ inhibited PMA‐stimulated ROS production, it did not show radical‐scavenging activities. The inhibition of ROS production by KCZ is probably attributable to the inhibition of NADPH oxidase activity.Conclusions The mechanism of the inhibitory action of KCZ against PMA‐stimulated ROS production is distinct from that of CPO. Knowledge of the inhibitory or scavenging effects of both antifungal agents on ROS released from inflammatory cells may be useful in developing a therapeutic strategy for dermatitis.

Weissenbacher, S.; Merkl, J.; Hildebrandt, B.; Wollenberg, A.; Braeutigam, M.; Ring, J.; Hofmann, H.

doi: 10.1111/j.1365-2133.2006.07669.xpmid: 17493072

SummaryBackground Rosacea remains difficult to treat, despite many therapeutic options.Objectives To investigate the effect of pimecrolimus cream 1% (Elidel®; Novartis Pharma, Nuremberg, Germany) in the treatment of papulopustular rosacea.Methods Forty patients with rosacea (25 men and 15 women, mean age 58 years) were enrolled in a randomized, vehicle‐controlled, double‐blind study. For 4–8 weeks, patients applied pimecrolimus cream or vehicle twice daily to the involved areas on the face. Rosacea severity score, subjective severity assessment and quality of life assessment were obtained, along with photographic documentation.Results Both treatment groups of 20 patients showed an improvement after 4 weeks. The differences were not significant (P > 0·05) with regard to mean absolute values, mean percentage changes from baseline, or mean absolute values as differences from baseline for the total score or scores of the different clinical signs (erythema, papulation, scaling and pustules). In the subjective severity score and the quality of life assessment, there was also no significant difference between pimecrolimus and the vehicle (P > 0·05).Conclusions Treatment of rosacea for 4–8 weeks with the topical calcineurin inhibitor pimecrolimus cream 1% was not more efficacious than treatment with the vehicle cream.