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Eczema: Diagnosis and treatment

A Lloyd-Lavery, L Solman, D J C Grindlay, N K Rogers, K S Thomas, K E Harman
This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It presents the key findings from 14 systematic reviews published in 2016, focusing on AE epidemiology, aetiology and risk factors. For systematic reviews on the treatment and prevention of AE and for nomenclature and outcome assessments, see Parts 1 and 3 of this update, respectively. The annual self-reported prevalence of AE is a range of 11...
January 31, 2019: Clinical and Experimental Dermatology
Jonathan Grigg, Anjan Nibber, James Y Paton, Alison Chisholm, Theresa W Guilbert, Alan Kaplan, Steve Turner, Nicolas Roche, Elizabeth V Hillyer, David B Price
Background: An inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA) may prevent wheezing/asthma attacks in preschoolers with recurrent wheeze when added to short-acting β-agonist (SABA). Objective: The aim of this historical matched cohort study was to assess the effectiveness of these treatments for preventing wheezing/asthma attacks. Methods: Electronic medical records from the Optimum Patient Care Research Database were used to characterize a UK preschool population (1-5 years old) with two or more episodes of wheezing during 1 baseline year before first prescription (index date) of ICS or LTRA, or repeat prescription of SABA...
2018: Journal of Asthma and Allergy
Mehmet Halil Celiksoy, Erdem Topal, Zeynep Hazıroglu Okmen, Cem Alataş, Mehmet Semih Demirtaş
BACKGROUND/OBJECTIVES: Diaper dermatitis is often caused by irritant contact occurring beneath the diaper of an infant, and it is aggravated by factors such as dampness, friction, urea, and feces. Food-allergic patients are known to exhibit various skin lesions ranging from urticaria to eczema. This study aims to determine the relationship between persistent diaper dermatitis and food allergy. METHODS: A retrospective chart review was conducted of pediatric patients with a diagnosis of persistent diaper dermatitis between August 2015 and November 2017...
November 28, 2018: Pediatric Dermatology
Wolfgang Schwinger, Christian Urban, Raphael Ulreich, Daniela Sperl, Anna Karastaneva, Volker Strenger, Herwig Lackner, Kaan Boztug, Michael H Albert, Martin Benesch, Markus G Seidel
Early diagnosis of primary immunodeficiency disorders (PID) is vital and allows directed treatment, especially in syndromes with severe or profound combined immunodeficiency. In PID patients with perinatal CMV or other opportunistic, invasive infections (e.g., Pneumocystis or Aspergillus ), multi-organ morbidity may already arise within the first months of life, before hematopoietic stem cell transplantation (HSCT) or gene therapy can be undertaken, compromising the definitive treatment and outcome. Deficiency of Wiskott-Aldrich syndrome (WAS) protein-interacting protein (WIP deficiency) causes an autosomal recessive, WAS-like syndrome with early-onset combined immunodeficiency that has been described in three pedigrees to date...
2018: Frontiers in Immunology
Claudia Ansorge, Johannes M Miocic, Dagmar von Bubnoff, Kristin Technau-Hafsi
BACKGROUND AND OBJECTIVES: Recently, there have been increasing numbers of patients consulting emergency units in all medical disciplines. Our aim was to analyze the demographics, referral mode, symptoms, localization of lesions, prior treatment, diagnoses and hospitalization rate of dermatological patients. PATIENT AND METHODS: The study was conducted as a prospective single center survey over six months in the dermatology unit of a university hospital in Germany...
November 12, 2018: Journal der Deutschen Dermatologischen Gesellschaft, Journal of the German Society of Dermatology: JDDG
Suzana Ljubojević Hadžavdić, Sandra Marinović Kulišić, Dragana Ljubojević Grgec, Ana Poljanac, Brankica Ilić
Autoimmune progesterone dermatitis (APD) is rare autoimmune response to endogenous progesterone or to earlier exposure to exogenous progesterone (1). Skin lesions typically occur due to increases in progesterone during the luteal phase of the menstrual cycle (2). A-31-year-old mother of two children presented to our Department with a 5-year history of pruritic and painful erythematosus macules, papules, and patches on her neck, pectoral region, and face, which appeared 2-3 days before the onset of menses and gradually resolved 7-10 days later (Figure 1)...
October 2018: Acta Dermatovenerologica Croatica: ADC
Maria Rotaru, Sanda Marchian, Gyula Laszlo Fekete, Gabriela Mariana Mariana Iancu
Dear Editor, Eczema is an inflammatory dermatitis mediated by cellular immunity, with an etiology in which environmental, immunological, and genetic factors are involved. Skin inflammation through proinflammatory cytokines creates a favorable environment for microbial antigens and optimal conditions for infection (1). In case of underlying immunosuppression, inflammatory features of dermatitis and superimposed infections are more severe. The presence of minor trauma of the skin in the form of fissures can favor both easier inoculation of some bacterial germs, leading to a dermatitis superinfection, and/or the transcutaneous inoculation of atypical mycobacteria, with a possibility of developing localized types of tuberculous lymphadenitis (TLA)...
October 2018: Acta Dermatovenerologica Croatica: ADC
Stanislav N Tolkachjov, Mark D P Davis, James A Yiannias
Crusted scabies (CS) is a highly infectious hyperinfestation variant of scabies with up to millions of Sarcoptes scabiei mites present on the skin surface. Diagnostic clues include intense itching and thick crusting especially on the face, groin, and buttocks, although variable presentations may mimic other dermatoses. CS has been associated with immunosuppression including the human immunodeficiency virus (HIV) and lymphoreticular malignancies.1-3 A long latency period from symptom onset to diagnosis and appropriate treatment is often reported...
October 1, 2018: Journal of Drugs in Dermatology: JDD
A Marzouki-Zerouali, A Schoeffler, A-L Liegeon, P Le Vaou, F Truchetet
BACKGROUND: Factitious disorders constitute a complex pathology for the dermatologist. Although a diagnosis is often indicated, it is difficult to confirm and treatment is complicated. Dermatitis artefacta is the somatic expression of an often serious psychiatric disorder consciously created by patients on their own cutaneous-mucosal surfaces but the motivation is unconscious and no secondary benefits are sought (in contrast to simulation). Pathomimicry represent a specific entity: the provocation of outbreaks of a known disease, triggered by voluntary exposure to a causative agent...
October 22, 2018: Annales de Dermatologie et de Vénéréologie
Barbara K Burton, Kyle Bradford Jones, Stephen Cederbaum, Fran Rohr, Susan Waisbren, Debra E Irwin, Gilwan Kim, Joshua Lilienstein, Ignacio Alvarez, Elaina Jurecki, Harvey Levy
BACKGROUND: Phenylalanine hydroxylase (PAH) deficiency, otherwise known as phenylketonuria (PKU), is an inborn error of metabolism that requires treatment to be initiated in the newborn period and continued throughout life. Due to the challenges of treatment adherence and the resulting cumulative effects of high and labile blood phenylalanine, PKU exerts a significant burden of disease. Retrospective studies using large databases allow for unique perspectives on comorbidities associated with rare diseases...
September 12, 2018: Molecular Genetics and Metabolism
Kathryn P Trayes, Katherine Savage, James S Studdiford
Annular lesions can present in a variety of diseases. Knowledge of the physical appearance and history of presentation of these skin findings can help in the diagnosis. A pruritic, annular, erythematous patch that grows centrifugally should prompt evaluation for tinea corporis. Tinea corporis may be diagnosed through potassium hydroxide examination of scrapings. Recognizing erythema migrans is important in making the diagnosis of Lyme disease so that antibiotics can be initiated promptly. Plaque psoriasis generally presents with sharply demarcated, erythematous silver plaques...
September 1, 2018: American Family Physician
Ugo Bottoni, Stefania Tamburrini, Elisabetta Scali, Stefano Dastoli, Giuseppe Fabrizio Amoruso, Giovanni Paolino, Elisa Moliterni, Teresa Grieco, Guglielmo Pranteda, Stefano Calvieri
Hand eczema is a chronic disease (1), commonly considered the expression of a contact allergic or irritative dermatitis. However, when the prick/patch tests and laboratory investigations are negative, important diagnostic challenges may arise. Peripheral nerve fibers are in fact capable of releasing neuromediators. Thus, an alteration of the central and/or peripheral nervous system can cause the exacerbation as well as the onset of a cutaneous disease (2). From September 1, 2013 to August 31, 2015, we observed 5 female patients between 20 and 40 years old, with particular hand dermatitis lesions on the volar area, unilateral on the right hand in 3 patients and bilateral in 2 patients...
December 2017: Acta Dermatovenerologica Croatica: ADC
Margaret Rosenfeld, Claire E Wainwright, Mark Higgins, Linda T Wang, Charlotte McKee, Daniel Campbell, Simon Tian, Jennifer Schneider, Steve Cunningham, Jane C Davies
BACKGROUND: Ivacaftor is generally safe and effective in patients aged 2 years and older who have cystic fibrosis and specific CFTR mutations. We assessed its use in children aged 12 to <24 months. METHODS: The ARRIVAL study is a phase 3, single-arm, two-part, multicentre study. Eligible children were aged 12 to <24 months at enrolment and had a confirmed diagnosis of cystic fibrosis and a CFTR gating mutation on at least one allele and could participate in one or both parts of the study...
July 2018: Lancet Respiratory Medicine
Lauren Kwa, Jonathan I Silverberg
BACKGROUND: Little is known about the usage and financial burden of emergency care visits for atopic dermatitis (AD) or eczema (AD-E) in the United States. OBJECTIVE: To determine the prevalence, risk factors, and cost of emergency care for AD-E in the United States. METHODS: Cross-sectional study of the 2006-2012 National Emergency Department Sample, including a 20% sample of emergency department (ED) visits throughout the United States (n = 198,102,435)...
September 2018: Journal of the American Academy of Dermatology
Y Liu, H Yan, F Shao, Q H Li, M Cui
Eczema, a common pediatric dermatosis with unclear pathogenesis, can seriously affect the life quality of children due to its recurrence and long course. Recent study has found that food specific IgG (sIgG) might be involved in the course of eczema. To analyze the correlation between childhood eczema and sIgG and evaluate the role of avoiding taking intolerance food in the treatment of childhood eczema, this study enrolled 216 children with eczema who were admitted to the Taian Maternal and Child Health Care Hospital, Shandong, China, between August 2014 and October 2015...
March 2018: Journal of Biological Regulators and Homeostatic Agents
Arti Nanda, Maitham A A Husain, Waleed Al-Herz, Adla Almekaimi, Humoud Al-Sabah, Mohammad Al-Otaibi
BACKGROUND/OBJECTIVES: Allogeneic hematopoietic stem cell transplantation (HSCT) is a treatment option for many life-threatening disorders in children. Chronic graft-versus-host disease (cGVHD) is a significant complication of HSCT, and its treatment is challenging. Skin is the most common organ affected in cGVHD, with protean manifestations posing a challenge in diagnosis and management. The objective was to have a better understanding of the spectrum of chronic cutaneous GVHD (cc-GVHD) in children...
May 2018: Pediatric Dermatology
Maria Papadopoulou, Paraskevi Panagopoulou, Anastasia Papadopoulou, Emmanuel Hatzipantelis, Ioannis Efstratiou, Assimina Galli-Tsinopoulou, Efimia Papadopoulou-Alataki
Langerhans cell histiocytosis (LCH) is a rare hematologic disorder that results from the clonal multiplication and accumulation of immature dendritic Langerhans cells. Its reported incidence rate varies, but is considered to be 2.6-8.9 per million children who are <15 years of age each year. It may affect any system or organ. The present study reported 4 pediatric LCH cases in order to highlight the heterogeneity of the initial presentation, and the pitfalls that may mislead clinicians and delay diagnosis...
March 2018: Molecular and Clinical Oncology
Jose M Villalon-Gomez
Pityriasis rosea is a common self-limiting rash that usually starts with a herald patch on the trunk and progresses along the Langer lines to a generalized rash over the trunk and limbs. The diagnosis is based on clinical and physical examination findings. The herald patch is an erythematous lesion with an elevated border and depressed center. The generalized rash usually presents two weeks after the herald patch. Patients can develop general malaise, fatigue, nausea, headaches, joint pain, enlarged lymph nodes, fever, and sore throat before or during the course of the rash...
January 1, 2018: American Family Physician
S Roenneberg, T Biedermann
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease that affects men and women of all ages and also children. The clinical appearance of PRP is highly variable, as is the individual prognosis. Therefore, stratifying PRP into six disease subtypes represents a first step to personalized medicine for this rare inflammatory skin disease. The next step should be to associate specific therapeutic strategies with these subtypes of PRP. However, no randomized, controlled trials on the treatment of PRP have been performed...
June 2018: Journal of the European Academy of Dermatology and Venereology: JEADV
Dominik Nowak, Jensen Yeung
OBJECTIVE: To describe an approach that allows for a streamlined assessment and accurate differentiation of most patients with itch in primary care and to provide an update on the available nonpharmacologic, topical, and systemic therapies. SOURCES OF INFORMATION: MEDLINE (Ovid) and PubMed were searched for the key words itch or pruritus. Searches were refined for each cause and treatment by adding appropriate key words, and subsequent hand searches of the references of retrieved literature were performed...
December 2017: Canadian Family Physician Médecin de Famille Canadien
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