Beta adrenergic receptor binding on polymorphonuclear leukocytes in atopic dermatitis

It has been postulated that the patient with atopic dermatitis has defective beta adrenergic receptor function. However, a more generalized defect is suggested by the observation that cyclic AMP generation is diminished in these patients following stimulation with both isoproterenol and PGE1. To determine the nature of this abnormality, we measured beta adrenergic receptor binding directly on polymorphonuclear leukocyte membranes using the radiolabeled beta adrenergic antagonist (-) [3H]dihydroalprenolol (DHA). DHA binding was studied in 6 mild and 9 moderate-to-severe atopic dermatitis patients, and 8 normal controls using a subsaturating concentration of DHA (0.5 nM) to estimate receptor affinity and a saturating concentration of DHA (30 mM) to determine the total number of receptors per cell. No significant differences (p greater than .05) were found in the total number of receptors per PMN between the control population (805 +/- 95) and the mild atopic dermatitis patients (745 +/- 91) or the moderate to severe group (621 +/- 79). In addition, no significant differences in receptor affinity were found among any of the 3 study groups. These findings suggest that beta receptor binding in atopic dermatitis is normal. Reduced cyclic AMP generation in atopic dermatitis PMN leukocytes would appear to be due to a defect distal to the beta adrenergic receptor itself.

Athletic shoe dermatitis. Contact allergy to ethyl butyl thiourea

Ten patients with severe foot dermatitis were found to be highly allergic to innersole material prepared by Spenco Medical Corporation and used in Nike athletic shoes. Contact allergy testing showed sensitivity to ethyl butyl thiourea, a chemical accelerator in some neoprene (polychioroprene) rubber products. The dermatitis was recalcitrant and in many cases persisted long after discontinuance of wearing Nike shoes, raising the concern that traces of ethyl butyl thiorea or cross-reacting chemicals may be present in other footwear.

Delayed cutaneous hypersensitivity and lymphocyte transformation: dissociation in atopic dermatitis

Studies of cell mediated immunity (CMI) in atopic dermatitis have demonstrated various defects and frequently contradictory results. The true nature of immune dysfunction remains uncertain. We approached this question by concurrently examining two aspects of CMI: delayed cutaneous hypersensitivity and in vitro lymphocyte transformation. Responses were tested using the antigens Candida albicans and streptokinase-streptodornase (SKSD). Mean lymphocyte transformation was equal in atopic patients and controls, although a subgroup of severely dermatitic patients showed depressed responses. Cutaneous anergy was the rule in atopic patients (96% to candidin and 84% to SKSD). Although normal subjects showed good correlation between in vitro and cutaneous responses, atopic patients showed a significant lack of correlation. Many patients manifested cutaneous anergy in the face of normal lymphocyte transformation re sponses.

Lack of functional immunoregulatory cells in a patient with mycosis fungoides and circulating Sézary cells

Peripheral blood lymphocytes obtained at various intervals from normal individuals and from a patient with mycosis fungoides (MF) were cultured with phytohemagglutinin (PHA) for 3 days to activate suppressor cells. After being cultured, the PHA-treated cells were irradiated, washed, and then transferred to fresh medium with PHA. The PHA responsiveness of the cells from normal individuals was suppressed approximately 90% by autologous or normal allogeneic lymphocytes activated for 3 days with PHA, whereas the cells activated for 3 days with PHA from the patient with MF lacked the capacity to inhibit the mitogenic response of autologous or allogeneic lymphocytes. These data suggest that this patient lacked suppressor T-cells that have a specificity for helper T-cells.

The glucagonoma syndrome. A distinctive cutaneous marker of systemic disease

The glucagonoma syndrome is a rare clinical condition characterized by a distinctive cutaneous eruption associated with a glucagon-secreting islet cell neoplasm of the pancreas. A 19-year-old woman manifested typical features of this condition: a polymorphous skin eruption with characteristic distribution of lesions in perioral and paragenital regions; lesions in sites of cutaneous trauma; a skin biopsy that showed epidermal cleavage; glossitis; weight loss; mild anemia; abnormal glucose tolerance test results. Plasma glucagon levels, determined by radioimmunoassay, were approximately five times normal. Angiography indicated a pancreatic tumor with liver metastases. Islet cell origin was confirmed histologically. It is hoped that wider recognition of the distinctive clinical features of this syndrome will result in earlier detection and possible surgical cure of the underlying malignancy.

Staphylococcal infections in patients with atopic dermatitis

Cutaneous staphylococcal infections appear to be relatively infrequent in atopic dermatitis even though patients have broken skin heavily colonized with staphylococcal organsism. We found superficial staphylococcal pustules on the skin of 22 patients with atopic dermatitis. Such lesions were more commonly found with severe exacerbations of atopic dermatitis. They appeared on unbroken skin independent of hair follicles and were associated with considerable pruritus. Such lesions were rapidly removed by excoriation and frequently were overlooked by patients and physicians. Most lesions appeared when polymorphonuclear leukocyte chemotaxis was depressed. Ineffective chemotaxis combined with high-colonization density and inadequate stratum corneum barrier during exacerbations of atopic dermatitis may lead to mild staphylococcal infections. These infections appear to have no systemic effects but possibly the considerable associated pruritus could worsen the atopic dermatitis. Occasional patients may require intermittent or continuous antibiotic therapy.

Immunodeficiencies in severe atopic dermatitis. Depressed chemotaxis and lymphocyte transformation

Various reports have indicated assorted immune defects in atopic dermatitis, but the prevalence and degree of the defects remain unclear. We assessed various immunological factors in 14 patients with atopic dermatitis to determine whether immunodeficiencies were present consistently and were reflected by the patients' clinical characteristics. A high incidence of cutaneous infection was noted. Cutaneous delayed-hypersensitivity testing showed anergy in eight (67%) patients. Only the seven patients with the most severe condition showed altered leukocyte function, as determined by polymorphonuclear and mononuclear leukocyte chemotaxis and by lymphocyte responsiveness to phytohemaglutinin. All three cell types where shown to be simultaneously dysfunctional during severe atopic flares. Chemotactic studies during clinical remissions disclosed notable improvement in cell migration. Serum IgE levels were elevated in each patient, but did not correlate with the degree of cutaneous anergy or altered leukocyte function.

Allergic contact dermatitis caused by idoxuridine. Patterns of cross reactivity with other pyrimidine analogues

Idoxuridine has been used for many years in the treatment of herpex simplex infections of the eye. Use of the drug for herpes simplex infection of the skin is increasing. Ophthalmologists have noted occasional conjunctival and corneal irritant reactions, but no true delayed cutaneous hypersensitivity has been verified. We report four cases of allergic contact dermatitis from idoxuridine, sensitized by both eye and skin applications. Cross reactivity to brominated and chlorinated, but not fluorinated, pyrimidine analogues is noted. Extensive patch testing indicates the general relationship between the structure of pyrimidine compounds and their antigenic cross reactivity.

Human monocytes and macrophages. Interaction with antigen and lymphocytes

PPD-sensitized monocytes and macrophages from tuberculin-positive subjects are both capable of inducing blastogenic transformation of autologous lymphocytes. Incorporation of thymidine-(3)H and morphological transformation were always greater in lymphocyte cultures containing macrophages than in those containing monocytes. More lymphocytes entered the first detectable S phase in cultures containing macrophages. Lymphocyte DNA synthesis occurred as early as 40 hr of culture and always in cells in contact with mononuclear phagocytes. By 120-144 hr, many transformed lymphocytes were free in suspension; at the same time, the "immunological cluster" had increased greatly in size and contained transformed and untransformed lymphocytes. The greater effectiveness of macrophages at induction of lymphocyte transformation may be related to the efficiency of this cell type at trapping antigen and its effectiveness at making contact with and binding lymphocytes.

Secular change in the occurrence of atopic dermatitis

Atopic dermatitis is a common disease, and population-based studies indicate that the frequency of atopic dermatitis has increased substantially during recent decades. It has been generally accepted that disease onset occurs before 7 years of age in 80-90% of the cases, and consequently the epidemiology of atopic dermatitis has been studied mostly in children on admission of first grade school. Before 1960 about 2-3% of children suffered from atopic dermatitis. In the 1960s, some 4-8% was recorded in several studies, and for those born after 1970 most researchers found that 9-12% developed atopic dermatitis during childhood. The diagnostic criteria of Hanifin and Rajka are cumbersome for population studies not designed specifically for children. In order to compare epidemiologic data from varying times and locations, a framework for questionnaire studies in atopic dermatitis is proposed.

Atopic dermatitis and atopy in non-clinical populations

A group of 523 individuals from the general population in the Denver, Colorado area responded to an advertisement for subjects with "problem skin" conditions, such as eczema, dry skin, rashes, etc. The subjects completed screening history information and were evaluated for various characteristics during an examination by a dermatologist. Of the entire population, 33% satisfied the criteria for atopic dermatitis. Another group, described as the generic atopy subset, emerged from the classification and constituted 23% of the total. Individuals in this subset typically had either a personal history of atopic disease or a limited family history. They lacked past or present evidence of flexural rash. A third group, totaling 44%, was classified as nonatopic. A relatively large percent of each of the three groups exhibited some clinical signs of dry skin (e.g., scaling, flakiness). This feature is believed to be due, at least in part, to the damaging effects of the cold, dry conditions in Denver, Colorado.