Atopic dermatitis, dry skin and serum IgE in children in a community in japan

BACKGROUND

Long-term, prospective studies investigating the prevalence, serum IgE and the natural history of atopic dermatitis (AD) in a community are lacking.

METHODS

In a Japanese community, the skin of primary school children and junior high school students was examined and a questionnaire was given to their parents; their serum total IgE, and house dust mite (HDM)- and Japanese cedar pollen (JCP)-specific IgE levels were also assessed once a year for 9 years.

RESULTS

The median AD prevalence in all students (492 in 1998 and 380 in 2004) was 7.6% (6.1-10.4%). The prevalence and the area of skin eruptions of AD decreased with growth. Serum total and HDM-specific IgE levels were high in AD patients, and significant differences were noted for both levels between children with and without later remission of skin eruptions at the time of primary school entry. IgE level increases were noted in the following order: healthy skin < dry skin < AD. In children presenting only with dry skin without atopic disorders, such as AD, asthma and allergic rhinitis, levels of total HDM- and JCP-specific IgE were significantly higher than in children with healthy skin.

CONCLUSIONS

The infantile IgE level serves as a prognostic index, and sensitization to inhalant allergens may be easily established in individuals with clinically dry skin, even when AD is not present, and this may lead to the development of atopic disorders.

Experimental evaluation of photocrosslinkable chitosan hydrogel as injection solution for endoscopic resection

BACKGROUND AND STUDY AIMS

Saline as an injection solution for endoscopic resection techniques has several disadvantages such as a short-lasting effect leading to a potentially higher risk of bleeding and perforation. The new substance of photocrosslinkable chitosan hydrogel in a DMEM/F12 medium (PCH) can be converted into an insoluble hydrogel by ultraviolet irradiation for 30 s, and was evaluated in two sets of animal experiments.

METHODS

18 pigs were used in the two parts of the study. First, mucosal resections were done with either PCH or hypertonic saline; the effects of both agents on wound healing were examined endoscopically and histologically. Second, in vivo degradation of PCH was examined using six pig stomachs.

RESULT

PCH injection led to a longer-lasting elevation with clearer margins, compared with hypertonic saline, thus enabling precise endoscopic submucosal dissection (ESD) along the margins of the elevated mucosa. The endoscopic appearance after ESD was similar in both groups. PCH biodegradation was completed within 8 weeks according to endoscopic and histologic analyses.

CONCLUSION

PCH is a promising agent for submucosal injection prior to various techniques of endoresection. It should be evaluated in clinical trials after biocompatibility testing for PCH is completed.

Elevated platelet activation in patients with atopic dermatitis and psoriasis: increased plasma levels of beta-thromboglobulin and platelet factor 4

BACKGROUND

Beyond their role in hemostasis and thrombosis, platelets are important for modulating inflammatory reactions. Activated platelets play a role in the pathomechanism of inflammatory diseases such as asthma, but little is known about platelet activation in chronic skin inflammation, including atopic dermatitis (AD) and psoriasis. Furthermore, the relationship between platelet activation and disease severity is not understood. This work was performed to investigate plasma levels of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) as platelet activation markers in patients with AD or psoriasis, and to determine the relationships between these markers and disease severity.

METHODS

Plasma levels of beta-TG and PF4 were measured by enzyme-linked immunoassay in 22 healthy controls, 44 patients with AD, and 16 patients with psoriasis. The relationships between these markers and the scoring AD (SCORAD) index, blood eosinophilia, serum IgE and serum lactate dehydrogenase were investigated in AD patients, and relationships with the psoriasis area and severity index (PASI) score were examined in psoriatic patients.

RESULTS

Plasma beta-TG and PF4 levels were significantly higher in patients with AD or psoriasis compared with healthy controls. beta-TG and PF4 levels correlated with the SCORAD index, and PF4 levels correlated with PASI scores. Elevated beta-TG and PF4 levels were significantly reduced after treatments.

CONCLUSIONS

Our results show that blood platelets are activated in patients with AD or psoriasis, suggesting that activated platelets play a role in the pathomechanism of chronic skin inflammation. Furthermore, plasma beta-TG and PF4 may be markers for the severity of AD and psoriasis.

Symmetrical drug-related intertriginous and flexural exanthema caused by valacyclovir

Drug-related eruptions that appear only on intertriginous or flexural folds and in gluteal areas have recently been termed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). We report a case of a 56-year-old woman with acute erythematous rash in the intertriginous areas after treatment with the L-valine ester of acyclovir, valacyclovir. Oral-challenge tests resulted in erythematous pruritic rash in the intertriginous area by valacyclovir. The patient was diagnosed as having SDRIFE due to valacyclovir.

Narrow-band ultraviolet B phototherapy in patients with recalcitrant nodular prurigo

Management of nodular prurigo has been less than satisfactory. Conventional therapies such as systemic antihistamines and topical steroids have not been particularly successful. The effects of narrow-band ultraviolet B (NB-UVB) phototherapy in the treatment of various inflammatory dermatoses have been proven, however, no data exist on the efficacy and the duration of remission in NB-UVB monotherapy for nodular prurigo. The aim of this study was to evaluate the effect of NB-UVB phototherapy on recalcitrant nodular prurigo. NB-UVB phototherapy was performed once a week on 10 patients with recalcitrant nodular prurigo. The initial dose was 0.4 J/cm(2), and the dose was increased by 0.1 J/cm(2) for each treatment. The treatment was performed until the eruption was almost clear. In each patient, a mean cumulative dose of 23.88 J/cm(2) was applied over a mean of 24.3 irradiations. The mean maximum daily dose of ultraviolet B was 1.2 +/- 0.4 J/cm(2). NB-UVB phototherapy notably improved the eruption of nodular prurigo in all patients. Follow up at 1 year revealed that only one patient had relapsed. The remaining nine patients continued to derive long-term benefits. NB-UVB phototherapy appears to be an effective treatment for recalcitrant nodular prurigo, offering long-term benefits in the majority of those treated.

Primary cutaneous anaplastic large cell lymphoma associated with vascular endothelial growth factor arising from a burn scar

We present a case of primary cutaneous anaplastic large cell lymphoma manifesting with widespread erythema around an ulcer. Skin biopsy from the ulcer showed CD30-positive atypical lymphocytes throughout the dermis, and immunostaining demonstrated that these cells produced vascular endothelial growth factor, a potent stimulus for angiogenesis. Skin biopsy from the erythema revealed rich neovascularization, which was probably associated with vascular endothelial growth factor.

The role of platelets in leukocyte recruitment in chronic contact hypersensitivity induced by repeated elicitation

Platelets have been shown to be important in inflammation, but their role in chronic allergic dermatitis remains unclear. To investigate the role of platelets in a mouse model of chronic contact hypersensitivity induced by repeated elicitation, mice were sensitized and repeatedly elicited in ears with hapten, with or without platelet depletion, by administering antiplatelet antibody or busulfan. Ear thickness, leukocyte infiltration, serum IgE, and scratching behavior significantly decreased in thrombocytopenic mice. cDNA microarray of ear tissue showed reduced gene expression associated with Th2 lymphocytes. Flow cytometry showed increased P-selectin expression on platelets and an increased number of platelet-leukocyte aggregates in blood of repeatedly elicited mice, compared with sham-sensitized mice. In thrombocytopenic mice, inflammation was restored by platelet infusion, which was blocked by platelets from P-selectin-deficient mice or by pretreating platelets with anti-P-selectin antibody. Moreover, injection of activated platelet supernatant into ears led to increased leukocyte infiltration, which was blocked by pretreating platelets with antiplatelet compounds or neutralizing several chemokines in the platelet supernatant. These results suggest that platelets induce leukocyte recruitment into skin by forming platelet-leukocyte aggregates via P-selectin in blood and secreting chemokines at inflamed sites. Therefore, controlling platelet activity may be useful for treatment of chronic allergic dermatitis.

A full digital, high definition video system (1080i) for laryngoscopy and stroboscopy

Objective:

This study aimed to estimate the effectiveness of a full digital, high definition video system for laryngeal observations.

Methods:

A newly available, full digital, high definition video camera and high definition video monitor were used. With an endoscopic adaptor and rigid telescope, laryngoscopy and stroboscopy were performed on patients with various kinds of laryngeal lesions.

Results:

All laryngeal lesions were observed and recorded by the full digital, high definition video camera without incident. The image quality for laryngoscopy and stroboscopy was far superior to that of a conventional video system, including video-endoscopy. Even tiny structures or lesions could clearly be visualised on the monitor. The still image obtained from the full digital, high definition video camera was 1920 × 1080 pixels and was comparable to that obtained from a still camera.

Conclusions:

Full digital, high definition video cameras are now commonplace products and can easily be applied to patients with laryngeal disorders. They provide superior laryngeal images, compared with conventional video systems. Furthermore, high definition video systems are cheaper than proprietary medical video systems. We consider our system to represent an accessible technique of gaining superior laryngeal observation in otolaryngological clinics.

Allergic contact cheilitis due to geraniol in food

Fragrance materials are present in many foods and are referred to as flavours and spices. However, despite their widespread use, there are few reports of allergic contact dermatitis caused by these additives. Here, we report contact allergy to geraniol in a patient who developed cheilitis on exposure to certain foods.

Serotonin activates human monocytes and prevents apoptosis

Monocytes play a critical role in chronic atopic dermatitis (AD) and are the primary leukocytes that interact with activated platelets. Although activated platelets release a variety of mediators, the role of platelets in cutaneous allergic inflammation remains unclear. Serotonin (5-hydroxytryptamine, 5-HT) is one of the prototypic mediators produced by activated platelets. We examined the effect of 5-HT on the function and lifespan of human monocytes. Normal human monocytes treated with 5-HT exhibited upregulated expression of costimulatory molecules, enhanced capacity to produce cytokines following lipopolysaccharide treatment, and to stimulate allogeneic CD4+ T cells. 5-HT also attenuated the apoptosis in normal human monocytes in a dose-dependent manner. The plasma levels of 5-HT were increased in patients with AD compared with controls and correlated with the SCORAD index. 5-HT also inhibited monocyte apoptosis in these patients. 5-HT upregulated Bcl-2 and Mcl-1, and inhibited the activation of caspase-3. The effects of 5-HT on monocyte apoptosis were mediated by the 5-HT1 and/or 5-HT7 receptors. 5-HT and a 5-HT(1/6/7)-receptor agonist induced phosphorylation of extracellular signal-regulated kinase1/2 and activation of nuclear transcription factor-kappaB. These findings support that 5-HT activates monocytes and inhibits apoptosis, allowing them to remain in the tissue and contribute to chronic inflammation.

Histamine prevents apoptosis in human monocytes

BACKGROUND

As chronic atopic dermatitis (AD) is associated with activation of circulating and infiltrating monocytes, monocytes are considered to play a pivotal role in the establishment of chronic lesions in AD. Histamine is an important mediator of inflammatory and allergic responses. Although new immunomodulatory functions of histamine have recently become apparent, the effect of histamine on the life span of monocytes remains unclear.

OBJECTIVE

In the present study, we investigated the effect of histamine on the life span of human monocytes from normal healthy donors and patients with AD.

METHODS

Monocyte apoptosis was induced by serum deprivation, CD95/Fas ligation, or dexamethasone in the presence of histamine, and measured using annexin V-and propidium iodide-staining. Bcl-2 protein and activated caspase-3 were determined by flow cytometry. We also examined the effect of soluble, histamine-induced factors produced by monocytes on apoptosis. Furthermore, we examined whether monocytic apoptosis is dependent on the cAMP pathway.

RESULTS

Histamine prevented monocytic apoptosis induced by serum deprivation, CD95/Fas ligation, or dexamethasone in a dose- and time-dependent fashion. The inhibitory effects of histamine on monocytic apoptosis were blocked by an H2R antagonist, and mimicked by an H2R agonist. Histamine also up-regulated the expression of Bcl-2 and Mcl-1, and inhibited the activation of caspase-3. The culture supernatants from histamine-treated monocytes inhibited monocytic apoptosis, which was partly reversed by the removal of IL-10. Monocytes cultured with anti-IL-10 mAb and histamine did not exhibit an inhibitory effect on apoptosis. The histamine-induced anti-apoptotic effect was attenuated when monocytes were cultured in the presence of a cAMP inhibitor.

CONCLUSIONS

These results indicate that the H2R signals induced by histamine allow monocytes to prolong their life span and infiltrate to the site of inflammation. This process may contribute to the establishment of chronic allergic disorders, such as AD.

Relationship of serum brain-derived neurotrophic factor level with other markers of disease severity in patients with atopic dermatitis

Elevated serum levels of neurotrophins such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) have been reported in allergic and autoimmune diseases. The aim of this study was to assess serum levels of BDNF in patients with atopic dermatitis (AD) and to investigate the relationship of the BDNF level with other markers of disease severity. Serum BDNF concentration was significantly higher in patients with AD (n=62) compared to control subjects (n=20) (P<0.01). Stepwise multiple regression analysis showed a significant influence of the peripheral blood eosinophil counts (F=6.90) and the percentage of CD4(+)IL-4(+) (Th2) cells (F=6.61). Moreover, after remission of AD patients with conventionally treated AD patients (n=14), serum levels of BDNF, eosinophil counts and percentage of Th2 cells were decreased significantly. These results suggest that serum BDNF may be a useful marker of disease activity in AD and that both eosinophils and Th2 cells are major cellular sources of serum BDNF.

Features and prognoses of infantile patients with atopic dermatitis hospitalized for severe complications

Although atopic dermatitis (AD) itself is regarded as a non-life threatening disease, childhood AD may be rarely accompanied by some serious complications. Six infantile AD patients who were hospitalized because of severe systemic complications, in addition to severe dermatitis on almost the entire body surface, are described. They were complicated by hypoproteinemia, hypovolemia, thrombocytosis, reduced serum immunoglobulin G, elevated serum liver enzymes and growth retardation. They had not been treated with topical corticosteroid before hospitalization. They were treated with topical corticosteroid and their eruption remarkably improved within 20 days (median) of hospitalization. Most of the abnormal clinical data including platelet numbers, serum levels of total protein, and liver enzymes had become normal at the day of discharge. After 30 +/- 4 months of follow up, their skin condition was fair with daily application of moisturizer and occasional use of topical corticosteroid, without any systemic problems. Although severe infantile AD may be accompanied by potentially life-threatening systemic complications, their prognoses concerning AD are favorable if they are treated adequately from the beginning of their infancy.

Effect of serotonin on the differentiation of human monocytes into dendritic cells

The local cytokine environment and presence of stimulatory signals determine whether monocytes acquire dendritic cell (DC) or macrophage characteristics and functions. Because enhanced platelet activation is reported in patients with many allergic disorders, such as atopic dermatitis, platelet-derived factors may influence monocytic differentiation into DC. In this study we examined the effect of serotonin, a prototypic mediator of allergic inflammation released mainly by activated platelets at the inflammatory site, on the granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin (IL)-4-driven differentiation of monocytes into monocyte-derived DC. Monocytes from healthy adult donors were cultured with GM-CSF and IL-4 in the presence or absence of serotonin, and the phenotypes and function of these cells were analysed. In the presence of serotonin, monocytes differentiated into DC with reduced expression of co-stimulatory molecules and CD1a, whereas expression of CD14 was increased. These serotonin-treated DC exhibited significantly reduced stimulatory activity toward allogeneic T cells. However, these cells showed enhanced cytokine-producing capacity, including IL-10 but not IL-12. There was no significant difference between both types of DC in phagocytic activity. Experiments using agonists and antagonists indicated that serotonin 5-hydroxytryptamine (5-HT) induced the alteration of their phenotype and reduction in antigen-presenting capacity were mediated via 5-HTR(1/7). It is therefore suggested that serotonin-driven DC may have a regulatory function in the inflammatory process.