Electrical impedance spectroscopy for the characterization of skin barrier in atopic dermatitis

BACKGROUND

Allergic disorders such as atopic dermatitis (AD) are strongly associated with an impairment of the epithelial barrier, in which tight junctions and/or filaggrin expression can be defective. Skin barrier assessment shows potential to be clinically useful for prediction of disease development, improved and earlier diagnosis, lesion follow-up, and therapy evaluation. This study aimed to establish a method to directly assess the in vivo status of epithelial barrier using electrical impedance spectroscopy (EIS).

METHODS

Thirty-six patients with AD were followed during their 3-week hospitalization and compared with 28 controls. EIS and transepidermal water loss (TEWL) were measured in lesional and non-lesional skin. Targeted proteomics by proximity extension assay in serum and whole-genome sequence were performed.

RESULTS

Electrical impedance spectroscopy was able to assess epithelial barrier integrity, differentiate between patients and controls without AD, and characterize lesional and non-lesional skin of patients. It showed a significant negative correlation with TEWL, but a higher sensitivity to discriminate non-lesional atopic skin from controls. During hospitalization, lesions reported a significant increase in EIS that correlated with healing, decreased SCORAD and itch scores. Additionally, EIS showed a significant inverse correlation with serum biomarkers associated with inflammatory pathways that may affect the epithelial barrier, particularly chemokines such as CCL13, CCL3, CCL7, and CXCL8 and other cytokines, such as IRAK1, IRAK4, and FG2, which were significantly high at admission. Furthermore, filaggrin copy numbers significantly correlated with EIS on non-lesional skin of patients.

CONCLUSIONS

Electrical impedance spectroscopy can be a useful tool to detect skin barrier dysfunction in vivo, valuable for the assessment of AD severity, progression, and therapy efficacy.

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Zusammenfassung. In dieser Arbeit wird auf Kortikoid-Alternativen wie Calcineurin-Inhibitoren, sulfonierte Schieferöle, Ultraviolettlicht und Klimatherapie näher eingegangen. Topische Calcineurin-Inhibitoren lassen sich als Immunsuppressiva verstehen, die eine T-Lymphozytenaktivierung inhibieren und eine Freisetzung proinflammatorischer Zytokine über den Calcineurinweg verhindern. Die Entzündungshemmung sulfonierter Schieferöle soll auf einer Hemmung der 5-Lipoxygenase sowie der 5-Hydroxyeicosatetraensäure und des Leukotriens B4 beruhen. Die Rationale für den Einsatz einer UV-Lichtbehandlung liegt in deren antiinflammatorischer Wirkung u.a. auf Antigen-präsentierende Langerhanszellen, infiltrierende T-Zellen und proinflammatorische Zytokine. Eine Klimatherapie im Hochgebirge oberhalb von 1500 Höhenmeter vermag unter anderem eine Freiheit von Hausstaubmilben-Allergenen zu gewährleisten. Andere potente Allergene (z.B. Birken- und Gräserpollen, Schimmelpilzsporen) sind deutlich in der Konzentration als auch in der Zeitdauer ihres Auftretens reduziert.

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Cutaneous pruritus can be caused by systemic as well as skin diseases. This paper focuses on differential diagnosis of pruritus and covers therapeutic options.

Chronic relapsing urticaria confined to injection sites of upper arms

New ongoing urticarial lesions confined to former injection sites of vaccination and allergy immunotherapy were observed in an 8-year-old boy. This finding can be best explained as an isotopic response phenomenon.

Molecular genetics of atopic eczema

In both clinical experience and molecular genetic studies, atopic diseases (asthma, rhinoconjunctivitis and eczema) have been found to be strongly genetically influenced. The epidermal protein filaggrin seems to play a crucial role and is encoded within the so-called epidermal differentiation complex on chromosome 1. Filaggrin mutations predispose significantly to an increased risk to develop atopic eczema. Apart from filaggrin, other proteins involved in skin barrier functions such as lipid synthesis and metabolism, protease or protease inhibitor functions also seem to play a role. Besides skin barrier function, immune deviation versus a Th2 dominance and increased IgE production is also genetically determined. Polymorphisms have been found in genes encoding IL-4, IL-13 and STAT-6, and recently a polymorphism on the high-affinity IgE receptor gene has been found. Using genome-wide association studies, new genes with yet unknown functions have been determined to be associated with atopy and atopic eczema.

Acquired nonscarring diffuse hair loss in a 3-year-old girl

A 3-year-old girl showed fine, sparse, and brittle scalp hair without signs of cicatricial cutaneous alterations. Dermoscopy as well as scanning electron microscopy revealed elliptical nodes as well as constricted regions along the hair shaft.

Deodorant spray: a newly identified cause of cold burn

Two patients encountered a first-degree cold burn after use of a deodorant spray. The spray-nozzle to skin-surface distance was approximately 5 cm, and the spraying lasted approximately 15 seconds. Under laboratory conditions, the deodorant in use was able to induce a decline in temperature of >60 degrees C. These 2 cases highlight a little-known potential for skin damage by deodorant sprays if used improperly.

Department-related tasks and organ-targeted therapy in Fabry disease: an interdisciplinary challenge

Fabry disease is a rare X-linked storage disorder leading to an accumulation of globotriaosylceramides in all cells carrying lysosomes. As the accumulation occurs in most organs, different medical specialties are involved in the diagnostics and therapy of Fabry disease. With this review of the 3 main specialties (cardiology, nephrology, and neurology) and, in addition, the adjacent specialties (ophthalmology and dermatology), we aim to discuss the division-related responsibilities and want to suggest an organ-related additional therapy besides enzyme replacement therapy.

Food allergy: an increasing problem for the elderly

As populations become older all over the world, allergic reactions in elderly persons will be encountered more often in the future. Up to now, there has been much more literature on allergy prevalence in childhood than on allergy diseases in adults. As a challenge to epidemiology, allergic disorders in elderly persons may be masked by various symptoms corresponding with a general age-induced decline of physiological functions, including vitamin D deficiency and gastric pH increase. How much structural and functional changes (e.g. low calcitriol level) or effects caused by drugs (e.g. acid-suppression medications) in addition to immunological alterations encountered at old age are responsible for this development is a matter of debate. In the years ahead, the problem of allergy in adulthood and especially in the elderly will become more pronounced.

Anaphylaxis: acute treatment and management

Anaphylaxis is the maximal variant of an acute life-threatening immediate-type allergy. Due to its often dramatic onset and clinical course, practical knowledge in the management of these reactions is mandatory both for physicians and patients. It has to be distinguished between acute treatment modalities and general recommendations for management of patients who have suffered from an anaphylactic reaction. Acute treatment comprises general procedures like positioning, applying an intravenous catheter, call for help, comfort of the patient as well as the application of medication. The acute treatment modalities are selected depending upon the intensity of the clinical symptomatology as they are categorized in 'severity grades'. First of all it is important to diagnose anaphylaxis early and consider several differential diagnoses. This diagnosis is purely clinical and laboratory tests are of no help in the acute situation. Epinephrine is the essential antianaphylactic drug in the pharmacologic treatment. It should be first applied intramuscularly, only in very severe cases or under conditions of surgical interventions intravenous application can be tried. Furthermore, glucocorticosteroids are given in order to prevent protracted or biphasic courses of anaphylaxis; they are of little help in the acute treatment. Epinephrine autoinjectors can be used by the patient him/herself. Histamine H(1)-antagonists are valuable in mild anaphylactic reactions; they should be given intravenously if possible. The replacement of volume is crucial in antianaphylactic treatment. Crystalloids can be used in the beginning, in severe shock colloid volume substitutes have to be applied. Patients suffering from an anaphylactic episode should be observed over a period of 4-10 h according to the severity of the symptomatology. It is crucial to be aware or recognize risk patients as for example patients with severe uncontrolled asthma, or under beta-adrenergic blockade. When bronchial symptoms are in the focus, inhaled beta(2)-agonists can be tried, also for laryngeal edema. The use of combined H(1)- and H(2)-antagonists has been recommended for prophylaxis prior to application of potentially anaphylaxis-eliciting drugs (e.g. radiographic contrast media). Patients who have survived an anaphylactic reaction have to be thoroughly examined and an allergy diagnosis has to be performed with regard to the eliciting agent and the pathogenic mechanism involved. In cases of clear-cut IgE-mediated anaphylaxis, allergen-specific immunotherapy is available for some allergens and helpful as for example for insect venom anaphylaxis. Furthermore, patients should be trained with regard to the nature of anaphylaxis, the major eliciting agents and the principles of behavior and coping with the situation including the handling of epinephrine autoinjectors and the application of antianaphylactic medication. Educational programs for anaphylaxis have been developed.

A 12-month-old boy with a localized verrucous tumor

A 12-month-old boy was admitted suffering from a localized pad-like thickening of tissue affecting the area of his right hand joint. First affection of skin was detected at age of 6 months, when a red macula was noted. The parents were now afraid of a viral or malignant disorder. The lesion completely resolved by the second birthday without medical intervention.

Autologous "foreign body" as a sequel of improper cutting of an ingrowing toe nail?

We report on a 63-year-old male who suffered from an ingrown toenail affecting the left first digit for several years. Medical history revealed that repeated vigorous nail plate trimming by the patient relieve the red, painful swelling of his great toe. Furthermore, Emmert onychoplasty as well as non-invasive procedures did not achieve improvement. A thorough surgical exploration of the affected area detected a nail spicule in the deeper paronychium. This was likely caused by improper cutting of the nail plate. Removal of the fragment in combination with partial nail plate excision, followed by phenol cauterization of the matrix resulted in full recovery.

Expanding the phenotype of alopecia-contractures-dwarfism mental retardation syndrome (ACD syndrome): description of an additional case and review of the literature

Alopecia-contractures-dwarfism mental retardation syndrome (ACD syndrome; OMIM 203550) is a very rare genetic disorder with distinct features. To our knowledge, there have been four cases documented to date. In addition, another three patients, previously described as having IFAP syndrome (OMIM %308205), may also have ACD syndrome. We report on one patient with short stature, total alopecia, ichthyosis, photophobia, seizures, ectrodactyly, vertebral anomalies, scoliosis, multiple contractures, mental retardation, and striking facial and other features (e.g. microdolichocephaly, missing eyebrows and eyelashes, long nose, large ears) consistent with ACD syndrome. Results of laboratory testing in the literature case reports were normal, although in none of them, array-CGH (microarray-based comparative genomic hybridization) analysis was performed. In conclusion, the combination of specific features, including total alopecia, ichthyosis, mental retardation, and skeletal anomalies are suggestive of ACD syndrome. We propose that children with this syndrome undergo a certain social pediatric protocol including EEG diagnostics, ophthalmological investigation, psychological testing, management of dermatologic and orthopedic problems, and genetic counseling.

A study on serum IgE and clinical symptomatology of atopy in patients suffering from the lysosomal storage disorder Fabry disease

BACKGROUND

Lysosomal storage disorders may impair intracellular lysosomal processing of antigen with consequences for antibody production [e.g. immunoglobulin E (IgE)] and atopic disease status.

AIMS

Serum concentration of total IgE as well as clinical symptoms of atopic disorders as an indirect consequence of lysosomal impairment of antigen processing were studied in male and female Fabry disease (FD) patients with and without replacement of the missing lysosomal enzyme, alpha-galactosidase A (alpha-Gal A).

METHODS

Observational study in 31 adult FD patients with measurements of total serum IgE concentration. Questionnaire-derived data were obtained for atopic eczema (AE) skin lesions, allergic rhinoconjunctivitis (RCA) and allergic asthma (AA) at present or in the past.

RESULTS

Among 12 FD males under enzyme replacement therapy (ERT), 2 showed total IgE concentrations above 100 kU/L. Clinical symptoms for AA were found in 2, RCA and AE in 1, respectively. Among 10 FD females under ERT, 4 showed total IgE concentrations above 100 kU/L. Clinical symptoms for AA were found in 4, RCA in 2 and AE in 2. Among 9 females without ERT, 2 showed total IgE concentrations above 100 kU/L. Clinical symptoms for AA were found in 2, RCA in 2 and AE in none.

CONCLUSIONS

FD patients may demonstrate an increased total serum IgE concentration and may show symptoms of atopic disorders (AA, RCA, AE) in a prevalence rate comparable to international experience for individuals without FD. There was no difference between patients with and without ERT. Lack of detection of AE in females without ERT is suggested to be caused by the small sample size. FD patients without any alpha-Gal A activity prior to initiation of ERT should be in the focus of future studies.