Topical non-pharmacological treatment of eczema: an Italian consensus.

Eczematous diseases (contact dermatitis, atopic dermatitis, hand eczema) are among the most frequent findings in dermatological clinical practice. A large body of evidence exists on structural and functional skin barrier damage in eczematous diseases, and on the importance of interventions aimed to repair such damage. While there is substantial agreement on pharmacological treatment, more sparse data are available on role, indications and usefulness of topical non-pharmacological treatments, despite significant research and progress in the composition and technology of emollients, cleansers and barrier creams significantly changed and expanded the functional activities of these products. This often leads to inadequate prescription and/or use, which increase individual and social costs of the disease and make the products useless or, in some cases, even counterproductive. This consensus document, discussed and compiled in a series of meetings by a group of Italian dermatologists experienced in the field of eczematous diseases, summarizes epidemiology and clinical features of the nosological entities of the "eczema family", illustrates the chemical/biochemical structure of emollients, cleansers and barrier creams, and aims to help physicians to exploit the full potential of available products, by providing a detailed but practical guide on characteristics, indications and correct use of non-pharmacological treatments currently available for eczematous diseases.

Molecular characterization of xerosis cutis: A systematic review.

BACKGROUND: Xerosis cutis or dry skin is a highly prevalent dermatological disorder especially in the elderly and in patients with underlying health conditions. In the past decades, numerous molecular markers have been investigated for their association with the occurrence or severity of skin dryness. The aim of this review was to summarize the molecular markers used in xerosis cutis research and to describe possible associations with different dry skin etiologies. METHODS: We conducted a systematic review of molecular markers of xerosis cutis caused by internal or systemic changes. References published between 1990 and September 2020 were searched using 'MEDLINE', 'EMBASE' and 'Biological abstracts' databases. Study results were summarized and analyzed descriptively. The review protocol was registered in PROSPERO database (CRD42020214173). RESULTS: A total of 21 study reports describing 72 molecules were identified including lipids, natural moisturizing factors (NMFs), proteins including cytokines and metabolites or metabolic products. Most frequently reported markers were ceramides, total free fatty acids, triglycerides and selected components of NMFs. Thirty-one markers were reported only once. Although, associations of these molecular markers with skin dryness were described, reports of unclear and/or no association were also frequent for nearly every marker. CONCLUSION: An unexpectedly high number of various molecules to quantify xerosis cutis was found. There is substantial heterogeneity regarding molecular marker selection, tissue sampling and laboratory analyses. Empirical evidence is also heterogeneous regarding possible associations with dry skin. Total free fatty acids, total ceramide, ceramide (NP), ceramide (NS), triglyceride, total free amino acids and serine seem to be relevant, but the association with dry skin is inconsistent. Although the quantification of molecular markers plays an important role in characterizing biological processes, pathogenic processes or pharmacologic responses, it is currently unclear which molecules work best in xerosis cutis.

Dermatological complications of therapy with biologics in inflammatory autoimmune diseases.

BACKGROUND AND OBJECTIVE: Cutaneous adverse events (CAEs) occur in up to 10 % of patients with immune-mediated inflammatory disease (IMID) treated with antitumor necrosis factor (TNF)α agents. The aim of this clinical study was to track and observe the course of CAEs in all biologic therapies. PATIENTS AND METHODS: The population for this study consisted of patients with CAEs under biologic therapy who were examined by experienced board-certified dermatologists in the outpatient department of the University Hospital Essen, Department of Dermatology. RESULTS: Altogether 39 patients with a total of 45 CAEs were included in this study. In 60 % of the cases a form of paradoxical psoriasis was diagnosed. Two thirds (66.6 %) of the patients with CAEs were diagnosed with an underlying inflammatory bowel disease (IBD). TNFα antagonists were the triggering agents in about 95 % of the cases. Changes in biological therapy were required in nearly half of the cases (46.2 %). Almost 90 % of the patients had either a complete (42.1 %) or a partial response (47 %). CONCLUSIONS: Management of CEAs under biological therapy can be challenging in clinical practice. Case discussions between gastroenterologists, rheumatologists and dermatologists should be undertaken to best manage patients with CAEs and avoid unnecessary changes of therapy.

Terra firma-forme dermatosis: Differential diagnosis and response to salicylic acid therapy.

Terra firma-forme dermatosis (TFFD), first described by Duncan in 1987, is a relatively common but probably underdiagnosed condition, characterized by a reticular hyperpigmented dirtlike eruption resistant to washing with common soap but typically removed with rubbing with 70% isopropyl alcohol. We present a case of TFFD in an 8-year-old boy with rapid response to 5% salicylic acid in petrolatum ointment.

The Endocannabinoid System and Its Role in Eczematous Dermatoses.

The skin serves as the foremost barrier between the internal body and the external world, providing crucial protection against pathogens and chemical, mechanical, and ultraviolet damages. The skin is a central player in the intricate network of immune, neurologic, and endocrine systems. The endocannabinoid system (ECS) includes an extensive network of bioactive lipid mediators and their receptors, functions to modulate appetite, pain, mood, and memory, and has recently been implicated in skin homeostasis. Disruption of ECS homeostasis is implicated in the pathogenesis of several prevalent skin conditions. In this review, we highlight the role of endocannabinoids in maintaining skin health and homeostasis and discuss evidence on the role of ECS in several eczematous dermatoses including atopic dermatitis, asteatotic eczema, irritant contact dermatitis, allergic contact dermatitis, and chronic pruritus. The compilation of evidence may spark directions for future investigations on how the ECS may be a therapeutic target for dermatologic conditions.

Dermatological emergencies: one-year data analysis of 8,620 patients from the largest Portuguese tertiary teaching hospital.

Skin conditions frequently lead to emergency department (ED) visits. While most are benign in course, some will present as true dermatological urgencies/emergencies, requiring admission. To present data on skin diseases most frequently found in the ED, and those most frequently requiring admission at the largest Portuguese tertiary teaching hospital, and to explore an association between epidemiological variables and frequency of diagnoses within this context. A retrospective study was conducted on all patients examined during 2012 for dermatology emergency consultation (DEC) at the Hospital de Santa Maria, Lisbon, Portugal. Association between epidemiological variables (gender and age of patients, and season of the year) and frequency of diagnoses was investigated. In total, 8,620 patients were examined by a dermatologist in the ED, constituting 3.9% of all ED visits in our centre. Overall, 333 diagnoses were made, the most frequent of which was eczema not-otherwise-specified (9.4%). However, infectious and parasitic diseases constituted the leading motive for DEC (31.5%). Only 264 patients were admitted, with 65 diagnoses leading to admission. Nine diagnoses alone led to 60% of all admissions. Infectious and parasitic diseases constituted the leading cause of admission (34.7%). An association between frequency of diagnoses and gender, age, and season was identified. Despite the variety of dermatological pathologies, only a limited group of diseases was responsible for most of the true dermatological emergencies. Therefore, in the absence of a readily available dermatologist, knowledge of these entities, as well as demographic and environmental data, may help to improve the management of these patients.

[Eczematous disorders in adolescents]. / Ekzemerkrankungen in der Adoleszenz.

Eczematous disorders in adolescence (definition WHO: the period between 10 and 20 years) are common and include mainly atopic dermatitis, contact eczema, and seborrheic dermatitis. They all share the similarity of inflammatory reactions which mainly affect the epidermis and can take a chronic course, depending on the underlying dermatosis. In the following article, the particularities of eczematous diseases in adolescents are discussed.

Soak and smear: an effective treatment for eczematous dermatoses.

Eczematous dermatoses are common inflammatory skin diseases that can be difficult to treat and have a major impact on patients' quality of life and psychological status. Soak and smear is an effective treatment that can eliminate the need for oral steroids and, in chronic situations, other systemic immunosuppressives.

Accumulation of invariant NKT cells into inflamed skin in a novel murine model of nickel allergy.

Nickel (Ni) can cause delayed-type hypersensitivity reactions, which are thought to be mediated by the accumulation of T cells into inflamed skin. Accumulated T cells at the developmental stages in metal allergy are poorly characterized because a suitable animal model has not been established. To investigate the accumulated T cells in allergic inflamed skin, we generated a novel murine model of Ni-induced allergy. The murine model of Ni allergy was induced by two sensitizations of Ni plus lipopolysaccharide solution into the groin followed by three challenges with Ni solution into the footpad. Here we show that a specific TCR repertoire bearing Vα14Jα18, called natural killer (NK) T cells, was expanded monoclonally in BALB/c or C57BL/6 mice. Accumulation of NKT cells was characterized as CD4(+) or CD4(-)CD8(-) T cells. These results suggested that NKT cells are major pathogenic T cells at the elicitation phase of Ni allergy.

A survey of the factors associated with concerns about oral antihistamine use in Japanese pruritic skin disease patients.

BACKGROUND: To improve health outcomes during the treatment for pruritic skin diseases, it is important to understand which factors most influence patients' concerns about oral antihistamine drugs. OBJECTIVES: To survey the nature of patients' concerns about oral antihistamine drugs and to examine the factors associated with them. METHODS: Patients with pruritic skin diseases expressed their concerns regarding the use of oral antihistamine drugs. The independent effects of the patients' background characteristics on their concerns were examined by multiple logistic regression analysis. RESULTS: A total of 291 outpatients were completed the study. Overall, 32% of patients were worried about using oral antihistamine drugs. The most common concern was about their adverse drug events (except drowsiness) and the effects of long-term use. Overall, being concerned about antihistamine use was found to be significantly and independently associated with a younger age, severe itching, being a homemaker, and having previous personal experience of embarrassment due to drowsiness caused by taking over-the-counter drugs. CONCLUSIONS: Several factors are associated with altered self-reported concerns about antihistamines. Our results suggest the importance of understanding the nature of patients' fears about oral antihistamine use so that sound advice can be offered to them in a timely manner.

Pellagra revealing a congenital duodenal diaphragm in an adult.

Pellagra is a nutritional disease caused by the deficiency of niacin. It is a clinical syndrome characterized by four "D's": diarrhea, dermatitis, dementia and ultimately death. We describe a case of pellagra as the initial presentation of congenital duodenal diaphragm.

Thyroid hormone action on skin.

PURPOSE OF REVIEW: To review the current understanding regarding thyroid hormone action on skin. To provide a historical context for the recent findings. RECENT FINDINGS: Although direct thyroid hormone actions have been demonstrated on multiple aspects of cutaneous biology, rigorous study remains scant. Still, there is a slowly evolving literature supporting the concept that thyroid hormone can directly stimulate epidermis, dermis, and hair. That action may be accessed to treat cutaneous disease. SUMMARY: Here, we review the literature regarding thyroid hormone action on skin along with skin manifestations of thyroid disease. We provide context for more recent findings of direct thyroid hormone stimulation of cutaneous cell proliferation in vitro and in vivo which may portend the use of thyroid hormone to treat cutaneous pathologies.

Melanocytic lesions with eczematous reaction (Meyerson's phenomenon) - a histopathologic analysis of 64 cases.

BACKGROUND: Eczematous (spongiotic) reaction in melanocytic lesions (Meyerson's phenomenon) has not been systematically analyzed and has not been convincingly documented in melanoma. METHODS: We analyzed 64 consecutive melanocytic lesions with spongiotic reaction, occurring in 57 patients (age range 14-81 years; mean, 39 years; 30 females, 27 males) including 16 common acquired nevi, 3 nevi with congenital features, 2 Spitz nevi, 29 dysplastic nevi, 6 in situ and 8 invasive melanomas. RESULTS: The intensity of the spongiotic reaction was graded as mild in 24 (38%), moderate in 22 (34%) and marked in 18 (28%) lesions. It was moderate/marked in 6 of 14 (43%) in situ or invasive melanomas. Upward migration of melanocytes in the epidermis was noted in 7 (33%) non-dysplastic and 10 (34%) dysplastic nevi but was generally limited to the lower half of the epidermis. Moderate/severe cytologic atypia was found in 14 (48%) dysplastic nevi and all melanomas but not in non-dysplastic nevi. CONCLUSIONS: Prominent spongiotic reaction with eosinophils in the inflammatory infiltrate can affect all types of melanocytic lesions. Upward migration involving the uppermost layers of the epidermis, especially when extensive and present in areas with a less pronounced spongiotic reaction, and moderate/severe cytologic atypia indicate a melanoma.

[Disseminated perinaevic Meyerson phenomenon revealing melanoma]. / Phénomène de Meyerson périnævique disséminé révélateur d'un mélanome.

BACKGROUND: Meyerson phenomenon (MP) consists of an eczematous reaction occurring around a pre-existing dermatologic lesion that is usually melanocytic and generally benign, and which is known as a Meyerson naevus. We report a case of multiple Meyerson naevi revealing melanoma, which itself was surrounded by a halo of eczema. PATIENTS AND METHODS: A 55-year-old man of phototype III with atopic eczema presented for pruritic eczema present for a fortnight, found solely on and around the naevi on his trunk and at roots of his limbs. One of the melanocytic lesions affected by these Meyerson phenomena was clinically atypical and had been active for several years. Excision confirmed the diagnosis of level II extensive superficial melanoma measuring 0.75 mm in thickness and associated with lesional and perilesional eczematous remodelling. After surgery involving a 1-cm excision margin and local corticosteroid therapy of the eczema, the Meyerson phenomenon subsided with complete remission of the melanoma at 1 year. DISCUSSION: Meyerson phenomenon can affect one or more naevi at the same time; it is generally transient, may recur on occasion, and has a favourable outcome either spontaneously or with corticosteroid treatment. When not removed for histological verification, the melanocytic lesion regains its initial appearance following resolution of the phenomenon. MP differs from Sutton phenomenon (SP), which is a perinaevic vitiligo reaction leading to complete or partial regression of the melanocytic lesion, which may be either benign or malignant. CONCLUSION: This case of Meyerson phenomenon revealing melanoma shows that the melanocytic lesions targeted by MP are not necessarily benign.

Eczema diagnosis and management in the community.

The old saying, 'a stitch in time saves nine' is particularly true in the management of eczema. Early diagnosis and the recognition of an underlying cause can mean that more simple measures, such as moisturizers, may be sufficient to keep eczema under control, while the identification of an allergic stimulus can forestall further problems. Equally, being aware of what action to take when a course of treatment is ineffective, and having the ability to teach parents and families to realize when they need extra help, may allow changes to be made that will restore control of the condition more quickly. An understanding and empathetic ear may make all the difference when a patient is having to come to terms with eczema. This article discusses the aetiology and symptoms of different types of eczema, and summarises the range of available options for the management of this often disruptive condition.