Hydrocortisone acetate alone or combined with mupirocin for atopic dermatitis in infants under two years of age - a randomized double blind pilot trial.

BACKGROUND: The skin of patients with atopic dermatitis (AD) is heavily colonized with Staphylococcus (S.) aureus, even at uninvolved sites. Toxins secreted by the majority of S. aureus on the skin behave as superantigens and can directly influence the disease activity, although clinical signs of bacterial superinfection might be absent. OBJECTIVES: This study was conducted to compare the efficacy of hydrocortisone cream, combined with mupirocin or alone with emmolient ointment for the treatment of mild to moderate AD in infants between six months and two years of age. MATERIALS AND METHODS: A total of 83 patients with mild to moderate AD were randomized to receive hydrocortisone, hydrocortisone+ mupirocin or emmolient ointment twice daily in one week and followed-up for 8 weeks, in a blind study. Efficacy evaluation made by SCORAD and eczema area and severity index (EASI) at baseline, day 7, and weeks 2, 4, and 8. Possible adverse events were recorded to evaluate safety. RESULTS: At the end of study, 65% (17 of 26) of the patients were treated successfully with hydrocortisone ointment based on SCORAD and EASI scores. Also there was a significant improvement in patients combined with mupirocin ointment [74% (20 of 27)]. The percent improvement from baseline in EASI scores was also significantly greater in hydrocortisone and combined group compared with emmolient-treated patients (36%) (p = 0.0187, p = 0.012 respectively). CONCLUSIONS: Monotherapy with hydrocortisone ointment is the main treatment in infants with mild to moderate AD and combination with mupirocin is safe and effective often needed because of possible Staphylococcus carriage.

Does autonomic dysfunction play a role in atopic dermatitis?

BACKGROUND: Atopic dermatitis (AD) is a chronic dermatitis characterized by intense itching and excessive skin dryness. The factor most commonly blamed for the pathogenesis of skin dryness in the disease is impaired barrier function of the stratum corneum. However, there are findings indicating that the autonomic nervous system, and the sympathetic nervous system in particular, is affected negatively in AD, and thus, autonomic dysfunction can be an important factor leading to skin dryness. OBJECTIVE: In this study we aimed to evaluate the functioning of the autonomic nervous system electrophysiologically using R-R interval variation (RRIV) and the sympathetic skin response (SSR) in patients with AD, and to examine whether there is an underlying autonomic nervous system dysfunction. PATIENTS AND METHODS: The study registered a total of 38 (12 males and 26 females) patients with AD, of whom 24 had active and 14 inactive disease, and 20 (10 males and 10 females) healthy control subjects. RRIV was used in our study as the electrophysiological test to evaluate the parasympathetic system. The SSR method, which is a noninvasive electrophysiological test with a significant role in evaluating the sudomotor activity of skin, as well as that of the unmyelinated fibres that take a part in this activity, was employed to assess the sympathetic nervous system. RESULTS: Our study revealed a significantly prolonged SSR latency and amplitude of the upper extremity in the patient group, relative to the control group (P < 0.05). When the group with active skin lesions was compared with the control group, the former was found to have prolonged SSR latency and amplitude in the upper extremity. The prolongation in SSR latency of the upper extremity was statistically significant (P < 0.05), while the prolongation in amplitude was not (P = 0.5). An evaluation of RRIV results did not show a significant difference between the patient and control groups. CONCLUSIONS: These findings demonstrate that the sudomotor activity controlled by the sympathetic nervous system, as well as unmyelinated fibres that play a role in this activity are affected in patients with AD. We think that the involvement of sudomotor activity may be one of the causes that leads to dysfunction in sweat glands and skin dryness.

Clinical features and natural course of Behçet's disease in 661 cases: a multicentre study.

BACKGROUND: Behçet's disease (BD) is a systemic inflammatory disease with unpredictable exacerbations and remissions. The natural course of BD is not fully known. OBJECTIVES: We aimed retrospectively to determine the occurrence of the symptoms in chronological order. We also evaluated the influence of the treatment and follow-up on the clinical severity and tried to identify the factors determining severe organ involvement. METHODS: Six hundred and sixty-one patients were involved in this multicentre study. The symptoms of the disease were recorded retrospectively in the time order of the manifestations in each patient. RESULTS: Oral ulcers were the most common manifestation (100%), followed by genital ulcers (85.3%), papulopustular lesions (55.4%), erythema nodosum (44.2%), skin pathergy reaction (37.8%), and articular (33.4%) and ocular involvement (29.2%). Oral ulcers were the most common onset manifestation (88.7%). The mean +/- SD duration between the onset symptom and the fulfilment of diagnostic criteria was calculated to be 4.3 +/- 5.7 years. The clinical severity score was significantly increased in the noncompliant treatment group compared with the compliant group with the passage of time (P < 0.001). The frequency of ocular involvement and genital ulcers was significantly higher in patients whose disease onset was at < 40 years. Genital ulcers, ocular involvement, papulopustular lesions, thrombophlebitis and skin pathergy reaction were found to be significantly more frequent in males. CONCLUSIONS: Mucocutaneous lesions are the hallmarks of the disease, and especially oral ulcers precede other manifestations. The increase in clinical severity score is more pronounced in patients without regular treatment and follow-up. Male sex and a younger age at onset are associated with more severe disease.

A comparison between the effects of low (1 microg) and standard dose (250 microg) ACTH stimulation tests on adrenal cortex functions with Behçet's disease.

INTRODUCTION: Behçet's disease is a rare, chronic disorder. The cause of Behçet's disease is unknown. It is believed to be caused by an autoimmune reaction. As in other chronic autoimmune diseases, Behçet's disease may show a subclinical adrenal failure and some changes in cortisol levels. We aimed to evaluate adrenal gland function in Behçet's disease patients. MATERIAL AND METHOD: This study included 18 Behçet's disease patients and 15 healthy controls. Patient and control groups were administered i.v. 1 microg low dose test (LDT) and 250 microg standard dose test (SDT) adrenocorticotropic hormone (ACTH) stimulation test after 12 h of night fasting with an interval of 3-days and cortisol responses in the 0th, 30th and 60th minutes were evaluated. RESULTS: There was no statistically significant difference between basal cortisol values of Behçet's disease and control groups. Cortisol values in the 60th minute in LDT were significantly lower in Behçet's disease group than in the control group. In the peak cortisol responses to LDT, a significant decrease was found in Behçet's disease group. CONCLUSION: These findings suggest that hypothalamo-pituitary adrenal axis is partially suppressed in Behçet's disease.