Shifts in the Skin Microbiota after UVB Treatment in Adult Atopic Dermatitis.

BACKGROUND: The pathophysiology in atopic dermatitis (AD) is not fully understood, but immune dysfunction, skin barrier defects, and alterations of the skin microbiota are thought to play important roles. AD skin is frequently colonized with Staphylococcus aureus (S. aureus) and microbial diversity on lesional skin (LS) is reduced compared to on healthy skin. Treatment with narrow-band ultraviolet B (nb-UVB) leads to clinical improvement of the eczema and reduced abundance of S. aureus. However, in-depth knowledge of the temporal dynamics of the skin microbiota in AD in response to nb-UVB treatment is lacking and could provide important clues to decipher whether the microbial changes are primary drivers of the disease, or secondary to the inflammatory process. OBJECTIVES: To map the temporal shifts in the microbiota of the skin, nose, and throat in adult AD patients after nb-UVB treatment. METHODS: Skin swabs were taken from lesional AD skin (n = 16) before and after 3 treatments of nb-UVB, and after 6-8 weeks of full-body treatment. We also obtained samples from non-lesional skin (NLS) and from the nose and throat. All samples were characterized by 16S rRNA gene sequencing. RESULTS: We observed shifts towards higher diversity in the microbiota of lesional AD skin after 6-8 weeks of treatment, while the microbiota of NLS and of the nose/throat remained unchanged. After only 3 treatments with nb-UVB, there were no significant changes in the microbiota. CONCLUSION: Nb-UVB induces changes in the skin microbiota towards higher diversity, but the microbiota of the nose and throat are not altered.

Early transcriptional changes after UVB treatment in atopic dermatitis include inverse regulation of IL-36γ and IL-37.

Phototherapy with narrow-band Ultraviolet B (nb-UVB) is a major therapeutic option in atopic dermatitis (AD), yet knowledge of the early molecular responses to this treatment is lacking. The objective of this study was to map the early transcriptional changes in AD skin in response to nb-UVB treatment. Adult patients (n = 16) with AD were included in the study and scored with validated scoring tools. AD skin was irradiated with local nb-UVB on day 0, 2 and 4. Skin biopsies were taken before and after treatment (day 0 and 7) and analysed for genome-wide modulation of transcription. When examining the early response after three local UVB treatments, gene expression analysis revealed 77 significantly modulated transcripts (30 down- and 47 upregulated). Among them were transcripts related to the inflammatory response, melanin synthesis, keratinization and epidermal structure. Interestingly, the pro-inflammatory cytokine IL-36γ was reduced after treatment, while the anti-inflammatory cytokine IL-37 increased after treatment with nb-UVB. There was also a modulation of several other mediators involved in inflammation, among them defensins and S100 proteins. This is the first study of early transcriptomic changes in AD skin in response to nb-UVB. We reveal robust modulation of a small group of inflammatory and anti-inflammatory targets, including the IL-1 family members IL36γ and IL-37, which is evident before any detectable changes in skin morphology or immune cell infiltrates. These findings provide important clues to the molecular mechanisms behind the treatment response and shed light on new potential treatment targets.

Self-reported Occupational Skin Exposure and Risk of Physician-certified Long-term Sick Leave: A Prospective Study of the General Working Population of Norway.

Little is known about the contribution of occupational skin exposure as a risk factor for physician-certified long-term sick leave in the general working population of Norway. This study drew a cohort (n = 12,255; response at baseline 69.9%) randomly from the general population of Norway. Occupational skin exposure (in 2009) was measured based on 5 items. The outcome of interest was physician-certified long-term sick leave ≥ 16 days during 2010. Statistical adjustment for psychosocial and mechanical occupational exposures was performed. Long-term sick leave was predicted by occupational skin exposure to cleaning products (odds ratio (OR) 1.7; 95% confidence interval (95% CI) 1.1-2.5) and waste (OR 2.1; 95% CI 1.1-3.7) among men, and occupational skin exposure to water (OR 1.3; 95% CI 1.0-1.6) among women. The estimated population attributable risk for occupational skin exposure was 14.5%, which emphasizes its contribution as an important risk factor for long-term sick leave.

A toddler with systemic contact dermatitis caused by diabetes devices.

Continuous glucose monitors (CGM) and insulin pumps have become the preferred treatment option for most young children and adolescents with type 1 diabetes (T1D), by avoiding fingerstick testing and providing real-time glucose measurements. These medical devices and their adhesives contain substances which have been identified as being responsible for allergic contact dermatitis. We describe the case of a toddler who developed severe contact dermatitis from her diabetes devices, leading to secondary infections and hospital admissions. This was followed by the development of a symmetrical exanthema with retroauricular and glutaeal distribution. Patch tests were positive for isobornyl acrylate (IBOA) and 4-tert-butylcatechol (PTBC). Her symmetrical exanthema was interpreted as systemic contact dermatitis due to IBOA and PTBC in her diabetes devices. We suspect that systemic contact dermatitis is an underreported complication in diabetic patients.

Variability in patch test reactions--first report from the Norwegian Patch Test Registry.

BACKGROUND: A nation-wide Norwegian Patch Test Registry (NOLAR) was established in 2005 as a collaboration between six dermatology departments. International, multi-centre studies have documented great variability in the frequency of positive patch test reactions, considered as mainly due to heterogeneity of test populations. OBJECTIVES: To analyse the variability of positive test reactions by studying patch tests performed at the six collaborating departments, using standardized procedures. MATERIALS AND METHODS: Data from all patch tests (n = 2089) performed in 2007-2008 as registered in the NOLAR program. Differences between centres were analysed using Exact Pearson chi(2) test. RESULTS: Between the centres, positive test reactions (+, ++, or +++) varied significantly for 8 of the 26 allergens in the European Baseline Series. When considering strong reactions (++ or +++) only, the differences were statistically significant for six of these allergens, i.e. cobalt chloride, potassium dichromate, p-phenylenediamine, formaldehyde, paraben mix, and mercaptobenzothiazole. CONCLUSION: The results indicate regional differences in the prevalence of sensitization to certain allergens within the Norwegian population, although inter-observer differences cannot be ruled out as a factor.

Self-esteem and body satisfaction among late adolescents with acne: results from a population survey.

BACKGROUND: The association of acne and self-evaluation is barely explored among late adolescents in the general population. OBJECTIVE: We sought to explore self-esteem, body satisfaction, and acne among 18-year-old young adults at a community level. METHODS: We conducted a questionnaire-based survey among 3775 late adolescents. RESULTS: Our response rate was 80%. The prevalence of acne was 13.5%. Girls and boys with acne had significantly more depressive symptoms, lower self-attitude, more feelings of uselessness, fewer feelings of pride, lower self-worth, and lower body satisfaction than those without acne. In a regression model adjusting for body mass index and depressive symptoms, acne explained significantly poor self-attitude for boys only (odds ratio 2.07 [confidence interval 1.10; 3.88]) and poor self-worth for girls only (odds ratio 1.88 [confidence interval 1.23; 2.88]). LIMITATIONS: Not all items of the self-esteem instrument were included. CONCLUSIONS: At age 18 years, acne is related to self-evaluation independent of body mass index and depressive symptoms.

Self reported skin morbidity and ethnicity: a population-based study in a Western community.

BACKGROUND: Recent studies have shown ethnic differences concerning cardio-vascular disease, diabetes and mental health. Little is known about ethnic differences in skin morbidity. The purpose of this study was to describe possible ethnic differences in self-reported skin morbidity in a Western urban community. METHODS: The design was cross sectional. 40,888 adults in Oslo, Norway, received a postal questionnaire providing information on socio-demographic factors and self-reported health, including items on skin complaints. RESULTS: 18,770 individuals answered the questionnaire. In the sample 84% were from Norway. The largest immigrant group was from Western countries (5%) and the Indian Subcontinent (3%). Itch was the most prevalent reported skin symptom (7%), and was significantly more reported by men from East Asia (18%) and Middle East/North Africa (13%). The same observations were seen for reported dry and sore skin. Hair loss was a dominating complaint for men from the Indian Subcontinent and the Middle East/North Africa (23% and 25%) and for women from the same ethnic groups. Women from Sub-Saharan Africa reported significantly more pimples than in the other groups (17%). CONCLUSION: The study showed that there were significant differences in self-reported skin complaints among ethnic groups. Issues concerning the cultural value of some skin symptoms should be examined further.

Self-reported skin morbidity among adults: associations with quality of life and general health in a Norwegian survey.

Life-quality studies among dermatologic patients have shown that chronic skin diseases have an impact on patients' lives. The purpose of this study was to assess the burden of skin morbidity at a community level. This was presented as prevalence of self-reported skin morbidity and dermatologic life-quality items. The association of skin disease and general health measures like feeling depressed and self-reported general health were measured. The method used was a questionnaire on self-reported skin complaints, including variables such as demographic, psychosocial, general health, dermatologic life-quality items. The design of the study was cross-sectional, with answers from 18,770 adult responders. The results confirmed that skin morbidity is common; itch was the dominating symptom. Younger adults reported more social problems as a result of skin problems than older. The life-quality domain most affected by skin disease was the social one. In a regression model skin disease was as well as rheumatism more strongly associated with feeling depressed than asthma, diabetes, and angina pectoris. Skin disease was also strongly associated with reporting poor general health, although less than other nondermatologic chronic diseases. In conclusion, in this study skin morbidity was strongly associated with general health measures among adults in a population-based setting. To the best of our knowledge these associations have not been described previously at a community level.