Topical therapy of atopic dermatitis with a focus on pimecrolimus.

Atopic dermatitis (AD) is a chronic and relapsing, inflammatory skin disease characterized by impaired skin barrier function and immune system dysregulation that results in dryness, skin microbiome dysbiosis and intense pruritus. It is highly heterogeneous, and its management is demanding. Patients with AD are at greater risk of comorbidities such as attention-deficit hyperactivity disorder as well as other atopic diseases. Early-onset AD cases typically improve or resolve in late childhood; however, it is proposed that the prevalence of persistent or adult-onset AD is higher than previously thought. Basic therapy consists of emollient application and trigger avoidance, and when insufficient, topical corticosteroids (TCS) are the first-line treatment. However, corticophobia/steroid aversion and TCS side-effects, particularly on sensitive skin areas, lead to low compliance and insufficient disease control. Several long- and short-term randomized controlled and daily practice studies have demonstrated that topical calcineurin inhibitors, such as pimecrolimus, have similar anti-inflammatory effects to low-to-medium strength TCS, reduce pruritus and improve the quality of life of patients. In addition, pimecrolimus does not cause skin atrophy, is steroid-sparing and has a good safety profile, with no evidence for an increased risk of malignancies or skin infections. In general, pimecrolimus cream is well-accepted and well-tolerated, encouraging patient adherence and leading to its use by many physicians as a preferred therapy for children and sensitive skin areas.

Thrombomodulin expression on dermal cells in normal and psoriatic skin.

The various subsets of dermal cells with a dendritic appearance can be identified by phenotypic differences in cell markers. We report on the morphology and tissue distribution of dermal cells detected with a monoclonal antibody against thrombomodulin in histological sections of normal arm and scalp skin and psoriatic skin. Double staining with antibodies to factor XIIIa, CD34 and CD68 was also employed in scalp biopsies to elucidate the relationship between thrombomodulin+ dermal cells and dermal dendrocytes and macrophages described by others. Thrombomodulin+ dermal cells in normal arm skin had little cytoplasm with fine branched dendrites and tended to be localized just beneath the epidermis. In scalp skin these cells had longer, more numerous dendrites and were distributed in the papillae and perivascular adventitial dermis primarily in the upper and central reticular dermis. In psoriatic skin, thrombomodulin+ dermal cells had an increased cytoplasmic volume with stout, less branched dendrites and appeared in the papillae and among inflammatory cells. Dermal cells detectable by thrombomodulin expression were factor XIIIa-, CD34- and CD68-, and seemed to represent a distinct subset of dermal cells which may function in tissue repair. However, thrombomodulin+ dermal cells and factor XIIIa+ dendrocytes were frequently seen close together and could act cooperatively to regulate extravascular thrombin homeostasis in both normal and pathological dermal environments.

Cutaneous malignant epithelioid neoplasms.

In summary, cutaneous malignancies with an epithelioid appearance form a diverse group of neoplasms that may be difficult to diagnose by utilizing routine microscopy alone. Cutaneous malignancies, including malignant melanoma and metastatic carcinoma, certain benign neoplasms such as mixed tumor of the skin and angiolymphoid hyperplasia with eosinophils (epithelioid hemangioma), and infectious conditions such as bacillary (epithelioid) angiomatosis can be considered in this differential. However, through recognition of the characteristic histologic, immunocytochemical, and ultrastructural findings outlined above, definitive diagnosis of these challenging neoplasms is usually possible.

Old, new, and emerging therapies for atopic dermatitis.

Atopic dermatitis is the most common skin condition in children under the age of 11 years. The chronic, cyclical, pruritic course of AD exacts a huge financial and emotional toll on its sufferers. Confusion about appropriate skin care and the role of allergic factors further complicates management. Although diligent moisturization and judicious use of topical steroids remain the therapeutic standard, new, effective local and systemic agents are now available, and several promising nonsteroidal products may be available soon.

Dermatologic clues to inherited disease.

Genetic diseases often have cutaneous manifestations, which can be the first or most prominent signs of the underlying problem. Recognition of these dermatologic clues allows prompt diagnosis and intervention. In this article, the authors have attempted to outline several important examples of genodermatoses.

Systemic therapy of atopic dermatitis.

Atopic dermatitis is a chronic, relapsing, inflammatory skin disease. Topical therapy is the mainstay, but patients with widespread moderate to severe atopic dermatitis may require systemic therapy. Immunosuppressants, immune response modifiers, antihistamines and antibiotics are among the classes of systemic medications frequently used to treat extensive atopic dermatitis; the indications and scientific support for the use of these and other less commonly used medications will be reviewed in this article.

Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients.

BACKGROUND: Molluscum contagiosum (MC) is a common cutaneous infection in children. Cantharidin, a chemovesicant that is highly effective in treating MC, has lost favor with some physicians because of concerns over its safety. OBJECTIVE: We attempted to determine the safety, efficacy, and parental satisfaction of cantharidin therapy for MC in children who were treated in a pediatric dermatology clinic at a large referral hospital. METHODS: A total of 537 charts of children who presented with MC were reviewed. We found 300 children who were treated with cantharidin and who had parents available for telephone interview, which was performed in addition to chart review. RESULTS: With cantharidin therapy, 90% of patients experienced clearing and 8% improved. The average number of treatment visits was 2.1. Blisters occurred at sites of application in 92% of patients. Temporary burning, pain, erythema, or pruritus was reported in 6% to 37% of patients. No major side effects were reported, and no patients experienced secondary bacterial infection. A total of 95% of parents reported they would proceed with cantharidin therapy again. CONCLUSION: To our knowledge ours is the largest retrospective series of childhood MC treated with cantharidin. In these patients the therapy was extremely effective and well tolerated, and parental satisfaction was high. Cantharidin is a safe and effective therapy for MC in children.