The positive effects of habit reversal treatment of scratching in children with atopic dermatitis: a randomized controlled study.

BACKGROUND: Scratching and itch are common clinical signs of atopic dermatitis (AD). Studies of adult patients have shown that a decrease in scratching behaviour results in regression of inflammation and improved healing of the skin. OBJECTIVES: To investigate whether a modified habit reversal (HR) treatment protocol could be used for the treatment of scratching in children to improve skin status. METHODS: The study is a single-blind, randomized controlled trial of 39 patients who started with registration a week before randomization into one of two groups (intervention or control). The participants in the intervention group received a habit-breaking therapy of their scratching behaviour (i.e. HR) in addition to a potent steroid (mometasone furoate), whereas the patients in the control group received the steroid alone. The patients were assessed by an independent dermatologist after the first week of registration (baseline assessment) and then after 3 and 8 weeks of treatment. The primary efficacy variable was a change in objective Scoring Atopic Dermatitis (SCORAD). RESULTS: At the end of the 3-week treatment period, the change in mean objective SCORAD was significantly (P = 0·027) higher in the intervention group (-31·9 ± 9·5) than in the control group (-23·8 ± 10·1). After the 8-week follow-up, the change in mean objective SCORAD was significantly (P = 0·0038) higher in the intervention group (-31·7 ± 10·4) than in the control group (-19·7 ± 9·4). CONCLUSIONS: The treatment of scratching with the HR method in combination with a potent steroid was found to improve skin status significantly after 3 and 11 weeks.

On assessment of skin reactivity using electrical impedance.

Pathophysiological events in biological tissue are characterized by a shift in electrical impedance spectra of the tissue under study. In this paper, techniques based on electrical impedance are reviewed with emphasis on their possible role in evaluating the skin reactivity of an individual, including results from impedance measurement studies on patients with allergic contact reactions, wheals, tuberculin tests, and irritant contact reactions and on an appropriate number of controls. The results show that, compared to relevant controls, at different types of experimental cutaneous reactions, both of allergic and irritant type, statistically significant changes of the impedance parameters have been detected. Each reaction type had a specific impedance index pattern. Data up to now indicate that the improved impedance technique offers not only a noninvasive alternative for characterization and perhaps differentiation between the skin responses induced by either an allergen or an irritant, but also a capability to distinguish responses induced by chemically different irritants.

Biophysical assessment of atopic dermatitis skin and effects of a moisturizer.

BACKGROUND: The mechanisms of the skin barrier impairment in patients with atopic dermatitis (AD) are still unknown and need further studying. OBJECTIVE: We evaluated the skin of healthy subjects and of patients having atopic dermatitis with an instrument measuring electrical impedance and other noninvasive methods (transepidermal water loss, capacitance) and studied the effects of a new emollient [Proderm (Pro-Q in the USA)]. METHODS: After a 2-week washout period, we treated clinically noneczematous skin on the forearm of 24 patients with AD and assessed the effects with the noninvasive methods. 22 healthy subjects were used as controls. RESULTS: The findings indicate that barrier function and hydration, and certain patterns of electrical impedance of AD skin are abnormal compared with normal skin. Moreover, there was an increase in hydration in patients' skin after treatment and a reversal of certain impedance indices towards normal. CONCLUSIONS: Our findings demonstrate that the moisturizer we used changes some biophysical parameters when applied to atopic skin. In addition, a technique based on electrical impedance seems to give valuable information in atopic skin studies, especially the effects of moisturizers.

Instrumental measurement of the Mantoux test: differential effects of tuberculin and sodium lauryl sulphate on impedance response patterns in human skin.

BACKGROUND AND OBJECTIVE: The tuberculin (PPD) test is a model reaction for the cell-mediated immune system of the skin. The aim of this study is to compare the non-invasive technique based on electrical impedance for investigation of the tuberculin test with an irritant contact reaction induced by sodium lauryl sulphate, which has already been carefully evaluated using this method. METHODS: 0.1 ml of PPD (2 TU) was injected intracutaneously into the volar forearms of 20 adult healthy subjects, all known to be tuberculin sensitized. Assessments were performed 3 and 7 days after the injections, using visual scoring, a new electrical impedance technique and transepidermal water loss (TEWL). RESULTS: In the 16 cases that completed the study, compared to relevant controls and reactions induced by sodium lauryl sulphate statistically significant changes in 3 of the 4 impedance indices were found: both the means of index MIX and index IMIX increased (p< or = 0.01) and the mean of index PIX decreased (p< or = 0.05). Furthermore, similar impedance response patterns occurred in another cell- mediated immune reaction that we have studied previously - namely, the allergic contact reaction induced by nickel sulphate. Unlike the irritant reactions, no significant increase in TEWL values in tuberculin reactions were found. This can be explained by the fact that the epidermis is little affected, since the inflammatory process in the tuberculin reaction is located more deeply in the dermis than with the irritant reaction. CONCLUSION: The current study strongly indicates that electrical impedance in the described version, besides contact dermatitis, also seems suitable for studies of the tuberculin reaction. This will add a new indication for the technique, and studies of further clinical applications are in progress.

Do urea and sodium chloride together increase the efficacy of moisturisers for atopic dermatitis Skin? A comparative, double-blind and randomised study.

Urea has long been used to treat dry skin. In the present report, we compared two creams, identical with the exception that one contained both urea and sodium chloride and the other urea alone, in 22 patients with atopic dermatitis. Following a 2-week wash-out period, their clinically non-eczematous, rough or normal-appearing skin on the forearms was treated twice daily in a double-blind and randomised manner. We examined the treated areas by measuring transepidermal water loss, capacitance and electrical impedance. Our findings suggest that a moisturiser containing both urea and sodium chloride seems somewhat more effective than the same moisturiser without sodium chloride, at least concerning the ability to reverse impedance indices of atopic skin towards normal, an effect ascribed mainly to changes in hydration of the stratum corneum. However, the clinical significance of our impedance measurements is somewhat premature to decide.