Atopic dermatitis: an overview.

Atopic dermatitis, also known as atopic eczema, is a chronic pruritic skin condition affecting approximately 17.8 million persons in the United States. It can lead to significant morbidity. A simplified version of the U.K. Working Party's Diagnostic Criteria can help make the diagnosis. Asking about the presence and frequency of symptoms can allow physicians to grade the severity of the disease and response to treatment. Management consists of relieving symptoms and lengthening time between flare-ups. Regular, liberal use of emollients is recommended. The primary pharmacologic treatment is topical corticosteroids. Twice-daily or more frequent application has not been shown to be more effective than once-daily application. A maintenance regimen of topical corticosteroids may reduce relapse rates in patients who have recurrent moderate to severe atopic dermatitis. Pimecrolimus and tacrolimus are calcineurin inhibitors that are recommended as second-line treatment for persons with moderate to severe atopic dermatitis and who are at risk of atrophy from topical corticosteroids. Although the U.S. Food and Drug Administration has issued a boxed warning about a possible link between these medications and skin malignancies and lymphoma, studies have not demonstrated a clear link. Topical and oral antibiotics may be used to treat secondary bacterial infections, but are not effective in preventing atopic dermatitis flare-ups. The effectiveness of alternative therapies, such as Chinese herbal preparations, homeopathy, hypnotherapy/biofeedback, and massage therapy, has not been established.

Role of gabapentin in the treatment of uremic pruritus.

OBJECTIVE: To evaluate the efficacy of gabapentin for the treatment of uremic pruritus (UP). DATA SOURCES: Literature retrieval was accessed through MEDLINE (1950-March week 3, 2008; In-Process & Other Non-Indexed Citations, April 1, 2008) and International Pharmaceutical Abstracts (1970-March 2008) using the terms gabapentin, pruritus, itch, urem$ (truncated), dialysis, and kidney disease. The Google Scholar search engine was used to identify articles that MEDLINE did not capture with the described search terms. Additionally, reference citations from publications identified were reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles in English and studies conducted in humans were identified and evaluated. DATA SYNTHESIS: UP is an unpleasant itching sensation that affects approximately 30% of patients on hemodialysis (HD). The current mainstays of therapy include antihistamines and topical therapies, although many patients remain symptomatic despite these treatments. Alternative therapeutic approaches, including topical, oral, and intravenous drugs; dialysis modifications; homeopathic therapies; and physical treatments have been used, but few evidence-based studies exist to support their utility. Gabapentin has been evaluated for the treatment of UP in 2 small, randomized, placebo-controlled studies, 1 pilot evaluation, and 1 index case. Gabapentin has demonstrated efficacy in the treatment of multiple types of itch and shows promise in treating patients with UP who are unresponsive to standard therapies. All of the controlled studies consisted of 4 weeks of active treatment, and no patients discontinued gabapentin due to adverse events. The most common adverse events noted in these trials were consistent with gabapentin's safety profile (dizziness, somnolence, fatigue, nausea). CONCLUSIONS: Available data support the use of gabapentin as a well-tolerated and effective treatment option for patients with UP who are unresponsive to traditional therapies. Further well-designed trials are warranted to establish the most appropriate dosing regimen in patients on HD.

Treatment of childhood eczema.

Eczema in childhood is almost always atopic eczema, a common disease with huge impact on the quality of life of the child and family. Although atopic eczema constitutes part of the atopic syndrome, avoidance of allergens is never enough for disease control. Treatment of eczema in childhood has the same components as in adults. Emollients constitute the preventive background therapy in all stages of eczema, and topical corticosteroids are still the mainstay of treatment. Infectious exacerbation may require the use of a short course of topical or systemic antimicrobials. UV phototherapy should be considered as an adjunctive treatment to assist topical corticosteroids after an acute exacerbation of the disease. Cyclosporine can also be used in the treatment of childhood eczema in severe cases. Maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house-dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, and topical coal tar are other temporarily used treatment modalities, without, however, firm evidence of efficacy from proper controlled trials. Calcineurin inhibitors constitute a new generation of drugs for both adult and childhood eczema already marketed in some countries. It is postulated that they will replace topical corticosteroids as first-line treatment of eczema.

Reliéva, a Mahonia aquifolium extract for the treatment of adult patients with atopic dermatitis.

This clinical study was conducted to determine the efficacy and safety of Reliéva cream in adult patients with atopic dermatitis (eczema). This was an open-label trial in 42 patients with atopic dermatitis treated for 12 weeks with Reliéva cream (a homeopathic product containing Psorberine, a proprietary Mahonia aquifolium extract). Efficacy and safety was assessed using Eczema Area and Severity Index scores and a Subject Reported Evaluation of Treatment. The results showed significant (P < 0.05) improvements with respect to Eczema Area and Severity Index scores by comparison to subjects' baseline scores. In addition, subjects responding to a posttreatment evaluation questionnaire indicated a substantial benefit when rating effectiveness, itching, and appearance as a result of using the study preparation. Reliéva cream appears to be a safe and effective treatment for adult patients with atopic dermatitis (eczema).

Homoeopathy for the treatment of lichen simplex chronicus: a case series.

Twenty-seven patients with chronic lichen simplex involving various parts of the body were treated. Hydrocotyle was prescribed to 21 patients in different potencies (6c, 30c, 200c, 1 M, 10 M), Thuja to three patients (1 M, 10 M), Graphites (6c), Kali bich (30c) and Sulphur (200c) to one patient each during 1 year study period. Only two patients showed complete improvement with Thuja and one with Graphites. In other cases, the response was limited to partial relief of [corrected] itching.

Katayama fever in scuba divers. A report of 3 cases.

Katayama fever or acute schistosomiasis probably occurs more commonly than is recorded. Interviews with a 3-man scuba diving team who had had contact with a large dam in an endemic area of the eastern Transvaal Lowveld at the same time and contact area on the same day during late summer of 1986 are discussed. Two, who had not previously been exposed to infected water, presented with Katayama fever, due to Schistosoma mansoni infection, 21 days after contact and it took 30-36 months for them to recover fully after several treatments. The third patient, a keen water-sportsman and resident in the endemic area for a period of 10 years, presented with a mild infection, probably due to acquired immunity initiated during previous contacts with infected water; he took about a year to recover. The pathogenesis, clinical features, diagnosis and treatment of the 3 cases are described in the light of recent observations made elsewhere on Katayama fever cases and the effects of chemotherapy on the course of illness. The necessity of obtaining basic information on the travel and water-contact activities of patients in order to make a diagnosis is emphasised.

Effects of homeopathic treatment on pruritus of haemodialysis patients: a randomised placebo-controlled double-blind trial.

Pruritus is a frequent and difficult to treat problem in haemodialysis. This double-blind placebo-controlled randomised clinical trial assessed the role of homeopathic treatment in this situation. The code was held by the pharmacist who dispensed the medications. Pruritus was evaluated using a previously published scale. Only patients with initial values above 25% of maximum pruritus score were entered. Data were analysed after partial code break, separating the two groups of patients, but with no awareness of which one received verum or placebo. Patients were classified as responders if they had >50% reduction of pruritus score. Twenty-eight patients (16M/12F, 51 +/- 11 years of age) were entered and 20 (12M/8F, 52 +/- 8 years of age) remained for final analysis: 11 in the verum group, 9 in placebo. At entry, the mean pruritus score was 65 +/- 25% for the treated patients and 70 +/- 27% for placebo. After 15, 30, 45, and 60 days of follow-up, pruritus score were respectively: 46 +/- 29, 41 +/- 30, 42 +/- 29, and 38 +/- 33 for the treated patients and 61 +/- 29, 67 +/- 31, 64 +/- 35, and 57 +/- 39 for placebo. Reduction was statistically significant (P<0.05) at every point of observation. According to the patients' own assessment, at the end of the study period, the homeopathic treatment reduced the pruritus score by approximately 49%. Responders were more frequent in the treated group with statistical significance at 30 days (0% vs 45%, P=0.038). Homeopathic treatment may represent a worthwhile alternative to relieve pruritus in patients undergoing haemodialysis.

Experimental human infection with the dog hookworm, Ancylostoma caninum.

OBJECTIVE: To investigate possible routes for human infection by the dog hookworm (Ancylostoma caninum). DESIGN, SETTING AND PARTICIPANT: Relatively small numbers of infective larvae were administered orally and percutaneously to an informed healthy volunteer (J K L) under medical supervision, at intervals between May 1998 and May 1999. MAIN OUTCOME MEASURES: Symptoms; weekly blood eosinophil counts; faecal microscopy. RESULTS: A marked blood eosinophilia followed a single oral exposure to 100 infective larvae, while faecal examination remained negative. Eosinophil counts then declined gradually, although a rapid, spontaneous rise several months later, at the beginning of spring, possibly indicated reactivation of dormant larvae. Blood eosinophil numbers did not rise significantly after percutaneous infection with 200 larvae. A subsequent, smaller, oral inoculum of 20 larvae provoked an eosinophil response similar to that of the first experiment. CONCLUSIONS: Our findings suggest that, following ingestion, some infective larvae of A. caninum develop directly into adult worms in the human gut (as they do in dogs). While the percutaneous route might be the most common means of human exposure to canine hookworm larvae, leading generally to subclinical infection, oral infection may be more likely to provoke symptomatic eosinophilic enteritis.

Homeopathic treatment of radiation-induced itching in breast cancer patients. A prospective observational study.

Following surgery for carcinoma of the breast, patients receive local radiotherapy. This can cause itching, which may be severe, in the radiation field. The affected skin usually is dry, rough and red. Twenty-five patients were treated homeopathically for radiation-induced itching. Fourteen patients developed itching during their course of post-operative radiation at 27 days median (range: 14-40). Eleven patients experienced itching in the radiation field after completion of treatment (median 21 days) after the end of their radiation treatment. A single dose of an individually selected homeopathic medicine in 30C dilution was given in the clinic, on the basis of repertorisation. Patients were asked to record a visual analogue scale (VAS) before prescription of the homeopathic medicine and at follow-up. Patients were evaluated at median 3 days (range: 1-27 days) after administration of the homeopathic medicine. In total, 14 of 25 patients (56%) responded to the first medicine. Nine patients had a second medicine, seven responded. Altogether 21 of 25 (84%) patients were successfully treated. The following medicines were employed successfully: Fl-ac 9/13, Rhus-t 3/5, Caust 2/3, Ign 2/2, Psor 2/2, gamma-ray 2/2 and Kali-bi 1/1. The VAS measurements before and after homeopathic treatment showed a reduction of the median value of 64mm (range: 20-100mm) to 34mm (median; range: 0-84mm). Homeopathic treatment of radiation-induced itching appears quite successful. The most frequently indicated and most frequently effective medicine was Fluoric acid. An approach that allows greater understanding of the patient as a whole in the short time available in a busy clinic may be required.

Dermatite atopica: avaliação de terapêutica complementar / Atopic dermatitis: an assessment of complementary therapeutic

Avaliar métodos terapêuticos não convencionais ou complementares no tratamento da dermatite atópica, por meio de uma revisão bibliográfica, enfocando o uso de probióticos, óleos essenciais, ervas chinesas e a possibilidade de uma terapia comportamental para o controle do prurido. Fontes pesquisadas: Foram revisadas as bases de dados LILACS, MEDLINE e SciFinder Schollar, com os descritores dermatite atópica, ácidos graxos essenciais, ervas medicinais, probióticos, psiquiatria e psicologia. Síntese de dados: A dermatite atópica, crônica e frequente na infância, requer tratamento que envolva desde medidas gerais até o uso de imunossupressores. A suplementação com ácidos graxos poliinsaturados ômega-3 na dieta destes pacientes pode diminuir a produção de mediadores inflamatórios e, até o momento, não há demonstração da sua eficácia na dermatite atópica. O uso de probióticos no início da vida pode reduzir a ocorrência de dermatite atópica pelo desvio da resposta imunológica para um perfil TH1, sem evidências científicas até o momento. O uso de ervas chinesas ocasionou melhora no prurido da dermatite atópica. A intervenção no comportamento destes pacientes é muito importante para melhorar a qualidade de vida, devido ao estresse ser um fator desencadeante para a dermatite atópica. Conclusões: Não há evidências científicas da eficácia do uso de ácidos graxos essenciais, probióticos e medidas comportamentais na dermatite atópica, porém são necessárias maiores pesquisas, pois algumas sugeriram melhora parcial de sintomas e sinais da doença...

To search complementary or nonconventionals therapeutics methods to treat atopic dermatitis through a bibliographic review, focusing on the use of probiotics, essential oils, chinese herbal medicine and the possibility of a behavioural therapy to reduce pruritus. Data Source: The LILACS, MEDLINE and SciFinder Schollar were searched with the keywords atopic dermatitis, essential fatty acids, medicinal plants, probiotics, psychiatry and psychology. Data Synthesis: Atopic dermatitis, achronic condition that often presents in early infancy, requires a treatment that includes ancillary therapies and immunomodulators. Oral a-linoleic polyunsaturated fatty acid supplementation showed decreased production of inflammatory mediators and, at this moment, there is no effectiveness in atopic dermatitis. The use of probiotics in early infancy can reduce the incidence of atopic dermatitis due the change to a TH1 immunological response, at this moment, with no scientific evidences. Chinese herbs caused improvement in pruritus on atopic dermatitis. Stress is a trigger for atopic dermatitis, so behavioural inverventions are very important to improve the quality of life of this patients. Conclusions: There is no scientific evidence of effectiveness about the use of essential fatty acids, probiotics and behavioural interventions in atopic dermatitis. However, more researchs are necessary, because some of them suggest partial improvement of symptoms and signals of the disease...