Electroacupuncture inhibits mast cell degranulation via cannabinoid CB2 receptors in a rat model of allergic contact dermatitis.

OBJECTIVE: Cannabinoid CB2 receptors (CB2Rs) are mainly present on immune cells including mast cells, which participate in 2,4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis (ACD). In this study, we aimed to investigate whether inhibition of mast cell degranulation was involved in the anti-ACD effect of electroacupuncture (EA) at ST36 via CB2R. METHODS: Sprague-Dawley rats were sensitised and challenged with DNFB following EA stimulation for 1 week. Ear swelling, serum IgE levels, local cytokine production and mast cell infiltration were evaluated. Additionally, rat peritoneal mast cells (RPMCs) were isolated and cultured for detection of CB2R expression, mitogen-activated protein kinase (MAPK) signalling activation and mast cell degranulation (including ß-hexosaminidase and histamine release) in the presence or absence of CB2R antagonists. RESULTS: EA treatment inhibited ear swelling, suppressed IgE and cytokine production, decreased the number of mast cells and curbed mast cell degranulation, which was associated with the inhibition of p38 phosphorylation in DNFB-induced ACD. Importantly, EA enhanced the expression of CB2R mRNA and protein in the RPMCs. CB2R antagonist AM630 but not CB1R antagonist AM251 effectively reversed the suppressive effect of EA on p38 activation, mast cell infiltration and degranulation. CONCLUSION: These findings provide more evidence to support the hypothesis that EA promotes CB2R expression in mast cells, which is followed by inhibition of the p38 MAPK pathway, potentially resulting in the anti-ACD effect of EA. This suggests that EA at ST36 may be an effective candidate therapy for treating inflammatory skin diseases such as ACD.

Chronic hand eczema in Germany: 5-year follow-up data from the CARPE registry.

BACKGROUND: The CARPE registry was set up in 2009 to prospectively investigate the management of patients with chronic hand eczema (CHE). OBJECTIVES: To report comprehensive follow-up data from the CARPE registry. PATIENTS AND METHODS: We investigated sociodemographic and clinical characteristics, provision of medical care, physician-assessed outcomes, and patient-reported outcomes (PROs). Data were collected between 2009 and 2016, with up to 5 years of follow-up, and are reported descriptively. RESULTS: Overall, 1281 patients were included in the registry (53.7% female). Mean age was 47.0 years. Of the patients, 793 and 231 completed the 2-year follow-up and 5-year follow-up, respectively. At baseline, 5.4% had changed or given up their job because of CHE, the average duration of CHE was 6.1 years, and, in 22.4%, the CHE was severe according to physician global assessment. Systemic treatment (alitretinoin, acitretin, and methotrexate) was prescribed at least once to 39.0% of the patients during the course of the follow-up. Disease severity, quality of life and treatment satisfaction improved over time, and the proportion of patients receiving systemic treatments decreased. CONCLUSIONS: Under continued dermatological care, substantial improvements in disease severity and PROs over time was achieved during the course of the CARPE registry, even in patients with long-standing and severe hand eczema.

Involvement of the Negative Feedback of IL-33 Signaling in the Anti-Inflammatory Effect of Electro-acupuncture on Allergic Contact Dermatitis via Targeting MicroRNA-155 in Mast Cells.

In this study, we aimed to investigate the effect of electro-acupuncture (EA) at the Zusanli acupoint (ST36) on interleukin (IL)-33-mediated mast cell activation. Firstly, 2,4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis (ACD) in rats was developed with or without EA treatment. Then, rat peritoneal mast cells (RPMCs) were obtained and cultured in the presence of IL-33. EA treatment relieved ear swelling and reduced mast cell infiltration in the local inflammation area with DNFB challenge, accompanying the decrement of IL-33 production. RPMCs isolated from ACD rats with EA treatment showed significant downregulation of IL-6, TNF-α, IL-13, and MCP-1 production following IL-33 stimulation. However, there was no obvious difference in surface ST2 receptor expression among different groups. In addition, EA selectively altered IL-33 signaling, suppressing p38 phosphorylation as well as NF-κB- and AP-1-mediated transcription but not Akt phosphorylation. Importantly, EA lowered microRNA (miR)-155 expression in the RPMCs, which presented a positive correlation with IL-33-induced IL-6 production. Furthermore, overexpression of miR-155 in the RPMCs was established following miR-155 mimic transfection. RPMCs with the overexpressed miR-155 displayed an obvious increment of inflammatory cytokine and abrogated the inhibitive effect of EA on NF-κB- and AP-1-regulated transcription in response to IL-33 compared with those without transfected-miR-155. These findings demonstrate EA treatment inhibits NF-κB and AP-1 activation as well as promotes the negative feedback regulation of IL-33 signaling via targeting miR-155 in mast cells, which contribute to the anti-inflammatory effect of EA on DNFB-induced ACD in rats.

Effects of Acupuncture on 1-chloro-2,4-dinitrochlorobenzene-induced Allergic Contact Dermatitis in Mice.

Allergic contact dermatitis (ACD) is a chronic inflammatory skin disease. Topical corticosteroids are the first-line therapy for ACD despite their significant adverse effects. Acupuncture has been widely used in the treatment of various skin diseases, but its underlying mechanism remains unrevealed. In this study, we investigated the characteristics of acupuncture treatment based on effectiveness and mechanism. BALB/c mice received 1-chloro-2,4-dinitrobenzene (DNCB) application to build AD-like model. Results showed that acupuncture was an effective treatment method in inhibiting inflammatory conditions, serum IgE levels, and expression of proinflammatory cytokine Th2 (IL-4, IL-6), and Th2 (IL-1ß, TNF-α) mRNA compared with DNCB treatment. Acupuncture treatment also inhibited nuclear factor-κB p65, phosphorylation of IκBα, and phosphorylation of occludin proteins expression. Furthermore, it could improve the expression of epidermal growth factor in both mRNA and protein levels. These results suggest that acupuncture, as an alternative therapy treatment for its no significant side effects, was effective in alleviating ACD by reducing proinflammatory cytokines and changing proteins' expression.

Heat immersion therapy-A new approach for contact dermatitis to propolis?

No disponible

Topical botanically derived products: use, skin reactions, and usefulness of patch tests. A multicentre Italian study.

BACKGROUND: The evidence on the safety of topical preparations containing botanical extracts is limited. OBJECTIVES: To assess (i) the use of botanically derived compounds in a large population, (ii) the incidence of cutaneous side-effects, and (iii) the diagnostic usefulness of patch testing. METHODS: A questionnaire was used in 2661 patients to assess both the prevalence and type of topical botanical preparations used, and the occurrence of adverse skin reactions. Patients declaring adverse reactions were patch tested with (i) the Italian (SIDAPA) baseline series, (ii) an additional botanical series, and (iii) the patients' own products. RESULTS: Of the patients, 1274 (48%) reported the use of topical botanical products; 139 patients (11%) commented on adverse cutaneous reactions; 75 (54%) showed positive reactions with the Italian baseline series. Among the 122 patients tested with the botanical series, 19 (16%) showed positive reactions, in many cases with concomitant relevant positivity to at least one allergen of the Italian series connected with cosmetics. The commonest botanically derived allergens were propolis, Compositae extracts, and Melaleuca alternifolia (tea tree) oil. CONCLUSIONS: Contact allergy is a possible adverse effect of natural products. Baseline series supplemented with the commonest botanical allergens may be adequate for detecting most of the cases of contact allergy to natural topical products.

Surgery for a tree surgeon? Acute presentation of contact dermatitis due to Ailanthus altissima.

A tree surgeon presented to hospital with multiple blackening, non-blanching regions of skin on both forearms, following exposure to sap from the 'tree of heaven' (Ailanthus altissima). A referral to plastic surgery was made to consider debridement. Following input from the national poisons centre and dermatology, conservative management with emollient was undertaken. The lesions blistered and exfoliated and were treated with topical steroid and oral antihistamines. Resolving erythema was the only symptom at three weeks. A. altissima, also known as the 'tree of heaven' has known toxins in its bark, leaves and flowers but is also commonly used in folk medicine. Two previous cases of contact dermatitis are reported in the literature but not with acute photo documentation of the lesions or with surgical referral. This demonstrates an important lesson that debridement would not be the appropriate management despite the initial presentation.

Topical and systemic therapies for nickel allergy.

Nickel allergy can result in both cutaneous and systemic manifestations, and can range from mild to severe symptoms. A severe form of this allergy is the Systemic nickel allergy syndrome, clinically characterized by cutaneous manifestions (contact dermatitis, pompholyx, hand dermatitis dyshydrosis, urticaria) with chronic course and systemic symptoms (headache, asthenia, itching, and gastrointestinal disorders related to histopathological alterations of gastrointestinal mucosa, borderline with celiac disease). This review aims to briefly update the reader on past and current therapies for nickel contact allergy.

Systemic contact dermatitis.

Systemic contact dermatitis (SCD) describes a cutaneous eruption in response to systemic exposure to an allergen. The exact pathologic mechanism remains uncertain. The broad spectrum of presentations that are often nonspecific can make it difficult for the clinician to suspect this disease, but it is an important diagnosis to consider in cases of recalcitrant, widespread, or recurrent dermatitis, in which patch testing often reveals allergy to nickel or balsam of Peru. Diagnosis and appropriate management can be life-altering for affected patients. This article on SCD provides an overview of the disease with descriptions of common allergens and some insight into the possible mechanism of action seen in SCD.

Pharmacotherapy for allergic contact dermatitis.

Allergic contact dermatitis is a highly prevalent, potentially chronic disease, with a significant economic and quality of life impact. Culprit causal allergen(s) can be identified though patch testing, the 'gold-standard' diagnostic method. For most people, identification and subsequent avoidance of their clinically relevant allergens will results in resolution of the dermatitis. However, when an avoidance regimen is not possible, or an allergen is not identified, patients potentially require symptomatic and immunosuppressive therapy to diminish the manifestations of their disease. This article reviews a therapeutic approach to allergic contact dermatitis.

Use of complementary and alternative treatment for allergic contact dermatitis.

BACKGROUND: Previous studies show that use of complementary and alternative medicine (CAM) is frequent among dermatological patients in general and that the use of CAM is linked to disease severity and duration. OBJECTIVES: To investigate factors influencing the use of CAM and visits to alternative practitioners among patients with allergic contact dermatitis. METHODS: The study was a postal questionnaire survey among 485 patients with allergic contact dermatitis to fragrances and preservatives in consumer products. The questionnaire included questions about use of conventional treatment, use of CAM and visits to alternative therapists. It also included questions about eczema severity and duration as well as social factors. The patients were recruited from one dermatological clinic in the capital city area and two clinics in smaller cities. RESULTS: The response rate was 79%. Forty per cent of respondents were users of CAM, predominantly in combination with conventional treatment, and 29% had visited an alternative practitioner. Women were found to be significantly more frequent users of CAM and visitors to alternative practitioners than men, and patients from urban/rural districts reported more frequent use of CAM than patients from the capital city area. Frequent eczema eruptions, hand eczema, long duration of disease and work-related problems were positively associated with use of CAM and/or visits to alternative practitioners. CONCLUSIONS: The typical CAM user is female, lives in a rural district or town (not the capital area), has long disease duration and often work-related problems. Overall, the use of CAM is not an alternative to conventional treatment, but is a supplement.

Utilización de extractos de avena sativa l. en dermatitis / Utilization of avena sativa l. extract in dermatitis

Los polifenoles (flavonoides y antocianinas) están ampliamente distribuidos entre las diferentes especies vegetales. Estos poseen gran capacidad antioxidante; existiendo correlación positiva entre la actividad antioxidante y los polifenoles totales. El objetivo de este trabajo fue evaluar: 1° El contenido de polifenoles y antocianas totales de semillas, glumelas y extracto acuoso de Avena sativa L. 2° El efecto de la aplicación tópica de extracto acuoso de avena en 45 casos (10 mujeres y 35 hombres, entre 1 y 56 años de edad) con dermatitis atópica, dermatitis de contacto irritativa y dermatitis de contacto alérgica; y 30 controles normales (15 mujeres y 15 hombres, entre 1 y 60 años de edad). Tratamiento: aplicación de compresas del extracto crudo de avena en la piel dañada durante 5 minutos, seguida de la colocación de la biomasa (T°= 33 + 2°C) cubierta por una tela de gasa durante 5 minutos. Dicha biomasa se retira con el extracto de avena líquido. Entre 1 y 36 meses de iniciado el tratamiento se observó remisión de los síntomas cutáneos. El extracto acuoso, la biomasa de Avena sativa L., glumelas y semillas enteras contenían 6.12+0,45, 46,11+0,36, 212,81+0,19 y 286,60+0,50 mg/100 g ác. Gálico, respectivamente, de polifenoles totales.

Polyphenols (flavonoids and anthocyanins) are widely spread among the different vegetables species. They have a big antioxidant capacity. One important correlation exists between the antioxidant activity and the quantity of total polyphenols. The objective of this work was to evaluate: 1- the contents of polyphenols and anthocyanins of whole seeds, glumes and aqueous extract of Avena Sativa L., 2- the effects of topical application of aqueous extract of Avena sativa L. in 45 patients (10 females and 35 males, between 1 and 56 years olds) with Atopic Dermatitis, Contact Irritative Dermatitis and Contact Allergic Dermatitis, and 30 normal controls (15 females and 15 males, between 1 and 60 years olds). Treatment: were applications of compress of aqueous extract Avena Sativa L over the damaged skin for approximately five minutes, immediately after, one must cover with the biomass of oat (T° = 33 + 2 C°) and a clothe for five minutes. The biomass was removed using the Avena Sativa L. acqueous extract. Remissions of the cutaneous symptoms were noticed between 1 and 36 months after the beginning of the treatment. Aqueous extract, Avena Sativa L. biomass, glumes and whole seeds contents were: 6.12+0.45; 46.11+0.36, 212.81+0.19 y 286.60+0.50 mg/100 g gallic ac., respectively, of total polyphenols.

[Allergic contact dermatitis: how to re-induce tolerance?]. / Eczéma allergique de contact: comment ré-induire une tolérance?

Allergic contact dermatitis (ACD) is a skin inflammatory disease mediated by activation of CD8+ cytotoxic T cells specific for haptens in contact with the skin. CD4+ T cells behave as both regulatory and tolerogenic cells since they down-regulate the skin inflammation in patients with ACD (regulation) and prevent the development of eczema (tolerance) in normal individuals. Thus, ACD corresponds to a breakdown of immune tolerance to haptens in contact with the skin. Several regulatory CD4+ T cell subsets (Treg), especially CD4+CD25+ natural Treg cells, are involved in immunological tolerance and regulation to haptens through the production of the immunosuppressive cytokines IL-10 and TGF-beta. Ongoing strategies to re-induce immune tolerance to haptens in patients with eczema include improvement of existing methods of tolerance induction (oral tolerance, low dose tolerance, allergen-specific immunotherapy, UV-induced tolerance) as well as development of new drugs able to activate IL-10 producing Treg cells in vivo. Ongoing and future progress in this area will open up new avenues for treatment of eczema and more generally autoimmune and allergic diseases resulting from a breakdown of tolerance to autoantigens and allergens, respectively.

Cosmetic allergy: incidence, diagnosis, and management.

A recent epidemiologic survey in the UK revealed that 23% of women and 13.8% of men experience some sort of adverse reaction to a personal care product over the course of a year. Although most of these reactions may be due to subjective sensory irritation, various studies reveal that up to 10% of dermatologic patients who are patch tested are allergic to cosmetic products or their constituent ingredients. Causative products include deodorants and perfumes, skin care products, hair care products, and nail cosmetics. Allergic contact dermatitis mainly results from fragrance chemicals and preservatives. Recent work has suggested that additional fragrance chemicals may need to be tested in order to identify those patients 'missed' by the current fragrance mix; in particular, hydroxy-isohexyl-3-cyclohexene carboxaldehyde (HMPPC Lyral) has been singled out as an important sensitizing agent. The increased usage of natural fragrances and botanic extracts can also cause problems in their own right or through co-reactivity. The preservative methyldibromo glutaronitrile has also been recognized as an increasingly important sensitizer in Europe, which has led to the recent recommendation that it should be prohibited from 'leave-on' products until information on 'safe' consumer levels becomes available. Other emerging allergens include UV filters, tosylamide/formaldehyde resin, and nail acrylates. The diagnosis of cosmetic allergy should be confirmed with patch testing, including testing of 'whole' products, when necessary, and repeat open application tests can be used to confirm the relevance of reactions in cases of doubt.

Treatment of irritant and allergic contact dermatitis.

The treatment of contact dermatitis lies principally in the avoidance of the offending agent. In certain circumstances, avoidance protocols are insurmountable, and therapy is rendered to assuage the inflammatory component and its consequent objective and subjective findings. However, the options thereafter vary, as some patients will require continuous symptomatic therapy despite avoidance of the purported offending agent. This manuscript will review established treatment options for contact dermatitis, such as corticosteroids and dietary manipulation, as well as discuss some promising new therapies from the last decade, such as the immunomodulatory and anti-inflammatory agents.

Cutaneous field stimulation of sensory nerve fibers reduces itch without affecting contact dermatitis.

BACKGROUND: A new technique, cutaneous field stimulation (CFS), which activates electrically unmyelinated C-fibers, is used to treat localized itch. Its action is similar to that of capsaicin, the pungent agent in hot peppers, which enhances delayed allergic reactions. The aim of the study was to investigate how experimental contact dermatitis responds to CFS. METHODS: Twelve patients with contact dermatitis in response to nickel were treated by CFS for 1 h each for four consecutive days. A flexible plate containing electrodes was applied to a test area on the upper arm and was stimulated by a constant current (0.8 mA). On the fifth day, patients were provoked by epicutaneous application of nickel sulfate (allergic contact dermatitis) and benzalkonium chloride (irritant contact dermatitis), and by intradermal tuberculin (delayed immunologic reaction). Twelve other patients with IgE-mediated allergy were treated by CFS on the lower arm for 1 h and were then pricked with histamine and allergen extracts (wheal volume was measured) and were tested using benzoic acid (nonimmunologic contact urticaria; closed test). Ten of these patients were also treated by CFS for four days, and experiments were performed on the fifth day. RESULTS: Test reactions to nickel, benzalkonium, and tuberculin were found to be unaffected by CFS treatment. Although allergic prick test reactions were enhanced (by 28%) after a single CFS treatment, the associated itch was significantly reduced both after single and repeated CFS treatments (by 65% and 38%, respectively). CONCLUSIONS: Repeated use of CFS to reduce itch has no adverse effects on contact dermatitis.