Challenging a paradigm: skin sensitivity to sodium lauryl sulfate is independent of atopic diathesis.

BACKGROUND: Sodium lauryl sulfate (SLS) is the best-studied detergent in irritant contact dermatitis. In atopic dermatitis, the two major pathophysiological abnormalities concern skin barrier function and regulation of cutaneous immune responses. The probability of atopic skin diathesis can be assessed by comprehensive analysis of patient history, as well as clinical and laboratory findings, resulting in the Erlangen Atopy Score (EAS). OBJECTIVES: To investigate the impacts of (i) atopic skin diathesis according to the EAS and (ii) the physician-assessed diagnoses 'atopic dermatitis', 'allergic rhinitis' and 'allergic asthma' on SLS skin reactions. METHODS: This is a retrospective analysis of data from 2030 consecutive patients patch tested with SLS (0·25% aqueous) from two tertiary referral centres in Germany, from 2008 to 2014. RESULTS: Patients with a high probability of atopic skin diathesis showed no significant increase in positive SLS reactions compared with patients without atopic skin diathesis (14·2% vs. 16·8%). The grading of positive SLS skin reactions (1-4) revealed no differences in patients with or without atopic skin diathesis. Furthermore, diagnoses of atopic dermatitis, allergic rhinitis or allergic asthma had no impact on positive SLS skin reactions in multivariate logistic regression analysis. CONCLUSIONS: We found no association of increased skin irritability to SLS with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. It therefore seems that the test of skin irritability with SLS, which is currently common practice in many centres, does not allow prediction of susceptibility to irritant eczematous inflammation in atopic vs. nonatopic individuals. What's already known about this topic? Irritant contact dermatitis and atopic skin diathesis share impaired skin barrier function as a pathophysiological pattern. Sodium lauryl sulfate (SLS) is tested at 0·25% aqueous as an irritant control in patch testing, and hence the results might be affected by atopic skin diathesis. What does this study add? Challenging a long-standing paradigm, we found no association of increased reactivity to SLS patch tests in individuals with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. Thus, irritant control testing with SLS, which is useful in interpreting doubtful allergen patch test results, does not depend on individual atopy status.

The genetic basis for most patients with pustular skin disease remains elusive.

BACKGROUND: Rare variants in the genes IL36RN, CARD14 and AP1S3 have been identified to cause or contribute to pustular skin diseases, primarily generalized pustular psoriasis (GPP). OBJECTIVES: To better understand the disease relevance of these genes, we screened our cohorts of patients with pustular skin diseases [primarily GPP and palmoplantar pustular psoriasis (PPP)] for coding changes in these three genes. Carriers of single heterozygous IL36RN mutations were screened for a second mutation in IL36RN. METHODS: Coding exons of IL36RN, CARD14 and AP1S3 were sequenced in 67 patients - 61 with GPP, two with acute generalized exanthematous pustulosis and four with acrodermatitis continua of Hallopeau. We screened IL36RN and AP1S3 for intragenic copy-number variants and 258 patients with PPP for coding changes in AP1S3. Eleven heterozygous IL36RN mutations carriers were analysed for a second noncoding IL36RN mutation. Genotype-phenotype correlations in carriers/noncarriers of IL36RN mutations were assessed within the GPP cohort. RESULTS: The majority of patients (GPP, 64%) did not carry rare variants in any of the three genes. Biallelic and monoallelic IL36RN mutations were identified in 15 and five patients with GPP, respectively. Noncoding rare IL36RN variants were not identified in heterozygous carriers. The only significant genotype-phenotype correlation observed for IL36RN mutation carriers was early age at disease onset. Additional rare CARD14 or AP1S3 variants were identified in 15% of IL36RN mutation carriers. CONCLUSIONS: The identification of IL36RN mutation carriers harbouring additional rare variants in CARD14 or AP1S3 indicates a more complex mode of inheritance of pustular psoriasis. Our results suggest that, in heterozygous IL36RN mutation carriers, there are additional disease-causing genetic factors outside IL36RN.

Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey.

BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). Anecdotally, prescribing practice differs widely between centres. OBJECTIVES: The Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce was founded to establish patterns of use of propranolol in IHs. METHODS: Participating centres entered data on all of their patients who had completed treatment with oral propranolol for IHs, using an online data capture tool. RESULTS: The study cohort comprised 1097 children from 39 centres in eight European countries. 76·1% were female and 92·8% had a focal IH, with the remainder showing a segmental, multifocal or indeterminate pattern. The main indications for treatment were periocular location (29·3%), risk of cosmetic disfigurement (21·1%) and ulceration and bleeding (20·6%). In total 69·2% of patients were titrated up to a maintenance regimen, which consisted of 2 mg kg(-1) per day (85·8%) in the majority of cases. 91·4% of patients had an excellent or good response to treatment. Rebound growth occurred in 14·1% upon stopping, of whom 53·9% were restarted and treatment response was recaptured in 91·6% of cases. While there was no significant difference in the treatment response, comparing a daily maintenance dose of < 2 mg kg(-1) vs. 2 mg kg(-1) vs. > 2 mg kg(-1) , the risk of adverse events was significantly higher: odds ratio (OR) 1 vs. adjusted OR 0·70, 95% confidence interval (CI) 0·33-1·50, P = 0·36 vs. OR 2·38, 95% CI 1·04-5·46, P = 0·04, Ptrend < 0·001. CONCLUSIONS: The PITCH survey summarizes the use of oral propranolol across 39 European centres, in a variety of IH phases, and could be used to inform treatment guidelines and the design of an interventional study.

[Medication-based therapy of infantile hemangioma and lymphatic malformations]. / Medikamentöse Behandlungsansätze für infantile Hämangiome und lymphatische Malformationen.

The therapy of vascular tumors and malformations should be interdisciplinary and performed according to available guidelines. Infantile hemangiomas (IH) are the most frequent vascular tumors of childhood and do not require treatment in most cases. If the IH is complicated by its location (e.g. facial or genital) or if the lesion threatens to cause loss of function, small localized IH should be treated by laser- or cryotherapy. If the IH is diffuse or rapidly growing it can be successfully treated using the ß blocker propranolol. The mechanism underlying the efficacy of this medication-based therapy is not completely understood and this still represents an experimental therapy. The results of molecular studies on vascular malformations have indicated new strategies for medical therapies. However, lymphatic malformations (LM) are still treated by surgery where possible, or sclerotherapy. Further investigations are necessary to determine whether new drugs such as the mTOR inhibitor rapamycin may be effective for treatment of diffuse LM. First case reports seem to be promising.

Successful treatment of ulcerated haemangioma with propranolol.

BACKGROUND: Ulceration is a frequent complication of proliferating haemangioma. METHODS: Four patients with ulcerated hemangioma aged 2, 4, 5 months and 5 weeks were treated with 2 mg/kg KG propranolol. RESULTS: Efficacy and safety of propranolol were excellent in all four cases. CONCLUSIONS: Propranolol may be the first-choice therapy for ulcerated haemangioma.

Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection.

OBJECTIVE: To determine the feasibility of using frozen-thawed testicular spermatozoa for intracytoplasmic sperm injection. DESIGN: Prospective clinical study. SETTING: A university hospital. PATIENT(S): One hundred seventy-five azoospermic men participating in a routine intracytoplasmic sperm injection program. INTERVENTION(S): The men underwent testicular biopsy for cryopreservation of tissue to be used in consecutive intracytoplasmic sperm injection treatment cycles. Their female partners underwent controlled ovarian hyperstimulation for conventional IVF treatment. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy rates. RESULT(S): In 77% of the patients, spermatozoa could be harvested from the testis by an open testicular biopsy technique and used for intracytoplasmic sperm injection after freezing and thawing of testicular tissue. Histopathologic evaluation revealed a Sertoli cell-only pattern in 21%, maturation arrest in 60%, and hypospermatogenesis in 19% of the patients. In 2. 9% of the patients, carcinoma in situ or a germ cell tumor was detected. In all patients, viable spermatozoa could be visualized after the tissue samples were thawed. One hundred thirty-five intracytoplasmic sperm injection treatment cycles were performed, with a fertilization rate of 45% and a clinical pregnancy rate of 30% per oocyte retrieved. CONCLUSION(S): The use of frozen-thawed testicular tissue allows ovarian stimulation of the female partner to be timed and avoids cancellation of ovum pick-up when spermatozoa cannot be retrieved.

Differences in sexual attitudes and likeliness of sexual behaviors of black lower-socioeconomic father-present vs. father-absent female adolescents.

This study compared sexual permissiveness attitudes and likely behaviors of father-absent vs. father-present black, lower-socioeconomic female adolescents. Father-absent subjects were not found to be more sexually permissive in reported likely behavior or attitude than father-present subjects. However, the father-absent group was found to have significantly greater inconsistency between behavioral and attitudinal scores in which the reported behavior was more permissive than the reported attitude. Finally, within the father-absent group, those subjects whose fathers became absent before they were five years old, were found to have a significantly higher need for social approval than subjects whose fathers became absent after they were five years old. The implications of these results are discussed.

Are childhood misbehavior and physical illness factors in the development of self-defeating personality.

49 undergraduate men and 45 women took Schill's 1990 Self-defeating Personality Scale and answered questions about their physical health and misbehavior as children and the amount of attention such behavior elicited from their parents. No support was found for the idea that individuals who currently score more self-defeating had been more likely to engage in such behavior or had been able to gain attention thereby. In fact, these people reported getting less rather than more attention from parents when they were physically ill. Results were discussed as consistent with prior findings wherein self-defeating individuals have described their parents as being nonsupportive, inconsistent, and rejecting.

Self-handicapping and obesity: is there a sympathetic audience out there?

After reading a case description of a 20-year-old woman, subjects attributed her personal shortcomings to her weight rather than to herself per se. In particular, people who scored higher on a measure of self-handicapping were even more likely to attribute shortcomings to a person's weight and excuse or overlook them. A person who attributes shortcomings to being overweight will very likely find a sympathetic audience. These results support the suggestion by Baumeister, Kahn, and Tice (1990) that obesity can be a self-handicapping strategy.

Social skills of persons with self-defeating personality.

55 undergraduate men and 55 women took Schill's 1990 Self-defeating Personality Scale and Lorr, Youniss, and Stefic's (1991) multidimensional Social Relations Survey. As expected, persons who endorsed more self-defeating characteristics scored lower on scales which make up the Social Skills or Assertiveness Factor. However, these scores did not have significant correlations with the Empathy or Social Approval Need Scales; two of the three scales which make up the Empathy Factor. The results were discussed in terms of prior work relating deficits in social skills to dysfunctional early parenting.

A validity study of the MMPI-TRI Acting-out Scale.

49 college men and 45 women were administered the 1995 MMPI-TRI by Swanson, Templer, Thomas-Dobson, Cannon, Streiner, Reynolds, and Miller and a short form of the MMPI with scales for Subjective Distress, Acting-out, and Psychosis. To test the validity of the Acting-out scale respondents also took measures of sexual and aggressive acting out as well as a measure of alcohol use. They were asked about their use of drugs. Women had significant correlations between scores on the Acting-out Scale and scores on measures of Sexual Sensation Seeking .57, Sexual Compulsion .54, Anger Control -.40, Anger-out .50, Anger-in .32, and Drug Use .40. Men had significant correlations for scores on measures of Sexual Compulsion .51, Anger Control -.39, Anger-in .37, and Alcohol Use .35 but not Anger-out. Results suggest the Acting-out scale is more valid for college women than for men.

Self-defeating personality, argumentativeness, and assertive self-statements.

55 men and 55 women were administered Schill's Self-defeating Personality Scale, an argumentativeness scale, and a measure of assertive self-statements. Women with higher scores on the Self-defeating Personality Scale had lower scores on the argumentativeness scale. Both men and women scoring higher on the Self-defeating Personality Scale recalled having thoughts which inhibited them from making assertive statements. These results were discussed as supporting prior research showing that persons reporting more self-defeating characteristics were relatively unassertive.

Adult attachment, love styles, and self-defeating personality characteristics.

The present research showed for 79 men and 79 women that people with more characteristics of the proposed self-defeating personality diagnosis had less secure adult attachments. In addition, self-defeating women described their style of loving as game playing and being less romantically involved. Both men and women who were more self-defeating, once in a relationship, reported feeling dependent, jealous, and desperate to maintain it. These results are consistent with the 1993 findings of Williams and Schill that people with more self-defeating characteristics were more likely to lack secure attachments with parents.

Attachment histories for people with characteristics of self-defeating personality.

Correlations of undergraduates' responses (79 men, 79 women) to the Self-defeating Personality Scale and Gough and Heilbrun's Adjective Check List indicated people who had more characteristics of self-defeating personality were more likely to recall ambivalent and avoidant attachment histories regarding their mothers. There was a tendency for men to recall avoidant attachment histories for fathers as well. These results lend some support to Glickhauf-Hughes and Wells who in 1991 contended being reared in an unpredictable environment by parents who are ambivalent contributes to the development of self-defeating personality. The rs suggest these characteristics are related to cold and rejecting parenting as well.

Self-defeating personality, self-reinforcement, and depression.

51 men who were more self-defeating were observed to use lower frequency of self-reinforcement and to be more depressed. The results were seen as supporting Beck's early work which proposed a relationship between depression and self-defeating patterns. They also provide construct validity for the measure of Self-defeating Personality used in the study.

Self-defeating personality and strategies for coping with stress.

People who scored higher on a measure of self-defeating personality also scored low on ego-strength, showed an external locus of control, and used less adaptive coping strategies than those who scored lower. These strategies (denial, mental disengagement, alcohol and drug use) were viewed as helping to perpetuate their positions as victims.

Relation among self-defeating personality, troubled eating patterns, and dissociation.

Significant small correlations were found between scores on a measure of self-defeating personality with scores on the Bulimia Test-Revised (r = .27) and also scores on the Dissociative Experiences Scale (r = .20) for a sample of 165 college women. The correlation between the Bulimia Test and the Dissociative Experiences Scale was .26. Although the research literature led us to expect stronger relationships on theoretical and empirical grounds, it appears these small relationships were more likely due to the fact that scoring higher on all these measures indicates greater psychopathology.

Relation between MacAndrew Scale scores and coping styles.

Correlations between MacAndrew Alcoholism Scale scores and styles of coping for 66 college women indicated higher MacAndrew scores felt more dysfunctional under stress, were more prone to use drugs and alcohol to cope, and had a greater tendency to seek out others, including professionals, for help with their problems. Results were seen as support for the utility of the MacAndrew Scale with college women although the scale was constructed on and for male alcoholics.

Relationships between Schill's Self-defeating Personality Scale and Coolidge's Personality Disorders Inventory.

81 men and 82 women were administered Schill's (1990) Self-defeating Personality Scale and Coolidge's (1992) Axis Two Inventory. As expected, Schill's and Coolidge's measures of self-defeating personality disorder were highly correlated (.70 for men and .74 for women). Scores on Schill's scale also had correlations > .50 with scores on six of the other personality disorder scales for men and five for women. This argues against self-defeating personality disorder as measured by Schill's scale being a distinct construct. The pattern of the correlations suggests that besides assessing a person's maladaptive self-defeating traits, Schill's measure also may assess the person's anxiety and concerns about interpersonal relationships.