Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study.

The purpose of this study was to investigate whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients. In a double-blind, multicentre study lasting 4 months, during wintertime, 145 patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n-3 fatty acids, or an isoenergetic amount of corn oil. As local treatment, only an emollient cream or hydrocortisone cream was allowed. The fatty acid pattern in serum phospholipids, and the dietary intake of nutrients were monitored in a subgroup of patients, and the results were compared with a group of patients with psoriasis. The overall clinical score, as evaluated by the physicians, improved during the trial by 30% in the fish oil (P < 0.001) and 24% in the corn oil group (P < 0.001). This was also consistent with the results from a selected skin area, and it was further confirmed by the total subjective clinical score reported by the patients. There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study. In the fish oil group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values (P < 0.001), whereas the level of n-6 fatty acids was decreased (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis.

BACKGROUND: In several studies dietary fish oil has been found to have beneficial effect on psoriasis, but the results are contradictory and based mainly on open studies or studies of small numbers of patients. METHODS: In a four-month double-blind, multicenter trial, we randomly assigned 145 patients with moderate-to-severe psoriasis to receive in their diet either highly purified ethyl esters of n-3 fatty acids ("fish oil"; 6 g of oil per day, containing 5 g of eicosapentaenoic and docosahexaenoic acid) or an isoenergetic amount of corn oil containing mainly n-6 fatty acids. All the patients were advised to reduce their intake of saturated fatty acids. A 48-hour dietary recall was performed, and the fatty-acid pattern in the serum phospholipids was monitored in a subgroup of patients. RESULTS: In the fish-oil group, n-3 fatty acids were increased in serum phospholipids (P < 0.001), the ratio of arachidonic acid to eicosapentaenoic acid decreased (P < 0.001), and the level of n-6 fatty acids decreased (P < 0.001). In the corn-oil group, only docosahexaenoic acid increased significantly (P < 0.05). The ratio of polyunsaturated to saturated fatty acids increased in both groups. Plasma concentrations of triacylglycerol decreased from base line in the fish-oil group (P < 0.05). The score on the Psoriasis Area and Severity Index, as evaluated by the physicians, did not change significantly during the trial in either group. This was also true of a total subjective score reported by the patients, but a selected area of skin in the corn-oil group showed a significant reduction in the clinical signs (P < 0.05). Scaling was reduced from base line in both groups (P < 0.01). The fish-oil group had less cellular infiltration (P < 0.01), and the corn-oil group had improvement in desquamation and redness (P < 0.05). There was no significant difference in clinical manifestations between the groups. Among the patients in the fish-oil group, an increase in the concentration of n-3 fatty acids in serum phospholipids was not accompanied by clinical improvement, whereas in the corn-oil group there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids. CONCLUSIONS: Dietary supplementation with very-long-chain n-3 fatty acids was no better than corn-oil supplementation in treating psoriasis. Clinical improvement was not correlated with an increase in the concentration of n-3 fatty acids in serum phospholipids among the patients in the fish-oil group, whereas there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids in the corn-oil group.

[Malignant melanoma--a warning. How to reduce mortality?]. / Malignt melanom--et varsko. Hvordan redusere dødeligheten?

Incidence of malignant melanoma of the skin has risen rapidly during the last decades. Mortality rates are also rising, although not so much as incidence rates. There is strong evidence that exposure to sunlight is a major factor in the etiology of melanomas. There appears to be no direct cumulative dose-response relationship, except in the case of lentigo maligna melanoma. Episodes of sunburn among children and young individuals seem to be more important as an etiologic factor for melanoma than chronic exposure to the sun. Very high risk of melanoma exists in persons with dysplastic nevus syndrome. Persons with giant congenital nevi are also at increased risk. However, many melanomas arise de novo. It is our intention to reduce mortality by screening families at risk, by early detection and treatment of melanomas, and by education.

Effect of n-3 fatty acid supplement to patients with atopic dermatitis.

The effects of dietary supplement with n-3 fatty acids to patients with atopic dermatitis were investigated in a 12-week, prospective, double-blind study. The experimental group received daily 10 g of fish oil, containing 3 g n-3 fatty acids, of which eicosapentaenoic acid represented about 1.8 g. The controls received an isoenergetic placebo supplement containing olive oil. Compliance was monitored by gas chromatographic analysis of fatty acid pattern in serum phospholipids. Results favoured the experimental group with regard to scale (P less than 0.05), itch (P less than 0.05) and overall subjective severity (P less than 0.02) as compared to the controls.

Grading of the severity of atopic dermatitis.

A simple system for baseline grading the severity of atopic dermatitis in clinical work, is presented. The grading, which may be carried out on the basis of one single consultation, permits distinction between mild, moderate and severe atopic dermatitis by means of a score summation using the following parameters: 1) extent (by "rule of nine"), 2) course (via history) and 3) intensity (disturbance of night's sleep by itching).

Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis.

The effects of a dietary supplement of n-3 fatty acids in patients with atopic dermatitis were investigated in a 12-week, double-blind study. The experimental group received 10 g of fish oil daily, of which about 1.8 g was eicosapentaenoic acid. This amount of eicosapentaenoic acid can be obtained from a daily intake of fat fish. The controls received an iso-energetic placebo supplement containing olive oil. Compliance was monitored by gas-chromatographic analysis of the fatty acid pattern in serum phospholipids. Results favoured the experimental group with regard to scale (P less than 0.05), itch (P less than 0.05) and overall subjective severity (P less than 0.02) as compared to the controls.

Atopic dermatitis. Correlation of environmental factors with frequency.

Answers to a questionnaire on atopic dermatitis sent to clinicians in different countries--excluding Europe and North America--were evaluated. The questions included frequency as well as the possible role of special influencing/aggravating factors in atopic dermatitis patients. According to the data from 19 different countries, climatologic/geographic conditions, profession, and psychic stress have a decisive role, whereas food items have a smaller role in the course of atopic dermatitis.

Treatment of acanthosis nigricans with etretinate (Tigason) in a patient with Lawrence-Seip syndrome (generalized lipodystrophy).

The major symptoms of Lawrence-Seip syndrome or generalized lipodystrophy consist of muscle hypertrophy, loss of subcutaneous fat, hyperlipaemia, diabetes mellitus and acanthosis nigricans. We have successfully treated acanthosis nigricans in a patient with Lawrence-Seip syndrome.

Hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream versus desonide (Apolar) 0.1% ointment in the treatment of patients suffering from atopic dermatitis.

A randomized, double-blind, left-right study to compare the therapeutic efficacy and the cosmetic acceptability of the new hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream application form with desonide (Apolar) 0.1% ointment was performed in thirty patients suffering from moderate to severe atopic dermatitis. The medications were applied to symmetrical, bilateral skin lesions twice daily for 4 weeks. Both treatments effected highly significant reductions of the score values for the severity of all clinical skin parameters assessed. Score reductions were, however, more pronounced on Locoid-treated sides than on Apolar-treated sides both after 2 and 4 weeks of therapy. It appeared further that clinical efficacy of treatment at completion of the study was also in favour of Locoid-treated sides, indicating that Locoid fatty cream is more effective than Apolar ointment. No serious side-effects were reported during the study. The expressed patient preferences with respect to cosmetic acceptability of treatments were significantly in favour of Locoid fatty cream, indicating that patients preferred the use of this new galenic formulation over an ointment formulation. It is concluded that the new application form of Locoid, a fatty cream, is a useful and beneficial addition to topical corticosteroid therapy, which will promote patient compliance in a wide range of corticosteroid-responsive skin diseases.

[Acrodermatitis papulosa eruptiva infantum as a prodrome in hepatitis B infection]. / Acrodermatitis papulosa eruptiva infantum als Prodrom bei Hepatitis-B-Infektion.

We report on a 4-year-old boy suffering from typical infantile papular acrodermatitis with an unusual course. The eruption occurred seven weeks before the signs and symptoms of hepatitis. Only trace concentrations of hepatitis B surface antigen (HBsAg) could be detected after three weeks history of the disease. The lesions which persisted for nine weeks were itching, and there were signs of superinfection. We found only localized lymphadenopathy. The condition developed into a chronic HBsAg carrier state.

On therapeutic approaches to some special types of acne.

The aim of the present study was to evaluate different treatment schedules in some different types of acne using a quantitative counting technique. Systemic treatment with erythromycine 0.5 g daily and topical treatment with clindamycin phosphate solution 1% was found to be optimal from the efficacy/side effect ratio. The combined treatment was tried in heat-provoked and cosmetic acne with favourable results. Doubling of erythromycine dosage could not prevent premenstrual exacerbation of acne. Diazepam 4 mg daily for two weeks followed by an antihistamine in addition to erythromycine 0.5 g daily gave relatively good results in female patients with acne excorié. In acne coexisting with pronounced seborrhoic dermatitis of the face the addition of hydrocortisone cream 1% was of benefit, although Roaccutane may here be the drug of choice. In female postpubertal acne, the effect of cyproteronacetate-etynilestradiol (Diane) was not superior to treatment with erythromycine 0.5 g daily. By treating special subtypes differently, one could be able to improve the results of acne therapy.

Pregnancy and porphyria cutanea tarda.

A 31-year-old woman developed typical clinical and laboratory signs of PCT at the end of her second pregnancy coincident with the summer season. She had elevated liver function values without history of alcoholism, hepatitis or chemical liver damage. She had taken oral contraceptive only before her first pregnancy which was normal. Her hormone analytic values including estrogens corresponded to normal values in pregnancy. Venesections had a beneficial affect on her condition.

Atopic dermatitis and Sézary syndrome.

A patient with severe atopic dermatitis had pre-Sézary and Sézary syndromes. Although elevated serum IgE values in mycosis fungoides and Sézary syndrome are not infrequent, the direct sequential occurrence of atopic dermatitis and Sézary syndrome is uncommon. The clinical and laboratory changes we observed imply that the relationship of these disorders may be conditioned by changes in immunoresponsiveness.