A prospective study of atopic dermatitis managed without topical corticosteroids for a 6-month period.

Topical corticosteroids (TCS) are regarded as the mainstay treatment for atopic dermatitis (AD). As AD has a tendency to heal naturally, the long-term efficacy of TCS in AD management should be compared with the outcomes seen in patients with AD not using TCS. However, there are few long-term studies that consider patients with AD not using TCS. We designed a prospective multicenter cohort study to assess the clinical outcomes in patients with AD who did not use TCS for 6 months and then compared our results with an earlier study by Furue et al which considered AD patients using TCS over 6 months. Our patients' clinical improvement was comparable with the patients described in Furue's research. In light of this, it is reasonable for physicians to manage AD patients who decline TCS, as the expected long-term prognosis is similar whether they use TCS or not.

Topical steroid addiction in atopic dermatitis.

The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome.

Topical clofibrate improves symptoms in patients with atopic dermatitis and reduces serum TARC levels: a randomized, double-blind, placebo-controlled pilot study.

BACKGROUND: Though topical corticosteroids (TC) are used for treating atopic dermatitis (AD) as a standard, there exist several problems including topical steroid addiction (TSA) or Red skin syndrome. Moreover, the number of patients, who refrain from using TC because of steroid-phobia, is increasing. Recently, topical PPAR alpha ligand application has been reported to improve experimental allergic dermatitis. The purpose of this study was to investigate the short-term efficacy and safety of topical clofibrate, one of PPAR alpha ligand, in such steroid-phobic patients with AD. METHODS: This study was conducted as a double-blind design to investigate the effects of random administration of topical clofibrate and base (placebo) on skin manifestation and blood parameters of patients for 2 weeks. Severity was digitized using severity scoring systems for atopic dermatitis by the Japanese Dermatological Association (SSS-JDA) before and after two weeks. Subjective severity of patients was evaluated using visual analog scale (Pt-VAS). Serum thymus and activation-regulated chemokine (TARC) and immunoglobulin E (IgE) were also investigated. RESULTS: Twenty patients were enrolled, and 19 of 20 patients completed the study. In 19 patients, the value of severity score using SSS-JDA was decreased significantly after administration of topical clofibrate (P=0.001). Subjective evaluation using Pt-VAS (P=0.008) and serum TARC levels (P=0.03) were also significantly decreased after two weeks of topical clofibrate. There was not a significant difference in serum IgE levels. No adverse effect was observed. CONCLUSIONS: Topical clofibrate is useful for patients with AD especially who are reluctant to use topical steroids.

Modulation of fecal polyamines by viewing humorous films in patients with atopic dermatitis.

BACKGROUND/OBJECTIVE: Alteration of intestinal flora was involved in the pathogenesis of atopic dermatitis. Patients with atopic dermatitis were less colonized with Lactobacilli or Bifidobacterium, whereas they were more colonized with Staphylococcus aureus or Enterobacteria. Consequently, fecal levels of bacterial metabolite (polyamines) were reduced. In contrast, stress also induced intestinal mucosal dysfunction against bacteria and impaired intestinal barrier function. We studied the effect of relaxation by viewing humorous films on fecal flora and fecal levels of polyamines. METHODS: Twenty-four healthy individuals and 24 patients with atopic dermatitis either viewed seven control nonhumorous films or seven humorous films sequentially for 7 days. Before and after viewing, feces were obtained, and fecal flora and fecal levels of polyamines were assessed. RESULTS: Neither viewing humorous films nor viewing control nonhumorous films had any effect on healthy individuals. In contrast, viewing humorous films (i) increased colonization with lactobacilli and bifidobacterium, (ii) decreased colonization with S. aureus and Enterobacteria, and (iii) increased fecal levels of polyamines; whereas viewing control nonhumorous films failed to do so in patients with atopic dermatitis. CONCLUSION: Viewing humorous films may modulate fecal levels of polyamines by restoring intestinal flora in atopic dermatitis.

Ethylene vinyl alcohol (EVOH) fiber compared to cotton underwear in the treatment of childhood atopic dermatitis: a double-blind randomized study.

The aim of this study was to evaluate the effect of underwear made of ethylene vinyl alcohol (EVOH) fiber in children with atopic dermatitis (AD). Twenty-one AD children (11 EVOH group and 10 control group) were studied for 4 weeks. Their AD severity based on the Scoring Atopic Dermatitis (SCORAD) score and physiological functions were assessed. The objective SCORAD significantly decreased in both groups. However, the SCORAD score (P<0.01) and urinary cortisol levels (P<0.05) were decreased only in EVOH group. It was concluded that EVOH fiber underwear might be useful for children with atopic dermatitis.

Viewing a humorous film decreases IgE production by seminal B cells from patients with atopic eczema.

OBJECTIVE: Sperms induced IgE production by seminal B cells from patients with atopic eczema via interaction of B cells with galectin-3 on sperms. We studied the effect of viewing a humorous film on IgE production by seminal B cells cultured with sperms. METHODS: Twenty-four male patients with atopic eczema viewed a humorous film (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, semen was collected, and seminal B cells and sperms were purified. Seminal B cells were cultured with sperms and IgE production was measured, while expression of galectin-3 on sperms was assessed. RESULTS: After viewing the humorous film, IgE production by B cells cultured with sperms was significantly decreased. Moreover, expression of galectin-3 on sperms was reduced. CONCLUSION: Viewing a humorous film reduced galectin-3 expression on sperms, which in turn decreased IgE production by seminal B cells cultured with sperms. These results indicate that viewing a humorous film may be helpful for the study and treatment of local IgE production and allergy in the reproductive tract.

Short-term improvement of erectile dysfunction by viewing humorous films in patients with atopic dermatitis.

INTRODUCTION: Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by eczema, pruritus and cutaneous hyperreactivity to allergic triggers. We and others have reported that psychogenic stress aggravates these symptoms, while viewing humorous films alleviates them. We have also found that many AD patients suffer from erectile dysfunction (ED). ED exhibits multifactorial etiologies, including psychogenic stress and reduction of serum testosterone levels. AIMS: This study assessed the effects of viewing humorous films on ED in patients with AD. MAIN OUTCOME MEASURES: The effects of viewing humorous films on International Index Erectile Function (IIEF) domain (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) were studied. METHODS: Subjects comprised 36 AD patients with ED and their healthy wives. Randomly assigned 18 patients and their healthy wives first viewed humorous films on three consecutive days (Days 1-3). After 2 weeks, they viewed control nonhumorous weather information films on three consecutive days (Days 1-3). Alternatively, other 18 patients and their wives first viewed control films on three consecutive days, and after 2 weeks they viewed humorous films on three consecutive days. Severity of ED and serum testosterone and estradiol levels were assessed 1 day before viewing (Day -1) and 1-4 days after viewing (Days 4-7). RESULTS: Viewing humorous films significantly improved the IIEF domain in association with increased serum testosterone levels and decreased serum estradiol levels on Day 4, while viewing control films failed to do so. However, this effect was short-term. After 4 days of viewing (Day 7), no improvement in ED or modulation of serum sex hormone levels was observed. CONCLUSIONS: Viewing humorous films improved ED in AD patients in association with increased serum testosterone levels and decreased serum estradiol levels. These results may be useful for the study and treatment of ED.

Elevation of testosterone and reduction of transepidermal water loss by viewing a humorous film in elderly patients with atopic dermatitis.

The effect of viewing a humorous film on salivary testosterone levels and transepidermal water loss (TEWL) values on the back of the neck in 36 elderly healthy people (36 male, mean 70 years) and 36 elderly patients with atopic dermatitis (AD) (36 male, mean age 70 years) were studied. Salivary testosterone levels were decreased while TEWL values were increased in elderly patients with AD compared to those in elderly healthy people. Viewing a humorous film (The Best Bits of Mr. Bean, Universal studios, 1996) slightly, but significantly (P<0.05), elevated salivary testosterone levels and reduced TEWL values in elderly healthy people, while viewing a control non-humorous film (weather information) failed to do so. Similarly, but more pronouncedly, viewing a humorous film markedly elevated salivary testosterone levels and reduced TEWL values in elderly patients with AD, while viewing a control non-humorous film failed to do so. These finding indicate that viewing a humorous film may be useful in the study of testosterone and TEWL, and treatment for dry skin in elderly people with or without AD.

Laughter elevates the levels of breast-milk melatonin.

OBJECTIVE: Patients with atopic eczema (AE) often complain of sleep disturbance. Melatonin is involved in sleep, and the levels of blood melatonin in patients with AE are decreased in comparison to healthy subjects. However, the levels of breast-milk melatonin had only been reported in healthy subjects. Laughter increased natural killer cell activity in blood and free radical-scavenging capacity in saliva in healthy subjects. Thus, the effect of laughter on the levels of breast-milk melatonin was studied in mothers with AE. Moreover, the effect of feeding with breast milk after laughter on allergic responses in infants was studied. METHODS: Forty-eight infants aged 5-6 months were enrolled. All of the infants had AE and were allergic to latex and house dust mite (HDM). Half (n=24) of the mothers of these infants were patients with AE, while another 24 mothers were healthy subjects. The mothers viewed either an 87-min humorous DVD (Modern Times, featuring Charlie Chaplin) or an 87-min nonhumorous weather information DVD at 2000 h. After viewing, breast milk was collected sequentially from 2200, 2400, 0200, 0400 to 0600 h. The levels of breast-milk melatonin were measured. In addition, skin wheal responses to HDM and histamine were studied in infants. RESULTS: Laughter caused by viewing a humorous DVD increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers. In addition, allergic responses to latex and HDM of infants were reduced by feeding with breast milk after laughter of mothers with AE or of healthy mothers. CONCLUSION: Laughter increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers, and feeding infants with increased levels of melatonin-containing milk reduced allergic responses in infants. Thus, laughter of mothers may be helpful in the treatment of infants with AE.

Viewing humorous film improves nighttime wakening in children with atopic dermatitis.

INTRODUCTION: Patients with atopic dermatitis suffered from night-time wakening, but the exact mechanism of it was not known. Ghrelin was involved in growth hormone secretion, regulation of appetite, anxiety,night-time wakening and stress. METHODS: Thus salivary ghreli levels during the night were measured in 40 healthy children or 40 patients with atopic dermatitis with night-time wakening. Salivary ghrelin levels at 02:00 h were markedly elevated in patients with atopic dermatitis compared to those in healthy children. RESULTS: Neither viewing control non-humorous film nor viewing humorous film had any effect on healthy children. In contrast, viewing humorous film improved night-time wakening and reduced elevation of salivary ghrelin levels in patients with atopic dermatitis, while viewing control film failed to do so. CONCLUSION: Viewing humorous film may be useful in the treatment of night-time wakening in patients with atopic dermatitis.

Increase in dermcidin-derived peptides in sweat of patients with atopic eczema caused by a humorous video.

OBJECTIVE: Dermcidin (DCD)-derived peptide is an antimicrobial peptide produced by the sweat glands. However, the levels of DCD-derived peptide in sweat were decreased in patients with atopic eczema (AE). The effect of viewing a humorous video on the levels of DCD-derived peptide was studied. METHODS: Twenty patients with AE viewed an 87-min humorous video (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, sweat was collected, and the levels of DCD-derived peptide and total protein in sweat were measured. RESULTS: Viewing a humorous video increased the levels of DCD-derived peptide without affecting the levels of total protein in sweat. CONCLUSION: Viewing a humorous video increased DCD-derived peptide in sweat of patients with AE, and thus, it may be helpful in the treatment of skin infection of AE.

Improvement of atopic dermatitis and reduction of skin allergic responses by oral intake of konjac ceramide.

Although topical application of ceramide is effective in the treatment of atopic dermatitis, its effect is transient. Thus, the effect of oral intake of ceramide on atopic dermatitis was studied. Two groups of 25 children with moderate atopic dermatitis, who were allergic to house dust mite took either milk sugar (control group) or 1.8 mg/day of konjac ceramide in milk sugar (ceramide group) once a day for 2 weeks. Before and after 2 weeks, skin symptoms were assessed using the SCORAD index, while allergic skin responses to house dust mite were assessed by skin prick test. Moreover, production of allergen-specific IgE and various cytokines by mononuclear cells was measured. After 2 weeks, SCORAD index score, allergic skin responses to house dust mite and house dust mite-specific IgE production were significantly reduced in the ceramide group, but not in the control group. Moreover, house dust mite-induced cytokine production was skewed towards the Th1 type, since production of Th1 cytokine, IFN-gamma, and IL-12, was increased, while production of Th2 cytokine, IL-4, and IL-13, was decreased. In contrast, no change of these parameters was found in control group. Collectively, oral intake of konjac ceramide improved skin symptoms and reduced allergic responses with concomitant skewing of the cytokine pattern towards the Th1 type.

Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy.

OBJECTIVE: Allergic responses are enhanced by stress, whereas they are reduced by laughter in atopic eczema patients. Emotion with tears decreases plasma IL-6 levels in patients with rheumatoid arthritis. Thus, the effect of emotion with tears on allergic responses in patients with atopic eczema was studied. METHODS: Sixty patients with atopic eczema having latex allergy viewed both the weather information video and the heart-warming movie, Kramer vs. Kramer. Just before and immediately after viewing each video, allergic responses to latex were measured. RESULTS: Viewing the weather information video did not cause emotion with tears in any patients, and it failed to modulate allergic responses. In contrast, viewing Kramer vs. Kramer caused emotion with tears in 44 of 60 patients, and it reduced allergic skin wheal responses to latex and latex-specific IgE production in them. CONCLUSION: Emotion with tears reduced allergic responses, and it may be useful in the treatment of allergic diseases.

Prevalence of suicidal ideation in patients with atopic dermatitis.

The prevalence of suicidal ideation in patients with mild, moderate, and severe atopic dermatitis between the age of 15 to 49 years were 0.21%, 6%, and 19.6%, respectively. In addition, the prevalence of homicide-suicidal ideation in mothers or fathers of patients (aged 0-14 years) with mild, moderate, and severe atopic dermatitis were 0.11%, 0.35%, and 3.28%, respectively. These results indicate that patients with atopic dermatitis or even parents of patients with atopic dermatitis have high prevalence of suicidal ideation.

Prevalence of fatty liver in non-obese Japanese children with atopic dermatitis.

Fatty liver in non-obese Japanese children was observed in 3.2% of non-atopic children and in 17.6% of patients with atopic dermatitis in 2000. The prevalence of fatty liver in non-obese children aged 0-12 years was studied from 2001 to 2003. Subjects were either non-atopic children, or suffering from bronchial asthma, allergic rhinitis, or atopic dermatitis. Fatty liver was studied by abdominal ultrasound scans. The prevalence of fatty liver was increasing annually, and it reached to 12.5% in non-atopic children, 13.1% in patients with bronchial asthma, 13.7% in patients with allergic rhinitis, or 33.9% in patients with atopic dermatitis, in 2003. Since fatty liver in childhood may be a risk factor for lifestyle-related diseases in future, care should be taken to prevent it.

Cholesterol selectively enhances in vitro latex-specific IgE production in atopic dermatitis patients with latex allergy.

Effect of cholesterol on in vitro latex-specific IgE production by mononuclear cells from atopic dermatitis patients with latex allergy. Cholesterol enhanced latex-specific IgE production in a dose-dependent fashion, and maximal enhancement was achieved at 1 microg/ml. In contrast, cholesterol had no effect on latex -specific IgA or IgG4 production. Study for cytokine production revealed that cholesterol decreased latex-induced production of IFN-gamma and IL-12, while it increased latex-induced production of IL-4, IL-10 and IL-13. These results indicate that cholesterol skews cytokine pattern toward Th2 type. Collectively, cholesterol may increase allergen-specific IgE production, which may in turn aggravate allergic symptoms.