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1.
Arerugi ; 68(6): 696-700, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31308336

RESUMO

Atopic dermatitis and bronchial asthma are common diseases in children. We report the development of eosinophilic polyangiitis granulomatosis (EGPA) in a young girl being treated for both atopic dermatitis, diagnosed at 1 year of age, and bronchial asthma, diagnosed at 4 years of age. Her eruption did not result in lichenification and was not fully responsive to corticosteroid ointment. Asthma lightened by treatment of inhalational steroids. Hypereosinophilia was detected at 5 years of age, at least 20% of white blood cells, and 44% at 8 years of age. At 10 years of age, she was diagnosed with anti-neutrophil cytoplasmic antibody-negative EGPA. The diagnosis was based on findings of eosinophil-infiltrating granulomatous vasculitis of the skin accompanied by notable peripheral blood eosinophilia, sinusitis, and pulmonary nodules on radiographic evaluation. Asymptomatic myocardial involvement was also detected utilizing dual perfusion and metabolic scintigraphy with 201Tl/123I-BMIPP, which was relieved by 1-year treatment of glucocorticoid combined with immunosuppressive drugs. EGPA is an extremely rare vasculitis that develops several years after preceding allergic disorders. Pediatric-onset EGPA has a poorer prognosis than adult-onset EGPA, which can be attributed to a high prevalence of cardiac involvement. Therefore, accurate diagnosis is critical for improving prognosis. EGPA should be considered when atypical findings are noted in management of atopic dermatitis and bronchial asthma.


Assuntos
Asma/complicações , Síndrome de Churg-Strauss/diagnóstico , Dermatite Atópica/complicações , Eczema/complicações , Corticosteroides/uso terapêutico , Asma/diagnóstico , Criança , Pré-Escolar , Síndrome de Churg-Strauss/complicações , Dermatite Atópica/diagnóstico , Eczema/diagnóstico , Feminino , Humanos
2.
Hautarzt ; 70(10): 773-777, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31359075

RESUMO

BACKGROUND: To enhance the informative value and comparability of hand eczema trials, the consensus of a set of core outcomes is necessary. OBJECTIVES: How is success of therapeutic and preventive interventions currently determined in hand eczema trials? Which standard should apply in the future? MATERIALS AND METHODS: As a first step, a systematic literature review was conducted to describe the status in controlled and randomized-controlled hand eczema trials from 2000-2017 and to identify the applied outcomes. The Hand Eczema Core Outcome Set (HECOS) initiative follows the guidelines of the Cochrane Skin Group Core Outcomes Set Initiative (CS-COUSIN) so that its further process is going to ensure the validity of the proposed measurement instruments and the appropriate inclusion of patients', physicians', and researchers' perspectives. RESULTS: Previous trials predominantly assessed erythema, scaling, fissures, vesicles, or pruritus as clinical signs and symptoms of hand eczema. These variables were often not reported separately but as part of a variety of scores. Only few hand eczema scores were applied in more than one trial-most commonly the Hand Eczema Severity Index (HECSI, in 10% of the trials). Overall skin condition, without mentioning specific signs or symptoms, was assessed in 51% of the trials. CONCLUSIONS: Although certain clinical signs and symptoms were assessed by a majority of hand eczema trials, comparability of results was not ensured because various measurement instruments were applied. HECOS is going to agree on a set of relevant and valid core outcome measurement instruments.


Assuntos
Dermatite Atópica/diagnóstico , Dermatologia/normas , Eczema/diagnóstico , /normas , Ensaios Clínicos como Assunto , Dermatite Atópica/complicações , Eczema/complicações , Previsões , Humanos , Prurido/etiologia , Índice de Gravidade de Doença , Avaliação de Sintomas
3.
J Dermatol ; 46(8): 680-685, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187925

RESUMO

Systemic treatment options for chronic hand eczema are limited. Dupilumab is used in atopic dermatitis (AD) but is not licensed for (isolated) hand eczema. In this observational prospective study we aimed to determine the response of hand eczema to dupilumab in patients with AD. Adult patients with hand eczema and AD received dupilumab s.c. at a 600 mg loading dose, followed by 300 mg every 2 weeks. Primary outcome was a minimum improvement of 75% on the Hand Eczema Severity Index after 16 weeks (HECSI-75). Secondary outcomes were severity, measured using the Photographic guide; quality of life improvement as patient-reported outcome, measured using the Dermatology Life Quality Index (DLQI); and AD severity, measured using the Eczema Area and Severity Index (EASI). Forty-seven patients were included (32 males; mean age, 45 years). HECSI-75 was achieved by 28 (60%). Mean HECSI score reduction was 49.2 points (range, 0-164; 95% within-subject confidence interval, 46.4-52.0), which was already significantly decreased after 4 weeks (P < 0.001). DLQI score mean improvement was 8.8 points (standard deviation [SD], 6.0) or 70.0% decrease (SD, 26.4) (P < 0.001). Eighteen patients (38%) were classified as responders on the Photographic guide. There was no difference in response between chronic fissured and recurrent vesicular clinical subtypes. Similar percentages of patients achieving EASI-75 and HECSI-75 were seen after 16 weeks. In conclusion, this study shows a favorable response of hand eczema to dupilumab in patients with AD. This raises the question whether a response will also be seen in isolated hand eczema.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Eczema/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Doença Crônica/tratamento farmacológico , Dermatite Atópica/complicações , Método Duplo-Cego , Esquema de Medicação , Eczema/complicações , Eczema/diagnóstico por imagem , Eczema/imunologia , Feminino , Mãos , Humanos , Injeções Subcutâneas , Subunidade alfa de Receptor de Interleucina-4/antagonistas & inibidores , Subunidade alfa de Receptor de Interleucina-4/imunologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Fotografação , Estudos Prospectivos , Qualidade de Vida , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
4.
Int J Dermatol ; 58(8): 976-981, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31168791

RESUMO

BACKGROUND: Sleep problems are common in patients with dermatologic disorders. However, it is unknown whether inflammatory skin disorders are associated with more sleep problems than noninflammatory skin disorders. PURPOSE: To determine whether sleep problems occur more frequently in people with inflammatory skin disorders compared to noninflammatory skin disorders. STUDY DESIGN: Observational case-control study. METHODS: Patients with inflammatory skin disorders (psoriasis [n = 17] and chronic eczema [n = 30]) and noninflammatory skin disorders (nonmelanoma skin cancers [NMSC] [n = 31]) were enrolled. Data collection occurred during a single visit. Statistical analysis of questionnaire results between groups utilized inverse propensity score weighted (IPSW) ANOVA and logistic regression models. RESULTS: Groups differed in mean (SD) age (P < 0.001) and itch severity (P < 0.001). Based on IPSW ANOVA models, the inflammatory group had significantly higher fatigue scores (mean [95% CI]; 32.0 [28.4-35.5]) than the noninflammatory group (25.5 [21.6-29.3]; P = 0.017). The inflammatory group odds of insomnia were significantly greater based on two definitions of insomnia, ISI ≥ 15 and PSSQ-I, with odds ratios (95% CI) of 14.4 (2.16-525) and 4.82 (1.45-20.7), respectively. These results were consistent in comparisons between the three groups, with no difference between psoriasis and chronic eczema, but with chronic eczema, significantly more were affected than NMSC. CONCLUSIONS: Patients with inflammatory skin disorders report significantly more fatigue and have higher odds of insomnia compared to patients with noninflammatory skin cancers.


Assuntos
Eczema/complicações , Fadiga/epidemiologia , Psoríase/complicações , Neoplasias Cutâneas/complicações , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Estudos de Casos e Controles , Doença Crônica , Fadiga/diagnóstico , Fadiga/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/etiologia , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
6.
Medicine (Baltimore) ; 98(17): e15264, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027078

RESUMO

RATIONALE: Histoplasmosis occurs most commonly in Northern and Central America and Southeast Asia. Increased international travel in Japan has led to a few annual reports of imported histoplasmosis. Healed sites of histoplasmosis lung infection may remain as nodules and are often accompanied by calcification. Previous studies in endemic areas supported the hypothesis that new infection/reinfection, rather than reactivation, is the main etiology of symptomatic histoplasmosis. No previous reports have presented clinical evidence of reactivation. PATIENT CONCERNS: An 83-year-old Japanese man was hospitalized with general fatigue and high fever. He had been treated with prednisolone at 13 mg/d for 7 years because of an eczematous skin disease. He had a history of travel to Los Angeles, Egypt, and Malaysia 10 to 15 years prior to admission. Five years earlier, computed tomography (CT) identified a solitary calcified nodule in the left lingual lung segment. The nodule size remained unchanged throughout a 5-year observation period. Upon admission, his respiratory condition remained stable while breathing room air. CT revealed small, randomly distributed nodular shadows in the bilateral lungs, in addition to the solitary nodule. DIAGNOSIS: Disseminated histoplasmosis, based on fungal staining and cultures of autopsy specimens. INTERVENTIONS: The patient's fever continued despite several days of treatment with meropenem, minocycline, and micafungin. Although he refused bone marrow aspiration, isoniazid, rifampicin, ethambutol, and prednisolone were administered for a tentative diagnosis of miliary tuberculosis. OUTCOMES: His fever persisted, and a laboratory examination indicated severe thrombocytopenia with disseminated intravascular coagulation. He died on day 43 postadmission. During autopsy, the fungal burden was noted to be higher in the calcified nodule than in the disseminated nodules of the lung, suggesting a pathogenesis involving endogenous reactivation of the nodule and subsequent hematogenous and lymphatic spread. LESSONS: Physicians should consider histoplasmosis in patients with calcified nodules because the infection may reactivate during long-term corticosteroid therapy.


Assuntos
Histoplasmose/patologia , Pneumopatias Fúngicas/patologia , Idoso de 80 Anos ou mais , Calcinose , Eczema/complicações , Eczema/tratamento farmacológico , Glucocorticoides/uso terapêutico , Histoplasmose/complicações , Humanos , Hospedeiro Imunocomprometido , Japão , Pneumopatias Fúngicas/complicações , Masculino , Tomografia Computadorizada por Raios X
7.
Immun Inflamm Dis ; 7(2): 74-85, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30859748

RESUMO

INTRODUCTION: Allergen-specific immunoglobulin isotype formation associated with immunoglobulin class-switching during the lactation period is the immunological background for food allergy in infants. We analyzed the serial changes in the production of feeding type-related egg- and milk-specific immunoglobulin isotypes from birth to 6 months of age with or without eczema in 84 infants. METHODS: Allergen-specific immunoglobulin G1 (IgG1), IgG2, IgG3, IgG4, IgA, and IgE levels of hen's egg and bovine milk were measured in cord blood and blood samples from infants at 2, 4, and 6 months of age by the densely carboxylated protein microarray. RESULTS: Formula and mixed feeding were associated with a rapid increase in cow's milk allergen-specific immunoglobulins and feeding type-related significant differences in casein-specific immunoglobulin levels were detected. Breast and mixed feeding were associated with slow but significant increase in ovalbumin-specific IgG1 and IgE levels, but not other immunoglobulins. We found two different immunoglobulin isotype formation at 6 months of age with low- or high-affinity IgE against ovalbumin. One isotype formation pattern had relatively high ovalbumin-specific IgG1 levels, detectable IgG2, and low-affinity IgE, while the other had low ovalbumin-specific IgG1 levels, undetectable IgG2, and high levels of high-affinity IgE. The incidence of eczema was significantly higher in the latter pattern (84.6%), compared with the remaining infants (42.2%). CONCLUSIONS: Feeding practice-related allergen sensitization and immunoglobulin isotype formation were identified during the lactation period. The development of eczema during the lactation period could potentially modify the immunoglobulin isotype formation with high levels of high-affinity IgE.


Assuntos
Alérgenos/imunologia , Eczema/imunologia , Hipersensibilidade a Ovo/imunologia , Ovos/efeitos adversos , Switching de Imunoglobulina/imunologia , Imunoglobulina E/imunologia , Hipersensibilidade a Leite/imunologia , Leite/efeitos adversos , Fatores Etários , Animais , Afinidade de Anticorpos/imunologia , Formação de Anticorpos/imunologia , Especificidade de Anticorpos/imunologia , Bovinos , Galinhas , Eczema/complicações , Hipersensibilidade a Ovo/complicações , Hipersensibilidade a Ovo/genética , Feminino , Humanos , Isotipos de Imunoglobulinas/genética , Isotipos de Imunoglobulinas/imunologia , Lactente , Recém-Nascido , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/genética , Gravidez
8.
J Atheroscler Thromb ; 26(9): 775-782, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30700678

RESUMO

AIM: Previous studies suggested a positive association between eczema and cardiovascular disease (CVD), probably through enhanced systemic inflammation. However, several studies reported null findings about eczema and CVD, so the evidence is still controversial. METHODS: We asked 85,099 participants (35,489 men and 49,610 women), aged 40 to 79 years, without a history of CVD or cancer at baseline between 1988 and 1990, to complete a lifestyle questionnaire, including information eczema frequency (seldom, sometimes or often). RESULTS: During the 6,389,818 person-years of follow-up, there were 1,174 deaths from coronary heart disease (CHD), 979 from heart failure, 366 from cardiac arrhythmia, 2,454 from total stroke, 1,357 from ischemic stroke, 1,013 from hemorrhagic stroke, and 201 from aortic aneurysm or dissection. The multivariable-adjusted model showed that individuals who "sometimes" or "often" had eczema had 0.82 (95%confidence interval (CI): 0.69-0.97) or 1.26 (95%CI: 1.01-1.56) times the risk of mortality from CHD, respectively, compared to those who "seldom" did. Individuals who "often" had 1.30 (95%CI: 1.05-1.61) times the risk of mortality from CHD, compared to those who "seldom or sometimes" did. There was no association of eczema with mortality from other CVD, or no interaction between eczema and sex or age, in relation to any CVD mortality risk. CONCLUSIONS: Self-reported frequent eczema was associated with increased risk of mortality from CHD, but not other major CVD, in a Japanese general population. Since steroid usage was not considered, future studies should include it as a potential confounding factor.


Assuntos
Doenças Cardiovasculares/mortalidade , Eczema/complicações , Estilo de Vida , Autorrelato , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Taxa de Sobrevida
10.
J Dermatol ; 45(11): 1301-1305, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30264908

RESUMO

Hand eczema (HE) is a common skin disease that impairs health-related quality of life (HRQOL). Impairments in HRQOL have already been reported in Japanese HE patients using the Skindex-16. Recently, an instrument to measure disease-specific HRQOL in HE patients was developed by an international expert group, consisting of domains for: (i) symptoms; (ii) emotions; (iii) functioning; and (iv) treatment and prevention. The objective of this study is to translate the English-language version of the Quality of Life Hand Eczema Questionnaire (QOLHEQ) to Japanese and then to validate the Japanese version. The Japanese version of the QOLHEQ, the Dermatological Life Quality Index (DLQI) and a questionnaire regarding basic demographic information, including patient ratings of HE severity, were distributed to Japanese HE patients. Additionally, a dermatologist evaluated patients' HE severity using the Physician Global Assessment. A total of 124 patients with a mean age of 43.7 years were included in the analysis, and 78% of the sample was female. Cronbach's alphas for the domains symptoms, emotions, functioning, and treatment and prevention were 0.76, 0.89, 0.88 and 0.81, respectively. The total QOLHEQ score showed a strong correlation with the DLQI, a moderate correlation with patient-rated severity and weak correlations with dermatologist-rated severity and the number of consultations. The Japanese version of the QOLHEQ showed excellent reliability and high validity. The Japanese version of the QOLHEQ is ready for use in epidemiological studies to evaluate HRQOL impairments in HE patients.


Assuntos
Eczema/complicações , Dermatoses da Mão/complicações , Qualidade de Vida , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Eczema/diagnóstico , Feminino , Dermatoses da Mão/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Adulto Jovem
12.
Clin Pediatr (Phila) ; 57(14): 1624-1629, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30141340

RESUMO

The multitude of treatment options for atopic dermatitis (AD) makes management frustrating for providers and patients. Eczema action plans (EAPs) have been proposed to improve parental and provider management. We developed a single-site randomized controlled trial to evaluate the impact of an EAP on quality of life (QOL), provider knowledge, and comfort with AD management. Providers were randomized into an EAP-use group and a traditional care group. All patients completed validated AD QOL surveys, and those with AD were verbally administered the survey 1 month later. Providers' perceptions on managing AD were compared in the EAP and usual use groups. Parents in the EAP group demonstrated a significantly increased understanding of AD treatment, and providers in the EAP group had a significantly increased understanding and management of AD. The EAP is a feasible tool that can be integrated into a busy clinic practice with a positive impact on physicians and patients.


Assuntos
Dermatite Atópica/terapia , Eczema/terapia , Planejamento de Assistência ao Paciente , Qualidade de Vida , Adolescente , Adulto , Criança , Pré-Escolar , Competência Clínica , Dermatite Atópica/complicações , Eczema/complicações , Feminino , Humanos , Lactente , Masculino , Pais , Inquéritos e Questionários
13.
Sci Rep ; 8(1): 10754, 2018 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-30018382

RESUMO

Itching is a leading symptom of eczema or dermatitis and has a great impact on patients' lives. Previous studies on itching have focused mostly on atopic dermatitis (AD). A cross-sectional multicenter study was conducted among outpatients with eczema from 39 tertiary hospitals in mainland China from July 1 to September 30, 2014. This work elaborates on itching in different types of eczema. Itching was very common (97%, 8499/8758) in outpatients with eczema. The severity of the itch increased with age and disease duration (P < 0.001). The top three subtypes of dermatitis with severe itching were atopic dermatitis (30.4%), widespread eczema (30.1%), and asteatotic eczema (27.9%). Widespread eczema refers to the involvement of more than three body parts, without clinical features of other specific types of eczema. The proportion of outpatients without itching was highest in hand eczema (6.8%). Positive correlations were observed between the severity of itching and the proportions of different diseases based on trend tests, including atopic dermatitis (P < 0.001), widespread eczema (P < 0.001), asteatotic eczema (P < 0.001), and autosensitization dermatitis (P < 0.001). Eczema outpatients with older age, longer disease duration, and, especially, a history of allergic diseases might be more prone to itching.


Assuntos
Dermatite/complicações , Eczema/complicações , Prurido/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/complicações , Centros de Atenção Terciária
14.
Clin Pediatr (Phila) ; 57(13): 1506-1514, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30008244

RESUMO

We investigated factors associated with quality of life (QOL) in children with eczema. We conducted a cross-sectional analysis of survey data from 224 parents of children with eczema attending a large, hospital-based pediatric clinic. Parents completed a validated eczema severity scale (Patient-Oriented Eczema Measure), a QOL scale (Infants' Dermatitis QOL Index or Children's Dermatology Life Quality Index), and a knowledge and understanding questionnaire. In adjusted multivariate analyses, worse eczema severity was associated with worse overall QOL (ß = 0.5; 95% confidence interval [CI] = [0.5, 0.6]), while a higher knowledge score was associated with better QOL (ß = -3.4; 95% CI = [-6.6, -0.2]). Similarly, even after adjustment for eczema severity, greater understanding of a child's individual treatment plan was associated with better QOL (ß = -0.7; 95% CI = [-1.4, -0.08]), while increased frequency of worrying about a child's eczema was associated with worse QOL (ß = 0.7; 95% CI = [0.03, 1.1]). These results suggest primary care providers may be able to influence QOL through optimal eczema management and family education.


Assuntos
Eczema/complicações , Eczema/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Qualidade de Vida , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Atenção Primária à Saúde , Índice de Gravidade de Doença , Inquéritos e Questionários
15.
J Affect Disord ; 238: 458-464, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29929155

RESUMO

BACKGROUND: Several studies were conducted to investigate the association between eczema and risk of depression. This was important because the care of patients with eczema might be inadequate if their psychological problems were not also recognized and treated. However, these studies had some inherent limitations such as small sample sizes or lack of controlling for potential confounders. Further, little was known about psychological co-morbidity of eczema from a global perspective. METHODS: We conducted a systematic literature search in PubMed (1966 through January 26th 2017), Cochrane Library (the Cochrane central register of controlled trials, up to January 26th 2017), Scopus (up to December 31st 2016) and Embase (1980 through January 26th 2017) supplemented by manual searches of bibliographies and conference proceedings. The relative risk (RR) with 95% confidence interval (CI) was estimated. RESULTS: Ten studies with a total of 188,495 patients were included. Overall, the random effects model summarizing all comparisons suggested a positive association between eczema and risk of depression, the pooled RR was 2.02 (95% confidence interval 1.76 to 2.31, I²â€¯= 33.7%). Similar results were observed in subgroup analysis by region. LIMITATIONS: Methodological limitations such as selection biases, sample sizes, severity of other diseases, treatment strategy, age and other factors might have influenced the results. CONCLUSIONS: Our study showed that patients with eczema were associated with an increased risk of depression. These findings implicated that clinical doctors should continue to be more aware of the association between eczema and the risk of depression.


Assuntos
Depressão/complicações , Depressão/terapia , Eczema/complicações , Eczema/terapia , Adulto , Ensaios Clínicos como Assunto , Medicina Baseada em Evidências , Feminino , Humanos , Risco
16.
Minerva Med ; 109(4): 276-279, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29696940

RESUMO

BACKGROUND: Superficial thrombophlebitis (STP) is a relatively frequent pathology characterized by possible extension to the deep venous circulation, with notable local inflammatory reaction which is treated by subcutaneous administration of Fondaparinux. Stasis dermo-hypodermitis is characterized by cutaneous hyperpigmentation and eczema, treatment for which consists of the use of drugs targeting endothelial cells (mesoglycan, FFPM, sulodexide). In this study we evaluated the impact of local application of a mixture of semi-synthetic polysulfated galactosaminoglycans on the regression rate of STP and dermo-hypodermitis in patients treated with best medical therapy (BMT). METHODS: Thirty patients (20 F and 10 M) were enrolled from May to December 2017, 20 with dermo-hypodermitis due to stasis secondary to post-thrombotic syndrome (PTS) and 10 with acute STP of the great saphenous vein or its collaterals. Topical administration of the galactosaminoglycan-based product was added to the BMT of 10 pts with PTS and 5 pts with STP for 45-60 days. In all patients a Visual Analogical Scale (VAS) was used to assess the intensity of spontaneous and induced pain at 0, 15, 30, 45 and 60 days. RESULTS: With regard to PTS, VAS values at time 0 were comparable between the two groups, while at later times there was a progressive reduction in the score, with values of ≤2 at 30 days for patients treated with the topical product based on galactosaminoglycans vs. 60 days for the other control subjects. With regard to STP, the values of VAS at time 0 between the two groups were comparable, while at time 15 the VAS value was lower in subjects treated with the topical product. CONCLUSIONS: This pilot study on the efficacy of a local formulation of a mixture of semi-synthetic polysulfated galactosaminoglycans highlighted the role of this product in accelerating the recovery of patients at the most advanced stages of chronic venous disease (CVD) and in the management of its complications. In the future, studies of larger series will be needed with the use of placebo to substantiate their effectiveness in these conditions and in other classes of CVD.


Assuntos
Eczema/tratamento farmacológico , Hiperpigmentação/tratamento farmacológico , Polissacarídeos/administração & dosagem , Tromboflebite/tratamento farmacológico , Doença Aguda , Administração Tópica , Idoso , Quimioterapia Adjuvante , Eczema/complicações , Feminino , Humanos , Hiperpigmentação/complicações , Masculino , Pessoa de Meia-Idade , Tela Subcutânea , Sulfatos
18.
J Allergy Clin Immunol ; 141(6): 1997-2001.e3, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29522845

RESUMO

The Learning Early About Peanut Allergy (LEAP) study proved that early introduction of peanut significantly prevented the development of peanut allergy. However, in regard to similar attempts to prevent egg allergy through early egg introduction, the Prevention of Egg Allergy in High-risk Infants with Eczema (PETIT) study is the only randomized intervention trial to show a statistically significant effect. Meta-analysis of those studies indicated that neither the total amount nor pretreatment of egg showed any effect on egg allergy at the age of 12 months. However, raw egg powder resulted in a significantly higher prevalence of allergic reactions at initial introduction, whereas use of boiled egg was much safer. The prevalence of atopic dermatitis/eczema at introduction of egg correlated significantly with the subsequent prevalence of allergic reactions at initial introduction. In addition, the prevalence of egg allergy in the late introduction group correlated significantly with the prevalence of atopic dermatitis at introduction, even when the atopic dermatitis was proactively treated with a topical corticosteroid ointment. It is definitely true that the number of trials and number of participants in each trial are insufficient for drawing firm conclusions, especially regarding the optimal dose, raw versus boiled, when to start, and for whom to intervene. Therefore we propose various studies that should be performed to generate stronger data and conclusions. However, on the basis of the most recent results, we postulate that simultaneous intervention by both early boiled egg introduction and eczema treatment is probably indispensable for primary prevention of egg allergy.


Assuntos
Dessensibilização Imunológica/métodos , Eczema/complicações , Hipersensibilidade a Ovo/complicações , Hipersensibilidade a Ovo/prevenção & controle , Anti-Inflamatórios/uso terapêutico , Dermatite Atópica/complicações , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/epidemiologia , Eczema/dietoterapia , Eczema/epidemiologia , Feminino , Humanos , Lactente , Masculino , Metanálise como Assunto , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Contact Dermatitis ; 78(5): 348-354, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29457230

RESUMO

BACKGROUND: An inverse relationship between disease severity and health-related quality of life (HR-QoL) in patients with hand eczema is well established, but modifying effects of demographic variables have been less well studied. OBJECTIVE: To identify the influence of metropolitan versus non-metropolitan residence on the relationship between disease severity and HR-QoL in patients with occupational hand eczema. METHODS: The city of Copenhagen and the rest of Zealand were defined as metropolitan and non-metropolitan areas, respectively. Participants were 773 persons with occupational hand eczema. A questionnaire on the severity of hand eczema and HR-QoL was sent to all participants. RESULTS: The odds for reporting moderate to high severity of occupational hand eczema were significantly lower in the metropolitan population than in the non-metropolitan population [odds ratio (OR): 0.42; 95%CI: 0.23-0.75], whereas low dermatology-related quality of life was more prevalent in metropolitan than in non-metropolitan patients (OR: 1.31; 95%CI: 0.83-2.05), indicating that hand eczema had a more pronounced negative effect in metropolitan patients, in spite of less severe eczema. CONCLUSION: Our data indicate that area of residence has a modifying effect on the relationship between disease severity and HR-QoL, with a more negative impact on HR-QoL in metropolitan than in non-metropolitan areas. This information is important with respect to fully appreciating the burden of occupational hand eczema.


Assuntos
Dermatite Ocupacional/complicações , Eczema/complicações , Dermatoses da Mão/complicações , Qualidade de Vida , População Suburbana , População Urbana , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
20.
Microb Pathog ; 117: 27-31, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29428424

RESUMO

Parvovirus B19 (PVB19) is a virus found in the skin that causes asymptomatic infections and can exist in the host for long periods to time. The virus induces a local inflammatory response and is associated with the development of arthritis and other autoimmunes diseases. Parvovirus B19 DNA was investigated by PCR in the skin of 20 patients with psoriasis and 20 patients with eczema. Additionally, immunohistochemistry was used to characterize the expression of cytokines in these lesions. The sociodemographic variables were similar in the two groups studied. Psoriasis vulgaris was the most common clinical type in men (50%) and women (80%) (p = 0.0106). Comorbidities were observed in most patients with psoriasis (75%), with an OR of 14 (p = 0.0068). Another important finding was the high prevalence (50%) of psychiatric disorders in patients with psoriasis (OR = 16, p = 0.0218). Only two patients (10%) with psoriasis were positive for PVB19. Comparison of cytokine expression showed the same cytokine profile in the two groups (p > 0.05). However, expression of TNF-α tended to be higher in psoriasis patients. There was no significant positivity for PVB19 in the two groups studied. Immunohistochemistry showed higher expression of TNF-α in psoriasis lesions compared to the eczema group.


Assuntos
Eczema/imunologia , Infecções por Parvoviridae/imunologia , Parvovirus B19 Humano/patogenicidade , Psoríase/imunologia , Dermatopatias/imunologia , Dermatopatias/virologia , Pele/imunologia , Pele/virologia , Infecções Assintomáticas , Brasil , Citocinas/metabolismo , DNA Viral/análise , Eczema/complicações , Eczema/epidemiologia , Eczema/virologia , Feminino , Humanos , Imuno-Histoquímica , Interferon gama/metabolismo , Interleucina-2/metabolismo , Interleucina-4/metabolismo , Masculino , Pessoa de Meia-Idade , Infecções por Parvoviridae/complicações , Infecções por Parvoviridae/epidemiologia , Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/genética , Parvovirus B19 Humano/imunologia , Parvovirus B19 Humano/isolamento & purificação , Prevalência , Psoríase/complicações , Psoríase/epidemiologia , Psoríase/virologia , Pele/patologia , Dermatopatias/epidemiologia , Dermatopatias/patologia , Fator de Necrose Tumoral alfa/metabolismo
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