Barbara B. Wilson

Use of specific IgE in assessing the relevance of fungal and dust mite allergens to atopic dermatitis: A comparison with asthmatic and nonasthmatic control subjects☆☆☆★

BACKGROUND Although allergens have been implicated as aggravating factors in atopic dermatitis (AD), there is little epidemiologic data on the significance of specific IgE. OBJECTIVE We sought to compare sensitization to dust mite and fungi between patients with AD and asthmatic and nonasthmatic control subjects. METHODS Total IgE and specific IgE to Dermatophagoides pteronyssinus, Alternaria alternata, Aspergillus fumigatus, Candida albicans, Malassezia furfur, and Trichophyton rubrum were measured in 73 patients with moderate to severe AD. Total IgE and IgE specific for D pteronyssinus, A alternata, and M furfur were also measured in sera from 156 asthmatic and 212 nonasthmatic control subjects. RESULTS Positive correlations were found between total IgE and IgE antibodies specific for each of the antigens. IgE specific for M furfur was observed more frequently in adults compared with children with AD (P <.01). AD sera had higher levels of total IgE and a higher prevalence of positive sera to D pteronyssinus (95% vs 42% and 17% for subjects with AD, asthmatic subjects, and nonasthmatic subjects, respectively), M furfur (53% vs 1% and 0.5%), and A alternata (49% vs 29% and 18%). Among the sera from subjects allergic to mites, the contribution of IgE specific for D pteronyssinus to the total IgE levels was similar regardless of the clinical status. CONCLUSIONS Our results demonstrate that moderate-to-severe AD is strongly associated with sensitization to dust mite andM furfur (odds ratios, 45.6 and 132 vs pooled control sera). These results suggest that both environmental allergens and colonizing fungi contribute to the severity of disease, which is consistent with the view that mite avoidance and antifungal treatment can be beneficial in the treatment of these patients.

The North American Menopause Society recommendations for clinical care of midlife women

In celebration of the 25th anniversary of The North American Menopause Society (NAMS), the Society has compiled a set of key points and clinical recommendations for the care of midlife women. NAMS has always been a premier source of information about menopause for both healthcare providers and midli

Effect of combined antibacterial and antifungal treatment in severe atopic dermatitis

Atopic dermatitis (AD) is a common chronic skin disease characterized by a typical distribution (facial and extensor surfaces in infants and flexural surfaces in older children and adults), intense pruritus, early age of onset (95% of pediatric cases are apparent by 5 years of age), and elevated serum IgE. 1, 2 Besnier,3 in 1892, first described the hereditary nature of AD and noted its association with hay fever. There is abundant evidence that patients with AD have IgE antibodies to both food and inhalant allergens. Furthermore, recent evidence has supported a role for foods, inhalant allergens, and staphylococcal infection in causing the rash. 4-6 Sampson et al. 4 demonstrated that food allergens can trigger cutaneous reactions in children with AD. It has also been shown that dust mite allergen applied to the skin can induce eczematous reactions: 7 Furthermore, anecdotal evidence suggests that decreasing exposure to the mite allergen by encasing mattresses and pillows and by cleaning homes may result in significant clearing of eczema. 5, 8 Indeed, as early as 1932, it was recognized that many patients with AD experienced improvement when they were admitted to a dust-free room. 9 Patients with AD have very high rates of colonization with pathogenic bacteria, such as Staphylococcus aureus, and treatment with antibiotics is regularly recommended. 6, Jo-~2 Similarly, coloniza

Nail unit basal cell carcinoma: A case report and literature review

in profilaggrin degradation in the granular layer that accounts for the presence of keratohyaline granules within corneocytes. Further evidence that this unusual axillary eruption is a disorder of cornification is suggested by its rapid response to an oral retinoid. REFERENCES 1. Northcutt AD, Nelson DM, Tschen JA. Axillary granular parakeratosis. J Am Acad Dermatol 1991;24:541-4. 2. Mehregan DA, Vandersteen P, Silkorski L, Mehregan DR. Axillary granular parakeratosis. J Am Acad Dermatol 1995;33:373-5.

Syringoma of the moustache area

Syringomas are benign tumors of the eccrine ducts that appear as small skin-colored or yellow papules. They usually occur in the periorbital area, but have also been found on the scalp, forehead, cheeks, axillae, abdomen, extremities, genitalia, and buttocks. We describe a patient with an unusual presentation of syringomas on the moustache area.

Sudden onset of disseminated porokeratosis of Mibelli in a renal transplant patient

Porokeratosis is a disorder of epidermal keratinization of uncertain cause. Five clinical variants of porokeratosis have been described. These include porokeratosis of Mibelli, punctate porokeratosis, linear porokeratosis, porokeratosis palmaris plantaris et disseminata, and disseminated superficial porokeratosis. Disseminated superficial porokeratosis and single plaque porokeratosis of Mibelli have each been documented to occur in association with immunosuppression. To our knowledge, only 5 cases of disseminated porokeratosis of Mibelli in transplant recipients have been reported. We present a patient who developed explosive onset of disseminated porokeratosis of Mibelli shortly after renal transplantation. It is important to differentiate this unusual variety of porokeratosis from other cutaneous manifestations in transplant patients so that appropriate therapy can be instituted.

Eruptive xanthomas during pregnancy

A case of eruptive xanthomas during two successive pregnancies is reported. These xanthomas developed in association with marked hypertriglyceridemia; complications included severe pancreatitis and acute respiratory distress syndrome. This patient most likely had combined familial hyperlipidemia which usually causes only a modest elevation in plasma lipid levels. However, with the added stimulus of estrogens during pregnancy, hypertriglyceridemia and secondary complications developed.

Contested Construction of Green Building Codes in North America: The Case of the Alley Flat Initiative

Building codes are both an index of social values and a strategy to enforce those values. On these grounds an examination is made of the emergence of green building codes in North America as a category of building codes that is particularly important for sustainable development. The classical definition of sustainability proposes that multiple, competing frames of interpretation—economic development, environmental protection and social equity—can, in theory, be balanced. It is found, however, that in practice equity is generally ignored. Through historical and theoretical investigation, it is hypothesised that codes which are successful in incorporating equity as a criterion emerge from public talk and social learning, not abstract speculation. The paper concludes by articulating a change-oriented research design for an ongoing project to test this hypothesis.

Something to Reed about: Fibroids, cutaneous leiomyomas, and renal cell carcinoma

A 48 year-old woman with a history of fibroids presents with asymptomatic skin lesions. Biopsy reveals cutaneous leiomyomas and subsequent genetic evaluation confirms the diagnosis of hereditary leiomyomatosis and renal cell cancer. In this report, we review the typical presentation of the syndrome as well as recommendations for surveillance.

Demodectic Frost of the Ear

Demodectic Frost of the Ear Demodicosis is a well-established pathologic entity in animals, but the role of Demodex infestation in humans is not uniformly accepted among dermatologists. There are several clinical variants of human demodicosis that bear resemblance to various inflammatory dermatoses. We propose a new clinical variant of Demodex infestation, which we call demodectic frost of the ear because of the frosted appearance of the skin on the ear caused by follicular-based scale.