C.A. Holden

The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis.

A working party of 13 dermatologists, two family practitioners and a paediatrician was assembled, with the aim of developing a minimum list of reliable discriminators for atopic dermatitis. Each physician was asked to select 10 consecutive new cases of unequivocal mild to moderate atopic dermatitis and 10 controls with other inflammatory dermatoses. Each subject was examined by two independent observers, who were blind to the clinical diagnosis and study aim, with regard to 31 clinically useful diagnostic features for atopic dermatitis. Two hundred and twenty‐four patients were studied (120 cases and 102 controls). Using the key physicians clinical diagnosis as a gold standard, the sensitivity and specificity of each of the 31 diagnostic criteria were tested. Using multiple logistic regression techniques, a minimum set of diagnostic criteria for atopic dermatitis was derived. These were: history of flexural involvement, history of a dry skin, onset under the age of 2, personal history of asthma, history of a pruritic skin condition, and visible flexural dermatitis. Adjustment for age, sex, region, social class and ethnic group did not alter the choice of final criteria. The discriminatory value of these criteria was also satisfactory when tested against a further sample of 150 patients drawn from the community, who did not have skin disease.

Long-term efficacy and safety of cyclosporin in severe adult atopic dermatitis.

A prospective, open, multicentre study was performed to investigate the efficacy and safety of longterm treatment with cyclosporin in adults with severe atopic dermatitis. Subjects were treated for a maximum of 48 weeks. For the first 8 weeks, cyclosporin was administered at 2.5 mg/kg per day. The dose was then adjusted according to response. Disease activity was monitored using the six‐area. six‐sign score and the proportion of skin involved. Pruritus and sleep disturbance were assessed using four‐point scales. Response was further evaluated on a five‐point scale. Adverse events. blood pressure and serum biochemistry were monitored. Tolerability was assessed on a five‐point scale.

Lack of c‐kit mutation in familial urticaria pigmentosa

Somatic mutations within c‐kit have been reported in individuals with mastocytoses, including urticaria pigmentosa (UP). We have identified three siblings with UP. We aimed to determine whether the c‐kit proto‐oncogene was playing a part in the aetiology of UP in these three siblings. Using seven microsatellite repeat markers spanning an 8‐cM interval encompassing the c‐kit gene we followed the transmission of the c‐kit gene in this family. Furthermore, single‐strand conformation polymorphism analysis was used to scan exon 17 of the c‐kit gene for mutations in genomic DNA of all family members and somatic DNA extracted from skin of the eldest affected sibling, the proband. No mutations were found in exon 17 in either genomic DNA of all family members or somatic DNA of the proband. Patients with UP have been shown to possess somatic mutations of the c‐kit gene. However, this locus has been excluded as playing a part in the three siblings examined here in whom a second gene locus must be determining their UP. Therefore, this study emphasizes genetic heterogeneity in UP. Future study to identify primary molecular determinants of UP should include affected sib‐pair studies.

Fluticasone propionate 0.05% cream in the treatment of atopic eczema: a multicentre study comparing once‐daily treatment and once‐daily vehicle cream application versus twice‐daily treatment

Summary The aim of this study was to compare the efficacy and safety of once‐daily with twice‐daily application of a 0.05% cream formulation of fluticasone propionate in the treatment of atopic eczema in adults and children.

Kikuchi disease (histiocytic necrotizing lymphadenitis) in association with HTLV1

We report a 25‐year‐old male with fever, generalized lymphadenopathy and an erythematosus maculo‐papular eruption affecting face and upper body, A diagnosis of Kikuchi disease (necrotizing histiocytic lymphadenitis) was made on lymph node histology. The patient was found to be positive for the human T‐cell leukaemia lymphoma virus (HTLV1). Kikuchi disease has been reported in association with infections such as Epstein‐Barr virus (EBV). herpes (HHV6) and toxoplasmosis, but to our knowledge this is the first case of Kikuchi disease associated with HTLV1.

Cyclosporin for Atopic Dermatitis in Children

This paper details a UK consensus conference held in London in April 2000 to establish guidelines for the use of cyclosporin A for atopic dermatitis in children. It should be reserved for the severest refractory atopic dermatitis. In view of its potential toxicity, careful monitoring is mandatory, in particular blood pressure and renal function.

Cutaneous reactions to substance P and histamine in atopic dermatitis.

The flare and weal reactions to intradermal injections of histamine and the peptide substance P were measured in a group of patients with atopic dermatitis and compared to reactions in a non‐atopic control group. There was no significant difference in the flare areas between the controls and atopies with either reagent. The weal volumes after injection of substance P and histamine were significantly larger in the atopic group. As substance P causes mast cell histamine release, the increased weal volumes produced by substance P in the atopies may be entirely due to the exaggerated atopic weal reaction to histamine.

Pemphigoid nodularis: a report of three cases and review of the literature

Many variants of bullous pemphigoid have been reported, some of which are clinically very atypical.

Coexistent cutaneous T-cell lymphoma and B-cell chronic lymphocytic leukaemia

Three patients with cutaneous T‐cell lymphoma (CTCL) are reported who had concurrent B‐cell chronic lymphocytic leukaemia (B‐CLL). The separate lineage and clonal nature of the individual lymphoid malignancies were confirmed by gene‐rearrangement analysis. The chronology of the illnesses did not support the hypothesis that CTCL predisposes to the development of B‐cell proliferative disorders. There was no clear association with immunosuppressive therapy, and HTLV‐1 studies were negative in all patients. Consequently, we speculate that a lymphoid stem cell defect, which may lead to the development of either aberrant B‐ or T‐cell clones, may be responsible for such cases of dual lymphoid neoplasia.

Neuropeptide modulation of Th1 and Th2 cytokines in peripheral blood mononuclear leucocytes in atopic dermatitis and non-atopic controls

The neuropeptides substance P (SP) and vasoactive intestinal peptide (VIP) are present in the nerve endings in the skin and SP is thought to be present at abnormal concentrations in atopic dermatitis (AD) patients. Th1 and Th2 imbalance in AD has been the focus of recent immunological investigations and a preferential Th2 response by atopic cells on stimulation has been proposed. We wished to establish whether neuropeptides acted on T cells to affect their cytokine profile directly, using an accessory cell‐independent stimulus (anti‐CD3 monoclonal antibody) and neuropeptides at several concentrations. We found that interferon (IFN)‐γ and interleukin (IL)‐4 release were lower in AD. SP had an enhancing effect on both IFN‐γ and IL‐4 at physiological concentrations (10−10–10−6mol/L) in AD, which was significantly different from controls (P<0.05). VIP had inhibitory effects over this range in AD and in controls. We conclude that these neuropeptides have a modest effect on T‐cell cytokine release and that their action is not cytokine‐specific.