C. M. Chow

Comparison of Skin Hydration Evaluation Sites and Correlations among Skin Hydration, Transepidermal Water Loss, SCORAD Index, Nottingham Eczema Severity Score, and Quality of Life in Patients with Atopic Dermatitis

AbstractBackground:Atopic dermatitis (AD) is characterized by dryness of the skin, pruritus and involvement of the skin flexures. Skin hydration (SH) and integrity, as measured by transepidermal water loss (TEWL), are important parameters for objectively quantifying AD research. Objectives:To evaluate if sites in the forearm are equivalent to the antecubital fossa for standard SH and TEWL measurements; and to determine the correlations among these measurements and scores of disease severity and quality of life. Methods:We evaluated SH and TEWL under standardized conditions at three common measurement sites in the forearm (antecubital flexure, 2 cm below the antecubital flexure, mid-forearm), and determined the SCORing Atopic Dermatitis (SCORAD) score, Nottingham Eczema Severity Score (NESS), and Children’s Dermatology Life Quality Index (CDLQI). Results:Significant correlations between clinical scores, SH, and TEWL were obtained at a site 2 cm below the antecubital fossa (r = -0.553, p < 0.001 for SH and SCORAD; r = 0.596, p <0.001 for TEWL and SCORAD). SH and TEWL were also correlated with long-term severity of AD as measured by NESS (r = -0.494, p = 0.001 for SH; r = 0.430, p = 0.004 for TEWL), while TEWL was significantly correlated with CDLQI (r = 0.323, p = 0.035). Overall, similar significant correlations were obtained at the mid-forearm, but less so at the antecubital fossa. Conclusion:In AD research, three sites on the forearm appear to be convenient for determination of SH and TEWL. This is the first report to demonstrate that significant correlations are obtained among acute and chronic scores of AD disease severity, quality of life, and the bioengineering parameters

Does age or gender influence quality of life in children with atopic dermatitis

Background.  Quality of life (QoL) is impaired in children with atopic dermatitis (AD) but the various aspects of QoL may not be equally affected.

Efficacy and tolerability at 3 and 6 months following use of azathioprine for recalcitrant atopic dermatitis in children and young adults

Introduction: Recalcitrant childhood atopic dermatitis (AD) causes significant morbidity and may necessitate systemic treatment with immunomodulating agents such as azathioprine. We reviewed the clinical and biochemical effects of this agent in children and adolescents receiving this treatment between November 2005 and December 2007. Methods: The clinical efficacy of azathioprine, and its hematological and biochemical effects (serum IgE level, liver and renal function), were assessed at 3 months and 6 months in 17 cases of recalcitrant AD. Disease severity was evaluated with the SCORing Atopic Dermatitis (SCORAD) score which has two components, namely (1) the objective SCORAD which measures the extent (percentage of body surface area involved) and intensity of the lesions, and (2) visual analog scales which measure the subjective symptoms of pruritus and sleep loss. Results: There were nine males and eight females with a mean (SD) age of 16.1 (3.9) years. Compared with baseline, significant improvements were observed at 3 months (n = 17) and 6 months (n = 16) in SCORAD (p = 0.002; p < 0.001), objective SCORAD (p = 0.002; p = 0.001), extent (p = 0.001; p < 0.001), pruritus (p = 0.004; p = 0.001) and dryness (p = 0.033 at 6 months). Compared with males, objective SCORAD was significantly lower in females (p = 0.009) at 6 months. Azathioprine was stopped in one female after 4 months due to lack of efficacy. Serum total IgE (p = 0.006) was significantly lower at 6 months. The frequency of oral antihistamine usage and Staphylococcus aureus carriage were also significantly reduced (p = 0.031 and p = 0.016, respectively). Mild transient elevation of glutamic-pyruvic transaminase in one patient which became normalized on cessation of the drug, and mild elevation of serum bilirubin in two other patients were observed. Conclusions: Azathioprine reduced the disease severity of AD within 3 months of use in these children. Better efficacy was observed in females at 6 months. Adverse hematologic and biochemical effects appeared acceptable but longer-term monitoring is desirable.

Patterns of food and aeroallergen sensitization in childhood eczema

Aim: To compare the patterns of Type 1 sensitization of common food and aeroallergens among infants and older patients with atopic dermatitis (AD).

Assessing itch in children with atopic dermatitis treated with tacrolimus: Objective versus subjective assessment

This study was undertaken to evaluate the clinical efficacy of tacrolimus for itch reduction in children with atopic dermatitis (AD). Seven children (3 boys and 4 girls) with AD were treated with topical tacrolimus for a consecutive 2-wk period after a 1-wk run-in. The clinical severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) scale. Sleep disturbance, as reported by patients, and nocturnal scratching documented by a wrist movement monitor (DigiTrac®), were evaluated at baseline and throughout treatment. The median (interquartile range) objective SCORAD scores before and after treatment were 27.2 (24.8–36.7) and 23.9 (22.6–36.5), respectively (P=.248). Overall SCORAD scores before and after treatment were 36.1 (32.8–45.7) and 29.4 (24.8–45.4), respectively (P=.05). Scores on the itch and sleep disturbance components of the SCORAD were reduced from 5.0 (5.0–6.5) and 4.0 (3.5–5.0) to 4.0 (2.0–5.0) and 3.0 (0.5–4.5), respectively. Total SCORAD was reduced in 6 patients (range, 8%–36% reduction) and remained similar in 1 patient. No significant change in the area or intensity component of the SCORAD was detected 14 d after treatment began (P=.48 andP=.115, respectively). Scratching activity, as documented by the DigiTrac movement recorder, was reduced from 115.0 g/min (64.8–215.5) to 71.5 g/min (51.0–118.0) (P=.028) after 2 wk of treatment. Daily symptom scores (n=6 pairs) for sleep disturbance reported separately each day by patients and parents correlated strongly with each other (intraclass coefficient, 0.60–0.98). The findings of this study show that tacrolimus is effective in relieving itch in children with AD. Investigators suggest that scratching movements, objectively measured with the use of DigiTrac, provide a reliable indicator of AD severity in children.

Efficacy and problems associated with using a wet-wrap garment for children with severe atopic dermatitis

Use of a wet wrap for short‐term relief of itch in children with severe atopic dermatitis has been advocated but objective determination of its efficacy has been difficult and many issues associated with its use are yet to be defined. We tested a new garment for the wet‐wrap procedure in six patients with atopic dermatitis and objectively determined whether a 3‐day usage could indeed relieve the distressing symptom of itch using a wrist motion monitor. The garments were effective in the short‐term improvement of itching, severity of atopic dermatitis and quality of life in these children. Many issues associated with its use were identified. Clear instructions and individualized regimes (such as the choice of emollient, bathing ointment and topical corticosteroid) are essential for optimal outcome.

Efficacy of sodium hypochlorite (bleach) baths to reduce Staphylococcus aureus colonization in childhood onset moderate-to-severe eczema: A randomized, placebo-controlled cross-over trial

Abstract Background: Staphylococcus aureus (S. aureus) colonization/infection is an important factor in the pathophysiology of atopic dermatitis (AD). Clinical trials have demonstrated conflicting efficacy of diluted bleach baths in treating moderate-to-severe AD. We conducted a double-blinded, placebo-controlled (water), cross-over trial among patients with AD to investigate the efficacy of bleach baths in reducing S. aureus colonization and AD severity. Method: In this cross-over trial, 40 patients with moderate-to-severe AD were randomized to receive twice-weekly bleach and water baths, each for four consecutive weeks with a four-week wash-out period in between. Condition of S. aureus growth and SCORing Atopic Dermatitis index (SCORAD) were recorded at baseline and four-weekly intervals. Patients’ blood was collected in first and second visits to investigate blood eosinophil count, serum levels of total IgE and specific IgEs against Staphylococcal enterotoxins A and B. In every visit, Children Dermatology Life Quality Index (CDLQI), skin hydration (SH), transepidermal water loss (TEWL) and usage frequency of prohibited medications (topical antibiotic, steroid and oral antihistamine) were recorded. Results: All 40 patients completed the trial, but 14 were non-adherent. By intention-to-treat (ITT) approach, comparing with water baths, bleach baths conferred no significant efficacy in CDLQI, SH, TEWL, blood eosinophil count, total IgE and the two specific IgEs over four weeks. Water baths caused a greater reduction in affected area of SCORAD than bleach baths (−5.7 ± 15.4 for water vs. 0.6 ± 12.4 for bleach; p = 0.03) by ITT, and in objective SCORAD and affected area (p < 0.05) from per-protocol approach. Bleach baths reduced topical corticosteroid use (mean difference = 1.1 ± 2.6 days/week; p = 0.014) and topical antibiotic use (mean difference = 1.0 ± 2.8 days/week; p = 0.044) in within-group analysis. Conclusions: This study demonstrated that a four-week, twice-weekly regime of diluted bleach baths is not more useful than water baths in reducing S. aureus colonization/infection and improving AD. A longer treatment period is needed to evaluate if the short treatment duration was the main cause for the discrepancy in outcome from other bleach-bath trials. The usage of a portable bath tub obviates the problems associated with unavailability of bathing facilities in some families.

Specific IgE of common foods in Chinese children with eczema

To cite this article: Hon KLE, Chan IH‐S, Chow C‐M, Wang SS, Lam CW‐K, Ng P‐C, Leung T‐F. Specific IgE of common foods in Chinese children with eczema. Pediatric Allergy Immunology 2011: 22: 50–53.

Which aeroallergens are associated with eczema severity

Summary We investigated if a correlation exists between aeroallergen sensitization and the severity of eczema. Data on aeroallergen response to skin‐prick testing (SPT) and disease severity of children with eczema (n = 119) were evaluated. Atopy, as defined by at least one positive response to aeroallergen skin prick testing, was found in > 90% of eczema patients. House dust mite was the most commonly sensitized aeroallergen, followed by cat fur. Dermatophagoides pteronyssinus and Dermatophagoides farinae sensitization were associated with eczema severity (present in 67% of the mild and 97% of the severe group; P = 0.001). However, there was no association between eczema severity and higher strengths of SPT response (defined as SPT > 1+ to dust mites or dust). Atopy to moulds, Bermuda grass, cockroach, cat and dog was less prevalent and was not associated with eczema severity. It is sensible to advise parents on specific avoidance strategies only in severely affected children who have a definitive history of eczema exacerbation by specific aeroallergens and who are not responsive to conventional treatment.

Atopy in children with eczema

ObjectiveTo explore the prevalence of common food and aeroallergens sensitization in early childhood skin diseases. and to compare the pattern of common food and aeroallergens sensitization before and after 6 months among infants with atopic dermatitis (AD).MethodsAll skin prick tests (SPTs) performed on children ≤ 18 months of age managed at the pediatric dermatology clinic of an university-affiliated teaching hospital over a 16-month period were examined.ResultsThere was generally no difference in the pattern of sensitization to common food and aeroallergens between AD patients and non-AD young children with miscellaneous dermatological or gastrointestinal conditions. Dust mites were the only common aeroallergens in these patients; whereas egg and peanuts were the common sensitizing food allergens. Cat and dog fur as aeroallergens, soy bean, orange and beef as food allergens were relatively uncommon among the studied subjects. In AD, infants ≤ 6 months were generally naive to aeroallergens but became sensitized to the D. Pteronyssinus in the next 12 months of age. 80% of these infants were not sensitized to cow’s milk and none sensitized to soybean.ConclusionAtopic sensitization to common allergens was common in early childhood with or without AD. Majority of young infants were not sensitized to milk, and develop eczema before they show atopy to the milk or soy allergens.