M. C.A. Lam

Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: A randomized, double-blind, placebo-controlled study

Background  There has been considerable interest in traditional Chinese herbal medicine (TCHM) as a treatment for atopic dermatitis (AD). A twice‐daily concoction of an ancestral formula containing five herbs has been found to be beneficial in an open study.

Pathophysiology of nocturnal scratching in childhood atopic dermatitis: the role of brain-derived neurotrophic factor and substance P

Background  Childhood atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. The pathophysiology of pruritus is complex and various neuropeptides may be involved.

Nocturnal wrist movements are correlated with objective clinical scores and plasma chemokine levels in children with atopic dermatitis.

Background  Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. Scratching due to pruritus is an important mechanism in the exacerbation of AD but is difficult to document in the home environment.

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.

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.

Exhaled Nitric Oxide Levels are not Correlated with Eczema Severity in Chinese Children with Atopic Dermatitis

Asthma is a common atopic disease associated with atopic dermatitis (AD) and allergic rhinitis (AR). Exhaled nitric oxide level (eNO) has been found to be an interesting noninvasive marker of disease severity in children with asthma. However, it is uncertain if eNO may be confounded by any coexisting AD or AR. In this study, eNO in Chinese children with moderate-to-severe AD and no asthma symptoms (n = 53) was measured online by a chemiluminescence analyzer. Severity of AD was assessed using the objective SCORing-Atopic-Dermatitis score and coexisting allergic rhinitis with the Allergic-Rhinitis-Score (ARS). Patients with active symptoms of asthma or inhaled/intranasal corticosteroids were excluded. There was no difference in eNO between genders and no correlation between eNO and AD severity regardless of ARS or bronchial reactivity status. ENO appears to be a noninvasive marker whose level is independent of the two atopic diseases of AD and AR in children old enough to perform exhalation maneuver.

Normal neonatal outcome in a Chinese woman with pemphigoid gestationis, Graves’ disease, and history of placental chorioangioma

Medical eponyms: our past, present, and future Eponyms play a historic role in medicine. The purpose of this letter is to enlighten and encourage those of us who thought eponym creation in the medical field has long been abandoned. A quick search on eponyms reveals that the literature continues to be flooded with lively and colorful debates. These debates are for and against this ancient naming practice. 1–3