T. F. Leung

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

Backgroundu2002 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.

Backgroundu2002 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.

Serum levels of cutaneous T-cell attracting chemokine (CTACK) as a laboratory marker of the severity of atopic dermatitis in children

There are at least 13 scoring systems for the assessment of disease severity in atopic dermatitis (AD). Each system has its problems with interobserver and intraobserver variability. Cutaneous T‐cell attracting chemokine (CTACK) is a skin‐specific chemoattractant which may correlate with AD severity and obviate the issue of observer reliability. We evaluated whether serum CTACK concentrations were associated with the severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. Thirty‐seven Chinese children with AD (23 boys, 14 girls; aged 1–11u2003years) and 13 controls were recruited. The median (interquartile range) overall SCORAD for AD patients was 29.7 (20.3–49.7). Serum concentrations of CTACK and two other atopy‐related chemokines, macrophage‐derived chemokine (MDC) and thymus and activation‐regulated chemokine (TARC), were measured by sandwich enzyme immunoassay. There were significant correlations between SCORAD (ru2003=u20030.394, Pu2003=u20030.016), its area (ru2003=u20030.528, Pu2003=u20030.001) and intensity components (ru2003=u20030.429, Pu2003=u20030.008) with serum levels of CTACK. The serum concentrations of inflammatory markers MDC and TARC also correlated with the CTACK concentrations (ru2003=u20030.618, Pu2003<u20030.001, and ru2003=u20030.587, Pu2003=u20030.001, respectively). Serum CTACK concentration appears to be a skin‐specific objective marker that correlates with various clinical and laboratory parameters of AD.

Lesson from performing SCORADs in children with atopic dermatitis: Subjective symptoms do not correlate well with disease extent or intensity

Backgroundu2002 Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. It is not known how well these symptoms correlate with the extent and intensity of eczematous involvement. We evaluated whether: (i) the level of sleep loss correlates with pruritus and (ii) the level of pruritus correlates with the extent or severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index.

Estimating emollient usage in patients with eczema.

Background.u2002 Atopic eczema (AE) is characterized by reduced skin hydration (SH) and impaired integrity of the skin. Proper emollient usage is an important facet of AE management and patients are encouraged to use emollients liberally.

In vitro and clinical immunomodulatory effects of a novel Pentaherbs concoction for atopic dermatitis.

Backgroundu2002 Our group recently reported a randomized and placebo‐controlled clinical trial on the efficacy of a twice‐daily concoction of five herbal ingredients (Pentaherbs formulation, PHF) in treating children with atopic dermatitis (AD).

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 (−5.7u2009±u200915.4 for water vs. 0.6u2009±u200912.4 for bleach; pu2009=u20090.03) by ITT, and in objective SCORAD and affected area (pu2009<u20090.05) from per-protocol approach. Bleach baths reduced topical corticosteroid use (mean differenceu2009=u20091.1u2009±u20092.6 days/week; pu2009=u20090.014) and topical antibiotic use (mean differenceu2009=u20091.0u2009±u20092.8 days/week; pu2009=u20090.044) 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.

Urinary leukotriene E4 correlates with severity of atopic dermatitis in children.

Leukotriene E4 (LTE4) is elevated in adults with atopic dermatitis (AD). We evaluated whether urinary LTE4 as a noninvasive marker correlates with clinical indices of disease activity in children with AD. AD patients aged 18u2003years or younger were eligible for inclusion in the study. Disease severity over the preceding 3u2003days was evaluated by the SCORing Atopic Dermatitis (SCORAD) index. Severity of AD over the past 12u2003months was evaluated by the Nottingham Eczema Severity Score (NESS) in Chinese. Urinary LTE4 concentration was measured by competitive enzyme immunoassay. One hundred and twenty‐six children with AD (82 boys and 44 girls) and 45 controls were recruited. The meanu2003±u2003SD urinary log‐transformed LTE4 concentration in AD patients and controls was 2.94u2003±u20030.32 and 2.62u2003±u20030.20u2003pg/mg creatinine, respectively (Pu2003<u20030.0001). SCORAD significantly correlated with NESS (ru2003=u20030.681, Pu2003<u20030.0001). There were significant correlations between urinary LTE4 concentration and overall SCORAD score (ru2003=u20030.270, Pu2003=u20030.002) and its extent (ru2003=u20030.185, Pu2003=u20030.038) and intensity components (ru2003=u20030.247, Pu2003=u20030.005), but not with NESS. When compared with mild AD, urinary LTE4 concentrations were higher in patients with moderate‐to‐severe disease (Pu2003=u20030.049). Urinary LTE4 measurement is noninvasive and may be useful in supplementing the SCORAD for following longitudinal changes in AD severity in children. However, the practical value of this assay in a clinical setting remains to be determined.

Issues regarding nonattendance at a paediatric dermatology centre

Summary Nonattendance in paediatric dermatology clinics is a significant problem. We reviewed the charts of all 400 new referrals to the Prince of Wales Hospital (PWH) paediatric dermatology clinic in the year 2000. Sixty‐six patients (17%) did not attend. The mean ageu2003±u2003SD of attenders (7.5u2003±u20035.1u2003years) and nonattenders (7.7u2003±u20034.5u2003years) did not differ significantly. Forty‐eight per cent of the referrals were females, 50% of the attenders were females and 67% of the nonattenders were male. Males were 2.1‐fold more likely not to attend clinic relative to females (95% confidence interval 1.14–3.71, Pu2003=u20030.010). Nonattendance was significantly higher among referrals from the PWH emergency department, compared with referrals by private practitioners (Pu2003=u20030.05) and referrals by other clinics in the PWH. Data in this retrospective study confirm that there is a gender disparity in hospital nonattendance. More dermatological referrals but more nonattendance were associated with the male patients.

Severe acute respiratory syndrome (SARS) in children: epidemiology, presentation and management.

n Abstractn n Severe acute respiratory syndrome (SARS) is a newly recognised and highly contagious respiratory infection caused by a new strain of coronavirus. The disease can result in progressive respiratory failure in adults and the mortality rate has been reported to be 8–15%. This infection spreads by droplet transmission and children appear to acquire SARS through close household contact exposure to infected adults. Disease severity is, however, much milder in the paediatric age group. The common laboratory findings in infected children and adolescents include lymphopaenia and elevated levels of lactate dehydrogenase and creatinine phosphokinase. Air space consolidation is commonly seen during the course of the illness although chest radiographs are normal on presentation in half of the cases. The pathophysiology of SARS appears to be related to immunological dysregulation in response to the coronavirus infection. The optimal treatment of SARS in children remains to be determined. No case fatality in infected children has been reported. The early and proper isolation of infected adults, meticulous infection control measures in the hospital setting, exhaustive contact tracing and quarantine measures are important steps in preventing the spread of the disease among health care workers and into the community. The development of a sensitive and rapid test for early diagnosis is underway. Further controlled trials are necessary to define the optimal treatment of this infection in children.n n