Therapy of eczema herpeticum

Optimal therapy of EH is a combination of topical and systemic actions, and should be started at the earliest possible time. Systemic antiviral chemotherapy is the mainstay of EH treatment, supported by topical antiviral chemotherapy in case of eye involvement (herpetic keratitis). Oral antibiotics are frequently given to control bacterial superinfection, and oral cephalosporine preparations (e.g. cefadroxil, 2 x 1 g day) are our treatment of first choice. Topical administration of antiseptic...

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Experimental therapeutic strategies for the treatment of atopic dermatitis Colossal progress in the understanding of the cellular and molecular mechanisms involved in inflammatory, allergic as well as autoimmune diseases, and the recent discoveries in biotechnology have led to the development of several novel immunomodulating and anti-inflammatory agents including drugs and specific biologics ('biological response modifiers') such as cytokines, antibodies and fusion proteins which may be...

Breastfeeding and maternal elimination diets in infants with atopic dermatitis

Breast-feeding is generally considered the most appropriate form of infant feeding, although it probably does not prevent food sensitization or the subsequent development of atopic disease.17,129,130,135 In breast-fed infants, AD may develop within the first weeks of life, often while being exclusive breast-fed. Onset of AD during the early lactation period may indicate sensitiza-tion of the infant to maternally ingested food aller-gens.136 Food antigens are secreted into breast milk and may...

Pathogenesis of eczema herpeticum

Infection of epithelial cells with HSV is initiated by contact of the virus with mucosa or abraded skin.27 Replication of HSV in epidermal and dermal cells follows, and HSV can even be spread via the lymphatics to regional lymph nodes.28 This may explain the severity and large affected area during primary infection. During this initial infection, HSV gains access to sensory neurons to establish latent infection. Reactivation and replication of latent HSV can be induced by stimuli such as light,...

Candida Infection In Atopic Dermatitis

More than 50 different Candida species have been characterized and many of these species can be isolated from human sources but only a few are dominant. Candida can be isolated from normal skin but is more frequently present in the gastrointestinal tract and on mucous membranes. Candida colonisation does not imply illness Candida is present in up to 65 of asymptomatic individuals.35 Skin diseases like immune deficiency, diabetes mellitus, hormonal dysfunction, and the use of drugs like oral...

Skin colonization with Malassezia

A great variation in the density and presence in various skin locations has been reported. Highest concentrations were found on the scalp and the upper trunk, lowest on the hands.5 The density of Malassezia yeasts decreases with increasing age on the other hand the number of yeast cells is larger in adults compared to children.6,7 The colonization of the skin with Malassezia was analysed in 112 individuals suffering from seborrhoeic dermatitis (20 of 39 were HIV-positive patients), pityriasis...

Prevalence Of Food Allergy

In recent years, the prevalence of atopic diseases and food allergies appears to have increased in many Western countries. Food allergy has its greatest incidence in infancy and early childhood.55 It is estimated that about 8 of children will develop adverse reactions to food, most of them in the first year of life.51 The prevalence of food allergy varies between regions and appears to be influenced by cultural and genetic fac-tors.3 For example, hypersensitivity to cow's milk and egg is...

The Immunophenotype Of Atopic Dermatitis

In order to elucidate the influence of inhalant allergens in AD it is necessary to characterize some of the immuno-logical processes of the disease. Skin lesions in AD generally evolve as the result of complex cellular interactions. One potential scenario is that IgE-bearing LCs and inflammatory dendritic epidermal cells (IDECs) present antigens which have penetrated the disrupted epidermal skin barrier29 to receptive sensitized T cells, and mast cells, leading to their activation and release...

Specific IgE antibodies to Malassezia

Specific IgE antibodies to Malassezia have been analysed in several clinical trials and were found in 20-100 of the analysed serum samples. The prevalence was highest in adults with HNAD, lower in adults with AD in other Table 7.1 Specific IgE antibodies to Malassezia in different populations. (Modified from Bayrou O, Pecquet C, Flahault A et al. Head and neck atopic dermatitis and Malassezia-furfur-specific IgE antibodies. Dermatology 2005 211 107- localisations and lowest in children (Table...

References

Senkevich T, Bugert J, Sisler J, Koonin E, Darai G et al. Genome sequence of a human tumorigenic poxvirus prediction of specific host response-evasion genes. Science 1996 273 813-16. 2. Xiang Y, Moss B. IL-18 binding and inhibition of interferon gamma induction by human poxvirus-encoded proteins. Proc Natl Acad Sci USA 1999 96 11537 2. 3. Wetzel S, Wollenberg A. Eczema molluscatum in tacrolimus treated atopic dermatitis. Eur J Dermatol 2004 14 73-4. 4. Syed TA, Goswami J, Ahmadpour OA, Ahmad...

The Atopy Patch Test

The presence of specific T cells directed to inhalant allergens along with the effects seen in AD patients upon epicutaneous or bronchial allergen administration highlight their possible impact on AD. Therefore, a major approach to the management of this part of the disease is to avoid these potential triggers. Identification of the offending allergens on the basis of history and diagnostic testing is needed to specify avoidance recommendations for the individual patient (Table 9.2). Many...

Animal Models Of Atopic Dermatitis

Several mouse models of food allergy and AD have been developed recently.106-108 These mouse models may be useful in exploring the pathophysiology of food allergy and developing new experimental treatments or vaccines. The first mouse model of IgE-mediated CMA successfully mimicked some of the clinical features observed in humans.106 In the following year, a model of peanut allergy and anaphylaxis was developed by the same group.108 This model successfully sensitized mice to the major peanut...

Introduction

Glucocorticosteroids (GCs) are the most widely used drugs in dermatology and remain the mainstay therapy for a multitude of indications. The frequency of systemic, intralesional, and in particular topical application of GCs in daily dermatological practice is thus not surprising (Table 14.1). Soon after its introduction more than 50 years ago, GC therapy became a cornerstone in the therapy of atopic dermatitis (AD) and application of topical GC is frequently the therapy of choice in AD to date,...

Chemical structure

Induced Skin Atrophy

Cortisol or hydrocortisone has a steroidal structure characterized by a keto group at position 3, a double bond at position 4, a P-hydroxyl group at position 11, an a-hydroxyl group, and a substituted carbon side chain at position 17. Oxidation of the hydroxyl group at position 11 gives cortisone, an inactive compound. (Figure 14.2).4 To achieve therapeutic efficacy, the chemical structure has to be modified. Fluorination at positions 6 and or 9 generally increases activity. The most commonly...

Epidermal barrier dysfunction in atopic dermatitis

Dust Mite Dermatitis

Michael J Cork, Simon Danby, Yiannis Vasilopoulos, Manar Moustafa, Alice MacGowan, Jibu Varghese, Gordon W Duff, Rachid Tazi-Ahnini and Simon J Ward Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with cutaneous hyper-reactivity to environmental triggers that are innocuous to normal, non-atopic individuals.1 Major contributors to this hyperactivity are the many changes in the cutaneous and systemic immune responses in individuals with AD.2 One example is the production...

Genetic dissection of eczema

Treatment Genetic Diseases Strategies

Eczema is a chronic inflammatory skin disease that is characterized by intense pruritus. In the industrialized countries the prevalence of eczema is approximately 15 with a steady increase over the last decades.1,2 Along with asthma and allergic rhinitis, eczema is commonly associated with the state of atopy which is characterized by the formation of allergy antibodies (IgE) to environmental allergens. Eczema is commonly the first clinical manifestation of allergic disease. Onset of disease is...

Psychosomatic aspects of atopic dermatitis

Significance Neurosecratory

THE HISTORICAL DEVELOPMENT OF PSYCHOSOMATIC DERMATOLOGY Embryologically, skin and the central nervous system (CNS) have the same origin in the ectoderm and are functionally closely related. One speaks of the skin as 'reflecting the soul'. Skin is a communication organ and plays an important role in the development and socialization over a whole life span. Skin is sensitive to tactile stimuli and responds to emotional stimuli. Skin diseases have a direct influence on communication, physical...

The clinical manifestations of atopic dermatitis

Atopic Dermatitis Black Child Pictures

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease related to other atopic symptoms like allergic rhinitis, allergic conjunctivitis, and asthma. AD usually starts before the age of 2 years and is the first of the atopic symptoms that shows clinical signs. Patients with AD have an increased risk of developing other atopic symptoms later in life. Both endogenous and exogenous factors interact in the development of clinical signs of the disease. Hereditary factors are...

General management of patients with atopic dermatitis

Wet Wrap Therapy For Atopic Dermatitis

EDUCATION OF PATIENTS AND CAREGIVERS Education of patients and their caregivers is a crucial component in caring for patients with atopic dermatitis AD. Learning about the chronic or relapsing nature of AD, exacerbating factors, and therapeutic options is important for both patients and caregivers. Just as asthma action plans are integral to the management of asthmatic patients, so too, clinicians treating patients with AD need to provide both verbal and written information that includes...

Geneenvironment Interactions Topical Corticosteroids

The positive anti-inflammatory effects of topical corti-costeroids have to be balanced with their potential to induce cutaneous atrophy as a result of the inhibition of the synthesis of collagen and glycosaminoglycans,180-182 and also against their effects on the integrity of the epidermal barrier.183-185 A significant increase in TEWL has been observed in patients following the long-term application of topical corticosteroids.186,187 Short-term application of topical corticosteroids (3 weeks)...

Clinical Implications Of Skin Barrier Dysfunction In Atopic Dermatitis

Our increasing awareness that epidermal barrier dysfunction is an extremely important component of the patho-physiology of AD should focus our attention on everything that comes into contact with the skin. This includes environmental agents such as soap, detergents, bacterial infection and inhalant allergens such as house dust mites, and the topical formulations used to treat AD. Exposure to soap and detergents has been recognized as an exacerbating environmental factor in AD for more than 40...

Eczema Herpeticum

Disseminated Eczema

The first description of EH dates back to 1887, when the Austrian dermatologist Moritz Kaposi described 10 children with eczema larvare infantum complicated by a vesicopustular eruption.13 Today, the term Kaposi's varicelliform eruption is used for any disseminated cutaneous infection with the herpes simplex virus (HSV) type 1 or 2, which may include AD, eczema, Darier disease,14 pemphigus foliaceus,15 mycosis fun-goides,16 Sezary syndrome,17 ichthyosis vulgaris,18 Hailey-Hailey disease,19 and...

Antiviral chemotherapy of eczema herpeticum

Systemic antiviral chemotherapy must be given to avoid complications of a disseminated HSV infection such as HSV encephalitis or herpetic keratitis. Currently, the most potent drugs used for HSV therapy are nucleoside analogues which interfere with viral DNA replication. Before the introduction of aciclovir treatment, the mortality rate of EH leading to multiple organ involvement and encephalitis was about 70 .22 Aciclovir is a nucleoside analogue that is converted by herpes virus-encoded...

Eczema Molluscatum

Spongiotic Dermatitis

Disseminated eruption of molluscum contagiosum virus (MCV) in an AD patient is known as EM. It is mostly a disease of children. The relatively small, skin-coloured frequently umbilicated papules vary in size (Figure 6.1). Though most papules are confined to the eczematous lesions of the underlying AD, autoinoculation of the virus may cause aberrant papules in other body regions. There is no fever, no malaise, and no general symptoms associated with EM. MCV was found to have unique genes not...

The pathogenesis of atopic dermatitis

Langerhans Skin Cells Images

The skin is much more than just a protective coat and encounters a high number of antigens at the interface between the body and the surrounding environment.1,2 Atopic dermatitis (AD) is a chronic inflammatory skin disease, clinically and histologically very similar to contact dermatitis. AD can occur at any age and has a high prevalence in children. In past years, the rising interest in this disease has been forced by its increasing prevalence in Western societies and its contribution to the...

Stria Distensae Genital

Severe Striae

Clinical aspects of glucocorticoid treatment The first report on the efficacy of topical steroids became available in 1952, when compound F (i.e. hydrocortisone) was documented to be effective in various dermatoses including the treatment of atopic eczema.1 Five decades of clinical documentation and the experience of many doctors have proven the usefulness of topical steroids, which together with emollients today still are the 'gold standard' of treatment for atopic eczema. Although hundreds of...