HND patients have eczema affecting other body sites as well or suffer from more refractory disease.
A past study which overlooked histological features of adult AD patientswith recalcitrant erythema on the face demonstrated a mixture of eczematous and steroid-induced rosacea-like changes. 7 Not too different from an already published work, histological observation in this study showed epidermal change of hyperkeratosis, acanthosis, with parakeratosis, and a presence of increased vessels in HND lesions. Increase inthe number and average area of vessels inthe dermis, confirmed with factor VIII-related antigen, most probably lie behind the intense redness noted in HND patients.
Kang HG, et al. • Application of topical corticosteroids and serum corticosteroid level Allergy Asthma Respir Dis
폭되어 나타난 결과로 생각할 수 있다. 연고나 크림의 형태로 피부 에 바르는 국소 스테로이드는 염증성 질환인 아토피피부염과 여드 름 질환, 건선, 습진과 같이 피부 질환을 치료하기 위한 목적으로 50여 년간 처방되고 있다. 그러나 국소 스테로이드의 사용과 관련 된 부작용의 보고와 연구는 미흡한 상태이며 특히 체중에 비해 체 표면적이 넓은 소아는 전신적 부작용에 취약한 대상에서의 연구도 제한적이다. 이에 국소 스테로이드를 장기간 사용하는 아토피피부 염 환자에서 고강도의 clobetasol proprionate와 가장 약한 강도의 hydrocortisone의 혈중 농도를 측정하여 전신 흡수 여부와 중증도, 국소 스테로이드 사용과의 연관성을 분석하고자 두 가지 물질의 liquid chromatography-tandem mass spectrometry (LC-MS/MS) 분석법을 개발하였다.
Based on the results ofthe study using Lactobacilli strain , we examined the hypothesis that probiotics have a bene- ficial effect on the alleviation of canine AD using a different strain of probiotics, i.e., Bifidobacteria, instead of Lactoba- cilli. However, in this randomized, placebo-controlled study, we found clinical complementary effects ofthe addition of probiotics for controlling the severity of canine AD by allevi- ating skin lesions. We found that the CADESI-4 scores ofthe probiotics group significantly decreased from the baseline to 4, 8 and 12 weeks; however, this was not observed inthe control group. These findings are consistent with those of a study evaluating the complementary effects of Lactobacillus paracasei K71 on canine AD . TEWL inthe probiotics group showed a similar tendency; however, it did not reach statistical significance within the group. Therefore, it appears that B. longum might have supplementary effect of only improving skin lesions in dogs with AD receiving standard Table 1. Summary of signalments and previously prescribed drugs ofthe 11 dogs involved inthe study
With this in mind, a group of experts from allergy and immunology, adult and pediatric dermatology, and pediatrics centers within Southeast Asia met to review current data and practice, and to develop recommendations regarding the use of moisturizers inpatientswith AD within the Asia-Pacific region. Chronicity and severity of AD, along with patient age, treatment compliance, and economic background should all be taken into account when selecting an appropriate moisturizer for AD patients. Other considerations include adjuvant properties ofthe product, cosmetic acceptability, and availability over the counter. Well-defined clinical phenotypes of AD could optimally benefit from specific moisturizers. It is hoped that future studies may identify such differences by means of filaggrin mutation subtypes, confocal microscopic evaluation, pH, transepidermal water loss or presence ofallergy specific IgE. Recommendations to improve the regular use of moisturizers among AD patients include measures that focus on treatment compliance, patient and caregiver education, appropriate treatment goals, avoidance of sensitizing agents, and collaboration with other relevant specialists.
Min-Young Jung·Kim-Min Jung·Jin-Su Song·Yu-Jin Lee·Soo-Yeon Park·Jong-Han Kim·Jeong-Hwa Choi
Eczema herpeticum is a widespread Herpes simplex virus(HSV) infection, which usually develops inpatientswithatopicdermatitis, because prutitis inpatientswithatopic dermatits leads them to scratch their bodies, it cause the dissemination of Herpes simplex virus. This study carried out to observe the progress of Eczema herpeticum and find effective remedy. The pastient was taken Herb-medicine with acupunture, cupping theraphy, aroma theraphy, and etc. After the treatment the grade of VAS was decressed and clinical symptoms were gradually disappeared. Those results suggest that herbal treatment was effective to Eczema herpeticum.
A premature stop codon mutation inthe SPINK5 gene, which encodes LEKTI, is known to be associated with NS, a rare ichthyosiform dermatosis characterized by congeni- tal ichthyosiform erythroderma, severe atopic manifesa- tions, and hair-shaft abnormality. 84 The SPINK5 gene consists of 33 exons, encoding 15 LEKTI inhibitory do- mains with selective/specific inhibitory function. 85 Previous study attempting to correlate genotype with phenotype in Japanese NS patients has demonstrated that theclinical severity of NS correlates withthe residual expression of LEKTI-1. 86 SPINK5-deficient mice have been reported to show increased proteolytic activities of KLK5 and KLK7 inthe epidermis, abnormal degradation of DSG1, and resultant abnormal corneodesmosome cleavage and premature desquamation, suggesting that LEKTI is a key regulator of KLK5 and KLK7 activity and that defective SC adhesion by epidermal protease hyperactivity is the primary pathogenic event in NS. 87 Recently, ELA2, a novel epidermal protease, has been identified in human and mouse skin and conceived as a potential trigger in NS pathogenesis by misprocessing of filaggrin and lipid. 88 Being localized to the keratohyalin granule, ELA2 directly degrades (pro-) filaggrin and disrupts the lipid lamellae formation. LEKTI was demonstrated to inhibit ELA2 acti- vity indirectly, by controlling KLK5-mediated cleavage of pro-ELA2, and indeed, ELA2 was observed to be hyperac- tive inthe LEKTI-deficient epidermis of NS patients and SPINK5-deficient mice. 88 Transgenic mice over-expres- sing ELA2 also mimic theclinical features of NS patientswith transient ichthyosiform dermatitis and impaired lipid barrier, implying that ELA2 is a critical epidermal protease that regulates epidermal barrier homeostasis, involving the
MATERIALS AND METHODS
From January 2004 to December 2010, 950 patients < 4 years of age visited our outpatient clinic for AD, and to exclude CM allergy, their concentrations of IgE to CM, ALA, BLG, and casein were evaluated. Medical records were reviewed and a telephone survey was used to document each patient’s current symptoms upon milk intake. Patients with either a convincing or vague history of CM allergy were included. We considered urticaria, angioedema, and anaphylaxis as convincing histories, while patients who had a history of aggravated AD after the ingestion of dairy foods and/or CM and/or breast milk without having completed a confirmative food challenge test met the definition of vague history. Subjects were divided into 2 age groups (< 2 years of age, 2-4 years of age) and patients who underwent a follow-up test every 6-12 months after milk avoidance were defined as follow-up patients.
Serum levels of inflammatory cytokines were higher in Ox-AD mice than in control mice, and even more so in mice with localized 11β-HSD1-inhibition, although the differences did not reach statistical significance.
IL-10 induces Th2 but also has anti-inflammatory effects, and is increased in skin lesions inpatientswith AD 45 . Decreased IL-10 levels are associated with AD flares 46 . IL-10 forms heterodimers and binds to the IL-10 receptor to activate the Janus kinase-signal transducer and activator of transcription signaling pathway, notably Janus kinase 1, tyrosine kinase 2, and signal transducer and activator of transcription 3 and 1 47 . Its anti-inflammatory effects are mediated by inhibition of IFN-γ and IL-2 production by Th1 cells and inhibition of IL-4 and IL-5 production by Th2 cells through interference with B7/CD28-dependent signals 48 . The present study showed increased IL-10 levels in Ox-AD mice and higher mean IL-10 levels in mice that were topically treated with 11β-HSD1 inhibitor compared to vehicle-treated mice; however, the difference was not statistically significant.
A 11-month-old boy was admitted to Nippon Medical School Musashi Kosugi Hospital with complaints of pyrexia for 2 weeks, poor oral ingestion and weight loss. He is the first child of nonconsanguineous parents. He was born by normal vaginal delivery at 38 weeks gestation with a birth weight of 2,282 g and birth height of 45 cm. He presented with a history of dry skin, chronic eczema, and egg allergy. He developed dry skin as early as 2 weeks of age and developed eczema at 1 month of age. Initially the eczema appeared on his face and neck and then extended to all over his body at 2 months of age. The eczema was treated with topical steroids. At 11 months of age (3 weeks prior to admission to our hospital), he developed hives on his face after eating cookies that contained egg and visited our hospital clinic. Based on the history of allergic symptoms on egg ingestion, clinical examination, and positive serum specific IgE to egg yolk (16.59 mg/dL), egg white (33.61 mg/dL), and ovomucoid (25.77 mg/dL), he was diagnosed as having egg allergy. On admission, he presented with extensive eczema all over the body with a SCORAD (SCORing Atopic Dermatitis) of 34.7, dry skin, sparse eyebrows and scalp hair, saddle nose, low-set ears, no teeth, and pigmentation around eyes (Fig. 1A, B). He had polydipsia and polyuria. His height was 72.8 cm and body weight was 7.08 kg (Kaup index;
Atopic dermatitis is a Th2-type skin disease in which the inflammation is characterized by the infiltration of lymphocytes into dermis. TARC is one ofthe functional ligands for CCR4 which is preferentially expressed on Th2-type cells and chemoattracts the CCR4-Th2-type cells into lesional sites in skin 22, 23 . Previous studies have demonstrated that TARC is highly expressed in a basal epidermis of lesional skin in NC/Nga mice 19 and in different layers of lesional epidermis from patientswith AD, but not inthe nonlesional skin 25 . MDC is another important chemokine for lymphocytes infiltration in inflammatory sites, and its receptor is CCR4 as TARC. High level of MDC was observed inthe monocyte derived dendritic cells (MoDCs) isolated from venous blood inpatientswith AD 71 and in keratinocytes in lesional skin ofatopicdermatitis 72 . Taken together, the levels of TARC and MDC were significantly higher in AD patients compared withthe healthy control subjects 24 . These preclinical and clinical studies suggest that TARC and MDC are major molecules which are involved inthe pathogenesis ofatopicdermatitis.
Methods: This study enrolled patientswith AD who were sensitized to cat and/or dog dander and underwent AIT (n = 19). Patients’ medical information was obtained, including past treatment history, treatment duration of AIT, and the progress of treatment. Also, the specific IgE levels and IgG4 levels were measured before and after AIT.
본 연구는 다음과 같은 제한점이 있다. 첫째는 인천의 실제 설문 조사의 협조가 가능한 중고등학교를 대상으로 하였으므로 지역 청 소년을 대표하는 자료로는 한계가 있다. 둘째로는 1개 남자 중학교, 1개 남녀공학 중학교, 2개 여자고등학교를 대상으로 하였기 때문에 연령대와 성별이 편의된 분포를 보이고 있다. 셋째로는 설문지만 이 용하여 키, 몸무게, 알레르기질환의 증상을 조사하여 분석하였기 에 검사 및 전문의의 진단과 무관한 조사였고 따라서 알레르기질 환에 대한 위양성 및 위음성이 나타날 수 있다. 또한 여학생에서 체 중과 체질량지수에 대한 결측이 남학생보다 높았는데, 사춘기 여 학생이 체중을 밝히는데 대한 부끄러움으로 인해 체질량지수가 과 소 추정될 확률이 있다. 미국의 국민건강영양조사(The National Health and Nutrition Examination Survey in United States)에서 실측조사와 설문조사 사이의 bias에 대한 연구가 있었는데 대체로 키는 과대 추정, 체중은 과소 추정되는 경향이 있었다. 그러나 이에 대한 민감도 분석 결과 두 조사 방식이 결과에 미치는 영향의 차이 가 없었으므로 39) 본 연구의 결과도 실측 방식의 조사 방법에서 나 온 결과와 다르지 않을 것으로 예상한다. 본 연구의 결과도 실측 방 식의 조사 방법에서 나온 결과와 다르지 않을 것으로 예상한다. 넷 째, 코호트 연구가 아닌 단면적 연구이기 때문에 관련성을 알 수 있 으나 인과관계를 파악하기에는 한계점을 가지고 있다. 그러나 본 연구는 앞서 보고된 선행 연구와 같이 아토피피부염의 유병률과 체 질량지수와 연관성이 나타났다
2) Dermatology Life Quality Index(DLQI) 9) Finlay와 Khan이 개발한 DLQI는 피부병 환자들의 질환 특이 삶의 질 평가도구로서 (disease specific quality of life measure) 이 등이 한국어로 번역하여 임상적 유용성을 평가하였다. DLQI는 증상과 감정상 태, 일상생활, 여가생활, 직장과 학교, 대인관계와 치 료의 6개 항목을 평가하는 10점 문항으로 구성되어 있다. 각 10문항에서 가장 높은 점수는 3점, 가장 낮 은 점수는 0점으로 하여 최고 점수는 30점이고 높은 점수일수록 아토피 피부염이 환자의 삶의 질에 더 큰 악영향을 주는 것으로 해석한다 하였다.
ity, it may still be helpful in diagnosing CMV colitis in some cases because of its high specificity. 5 Although CMV infec- tion has been reported as a risk factor for poor outcomes in two prospective multicenter studies by the IBD Study Group ofthe Korean Association for the Study for Intestinal Diseas- es, 7,8 there is little data concerning the relationship between CMV antigenemia assay results and clinical outcomes.
Abstract : A 7.1 kg, seven-year old, castrated male, Shih-Tzu with severe pruritus, chronic otitis externa and Malassezia infection was referred to Veterinary Medical Teaching Hospital of Chungnam National University. In local animal hospital, steroid therapy was used to treat uncontrollable pruritus, but theclinical signs were recurrent when steroid therapy was discontinued. On physical examination, generalized alopecia, erythema, papules, severe crust and diffuse lichenification were presented. Tape strip test of skin lesions revealed cocci and Malassezia infections. Based on the result of history, clinical signs and examination described above, canine atopicdermatitiswith secondary superficial pyoderma and Malassezia dermatitis was diagnosed. Oral challenge with cyclosporine and antibiotics had good results inclinical signs. Clinical sign scores were evaluated by investigator with CADESI at 2weeks, 4weeks, 6weeks, 8weeks and 10weeks after cyclosporine administration. And inthe result of comparing of allergen-specific IgE value, the level of allergen-specific IgE to general causative allergen after 10 weeks of cyclosporine therapy was higher than that before cyclosporine therapy.
taste and smell. Drinking bottled water implies a hygienic lifestyle and good looks. This may be the reason why some people use bottled water to wash their faces or even to bath. For sparkling water, the carbon dioxide gas is added inthe bottling process which affects the pH ofthe water. Bottled natural mineral waters have various mineral contents. There are many regulations and standards for water intended for human consumption which limit the levels of disinfectants, DBPs (bromate, chlorine, chlorite, haloacetic acids, total trihalogenometals), inorganic chemicals (aluminum, amonium, antimony, arsenic, barium, beryllium, boron, cadmium, chloride, chrome, copper, cyanide, fluoride, iron, lead, manganese, mercury, molybdenum, nickel, nitrate, nitrite, selenium, silver, sodium, sulfate, thallium, uranium, zinc), organic chemicals (acrylamide, benzene, total pesticides, polycyclic aromatic hydrocarbons, phenolics) . In our study, bottled drinking still water had slightly alkaline pH, while the sparkling ones had lower pH.
Atopic dermatitis (AD) is a very common disease with a prevalence of 15 to 25%, especially in Western countries, and seems to be increasing worldwide and in Korea. The prevalence of AD in Korea is considered to be about 10%
inthe pediatric population less than 6 years of age and decreases thereafter, falling to about 3% in adults. AD in Korea seems to be a little more common in girls than in boys. Infragluteal eczema, scalp scaling, and periauricular eczema, which are not included inthe worldwide diagnostic criteria, are reported to be quite common in Korean AD patients. Recently, the number of adult patientswith a more severe form of AD appears to be increasing in Korea.
아토피 피부염은 심한 소양감, 홍반, 부종, 건조한 피부, 만성 재발성 경과를 특징으로 하는 피부염증으로서,
최근 들어 흡연이나 공기오염 등 공해 물질에 대한 노출 증가, 애완동물 개체수 증가, 모체 출산연령의 상승, 식습관의 변화 등 다양한 원인에 의해서 아토피 피부 염의 유병률이 점차 증가하고 있다 11) . 통계에 따르면 Table 3. The Progress of Treatment(Case 2)