Asymmetric Overgrowth and a Facial Port Wine Stain Seiringer, Peter; Biedermann, MD, Tilo; Schnopp, MD, Christina
The Journal of pediatrics,
February 2021, 2021-02-00, 20210201, Letnik:
229
Journal Article
...the observed outcome in our omalizumab trial might not entirely reflect drug-associated clinical changes. ...only a very small proportion (probably between 1% and 5 % of all serum IgE molecules) ...in our patients was bound by omalizumab.
Psoriasis is characterized by an apoptosis-resistant and metabolic active epidermis, while a hallmark for allergic contact dermatitis (ACD) is T cell-induced keratinocyte apoptosis. Here, we induced ...ACD reactions in psoriasis patients sensitized to nickel (n = 14) to investigate underlying mechanisms of psoriasis and ACD simultaneously. All patients developed a clinically and histologically typical dermatitis upon nickel challenge even in close proximity to pre-existing psoriasis plaques. However, the ACD reaction was delayed as compared to non-psoriatic patients, with a maximum intensity after 7 days. Whole genome expression analysis revealed alterations in numerous pathways related to metabolism and proliferation in non-involved skin of psoriasis patients as compared to non-psoriatic individuals, indicating that even in clinically non-involved skin of psoriasis patients molecular events opposing contact dermatitis may occur. Immunohistochemical comparison of ACD reactions as well as in vitro secretion analysis of lesional T cells showed a higher Th17 and neutrophilic migration as well as epidermal proliferation in psoriasis, while ACD reactions were dominated by cytotoxic CD8+ T cells and a Th2 signature. Based on these findings, we hypothesized an ACD reaction directly on top of a pre-existing psoriasis plaque might influence the clinical course of psoriasis. We observed a strong clinical inflammation with a mixed psoriasis and eczema phenotype in histology. Surprisingly, the initial psoriasis plaque was unaltered after self-limitation of the ACD reaction. We conclude that sensitized psoriasis patients develop a typical, but delayed ACD reaction which might be relevant for patch test evaluation in clinical practice. Psoriasis and ACD are driven by distinct and independent immune mechanisms.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Conventional therapy for atopic dermatitis has evolved along with better understanding of underlying impaired barrier function, role of microorganisms, and immune abnormalities. Emollients, along ...with antimicrobial and topical anti-inflammatory therapies, remain the cornerstone of conventional therapy. Recent therapeutic advances include use of nonsteroidal therapy for epidermal barrier repair, along with proactive therapy with topical corticosteroids and calcineurin inhibitors. Minimal anti-inflammatory treatment of the underlying residual disease is the immunobiologic rationale for proactive therapy. Further progress in understanding this increasingly common disease will hopefully lead to more targeted therapies.
Importance of the field: Atopic eczema is highly colonized with Staphylococcus aureus in lesional as in non-lesional skin. Antimicrobial therapy as part of a comprehensive therapeutic concept in ...atopic eczema has been discussed for a long a time.
Areas covered in this review: A complete literature review of the accessible publications concerning antibacterial and antiseptic therapy has been undertaken.
What the reader will gain: This review covers the literature on antimicrobial therapy in atopic eczema and will try to weigh the different publications in the field.
Take-home message: A beneficial role for antibacterial/antiseptic therapy on top of anti-inflammatory therapy in atopic eczema has to be questioned. However, a role in prevention of overt skin infection seems possible.
Background It was reported that in infants with eczema and food sensitization, the presence of a filaggrin (FLG) null mutation predicts future asthma with a specificity and positive predictive value ...of 100%. Objectives We sought to evaluate the predictive value of food sensitization and food allergy, FLG haploinsufficiency, and their combination in infants with early-onset eczema for persistent eczema and childhood asthma. Methods The German Infant Nutritional Intervention (GINI) and Influence of Lifestyle-related Factors on the Immune System and the Development of Allergies in Childhood (LISA) birth cohorts, as well as a collection of 65 cases of early-onset eczema with and without food allergy were investigated. Results The risk for asthma was significantly increased by food sensitization (positive diagnostic likelihood ratios PLRs of 1.9 95% CI, 1.1-3.4 in the GINI cohort and 5.5 95% CI, 2.8-10.8 in the LISA cohort) and the presence of an FLG mutation (PLRs of 2.9 95% CI, 1.2-6.6 in the GINI cohort and 2.8 95% CI, 1.0-7.9 in the LISA cohort) with a rather high specificity (79.1% and 92.9% in the GINI cohort and 89.0% and 91.7% in the LISA cohort, respectively) but low sensitivity (40.0% and 39.3% in the GINI cohort and 31.6% and 23.5% in the LISA cohort, respectively). Likewise, the risk for persistent eczema was increased. In the clinical cases neither food allergy nor FLG mutations had a significant effect. The combination of both parameters did not improve prediction and reached positive predictive values of 52.3% (GINI cohort), 66.9% (LISA cohort), and 30.6% (clinical cases), assuming an asthma prevalence in children with early eczema of 30%. Conclusion Early food sensitization and the presence of an FLG mutation in infants with early eczema increase the risk for later asthma, but the combination of the 2 factors does not represent a clinically useful approach to reliably identify children at risk.
Zusammenfassung
Die atopische Dermatitis ist die häufigste chronische Hauterkrankung im Kindesalter mit einer Prävalenz von 10% bei Kleinkindern unter 2 Jahren, wovon etwa 15% einen hohen Schweregrad ...aufweisen. „Kinder sind keine kleinen Erwachsenen“, dies trifft für die schwere frühkindliche atopische Dermatitis in besonderem Maße zu. Innerhalb dieser sensiblen Lebensphase zeigen sich alterstypische Facetten der Erkrankung (psychosozial, neurokognitiv, klinisch‐morphologisch), die Unterschiede im Management mit sich bringen.
Besondere Bedeutung hat die Identifikation von Säuglingen und Kleinkindern mit früh‐persistierendem, schwerem Verlauf mit Blick auf eine erstmals für diese Altersgruppe zugelassene Systemtherapie: sowohl für die unmittelbare Versorgung der Hauterkrankung als auch unter dem Aspekt einer möglichen Prävention von Begleiterkrankungen. Da der „atopische Phänotyp“ klinische Überlappungen zum Spektrum der Immundefekte aufweist, ist die korrekte Einordnung des Hautbefundes bei therapierefraktärem Ekzem essenziell. In dieser Arbeit beschreiben wir eine alltagstaugliche Strategie, um anhand anamnestischer Warnhinweise, dermatologischer Leitbefunde und Labordiagnostik eine Abgrenzung von ekzematösen Hauterscheinungen bei primären Immundefekten vorzunehmen. Dazu geben wir aktuelle Empfehlungen zum Management des schweren frühkindlichen atopischen Ekzems, auch in Bezug auf die Indikation zur Systemtherapie.
PDF
