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Coexistence of digestive tract symptoms in children with atopic dermatitis — based on own observations
Barbara Kamer,Renata Pasowska,Helena Rotsztejn,El?bieta Dó?ka
Polish Gastroenterology , 2010,
Abstract: Introduction: Clinical manifestation of atopic dermatitis (AD) is complex and usually involves at least two systems. In infants skin lesions are often accompanied by symptoms of the digestive tract. Aim of the study: Estimate the frequency of coexistence and kind of digestive tract symptoms in children with atopic dermatitis. Material and methods: The retrospective analysis comprised 2256 children aged from 0 to 6 months of life treated in the II Department of Pediatrics and Allergology of Polish Mother's Memorial Hospital Research Institute in the years 2003-2009. Among them, 471 children had various types of skin lesions. Among these children we separated patients with atopic dermatitis who have an allergy as the cause confirmed by a positive food challenge and the results of allergic and immunological studies. Results: Atopic dermatitis was diagnosed in 391 children, which accounted for 17.3% of all the hospitalized patients. In 140 of them, symptoms of the digestive tract were found, including intestinal colic in 49.3%, obstipation in 6.4%, regurgitation and vomiting in 33.6% and chronic diarrhea in 10.7% of the examined children. Conclusions: The conducted examinations showed frequent coexistence of atopic skin lesions and symptoms of the digestive tract (1/3 of the analyzed children). 71.6% children had disseminated skin lesions which indicates the tendency for more frequent dissemination of skin lesions in the smallest children. Improvement after dietary therapy confirmed the cause-effect relationship between food allergy and atopic dermatitis.
Evaluation of a Parental Questionnaire to Identify Atopic Dermatitis in Infants and Preschool Children  [PDF]
Laura B. von Kobyletzki,Staffan Janson,Mikael Hasselgren,Carl-Gustaf Bornehag,?ke Svensson
Journal of Allergy , 2012, DOI: 10.1155/2012/945617
Abstract: Aim. To develop and validate a questionnaire for detecting atopic dermatitis in infants and small children from the age of 2 months. Methods. Parents to 60 children answered a written questionnaire prior to a physical examination and individual semistructured interview. Qualitative and quantitative analyses of validity, sensitivity, specificity, and predictive values of the questionnaire were performed. Results. A total of 27 girls and 33 boys, aged 2 to 71 months, 35 with and 25 without physician-diagnosed eczema, participated. Validation of the questionnaire by comparisons with physicians’ diagnoses showed a sensitivity of 0.91 (95% CI 0.77–0.98) and a specificity of 1 (95% CI 0.86–1). Conclusions. Three questions in a parental questionnaire were sufficient for diagnosing eczema in infants and small children. 1. Introduction Atopic dermatitis affects 15 to 20% of preschool children in western countries [1–4]. The lifetime prevalence of eczema in children aged 1–4 years in V?rmland county, Sweden, was assessed in 2000 in the cohort study Dampness in Building and Health to be 22% [5]. The burden of disease has been assessed to be at least comparable to other chronic illnesses, such as diabetes or neurological disorders [6–8]. For population-based, epidemiological investigations, parental written questionnaires detecting eczema during childhood are advantageous. However, current questionnaires have been developed for older children and adults [9]. Given that in small children atopic dermatitis is the most common inflammatory disease, the deficiency of validated questionnaires diagnosing eczema in very young children is noteworthy [10]. A questionnaire should be suitable to the general population and therefore evaluated in such a setting. Furthermore, it should be applicable to eczema with different severity categories. A new questionnaire detecting atopic dermatitis in young children could probably be based on previous tools for older children. For the current study, a questionnaire was based on the existing ISAAC (International Study of Asthma and Allergies in Childhood) questions for school children [9]. The aim of the current study was to estimate the diagnostic precision of the children’s eczema questionnaire compared to physicians’ clinical diagnoses as the gold standard in preschool children from the age of two months. Further, we evaluated whether the parents considered the questions to be understandable and suitable for diagnosing eczema in this age group. 2. Methods 2.1. Study Design and Procedures A case control design similar to that used by
An uncontrolled open pilot study to assess the role of dietary eliminations in reducing the severity of atopic dermatitis in infants and children  [cached]
Dhar Sandipan,Malakar Rajib,Banerjee Raghubir,Chakraborty Saswati
Indian Journal of Dermatology , 2009,
Abstract: Background: The severity of atopic dermatitis (AD) has been reported to be reduced by dietary eliminations in a subset of patients with AD. Aims: To assess the reduction of the severity of atopic dermatitis in infants and children after eliminations of certain dietary items. Materials and Methods: The study group comprised of 100 children with atopic dermatitis. Their severity of itching, surface area of involvement, and SCORAD index were measured. Patients who did not have any systemic disease or were not on systemic corticosteroids were included in the study. Selected patients were advised to strictly adhere to a diet excluding milk and milk products, all kinds of nuts and nut-containing foods, egg and egg-containing foods, seafish and prawns, brinjal and soyabean for a period of 3 weeks. Instead of these avoided items, the food items to be included freely to maintain proper nutrition were dal and dal products, rohu fish, chicken, and fruits. All the preintervention parameters were measured again after 3 weeks. Results: There was a statistically significant reduction in severity scores after dietary elimination alone. Conclusion: Dietary elimination helped to alleviate symptoms and signs in a subset of infants and children with AD.
Atopic dermatitis in infants and children in India  [cached]
Dhar Sandipan,Banerjee Raghubir
Indian Journal of Dermatology, Venereology and Leprology , 2010,
Abstract: Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease characterized by pruritus and inflammation and accompanied by cutaneous physiological dysfunction, with a majority of the patients having a personal or family history of "atopic diathesis." The term "atopic diathesis" refers to the presence of allergic rhinitis, bronchial asthma or AD. The universal occurrence of AD is no longer debated. However, published material about its natural history, etiopathogenesis, epidemiology, clinical patterns and management leave a lot to be known in the Indian scenario. In the present write-up, we will try to explore the wealth of knowledge about the disease available in our country and try to unfurl the complex interplay of different factors that are implicated for the development of this condition. The diagnosis of AD is based on a constellation of signs and symptoms. There is no laboratory "gold standard" for the diagnosis of AD. In a majority of the cases, the diagnosis is quite easy. Topical corticosteroids form the mainstay of topical treatment and, along with emollient, are able to control the condition in more than 80% of the cases. However, as use of long-term topical corticosteroid has the potential to produce local and systemic adverse effects, topical tacrolimus has come up as a useful molecule for the long-term control of the disease.
Clinical correlations of recent developments in the pathogenesis of atopic dermatitis
Sehra, Sarita;Tuana, Florencia M. Barbé;Holbreich, Mark;Mousdicas, Nico;Kaplan, Mark H.;Travers, Jeffrey B.;
Anais Brasileiros de Dermatologia , 2008, DOI: 10.1590/S0365-05962008000100009
Abstract: atopic dermatitis is a chronic inflammatory skin disease with a steadily increasing prevalence affecting 10-20 of infants and 1-3 of adults globally. it is often the first clinical manifestation of atopic disease preceding asthma and allergic rhinitis. probably half of the children with atopic dermatitis develop some other form of atopic disease later in life. the pathogenesis involves a complex interplay of factors including genetic predisposition due to altered immune or skin barrier function, interactions with the environment such as food and allergen exposures, and infectious triggers of inflammation. in this review, we summarize the recent advances in understanding the contribution of different factors in the pathophysiology of atopic dermatitis and how insights provide new therapeutic potential for its treatment.
Quality of life in infants and children with atopic dermatitis: Addressing issues of differential item functioning across countries in multinational clinical trials
Stephen P McKenna, Lynda C Doward, David M Meads, Alan Tennant, Gemma Lawton, Jens Grueger
Health and Quality of Life Outcomes , 2007, DOI: 10.1186/1477-7525-5-45
Abstract: The 45 items were included in three clinical trials designed to test the efficacy of a new topical treatment (pimecrolimus, Elidel cream 1%) in the treatment of AD in infants and children and in validation studies in the UK, US, Germany, France and the Netherlands. Rasch analyses were undertaken to determine whether an internationally valid, unidimensional scale could be developed that would inform on the direct impact of AD on the child.Rasch analyses applied to the data from the trials indicated that the draft measure consisted of two scales, one assessing the QoL of the carer and the other (consisting of 12 items) measuring the impact of AD on the child. Three of the 12 potential items failed to fit the measurement model in Europe and five in the US. In addition, four items exhibiting differential item functioning (DIF) by country were identified. After removing the misfitting items and controlling for DIF it was possible to derive a scale; The Childhood Impact of Atopic Dermatitis (CIAD) with good item fit for each trial analysis. Analysis of the validation data from each of the different countries confirmed that the CIAD had adequate internal consistency, reproducibility and construct validity.The CIAD demonstrated the benefits of treatment with Elidel over placebo in the European trial. A similar (non-significant) trend was found for the US trials.The study represents a novel method of dealing with the problem of DIF associated with different cultures. Such problems are likely to arise in any multinational study involving patient-reported outcome measures, as items in the scales are likely to be valued differently in different cultures. However, where all items in a scale fit both a single theoretical construct and the Rasch measurement model, it is feasible to conceive of outcome measures with a different set of items in each language.Paediatric atopic dermatitis (AD) is a common skin condition affecting 12–15% of children in early childhood [1]. There is a w
Management of Patients with Atopic Dermatitis: The Role of Emollient Therapy  [PDF]
M. Catherine Mack Correa,Judith Nebus
Dermatology Research and Practice , 2012, DOI: 10.1155/2012/836931
Abstract: Atopic dermatitis is a common inflammatory skin disorder that afflicts a growing number of young children. Genetic, immune, and environmental factors interact in a complex fashion to contribute to disease expression. The compromised stratum corneum found in atopic dermatitis leads to skin barrier dysfunction, which results in aggravation of symptoms by aeroallergens, microbes, and other insults. Infants—whose immune system and epidermal barrier are still developing—display a higher frequency of atopic dermatitis. Management of patients with atopic dermatitis includes maintaining optimal skin care, avoiding allergic triggers, and routinely using emollients to maintain a hydrated stratum corneum and to improve barrier function. Flares of atopic dermatitis are often managed with courses of topical corticosteroids or calcineurin inhibitors. This paper discusses the role of emollients in the management of atopic dermatitis, with particular emphasis on infants and young children. 1. Introduction Atopic dermatitis (AD) is a skin disease characterized by inflammation, pruritus, and chronic or relapsing eczematous lesions. As one of the most common childhood skin diseases, AD afflicts approximately 17% of children in the United States [1]. Worldwide, the prevalence of symptoms for AD has generally risen, although countries with previously high rates appear to have reached a plateau [1, 2]. The increased prevalence over the last few decades is reflected in more recent data from a survey of Greek schoolchildren (Figure 1) [3]. Onset often occurs during early childhood, with 45%, 60%, and 85% of children presenting with clinical symptoms by 6 months, 1 year, and 5 years of age, respectively [4]. In the adult population, AD has an estimated lifetime prevalence of 2%–10% [4]. Although AD is a chronic disease, it resolves in about 60% of patients before adulthood. Figure 1: Prevalence of atopic dermatitis in Greek schoolchildren, 1991–2008 [ 3]. Patients with AD frequently develop other forms of atopy. In addition to AD, food allergies are common during the first 2 years of life, with improvement during the preschool years [5]. Children with these conditions typically develop allergic rhinitis and asthma in childhood, which can persist or resolve with age [6]. The progression from AD to other forms of atopic disease is referred to as the atopic march; AD, allergic rhinitis, and asthma comprise the atopic triad. In one study, 87% of children with AD showed improvement in AD by 7 years of age, but 43% and 45% developed asthma and allergic rhinitis, respectively, by age
Atopic dermatitis, cutaneous steroids and cataracts in children: two case reports
Andrew Tatham
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-124
Abstract: We describe two children with atopic dermatitis, treated with cutaneous corticosteroids, both of whom were diagnosed with bilateral posterior sub-capsular cataracts.These cases demonstrate that atopic dermatitis and topical corticosteroids may be associated with cataracts in children as well as adults. The cause of cataracts in atopic dermatitis is not known, however, it has been suggested that habitual tapping and rubbing of the face may play a role. Care needs to be taken when prescribing corticosteroids. Inadequate treatment of atopic dermatitis may lead to other ocular complications such as keratitis and permanent visual loss.Atopic dermatitis (AD) is a chronic, pruritic, eczematous skin disease mediated through an immediate (type I) hypersensitivity reaction. It primarily affects the flexural surfaces and lesions exhibit a red, elevated, scaly and often excoriated appearance. AD is typically manifest in infants aged 1 to 6 months and 90% of eventual sufferers have had their first outbreak by age 5 years. Ocular complications of AD in adults include blepharitis, keratoconjunctivitis, keratoconus, uveitis, sub-capsular cataract and retinal detachment. Cataracts secondary to AD may occur in 25 to 50% of adults but are rare in adolescents and young adults [1]. The most common ocular finding in children is a papillofollicular conjunctivitis [1]. Two main types of cataract are seen in patients with AD, an anterior sub-capsular plaque and anterior and posterior sub-capsular opacities.The management of AD is based on the exclusion of allergens, the use of emollients and on topical corticosteroids for disease exacerbations. Cataracts may be due to AD but may also occur secondary to the use of corticosteroids. The cataract associated with corticosteroids tends to be posterior sub-capsular. Ocular complications of corticosteroids may occur following intravenous, oral, inhaled or ocular administration. Although corticosteroids are commonly used in the treatment of dermatol
Synbiotics could not Reduce the Scoring of Childhood Atopic Dermatitis (SCORAD): A Randomized Double Blind Placebo-Controlled Trial
Alireza Shafiei,Mostafa Moin,Zahra Pourpak,Mohammad Gharagozlou
Iranian Journal Of Allergy, Asthma and Immunology , 2011,
Abstract: Despite preliminary evidence, the role of probiotic and synbiotic in treatment of the atopic dermatitis has shown varying results. We aimed to evaluate whether synbiotic supplementation decrease severity of atopic dermatitis (AD) in childhood. In a randomized double blind-placebo controlled trial, we evaluated the synbiotic supplementation efficiency on the treatment of atopic dermatitis. Infants aged 1-36 months with moderate to severe atopic dermatitis were randomized (n=41) and received either synbiotic (probiotic plus prebiotic) (n=20) or placebo (n=21) daily as a powder for two months. Emollient (Eucerin) and topical corticosteroid (Hydrocortisone) were permitted. Children were scored for severity of atopic dermatitis (SCORAD). Also allergen Skin Prick Tests (SPT), IgE blood level and eosinophil count were measured at first visit. Patients' SCORAD were reevaluated at the end of intervention. We followed 36 out of 41 subjects for two months (drop out rate = 9%). In the whole group, the mean Total SCORAD (at base line 40.93) decreased by 56% (p=0.00). The mean Objective SCORAD (at base line 31.29) decreased by 53% (p=0.00). There was no significant difference in the mean decrease of total SCORAD between placebo (22.3) and synbiotic groups (24.2). There was also no difference between two intervention groups in the mean decrease of total SCORAD regarding to different demographic, clinical and para clinical subgroups. This study could not confirm synbiotic as an effective treatment for childhood atopic dermatitis and further studies are needed. These findings challenge the role of synbiotics in the treatment of childhood atopic dermatitis
An Alternative Approach to Atopic Dermatitis: Part II—Summary of Cases and Discussion  [PDF]
Hiromi Kobayashi,Kuniaki Takahashi,Nobuyuki Mizuno,Haruo Kutsuna,Masamitsu Ishii
Evidence-Based Complementary and Alternative Medicine , 2004, DOI: 10.1093/ecam/neh026
Abstract: In the first part of this Review, we presented case-series where Kampo treatment was introduced for those atopic dermatitis (AD) patients who had failed with conventional therapy, in an attempt to prove that there exists a definite subgroup of AD patients for whom Kampo treatment is effective. In this second part, we will first provide the summary of the results for 140 AD patients we treated in 2000. The results suggest that Kampo treatment is effective for more than half of AD patients who fail with conventional therapy. In the Discussion, we will examine the evidential basis for conventional AD therapy and discuss how Kampo treatment should be integrated into the guidelines for AD therapy. We contend that Kampo treatment should be tried before systematic immunosuppressive agents are considered. As each Kampo treatment is highly individualized, it should be regarded more as ‘art’ than technology, and special care should be taken to assess its efficacy in clinical trial.
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