RESUMO
BACKGROUND: Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. OBJECTIVE: To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. METHODS: This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups â nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. RESULTS: Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. STUDY LIMITATIONS: Lack of long term follow-up and no large studies in literature to compare results. CONCLUSION: Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.
Assuntos
Doenças Mamárias/patologia , Dermatite Atópica/patologia , Eczema/patologia , Mamilos/patologia , Complicações na Gravidez/patologia , Adulto , Doenças Mamárias/sangue , Doenças Mamárias/diagnóstico , Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Eczema/sangue , Eczema/diagnóstico , Feminino , Humanos , Imunoglobulina E/sangue , Índia , Contagem de Leucócitos , Neutrófilos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Trimestres da Gravidez , Estudos ProspectivosRESUMO
Abstract Background Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. Objective To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. Methods This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. Results Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. Study limitations Lack of long term follow-up and no large studies in literature to compare results. Conclusion Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Doenças Mamárias/patologia , Dermatite Atópica/patologia , Eczema/patologia , Mamilos/patologia , Complicações na Gravidez/patologia , Doenças Mamárias/diagnóstico , Doenças Mamárias/sangue , Imunoglobulina E/sangue , Estudos Prospectivos , Dermatite Atópica/diagnóstico , Dermatite Atópica/sangue , Eczema/diagnóstico , Eczema/sangue , Índia , Contagem de Leucócitos , NeutrófilosRESUMO
Vitamin D (VD) deficiency has been associated with increased incidence and severity of atopic dermatitis (AD), but the mechanisms through which VD may ameliorate AD are unclear. We compared the phenotypic characteristics of circulating myeloid and plasmacytoid dendritic cells (mDCs and pDCs, respectively) of children with AD vs healthy controls (HC) and evaluated if VD can modulate the allergic phenotype of circulating DCs in AD patients. Although there was no difference in frequency of circulating DCs between groups, among children with AD there was an inverse correlation between SCORAD and circulating total DCs and mDCs. In AD, serum IgE concentration correlated with FcεRI and surface-bound IgE expression on mDCs and pDCs; pDCs expressing FcεRI and IgE were significantly increased compared to HC. Ex vivo, 1,25(OH)2 D3 significantly decreased FcεRI expression on mDCs and surface-bound IgE on mDCs and pDCs. Oral VD supplementation reduced expression of surface-bound IgE on pDCs in children with AD. In summary, VD decreases the allergic phenotype of circulating DCs in children with AD, a potential mechanism for how VD supplementation may improve AD severity. Future studies are needed to further assess the role of VD supplementation as an immunomodulatory therapy for AD.
Assuntos
Células Dendríticas/citologia , Dermatite Atópica/sangue , Dermatite Atópica/terapia , Deficiência de Vitamina D/sangue , Vitamina D/farmacologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Células Mieloides/citologia , Fenótipo , Deficiência de Vitamina D/terapiaRESUMO
BACKGROUND: Vitamin D has immunomodulatory effects both in the innate and adaptive immune systems, and there is growing scientific evidence demonstrating its relevance in inflammatory processes such as AD. HYPOTHESIS: If vitamin D3 promotes the skin immune system, then it should improve the response to treatment of patients with AD. METHODS: A randomized, double-blind placebo-controlled clinical trial was conducted, which included 65 patients with AD according to Hanifin-Rajka criteria and the severity scale (SCORAD). The patients were divided into two groups to receive either vitamin D3 5000 IU/day (n = 33) or placebo (n = 32), plus baseline therapy (topical steroid, soap substitute, and emollient) during 3 months. RESULTS: Fifty-eight of the 65 enrolled subjects were included in the analysis. At the end of the intervention, the treated group achieved higher levels of 25(OH)D (P < 0.001). At week 12, those patients who registered serum levels of 25(OH)D ≥20 ng/ml, regardless of whether or not they had received supplementation, showed a lower SCORAD compared to those with levels <20 ng/ml (P < 0.001). Eighty percent of the patients with serum levels <20 ng/ml (n = 9) had moderate-severe AD despite standard treatment. Vitamin D levels ≥20 ng/ml associated with baseline therapy strongly favored remission of atopic dermatitis (P = 0.03). No significant differences were found between patients with serum levels of ≥20 ng/ml vs. ≥30 ng/ml. CONCLUSIONS: Reaching serum levels of 25(OH)D > 20 ng/ml in conjunction with standard therapy is sufficient to achieve a reduction in severity (SCORAD) in patients with AD.
Assuntos
Colecalciferol/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Vitaminas/administração & dosagem , Administração Cutânea , Administração Oral , Adolescente , Adulto , Criança , Pré-Escolar , Dermatite Atópica/sangue , Suplementos Nutricionais , Método Duplo-Cego , Quimioterapia Combinada , Emolientes/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Esteroides/administração & dosagem , Vitamina D/análogos & derivados , Vitamina D/sangue , Adulto JovemRESUMO
INTRODUCTION: Our group recently demonstrated that IgG modulates αßT cell cytokine production during the maturation process in the human thymus. The effects of this modulation are IgG repertoire dependent and can exert a systemic and long-term impact. OBJECTIVE: To investigate whether IgG from atopic dermatitis (AD) patients can modulate cytokine production of infant intrathymic TCD4 and TCD8 cells in vitro. METHODS: Thymic tissues were obtained from newborn children from nonatopic mothers, and thymocytes were cultured for 6 days with purified IgG from AD patients or with intravenous immunoglobulin (IVIG) or mock conditions as controls. Cells were gated as double positive T cells (TDP- CD4+ CD8+ ), TCD4 cells (CD4+ CD8- ), or TCD8 cells (CD4- CD8+ ), and intracellular levels of IL-17A, IFN-γ, TNF-α, IL-4, IL-10, and TGF-ß were evaluated by flow cytometry. RESULTS: Compared to mock and IVIG culture conditions, IgG of AD individuals induced in vitro intracellular production of IL-17 and IL-10 by intrathymic TDP, TCD4, and TCD8 cells of infants. TGF-ß was also detected at a higher frequency in response to AD IgG in TDP and TCD8 cells compared to mock and IVIG cultured conditions. An opposite effect was detected upon IFN-γ production in TCD4 cells, such that AD IgG reduced IFN-γ production compared to production under mock conditions but not under IVIG conditions. CONCLUSION: IgG of AD patients can stimulate cytokine production in infant thymocytes and thus resembles the peripheral profile observed in adults. These findings suggest a novel mechanism that can contribute to AD pathogenesis.
Assuntos
Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Citocinas/biossíntese , Imunoglobulina G/farmacologia , Biossíntese de Proteínas/efeitos dos fármacos , Adulto , Células Cultivadas , Dermatite Atópica/sangue , Humanos , Imunoglobulina G/sangue , Imunoglobulinas Intravenosas/farmacologia , Recém-Nascido , Interferon gama/biossíntese , Interleucina-10/biossíntese , Interleucina-17/biossíntese , Interleucina-4/biossíntese , Timócitos , Timo/citologia , Fator de Crescimento Transformador beta/biossíntese , Fator de Necrose Tumoral alfa/biossínteseRESUMO
BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory and complex skin disease, typically occurring in individuals with a personal or family history of atopy. It is characterized by lesions of dermatitis, pruritus and dry skin (xerosis) that evolve with chronic course and intermittent outbreaks alternating with remission phases. AD appears from 5-15 % of the general population, 10-20 % of the pediatric population, and 1-3 % of the adult population. CLINICAL REPORT: A 19-year-old male patient with a severe AD (SCORAD of 84.3), and hyper-IgE (34 400 UI/mL), who was treated with deflazacort, Healing creams and emollients, as well as detergent-free gel. With which did not progress favorably, so a combinated therapy with deflazacort, methotrexate, tacrolimus, and transfer factor was prescribed, obtaining excellent results. CONCLUSION: There are many algorithms reported in the literature for the treatment of AD, but the evolution of the disease is the only one that will give us the guidelines for the treatment to be followed.
Antecedentes: la dermatitis atópica es una enfermedad cutánea compleja, inflamatoria y crónica, que ocurre típicamente en individuos con una historia personal o familiar de atopia. Se caracteriza por lesiones de dermatitis, prurito y piel seca (xerosis) que evolucionan con curso crónico y brotes intermitentes que alternan con periodos de remisión. La padecen entre 5 y 15 % de la población general, entre 10 y 20 % de la población pediátrica y entre 1 y 3 % de la población adulta. Caso clínico: hombre de 19 años, con dermatitis atópica severa (SCORAD de 84.3) e hiper-IgE (34 400 UI/mL). Se prescribió deflazacort y uso de cremas cicatrizantes y emolientes, así como de gel libre de detergente, tratamiento con el cual no evolucionó favorablemente, por lo que se indicó la combinación de deflazacort, metotrexate, tacrolimus y factor de transferencia, con la cual se obtuvieron excelentes resultados. Conclusión: en la literatura se describen numerosos algoritmos para el tratamiento de la DA, pero la evolución de la enfermedad es la que marca la pauta para el tratamiento que debe seguirse.
Assuntos
Dermatite Atópica/imunologia , Imunoglobulina E/imunologia , Dermatite Atópica/sangue , Humanos , Imunoglobulina E/sangue , Masculino , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Prolactin performs as a neuroendocrine modulator of skin epithelial cell proliferation and the skin immune system. OBJETIVE: The aim was to assess the serum prolactin levels in patients with atopic dermatitis and the relationship with disease severity. METHODS: The study was performed on 46 patients with atopic dermatitis and 100 healthy controls aged between 0.5 years and 19.5 years. The diagnosis of atopic dermatitis was based on clinical findings and the severity of the disease was documented. Venous blood sampling was performed in order to measure prolactin levels. RESULTS: Prolactin levels in atopic dermatitis were not different from controls and there was no relationship between the severity of atopic dermatitis and serum prolactin levels. Prolactin may not have a role in the pathogenesis of atopic dermatitis. Further studies with larger sample sizes and measurement of prolactin levels in the skin may help to understand the role of prolactin in the pathogenesis of atopic dermatitis.
ANTECEDENTES: La prolactina actúa como modulador neuroendocrino de la proliferación de las células epiteliales de la piel y del sistema inmunitario cutáneo. OBJETIVO: Evaluar la concentración sérica de prolactina en los pacientes con dermatitis atópica y su relación con gravedad de la enfermedad. MÉTODOS: El estudio se llevó a cabo en 46 pacientes con dermatitis atópica y 100 controles sanos de entre 0,5 y 19,5 años. El diagnóstico de dermatitis atópica se basó en las manifestaciones clínicas y se documentó la gravedad de la enfermedad. Se tomaron muestras de sangre venosa para medir la concentración de prolactina. RESULTADOS: La concentración de prolactina no difirió entre los pacientes con dermatitis atópica y los controles, y no se estableció una relación entre la gravedad de la dermatitis atópica y la concentración sérica de prolactina. La prolactina no participa en la patogenia de la dermatitis atópica. Se necesitan otros estudios con tamaños muestrales más grandes y la medición de la concentración de prolactina en la piel para comprender la función de la prolactina en la patogenia de la dermatitis atópica.
Assuntos
Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Prolactina/sangue , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
This study aims to investigate the correlation between allergic sensitization of atopic dermatitis (AD) patients and their serum interleukin (IL)-16 levels. AD patients, healthy volunteers, and patients with psoriasis (N = 80, 35, 20, respectively) were tested for serum IL-16 and total and specific IgE levels by enzyme-linked immunosorbent assay, along with eosinophil counts. Serum allergen-specific IgE levels were determined, and skin-prick testing conducted in a subgroup of 45 AD patients. Based on specific IgE levels, AD patients were categorized into non-sensitized group 1 and sensitized group 2. Furthermore, they were sorted as non-sensitized group A and sensitized group B based on skin-prick results. Next, the serum IL-16 and total IgE levels in these subgroups were determined. Compared to levels in healthy volunteers and psoriasis patients, the serum IL-16 levels in AD patients were significantly higher (P < 0.001). Additionally, total serum IgE levels were significantly correlated with serum IL-16 levels and eosinophil counts. However, no correlation was observed between serum IL-16 levels and eosinophil counts. The serum IL-16 and total IgE levels in group 2 were also significantly elevated (P < 0.001) in contrast to those in group 1. Although we did not observe any significant difference between serum IL-16 levels in groups A and B, the total serum IgE level in group B was significantly higher than that in group A (P < 0.001). Thus, allergic sensitivity in AD patients correlates with total serum IgE as well as serum IL-16; the correlation with IL-6 is weaker.
Assuntos
Dermatite Atópica/sangue , Interleucina-16/sangue , Adolescente , Adulto , Criança , Ensaio de Imunoadsorção Enzimática , Eosinófilos/citologia , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Psoríase/sangue , Adulto JovemRESUMO
BACKGROUND: The role played by vitamin D in atopic dermatitis is controversial and has been the focus of many studies. The ultraviolet index has not been considered in this type of research. OBJECTIVES: The objectives of the study were to assess 25-hydroxy vitamin D [25(OH)D] serum level in atopic dermatitis patients and control group, to investigate the association between atopic dermatitis clinical severity (using the SCORing Atopic Dermatitis index - SCORAD) and 25(OH)D serum levels, and to evaluate the independent predictors, including Ultraviolet index, SCORAD and 25(OH)D. METHODS: We conducted a cross-sectional study of 106 atopic dermatitis patients. A control group was matched with a subsample of 54 participants with atopic dermatitis. SCORAD index, laboratory tests, and local Ultraviolet index were assessed. RESULTS: The atopic dermatitis patients had serum 25(OH)D levels and mean UVI significantly higher than the control group. Immunoglobulin E and Ultraviolet index were associated with the SCORAD index. Skin type, age and Ultraviolet index were independent predictors of 25(OH)D. CONCLUSIONS: Although statistically significant, the different levels of 25(OH)D between the paired groups may be attributed to the higher mean Ultraviolet index in atopic dermatitis patients. Since Ultraviolet index is an independent predictor of SCORAD index and of 25(OH)D level, it may work as a confounding factor in studies involving atopic dermatitis and 25(OH)D and must be considered in this kind of research.
Assuntos
Dermatite Atópica/sangue , Raios Ultravioleta , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Adolescente , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Dermatite Atópica/etiologia , Dermatite Atópica/patologia , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Valores de Referência , Fatores de Risco , Estações do Ano , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Luz Solar/efeitos adversos , Fatores de Tempo , Raios Ultravioleta/efeitos adversos , Vitamina D/sangue , Deficiência de Vitamina D/complicaçõesRESUMO
BACKGOUND/OBJECTIVES: The objective of the current study was to determine the relationship between serum vitamin D levels and the severity of atopic dermatitis (AD) in a Brazilian population. METHODS: This was a cross-sectional study of patients younger than 14 years of age seen from April to November 2013. All patients fulfilled the Hanifin and Rajka Diagnostic Criteria for AD diagnosis. Disease severity was determined using the SCORing Atopic Dermatitis index and classified as mild (<25), moderate (25-50), or severe (>50). Serum vitamin D levels were classified as sufficient (≥30 ng/mL), insufficient (29-21 ng/mL), or deficient (≤20 ng/mL). RESULTS: A total of 105 patients met the inclusion criteria. Mild AD was diagnosed in 58 (55.2%) children, moderate in 24 (22.8%), and severe in 23 (21.9%). Vitamin D deficiency was observed in 45 individuals (42.9%). Of these, 24 (53.3%) had mild AD, 13 (28.9%) moderate, and 8 (17.7%) severe. Insufficient vitamin D levels were found in 45 (42.9%) individuals; 24 (53.3%) had mild AD, 9 (20.0%) moderate, and 12 (26.7%) severe. Of the 15 individuals (14.2%) with sufficient vitamin D levels, 10 (60.7%) had mild AD, 2 (13.3%) moderate, and 3 (20.0%) severe. The mean vitamin D level was 22.1 ± 7.3 ng/mL in individuals with mild AD, 20.8 ± 6.5 ng/mL in those with moderate AD, and 21.9 ± 9.3 ng/mL in those with severe AD. Variables such as sex, age, skin phototype, season of the year, and bacterial infection were not significantly associated with vitamin D levels. CONCLUSION: Levels of 25-hydroxyvitamin D were deficient or insufficient in 85% of the children, but serum vitamin D concentrations were not significantly related to AD severity.