Trasplante de médula ósea haploidéntico en un paciente pediátrico con síndrome de Wiskott-Aldrich. A propósito de un caso / Haploidentical bone marrow transplantation in a pediatric patient with Wiskott-Aldrich syndrome. A case report

El síndrome de Wiskott-Aldrich es un error innato de la inmunidad de herencia ligada al cromosoma X, producido por variantes en el gen que codifica la proteína del síndrome de Wiskott-Aldrich (WASp). Reportamos el caso clínico de un paciente de 18 meses con diagnóstico de Wiskott-Aldrich que no presentaba donante antígeno leucocitario humano (HLA) idéntico y recibió un trasplante de células progenitoras hematopoyéticas (TCPH) con donante familiar haploidéntico. La profilaxis para enfermedad de injerto contra huésped incluyó ciclofosfamida (PT-Cy). El quimerismo del día +30 fue 100 % del donante y la evaluación postrasplante de la expresión de la proteína WAS fue normal. Actualmente, a 32 meses del trasplante, presenta reconstitución hematológica e inmunológica y quimerismo completo sin evidencia de enfermedad injerto contra huésped. El TCPH haploidéntico con PT-Cy se mostró factible y seguro en este caso de síndrome de WiskottAldrich en el que no se disponía de un donante HLA idéntico.

Wiskott-Aldrich syndrome (WAS) is an X-linked genetic disorder caused by mutations in the gene that encodes the Wiskott-Aldrich syndrome protein (WASp). Here, we report the clinical case of an 18-month-old boy diagnosed with Wiskott-Aldrich syndrome, who did not have an HLA-matched related or unrelated donor and was treated successfully with a hematopoietic stem cell transplant (HSCT) from a haploidentical family donor. Graft-versus-host disease (GvHD) prophylaxis included post-transplant cyclophosphamide (PT-Cy). At day +30, the peripheral blood-nucleated cell chimerism was 100% and the WAS protein had a normal expression. Currently, at month 32 post-transplant, the patient has hematological and immune reconstitution and complete donor chimerism without evidence of GvHD. HSCT with PT-Cy was a feasible and safe option for this patient with WAS, in which an HLA matched donor was not available.

Prevalence of eczema among older persons: A population-based cross-sectional study

Background: There are very few population-based studies on the prevalence of eczema among older persons Aims: To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding. Methods: In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex. Results: Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema. Limitations: Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits. Conclusion: There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes

Dermatitis atópica en niños y adolescentes asistidos en un hospital general de la Ciudad Autónoma de Buenos Aires / Atopic dermatitis in children and adolescents seen at a general hospital in the City of Buenos Aires

La dermatitis atópica (DA) es una enfermedad inflamatoria de la piel de alta prevalencia en pediatría, de acuerdo a estudios internacionales. Existe escasa información sobre las características epidemiológicas en la población pediátrica Argentina. El objetivo fue describir la prevalencia y características clínicas de la DA en una población de niños argentinos atendidos en el servicio de pediatría de un hospital general. Estudio observacional, de corte transversal. Se incluyeron 500 pacientes al azar, media de edad de 10 años (DE 5), el 50 % (250) de sexo femenino, de los cuales 24 presentaron DA. La prevalencia global fue del 5 % (IC95 % 3-7) y 3/24 fueron formas graves. La comorbilidad atópica más frecuente fue asma. La DA es una enfermedad con una prevalencia en nuestra población similar a la de otros países. Nuestro estudio aporta nuevos datos acerca de las características epidemiológicas de la dermatitis atópica en nuestra región

Atopic dermatitis (AD) is an inflammatory skin disease highly prevalent in pediatrics as per international studies. There is scarce information on the epidemiological characteristics of AD in the Argentine pediatric population. The objective of this study was to describe the prevalence and clinical characteristics of AD in a population of Argentine children seen at the Department of Pediatrics of a general hospital. Observational, cross-sectional study. Five hundred patients were randomly included; their mean age was 10 years (SD: 5); 50% (250) were female. A total of 24 had AD. The overall prevalence was 5% (95% confidence interval: 3­7) and 3/24 were severe forms. The most frequent atopic comorbidity was asthma. The prevalence of AD in our population is similar to that of other countries. Our study provides new data on the epidemiological characteristics of AD in our region.

Clinical study on the treatment of chronic perianal eczema with Qufeng Zhiyang Decoction and Fuzhiqing Ointment / 国际中医中药杂志

Objective:To evaluate the efficacy of Qufeng Zhiyang Decoction combined with Fuzhiqing Ointment in the treatment of chronic perianal eczema.Methods:Randomized controlled trial. A total of 122 patients with chronic perianal eczema in Meishan People's Hospital from January 2020 to May 2021 were selected as the observation objects and divided into 2 groups according to random number table method, with 61 cases in each group. The conventional group was treated with Fuzhiqing Ointment. The study group was treated with Qufeng Zhiyang Decoction. The treatment for both groups lasted for two weeks. TCM symptom score was recored before and after treatment; the degree of skin lesions was evaluated by the area and Eczema Area and Severity Index (EASI); the quality of life of patients was evaluated by the quality of life index of dermatosis (DLQI); the number of Treg and Th17 cells was measured by flow cytometry; the ratio of Th17/Treg cells was calculated; the levels of TNF-α, IL-10 and IL-6 were detected by ELISA. The adverse reactions were recorded and the clinical efficacy was evaluated. The patients were followed up for 3 months and the recurrence was recorded.Results:The total effective rate of the study group was 86.89% (53/61) and that of the conventional group was 72.13% (44/61), with statistical significance ( χ2=4.08, P=0.044). After treatment, the scores of pruritus, spurt water, erythema and burning, upset and thirsty, yellow urine and dry urine in the study group were lower than those in the conventional group ( t values were 19.64, 49.13, 19.64, 33.14, 24.61, P<0.01); EASI and DLQI scores were lower than those in the conventional group ( t values were -6.52 and -29.33, P<0.01). After treatment, Treg cells [(6.58±0.78) % vs. (5.49±0.81) %, t=7.57] in the study group was higher than that of the conventional group ( P<0.01), Th17 cells [(1.03±0.28) % vs. (1.27±0.39) %, t=-3.90] and Th17/Treg ratio [(0.15±0.07) vs. (0.23±0.05), t=7.68] were lower than those in the conventional group ( P<0.01). After treatment, the level of IL-10 in the study group was higher than that of the conventional group ( t=-16.97, P<0.01), and the levels of IL-6 and TNF-α were lower than those in the conventional group ( t values were -21.48 and -25.59, P<0.01). During treatment, the incidence of adverse reactions was 6.56% (4/61) in the study group and 9.84% (6/61) in the conventional group, without statistical significance in the incidence of adverse reactions between the two groups ( χ2=0.44, P=0.509). During the follow-up period, the recurrence rate was 15.09% (8/53) in the study group and 50.00% (22/44) in the conventional group, with statistical significance in the recurrence rate between the two groups ( χ2=14.55, P<0.01). Conclusion:Qufeng Zhiyang Decoction combined with Fuzhiqing Ointment can reduce the levels of inflammatory factors in patients with chronic perianal eczema, maintain Th17/Treg cell immune balance, improve clinical efficacy, and have a low recurrence rate.

Study on the effects and mechanism of total glucosides of paeony on enhancing efficacy and reducing toxicity of Tripterygium wilfordii polyglycoside in the treatment of eczema / 中国药房

OBJECTIVE To investigate the effects of total glucosides of paeony （TGP） on enhancing efficacy and reducing toxicity of Tripterygium wilfordii polyglycoside （TWP） in the treatment of eczema. METHODS Totally 50 SD male rats were collected to establish eczema model by sensitizing with 2，4-dinitrofluorobenzene-acetone olive oil solution （volume ratio was 4∶1） on the abdominal area and provoking on the back and ear. Model rats were randomly divided into model group， loratadine group （0.9 mg/kg）， TWP group （9.45 mg/kg）， TGP group （162 mg/kg） and compatibility group （TWP 9.45 mg/kg+TGP 162 mg/kg）， with 10 rats in each group. Other 10 rats were collected to set as normal group. Three days after the first sensitization， administration groups were given relevant medicine intragastrically， and normal group and model group were given constant volume of 0.1% CMC-Na solution intragastrically， once a day， for consecutive 21 d. Twenty-four hours later after the final administration， the general condition of rats in each group was observed， and the eczema area and severity index （EASI） were scored； ear swelling degree of rats was measured， and the skinhistomorphology observation and pathological score were performed； protein expressions of p38 mitogen-activated 13938427612@126.com protein kinase （p38 MAPK）， phosphorylated p38 MAPK （p- MAPK） and phosphorylation level of p38 MAPK in rat skin tissue were detected； the levels of inflammatory indexes （interleukin-4， interferon- γ）， liver and kidney function indexes [glutamic-pyruvic transaminase （GPT）， glutamic-oxaloacetic transaminase （GOT）， serum creatinine （SCr） and blood urea nitrogen （BUN）] and oxidant stress indexes [total superoxide dismutase （T-SOD） and malondialdehyde （MDA）] were measured. RESULTS Compared with normal group， EASI score， ear swelling degree， pathological score， protein expressions of p38 MAPK and p-p38 MAPK， phosphorylation level of p38 MAPK， the levels of inflammatory indexes and BUN were all increased significantly in model group （P＜0.05）. Compared with model group， EASI scores， ear swelling degree， pathological scores， protein expressions of p38 MAPK and p-p38 MAPK， phosphorylation levels of p38 MAPK and levels of inflammatory indexes were all improved significantly in administration groups （P＜0.05）. The levels of GPT， GOT， SCr and BUN were increased significantly in TWP group， while the serum levels of GOT and SCr in TGP group and serum level of SCr in loratadine group were all decreased significantly （P＜0.05）. The levels of T-SOD in liver and kidney tissue were all decreased significantly in TWP group and compatibility group， while the levels of MDA were increased significantly （P＜0.05）. The compatibility group showed more obvious effect in improving the ear swelling degree， pathological score， p38 MAPK expression and its phosphorylation level and levels of inflammatory indexes， and could reverse the abnormality of liver and kidney indexes caused by TWP （P＜0.05）. CONCLUSIONS The combination of TGP and TWP has the effects of anti-inflammatory， synergistic and hepatorenal detoxification in eczema model rats. Its mechanism may be associated with down-regulating the expression of serum proinflammatory indexes and inhibiting the activation of p38 MAPK pathway.

Relationship between eczema and indoor environmental factors among preschool children in Haikou / 中国学校卫生

Objective@#To investigate the influencing factors of home environment on eczema in preschool children, so as to provide theoretical basis for taking effective regional prevention for preschool children.@*Methods@#From December 2020 to January 2021, a cross sectional survey of 3 049 preschool children was randomly carried out by stratified cluster sampling in Haikou kindergartens, and the impact of indoor environmental factors on preschool children s eczema was analyzed. Chi squared test and binary Logistic regressive were used to analyze the related factors.@*Results@#The prevalence of eczema in preschool children was 13.6%. Multivariate Logistic regression showed that the positive correlation factors of eczema included the new decoration in the mother s residence one year before pregnancy ( OR=1.71, 95%CI =1.09-2.68), the addition of new furniture in the child s residence when the child was 0-1 years old ( OR=1.53, 95%CI =1.03-2.27), cockroaches in the house ( OR=1.35, 95%CI =1.02-1.81) and cleaning of less than once per week ( OR=1.30, 95%CI =1.01-1.66). The starting age of children s collective life since 3 years old ( OR=0.76, 95%CI =0.60-0.96) had a negative correlation with eczema ( P <0.05).@*Conclusion@#There are multiple indoor environmental factors related to eczema among preschool children in Haikou city. Parents should take measures to prevent eczema in preschool children by paying attention to home environment and the starting age of children s collective life.

Eczematoid clear cell acanthoma of the nipple/areola: the first case reported in China and literature analysis / 中华皮肤科杂志

Objective:To investigate clinical manifestations, pathological features and diagnosis of eczematoid clear cell acanthoma of the nipple/areola.Methods:The clinical manifestations, histopathological features, special staining results and immunohistochemical features of a case of eczemtoid clear cell acanthoma of the nipple/areola firstly reported in China were analyzed, and compared with those of similar cases in foreign literature.Results:The female patient presented with recurrent pruritic rashes on the left nipple and areola for over 2 years. Skin examination showed hypertrophic skin on the left nipple and areola, and scattered erythema, hypopigmented macules and hyperpigmented macules on the areola, which were covered with a few crusts and scales. Histopathological examination of the skin lesions showed focal epidermal crusts and scales, focal parakeratosis, extended and fused rete ridges, thickened spinous layer, focal spongiosis, clear cell clumps in the spinous cell layer, telangiectasia in the superficial dermis, with infiltration of a few eosinophils and neutrophils. Periodic acid-Schiff staining showed positive results, and immunohistochemical staining revealed positive reaction for epithelial membrane antigen. Topical treatment with triamcinolone acetonide and econazole cream was effective, and topical application of 3% boric acid solution could alleviate exudation. During the 6-month follow-up, the patient experienced intermittent recurrence twice, and responded well to the above treatment.Conclusions:Eczematoid clear cell acanthoma of the nipple/areola has unique clinical and pathological features, revealing that it′s a new subtype of clear cell acanthoma. Pathological examination is the gold standard for its diagnosis.

Analysis of serum allergen-specific immunoglobulin E in 3 051 patients with eczema or dermatitis in an allergy clinic / 中华皮肤科杂志

Objective:To analyze measurement results of serum allergen-specific immunoglobulin E (IgE) in patients with eczema/dermatitis.Methods:A retrospective analysis was conducted on serum allergen-specific immunoglobulin E (IgE) levels in 3 051 patients with eczema/dermatitis, who visited the allergy clinic of Huashan Hospital from April 1, 2021 to March 31, 2022. The serum allergen-specific IgE level was detected by using the Phadia allergen detection system, and positive rates of allergens were calculated to determine common inhaled allergens and food allergens in patients with eczema/dermatitis. Comparisons of enumeration data between groups were performed by chi-square test.Results:Among the 3 051 patients with eczema/dermatitis, there were 1 412 with atopic dermatitis and 1 639 were other eczema/dermatitis. Detection of serum allergen-specific IgE showed that 1 629 (53%) patients were positive for allergens, and the number of positive allergen-specific IgEs in each patient was 3.0 ± 1.6. The top 3 common inhaled allergens in patients with eczema/dermatitis were Dermatophagoides farinae (904/1 522, 59%) , Dermatophagoides pteronyssinus (891/1 513, 59%) and Alternaria alternata (206/1 068, 19%) , and the top 3 common food allergens were shrimps (251/1 432, 18%) , egg white (165/992, 17%) and cow milk (149/994, 15%) . Among the 3 051 patients, 25 (1%) were aged < 2 years, 571 (19%) aged 2 - 12 years, 285 (9%) aged 12 - 18 years, and 2 170 (71%) were aged > 18 years. The most common food allergens were both egg white in the age groups of < 2 years and 2 -12 years (77%, 37%, respectively) , and were both shrimps in the age groups of 12 - 18 years and > 18 years (31%, 17%, respectively) . Dermatophagoides pteronyssinus and Dermatophagoides farina were the top 2 common inhaled allergens in all age groups, with the positive rate ranging from 36% to 84%; in addition, the positive rate of molds was relatively high in the age group of 2 - 12 years (mold mixture: 37%; Alternaria alternata: 27%) . From April 2021 to March 2022, the positive rate of outdoor allergens ranged from 10% to 15% among outpatients in every month; the positive rates of tree pollen and grass pollen increased from April 2021, and peaked in October 2021. The patients with atopic dermatitis showed a significantly increased positive rate of allergens (73%) compared with those with other eczema/dermatitis (37%, χ2 = 389.36, P<0.001) , and the rank of common allergens in the patients with atopic dermatitis was basically the same as that in those with eczema/dermatitis. Conclusions:The common allergens were Dermatophagoides farina, Dermatophagoides pteronyssinus and Alternaria alternata in the patients with eczema/dermatitis. Food allergy was more common in infant patients, and inhalation allergy was more common in child, adolescent and adult patients. The positive rate of allergen-specific IgEs was markedly higher in the patients with atopic dermatitis than in those with other eczema/dermatitis.

The relation between atopic dermatitis and depressive symptoms / A relação entre dermatite atópica e sintomas depressivos

Introdução: O quadro da dermatite atópica (DA) é caracterizado por prurido crônico de evolução flutuante, que pode resultar em distúrbios no padrão de sono e em estigmatização social devido à presença de lesões visíveis e recidivantes, as quais tendem a se tornar progressivamente liquenificadas. Fatores como os já citados e outros associados, como incapacidade laboral, falta de concentração ao longo do dia e isolamento apresentam-se como profundos impactantes para a saúde mental do paciente, podendo resultar em baixa autoestima, depressão e frustração. Além disso, sabe-se que a DA é uma doença essencialmente inflamatória, ao mesmo tempo em que estudos recentes demonstram papel de citocinas no desenvolvimento de síndromes depressivas, podendo haver correlação causal entre os quadros por vias inflamatórias. Objetivos: Essa revisão sistemática de literatura objetivou analisar a relação entre dermatite atópica e sintomas depressivos, identificando possíveis mecanismos responsáveis por essa ligação. Métodos: A busca foi feita entre 17/11/2020 e 18/11/2020 seguindo o modelo PRISMA e utilizando as bases PUBMED, Biblioteca Virtual em Saúde (BVS) - IBECS, LILACS e CUMED - e EMBASE. As palavras-chave "Depression" e "Atopic Eczema", em conjunto com seus termos MeSh e DECS, foram utilizadas e associadas através do método booleano. Critérios para inclusão foram definidos como artigos que são ensaios clínicos ou observacionais envolvendo grupo de pacientes com dermatite atópica e grupo controle, que pôde ser constituído pelo próprio grupo com dermatite atópica, porém, após intervenção. Os sintomas depressivos precisavam ser medidos por escalas ou terem critérios para diagnóstico de síndrome depressiva estabelecidos. A seleção foi feita por todos os autores de forma independente, sendo discordâncias solucionadas por consenso. Resultados: Ao final, quinze estudos restaram, os quais foram classificados entre aqueles que comparam tratamentos e seus desfechos relacionados à depressão e DA, aqueles que propõem DA como agravante de sintomas depressivos, aqueles que propõem sintomas depressivos como agravantes da DA e aqueles que trazem análises estatísticas sem estabelecer claramente onde reside a relação de causalidade entre os dois quadros. Conclusões: Diversos estudos mostraram a existência de relação entre o quadro de DA e sintomas depressivos em vias distintas, tanto analisando a DA como agravante de sintomas depressivos como vice-versa. A partir dessa perspectiva, é possível que haja uma causalidade bidirecional cíclica, na qual um constante feedback positivo gera piora de ambos os quadros até que a abordagem adequada seja tomada, evidenciando a importância da propedêutica multidisciplinar para esses pacientes (AU)

Introduction: Atopic dermatitis (AD) is characterized by chronic itching, presenting with fluctuating evolution, resulting in sleep disorders and social stigmatization due to the presence of visible and recurrent lesions, that might become progressively lichenified. Factors such as those mentioned and others associated, such as incapacity for work, lack of concentration throughout the day and isolation have profound impacts on the patient's mental health, resulting in low self-esteem, depression and frustration. In addition, it is known that AD is essentially an inflammatory disease. And, recent studies demonstrate the role of inflammatory cytokines in the development of depressive syndromes, therefore may be a causal correlation between the conditions by inflammatory pathways. Objectives: This systematic literature review aimed to analyze a relationship between atopic dermatitis and depressive symptoms, identifying mechanisms responsible for this connection. Methods: The research was carried out between 11/17/2020 and 11/18/2020 following the PRISMA model and using PUBMED, Virtual Health Library (VHL) - IBECS, LILACS and CUMED - and EMBASE databases. Keywords "Depression" and "Atopic Eczema", along with its MeSh and DECS terms, were used and associated using the Boolean method. Inclusion criteria were defined as articles that are clinical or observational trials involving a group of patients with atopic dermatitis and a control group, which could be constituted by the group with atopic dermatitis itself, however, after an intervention. The depressive symptoms had to be measured by scales or, at least, the criteria for diagnosis of depressed syndrome must have been established. Results:In the end, fifteen studies remained, which were classified among those that compare treatments and their outcomes related to depression and AD, those that propose AD as an aggravator of depressive symptoms, those that propose depressive symptoms as an aggravating factor for AD and those that bring statistical analysis without clearly establishing where the causality relation resides. Conclusion: Several studies have presented a relationship between the condition of AD and depressive symptoms in distinct pathways, or analyzing AD as an aggravating factor for depressive symptoms or vice-versa. From this perspective, there may be a cyclical bidirectional causality, in which constant positive feedback generates worsening of both conditions until the adequate approach is taken, highlighting the importance of the multidisciplinary propaedeutics for these patients (AU)

Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) Written Atopic Eczema Questionnaire for telephone survey in children aged 6-7 years

Abstract Background The prevalence of atopic eczema is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) is an epidemiological landmark in the study of allergic diseases. Objective To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children aged between 6 and 7 years by telephone contact. Methods Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks: telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients. Results Data from 88 children (32 from the atopic eczema group) were analyzed. Reproducibility showed almost perfect agreement for the questions "Recurrent pruritic lesions" and "Lesions in typical locations" (Kappa between 0.81-0.82), while a substantial agreement was observed for all other indicators (Kappa variation between 0.66 and 0.78). The validation showed high specificity (≥ 80.4%) and sensitivity (≥ 87.5%) for all questions, except those related to chronicity and medical diagnosis (34.4% and 40.6%, respectively). Study limitations Non-random selection, no sample size calculation, participants from a tertiary hospital and study period coincident with the Coronavirus pandemic. Conclusions Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema. It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema, especially in periods of social isolation.

A relação entre dermatite atópica e sintomas depressivos / The relation between atopic dermatitis and depressive symptoms

RESUMO: Introdução: O quadro da dermatite atópica (DA) é caracterizado por prurido crônico de evolução flutuante, que pode resultar em distúrbios no padrão de sono e em estigmatização social devido à presença de lesões visíveis e recidivantes, as quais tendem a se tornar progressivamente liquenificadas. Fatores como os já citados e outros associados, como incapacidade laboral, falta de concentração ao longo do dia e isolamento apresentam-se como profundos impactantes para a saúde mental do paciente, podendo resultar em baixa autoestima, depressão e frustração. Além disso, sabe-se que a DA é uma doença essencialmente inflamatória, ao mesmo tempo em que estudos recentes demonstram papel de citocinas no desenvolvimento de síndromes depressivas, podendo haver correlação causal entre os quadros por vias inflamatórias. Objetivos: Essa revisão sistemática de literatura objetivou analisar a relação entre dermatite atópica e sintomas depressivos, identificando possíveis mecanismos responsáveis por essa ligação. Métodos: A busca foi feita entre 17/11/2020 e 18/11/2020 seguindo o modelo PRISMA e utilizando as bases PUBMED, Biblioteca Virtual em Saúde (BVS) - IBECS, LILACS e CUMED - e EMBASE. As palavras-chave "Depression" e "Atopic Eczema", em conjunto com seus termos MeSh e DECS, foram utilizadas e associadas através do método booleano. Critérios para inclusão foram definidos como artigos que são ensaios clínicos ou observacionais envolvendo grupo de pacientes com dermatite atópica e grupo controle, que pôde ser constituído pelo próprio grupo com dermatite atópica, porém, após intervenção. Os sintomas depressivos precisavam ser medidos por escalas ou terem critérios para diagnóstico de síndrome depressiva estabelecidos. A seleção foi feita por todos os autores de forma independente, sendo discordâncias solucionadas por consenso. Resultados: Ao final, quinze estudos restaram, os quais foram classificados entre aqueles que comparam tratamentos e seus desfechos relacionados à depressão e DA, aqueles que propõem DA como agravante de sintomas depressivos, aqueles que propõem sintomas depressivos como agravantes da DA e aqueles que trazem análises estatísticas sem estabelecer claramente onde reside a relação de causalidade entre os dois quadros. Conclusões: Diversos estudos mostraram a existência de relação entre o quadro de DA e sintomas depressivos em vias distintas, tanto analisando a DA como agravante de sintomas depressivos como vice-versa. A partir dessa perspectiva, é possível que haja uma causalidade bidirecional cíclica, na qual um constante feedback positivo gera piora de ambos os quadros até que a abordagem adequada seja tomada, evidenciando a importância da propedêutica multidisciplinar para esses pacientes.(AU)

ABSTRACT: Introduction: Atopic dermatitis (AD) is characterized by chronic itching, presenting with fluctuating evolution, resulting in sleep disorders and social stigmatization due to the presence of visible and recurrent lesions, that might become progressively lichenified. Factors such as those mentioned and others associated, such as incapacity for work, lack of concentration throughout the day and isolation have profound impacts on the patient's mental health, resulting in low self-esteem, depression and frustration. In addition, it is known that AD is essentially an inflammatory disease. And, recent studies demonstrate the role of inflammatory cytokines in the development of depressive syndromes, therefore may be a causal correlation between the conditions by inflammatory pathways. Objectives: This systematic literature review aimed to analyze a relationship between atopic dermatitis and depressive symptoms, identifying mechanisms responsible for this connection. Methods: The research was carried out between 11/17/2020 and 11/18/2020 following the PRISMA model and using PUBMED, Virtual Health Library (VHL) - IBECS, LILACS and CUMED - and EMBASE databases. Keywords "Depression" and "Atopic Eczema", along with its MeSh and DECS terms, were used and associated using the Boolean method. Inclusion criteria were defined as articles that are clinical or observational trials involving a group of patients with atopic dermatitis and a control group, which could be constituted by the group with atopic dermatitis itself, however, after an intervention. The depressive symptoms had to be measured by scales or, at least, the criteria for diagnosis of depressed syndrome must have been established. Results:In the end, fifteen studies remained, which were classified among those that compare treatments and their outcomes related to depression and AD, those that propose AD as an aggravator of depressive symptoms, those that propose depressive symptoms as an aggravating factor for AD and those that bring statistical analysis without clearly establishing where the causality relation resides. Conclusion: Several studies have presented a relationship between the condition of AD and depressive symptoms in distinct pathways, or analyzing AD as an aggravating factor for depressive symptoms or vice-versa. From this perspective, there may be a cyclical bidirectional causality, in which constant positive feedback generates worsening of both conditions until the adequate approach is taken, highlighting the importance of the multidisciplinary propaedeutics for these patients. (AU)

Clinical study modified Chushi Weiling Decoction combined with fire acupuncture for the patients with chronic eczema and spleen deficiency and dampness syndrome / 国际中医中药杂志

Objective:To explore the effect of modified Chushi Weiling Decoction combined with fire acupuncture in the treatment of chronic eczema with spleen deficiency and dampness syndrome.Methods:A total of 106 patients with chronic eczema who met the inclusion criteria from January 2018 to January 2020 in Shandong Taishan hospital were randomly divided into two groups by random number table method, with 53 patients in each group. The control group was treated with loratadine tablets and compound glycyrrhizin tablets, and the observation group was treated with modified Chushi Weiling Decoction combined with fire acupuncture. Both groups were treated for 8 weeks and followed up for 12 months. TCM syndrome scores were performed before and after treatment, Eczema area and severity index (EASI) was used to assess the severity of eczema, and pruritus was assessed by pruritus VAS scale. The serum IgE level was detected by nephelometry, and eosinophils (EOS) count was detected by automatic hematology analyzer. The adverse events and recurrence were recorded and the clinical response rate was evaluated.Results:The response rate was 94.34% (50/53) in the observation group and 77.36% (41/53) in the control group. There was significant difference between the two groups ( χ2=6.29, P=0.012). After treatment, the score of TCM syndrome, EASI and VAS of pruritus in the observation group were significantly lower than those in the control group ( t values were 11.97, 6.31 and 10.61 respectively, all Ps<0.001). After treatment, the serum IgE level [(57.19±7.54) IU/ml vs. (81.55±12.08) IU/ml, t=12.45], EOS count [(310.54± 52.84) ×10 6/L vs. (465.51±58.04) ×10 6/L, t=14.37] in the observation group were significantly lower than those in the control group ( P<0.01). The incidence of adverse events was 15.09% (8/53) in the control group and 3.77% (2/53) in the observation group, and there was significant difference between the two groups ( χ2=3.98, P=0.046). The recurrence rate was 6.00% (3/50) in the observation group and 21.95% (9/41) in the control group, and there was significant difference between the two groups ( χ2=5.01, P=0.025). Conclusion:Modified Chushi Weiling Decoction combined with fire acupuncture can improve the skin lesions and itching symptoms, improve the clinical efficacy, reduce the long-term recurrence rate of patients with chronic eczema with spleen deficiency and dampness syndrome safely.

Advances in epidemiological research on effects of air pollution on skin diseases / 环境与职业医学

Air pollution is a major environmental threat to human health, and skin, as the largest organ of the human body, is a major exposure route of air pollutants, so the correlations between air pollutants and skin diseases are noteworthy to study. This paper reviewed the acute effects of air pollutants on the risks of dermatosis outpatient and emergency visits at home and abroad, especially on dermatitis, eczema, urticaria, acne, psoriasis, and other skin diseases with high prevalence rates and heavy disease burdens. The effects of air pollutants on skin diseases are affected by exposure characteristics of air pollutants (such as composition, concentration, and exposure time), environmental factors (such as temperature, humidity, and ultraviolet), and population characteristics. In view of insufficient evidence on the long-term effects of air pollutants on skin diseases and the interaction of environmental factors, future research directions were prospected, aiming to provide new ideas for further study on the effects of air pollutants on skin diseases and the formulation of relevant prevention and control strategies.

Clinical and pathological analysis of six cases of Meyerson nevi / 中华皮肤科杂志

Objective:To investigate clinical and histopathological features of Meyerson nevus.Methods:Clinical and histopathological data were collected from 6 patients with confirmed Meyerson nevi in Department of Dermatology, the Fourth Military Medical University from January 2015 to January 2019, and retrospectively analyzed.Results:Among the 6 patients, 3 were males and 3 were females, with a median age of 10.5 years (range, 7 months to 28 years). Skin lesions were located on the extremities of 3 cases, as well as on the trunk of 3 cases. Meyerson nevi arose from congenital pigmented nevi in 4 cases, as well as from acquired pigmented nevi in 2 cases. The duration of pigmented nevi varied from 7 months to 18 years. Four patients felt itching in the past 2 months, and 2 had no concomitant symptoms such as itching. Central pigmented nevi manifested as papules in 5 cases and a plaque in 1 case, which were brown or black in color, with regular shapes, uniform pigmentation and clear borders. Pigmented nevi were surrounded by a halo of erythema in 6 cases, and skin lesions were covered with scales or crusts in 4 cases. Histopathological examination of Meyerson nevi revealed characteristics of both pigmented nevus and eczema. Histopathologically, pigmented nevi manifested as junctional nevi or compound nevi, and eczema manifested as serous exudation, irregular epidermal hyperplasia, spongiosis and perivascular infiltration of lymphocytes in the superficial dermis.Conclusions:Meyerson nevus is rare, and mostly occurs on the trunk and extremities. When itching occurs or erythema appears around the pigmented nevus, the diagnosis of Meyerson nevus should be considered.

Research progress of primary immunodeficiency disease with hyper IgE syndrome / 中华实用儿科临床杂志

The hyper IgE syndrome (HIES) is a rare primary immunodeficiency disorder characterized by atopic dermatitis, recurrent skin and lung infections along with elevated IgE levels.The JOB syndrome due to heterozygous loss-of-function mutations in the signal transduction and transcription activator-3(STAT3) gene is the prototype of HIES.However, several other immunodeficiency disorders with the phenotype of HIES have been identified over the past decade.This study aims to review these disorders and their molecular mechanisms, aiming to improve the understanding of this rare disease.

Effect of acupuncture and moxibustion on skin barrier function in guinea pigs with eczema of skin damp-heat accumulation / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture and moxibustion on the water content of stratum corneum (WCSC), expression of serum inflammatory factors and aquaporin 3 (AQP3) in skin, lung and rectum in guinea pigs with eczema of skin damp-heat accumulation, and to explore the possible mechanism of acupuncture and moxibustion for regulating skin barrier function.@*METHODS@#A total of 24 male albino guinea pigs were randomly divided into a blank group (n=6) and a modeling group (n=18). The guinea pigs in the modeling group were induced by 2,4-dinitrochlorobenzene (DNCB) to establish the eczema model of skin damp-heat accumulation. The guinea pigs with successful modeling were further randomly divided into a model group, a medication group and an acupuncture-moxibustion group, 6 guinea pigs in each group. The guinea pigs in the medication group were treated with loratadine tablets (0.8 mg/kg) by gavage, once a day for 7 days; the guinea pigs in the acupuncture-moxibustion group were treated with acupuncture at "Feishu" (BL 13), "Pishu" (BL 20), "Quchi" (LI 11), "Zusanli" (ST 36) and "Xuehai" (SP 10); at the same time, moxibustion was applied at "Feishu" (BL 13) and "Zusanli" (ST 36), moxibustion intervention for 10 min and needle retaining for 15 min at each acupoint, once a day for 7 days. The eczema area and severity index (EASI) score was evaluated before and After intervention, and WCSC and trans-epidermal water loss (TEWL) were measured by skin tester. After intervention, The HE staining was used to observe the changes of skin histomorphology in each group; ELISA was used to measure the contents of serum immunoglobulin E (IgE), interleukin (IL)-4 and IL-17; Western blot was used to measure the protein expression of AQP3 in skin, lung and rectum.@*RESULTS@#Before the intervention, compared with the blank group, the EASI scores and TEWL were increased in the remaining groups (P<0.01), and the WCSC was decreased (P<0.01). After the intervention, compared with the model group, the EASI scores and TEWL were decreased (P<0.05, P<0.01), and WCSC was increased (P<0.01) in the medication group and the acupuncture-moxibustion group. The epidermal structure in the blank group was complete and the fibers in the dermis were arranged orderly; in the model group, epidermal hyperkeratosis, proliferation of granular layer, spinous cell layer and basal layer, and disordered arrangement of dermal fibers and infiltration of inflammatory cells were observed. The morphological performance in the medication group and the acupuncture-moxibustion group was better than that in the model group. Compared with the blank group, the contents of serum IgE and IL-17 were increased (P<0.01), and the content of serum IL-4 and the protein expression of AQP3 in skin, lung and rectum were decreased in the model group (P<0.01, P<0.05). Compared with the model group, the contents of serum IgE and IL-17 were decreased and the contents of serum IL-4 were increased in the medication group and the acupuncture-moxibustion group (P<0.01), and the protein expression of AQP3 in skin, lung and rectum in the acupuncture- moxibustion group were increased (P<0.05). Compared with the medication group, the contents of serum IgE and IL-17 were increased (P<0.01), and the content of serum IL-4 was decreased (P<0.01) in the acupuncture-moxibustion group.@*CONCLUSION@#Acupuncture and moxibustion could improve the epidermal water metabolism and skin tissue morphology in guinea pigs with eczema of skin damp-heat accumulation. Its mechanism may be related to regulating inflammatory factors, up-regulating the expression of AQP3, and then repairing the skin barrier function.

Clinical Features and Genetic Analysis of Autosomal Dominant and Recessive Hyperimmunoglobulin E Syndrome / 罕见病研究

  Objective  To summarize the clinical and genetic features of children with autosomal dominant and recessive hyperimmunoglobulin E syndrome (HIES).  Methods  HIES patients were studied at the dermatology department of Beijing Children's Hospital, Capital Medical University were collected, from January 2013 to December 2021, diagnosed by both clinical manifestation and genetic assessment. The general data were summarized, the clinical and genetic characteristics were analyzed, and the similarities and differences between autosomal dominant HIES (AD-HIES) and autosomal recessive HIES (AR-HIES) were compared.  Results  A total of 7 children with HIES were studied, including 3 cases of AD-HIES and 4 cases of AR-HIES. There were 4 males and 3 females. All children had recurrent eczema-like lesions, recurrent skin and pulmonary infections, and elevated serum IgE and eosinophil levels. The differences between AD-HIES and AR-HIES mainly include: the main cutaneous infection in 3 children with AD-HIES were bacterial infections (such as abscess and impetigo), while in 4 children with AR-HIES, cutaneous infections were mostly severe viral infection (such as verruca vulgaris and molluscum contagiosum). There were pulmonary parenchymal changes (such as pneumatoceles, cyst and atelectasis) in 3 children with AD-HIES, whilst there were no similar changes in the lungs of 4 children with AR-HIES; 75% of children with AR-HIES had allergic diseases (including asthma and food allergy), while there were no reports of allergic diseases in children with AD-HIES. As for manifestations outside of immune system, AD-HIES was more likely to appear facial dysmorphism(such a broad nasal bridge and a high-arched palate). Furthermore, the incidence of tumor in AR-HIES was higher than that in AD-HIES. AD-HIES was mainly caused by the mutation of STAT3 gene, and AR-HIES was mainly caused by the mutation of DOCK8 gene. We reported two new mutation sites of DOCK8 gene c.1798-2A > T and c.874G > A in two cases, respectively.  Conclusions  For children with clinical manifestations of recurrent eczema-like lesions, repeated infection and significant increase in serum IgE levels, HIES should be suspected, and genetic screening should be carried out to make definite diagnosis and classification, to achieve better long-term management and improve prognosis.

Efficacy of a skin care ointment containing oligomeric maltose X in the adjuvant treatment of pruritus in patients with mild to moderate eczema: a multicenter, randomized, double-blind controlled clinical study / 中华皮肤科杂志

Objective:To evaluate the clinical efficacy and safety of a skin care ointment containing oligomeric maltose X in the adjuvant treatment of eczema-related pruritus.Methods:A multicenter, randomized, double-blind, vehicle-controlled clinical study was conducted. From March to September 2021, outpatients with mild to moderate eczema were collected from departments of dermatology of 4 hospitals, including Beijing Friendship Hospital, Hebei Traditional Chinese Medical Hospital, the Third People′s Hospital of Hubei Province, and Taizhou Central Hospital in Zhejiang Province. The patients were randomly divided into two groups by using a random number table: observation group topically treated with a skin care ointment containing oligomeric maltose X, and vehicle control group topically treated with an ointment vehicle. The ointments were applied during the attacks of itching for 14 consecutive days. Visits were scheduled before, 7, and 14 days after the start of the adjuvant treatment. The efficacy was evaluated according to the eczema area and severity index (EASI) and visual analog scale (VAS) , and adverse events were recorded. The efficacy and safety analyses were conducted by using chi-square test and t test. Results:Totally, 232 patients with eczema were enrolled, including 90 males and 142 females, with the age being 40.13 ± 13.36 years; 156 patients were in the observation group, and 76 in the vehicle control group. Before the adjuvant treatment, there were no significant differences in EASI (2.07 ± 2.24 points vs. 2.29 ± 2.28 points) or VAS (6.22 ± 1.78 points vs. 6.20 ± 1.79 points) scores between the observation group and vehicle control group ( t = -0.70, 0.06, P = 0.486, 0.955, respectively) . After one-day treatment, the VAS scores significantly decreased compared with the baseline scores in the two groups ( P < 0.001, P = 0.003, respectively) . After 14-day treatment, the VAS score was significantly lower in the observation group (2.67 points) than in the vehicle control group (3.35 points; t = -2.28, P = 0.024) . After 7- and 14-day treatment, the EASI scores significantly decreased compared with the baseline scores in both the two groups (all P < 0.001) , but there were no significant differences between the two groups ( P = 0.853, 0.731) . No adjuvant treatment-related adverse events were recorded in either of the two groups. Conclusion:The skin care ointment containing oligomeric maltose X is safe and effective in the adjuvant treatment of eczema-related pruritus, and can be applied to clinical practice.

Successfully treated recalcitrant atopic eczema with acupoint autohemotherapy: A case report and hypothesized mechanism of the therapy / 中西医结合学报

Acupoint autohemotherapy at bilateral Zusanli (ST36) and Xuehai (SP10) was used to treat a 26-year-old female patient who had suffered from recalcitrant atopic eczema (AE) for five years. The treatment was applied at a frequency of once per week for the first month, followed by a three-month period of once every other week. At the end of treatment, the patient's AE symptoms were entirely resolved, and by the end of a six-month follow-up her immunoglobulin E level had returned to the normal range. Further, there was no relapse of AE symptoms during the six-month follow-up. Therefore, we hypothesized that after the repeated treatments the local inflammatory reaction induced by autologous blood injection triggered a local immune response, followed by a systemic immune response after the repeated treatment, finally leading to the anti-inflammation and immunomodulation effects. This case suggests that acupoint autohemotherapy could be used as an effective complementary treatment for recalcitrant AE, especially in cases where other treatments have failed. Further comparative studies are needed to corroborate the value and mechanisms of this therapy.

Evaluación de afección en calidad de vida en adultos con dermatitis atópica / Assessment of quality of life illness in adult patients with atopic dermatitis

Introducción: la dermatitis atópica (DA) es una enfermedad con repercusión en la calidad de vida (CV) del paciente. Para la evaluación de la gravedad clínica de la enfermedad se han diseñado diversas herramientas como el Eczema Area and Severity Index (EASI), mientras que para la evaluación de la CV se han creado instrumentos específico, como el Dermatology Life Quality Index (DLQI) y el Quality of Life Index for Atopic Dermatitis (QoLIAD). Objetivo: definir cuál es la mejor herramienta para evaluar la afección a la CV de pacientes adultos con DA, en relación con el EASI. Material y métodos: se seleccionaron pacientes con DA (> 18 años) que aceptaran responder a los cuestionarios DLQI y QoLIAD, así como tener una exploración dermatológica reportada según el EASI. Se ajustaron tres modelos de regresión lineal simple para poder cuantificar la asociación entre el EASI con el DLQI y el QoLIAD. Un valor de p < 0.05, se consideró de significancia estadística. El modelo de afección a CV con el valor más alto de pseudo R2, se consideró como el que tuvo mayor asociación con EASI. Resultados: se captaron en total 72 pacientes. Los modelos de regresión cuantílica simple revelaron un coeficiente de regresión de 0.243 para DLQI (p = 0.002) y 0.252 para QoLIAD (p = 0.003). Los valores de pseudo R2 fueron de 0.15 para DLQI y 0.10 para QoLIAD, por lo que el DLQI tuvo una mayor correlación con el EASI. Conclusiones: el DLQI resultó ser el mejor instrumento para evaluar la afección a la CV en pacientes adultos con DA.

Background: Atopic dermatitis (AD) is a disease with an im- pact on the patient's quality of life (QoL). Several tools have been designed to assess the clinical severity of the disease, such as the Eczema Area and Severity Index (EASI), while specific instruments have been created to assess QoL, such as the Dermatology Life Quality Index (DLQI) and the Quality of Life Index for Atopic Dermatitis (QoLIAD). Objective: To define which tool is the best to assess the QoL condition of adult patients with AD in relation to the EASI. Material and methods: Patients with AD (> 18 years old) were selected who agreed to complete the DLQI and QoLIAD questionnaires, as well as to have a dermatologic examination reported according to the EASI. Three simple linear regression models were fitted in order to quantify the association between EASI with DLQI and QoLIAD. A value of p < 0.05 was considered statistically significant. The CV condition model with the highest pseudo R2 value was considered to have the strongest association with EASI. Results: A total of 72 patients were included. Simple quantile regression models revealed a regression coefficient of 0.243 for DLQI (p = 0.002) and 0.252 for QoLIAD (p = 0.003). The pseudo R2 values were 0.15 for DLQI and 0.10 for QoLIAD, so DLQI had a higher correlation with EASI. Conclusions: DLQI proved to be the best instrument to assess CV impairment in adult patients with AD.