Síndrome de hiperinmunoglobulinemia E: dermatitis atópica como manifestación inicial. A propósito de un caso / Hyper IgE syndrome: atopic dermatitis as first manifestation. Case report

La dermatitis atópica es la forma más frecuente de eccema durante el primer año de vida; sin embargo, cuando la presentación es atípica o se asocia a infecciones, constituye un desafío diagnóstico para el pediatra. Es importante mantener un índice alto de sospecha para detectar inmunodeficiencias primarias asociadas a eccemas graves desde el período neonatal. Un ejemplo de estas es el síndrome de hiperinmunoglobulinemia E (hiper-IgE) autosómico dominante. Este cuadro se caracteriza por la presencia de infecciones cutáneas y respiratorias recurrentes, dermatitis atópica, eosinofilia y aumento de IgE. Se reporta el caso clínico de una niña de 1 mes y 29 días con diagnóstico de hiper-IgE con afección cutánea desde el nacimiento.

Atopic dermatitis is the most common form of eczema often developed before the first year of life. Nevertheless, when the presentation is atypical or related to infections the diagnostic represents a challenge for the pediatricians. It is important to maintain a high index of suspicion for the detection of primary immunodeficiency associated to severe eczema. One of them is the autosomal dominant hyper-IgE syndrome characterized by recurrent skin and respiratory infections, atopic dermatitis, eosinophilia, and high serum IgE concentrations. In this paper, we report a 1 months and 29 days old baby girl diagnosed with hyper-IgE and a skin involvement since birth.

Correlation of nipple eczema in pregnancy with atopic dermatitis in Northern India: a study of 100 cases

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.

Dermoscopy in tinea manuum

Abstract: Tinea manuum is a dermatophytosis which is often mistaken for other keratodermas, especially palmar psoriasis and chronic hand eczema. We report the use of dermoscopy as a diagnostic aid in a case of tinea manuum. The dermoscopic clue turned out to be the presence of whitish scaling located mainly in the furrows. This aspect has never been seen in other keratodermas and therefore can be considered as a useful finding to assist in the recognition of tinea manuum.

Tiña incógnita y granuloma de Majocchi adquirido de un erizo. Un caso mexicano / Mexican case of tinea incognito and granuloma de Majocchi acquired from a hedgehog

Resumen Las mascotas exóticas, como el erizo de tierra, son capaces de transmitir al ser humano diferentes infecciones, como salmonelosis, micobacterias, protozoos como Cryptosporidium parvum, y dermatofitosis. Presentamos el caso de un paciente adulto masculino, que recientemente había adquirido un erizo de tierra, que presentó en la mano una lesión de tiña incógnita y un granuloma de Majocchi. Se identificó el agente etiológico como Trichophyton erinacei, por cultivo micológico y biología molecular. El paciente se trató con terbinafina por vía oral, por seis meses, con excelente respuesta.

Exotic pets, such as the ground hedgehog, are capable of transmitting to the human being different zoonoses, such as salmonellosis, mycobacteria, protozoa such as Cryptosporidium parvum, and dermatophytosis. We present the case report of a male adult patient, who had recently acquired a ground hedgehog, who presented in his hand a ringworm lesion incognito and a Majocchi granuloma. The etiological agent was identified as Trichophyton erinacei by mycological culture and molecular biology. The patient was treated with terbinafine oral, with excellent response.

Case for diagnosis. Infective dermatitis associated with HTLV-1: differential diagnosis of atopic dermatitis

Abstract: Infective dermatitis associated with HTLV-1 (IDH) is the main cutaneous marker of HTLV-1 infection. This disease occurs primarily in children and should be differentiated from other eczemas, especially from atopic dermatitis. The largest series of IDH are from Jamaica and Brazil. There are an estimated 15 to 20 million infected people in the world, and Brazil is one of the endemic regions. Studies suggest that IDH in children may be a marker for the development of T-cell leukemia/lymphoma (ATL) or myelopathy associated with HTLV-1/tropical spastic paraparesis (HAM / TSP) in adulthood.

Particular characteristics of atopic eczema in tropical environments. The Tropical Environment Control for Chronic Eczema and Molecular Assessment (TECCEMA) cohort study

Abstract: Background: Atopic dermatitis is a prevalent health problem in the world. Allergic sensitization is an important risk factor, but the roles of other factors, inherent in tropic region, are unknown. Objective: A cohort study was designed in a tropical city to investigate molecular and environmental risk factors for eczema, considering as particular features perennial exposure to mites, poor living conditions and others tropical characteristics. Methods: 433 patients were included at baseline and biological samples were collected during 24 months of follow-up. Clinical information was collected using questionnaires (SCORAD, DLQI and a subjective scale) during each clinical assessment. Results: The prevalence of atopic eczema was 93%, with similar frequency between children and adults; parents history of eczema and polysensitization to mites, dogs, cats, cockroaches and birds, were risk factors for severe and persistent eczema and allergic comorbidities. Food sensitization was present in 16% of patients but food-induced allergies were scarce. Psychiatric, dental and ocular disorders were the most frequent non-allergic comorbidities. Study limitations: selection bias. Conclusion: We presented a tropical cohort of patients with eczema and we identified some risk factors for severe and persistent dermatitis. Some patterns of sensitization were associated with severe eczema and respiratory symptoms, and the natural history of "atopic march" is different to that described in some industrialized countries. The collection of biological samples will contribute to the understanding of the gene/environment interactions leading to allergy inception and evolution.

The Relationship Between Psychosocial Stress and Allergic Disease Among Children and Adolescents in Gwangyang Bay, Korea / 예방의학회지

OBJECTIVES: Stress is considered a causal factor in many diseases, allergic disease being one of them. The prevalence of allergic disease is increasing in Korea, but the relationship between allergic symptoms and stress is not empirically well known. We aimed to evaluate the relationship between allergy-related symptoms and stress in children and adolescents. METHODS: We investigated 698 children and adolescents living in Gwangyang Bay, Korea, using a multi-stage cluster sampling method. Using the International Study of Asthma and Allergies in Childhood and the Psychosocial Well-being Index, these subjects were surveyed on allergy-related symptoms and psychosocial stressors in their lives, respectively. We used a multivariate logistic analysis for odds ratios for the complaint rate of allergic symptoms, after adjusting for age, gender, household income, body mass index, and residence. RESULTS: After adjustments, lifetime rhinitis (odds ratio [OR], 1.024), rhinoconjunctivitis (OR, 1.090), diagnosis of itchy eczema (OR, 1.040), treatment of itchy eczema (OR, 1.049), 12-month allergic conjunctivitis (OR, 1.026), diagnosis of allergic conjunctivitis (OR, 1.031), and treatment of allergic conjunctivitis (OR, 1.034) were found to be significantly associated with stress. CONCLUSIONS: Our results support the notion that there is a relationship between stress and allergic symptoms in children and adolescents. Further research into any causal relationship between stress and allergies, as well as preventative public health plans for decreasing stress in children and adolescents are needed.

[Wiscott-Aldrich syndrome [WAS]]

Wiscott-Aldrich syndrome [WAS] is an x-linked immune-deficiency disorder associated with eczema, recurrent infections, and increased frequency of autoimmune diseases, malignancy and thrombocytopenia with small size platelet. Our case is an 11 year old from a non- related parent, who was admitted with abdominal pain [hematoma], lower extremities bleeding [ecchymosed] and vomiting. Also, he had many admition cause bleeding in different areas. Lastly, he had retinal bleeding associated with blindness from 1 year ago

[Effect of herbal topical cream AJMT in comparison with fluocinolone acetonide on hand eczema]

Topical glycocorticoid therapy is the first choice for the treatment of eczema. Eczema is the most common inflammatory skin disease. Different degrees of itching is the outstanding feature of this disease. In this study we have tried to investigate the efficacy of herbal drug AJMT in comparison with fluocinolone acetonide on hand eczema. In this study 64 patients with hand eczema that referred to dermatology clinic, were randomly divided in two 32 patients group. One group was treated with topical fluocinolone actinide cream and the other with AJMT cream. After 2 weeks of treatment we analyzed the data with SPSS software, using Macnemar and X[2] tests. This study showed, there was significant statistical difference regarding to pruritus and erythema in pre and post therapy [P < 0.05]. The difference was not significant for other symptoms. The results of therapy in AJMT group is superior for symptoms of skin lichenification, scalliness and fissure compared to fluosinolone acetonide group. AJMT cream is more effective than fluosinolone acetonide in hand eczema. On the other hand due to more side effects with long usage of topical corticosteroids we prefer the AJMT cream for topical therapy on hand eczema

Prevalence of asthma, rhinitis and eczema in 6 - 7 years old students from the western districts of São Paulo City, using the standardized questionnaire of the "International Study of Asthma and Allergies in Childhood" (ISAAC)-phase IIIB

The aims of the present work were the evaluation of allergic disease prevalence among 6 and 7 year-old students from the western districts of São Paulo city and the comparison of these data with those obtained in the International Study of Asthma and Allergies in Childhood (ISAAC) phase I, performed in the central-southern districts of São Paulo, using the ISAAC standardized written questionnaire. METHODS: 5,040 questionnaires were distributed and 3,312 were returned. Proportional differences were estimated by Chi square or Fisher exact tests. Odds Ratio and 95 percent confidence intervals between genders and allergic diseases were calculated. Values of p<0.05 were considered statistically significant. RESULTS: The corrected prevalences found were: asthma 24.4 percent, medical diagnosis of asthma 5.7 percent, rhinitis 25.7 percent, rhinoconjunctivitis 11.3 percent, medical diagnosis of rhinitis 20.0 percent, atopic eczema 9.2 percent. Significant associations between asthma and rhinitis (OR=3.3), asthma and eczema (OR=2.2), and rhinitis and eczema (OR=2.8) occurred. The male gender was prevalent regarding asthma and rhinitis. Compared to data from ISAAC phase I, higher asthma prevalence and severity, and lower values for rhinitis and eczema were observed in this study. CONCLUSIONS: The present study evidenced high prevalences for asthma and rhinitis compared to the children's medical diagnosis. The male gender predominated in all positive responses regarding asthma and rhinitis. The most frequent associations observed were between asthma and rhinitis and asthma and eczema. In the western districts of São Paulo, a higher prevalence of asthma symptoms and severity and lower prevalences for rhinitis and eczema occurred compared to the central-southern districts of the city.

OBJETIVOS: Avaliar a prevalência das doenças alérgicas na região oeste de São Paulo entre escolares de 6 a 7 anos e comparar os dados obtidos com aqueles da fase I da região centro-sul, através do questionário padronizado do International Study of Asthma and Allergies in Childhood. MÉTODOS: Foram enviados 5040 questionários escritos com resposta de 3.312 alunos. As diferenças entre proporções foram avaliadas pelo Teste do Qui-quadrado ou Teste Exato de Fisher, se calculado a Razão das Chances, intervalo de confiança 95 por cento entre os sexos e doenças alérgicas. Os valores de p < 0,05 foram considerados como significantes. RESULTADOS: As prevalências corrigidas encontradas foram: asma 24,4 por cento, diagnóstico médico de asma 5,7 por cento, rinite 25,7 por cento, rinoconjuntivite 11,3 por cento, diagnóstico médico de rinite 20 por cento, eczema atópico 9,2 por cento. Houve associação significativa entre asma e rinite (OR=3,3), asma e eczema (OR=2,2) e rinite e eczema atópico (OR=2,8). O sexo masculino foi predominante para asma e rinite. Comparando-se os dados da fase I, observou-se prevalência mais elevada dos sintomas e gravidade de asma e valores menores para rinite e eczema. CONCLUSÕES: As prevalências de asma e rinite neste estudo mostraram valores elevados em comparação ao diagnóstico médico. Houve predomínio do sexo masculino para asma e rinite. As associações mais freqüentes foram entre asma e rinite e asma e eczema. Em relação à região centro-sul de São Paulo, observou-se que na região oeste houve maior prevalência dos sintomas e gravidade da asma e menor prevalência de rinite e eczema.

Clinical profile of forefoot eczema: a study of 42 cases.

BACKGROUND: Forefoot eczema (FE) is characterized by dry fissured dermatitis of the plantar surface of the feet. AIM: To study the clinical profile of FE and the possible etiological factors. METHODS: Forty-two patients with FE were included in the study. A detailed history was recorded and examination done. Fungal scrapings and patch test with Indian Standard Series (ISS) were performed in all patients. RESULTS: The most common site affected was the plantar surface of the great toe in 16 (38.09%) patients. Hand involvement, with fissuring and soreness of the fingertips and palm, was seen in four patients (9.5%). Seven patients (16.6%) had a personal history of atopy whereas family history of atopy was present in six (14.2%). Seven patients (16.6%) reported aggravation of itching with plastic, rubber or leather footwear, and 13 (30.9%), with detergents and prolonged contact with water. Negative fungal scrapings in all patients ruled out a dermatophyte infection. Patch testing with ISS was performed in 19 patients and was positive in five. CONCLUSIONS: FE is a distinctive dermatosis of the second and third decade, predominantly in females, with a multifactorial etiology, possible factors being chronic irritation, atopy, footwear and seasonal influence.

Surveying the prevalence of asthma, allergic rhinitis and eczema in school-children in Khon Kaen, Northeastern Thailand using the ISAAC questionnaire: phase III.

This is the second survey of schoolchildren in Khon Kaen, Northeastern Thailand, using the Thai version of the ISAAC questionnaire to examine the trend in the prevalence of asthma, allergic rhinitis and eczema, and to compare the results with the ISAAC Phase I data. We analyzed 5,075 questionnaires comprising 2,119 six- to seven- and 2,956 thirteen- to fourteen-year-old children (48 and 42 percent male, respectively). The cumulative vs. 12-month prevalence according to the written questionnaires were: 14.3 vs. 9.8% for wheezing, 42.6 vs. 33.3% for rhinitis and 13.5 vs. 11.2% for eczema, respectively. The cumulative vs. 12-month prevalence for the wheezing module, based on the video questionnaire, was 9.2 vs. 6.3%, respectively. Most Phase III prevalence was significantly lower than the first survey except for the steady, 12-month prevalence of wheeze. Our study confirms the high prevalence of allergic diseases among school-children in Northeastern Thailand; albeit, prevalence has not increased in recent years. The Thai version of the English-language ISAAC questionnaire needs to be validated before further use in epidemiological research.

HTLV-I Associated infective dermatitis may be an indolent HTLV-I associated lymphoma

When present for a first time blood donation, a 28-year-old Brazilian white female reported a pruritic eczema of the scalp and retroauricular areas since childhood that had been frequently infected. Her mother had been diagnosed as having HTLV-I-associated myelopathy (HAM), and the patient was found to be a human T-lymphotropic virus type-I (HTLV-I) carrier. The patient had been breast-fed for 6 months. The patient had a complete examination, and a biopsy was taken from eczema in the retroauricular area. The byopsy indicated chronic lymphohistiocytic dermatitis with no abnormal lymphocystes. Eleven months later, the patient had an infliltration in the skin of the retroauricular area and a new biopsy revealed atypical lymphocytes. Nested polymerase chain reaction (PCR) was positive for HTLV-I and immunohistochemistry of the tissue at this time confirmed adult T-cell leukemia/lymphoma (ATLL). Retrospective immunohistochemistry showed that the first fragment submitted from the biopsy 11 months before was also compatible with the diagnosis of ATLL. This case fulfilled all major criteria for diagnosis of HTLV-I-associated infective dermatitis (HTLV-I-ID). We postulate that the patient has indolent ATLL associated with HTLV-I infective dermatitis since childhood. We recommended that tissue immunohistochemistry analysis be done in any patient with HTLV-associated infective dermatitis.

Prevalence of asthma, rhinitis and eczema in children from the Bangkok area using the ISAAC (International Study for Asthma and Allergy in Children) questionnaires.

Within the past three decades, there has been a rising trend for prevalences of asthma and allergic diseases worldwide, particularly from developed and industrializing countries. In Thailand, limited studies on epidemiology of atopic diseases have indicated relatively low prevalences of these conditions among the Thais. Recently, a standardized phase I questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) has been developed to study and to compare geographical and temporal trend for prevalences of asthma, allergic rhinitis and eczema in children. The objectives of phase I ISAAC study in Thailand are to study prevalence of the three most common allergic diseases i.e. asthma, allergic rhinitis and eczema among Thai children of the two age groups (i.e., 6-7 and 13-14 years) living in the Bangkok metropolitan area and to collect basic epidemiologic data of these diseases among these children. The Thai translated version of phase I ISAAC questionnaires was administered to Thai children of the two age groups as above. Questionnaires were answered by parents of younger children, whereas, they were self-administered by 13-14 years old children. In addition, the validated international video questionnaires were used with older children. Fourteen primary schools and 13 secondary schools were randomly selected to cover the entire Bangkok metropolitan area. A total of 7341 questionnaires were eligible for the analysis (3628 from the younger age group and 3713 from the older age group). Data were entered and analysed by the Epi-Info program. The cumulative and 12 month period prevalences of the three conditions for all children were as follows; wheezing, 18.3 per cent, 12.7 per cent; rhinitis, 44.2 per cent, 38.7 per cent; and eczema, 15.4 per cent, 14.0 per cent, respectively. The period prevalence of wheezing for older children (13.6%) was higher than for younger children (11.7%). Prevalences of severe wheeze and exercise wheeze were more common among older children (4.0% and 15.7%). Both age groups reported high percentages for night cough (23.6% and 28.6%). A significantly large number of children from both groups reported symptoms of rhinitis with the majority indicating that symptoms were severe enough to limit their daily activities. Nevertheless, when confined only to those with eye symptoms, the prevalence decreased to 13.1 per cent. Eczema, in contrast to the other two conditions, occurred more frequently among younger children than among older children (period prevalence of 16% vs 9.1%). The rash was of a relatively mild nature since 77 per cent of children reporting symptoms indicated that the rash had cleared within the past 12 months. Allergic conditions are very common among children residing in Bangkok. Compared to the last survey in 1990, the period prevalence of wheezing has increased 4 fold, allergic rhinitis has increased nearly 3 fold whereas, eczema has remained stable. A large number of children in Bangkok are suffering from rhinitis symptoms. Results of this phase I ISAAC study indicate that allergic diseases are perhaps the most common childhood diseases in Thailand and could lead to a substantial economical loss for the country. There is an urgent need for an in-depth study to define epidemiological factors responsible for this increase.

Test epicutáneos con alergenos aerotransportados en pacientes con eczema atopico / Epicutaneous tests with aerotransports allergens in patients with atopic eczem

El papel de los alergenos aerotransportados en la génesis de la fisiopatología de la dermatitis atópica ha sido discutido desde principios de siglo. A partir de 1982 han aparecido numerosas publicaciones sobre la realización de test epicutáneos con estos alergenos en pacientes atópicos. Los alergenos, la técnica y los resultados difieren de un estudio a otro, dificultando la formulación de conclusiones. En el presente trabajo, se relizaron test epicutáneos y test de lectura inmediata (prick-tests) con doce alergenos aerotransportados (200 IR/g) en 115 sujetos, 65 de los cuales presentaban eczema atópico. Se obtuvieron resultados positivos (a los tests epicutáneos) por lo menos a uno de los alergenos, en 8 (12,37 por ciento) de los pacientes atópicos, contra 1 (2 por ciento) de los del grupo control. La simultaneidad de reacciones positivas a los tests de lectura inmediata no fue obligatoria. En 5 casos el alergeno identificado fue incriminado por el paciente en la etiologia de su sintomatología. En 2 casos se constaron lesiones generalizadas de eczema, provocada por los tests

Reticuloide actínico: a propósito de una observación / Actinic reticuloid: case report

Se presenta un caso de Reticuloide actínico, en un hombre de 52 años, de 10 años de evolución. Se estudió la población linfocitaria T a nivel sérico a través de anticuerpos monoclonales y la presencia de inmunocomplejos circulantes. Se discuten las distintas terapéuticas existentes y la escasa respuesta obtenida