Efficacy and problems associated with using a wet-wrap garment for children with severe atopic dermatitis.

Use of a wet wrap for short-term relief of itch in children with severe atopic dermatitis has been advocated but objective determination of its efficacy has been difficult and many issues associated with its use are yet to be defined. We tested a new garment for the wet-wrap procedure in six patients with atopic dermatitis and objectively determined whether a 3-day usage could indeed relieve the distressing symptom of itch using a wrist motion monitor. The garments were effective in the short-term improvement of itching, severity of atopic dermatitis and quality of life in these children. Many issues associated with its use were identified. Clear instructions and individualized regimes (such as the choice of emollient, bathing ointment and topical corticosteroid) are essential for optimal outcome.

Eczema exacerbation and food atopy beyond infancy: how should we advise Chinese parents about dietary history, eczema severity, and skin prick testing?

Issues related to empirical dietary restriction are important, but they have been inadequately studied among children with atopic dermatitis (AD). To evaluate whether any association exists between food atopy, food avoidance, and AD severity, investigators in the present study reviewed all skin prick tests (SPTs) performed between January 2005 and April 2006 at a pediatric dermatology clinic and correlated findings with history of food avoidance and eczema severity. Only 13% of 114 children with AD had a positive SPT for beef. The most commonly sensitized foods were egg yolk (53%), egg white (42%), shrimp (35%), peanuts (31%), and crab (29%). Disease severity was not associated with prevalence of sensitization to these foods. The investigators concluded that immediate immunoglobulin E reaction to beef, as suggested by positive SPT findings, is unlikely to occur in most children with AD. SPT information may be useful in reassuring parents about the unlikelihood of a severe and immediate reaction to beef. As for other foods, it is sensible to advise parents about specific avoidance strategies only in more severely affected children with a definite history of eczema exacerbation by specific food allergens.

Assessing itch in children with atopic dermatitis treated with tacrolimus: objective versus subjective assessment.

This study was undertaken to evaluate the clinical efficacy of tacrolimus for itch reduction in children with atopic dermatitis (AD). Seven children (3 boys and 4 girls) with AD were treated with topical tacrolimus for a consecutive 2-wk period after a 1-wk run-in. The clinical severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) scale. Sleep disturbance, as reported by patients, and nocturnal scratching documented by a wrist movement monitor (DigiTrac), were evaluated at baseline and throughout treatment. The median (interquartile range) objective SCORAD scores before and after treatment were 27.2 (24.8-36.7) and 23.9 (22.6-36.5), respectively (P=.248). Overall SCORAD scores before and after treatment were 36.1 (32.8-45.7) and 29.4 (24.8-45.4), respectively (P=.05). Scores on the itch and sleep disturbance components of the SCORAD were reduced from 5.0 (5.0-6.5) and 4.0 (3.5-5.0) to 4.0 (2.0-5.0) and 3.0 (0.5-4.5), respectively. Total SCORAD was reduced in 6 patients (range, 8%-36% reduction) and remained similar in 1 patient. No significant change in the area or intensity component of the SCORAD was detected 14 d after treatment began (P=.48 and P=.115, respectively). Scratching activity, as documented by the DigiTrac movement recorder, was reduced from 115.0 g/min (64.8-215.5) to 71.5 g/min (51.0-118.0) (P=.028) after 2 wk of treatment. Daily symptom scores (n=6 pairs) for sleep disturbance reported separately each day by patients and parents correlated strongly with each other (intraclass coefficient, 0.60-0.98). The findings of this study show that tacrolimus is effective in relieving itch in children with AD. Investigators suggest that scratching movements, objectively measured with the use of DigiTrac, provide a reliable indicator of AD severity in children.

Are age-specific high serum IgE levels associated with worse symptomatology in children with atopic dermatitis?

BACKGROUND: Atopic dermatitis (AD) is a distressing disease associated with excoriations, pruritus, sleep disturbance, and elevation of serum total immunoglobulin E (IgE) levels. OBJECTIVE: To evaluate whether serum IgE levels correlate with the symptomatology and plasma chemokine levels in children with AD. METHODS: AD patients aged younger than 18 years were recruited from the pediatric dermatology clinic of a university teaching hospital, and the AD severity was evaluated using the SCORing Atopic Dermatitis (SCORAD) index. Concentrations of serum total IgE, eosinophil count, and plasma AD-associated chemokines [cutaneous T-cell-attracting cytokine (CTACK), thymus and activation-regulated chemokine (TARC)] were measured. RESULTS: One hundred and seventeen Chinese children with AD (64 boys and 53 girls), with an age (mean +/- standard deviation) of 10.7 +/- 4.4 years, were recruited. Their overall SCORAD index (mean +/- standard deviation) was 51.1 +/- 22.8. The total serum IgE level divided by the age-specific upper limit (AE) correlated well with the extent and intensity of AD, except for oozing/crusting, which was significant only in males. There was a significant correlation between AE and pruritus or sleep loss only in females. Levels of IgE, CTACK, and TARC, and eosinophil count, differed significantly between patients with mild, moderate, and severe disease. AE correlated well with TARC (r = 0.50, P < 0.001) and eosinophil count (r = 0.41, P < 0.001), but not with CTACK (r = 0.11, P = 0.270). The prediction of moderate to severe eczema by AE gave an area under the receiver-operating characteristic curve of 0.76 (95% confidence interval, 0.65-0.86; P = 0.004). An optimum positive predictive value of 94.2% was achieved with a cut-off point of AE of 2.95, sensitivity of 75.0%, and specificity of 66.7%. CONCLUSION: AE correlates significantly with various objective clinical scores and chemokine markers of AD, and is a useful indicator for predicting moderate to severe AD in children.

Steroid fears in children with eczema.

BACKGROUND: Topical glucocorticoids (GCs) are the mainstay of treatment for eczema, but GC phobia and fears are very common among the parents of paediatric patients. AIM: To survey the nature and extent of "fears" of GC use, and to evaluate if disease severity is associated with such fears. METHODS: Patients with eczema managed in the paediatric dermatology outpatient clinic of a university hospital were recruited in this survey. Disease severity and various aspects of belief and practices of GC use were assessed with the Nottingham Eczema Severity Score and a questionnaire. RESULTS: GC "fears" were present in two fifths of informants with non-eczematous skin disease and mild eczema, but three fifths in moderate-to-severe disease. Requests for steroid-sparing medications (such as tacrolimus or pimecrolimus) had been made in nearly 50% of cases with moderate-to-severe eczema, and many parents would wait until eczema had worsened or apply GC only as a last resort to avoid potential side effects. "Fears" were predominantly interpersonal and rarely iatrogenic in nature. Skin problems (in particular skin thinning) and adverse effects on growth were the side effects of GC of most concern. However, fewer than half of the informants had discussed their concerns with doctors. CONCLUSION: Our results suggest the importance of understanding the nature and extent to which GC fears, regardless of eczema severity, are prevalent so that sound advice can be offered in a timely manner to parents and patients.