Topical treatment with fresh human milk versus emollient on atopic eczema spots in young children: a small, randomized, split body, controlled, blinded pilot study.

BACKGROUND: Public health nurses report on effects of fresh human milk as treatment for conjunctivitis, rhinitis and atopic eczema (AE), the latter being highly prevalent in early childhood. Emollients and topical corticosteroids are first line treatment of AE. As many caregivers have steroid phobia, alternative treatment options for mild AE are of interest. The aim of this small pilot study was to assess the potential effects and risks of applying fresh human milk locally on eczema spots in children with AE. METHODS: This was a split body, controlled, randomized and physician blinded pilot study, of children with AE with two similar contralateral eczema spots having a mother breastfeeding the child or a sibling. Fresh expressed milk and emollient was applied on the intervention spot and emollient alone on the control area, three times a day for four weeks. The severity and area of the eczema spots was evaluated weekly, and samples from milk and the spots were analysed weekly with respect to bacterial colonisation. RESULTS: Of nine patients included, six completed the study. Mean age at inclusion was 18.5 months. The spots examined were localized on the arms, legs or cheeks. The spots were similar in severity, but differed in area. In one patient the eczema ceased after inclusion. In four patients both control and intervention areas increased during the intervention. The relative change in eczema area compared to baseline showed less increase in the intervention spots in two patients, whereas the opposite was observed in three. In four children Staphylococcus aureus was found in their eczema once or more. In three of the 28 human milk samples, Staphylococcus aureus, alfa haemolytic streptococci or coagulase negative staphylococci were detected. Staphylococcus aureus was found once both in human milk and in the eczema spots, no clinical signs of infection were however observed. No secondary infection due to milk application was detected. CONCLUSION: In this small pilot study, no effect was found on eczema spots treated with topical application of fresh human milk. (ClinicalTrials.gov Identifier, NCT02381028 ).

Ichthyosis prematurity syndrome: clinical evaluation of 17 families with a rare disorder of lipid metabolism.

BACKGROUND: Ichthyosis prematurity syndrome (IPS) is classified as a syndromic congenital ichthyosis based on the presence of skin changes at birth, ultrastructural abnormalities in the epidermis, and extracutaneous manifestations. Recently, mutations in the fatty acid transporter protein 4 gene have been identified in patients with IPS. OBJECTIVE: We sought to perform a detailed clinical evaluation of patients with IPS identified in Norway. METHODS: Clinical examination and follow-up of all patients (n = 23) and light and electron microscopic examination of skin biopsy specimens were performed. RESULTS: IPS was characterized prenatally by ultrasound findings of polyhydramnios, separation of membranes, echogenic amniotic fluid, and clear chorionic fluid. All patients were born prematurely with sometimes life-threatening neonatal asphyxia; this was likely caused by aspiration of corneocyte-containing amniotic fluid as postmortem examination of lung tissue in two patients revealed keratin debris filling the bronchial tree and alveoli. The skin appeared erythrodermic, swollen, and covered by a greasy, thick vernix caseosa-like "scale" at birth, and evolved rapidly to a mild chronic ichthyosis. Many patients subsequently had chronic, severe pruritus. Histopathologic and ultrastructural examination of skin biopsy specimens showed hyperkeratosis, acanthosis, dermal inflammation, and characteristic aggregates of curved lamellar structures in the upper epidermis. Peripheral blood eosinophilia was invariably present and most patients had increased serum immunoglobulin E levels. Over 70% of the patients had a history of respiratory allergy and/or food allergy. LIMITATIONS: The study included only 23 patients because of the rarity of the disease. CONCLUSION: IPS is characterized by defined genetic mutations, typical ultrastructural skin abnormalities, and distinct prenatal and postnatal clinical features.

[Cutaneous drug reactions]. / Kutane legemiddelreaksjoner.

BACKGROUND: Adverse cutaneous reactions to drugs are frequent in general practice. This article is a review of current knowledge of the pathogenesis, differential diagnosis and practical management of this wide spectrum of cutaneous manifestations. MATERIAL AND METHODS: Recent studies, guidelines and textbooks are reviewed. The literature was identified on PubMed and supplemented by clinical experience from two university hospitals in Oslo, Norway. RESULTS AND INTERPRETATION: Adverse cutaneous reactions to drugs are frequent, though most reactions are mild and self-limiting. Drug reactions in the skin may be difficult to distinguish from viral exanthemas and other skin diseases. Serious reactions are potentially life-threatening and in need of treatment in intensive-care units. Of the 1350 drugs registered in Norway, the most frequent drugs involved in serious drug reactions are antibiotics, non-steroidal anti-inflammatory drugs, and anticonvulsants. Cutaneous drug reactions can be markers of underlying disease, such as HIV infection or lymphoproliferative diseases. Withdrawal of the suspected drug is essential for prognosis. It is also important to perform a causality assessment of the suspected drug reaction so that it can be avoided in the future, as well as to put emphasis on patient education.

[Dermatitis herpetiformis]. / Dermatitis herpetiformis.

Dermatitis herpetiformis is characterised by an intensely itchy, chronic, papulovesicular eruption, usually on elbows, knees and buttocks. The diagnosis is based on granular IgA deposits in the dermal papillae in a perilesional skin biopsy analysed by immunofluorescence microscopy. Most patients have subclinical celiac disease; a gluten-free diet is effective in most cases. IgA antibodies against tissue transglutaminase (TG2) may be involved in the pathogenesis of celiac disease with or without dermatitis herpetiformis, and an epidermal transglutaminase (TG3) may be the autoantigen in dermatitis herpetiformis. This article provides a short review intended for the general practitioner of the pathogenesis, diagnosis and treatment of dermatitis herpetiformis.