The effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with atopic dermatitis.

BACKGROUND: The prevalence of atopic dermatitis (AD) is increasing worldwide, and many patients present to secondary care in adult life. This is a significant contribution to the workload of all dermatology departments. There are no studies investigating the impact of a dermatology consultation within secondary care. OBJECTIVES: To examine the effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with AD. METHODS: This prospective observational study recruited new adult patients with AD referred from primary care. Eczema severity was assessed using the SCORAD (Severity Scoring of AD) index and subjective good or poor clinical outcome. The Dermatology Life Quality Index (DLQI) was used to quantify the impact of AD on adult patients. Patients were assessed at initial consultation (T1), 6 weeks (T2) and 3 months (T3). Statistical analysis was performed using independent t-tests, repeated-measures analysis of variance, correlation coefficients and Bonferroni post hoc comparisons. RESULTS: Sixty-three patients were recruited (37 women, 26 men) with a mean age of 34 years. Mean SCORAD at T1 was 48.2 and the majority (51%) had severe eczema (objective SCORAD>40). Mean SCORAD reduced by 52% from T1 to T2 (P<0.001) but there was no significant change in SCORAD from T2 to T3. A subjective good clinical outcome was validated by a decrease in SCORAD of >20 (P<0.001). Patients in the good clinical outcome group were significantly older than those in the poor clinical outcome group (38 vs. 27 years, P<0.05). The mean age at presentation of women was significantly younger than men (29 vs. 43 years, P<0.01). Women's mean SCORAD improved over all three visits, while men's mean SCORAD improved from T1 to T2 but worsened from T2 to T3 (P<0.001). The mean DLQI reduced over all three visits, from 9.5 at T1 to 8.8 at T2 and 7.0 at T3, and was significantly correlated with SCORAD at T1 and T2 (P<0.01). Patients accurately self-scored their eczema on a body map as shown by a significant correlation between these scores and SCORAD at T1 and T2 (P<0.001). CONCLUSIONS: We have shown that within the first 3 months of referral to secondary care, new adult patients with AD have the greatest improvement in AD, measured by SCORAD, after their initial appointment. Quality of life, as measured by DLQI, continued to improve over all three visits.

Immunoglobulin E-dependent stimulation of human alveolar macrophages: significance in type 1 hypersensitivity.

Human alveolar macrophages were obtained during diagnostic bronchoalveolar lavage. Cells were cultured, and morphological examination (including electron microscopy) revealed that not more than 5% of the cultured cells were identifiable as cells other than alveolar macrophages. The cells were sensitized with human myeloma immunoglobulin E. and then challenged with anti-immunoglobulin E anti-sera. The experiments employed a highly specific monoclonal antibody and three affinity purified reagents. The formation of immunoglobulin E/anti-immunoglobulin E complexes facilitated release from alveolar macrophages of leukotriene B4, prostaglandin F2 alpha, thromboxane B2 and the lysosomal hydrolase N-acetyl-beta-D-glucosaminidase. There was no release of active oxygen species, with this stimulus, as measured by lucigenin chemiluminescence. Immunoglobulin E receptors were identified histochemically on the surface of human alveolar macrophages, and were visualized as conjugates with colloidal gold by electron microscopy. These results support the view that human alveolar macrophages may contribute to type 1 hypersensitivity reactions in the lung.

Differences in the inhibitory effects of N-(1-n-dodecyl)-heterocycles on the 2,3-oxidosqualene lanosterol-cyclase of rat liver and yeast.

The ability of thirteen N-(1-n-dodecyl)-heterocyclic compounds and one N-(1-n-fluoroalkyl)-heterocyclic compound to inhibit the 2,3-oxidosqualene lanosterol-cyclase of rat liver and yeast has been tested. Eight of the N-(1-n-dodecyl)-heterocycles inhibited the rat liver enzyme well but none inhibited the yeast enzyme at 100 microM concentrations. The N-(1-fluoroalkyl)-heterocycle inhibited the rat liver enzyme mildly but did not inhibit the yeast enzyme at 100 microM concentration. It is evident that the rat liver and yeast cyclases are different; the possible nature of these differences is discussed.