Comparison of racial distribution of photodermatoses in USA academic dermatology clinics: A multicenter retrospective analysis of 1080 patients over a 10-year period.

BACKGROUND: Previous studies at single academic institutions have identified variations in the prevalence of photodermatoses among racial groups. The purpose of the study was to compare the distribution of photodermatoses between Whites and Blacks at four academic medical centers in the USA. METHODS: A retrospective chart review was performed at four institutions' general dermatology clinics using diagnoses consistent with the International Classification of Disease (ICD), Ninth and Tenth Revisions, codes related to photodermatoses between August 2006 and August 2016. A total of 9736 charts were manually reviewed and classified. Analyses were performed analyzing the frequency of photodermatoses between Whites and Blacks in the pooled data. RESULTS: There were 1,080 patients with photodermatoses identified. Statistically significant differences in the frequency of photodermatoses between Whites and Blacks were identified for polymorphous light eruption (more common in Blacks), photoallergic contact dermatitis, phototoxic drug eruption, phytophotodermatitis, porphyria, and solar urticaria (more common in Whites). The most commonly diagnosed photodermatoses were polymorphous light eruption (total 672), and photodermatitis not otherwise specified (total 189). CONCLUSION: Our study demonstrated significantly higher proportions of polymorphous light eruption in Blacks, and higher proportions of photoallergic contact dermatitis, phototoxic drug eruptions, phytophotodermatitis, porphyrias, and solar urticaria in Whites.

Urticaria acuagénica / Aquagenic urticaria

Presentamos el caso de una mujer de 30 años con urticaria acuagénica; también su madre presenta el mismo diagnóstico. La urticaria acuagénica es una forma rara de urticaria física que cursa con habones que afectan generalmente la parte superior del cuerpo. Es importante hacer diagnóstico diferencial con otros tipos de urticaria. La etiopatogenia no está clara. Los antihistamínicos mejoran la clínica. (AU)

The present is the case of a 30 year-old woman with aquagenic urticaria; her mother has the same diagnosis. Aquagenic urticaria is a rare form of physical urticaria which causes wheals that usually affect the upper body. Differential diagnosis with other types of urticaria is important. Etiopathogenesis is not well known. Treatment with antihistamines improves clinical attention (AU)

IgE FcεR1β polymorphism and risk of developing chronic spontaneous urticaria: A study in an ethnic Kashmiri population

BACKGROUND: The pathogenesis of chronic spontaneous urticaria involves interplay between the genetic and environmental factors, most of which is still poorly understood. It is well-recognized that 30-40% of chronic spontaneous urticaria is autoimmune in nature. Chronic autoimmune urticaria is caused by anti-Fc¿R1β and less frequently, by anti-IgE auto antibodies that lead to mast cell and basophil activation, thereby giving rise to the release of histamine and other proinflammatory mediators. We investigated the association between SNP loci in Fc¿R1β and chronic spontaneous urticaria and to see its relation with serum IgE levels in Kashmiri population. METHODS: The autologous serum skin test was used as a screening test for chronic autoimmune urticaria. PCR-RFLP was used to detect the genotype of the SNP loci. Serum IgE levels were assessed by ELISA kit. RESULTS: No significant difference was found between the study population and control group in genotype distribution (wild and variant) among Fc¿R1β loci (P value = 0.06, odds ratio = 0.29). The frequency of c¿R1β (C109T) in autologous serum skin test positive chronic autoimmune urticaria patients with the CT genotype was found to be statistically non-significant when compared with the wild genotype (P = 0.35). Carriers of Fc¿R1β (T allele) had a more significant risk of developing CAU than those with C allele (P = 0.01). In our population serum total IgE levels did not find any statistical significance with regard to ASST positive & ASST negative patients (P = 0.26). CONCLUSIONS: There is statistically no significant association between Fc¿R1β gene polymorphism and CSU in Kashmiri population; however, there is a probability of developing CSU in patients carrying Fc¿R1β T allele. Furthermore, serum total IgE levels had no significant association with the development of CAU

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Urticaria acuagénica: presentación de un caso / Aquagenic urticaria: a case presentation

FUNDAMENTO: la urticaria acuagénica es una rara forma de presentación de las urticarias físicas. OBJETIVO: describir el cuadro clínico y conducta a seguir de la urticaria acuagénica en una lactante. CASO CLÍNICO: lactante blanca, femenina de siete meses. Refieren los padres que desde su nacimiento comenzó la aparición de pequeñas ronchas en el tronco, brazos y piernas, que coincidían con el horario del baño, desaparecían a los 30-60 minutos posterior al mismo. A pesar de modificar el tipo de jabón y la temperatura del agua se mantenía el cuadro. Señalan que no le aparecen las lesiones de piel con el baño de mar. Los antecedentes atópicos familiares son positivos. Al bañarse la niña se comprueba la aparición de las lesiones de piel. Se diagnosticó la presencia de urticaria acuagénica y se prescribió tratamiento con antihistamínicos con una buena evolución del cuadro. CONCLUSIONES: la urticaria acuagénica es poco frecuente en lactantes, de su correcto diagnóstico y tratamiento, depende la buena evolución, así como la vida del paciente que puede verse comprometida por acompañarse esta de manifestaciones extracutáneas.

BACKGROUND: aquagenic urticaria is an uncommon presentation of physical urticaria. OBJECTIVE: to describe the clinical manifestations and the behavior to follow in an infant. CLINICAL CASE: a seven-months-old, white, female infant. The parents said that since she was born, some little wheals started to appear in the trunk, arms and legs that coincided with the bath time and disappeared 30-60 minutes later. In spite of changing soaps and the water temperature the manifestations remained. The parents also said that the lesions in the skin did not appear when taking a bathe in the sea. Family atopic antecedents were positive. When the baby is given a bath, the appearance of the lesions in the skin could be verified. The presence of aquagenic urticaria was diagnosed and antihistamines were prescribed for the treatment. The patient condition had a good progress. CONCLUSIONS: aquagenic urticaria is not frequent in infants. The good progress and the life of the patient, which could be affected by the disease since extracutaneous manifestations come with it, depend on the correct diagnosis and treatment.

The inhibition by levocetirizine and fexofenadine of the histamine-induced wheal and flare response in healthy Caucasian and Japanese volunteers.

This randomized, double-blind, placebo-controlled crossover study compared inhibition by one 5 mg dose of levocetirizine with two 60 mg doses of fexofenadine separated by 12 h of histamine-induced wheal and flare responses in 9 Caucasian and 9 Japanese healthy male volunteers. Levocetirizine was more inhibitory than fexofenadine on wheal, flare and pruritus (p < 0.005). Variability, evaluated from the standard deviation of inhibition, ranged from 14% to 23.2% for levocetirizine and 65.4% to 112.4% for fexofenadine. Levocetirizine had a faster onset of action (30-90 min versus 2 h), shorter time to maximum effect (3-4 versus 3-6 h) and longer duration of action (at least 24 h versus ~12 h) than fexofenadine. The plasma levels of levocetirizine rose more quickly, reached higher levels, were more consistent and decreased slower than those of fexofenadine. There were no clinically significant ethnic differences in responsiveness to the drugs.

Prevalence of food avoidance and food allergy in Chinese patients with chronic urticaria.

BACKGROUND: Food avoidance is common among Chinese patients with chronic urticaria because food allergy is considered to be the cause of disease. The benefit of food avoidance and its relationship with food allergy is unknown. OBJECTIVES: The aims of this study were to examine the prevalence and effect of food avoidance and food allergy in patients with chronic urticaria. METHODS: Four hundred and ninety-four patients with chronic urticaria, who attended Peking University Third Hospital from January 2009 to December 2010, were studied. Food avoidance and its effect were investigated with a detailed questionnaire. Food allergy was diagnosed by serum food-specific immunoglobulin E (IgE), elimination diet based on food-specific IgE, and open food challenge. RESULTS: One hundred and fifty-eight patients (32%) avoided fish, shrimp, crab, lamb or beef prior to evaluation and 82·9% of them reported food avoidance ineffective. Out of 341 patients tested for serum food-specific IgE, 75 (22%) were positive, with soy, peanut, beef, lamb, chicken, crab and shrimp as the leading allergens. Chronic urticaria induced by food allergy was found in only 2·8% of patients. CONCLUSIONS: The prevalence of food avoidance is high and mostly ineffective in Chinese patients with chronic urticaria. Foods avoided do not correspond to serum food-specific IgE. The incidence of IgE-mediated urticaria, as demonstrated by open food challenge, is low. Physicians and patients should be aware of unnecessary dietary avoidance while seeking treatment of chronic urticaria.

The analysis of genetics and associated autoimmune diseases in Chinese vitiligo patients.

Vitiligo is a common skin and hair depigmentary disorder that results from selective destruction of melanocytes. It occurs in a typical multifactorial, polygenic inheritance. Several studies have indicated that vitiligo is associated with some autoimmune diseases. In this paper we examined 6,516 vitiligo patients including clinical characteristics, familial involvement, and their association with other autoimmune diseases. Compared with sporadic vitiligo probands, familial vitiligo probands have earlier age onset and longer disease duration. The prevalences of four autoimmune diseases namely rheumatoid arthritis, chronic urticaria, alopecia areata and psoriasis, were significantly elevated in generalized vitiligo probands and their first-degree relatives. The prevalences of chronic urticaria, rheumatoid arthritis, psoriasis were much higher in familial generalized vitiligo probands. In addition, the prevalences of diabetes mellitus and asthma were also higher in familial vitiligo probands. These findings indicate that generalized vitiligo may share common genetic aetiologic links with other autoimmune diseases, and the genetic component of familial generalized vitiligo is stronger.

Chronic idiopathic urticaria: prevalence and clinical course.

The purpose of our study was to assess the prevalence and clinical course of patients with chronic idiopathic urticaria (CIU), as well as possible causes or associated findings, laboratory findings and the duration of the disease in patients with chronic urticaria (CU). We retrospectively reviewed the 450 case record forms of patients with CU and/or angioedema who attended the Department of Dermatology, Siriraj Hospital, during the period 2000-2004. Of 450 patients with CU, 337 patients (75%) were diagnosed as CIU. Forty-three patients (9.5%) had physical urticaria, while 17 patients (3.8%) had infectious causes. Other possible causes were food, thyroid diseases, atopy, drugs, dyspepsia and collagen vascular diseases. In eighty-nine percent of patients, no abnormalities were detected at the time of physical examination. The most common abnormal laboratory finding was minimal elevation of the erythrocyte sedimentary rate (42%). In 61 patients, autologous serum skin tests had been done. Fifteen patients (24.5%) had positive results i.e. autoimmune urticaria. Anti-thyroglobulin and anti-microsomal antibodies were positive in 16 % and 12% of CIU patients respectively. After 1 year from the onset of the symptoms, 34.5% of CIU patients were free of symptoms and after 1.2 years from the onset of the symptoms, 56.5% of autoimmune urticaria patients were free of symptoms. The median disease duration of CIU and autoimmune urticaria were 390 days and 450 days respectively. Our study provided an overview of CU and CIU in a large series of Thai patients, based on etiological aspects and clinical courses.

Review of fexofenadine in the treatment of chronic idiopathic urticaria.

Chronic idiopathic urticaria (CIU), characterized by the appearance of itchy wheals of unknown etiology, can be extremely debilitating and can significantly reduce a patient's quality of life (QOL). Fexofenadine, a non-sedating, H1-receptor selective, long-acting antihistamine, is licensed worldwide for the treatment of CIU. A number of dose-ranging studies have evaluated the efficacy and safety of fexofenadine for the the treatment of CIU. In two similar North American studies, patients received either fexofenadine HCI (20, 60, 120, or 240 mg bid) or placebo. All four doses of fexofendine were statistically superior to placebo at reducing pruritus and reducing the number of wheals (P < or = 0.0238). A dose-finding study undertaken in Japanese patients confirmed that fexofenadine HCI (60 mg and 120 mg bid) is an effective treatment for CIU. A similar dose response was shown in all three studies when the results were compared. Furthermore, health outcome analyses of the North American studies indicated that fexofenadine HCI 60 mg bid significantly improved patient's QOL. In these studies, fexofenadine had a consistently comparable safety profile to placebo, with no dose-related trends in the incidence of adverse events. In conclusion, fexofenadine is an effective and well-tolerated treatment for CIU, with a wide therapeutic window. Importantly, the lack of ethnic differences between the studies from North America and Asia indicate that the efficacy and safety of fexofenadine demonstrated in these studies are cross-culturally applicable.