Evaluation of severity and therapy in children with atopic dermatitis

Atopic dennatitis (AD) is a conUllon chronically relapsing skin disorder affecting 9-20% of those born after 1970 [Schultz Larsen 1993]. TI,e aetiology is still not entirely elucidated and research is complicated by the multifactorial nature of the disease. Both genetical and environmental factors are involved in the pathogenesis of AD. The prevalence of atopic dennatitis seems to have increased along with astluna and allergic rhinitis during the past three decades [Williams 1992, Schultz Larsen 1996]. Several studies from different countries reported a two- to three-fold increase of the prevalence of AD over the past three decades. However, the reasons for this evolution of atopic diseases still remain to be elucidated. Furthennore, large, unexplained variations in prevalence have been reported between countries and within countries [ISAAC 1998], suggesting a critical role for environmental thctors in disease expression. Although some risk factors such as gender, parental smoking, and early exposure to allergens Olouse dust mite, pets, cow's milk and solid food) have becn identified, the role of other risk factors like socio-economic status, outdoor and indoor pollution and infections in early life are still a matter of discussion. Studies on the genetical and immunological background have provided new insights into the mechanisms involved in atopic diseases. However, therapeutical practice has not yet changed. Recently guidelines based on consensus have been established for the management of AD [Me Henry 1995]. Emphasis is put on educating and infonning the patients. Although these and other guidelines provide a good franlework for managing AD, the unpredictable course of the disease with exacerbations and remissions may fiustrate both patients and physicians [przybilla 1994]. Patients with AD account for about 30% of demlatological consultations in general practice, and dennatological consultations account for about 20% of all consultations in general practice [Rook 1986]. However, little attention has been paid to AD in tenns of research. A Medline literature search (title, abstract, and subject heading) from 1996 to May 1999 showed 8,986 publications related to astlUlla, but only 942 related to AD. This is surprising when the impact of the two diseases is compared. In tenns of prevalence, AD is more conunon than asthma in Y01Ulg children [Peat 1994, Burr 1989]; in tenns of economic resources, the direct fimUlcial cost in the care of a child with moderate to severe AD is substantially higher than for the average child with asthma [Su 1997]; and in tenns of family impact - taking into account fmaneial burden, familial/social impact, personal strain and mastery - even in mild AD, the impact on fanlilies was found to be equivalent to that for children with insulin dependent diabetes mellitus [Su 1997]. Consequently AD should not be perce

Protocol for the development of core set of domains of the core outcome set for patients with congenital melanocytic naevi (OCOMEN project)

Background: Having large congenital melanocytic naevi (CMN) is associated with a psychosocial burden on patients and their parents because of its remarkable appearance and the extra care it may require. Large CMN also pose an increased risk of malignant melanoma or neurocutaneous melanosis. There is a lack of international consensus on what important outcome domains to measure in relation to treatment. This makes it difficult to compare options, to properly inform patients and their parents, and to set up treatment policy for CMN. Therefore, we aim to develop a core outcome set (COS), i.e. the minimum set of outcomes that are recommended to be measured and reported in all clinical trials of a specific health condition. This COS can be used in the follow-up of CMN patients with or without treatment, in clinical research and practice. Methods: In the Outcomes for Congenital Melanocytic Nevi (OCOMEN) projects, we follow the recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the Cochrane Skin Core Outcomes Set Initiative (CS-COUSIN). This project entails the following: (i) a systematic review to identify the previous reported outcomes in literature; (ii) focus groups with national and international patients and parents to identify patient-important outcomes; (iii) classification of outcomes into outcome domains; (iv) e-Delphi surveys in which stakeholders (patients/parents and professionals) can rate the importance of domains and outcomes; and (v) an online consensus meeting to finalize the core outcome domains of the COS. Results: The results will be disseminated by means of publication in a leading journal and presentations in international meetings or conferences. We engage international experts in CMN, both patients and professionals, to ensure the international utility and applicability of the COS

Genome-wide association studies of autoimmune vitiligo identify 23 new risk loci and highlight key pathways and regulatory variants

Vitiligo is an autoimmune disease in which depigmented skin results from the destruction of melanocytes1, with epidemiological association with other autoimmune diseases2. In previous linkage and genome-wide association studies (GWAS1 and GWAS2), we identified 27 vitiligo susceptibility loci in patients of European ancestry. We carried out a third GWAS (GWAS3) in European-ancestry subjects, with augmented GWAS1 and GWAS2 controls, genome-wide imputation, and meta-analysis of all three GWAS, followed by an independent replication. The combined analyses, with 4,680 cases and 39,586 controls, identified 23 new significantly associated loci and 7 suggestive loci. Most encode immune and apoptotic regulators, with some also associated with other autoimmune diseases, as well as several melanocyte regulators. Bioinformatic analyses indicate a predominance of causal regulatory variation, some of which corresponds to expression quantitative trait loci (eQTLs) at these loci. Together, the identified genes provide a framework for the genetic architecture and pathobiology of vitiligo, highlight relationships with other autoimmune diseases and melanoma, and offer potential targets for treatment

An Overview of Three Promising Mechanical, Optical, and Biochemical Engineering Approaches to Improve Selective Photothermolysis of Refractory Port Wine Stains

During the last three decades, several laser systems, ancillary technologies, and treatment modalities have been developed for the treatment of port wine stains (PWSs). However, approximately half of the PWS patient population responds suboptimally to laser treatment. Consequently, novel treatment modalities and therapeutic techniques/strategies are required to improve PWS treatment efficacy. This overview therefore focuses on three distinct experimental approaches for the optimization of PWS laser treatment. The approaches are addressed from the perspective of mechanical engineering (the use of local hypobaric pressure to induce vasodilation in the laser-irradiated dermal microcirculation), optical engineering (laser-speckle imaging of post-treatment flow in laser-treated PWS skin), and biochemical engineering (light- and heat-activatable liposomal drug delivery systems to enhance the extent of post-irradiation vascular occlusion)

Generalized eczematous reaction after fractional carbon dioxide laser therapy for tattoo allergy

Allergic tattoo reactions form a therapeutically difficult entity. Treatment with conventional quality-switched lasers does not completely remove the allergenic particles and may lead to generalized hypersensitivity reactions. Recently, ablative fractional laser therapy was introduced as a treatment for allergic tattoo removal. We present two cases of allergic reactions to red tattoo ink treated with 10,600-nm fractional CO2 laser. At the end of treatment, almost complete removal of red ink accompanied by a significant reduction of symptoms was observed in the first patient, whereas the second patient developed an acute generalized eczematous reaction after five treatments. These findings confirm that ablative fractional laser therapy is capable of significant removal of tattoo ink in an allergic tattoo reaction. However, it implies a risk of generalized hypersensitivity reactions. To our knowledge, this is the first case of a generalized hypersensitivity reaction following treatment of tattoo allergy with the fractional CO2 laser

Generalized eczematous reaction after fractional carbon dioxide laser therapy for tattoo allergy

Allergic tattoo reactions form a therapeutically difficult entity. Treatment with conventional quality-switched lasers does not completely remove the allergenic particles and may lead to generalized hypersensitivity reactions. Recently, ablative fractional laser therapy was introduced as a treatment for allergic tattoo removal. We present two cases of allergic reactions to red tattoo ink treated with 10,600-nm fractional CO2 laser. At the end of treatment, almost complete removal of red ink accompanied by a significant reduction of symptoms was observed in the first patient, whereas the second patient developed an acute generalized eczematous reaction after five treatments. These findings confirm that ablative fractional laser therapy is capable of significant removal of tattoo ink in an allergic tattoo reaction. However, it implies a risk of generalized hypersensitivity reactions. To our knowledge, this is the first case of a generalized hypersensitivity reaction following treatment of tattoo allergy with the fractional CO2 lase

Long-term remission of folliculitis decalvans after treatment with the long-pulsed Nd:YAG laser

Folliculitis decalvans (FD) is a rare inflammatory scalp disorder presenting with tufted folliculitis, follicular papules and pustules, progressing to cicatricial alopecia. Current treatments mainly consist of antibiotic and immunomodulatory therapies and are often disappointing. FD has previously shown to respond to treatment with neodymium:yttrium aluminium garnet (Nd:YAG) laser in one case. We present a case of recalcitrant FD, successfully treated with a long-pulsed Nd:YAG lase