Biological washing powders 'don't cause eczema'

Biological washing powders do not irritate the skin or cause eczema, according to new research.
The idea that bio detergent can trigger skin reactions is a myth that has no scientific basis.
The powders and liquids contain enzymes that "digest" dirt and stains at low temperatures.
But Dr Sarah Wakelin, a dermatologist at St Mary's Hospital, London, said: "We have found that laundry detergents are not a cause of skin irritation or allergy."

Source: www.mirror.co.uk

Preventive treatment curbs eczema flare-ups

NEW YORK (Reuters Health) - Among adults with eczema, otherwise known as atopic dermatitis, "proactive" long-term treatment with tacrolimus ointment applied twice-weekly safely reduces exacerbations of the condition, European investigators have shown.
Conventional "reactive" treatment of atopic dermatitis involves applying anti-inflammatory medication to skin lesions only while they are visible. With a proactive approach, intensive treatment until lesions are no longer visible is followed by low-dose treatment of previously affected skin areas to prevent flare-ups, the researchers explain in the medical journal Allergy.
Dr. Andreas Wollenberg, from Ludwig-Maximilian Universitat in Munich, Germany, and members of the European Tacrolimus Ointment Study Group conducted a clinical trial in which 247 adult patients with atopic dermatitis initially applied tacrolimus ointment twice daily for up to 6 weeks to visible lesions.
Patients who responded well were then randomly assigned to apply tacrolimus or placebo ointment twice-weekly for 12 months. If exacerbations occurred, they were treated with daily tacrolimus until the flare-up subsided.
The average time to a first exacerbation was substantially longer for the proactively treated patients (142 days) than for the reactively treated patients (15 days), the investigators report.
The proactive group also had a lower percentage of days in which their condition flared up, the report indicates, and more of them had no exacerbations .
Proactive treatment with tacrolimus ointment "prevented, delayed and reduced the occurrence of atopic dermatitis exacerbations," Wollenberg and his associates conclude.

SOURCE: Allergy, June 2008.

Bacteria in Babies May Help Prevent Atopic Dermatitis

Sunday April 27, 2008
There's been a lot of research lately into ways to prevent children from getting atopic dermatitis. Studies have looked at the foods a breast-feeding mom eats, whether infants are breast or bottle fed, when babies start eating solid food, and feeding prebiotics or probiotics to babies to prevent or lessen the symptoms of atopic dermatitis. At best, these studies show further study is needed.
Along this line, recent studies presented at the International Symposium on Early Nutrition Programming found that bacteria in babies guts may be an area to focus on. These studies showed that babies who have a family history of atopic dermatitis have a higher chance of not developing it themselves if they have certain bacteria in their intestines.
It makes sense that the right balance of bacteria could be helpful. Soon after birth bacteria colonize babies' guts and their immune systems start to work developing what is known as gut immunity. Gut immunity is important because it's the first line of defense against absorption of substances that could trigger allergies.
The investigators are hoping that the risk of atopic dermatitis can be lessened by giving babies the right bacterial strains and prebiotic mixtures to boost their immune systems.

Source:
http://dermatology.about.com

Probiotics and dermatitis: A review in infants and kids

Researchers from Alfa Institute of Biomedical Sciences (AIBS) in Athens, Greece reviewed the evidence for probiotics in treating or preventing atopic dermatitis in children.
First, the details.
The results of 13 studies were reviewed.
10 evaluated probiotics as treatment of atopic dermatitis.
3 for prevention of atopic dermatitis.
The main outcome measure in 9 studies was SCORAD (SCORing Atopic Dermatitis) — a tool developed by the European Task Force on Atopic Dermatitis to evaluate the severity of this condition.
And, the results.
4 studies reported a significant decrease in SCORAD using probiotics in infants or children with atopic dermatitis for 1 or 2 months vs placebo.
But there was no consistent response in the various immunological/biochemical laboratory studies used to study atopic dermatitis.
In 2 studies, mothers given Lactobacillus rhamnosus GG with or without other probiotics during the time before birth, followed by treating the infants with the same probiotics for the first 6 months of life developed atopic dermatitis significantly less frequently during the first 2 years of life vs placebo.
However, another study reported no difference in frequency nor severity of atopic dermatitis using this treatment.
The bottom line?It appears that probiotics — especially L. rhamnosus GG — prevents atopic dermatitis. The probiotics studied also reduced the severity of atopic dermatitis in approximately half of the studies, although they didn’t change most of the inflammatory markers of this condition.
The findings are not conclusive, however. According to the authors, “More… [studies] need to be conducted to elucidate whether probiotics are useful for the treatment or prevention of atopic dermatitis.”

Source:
www.thecamreport.com

Relationship between disease severity, scratching and sleep quality in atopic dermatitis

April 30, 2008
The relationship between sleep quality and disease severity in atopic dermatitis (AD) was examined in a 2-night pilot study in 20 adults (<50 years). Sleep efficiency was measured by polysomnography (PSG) and actigraphy. Disease severity was assessed by the Dermatology Life Quality Index (DLQI) and itch by a visual analogue scale (VAS). Tumor necrosis factor (TNF), interleukin 6 (IL-6) and IL-10 were assayed from a subset of 9 participants. The sleep measures of PSG and actigraphy were strongly associated with each other. Decreased sleep efficiency was associated with increased disease severity, scratching and IL-6 levels. However, self-reported sleep quality and quality of life were not significantly correlated with objective PSG or actigraphy measures. These data suggest a relationship between decreased sleep quality and increased AD severity. IL-6 also appears to have an important role in the sleep-wake cycle (Bender, B.G. et al. J Am Acad Dermatol 2008, 58(3): 415-420).

Source: www.accessdermatology.com

Omega-3 can help eczema

A diet rich in omega-3 can help eczema sufferers reduce the severity of their symptoms, according to new research.
Patients with the most common atopic, or allergic, form of eczema given purified fish oil supplements cut their symptoms by almost a fifth.
Eczema, also known as dermatitis, is a group of skin conditions that causes dry, itchy inflammation of the skin. It affects approximately three per cent of the population, including as many as one fifth of children of school age.

Experts have suggested recent changes to Western diets which have reduced consumption of omega-3 and an increased that of omega-6 fatty acids may have played an important role in the increased prevalence of eczema.
German researchers, whose work was published in the British Journal of Dermatology, gave 44 patients with atopic eczema aged between 18- and 40-years-old daily tablets of either 5.7g Omega 3 supplements or placebos for eight weeks.
Those on the supplements recorded an average 18 per cent reduction in their symptoms, measured on a standard scale known as Severity Scoring of Atopic Dermatitis (SCORAD), by the end of the trial.
Nutritionists recommend people should consume omega-6 and omega-3 essential fatty acids in a ratio of two or three to one.
Too much Omega-6 prevents the body metabolising omega-3 into the fatty acids that form the structure of brain cell membranes and carry electrical signals between brain cells.
Co-author Prof Margitta Worm, from the Charité Department of Dermatology and Allergology, said: "The results of this trial are extremely interesting as the data clearly demonstrates that dietary DHA could be bioactive and may have a beneficial impact on the outcome of atopic eczema.
"These positive results will be investigated in further clinical trials to improve the management of atopic eczema which is a growing problem."
The richest sources of omega-3 are oily fish, particularly mackerel, herring, salmon, fresh tuna and trout. It is also found in walnuts and hazel nuts. Omega-3 essential fats have been shown to protect the body against heart attacks and strokes.
Official advice recommends people eat two portions of fish per week, one of which should be an oily fish. The average Briton consumes a third of a portion per week.

telegraph.co.uk

Does Infant/Mother Nutrition Affect Allergy-Related Problems?

1. The idea that egg, fish, and foods containing peanut protein should not be introduced before 1 year of age is not based on good science.
2. Maternal dietary restrictions during pregnancy do not appear to play a significant role in the prevention of atopic [allergy-related] disease in infants.
3. There is no convincing evidence for the use of soy-based infant formula for the purpose of allergy prevention.
4. For infants beyond 4-6 months of age, there is insufficient data to support a protective effect of any dietary intervention for the development of atopic disease.
5. In Infants who are at risk of developing atopic disease, the current evidence does not support the hypothesis that exclusive breast-feeding protects against allergic asthma occurring beyond the age of 6 years.
6. For a child who has developed an atopic disease that might be precipitated or exacerbated by ingested proteins (via human milk, infant formula, or specific complementary foods), treatment could require specific identification and restriction of causal food proteins .

Dust mites, roaches can weaken skin barrier: study

HONG KONG (Reuters)
Dust mites and cockroach allergens can weaken defense mechanisms of the human skin, making it more permeable and vulnerable, a study in South Korea has found.
In an article in the latest issue of the Journal of Investigative Dermatology, researchers said it was important, especially for people with eczema, to protect themselves from such microscopic bugs and filth.
Cockroach allergens are particles of feces, saliva and other matter found on the bodies of these insects.
In the study, the researchers disrupted the skin barrier function of a group of volunteers by repeatedly sticking cellophane tape on a part of their forearm and then stripping it off. They were then exposed to roach allergens and dust mites.
These particles were later found to have triggered a receptor in the skin, known as PAR-2, which delayed the skin repair process.
"The skin barrier function is already damaged in eczema patients and it has to repair itself. But allergens like dust mite and cockroach allergens will delay the repair function," said Jeong Se Kyoo, senior researcher at Neopharm Co. Ltd.
"Then more allergens will penetrate the skin, it's a vicious cycle," he said in a telephone interview.
Over 15 million Americans suffer from eczema, a chronic skin condition characterized by dry patches of very itchy skin. The most common form, atopic dermatitis, affects between 10 and 20 percent of the world's population at some point during childhood.
(Reporting by Tan Ee Lyn; Editing by Sugita Katyal)

AAD: Genetic Defect in Skin Barrier Tied to Eczema
Mutations in fillagrin gene leads to defect in outer layer of skin, allowing irritants to penetrate

Feb 4, 2008
(HealthDay News) -- A genetic defect in the skin's protective outer later that allows microbes, allergens and other irritants to penetrate the skin likely underlies atopic dermatitis and may contribute to the development of food allergies, according to research presented this week at the American Academy of Dermatology's 66th Annual Meeting in San Antonio, Texas.

Jon M. Hanifin, M.D., of Oregon Health and Science University in Portland, Ore., discussed new data on the genetic basis of atopic dermatitis, the relationship to childhood allergies, and implications for the management of childhood eczema.
The researchers gained insights into atopic dermatitis by studying another genetic skin disease, ichthyosis vulgaris. In both conditions, mutations in the filaggrin gene, necessary for the integrity of the skin's outer barrier layer, lead to breaches in the epidermis. When food allergens pass through this defective skin barrier, very elevated levels of IgE antibodies and allergic reactions to food can result. Thus, in contrast to the common misconception that food allergies cause eczema, it is rather the broken skin barrier of eczema that leads to food allergies.
Hanifin comments on the implications of this research: "Strong evidence linking a broken skin barrier to the development of future allergies offers an important prevention opportunity. Babies with eczema need early therapy with measures directed at repair and maintenance of the skin's barrier."

http://www.modernmedicine.com

Methotrexate Effective and Safe for Children With Severe Atopic Dermatitis: Presented at AAD


By Bruce Sylvester SAN ANTONIO, TX -- February 4, 2008

Methotrexate is an effective treatment for children with severe atopic dermatitis, researchers reported here at the American Academy of Dermatology 66th Annual Meeting (AAD). "Overall, we found that the vast majority of patients improved significantly," said presenter and lead investigator Christopher Rouse, MD, Senior Resident, Department of Dermatology, St. Louis University School of Medicine, St. Louis, Missouri, United States. In their poster, Dr. Rouse and colleagues indicated that atopic dermatitis is the most common cause of severe skin disease in children. Research on systemic treatments is limited. "Case reports have documented the efficacy of methotrexate for the treatment of severe atopic dermatitis in adults, but no information is published on treatment in children with this disease," Dr. Rouse said in a presentation on February 3. The investigators retrospectively reviewed data on 30 children with severe atopic dermatitis who had been treated with methotrexate. Patients ranged in age from 2 to 16 years and all had failed topical therapy. Many had been treated with cyclosporine and were successfully crossed-over to methotrexate. All subjects received an initial dose of 0.5 mg/kg/week (maximum 15 mg). Most of the children tolerated the tablet formulation. Of those who received a liquid formulation, most received the concentrated 25 mg/cc parenteral formulation. Supplemental folic acid (1 mg) was added after the first month of treatment and was taken on non-methotrexate days. Followup in the clinic and laboratory assessments took place at baseline and monthly for 3 months, followed every 3 months thereafter if the dosing remained stable. Laboratory parameters included complete blood counts with red blood cell indices and a comprehensive metabolic panel. The investigators reported that elevations in hepatic transaminases were transient and unusual, and were found in blood obtained within 1 to 2 days after methotrexate administration, or following a presumed viral illness. No child underwent liver biopsy. Dose adjustments occurred every 2 to 3 months as needed. The investigators found that the majority of methotrexate-treated subjects achieved a partial to complete response, with no serious adverse events occurring among the subjects during an average of 12 months exposure. "Methotrexate is a useful systemic treatment option for children with severe atopic dermatitis," the authors concluded. [[Presentation title: Methotrexate for Atopic Dermatitis in Children. Abstract P608]

SkinMedica Introduces Desonate(R) (desonide) Gel 0.05% TwinPack for Treatment of Mild to Moderate Atopic Dermatitis

January 8, 2008

CARLSBAD, Calif., Jan. 8 - SkinMedica, Inc., a specialty pharmaceutical company focused on dermatology, announced the availability of the Desonate (desonide) Gel 0.05% 120g TwinPack for the treatment of mild to moderate atopic dermatitis. Desonate is a low-potency prescription
topical steroid formulated in Dow Pharmaceutical Sciences’ proprietary water-based Hydrogel vehicle.

The new economical Desonate TwinPack contains two 60-gram tubes of Desonate Gel for greater coverage of affected areas during the cold-weather season when atopic dermatitis tends to flare most. With the Desonate TwinPack, patients have the added convenience of keeping their medication in two accessible locations. With one prescription, patients can receive twice as much therapy for the same pharmacy co-pay as the smaller tube.

“The Desonate TwinPack provides added value and flexibility to an already effective Desonate therapy,” said Dr. Rebecca Smith, Pediatric Dermatologist from a Charlotte, NC suburb. “I have many younger patients cared for by parents in more than one household, and having two tubes of Desonate allows both households to keep Desonate on hand when flares occur.
With the new TwinPack, Desonate with Hydrogel continues to provide effective therapy in a cosmetically acceptable, well tolerated formulation.”

Clinical studies with Desonate show significant reduction in itching and other symptoms of atopic dermatitis, and Desonate is clinically proven to moisturize and help skin maintain essential hydration by improving the skin barrier.

Additional Information about Desonate

As with other corticosteroids, therapy should be discontinued when control is achieved. Unless directed by a physician, the treated skin area should not be bandaged so as to be occlusive. Systemic absorption of topical corticosteroids, including Desonate Gel, has produced HPA axis
suppression, for which pediatric patients are more susceptible.

In clinical trials, the most frequent adverse events included headache (2%), application site burning (1%), rash (1%), and application site pruritus (<1%).>

About Desonate

Desonate is approved by the US Food and Drug Administration (FDA) for the treatment of mild to moderate atopic dermatitis in patients aged 3 months and older for up to 4 consecutive weeks. Formulated with desonide, the leading low-potency corticosteroid used in dermatology, Desonate is the first and only treatment for atopic dermatitis delivered via Hydrogel
technology. The versatile formulation can be used on small and large affected areas and is free of alcohol, fragrance, or surfactants that can be irritating or drying to the skin.

Desonate is jointly promoted by SkinMedica and Galderma Laboratories, L.P.

About Atopic Dermatitis

Atopic dermatitis affects more than 15 million patients, resulting in skin rash, redness, swelling, crusting, and scaling. The disease affects nearly 20% of infants and young children, some of which continue to experience symptoms as adults. The exact cause of atopic dermatitis is
unknown; however, genetics and environmental factors are considered key factors. Topical corticosteroids are the gold standard of treatment for atopic dermatitis, with more than $1 billion in prescriptions written annually by US physicians for inflammatory dermatoses.

For More Information on Desonate

For information about Desonate, including its approved labeling, please visit http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm or contact SkinMedica Customer Service at (877) 944-1412.

About SkinMedica

SkinMedica is a privately held pharmaceutical company marketing both prescription and aesthetic dermatology products. SkinMedica’s Desonate(R) (desonide) Gel 0.05% is indicated for the treatment of mild to moderate atopic dermatitis; EpiQuin(R) Micro (4% hydroquinone) cream is indicated for melasma and postinflammatory hyperpigmentation; VANIQA(R) (eflornithine hydrochloride) Cream, 13.9%, is the only FDA-approved prescription product
for the treatment of unwanted facial hair in women; and NeoBenz(R) Micro Cream and NeoBenz(R) Micro SD (single dose) are the only benzoyl peroxide prescription products that contain a patented gradual-release formulation of benzoyl peroxide to treat acne. The company’s full line of physician-dispensed skin care products includes TNS Recovery Complex(R) with NouriCel-MD(R) to help improve the health and appearance of aging
skin. SkinMedica is based in Carlsbad, California. For more information, visit http://www.skinmedica.com/.

Breast-Feeding Seems to Protect Against Some Allergies

It helps high-risk infants prone to eczema, asthma and food allergies, report suggests

By Amanda Gardner

Posted 1/7/08

MONDAY, Jan. 7 (HealthDay News) -- Atopic disease -- which includes eczema, asthma and food allergies -- may be delayed or even prevented in high-risk infants if they are exclusively breast-fed for at least four months or fed infant formula without cow milk protein.

That's the conclusion of a new clinical report from the American Academy of Pediatrics (AAP) that's published in the January issue of Pediatrics. The report replaces an earlier policy statement from the AAP.

"Basically, it probably does not matter what pregnant or lactating women eat," said Dr. Frank Greer, an author of the report, professor of pediatrics at the University of Wisconsin and chairman of the AAP Committee on Nutrition.

"The best prevention for atopic [allergic] disease is exclusive breast-feeding for four months," he added. "And if your infant comes from a family with significant atopic disease, then weaning from breast milk to a partially or extensively hydrolyzed [hypoallergenic] formula [without cow milk protein] may delay or prevent the onset of atopic disease, especially atopic dermatitis [eczema]."

Greer added that this recommendation would also apply to formula-fed infants who are at risk for atopic disease.

The timing and introduction of solid foods has no protective effect on the prevention of atopic disease, according to the new report.

"With the increase in asthma and food allergies that we've seen recently, we had hoped that maternal diet, breast-feeding and early childhood diet might all have some factor in decreasing incidence," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "Unfortunately, it doesn't seem to significantly impact, according to studies already done. The only one that seems to be impacted is the atopic dermatitis, which is decreased by about one third by breast-feeding. But the studies that have been done so far have not proven that breast-feeding will significantly impact childhood asthma or food allergies."

The incidence of allergic diseases such as asthma, food allergies and various skin conditions has exploded during the past few decades. In children 4 years of age and younger, the incidence of asthma has risen 160 percent, while the incidence of atopic dermatitis has almost tripled. And the incidence of peanut allergy has doubled just during the past decade, according to the report.

While genetics certainly plays a role in the development of these diseases, environmental factors such as diet are also strongly related.

The new report reviewed different evidence on nutrition during pregnancy, breast-feeding and the first year of life that might affect the development of allergic disease. Its major findings are as follows:

• Currently, there is no evidence that what a mother eats during pregnancy or breast-feeding plays a major role in preventing atopic disease in infants. There is some evidence, however, that avoiding certain foods during breast-feeding may help prevent atopic eczema.
• Exclusive breast-feeding for at least four months for infants at high-risk of developing atopic disease decreases the risk of developing eczema and cow milk allergy during the first two years of life.
• In high-risk infants who aren't breast-fed exclusively for four to six months, the use of hydrolyzed infant formula (as opposed to formula containing cow milk) may delay or prevent the onset of atopic dermatitis.
• Exclusive breast-feeding for at least three months protects an infant against wheezing in early life.
• There is no good evidence to support the use of soy-based infant formula to prevent allergies.
• There is no evidence to suggest that delaying the introduction of solid foods before the recommended 4 to 6 months of age will have an effect on the development of atopic disease.
• There is no convincing evidence to suggest that any dietary intervention will prevent atopic disease after 4 to 6 months of age.

"It's a mixed picture," Wu said. "We don't have proven efficacy for breast-feeding. It may mean that we need more robust studies and a longer-term follow-up for kids."

The new report is titled "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas.

Effects of wet-wrap dressing on the epidermal barrier in atopic dermatitis

January 7, 2008

The therapeutic efficacy and mode of action of wet-wrap dressing was investigated in 10 patients (mean age 22 years) with severe form atopic dermatitis (AD). Wet-wrap dressings (4-5 layers of gauze hydrated with 0.9% saline) were applied for 8 h/day for 7-14 days. Immediately and 7 days post-treatment, SCORing Atopic Dermatitis (SCORAD) index, corneum water content, transepidermal water loss (TEWL) and the lipid amount of the skin surface were measured.

Post-treatment SCORAD scores were significantly lower after wet-wrap dressing (p<0.01> vs. pretreatment). Moreover, epidermal water content significantly increased and TEWL was significantly decreased after wet-wrap dressing. There was a significantly increased release of lamellar body and recovery of damaged lamellar structures post-treatment. Neither keratinocyte differentiation nor changes in calcium ion gradient were detected (Lee, J.H. et al. JEADV 2007, 21(10): 1360-1368).
Source:
http://www.accessdermatology.com/