Atopic dermatitis and its association with serum immunoglobulin E levels: our experience in KVG medical college and hospital, Karnataka

<p><strong>Background:</strong> Eczema is an inflammatory skin reaction which presents as acute, subacute and chronic forms. Eczemas persisting for more than 6 weeks or characterized by thickening and discoloration of skin is typical of chronic eczema. Atopic dermatitis (AD) is a type of chronic or chronically relapsing eczematous skin disorder. To determine the percentage of AD in all forms of chronic eczema by using HRC. We also estimated serum immunoglobulin E (IgE) levels and determined its correlation with chronic eczemas and with various clinical parameters of HRC.</p><p><strong>Methods:</strong> A total of 50 patients with chronic eczema meeting defined inclusion and exclusion criteria were enrolled in this cross-sectional study after taking an informed consent and approval of institutional ethical committee. All patients were subjected to a detailed history based on a questionnaire. A thorough clinical examination was done to determine all major and minor clinical parameters of HRC for AD. Blood samples were collected and AEC and total serum IgE levels were determined.</p><p><strong>Results:</strong> Most of our study patients were females (64%). Majority of males (77.7%) were farmers and majority of females (56.2%) were housewives assisting in fieldwork activities. Various causes of chronic eczema were clinically diagnosed AD (34%), chronic actinic dermatitis (8%), polymorphic light eruption (4%), airborne contact dermatitis (10%), phyto-photodermatitis (10%), chronic hand and/or foot eczema (16%) and seborrheic dermatitis (2%). Thirty-two patients (64%) satisfied HRC. Among all clinical parameters of HRC, pruritus and xerosis were the commonest in AD patients. Serum IgE level was raised in 58% of chronic eczema and 68.7% of AD patients.</p><p><strong>Conclusions:</strong> Serum IgE levels showed significant association with typical morphology and distribution of lesions, early age of onset and perifollicular accentuation.</p><h2> </h2>

Study of clinical features of patients with chronic eczema

Objective — s to study the clinical features of chronic eczema (CE) in 96 patients aged 18 to 78 years. Materials and methods. The study was carried out in the city clinical dermatovenerological dispensary No. 5 in Kharkov. All patients gave written informed consent to participate in the study.The majority of them (66.7 %) were between 31 and 50 years old. The duration of dermatosis in 6.3 % of the surveyed persons ranged from 6 months to 1 year, in 33.3 % — from 1 year to 5 years, in 42.7 % — from 5 to 10 years, in 17.7 % — over 10 years. The most frequent causes of exacerbation in 51.1 % were neuropsychiatric trauma and stress, in 15.6 % — dise­ases of internal organs and acute respiratory diseases, in 13.5 % — contact with chemicals. In all patients, dermatosis was recurrent. Most often, the surveyed patients complained of moderate intensity itching (51 %) and severe sleep disturbances (66.7 %). Moderate leukocytosis and accelerated ESR were found in 21.9 % of patients, eosinophilia — in 5.1 %. Results and discussion. 96 patients with chronic eczema aged 18 to 78 years were under observation. The diagnosis of chronic eczema was based on anamnestic data, patients’ complaints of itchy skin of varying intensity, objective examination of the patient, as well as recurrences of dermatosis for more than 1 year. The largest number of patients had dermatosis from 5 to 10 years. Chronic eczema in the observed patients was recurrent. The duration of remission was (4.9 ± 0.2) months. The duration of exacerbation was (6.1 ± 0.2) weeks. To characterize the severity of chronic eczema, a scoring system was used, according to which the average severity was (2.63 ± 0.08) points.According to the degree of skin lesions, the forms of dermatosis were limited and widespread. Patients complained of skin itching of varying intensity: more often itching of moderate intensity, periodic; painful, persistent, with an insurmountable need to scratch; short-term; no itching.Also, patients noted sleep disturbance in the form of difficulty falling asleep, sudden awakening at night and lack of a feeling of rest after waking up in the morning. 39 patients had bad habits (smoking, alcohol abuse).Сlinical analysis of blood revealed moderate leukocytosis, accelerated ESR, eosinophilia, signs of secondary infection. Conclusions. The average age of the patients ranged from 31 to 50 years. All examined patients had recurrent dermatosis. The average degree of its severity was (2.63 ± 0.08) points. Most often, patients complained of moderate intensity itching (51 %) and severe sleep disturbances (66.7 %). In 21.9 % of the examined patients moderate leukocytosis and accelerated ESR were revealed, in 5.1 % — eosinophilia.

Case report on eczema dissemination

Disseminated Eczema also known as ID reaction is an inflammatory skin disease. It is also auto sensitization dermatitis, who’s cause is unknown. Person having eczema is hypersensitive to small irritants or allergies. The skin gets swelled, inflamed, cracked, itching or patchy. Skin of the eczema gets infected the agents can be contagious. It is seen in any age group without defined to specific age. In acute eczema inflammation leads to oedema which may turn into tiny blisters. Where as in chronic eczema epidermis thickens and hyperkeratosis occurs. Eczema affects a patient’s life in many aspects and effects the family too.

Diagnosis of Early Mycosis Fungoides

Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphomas, generally has a favorable clinical course. Early MF typically presents erythematous patches and/or plaques and lasts for many years without affecting the life expectancy. Only limited cases progress to develop skin tumors, with subsequent lymph nodes and rarely visceral organ involvement. One of the clinical problems in early MF is the difficulty in differentiating the disease from benign inflammatory disorders (BIDs), such as atopic dermatitis, chronic eczema, and psoriasis. In some MF cases, clinical and pathological findings are similar to those of BIDs. However, the accurate diagnosis of early MF is quite important, as inappropriate treatment including immunosuppressants can cause unfavorable or even fatal outcomes. This article focuses on general methods and novel tools for diagnosis of early MF.

To Determine the Efficacy and Safety of Narrow Band UVB (NB-UVB) in Chronic Hand Eczema (CHE)

Aim: To d etermin e the safety and efficacy of narrow band ultravoilet B radiations in chronic hand eczema. Methods: 62 patients were enrolled from OPD of Dermatology Unit II, KEMU/ Mayo Hospital, Lahore. They weregiven phototherapy treatment through NB UVB local chamber, t hrice weekly (on fixed days) for a total of 12 weeks or until clearance. Patients were followed up fortnightly for further 1 month and final assessment was done at the end of one month. Physician’s Global Assessment (PGA) Score was used to assess the sever ity of eczema affecting the hands. Results The data was collected from 62 patients with 0% dropout. There was only one patient who had improvement <25%, 4(6.45%) had improvement 25 50%, 8(12.90%) had 51 75% improvement and 49(79.03%)cases had improvem ent >75%. Minimal side effects were seen which included erythema, photosensitivity, itching and pain. Conclusion : NB UBV is a safe as well as effective treatment option for chronic eczema of hands. Keywords : Chronic Hand Eczema, Narrow Band UVB, Physician’s Global Assessment Score.

Efficacy and Safety of Qingpeng Ointment for Subacute and Chronic Eczema: A Systematic Review and Meta-Analysis

Objective. To evaluate the efficacy and safety of Qingpeng ointment for the treatment of subacute and chronic eczema. Method. Randomized controlled trials (RCTs) on Qingpeng ointment for subacute and chronic eczema were searched on PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Science and Technology Periodical Journal from their inception to 30 November 2020. Quality assessment and data analysis were performed by Review Manager 5.3. Results. A total of 26 RCTs were included. Qingpeng ointment could significantly improve the total efficacy rate (TER) ( RR = 2.60 , 95% CI: 2.11 to 3.21, P < 0.00001 ), reduce the total symptom score (TSS) ( SMD = − 2.35 , 95% CI: -3.74 to -0.97, P = 0.0009 ), and decrease visual analogue scale (VAS) for pruritus ( MD = − 3.86 , 95% CI: -4.41 to -3.31, P < 0.00001 ) compared with the placebo. The TER of Qingpeng ointment was similar to that of topical corticosteroid (TCS) ( RR = 0.96 , 95% CI: 0.88 to 1.03, P = 0.25 ), and the TSSs between Qingpeng ointment and medium or low potency TCS were not significantly different ( SMD = − 0.05 , 95% CI: -0.22 to 0.12, P = 0.54 ). However, Qingpeng ointment was not superior to TCS in reducing VAS score ( SMD = 0.48 , 95% CI: 0.00 to 0.96, P = 0.05 ). In addition, Qingpeng ointment combined with TCS performed better than TCS alone in all three outcomes. For safety, nothing but skin irritative reactions occurred in the Qingpeng ointment group, and its incidence of skin irritative reactions was similar to those of the placebo ( RR = 1.47 , 95% CI: 0.61 to 3.55, P = 0.40 ) and TCS ( RR = 1.82 , 95% CI: 0.79 to 4.22, P = 0.16 ). The combined therapy did not increase the risk of skin irritative reactions ( RR = 0.69 , 95% CI: 0.27 to 1.78, P = 0.44 ). Conclusion. Qingpeng ointment is an effective and safe treatment for subacute and chronic eczema. It is also an add-on treatment to TCS for eczema. However, due to the suboptimal quality of the included studies, more large-sample and high-quality RCTs are needed to improve the evidence quality.

Efficacy and Safety of Runzao Zhiyang Capsule as an Add-On Therapy for Chronic Eczema: A Systematic Review and Meta-Analysis

Background. Runzao Zhiyang capsule (RZC), an oral Chinese herbal medicine, has been widely used for chronic eczema in China for many years. This study aims to evaluate the efficacy and safety of RZC as an add-on therapy to conventional treatment for chronic eczema. Methods. Randomized controlled trials (RCTs) assessing the efficacy and safety of RZC as an add-on therapy for chronic eczema were retrieved from eight literature databases from their inception to 31 August, 2020, including CNKI, WanFang, VIP, Sinomed, PubMed, Cochrane Library, Web of Science, and Embase. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. The data were analyzed by RevMan5.3 software. Results. A total of 18 RCTs involving 1896 patients with chronic eczema were included. Compared with no oral treatment, RZC was superior on the total efficacy rate (TER) (RR = 1.45, 95% CI: 1.23 to 1.72, P < 0.0001 ), Eczema Area and Severity Index (EASI) (MD = −0.73, 95% CI: −0.90 to −0.56, P < 0.00001 ), and Visual Analogue Scale (VAS) for pruritus (MD = −2.76, 95%CI: −4.53 to −0.99, P = 0.002 ). Similar results were also seen in a randomized, placebo-controlled trial. Compared with the antihistamine (AH) group, TER in the RZC combined with AH group was significantly higher (RR = 1.32, 95% CI: 1.21 to 1.43, P < 0.00001 ), and the EASI score (MD = −0.29, 95% CI: −0.38 to −0.20, P < 0.001 ), the VAS score (MD = −0.19, 95% CI: −0.23 to −0.15, P < 0.00001 ), and the level of serum total IgE (MD = −9.83 ng/ml, 95% CI: −11.66 to −8.00 ng/ml, P < 0.00001 ) decreased more significantly in the RZC combined with AH group. In terms of safety, mild gastrointestinal diseases occurred more frequently in the RZC group, and no serious adverse effect was reported. Conclusions. RZC as an add-on therapy to conventional treatment shows good effects on chronic eczema, and there is no severe side effect from short-term use of RZC. However, due to suboptimal quality of the included studies, more large-sample and high-quality RCTs are needed to improve the evidence quality.