Approaches to treatment of recurrent eczema in practice of general practitioner (clinical example)

The article presents a clinical case of recurrent eczema. Despite treatment lasting more than 5 years, the patient observed only a short-term effect of the therapy. The cause of the continuous course of severe eczema was malnutrition and hypovitaminosis of vitamins A and E, due to a lack of fish and seafood in the diet. Despite the relatively rare occurrence of eczema in the outpatient practice of a general practitioner, on average from 2 to 5 % of the adult population in the world suffers from this disease. Among the main methods of treating eczema is long – term antihistamine and anti-inflammatory therapy. However, these methods of treatment are not always enough. The reason for the continuous course of eczema was irrational nutrition with a lack of fat-soluble vitamins A and E. Correction of the diet using a sorbent based on the herb Zostera marina allowed to achieve significant improvement and remission of the disease.Conclusions. 1) A thorough analysis of anamnestic data is required to determine the treatment regimen in cases of prolonged persistence of eczema symptoms, with resistance to standard therapy algorithms. 2) Patient’s refusal of certain types of food can lead to hypovitaminosis, which is accompanied by skin symptoms. 3) The appointment of retinol, tocopherol acetate and vitamin D 1 will contribute to a rapid and effective improvement of the condition of the skin in cases with insufficient consumption of products containing fat-soluble vitamins. Preparations made from the sea grass Zostera marina help to improve digestion, sorb and remove unwanted biologically active substances, reducing the severity and relieving skin manifestations.

Case Report: Dupilumab Successfully Controls Severe Eczema in a Child With Elevated IgE Levels and Recurrent Skin Infections

The efficacy of dupilumab in pediatric patients with severe eczema presenting in the setting of elevated immunoglobulin E (IgE) levels and recurrent bacterial skin infections is not well-understood. Here we present the case of a child with elevated IgE levels in whom dupilumab treatment led to remarkable control of his eczema and recurrent skin infections. We also review the use of dupilumab in other patients with molecularly proven cases of hyper IgE (HIGE) syndrome. Our case supports the notion that dupilumab may have a seminal application in treating severe eczema that occurs in the setting of elevated IgE levels and recurrent bacterial skin infections.

Leading typological characteristics of temperament and psychodynamic features of personality in men with various forms of eczema

Annotation. The problem of causation in the formation of eczema in terms of psychosomatic relationship is currently relevant and virtually unresolved. The application of the complex principle of research determines a multifaceted assessment of the psychological state of the personality of patients with eczema and the possibility of its optimal correction. The aim of the study was to study the differences between the indicators of the leading typological characteristics of temperament and psychodynamic features of personality between healthy and/or eczema patients depending on the severity of dermatosis. Men aged 22 to 35 years, with a diagnosis of true and microbial eczema, were evaluated for the leading typological characteristics of temperament according to the Eysenck questionnaire and psychodynamic personality traits according to the Spielberger-Khanin questionnaire. As a control from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya indicators of the level of subjective control of 82 practically healthy men of the same age group were selected. Statistical processing of the results was performed in the license package “Statistica 5.5” using non-parametric evaluation methods. In general, it was found that among patients with eczema 5.6 % are introverts, potential introverts – 12.3 %, ambiverts – 44.6 %, potential extroverts – 29.0 % and extroverts – 8.5 %. Compared with healthy individuals, the percentage of patients with various forms and severity of eczema is higher due to subjects with low (all groups of patients) and potentially low levels of neuroticism (true eczema of mild course), low situational (true eczema of mild course eczema and microbial eczema of severe course) and personal (truth of severe eczema) anxiety, and lover – due to patients with potentially high levels of neuroticism (truth of severe eczema), moderate (severe microbial eczema) and high (truth of eczema mild) level and situation level of personal anxiety (the truth of mild eczema). Patients with severe disease are characterized by a higher level of neuroticism (true eczema) and a higher level of personal anxiety (microbial eczema) compared to patients with mild disease. Patients with severe microbial eczema have a higher level of situational anxiety compared to patients with true eczema of similar severity. Thus, psychodiagnostics, which is based solely on patients' self-description of their behavior, emotional and volitional state, leads to inconsistency, subjectivity, uninformativeness of the results of the study and does not reveal the dynamics of the disease or treatment features.

Improvement of skin lesions in corticosteroid withdrawal-associated severe eczema by multicomponent traditional Chinese medicine therapy

Rationale We recently showed that multicomponent traditional Chinese medicine (TCM) therapy had steroid-sparing effects in moderate-to-severe eczema. We sought to evaluate TCM effects in severe eczema in a 7-year-old male with refractory disease and corticosteroid withdrawal syndrome. Methods Prior to referral, the patient had been treated since infancy with increasingly intensive standard of care, including high-dose topical and systemic corticosteroid and antibiotic therapy and was unable to tolerate further steroid treatment. The patient was administered a combination of oral and topical TCM for 17 months following discontinuation of his steroid regimen. His overall medical condition was assessed by SCORAD criteria and laboratory evaluations of serum IgE, absolute eosinophil count, and liver and kidney function tests. Results The patient showed rapid improvement of clinical measures of disease after starting TCM therapy, with marked improvement of sleep quality within the first week, complete resolution of itching, oozing, and erythema at 2 weeks, and a 79% and 99% decrease in his SCORAD values after one month and 3–6 months of TCM, respectively. Serum total IgE decreased by 75% (from 19,000 to 4630 (kIU/L), and absolute eosinophil counts decreased by 60% (from 1000 to 427 cells/μL) after 12 months of treatment. The patient did not require oral or topical steroids during the 17-month trial of TCM. TCM was tapered without complications. His dermatologic manifestations continued to be well-controlled 3 months after discontinuation. Conclusion This case study suggests TCM should be further evaluated in controlled clinical studies of patients with severe, refractory eczema and steroid withdrawal syndrome.

Successful Treatment of Refractory Atopic Dermatitis With the Use of High-Peak Power 1064 nm Nd:YAG Laser Therapy

Atopic dermatitis is a chronic inflammatory skin disease involving the complex association of genetic, immunologic, and environmental causes. Until recently, the treatment of eczematous processes was limited to the use of topical corticosteroids, systemic immunosuppressants, and controlling environmental triggers. Photobiotherapy offers a promising approach to the management of atopic dermatitis. Photobiotherapy is the clinical application of light for healing superficial wounds. We present 2 cases of patients with biopsy-proven, long-standing, poorly controlled atopic dermatitis successfully treated with a high-peak power 1064-nm neodynium:yttrium aluminum garnet (Nd:YAG) laser. Over the course of 9 years, each patient continued to undergo periodic laser treatments to maintain control over their disease. Both patients underwent a series of laser using high-peak power treatments with long-pulsed 1064-nm Nd:YAG laser (Cool Glide, Cutera, Brisbane, California) in “photorejuvenation/Genesis mode” over the course of 9 years. Case 1 received 29 treatments over a 9-year period. When financially able to, the patient had 1 treatment a month for 2 to 6 treatments a year. At the very least, she had a treatment during her worst flares. Case 2 received 19 treatments over 9 years with the timing being monthly when possible but with longer intervals between treatments if her disease was not flaring. One patient that was on systemic immunotherapy to control her atopic dermatitis was able to successfully come off this medication early in her treatment, and both patients experienced long-lasting improvement in their symptoms. The dramatic improvement in the skin eruption, symptoms, and quality of life in these patients further supports addition of the 300-µs 1064-nm Nd:YAG laser for the treatment of refractory atopic dermatitis. The authors are using this modality for less severe eczema that is refractory to topical therapies. However, a greater number of patients are needed as well as larger studies to further elucidate the mechanisms of lasers for eczematous processes. If further studies support this modality, it would be a safe alternative to systemic immunotherapies.

Features of longitudinal and transverse body sizes in men with various forms of eczema

Consideration of the aspect of adaptation, in particular morphological, is expedient with obligatory comparison of morphometric indicators in healthy and sick patients and between groups of patients with different degrees of severity of dermatosis. The aim of the study was to investigate the differences between longitudinal and transverse body sizes between healthy and/or patients with eczema men depending on the severity of the dermatosis. Patients with idiopathic (n=34) and microbial (n=38) eczema men of the first mature age underwent an anthropometric examination according to Bunak. The diagnosis of eczema was made according to the nomenclature of ICD-10. As a control from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya anthropometric data of 82 practically healthy men of the same age group were selected. Statistical data processing was performed in the license package “Statistica 5.5” using non-parametric methods of evaluation of the obtained results. In healthy men, compared with patients, higher values were found for: the height of the pubic anthropometric point by 3.5-5.7% and the height of the acetabular anthropometric point by 4.9-7.5% compared with sick men with idiopathic mild and severe eczema and mild and severe microbial eczema and lower values for: height of the suprathoracic anthropometric point by 1.7-2.6% for idiopathic eczema of mild, severe course and microbial eczema of mild course; height of the acromial anthropometric point by 1.6-2.3% compared with men with idiopathic eczema of mild and severe course; height of the finger anthropometric point by 3.0-5.9% compared with men with idiopathic eczema of mild and severe course and microbial eczema of mild and severe course. In healthy men, compared with patients, higher values were found: mid-thoracic diameter – by 3.1-11.1%, 5.5-14.4%, transverse lower thoracic diameter – by 8.6-14.1% and anterior-posterior mid-thoracic diameter – by 10.2-16.6% and smaller values: width of shoulders by 15.3-21.1% compared with men with idiopathic eczema of mild and severe course and microbial eczema of mild and severe course. In healthy individuals, the width of the distal epiphysis of the forearm is greater by 3.14% compared with patients with idiopathic severe eczema and the width of the distal epiphysis of the crus by 3.1% compared with patients with microbial eczema of mild course; smaller - the width of the distal epiphysis of the shoulder by 3.0% compared with patients with idiopathic eczema of severe course and the width of the distal epiphysis of the thigh by 5.2-7.6% compared with patients with idiopathic eczema of mild and severe course and microbial eczema of mild course. In healthy individuals, the values of the size of the pelvis are lower: interspinous distance – by 8.3-11.6%, intercristal distance – by 8.7-12.5% and intertrochanteric distance – by 7.7-10.5% compared with sick men with idiopathic mild and severe eczema and microbial eczema of the mild and severe course. Differences in longitudinal body size in patients with different forms and severity of eczema. When comparing anthropometric indicators between sick men, the following were found: the height of pubic and acetabular anthropometric points in sick men with idiopathic eczema of mild course is higher by 1.8% and 1.7%, respectively, compared with sick men with microbial eczema of similar severity; shoulder width in patients with idiopathic eczema of mild course is 4.8% less than in patients with idiopathic eczema of severe course. Thus, men with eczema have a subpathological constitutional type, which is characterized by an elongated “cylindrical” torso, shortened lower extremities, as well as more massive distal and less massive proximal epiphyses of the upper and lower extremities.

Parents and GPs’ understandings and beliefs about food allergy testing in children with eczema: qualitative interview study within the Trial of Eczema allergy Screening Tests (TEST) feasibility trial

AimTo explore parent and general practitioner (GP) understanding and beliefs about food allergy testing for children with eczema.Design and settingQualitative interview study in UK primary care within the Trial of Eczema allergy Screening Tests feasibility trial.ParticipantsSemi-structured interviews with parents of children with eczema taking part in the feasibility study and GPs at practices hosting the study.Results21 parents and 11 GPs were interviewed. Parents discussed a range of potential causes for eczema, including a role for food allergy. They believed allergy testing to be beneficial as it could potentially identify a cure or help reduce symptoms and they found negative tests reassuring, suggesting to them that no dietary changes were needed. GPs reported limited experience and uncertainty regarding food allergy in children with eczema. While some GPs believed referral for allergy testing could be appropriate, most were unclear about its utility. They thought it should be reserved for children with severe eczema or complex problems but wanted more information to advise parents and help guide decision making.ConclusionsParents’ motivations for allergy testing are driven by the desire to improve their child’s condition and exclude food allergy as a possible cause of symptoms. GPs are uncertain about the role of allergy testing and want more information about its usefulness to support parents and help inform decision making.Trial registration numberISRCTN15397185.

The Investigation of the Dependence between Hand Eczema Severity and Some Cytokine Profile Parameters, Vitamin D Level, and Glucocorticoid Receptor Gene Polymorphism

Hand eczema is one of the most important chronic diseases in the dermatology. There are a lot of researches presenting the role of individual cytokines in eczema development. However, currently, the complex analysis of cytokines, hormones, and gene polymorphisms' impact on the development of hand eczema and its severity is absent. Therefore, the purpose of our work was to study the possible association between hand eczema severity and rs41423247 SNP, the blood level of IL-17A, IL-2, and 25(OH)2D3. Material and methods. The venous blood of 143 patients with hand eczema aged (42.2±11.1) years was used in the study. During the patients examination the data on age, sex, BMI kg/m2, BMI ≥25 kg/m2 (%), smoking, IgE (iu/ml), IL-17A (pg/ml), IL-2 (pg/ml), and 25(OH)2D3 (ng/ml) were obtained. The HECSI index (Hand Eczema Severity Index) was also assessed in each subject. According to HECSI value all patients were divided into three subgroups: mild, moderate and severe eczema. BclI SNP (rs41423247) of the glucocorticoid receptor gene (NR3C1) was determined using PCR-RFLP method. The statistical analysis was performed using the program SPSS 22.0. Results and discussion. The obtained results showed that the number of overweight people was higher among patients with severe hand eczema compared to patients with mild to moderate disease (P = 0.052). It was also revealed that the concentration of IL-17A in the blood serum of patients with severe hand eczema was significantly higher than in patients with mild to moderate disease (P = 0.037). The distribution of BclI polymorphism genotypes (NR3C1 gene), the blood level of IgE, IL-2, and 25(OH)2D3 were statistically equal between patients with different degrees of hand eczema severity (P > 0.05). Conclusion. Thus, the IL-17A serum concentration and body mass index are related to hand eczema severity. However, the link between NR3C1 gene BclI polymorphism, the blood level of IgE, IL-2, 25(OH)2D3, and hand eczema severity was not detected