Cure Eczema Naturally

Eczema Free Forever Ebook

Eczema Free Forever program is the result of efforts by Rachel Anderson who herself was a sufferer of eczema and her son also suffered from eczema. The generally available treatments in the market for the treatment of eczema are consisted of the cream and lotions which bring relive it only on temporary basis while Eczema Free Forever system offers completely natural remedies which end eczema on permanent basis. This book offers a variety of foods which can work to heal effected areas, tips about what to avoid, advice on childhood ezcema, as well as a variety of detox diets which have been proven to work on those who suffer from this skin condition. This book is ideal for those who have been through dose after dose of doctor prescribed medication without any long lasting results, or for those who wish to avoid prescriptions and are seeking a more holistic cure for their eczema issues. Read more here...

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Irritant Contact Dermatitis Irritation

Irritant contact dermatitis (ICD) is a term given to a complex group of localized inflammatory reactions that follow nonimmunological damage to the skin. The inflammation may be the result of an acute toxic (usually chemical) insult to the skin, or of repeated and cumulative damage from weaker irritants (chemical or physical). There is no definite laboratory test for ICD diagnosis is by clinical morphology, of course, and appropriate negative patch-test results. Acute Irritant Contact Dermatitis An irritant reaction is a transient noneczematous dermatitis characterized by erythema, chapping, or dryness, and resulting from exposure to less potent irritants. Repeated irritant reactions may lead to contact dermatitis. Cumulative Irritant Contact Dermatitis Cumulative irritant contact dermatitis or chronic ICD develops as a result of a series of repeated and damaging insults to the skin. The insults may be chemical or physical. Delayed Acute Irritant Contact Dermatitis ALLERGIC CONTACT...

Photoallergic Contact Dermatitis

Photoallergic contact dermatitis (PACD) is an immunological response to a substance that requires the presence of light. The substance in the skin absorbs photons and is converted to a stable or unstable photoproduct, which binds to skin proteins to form an antigen, which then elicits a delayed hypersensitivity response. Examples of photoallergens present in cosmetics are musk ambrette and 6-methylcoumarin, which are present in fragrances. Photopatch testing is the diagnostic procedure for photoallergy.

Allergic Contact Dermatitis From Fragrances Epidemiology

In dermatitis patients seen by dermatologists, the prevalence of contact allergy to fragrances is between 6 and 14 only nickel allergy occurs more frequently. When tested with 10 popular perfumes, 6.9 of female eczema patients proved to be allergic to them 10 and 3.2 to 4.2 were allergic to fragrances from perfumes present in various cosmetic products 11 . In cosmetics causing contact allergic reactions, perfumes account for up to 18 and deodorants antiperspirants for up to 17 of all cases. When patients with Contact allergy to fragrances usually causes dermatitis of the hands, face, and or armpits 16-18 , the latter site being explained by contact allergy to deodorants and fragranced antiperspirants. In the face, the skin behind the ears and neck is exposed to high concentrations of fragrances in perfumes and aftershaves. Microtraumata from shaving facilitates (photo)contact allergy to aftershave fragrances. The sensitive skin of the eyelids is particularly susceptible to developing...

Photoirritant Contact Dermatitis Photoirritationphototoxicity

Photoirritant contact dermatitis (PICD) is a chemically induced nonimmunological skin irritation requiring light. This reaction will occur in all individuals exposed to the chemical-light combination. The clinical picture is that of erythema, edema, or vesiculation in sun-exposed areas, resembling an exaggerated sunburn. This may be followed by hyper-pigmentation, or if the exposure is repeated, scaling and lichenification may occur. Bergap-ten, a component of bergamot oil, which used to be a popular ingredient in perfume, is a potent photoirritant that causes berloque dermatitis.

Skin rash and HHV6 reactivation in hematopoietic stem cell transplant recipient

Several clinical conditions such as skin rash resembling acute GVHD, bone marrow suppression, interstitial pneumonitis, and encephalitis, may be related to HHV-6 infection after HSCT (Yoshikawa, 2004b). Moreover, an association between HHV-6 infection and acute GVHD was suggested in HSCT recipients. HHV-6 and human

Atopic dermatitis OMIM 603165

Atopic dermatitis (AD) is a clinical syndrome characterized by an itchy rash with a variety of morphological cutaneous features that change with age, in association with a positive family history and concomitant presence of other atopic diseases (atopic asthma, hay fever, and occasionally urticaria) (Williams, 1997). The atopic immunological state is characterized by a propensity to develop type 1 IgE mediated responses in response to certain antigens, but the cutaneous immuno-pathology of atopic dermatitis is characterized by the presence of a T cell and inflammatory cell infiltrate resembling the pattern seen in type IV hypersensitivity reactions (rather than the type 1-like response seen in urticaria). The onset of the rash is typically in early life, peaking at age four years and tending to improve with age, although a large proportion of subjects may develop other forms of eczema later in life (Williams, 1997). Drawing the boundary between mild atopic dermatitis and normality is...

Atopic Dermatitis And Eczema

Probiotics have the potential to moderate inflammatory and immune responses and strengthen the intestinal barrier function, three actions that are useful in addressing the underlying pathophysiological processes involved in atopic dermatitis (AD) and eczema (Rosenfeldt et al 2004). The use of probiotic therapy to prevent allergic disease has been demonstrated in studies using L. rhamnosus GG in neonates, whereas studies in infants and children with established AD have found that probiotics reduce the severity of the condition (Fume 2005, Weston et al 2005). Prevention of allergy A randomised, double-blind placebo-controlled study Probiotics 953 development of atopic eczema In children by 50 during the first 2 years of life. Some 1 59 mothers were randomly allocated to receive 2 capsules of placebo or 1010 viable L. rhamnosus GG daily for 4 weeks before expected delivery. After delivery, capsules were taken for 6 months. During lactation either the mother or the infant consumed the...

Atopic Dermatitis

A novel use for B12 in a topical cream for atopic dermatitis has recently been tested. A prospective, randomised, placebo-controlled phase III multicentre trial involving 49 patients was conducted. Subjects applied the B12 cream twice daily to one side of the body and a placebo cream to the contralateral side, according to the randomisation scheme, for 8 weeks. The B12 cream was reported to significantly improve the extent and severity of atopic dermatitis and was considered safe and very well tolerated (Stucker et al 2004).

Neurodermatitis

Neurodermatitis, also called atopic dermatitis, is a skin disease that may occur at a very early age. It can be identified by the so-called milk crust on the reddened, damp skin of the head and cheeks of the newborn. As the first indication of an outbreak of neurodermati-tis, the milk crust often provides the starting point for other skin disorders. The skin becomes cracked and transparent, and the permeability increases. Once the skin is damaged, the risk of infection is higher. The skin becomes increasingly dry, transparent, and irritated, with intensified itchiness. The temptation to keep on scratching the skin is usually almost irresistable for small children. Atopic dermatitis is an immunological reaction that affects the skin to an especially large extent. More than 10 of children in industrialized countries are already afflicted, with a rising tendency. The combination of the genetic predisposition and environmental influences as well as psychological and neurovegetative...

Cosmetic And Occupational Skin Irritants Occupational Skin Irritants

A broad definition of occupational contact irritant dermatitis is contact dermatitis caused wholly or partially by the occupation of the subject. Occupational irritants may cause an acute response that may take from 1 hour to 1 day to appear, and is usually traceable to a single factor. Chronic irritant contact dermatitis may take months or years to appear and is often multifactorial 33 . Hands are involved in 80 to 90 of all cases of occupational contact dermatitis, and in the minority of cases the wrist, forearm, lower leg, or face is the primary site. The clinical features are described as follows. Many cases of occupational irritant contact dermatitis start as erythema and scaling on the back of joints and adjacent parts of the back of the fingers, as well as in the web spaces between the fingers. A generalized, rather shiny, superficially fissured, scaly fingertip dermatitis is also characteristic of certain forms of irritancy. Exclusive or more severe involvement of the thumb,...

Individual Uv Filters

TiO2 was the first micropigment extensively used. Advantages include a broad spectrum of protection and inability to cause contact dermatitis. The use of rutile as opposed to anatase crystal forms of titanium dioxide lessens photoactivity. Newer materials are am-phiphilic, designed to be dispersed in both water- and oil-emulsion phases. Particle size and uniformity of dispersion is key to achieving SPF. Primary particle size may be 10 to 15 nm with secondary particle assembly to 100 nm. Particle size needs to be less than 200 nm to achieve transparency.

Adverse Reactionstoxicity

Subjective irritation associated with burning or stinging without objective erythema from some organic UV filters 27 is the most frequent sensitivity complaint associated with sunscreen use. This is most frequently experienced in the eye area. Longer lasting objective irritant contact dermatitis may be difficult to distinguish from true allergic contact dermatitis. In a postmarket evaluation of sunscreen sensitivity complaints in 57 patients, 20 of the patients had short-lasting symptoms, 26 long-lasting, and 11 mixed or borderline symptoms 28 . Half of the patients were patch and photopatch tested, and only three showed positive reactions to sunscreen ingredients. Virtually all sunscreen ingredients reported to cause contact allergy may be photoallergens 31 . Although still relatively uncommon, sunscreen actives seem to have become the leading cause of photocontact allergic reactions 32,33 . Individuals with pre-existing eczematous conditions have a significant predisposition to...

The Nature Of Cosmetic Allergens Fragrance Ingredients

Fragrance ingredients are the most frequent culprits in cosmetic allergies 11-15 . Katsarar et al., who investigated the results of patch testing over a 12-year period, found an increasing trend in sensitivity to fragrance compounds, which reflects the effectiveness of the advertising of perfumed products 16 . Common features of a fragrance contact dermatitis are localization in the axillae, localization on the face (including the eyelids) and neck, and well-circumscribed patches in areas of dabbing-on perfumes (wrists, behind the ears) and hand eczema or its aggravation. Airborne or connubial contact dermatitis should be considered as well. much more important, particularly as concerns quaternium-15 21 although its incidence seems to have recently slightly decreased 27 . Parabens are rare causes of cosmetic dermatitis. When a paraben allergy does occur, the sensitization source is most often a topical pharmaceutical product, although its presence in other products can be sensitizing...

Nature Of Interactions Between Products And The Superficial Epidermis

The intended, beneficial interactions of cosmetic products with the epidermis are the traditional ones, namely improvement of scaling, improvement of skin color, improvement of wrinkles (fine and coarse), improvement of elasticity, and a range of beneficial effects on the specialized superficial epidermis, namely the hair and nails. These effects are well known. However, interactions of products with the epidermis may also be innocent or irrelevant or directly harmful, with adverse events such as irritant or allergic contact dermatitis or special events such as development of comedoes and acne. Fragrance allergy is now the number two allergy in industrialized countries, with increasing prevalence. Fragrances are, however, contained not only in cosmetic products, but also in a broad range of household products. Harmful effects on the epidermis may be direct or indirect, acute short term or chronic long term, predictable and dose dependent (AHA products, urea, and others), or...

Hair Color Safety and Regulatory Issues

It should be noted that allergic contact dermatitis to hair dyes appears to be far less common today than decades ago. It has been suggested that PPD, although a strong sensitizer, is not likely to produce skin sensitization because of the short contact time with skin and rapid reaction of PPD with the oxidizing agent and couplers 13 .

Frequent Skin Problems In Newborns Diaper Dermatitis

At the beginning of this century, in 1905, a French pediatrician by the name of Jacquet gave the peculiar frequently occurring skin rash in the diaper area the name diaper dermatitis 16 . The skin alterations subcategorized under the diagnosis diaper dermatitis can have a variety of causes. They can be directly related to the contact dermatitis, which is diaper dermatitis in a narrow sense. The occurence can also be unrelated to the use of diapers. Today the factors that enhance this irritating contact dermatitis are known

Tests for Skin Protection Barrier Effect

Barrier creams (BC) may play an important role in the prevention of contact dermatitis 1-6 , and various in vitro and in vivo methods have been developed to evaluate their efficacy. In practice, their use remains the subject of lively debate some reports suggest that inappropriate BC application may exacerbate, rather than prevent, irritation 1-3, 69 . The accuracy of measurements depends on the use of proper methodology. This chapter reviews the investigative details of pertinent scientific literature, and summarizes the methodology and efficacy of BC.

In Vivo Studies Of The Antiirritation Properties Of Some Cosmetic Ingredients

In vivo evaluation of the anti-irritant and or anti-inflammatory effect of dermatocosmetic formulations on human skin is usually based on the quantification of the inhibition presented by these products against an artificially induced contact dermatitis 42 . The model irritant for this purpose can be selected out of a wide range of skin-aggravating factors. Irritation of the skin can be provoked after topical application of Peru balsam 43 , solutions of anionic surfactants 44,45 , nicotinates 46,47 , after exposure to UV-B radiation 48,49 , skin abrasion 50 , or tape stripping 51,52 . There is clearly a difficulty in identifying the conditions under which these various irritants can be used for inducing a ''suitable'' irritation. The induced irritation should be great enough to be measurable with good reproducibility and to allow quantification of its inhibition by the tested products. The anionic surfactant sodium lauryl sulphate (SLS) has lately become the model irritant of choice,...

Assessing Moisturizer Efficacy Overview of Lotion Function

Moisturizer Assay

Hand and body moisturizers have two primary functions. The traditional view of moisturizer function is that they alleviate pre-existing dry skin and prevent its return. Recently, however, reports in the scientific literature have shown that moisturizers can prevent the induction of some signs of irritant contact dermatitis 9,10 . The ability to prevent irritant contact dermatitis has relevance to a significant segment of the population. Epidemiological studies have shown that the prevalence of diag-nosable hand and forearm eczema can be as high as 5.4 of the population at any one time, and from 8 to 11 in the preceding year 11,12 . This often has an irritant component especially from repeated exposure to surfactant solutions. Being able to prevent irritation may provide a significant benefit to these individuals, as well as those with dry skin (xero-sis), which frequently affects the arms and legs of consumers. Although symptoms are usually less intense than eczema, dry skin probably...

Immunological Contact Urticaria

This term is a neologism for consumers' feelings about their intolerance to a variety of topical agents, be it topical medicaments or cosmetics and toiletries. Individuals present with very similar complaints, such as burning, stinging or itching sensations, on contact with certain cosmetic products that most people do not seem to react to, sometimes accompanied by slight erythema or edema. They frequently complain of a ''tight feeling'' in their skin, secondary to associated dry skin. Sensitive skin describes the phenotype noted by the consumer mechanisms include sensory irritation, suberythematous irritation, acute and cumulative irritation, contact urticaria, allergic contact dermatitis, as well as photoal-lergic and phototoxic contact dermatitis. Sensory irritation and suberythematous irritation are believed to be far more common than the remaining mechanisms. The term cosmetic intolerance syndrome (CIS) is applied to the multifactorial syndrome in which certain susceptible...

Cosmetic Skin Irritants

Intolerance to some ingredients is related to symptoms of contact dermatitis and allergic dermatitis. There is not always a clear distinction between these problems. Some cosmetic ingredients present both an irritant character with the additional possibility of allergic reaction (e.g., cinnamic acid derivates). An overview of cosmetic categories causing irritant side effects in descending importance has been given by A. C. de Groot and coworkers 1-3 and are summarized briefly in Table 3. It has clearly been shown that certain categories of cosmetics, taking into account their composition, frequency of use, mode of application on the skin, and skin area to be treated, are more specific candidates for causing symptoms of skin irritation.

Factors Predisposing To Cutaneous Irritation

Of 4 years, lack of dishwashing machine 30 , and preference for high-risk occupations contribute to the higher incidence of ICD in females 27 . The most established individual risk factor, out of several studies about occupational hand eczema, is probably atopic dermatitis 28,31-33 . On the other hand, experimental studies concerning the reactivity of atopics and nonatopics to standard irritants have given contradictory results 34,35 and, as shown in a Swedish study, about 25 of the atopics in extreme-risk occupations, such as hairdressers and nursing assistants, did not develop hand eczema 36 . Age is as well related to irritant susceptibility insofar as irritant reactivity declines with increasing age. This is true not only for acute but also for cumulative irritant dermatitis 37,38 . Fair skin, especially skin type I, is supposed to be the most reactive to all types of irritants, and black skin is the most resistant 39,40 .

In Vivo Irritation

Skin irritation is a localized nonimmunologically mediated inflammatory process. It may manifest objectively with skin changes such as erythema, edema, and vesiculation, or subjectively with the complaints of burning, stinging, or itching, with no detectable visible or microscopic changes. Several forms of objective irritation exist (see Table 1). Acute irritant dermatitis may follow a single, usually accidental, exposure to a potent irritant and generally heals soon after exposure. An irritant reaction may be seen in individuals such as hairdressers and wet-work performing employees, who are more extensively and regularly exposed to irritants. Repeated irritant reactions may develop into a contact dermatitis, which generally has a good prognosis. Other forms of irritant dermatitis include delayed acute irritant contact dermatitis, which occurs when there is a delay between exposure and inflammation, and cumulative irritant dermatitis, which is the most common form of irritant contact...

Epidemiology

Population-based data on the incidence and prevalence of ICD are rare, but there is agreement that incidence of ICD is higher than that of ACD in general. The figures on the incidence of ICD vary considerably, depending on the study population. Most data stem from studies about occupational hand dermatoses, and in this an overview is given about the important findings of these studies. In general, it can be assumed that nonoccupational contact dermatitis attributable to all causes is more frequent in comparison to occupational contact dermatitis 29 . Coenraads and Smit reviewed international prevalence studies for eczema attributable to all causes conducted with general populations in different countries (England, The Netherlands, Norway, Sweden, the United States) and found point prevalence rates of 1.7 to 6.3 , and 1- to 3-year period prevalence rates of 6.2 to 10.6 44 . An extensive study of Meding on hand eczema in Gothenburg, Sweden, included 20,000 individuals randomly selected...

In Vivo Methods

Zhai et al. 5 introduced a facile approach to screening protectants in vivo in human subjects. Two acute irritants and 1 allergen were selected 1) sodium lauryl sulfate (SLS), representative of irritant household and occupational contact dermatitis, 2) the combination of ammonium hydroxide (NH4OH) and urea to simulate diaper dermatitis, and 3) Rhus to evaluate the effect of model protective materials. Test materials were spread onto test area, massaged, allowed to dry for 30 minutes, and reapplied with another 30-minute drying period. The model irritants and allergen were applied with an occlusive patch for 24 hours. Inflammation was scored with an expanded 10-point scale at 72 hours after application. Most test materials statistically suppressed the SLS irritation and Rhus allergic reaction rather than NH4OH and urea-induced irritation.

Acute ICD

Stinging, and soreness of the skin, and are accompanied by clinical signs such as erythema, edema, bullae, and even necrosis. Lesions are usually restricted to the area that came into contact, and sharply demarcated borders are an important sign of acute ICD. Nevertheless, clinical appearance of acute ICD can be highly variable and sometimes may even be indistinguishable from the allergic type. In particular, combination of irritant and allergic contact dermatitis can be troublesome. Prognosis of acute ICD is good if irritant contact is avoided. Exsiccation Eczematid Exsiccation eczematid is a subtype of ICD that mainly develops on the extremities. It is often attributable to frequent bathing and showering as well as extensive use of soaps and cleansing products. It often affects elderly people with low sebum levels of the stratum corneum. Low humidity during the winter months and failure to remoisturize the skin contribute to the condition. The clinical picture is typical, with...

Safety

The visible color change associated with the use of artificial tanning products might suggest to some users that these products are hazardous. Based on the chemistry of DHA and its toxicological profile, it can be considered nontoxic. It reacts quickly in the stratum corneum minimizing systemic absorption. The acute toxicity of DHA was investigated for diabetics in the 1920s with their oral intake well tolerated 6 . The phosphate of DHA is found naturally as one of the intermediates in the Kreb's cycle. Contact dermatitis to DHA has only rarely been reported 16 . As with other topical products with active ingredients, such as sunscreens, much of the reported sensitivity is secondary to other ingredients in the vehicle 17 . Adverse reactions are more likely to occur on the basis of irritation

Kojic Acid

In Japan it is used in nonprescription skincare products up to a concentration of 1 . To increase percutaneous absorption and thus therapeutic activity, it is usually used at the highest concentration allowed 31 . Because it is used intensively in foods (e.g., bean paste, soy, and sake) in some countries, particularly Japan, its oral safety has been studied. Shibuya et al. 28 , investigating the mutagenicity of kojic acid by the Ames test, forward mutation test in cultured Chinese hamster cells, and dominant lethal test in mice, concluded that, although kojic acid is a weak mutagen in bacteria, it is nonmutagenic in eukaryotic system either in vivo or in vitro. Abdel-Hafez and Shoreit 30 tested the mycotoxins using the dilution-plate method. Results showed that kojic acid may induce some toxins. Fujimoto et al. 32 examined the tumorigenicity of kojic acid in B6C3Fj mice. Three groups of animals were given 0, 1.5, and 3.0 kojic acid-containing food for 6 weeks kojic acid groups...

Answers To Patients Frequently Asked Questions

Albizia is a traditional Ayurvedic medicine used to reduce allergic conditions, such as allergic rhinitis and urticaria. It is also used for atopic conditions, such as eczema and asthma, when indicated. Controlled trials have not been conducted, so it is uncertain whether it is effective. When will it start to work

Adverse Reactions

A study of over 1000 patients randomly chosen from several different patch test clinics identified only one who reacted to calendula (Bruynzeel et al 1992). Patch test results need to be carefully interpreted because false positives can occur, as the following case shows. A 35-year-old woman with recalcitrant atopic dermatitis, with a positive patch-test reaction to Compositae mix, was told she was allergic to calendula. However, it turned out that she followed a self-devised diet consisting largely of food products of the Compositae family (which includes lettuces and artichoke). On excluding these foods her skin condition improved quickly. This case report underscores the difficulty in determining the relevance of positive patch tests, and shows that thorough analysis of positive patch tests, by both patient and physician, may reveal unexpected or less common sources of contact allergens (Wintzen et al 2003).

Dpk Be Study Protocol Protocol and Subject Selection

Healthy volunteers with no history of previous skin disease or atopic dermatitis and with a healthy, homogeneous forearm (or other) skin areas sufficient to accommodate at least eight treatment and measurement sites (time points) should be recruited. The number of subjects to be entered may be obtained from power calculations using intra- and intersubject variability from the pilot study. Because skin stripping is highly sensitive to specific study site factors, care should be taken to perfecting the technique and enrolling a sufficient number of subjects. The following study design is based on a crossover study design, where the crossover occurs at the same time using both arms of a single subject. A crossover design in which subjects are studied on two different occasions may also be employed. If this design is employed, at least 28 days should be allowed to rejuvenate the harvested stratum corneum.

Clinical Manifestations

Skin reactions include urticaria, with itching and circumscribed red lesions, and contact dermatitis.33 Typically localized lesions appear quickly on the skin exposed to allergen, such as the face, neck, and arms, but skin reactions can be more generalized.48 Anaphylactic reactions are a rare manifestation of LAA that have been reported in association with both rat and mouse bites2,35 and a puncture wound from a needle used on a rabbit.36 These reactions can lead to generalized itching and urticaria, swelling of the face, lips, and tongue (angioedema), obstruction of the airways, and shock (low blood pressure). The symptoms may vary from mild skin rashes to life-threatening cardiorespiratory reactions.

Dermatitis And Psoriasis

Research from the 1930s to the 1950s established that a deficit of n-6 EFAs leads to an inflammatory skin condition in both animals and humans. More recently, it has been established that there is no deficit of LA in atopic eczema. Instead, concentrations of LA tend to be elevated in blood, milk and adipose tissue of patients with atopic eczema, whereas concentrations of LA metabolites are substantially reduced. This suggests reduced conversion of LA to GLA (i.e. delta-6-desaturase) is responsible In most studies, but not all, administration of GLA has been found to improve the clinically assessed skin condition, the objectively assessed skin roughness, and the elevated blood catecholamine concentrations of patients with atopic eczema. Atopic eczema may be a minor inherited abnormality of EFA metabolism in some cases (Horrobin 2000). Clinical studies While early results appear promising, including a meta-analysis published in 1998 that found that oral EPO provided significant...

Adverse drug reactions

An adverse drug effect is defined as 'any unwanted effect of treatment from the medical use of drugs that occurs at a usual therapeutic dose'. Almost every drug can cause an adverse reaction, which must be elicited in the history. Any substance that produces beneficial therapeutic effects may also produce unwanted, adverse or toxic effects. The severity of the reaction may range from a mild skin rash or nausea to sudden death from anaphylaxis. A study has shown that the incidence of adverse reactions increases from about 3 in patients 10-20 years of age to about 20 in patients 80-89 years of age. 1 Reactions can be classified in several ways, e.g. side effects, overdosage, intolerance, hypersensitivity and idiosyncrasy. However, a useful classification of unwanted effects is divided into type A and type B. Type A reactions are the most common and involve Augmented pharmacology, i.e. they are caused by unwanted, albeit predictable, effects of the drug. Examples

Studies by Molecular Methods

Results obtained by molecular-based culture-independent techniques are largely supportive of the findings presented above. In another prospective follow-up, the fecal microbiota in Finnish neonates was studied prior to the expression of atopy as detected by a positive skin prick test at year one (n 12). The microbiota of these sensitized children tended to contain lower numbers of bifidobacteria and significantly higher numbers of Clostridium histolyticum than those in samples from infants with a negative prick test (n 17) (48). The Clostridium species detectable with the oligonucleotide-probe used in that study include common infant gut colonizers such as C. paraputrificum, C. butyricum and C. perfringens but not C. difficile. However, another study indicated that relatively high fecal levels of rarely detected i-caproic acid indicative of C. difficile activity was associated with presence of IgE mediated allergic condition in Swedish infants at around one year of age (49). The...

Reflection of Atopic Genotype

Immunological deviancies that could result in impaired recognition of specific bacterial groups and thus allow them to flourish. These defects include compromised expression of Toll-like receptor (TLR) 4 and its soluble co-receptor CD14 (sCD14), albeit the results regarding sCD14 are conflicting (59-64). However, also low breast-milk levels of sCD14 have been associated with subsequent development of eczema in children irrespective of atopy (65). TLR4 and sCD14 are pattern recognition receptors of innate immune systems that are important in detection of components in both Gram-positive and Gram-negative bacteria but especially the cell-wall lipopolysaccharides (LPS) in the latter (66,67). Notably, CD14-independent recognition of LPS would seem to be defective during the neonatal period (68). Compromised recognition may facilitate colonization by bacteria which would otherwise be cleared or reduced in numbers due to immune responses mounted against them. This could partly explain why...

Reflection of Effects on Th1 Th2 and Treg Differentiation

Also Lactobacillus strains have been shown to confer differential effects on cytokine production and expression of surface markers on murine dendritic cells (85). Furthermore, lactobacilli induced in vitro, in a strain dependent manner, Treg-like low proliferating Th population producing TGF-b and IL-10 (86). TGF-b is the key cytokine in induction of T-cell differentiation towards Tregs (Fig. 2) (87). In a clinical study, improvement in atopic eczema symptoms following oral administration of lactobacilli was accompanied by increased serum concentrations of TGF-b (17). Interestingly, oral supplementation of lactobacilli in breast-feeding mothers was followed by increased TGF-b concentrations in breast-milk (88). This increase may have contributed to subsequently lower prevalence of atopic eczema in children. It should be noted, however, that allergic sensitization was not affected and allergic rhinitis and asthma may have increased in frequency (89). Nevertheless, these studies are not...

Reflection of Allergic Symptoms

The possibility that allergic symptoms either affect, or are affected by, the microbiota is supported by an observation that alleviation in atopic eczema and allergic inflammation following oral administration of bifidobacteria was accompanied by modified dynamics in the microbiota (i.e., restriction in the growth of E. coli and Bacteroides) (18). Also, earlier findings attest to this possibility implicating direct correlation between numbers of Enterobacteriaceae family bacteria and severity of atopic eczema symptoms (39). The compositional characteristics associated with the severity of symptoms may be caused by intestinal inflammation exacerbated in some allergic conditions (95,112-115).

Reflection of Environmental Factors

Amongst the best examples of factors which have been clearly shown to influence the development of the gut microbiota and have also been implicated in allergic diseases include the mode of delivery and breast-feeding (116-123). Indeed, it is plausible that the characteristics of fecal microbiota associated with atopic eczema and allergic sensitization may partly reflect dietary factors. It is well known that changes in diet may dramatically affect the microbial composition of the gut. Then again, in allergic infants the diet can reflect the child's health status due to food restrictions. In 39-63 of all infants and young children, atopic eczema is triggered by one or more challenge-confirmed food allergies (124-126). Moreover, the development of manifestations of allergic diseases in children correlates with differences in the composition and immunological characteristics of breast-milk, which on the other hand are affected by maternal gut microbiota and atopy (127-133). For example,...

Phenobarbital Luminal Solfoton

Infant and children < 12 yrs 10-20 mg kg IV in a single or divided dose, may give additional 5 mg kg dose every 15-30 minutes until seizure is controlled or a total dose of 40 mg kg is reached maintenance infants 5-8 mg kg day IV PO in 1-2 divided doses, children 1-5 yrs 6-8 mg kg day in 1-2 divided doses, children 5-12 yrs 4-6 mg kg day in 1-2 divided doses. Neonates 15-20 mg kg IV in single or divided dose maintenance 2-4 mg kg day in 1-2 divided doses, increase by 5 mg kg day if needed. Clearance hepatic metabolism, 25-50 renal elimination unchanged. Therapeutic level 15-40 mg L. Contraindications preexisting CNS depression, severe uncontrolled pain, porphyria, severe respiratory disease with dyspnea or obstruction. Adverse effects hypotension, drowsiness, cognitive impairment, ataxia, hepatitis, skin rash, respiratory depression, apnea, megaloblastic anemia. Comments multiple drug interactions through induction of hepatic enzyme systems use caution in hepatic or renal disease...

Pathogenesis of skin manifestations due to HHV6 infection

Patients with exanthem subitum as well as the absence of suitable animal models of primary HHV-6 infection. Recently, we reported the absence of rash after the resolution of fever in immunocompromised infants during primary HHV-6 infection (Yoshikawa et al., 2001a,b). Thus, the host immune response against the virus appears to play an important pathogenic role in the skin rash in patients with exanthem subitum. In addition to this in vivo data, we infected an epidermal cell line (A431 cells) with HHV-6 and examined the expression of several surface molecules to understand the pathogenesis of skin manifestations (Yoshikawa et al., 2003) HHV-6 can infect this epidermal cell line, and HLA-A, -B, and -C, HLA-DR, and ICAM-1 expression were upregulated in HHV-6-infected cells. Tissue culture supernatant did not affect the expression of these three surface molecules, and, therefore, direct viral infection probably causes the changes observed in these cells. When considered with a previous...

General Aspects of Therapy

Herpes zoster at any site of the body in patients beyond the age of 50 Herpes zoster in the head neck area of patients at any age Severe herpes zoster on the trunk and on the limb Herpes zoster in immunodeficient patients Herpes zoster in patients with severe atopic dermatitis and severe eczema and zoster oticus (table 1). Severe herpes zoster of the trunk and extremities as well as herpes zoster in immunodeficient patients and patients with atopic dermatitis or other eczema are also indications for antiviral therapy. Furthermore, zoster ophthalmicus and zoster oticus as well as age over 50 years are major risk factors for the development of PHN. Some authorities consider antiviral treatment to be only optional in patients younger than 50 years of age with shingles on the trunk or on the extremities. Nevertheless, antiviral therapy has potential benefit and bears a limited risk. The same is true for immunocompetent children. However, as a rule patients younger than 50 years should be...

Altered Self Reported Health Qualitative Approach

Many dermatologists rate HS as a heart-sink condition and would agree that it ranks among the most unpleasant of skin diseases. When looking at patients' statements about their disease they emphasize that the soreness and pain are the cause of their disability. Patients suffer from embarrassment and self-consciousness caused by the frequent occurrence of boils with malodorous discharge. One study in Denmark has shown impairment of self-reported health in HS 6 the general self-reported level of health is poorer among HS patients. The soreness, discharge, and appearance of lesions are described as problems for both work and leisure activities by 51 of all patients. In the same study, Jemec et al. 1996 found that patients with HS had lost an average of 2.7 days of work in 1 year specifically because of HS. This suggests an overall higher morbidity, as other days lost to other causes were not included in the data. The duration of 2.7 days however ranked below the average number of work...

Bone marrow transplant

Protocol for allogeneic transplants is considerably more aggressive than autologous transplants, there is no apparent significant difference in the incidence of HHV-6 recurrence between these transplants nor sibling versus unrelated donor grafts in a pediatric population (Yoshikawa et al., 2002 Savolainen et al., 2005). HHV-6 reactivation is common in BMT transplant patients (Wang et al., 2002) and associated with skin rash and fever, the same symptoms often manifested at the time of primary infection in children. Idiotypic myelosuppression is characterized by delayed ne-utrophil and platelet engraftment and is highly associated with the reactivation of HHV-6 (Dobryski et al., 1993 Carrigan and Knox, 1994). Bethge et al. (1999) has reported two cases of BMT patients with HHV-6 PCR-positive spinal fluid who display neurological symptoms, including disorientation, sleepiness, and short-term memory loss and showed improvement following treatment with foscarnet. Appleton et al. (1995)...

Allergic rhinosinusitis

Allergic rhinosinusitis is a diagnosis made clinically, as there are no definitive objective tests available for routine clinical use to confirm this entity. There are two major forms of this disorder seasonal and perennial. Thus, it is a diagnosis based on history (often by questionnaire) and physical examination. In some epidemiological studies, the presence of allergy is confirmed by results of skin prick tests or in vitro allergy testing. The prevalence of this disorder varies widely in the literature, based upon the different sources of the data (i.e., questionnaires, phone interviews, and direct examination), but the majority of the literature suggests that 20 to 25 of children and about 15 of adults suffer from this condition (1). Peak prevalence is between 10 and 30 years in most countries (2). Atopic individuals are at much increased risk for this disorder and there is a significant correlation between the report of nasal symptoms and the prevalence of allergen-specific IgE....

Effects Of Immunosuppressants On Coagulation During

Campath 1H (C1H) is a humanised monoclonal antibody directed against the CD52 antigen that is present on the surface of T cells, B cells, NK cells, and monocytes. It depletes the peripheral blood lymphocytes, preventing an aggressive lymphocytic immune response after transplantation. Adverse events include acute first-dose administration-related reactions (attributed to antibody-induced cytokine release), infectious complications (due to immuno-suppression), and haematological toxicities. Rigor, fever, nausea, vomiting, skin rash, dyspnea, and hypotension are among the most commonly reported infusion-related reactions with alemtuzumab. thrombocytopenia, anaemia, and neutropenia are the most common haematological alterations.35

Presentation And Clinical Course

After an incubation period of 2-20 days (10 days on average), patients typically experience the sudden onset of fever, chills, nausea, vomiting, headache, and myalgia. This corresponds to the septicemic phase, which lasts 3-7 days. Physical exam findings at this time are relatively nonspecific, and include maculopapular skin rash, pharyngeal injection, lymphadenopathy, organomegaly, and muscle tenderness. The presence of conjunctival suffusion or muscle tenderness involving the calves and lumbar region should raise the suspicion of leptospirosis.

HHV6 association with other liver disease

Hemophagocytic syndrome (HSP) is a clinicopathologic syndrome characterized by the systemic activation of macrophages leading to the phagocytosis of hematopoietic cells. HSP is characterized by the association of fever, he-patosplenomegaly, lymphadenopathy, skin rash, lung infiltration, and jaundice. Laboratory findings frequently demonstrate pancytopenia, elevated levels of hepatic transaminase, coagulopathy with low fibrinogen, hypertriglyceridemia, and elevated ferritin levels. Several viral infections, such as Epstein-Barr virus, have

Developmental Immunodeficiency Disorders

Wiskott-Aldrich syndrome is a sex-linked (male) disorder occurring mainly in children. The syndrome has three main features thrombocytopenia (manifested by bleeding), eczema, and recurrent infections. An increased incidence of lymphoreticular malignancies or lymphomas may occur.

Regulatory Status

OEP is regulated as a dietary supplement in the United States. It is approved in Canada as an over-the-counter product for use in EFA-deficiency conditions and as a dietary supplement to increase EFA intake. In the United Kingdom, it is on the General Sales List. In Germany, OEP is approved for use as food and is approved there in the treatment and symptomatic relief of atopic eczema. In Sweden, OEP is classified as a natural product. OEP has a Class 1 Safety Rating with the American Herbal Product Association (1,2,7).

Relation Between Atopy and Metal Hypersensitivity

The relation between atopy, a condition with inherited predisposition to develop IgE-mediated hyper-sensitivity to small quantities of inhaled or ingested environmental agents, and metal immunotoxicology was discussed at the workshop of Immunotoxicity of Metals and Immunotoxicology in 1989 (Cattaneo, 1990). Although case reports of type I hypersensitiv-ity caused by sensitization to chromium (Section 5.2), cobalt (Section 5.3), nickel (Section 5.6), and platinum (Section 5.7) have been published, only platinum allergy is sufficiently frequent to be assessed for the influence of atopy. A recent review found no association between atopy and type I allergy to platinum salts (Merget et al., 2003). With regard to metal-induced type IV allergy, allergic contact dermatitis, no increased predisposition was reported as a result of atopy at the workshop in 1989 (Cattaneo, 1990). No conclusive new information has been published since then. For example, with regard to the most frequent clinical...

Other Special Situations

The word panallergic can be used to describe patients who simply cannot tolerate virtually any medication for one reason or another. Allergic reactions to every topical glaucoma agent have been reported. Contact dermatitis is not uncommon with alpha-2 agonists, miotics, CAIs, and beta blockers. Also included in this category are patients who have multiple side effects to medications or who just cannot tolerate the baseline level of burning and stinging associated with their instillation.

The Platinum Group of Elements Palladium Platinum Rhodium

Pt is a highly corrosive-resistant, catalytic, and strong metal, which has been used for a long time in various applications, mainly in the form of complex salts, for example, platinum chloride, platinum dichloride, platinum dioxide, and platinum sulfate. Platinum complexes, in the form of platinum (II) compounds, cisplatin and carboplatin, are among the most important chemothera-peutic drugs. Biological reactivity, especially hypersen-sitivity, is limited to charged compounds that contain reactive ligands, halogenated Pt salts, and the sensitizing potential increases with the number of chlorine atoms. The sodium and potassium salts of hexachlorplatinic (IV) acid and tetrachlorplatinite (II) are the most potent sensitizers (Ravindra et al., 2004). Symptoms of allergic-like reactions such as lacrimation, sneezing, rhinorrhea, cough, dyspnea, and frank asthma in workers exposed to soluble complex platinum salts have been observed since the early 19th century and were called platinosis...

Studies by Traditional Plate Culture Methods

The first reports associating allergy with characteristic microbial composition in the gut appear to be from studies in the former Soviet Union in the early1980s (38-40). One of these studies, reported also in English, involved an assessment of 60 under one-year-old infants with food allergy and atopic eczema. It was claimed that the severity of the disease was in direct correlation with the stage of aberrancy in the fecal microbiota. This aberrancy was characterized as low prevalence of bifidobacteria and lactobacilli and high prevalence of Enterobactericeae, pathogenic species of staplylococci and streptococci as well as Candida species (39). Indication that such differences may persist beyond infancy was provided a few years later by Ionescu and co-workers (1986) who studied 10- to 45-year-old subjects. Subjects with atopic eczema (n 58) were shown to have lower prevalence of lactobacilli, bifidobacteria, and enterococci species than the healthy subjects (n 21) but higher...

Systemic Lupus Erythematosus

SLE is a common autoimmune connective-tissue disease affecting 1 in 1000. It is much more prevalent in young females, with a female-to-male incidence of 9 1. It affects many organ systems. Skin rash is a very common presentation, typically appearing in the malar areas following sun exposure. Oral ulcerations develop in 40 of patients. Other systemic manifestations include myocarditis, nephritis, pneumonitis, and central nervous system (CNS) involvement.

Solid organ transplant recipients

Clinical sequelae of HHV-6 may result from symptoms directly attributable to the virus or from its immunomodulatory effects. Table 1 shows a summary over the clinical syndromes that has been suggested being associated with HHV-6. Symptomatic infections seem to be more common in SCT than in SOT patients although published reports vary from very limited clinical effects of HHV-6 to a contributing effect on overall mortality. A fever of unknown origin with or without a skin rash bone marrow suppression, and encephalitis are the most frequently observed clinical features of HHV-6 (Carrigan et al., 1991 Drobyski et al., 1993 Carrigan and Knox, 1995 Wang et al., 1999 Ljungman et al., 2000 Zerr et al., 2001). Less commonly, interstitial pneumonitis, gastrointestinal disease, and hepatitis have been reported (Cone et al., 1993 Singh et al., 1997 Rossi et al., 2001 Hentrich et al., 2005).

Significance to humans

Pelagic Sea Cucumber

Holothuroids are a food item in several Asian and Pacific Island countries. The widespread use of holothuroids as food and medicine in Asia extends to at least the late sixteenth century, when detailed Chinese and European accounts of commerce first began mentioning trade in beche-de-mer. This long-term, domestic familiarity with holothuroids in the region is reflected in a small role for the animal in northern Asian culture as an object of poetry and popular cartoons. Several thousand individuals of colorful tropical species are harvested annually as part of the worldwide marine aquarium trade. Holothuroids are of minor medical significance because the potent dermal toxins of some species cause severe contact dermatitis in some people. These same toxins are of commercial interest because of their pharmacological properties. Compounds extracted from holothuroids exhibit antimicrobial, anticoagulating, tumor-inhibiting, and antiinflammatory activity. Other compounds are potent...

Pro Inflammatory Chemokines

Pma Activate Cells

Skin-pathogenic microorganisms such as S. aureus, B. burgdorferi or C. albicans together with several PAMPs (e.g., LPS or PGN) induce the abundant expression of IL-8 a chemokine now referred to as CXC chemokine ligand 8 (CXCL8) in a TLR-NF-kB-pathway-dependent manner 15, 47, 49, 59, 75 . Pathogen-induced secretion of keratinocyte-derived IL-8 initiates neutrophil chemoattraction and transendothe-lial migration. In addition, IL-8 is selectively involved in the transendothelial migration of CLA+ T cells, emphasizing the role of IL-8 in the homing of specific T cells to inflamed skin (Fig. 13.2). In addition to IL-8, pathogens and microbial products, such as heat-killed S. aureus and staphylococcal PGN, stimulate the expression of other chemokines in keratinocytes, such as RANTES CCL5 (regulated on activation, normal T expressed and secreted, RANTES) or MCP-1 CCL2 (monocyte chemoattractant pro-tein-1) 47 . RANTES-expressing keratinocytes were detected in the lesional skin of patients...

Dean Filandrinos Thomas R Yentsch and Katie L Meyers

John's wort has demonstrated clinical efficacy for mild to moderate depression and compares favorably to other more potent or toxic antidepressants. Low side effects and potential benefits warrant its use as a first-line agent for select patients with mild to moderate depression or anxiety-related conditions. Benefits related to other reported uses such as an antimicrobial, agent to treat neuropathic pain, antiinflammatory, treatment alternative for atopic dermatitis, and antioxidant are either not well documented or evidence is encouraging but not conclusive and further study is needed. St. John's wort has an inherently wide margin of safety when taken by itself, with most reported adverse drug reactions (ADRs) being related to skin reactions. Isolated, but more significant ADRs have been reported in relation to neurological effects, impact on thyroid function, and increased prothrombin time. Of greatest concern is the potential for interactions between St. John's wort and...

Allergy and Dermatitis

Contact allergy to chemicals used in ear drops is the most common type of dermatologic otitis externa. Hairsprays, dyes, and cosmetics can also result in an eczematoid and draining otorrhea. If the source of external canal weeping is not obvious, routine patch testing is strongly suggested (20). The autoeczematization (ID) reaction, which is an autoimmune reaction that may involve only the external auditory canal, has been recorded for over 70 years in the otolaryngology literature. Recent studies confirm that this is due to a local reaction to distant fungus infections, most commonly dermatophytid in the feet and inguinal area. Control of the primary fungal infection with prolonged antifungal systemic treatment will nearly always control the ear reaction (21,22). There are other less-common dermatologic conditions that may focus on the ear. Atopic dermatitis, which has recently been found to result from a superantigen reaction to Staphylococcus aureus exotoxin, has been implicated in...

Pharmacological Toxicological Effects

Atopic Dermatitis After it was found that St. John's wort, and more specifically hyperforin, has an inhibitory effect on epidermal langerhan cells, there was speculation that it may treat atopic dermatitis. A 4-week trial was conducted in which 21 patients with mild to moderate atopic dermatitis were treated twice daily with a cream standardized to 1.5 hyperforin on one side of their body and placebo on the other side. The primary end point of the study was severity scoring of atopic dermatitis (SCORAD) index, based on extent and intensity of erythema, papulation, crust, excoriation, lichenification, and scaling. Among the 18 participants that completed the study, the SCORAD index fell from a baseline score of 44.9 to 23.9 in the hyperforin group. The SCORAD index also fell from 43.9 to 33.6 in the placebo group. These results show statistically significant superiority of hyperforin cream over placebo, with no difference in skin tolerance to the two treatments. Of note, a...

Measure of Quality of Life Quantitative Approach

A quantitative approach for measuring QoL in HS was performed 2 . Questionnaires widely used in other skin diseases such as the Dermatology Life Quality Index (DLQI) questionnaire, Skindex and VQ-Dermato 1, 4, 5 were chosen. This approach allows a direct comparison of the results with those from previous studies on other skin diseases. We will discuss two studies, one already published and our unpublished data 2 . In both studies, in addition to this questionnaire, basic demographic data and aspects of the history of HS were collected 114 patients participated in the first one 2 and 61 in the second. In the study of der Werth and Jemec 2 the recorded mean DLQI score was 8.9, higher than scores found in several other dermatological conditions such as alopecia, acne, psoriasis, Hailey-Hailey disease, vascular anomalies of face, and atopic dermatitis. In our center (unpublished data) using two other skin-disease-specific QoL questionnaires (Skindex and VQ-Dermato) 1, 5 , the scores...

Spatiotemporal patterns of common skin diseases

Despite the absence of systematic data there are important secular and geographical differences in disease burden that (to this author) seem robust. Atopic dermatitis incidence appears to have increased by a factor of two or more in the last three decades in many developed countries (Williams, 1997). Cancers of the skin in many world populations (chiefly those with pale skin) have also increased two to three-fold over a similar time course (Marks, 1995). By contrast psoriasis incidence seems to have stayed constant. For other

Regulation of the Immune Responses

It is interesting to compare these experimental results to those described in human neonates by Lodinova-Zadnikova and coworkers (85). In their study, they colonized the digestive tract of babies just after birth with a given strain of E. coli. In these conditions E. coli is able to establish durably in the digestive tract of newborns as described previously (86). After 10 years (preterm infants) and 20 years (full-term infants), differences in occurrence of food allergies between colonized and control subjects were statistically significant 21 versus 53 , and 36 versus 51 respectively. Furthermore, recent clinical trials using ingestion of a strain of probiotic, Lactobacillus rhamnosus GG, during the last month of pregnancy to women and after birth to babies during 6 months, reduced the incidence of atopic eczema in at-risk children during the first 4 years of life (87). However, in this case, IgE levels were not decreased in the treated group as compared with the placebo group. The...

Anticoagulation During Cardiopulmonary Bypass

Protamine sulphate is a simple protein and is a strong base in characteristics, as against heparin which is acid. Therefore, it forms electrostatic complexes with the molecules of heparin and neutralises its action by inhibition of anti-thrombin III. It acts on all stages of the coagulation cascade. Protamine is extracted from a fish sperm and can show cross-immunity by giving a hypersensitivity reaction in patients who are allergic to fish protein. Protamine can also, by the same mechanism, give rise to allergic reactions in those who have a history of testicular trauma or procedures like vasectomy, in which there is a breach in the blood-sperm barrier. Patients, who are on protamine containing insulin preparations (PZI, NPH insulin), can also elicit strong reactions to protamine. Apart from minor reactions like skin rash, nausea, and lassitude it can give rise to some major reactions like hypotension, hypertension, bradycardia, and severe bronchospasm. Urticaria with severe...

Pharmacological Toxicological Effects 51 Dermatological Effects

A defect in the capability of the enzyme 8-6-desaturase to convert linoleic acid to y-linolenic acid is known to occur in patients with atopic dermatitis (9). Patients with atopic eczema have a dietary deficiency in metabolites of linoleic y-linolenic acid, dihomo-y-linolenic acid, arachi-donic acid, adrenic acid, and docosapentaenoic acid caused by a reduced rate of activity in the 8-6-desturase enzyme (8). Galli et al. compared blood samples from babies born to parents who suffered from atopic eczema. Results showed that dihomo-y-linolenic acid and arachidonic acid were consistently and significantly lower in children who later had atopic eczema (10). Some studies have shown that OEP administration can improve the percentage of body surface involvement, itch, dryness, scaling, and inflammation associated with atopic eczema. A meta-analysis (11) of nine controlled trials involving OEP in the treatment of atopic eczema showed a highly significant improvement in the symptom of itch...

Special Techniques and Considerations

Immunofluorescence immunofluorescent examinations are required for the diagnosis of chronic blistering diseases and are useful in connective tissue diseases. The site of biopsy is important for immunofluorescence, particularly in the blistering disorders. In dermatitis herpetiformis a biopsy for immunofluorescence should be taken from clinically normal skin away from the area of blistering. In the other blistering disorders, perilesional skin is submitted. The skin should have an intact epidermal dermal junction. In most of the connective tissue disorders lesional skin is submitted for immunofluorescence except for the lupus band test, where normal non-sun-exposed skin is used. Most patients having skin submitted for immunofluorescence should

Ginseng In Cosmetic Preparations

Ginseng saponins are structurally near chemical relatives of the antiinflammatory compounds such as steroids and glycyrrhetinic acid from liquorice (Glycyrrhiza glabra L.). It is thus not surprising that antiinflammatory properties have been reported for ginseng extracts and ginseng has been suggested as an ingredient of cosmetic creams with non-allergenic, cutaneous bioactivity for the treatment of wrinkles and eczema. The many recent patent applications involving cosmetic creams, anti-wrinkle creams, acne applications and hair growth preparations with supporting claims of efficacy suggest probable effectiveness (cf Chapter 9). Curri et al. (1986) had reported that ginseng extract applied topically as a phospholipid liposomal formulation produced a favourable effect on skin ageing, moisturisation of the stratum corneum and improved skin elasticity. Saponins of ginseng, the ginsenosides Rb1, Rb2, Rc, Re and Rg 1, as well as 70 per cent methanolic extract of P. ginseng, increased the...

Clinical

Dry-coated aloe vera gloves were tested by 30 women suffering from dry, cracked hands, with or without contact dermatitis due to occupational exposure, in an open contralateral comparison study (West & Zhu 2003). Women wore a glove on one hand for 8 hours daily for 30 days followed by a rest period for 30 days and then 10 more days of treatment. Results indicated that the aloe vera glove significantly Aloe vera 23

Treatment

Autoimmune disorders such as those discussed in this chapter are generally treated with immunosuppressive therapy. Corticosteroids are a mainstay of therapy in all of these disorders, but doses may vary widely, depending on the severity of disease manifestations. Among other immunosuppressives, those with more serious potential side effects are reserved for more severe disease manifestations. Often, however, the dermatologic manifestations of SLE and DM can be treated by hydroxychloroquine. This is a long-acting anti-inflammatory agent, not generally considered immunosuppressive, whose precise mechanism of action remains unclear. Hydroxychloroquine is frequently used alone or in combination with immunosuppressive therapy when skin rash is present however, it is not effective for the skin changes of scleroderma or the myositis of DM PM.

Clinical Safety

There is extensive data regarding the overall safety of the vaccinia virus, which was generated during its use in the eradication of smallpox. The complications associated with vaccinia virus include encephalitis, vaccinia necrosum, and eczema vaccinatum. These complications are more prevalent in immunocomprimised individuals and infants (see Fig. 2) (34-36). Eczema vaccinatum originates from the infection of eczematous skin throughout the body by vaccinia. It causes a large viral load that induces viremia with fever and malaise and can sometimes progress to death. Although rare, the side effects of vaccinia virus have been the focus of multiple laboratory experiments and animal models suggest a role of inflammatory cytokines in the pathogenicity of viral infection.

Malignant Tumours

Paget's disease of the nipple Paget's disease of the nipple is characterised by infiltration of malignant ductal epithelial cells into the epidermis of the nipple-areolar complex. Clinically, it presents as an itchy and scaly rash which may be mistaken for eczema but gradually gives rise to ulceration, crusting and bloody nipple discharge in advanced cases. Of breast cancers, 1-2 have associated Paget's disease. In patients presenting with features of Paget's disease without a clinically palpable mass, high nuclear grade DCIS is nearly always detected in the large subareolar lactiferous ducts and up to 40 will have an occult invasive tumour within the breast. An excision biopsy of the nipple is performed to confirm Paget's disease and treatment is usually by mastectomy.

Dermatitis

Atopic dermatitis A double-blind multicentre study involving 145 patients with moderate to severe atopic dermatitis showed that n-3 fatty acids (6 g day) improved clinical symptom scores by 30 after 4 months' treatment (Soyland et al 1994). The results were confirmed by the total subjective clinical score reported by the patients. An earlier, 12-week, prospective double-blind study produced similar results with a dose of 10 g day (fish oil) improving overall severity of atopic dermatitis and reducing scaling (Bjorneboe et al 1989).

Allergiesan Overview

Allergies are by definition immunological hypersensitivity reactions to substances (allergens), usually proteins, tolerated in defined dose by normal individuals (21). Allergic reactions are manifested in allergic diseases such as asthma, eczema, and rhinoconjuncti-vitis, each defined by a group of symptoms and signs. The life-impairing effect of these diseases varies from subtle to dominant. In addition to impairing physical health there may be an impact on social and emotional health, especially in childhood (22). Allergic symptoms can significantly disturb productivity in school and work where they are among the major causes of absenteeism. The personal and social economic burden is considerable (22-24). During the second half of the twentieth century the prevalence of allergic diseases has increased in epidemic proportions. The highest prevalence is in children and teenagers. With, on average, every fourth child affected, allergic diseases represent the most common chronic...

Exanthem subitum

Fig. 1 Typical skin eruption observed in patient with primary HHV-6 infection. Maculopapular skin rash is observed on the trunk and extremity. (for colour version see colour section on page 352). Fig. 1 Typical skin eruption observed in patient with primary HHV-6 infection. Maculopapular skin rash is observed on the trunk and extremity. (for colour version see colour section on page 352).

Alopecia

A RCT of scalp massage using thyme, rosemary, lavender and cedarwood essential oils in 86 patients with alopecia areata found a significant improvement in hair growth after 7 months (Hay et al 1998). Although the efficacy of lavender as a stand-alone treatment was not clarified with this trial, it is known that the herb has some antibacterial and antifungal activity that may play a role. In a single case study, topical application of lavender, together with other essential oils, was reported to assist in treating scalp eczema (De Valois 2004).

Allergic Reactions

Lepirudin administration during prospective studies in patients with HIT was associated with a low incidence of allergic events, as well as during the much larger clinical trials in patients with ACS. Among the adverse events reported were eczema, rash, pruritus, hot flushes, fever, chills, urticaria, bronchospasm, cough, stridor, dyspnea, angioedema (face, tongue, larynx), and injection-site reactions. Any causal relationship of lepirudin to these adverse events is unclear.

Food Allergies

Considering that the gut microflora is an important factor in regulating both the intestinal and systemic immune system, probiotics are used to promote endogenous barrier mechanisms, reduce gut permeability and alleviate intestinal inflammation in patients with atopic dermatitis and food allergy (Majamaa & Isolauri 1997). A 1 -month study of 10 breastfed infants who had atopic eczema and cow's milk allergy found that L GG reduced certain faecal inflammatory markers. closely observed cohort of 329 Finnish children it was shown that the earlier an acute respiratory infection occurred, the greater the protective effect was against atopic eczema (Vanderhoof & Young 2003). The obvious solution for increasing microbial exposure without increasing the health risk is the use of prebiotics and probiotics. Supplementation with probiotics has been shown to both reduce the risk and treat the symptoms of childhood eczema (see later).

Red clover

Historical note Red clover has been used for a long time as an animal fodder as well as a human medicine. Traditionally, it is considered an alternative remedy with good cleansing properties useful in the treatment of skin diseases such as psoriasis, eczema and rashes. A strong infusion was used to ease whooping cough and other spasmodic coughs due to measles, bronchitis and laryngitis. It was recommended for 'ulcers of every kind, and deep, ragged-edged, and otherwise badly-conditioned burns. It possesses a peculiar soothing property, proves an efficient detergent, and promotes a healthful granulation'. Combined with other herbs, red clover was recommended for syphilis, scrofula, chronic rheumatism, glandular and various skin affections (Felter & Lloyd 1 983). Interestingly, red clover was not traditionally used for the treatment of menopausal symptoms.

Other Skin Tumours

Paget's disease of nipple presents as an eczematous area on the nipple or areola. It is associated with underlying malignancy in the breast. Leukaemia and lymphoma leukaemias and lymphomas may affect the skin in two main ways (a) as an inflammatory skin rash as a consequence of the underlying malignancy and (b) as a lymphoma leukaemia involving the skin, either as a primary skin lesion or spread to the skin as part of systemic disease. Lymphoma and leukaemia involvement of the skin may present as a skin rash, plaques or nodules of tumour. Usually, a small diagnostic biopsy is taken in such cases, either as a punch or an ellipse.

Asthma

(British Thoracic Society Scottish Intercollegiate Guidelines Network, 2003). Asthma is strongly associated with atopy as demonstrated by the link with eczema and hay fever and the detection of IgE, or a positive skin prick test, to a specific allergen (Witt et al., 1986 Woolcock et al., 1987). Asthma is termed extrinsic if it is associated with atopy and intrinsic if it occurs in the absence of atopy.

Cobalt

Cobalt (Co) is an essential element necessary for production of vitamin B12 (Barceloux, 1999). Two valence states exist Co(II) and Co(III) the former is often used in the chemical industry, whereas metallic Co is used in the metal industry to produce alloys, especially hard metals (Barceloux, 1999). Immunological reactions to Co include sensitization, which is quite unusual in the common population (< 1 ) but may occur concomitantly with sensitization to Ni in women and Cr in men. The most common hypersensitivity reaction to Co is allergic contact dermatitis, a type IV reaction (Garner, 2004), although occupational asthma with increased serum IgE antibodies to Co indicative of a type I reaction has also been reported (Shirakawa and Morimoto, 1997).

Mercury

Hg is a well-known inductor of allergic contact dermatitis, which was first recognized at the end of the 19th century (Boyd et al., 2000). Heavy proteinuria, usually a nephrotic syndrome, has been described during Hg exposure since the 19th century. In modern times, Kazantzis et al. (1962) described four cases of occupa-tionally mercury-exposed workers with a nephrotic syndrome among a cohort of similarly exposed individuals. Stewart et al. (1977) described proteinuria in 9 of 21 technicians occupationally exposed to mercury after spillage of corrosive sublimate and with a wide excretion rate of Hg. In these case reports, the heavy proteinuria dominated by albumin suggests a glomerular damage in contrast to the more modest, low-molecular weight proteinuria associated with the tubulotoxic effect of Hg. A number of case reports have described an IC-mediated membranous GN after occupational exposure to Hg, after use of skin-lightening creams and laxatives containing Hg, as well as other...

Infection Viral

Epstein-Barr virus (EBV) is the causative agent of infectious mononucleosis. EBV is a double-stranded DNA virus in the herpesvirus family. It is transmitted by direct contact or by aerosolized viral particles. The virus infects B lymphocytes, and symptom manifestation consists of the triad of fever, lymphadenopathy, and pharyngitis. A white exudate on the tonsils is characteristic of EBV infection, and a skin rash may occur in patients treated with antibiotics, especially amoxicillin. Other symptoms include hepatosplenomegaly, hepatomegaly, encephalitis, pericarditis, and autoimmune hemolytic anemia. In rare cases, patients may present to an otolaryngologist with airway obstruction or cranial nerve palsies.

Scope of chapter

I will take a selective approach dealing with the most common diseases acne, dermatitis, psoriasis and skin cancer account for over half the dermatology cases seen in primary care and around 80 of the workload of a secondary care dermatologist (Harris et al., 1990). What (little) we know of the genetics of acne, atopic dermatitis and psoriasis will be summarized briefly, and the role of genetic factors in skin cancer dealt with in more detail.

Aminoglutethimide

In patients refractory to first-line hormonal therapy with castration or estrogens, aminog-lutethimide with hydrocortisone produces a symptomatic and biochemical response up to 48 of the time, with responding patients often experiencing clinical improvement for some months and occasionally up to 3-4 years.159-162 Side effects include adrenal insufficiency (in the absence of corticosteroid-replacement therapy), skin rash, hypothyroidism, and less commonly thrombocy-topenia.159,163,164 Another troublesome side ef

Conclusions

Other potential applications of ginseng in anticancer treatment, as liver protective agents, in alcohol intoxication therapy, for morphine, cocaine and amphetamine withdrawal problems, in topical preparations for skin affections such as acne and eczema and in cosmetics still require careful clinical trials to demonstrate indisputably that standardised ginseng phytochemicals or formulations are really effective in human subjects.

Teratology

Treponema pallidum is a spirochete that causes syphilis. It is transmitted to the fetus transplacentally. This spirochete can cause miscarriage, perinatal death, he-patosplenomegaly, joint swelling, skin rash, anemia, jaundice, metaphyseal dystrophy, abnonnal teeth (Hutchinson teeth), and changes in cerebrospinal fluid. Antibiotics given to the affected mother usually provide adequate therapy for the fetus.

Garlic Allergy

Allergic reactions to garlic have also been reported in the literature. Garlic allergy can manifest as occupational asthma, contact dermatitis, urticaria, angioedema, rhinitis, and diarrhea. A 35-year-old woman experienced several episodes of urticaria and angioedema associated with ingestion of raw or cooked garlic, as well as urticaria from touching garlic. Two garlic extracts as well as fresh garlic produced a 4+ reaction on skin prick tests (SPTs) in this patient, but no other food allergens produced positive results. The patient's symptoms were immunoglobulin E (IgE)-mediated, but she also produced specific IgG, which confounded the results of IgE testing (90). A group of 12 garlic workers with respiratory symptoms associated with garlic exposure underwent SPTs using garlic powder in saline, commercial garlic extract, and various other possible allergens bronchial provocation tests with garlic powder oral challenge with garlic dust and specific IgE testing using the CAP (CAP...

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