Essential Aspects of Atopic Dermatitis

ISBN-13: 9783642747687 / Angielski / Miękka / 2011 / 261 str.

Georg Rajka

Opis

"Le secret d'ennuyer est celui de tout dire. " Voltaire (Discours sur l'homme) Atopic dermatitis (AD) is frequently seen by dermatologists and pediatricians, by allergologists, and by many practitioners. The amount of data on AD is vast as it has been recognized for a very long time, has a worldwide distribution, and has a chapter or section devoted to it in every textbook or review of skin diseases. Difficulty arises in evaluating certain aspects of this complex disease, for many studies have been concerned with only some of its facets and with small numbers of patients. In addition a monograph on AD should also try to encompass the important theoretical aspects of this fascinating disease. There fore, the problem in presenting a monograph on AD lies more in the critical se lection than in the gathering of information, much of which is conflicting. This applies both to basic data and to details. Furthermore, the many divergent opinions in almost every field make it extremely difficult to draw unanimous conclusions. Consequently, the author has no option but to quote antagonistic views, try to make a compromise between these, and express his own opinion based on clinical experience and fundamental literary work."

Spis treści

1 History and Nomenclature.- 1.1 History.- 1.2 Nomenclature.- References.- 2 Clinical Aspects.- 2.1 Prevalence.- 2.1.1 Worldwide Distribution.- 2.1.2 Sex Incidence.- 2.2 Course.- 2.2.1 Onset, Phases, and Morphological Characteristics.- 2.2.2 Infantile Phase.- 2.2.3 Childhood Phase.- 2.2.4 Adolescent/Young Adult Phase.- 2.2.5 Onset at Elder Age.- 2.3 Prognosis.- 2.3.1 Phases and Prognostic Problems.- 2.3.2 Cases Healed After the Infantile Phase.- 2.3.3 Clearing of the Disease.- 2.4 Basic Clinical Features.- 2.4.1 Primary Trait.- 2.4.2 Prurigo.- 2.4.3 Lichenification.- 2.4.4 Eczematous Lesions.- 2.4.5 Correlation Between Itch and Major Features.- 2.5 Morphology and Distribution.- 2.5.1 Sites of Predilection.- 2.5.2 Head and Face.- 2.5.3 Body.- 2.5.4 Hands.- 2.5.5 Feet.- 2.6 Other Essential Features.- 2.6.1 Dry Skin.- 2.6.2 Photosensitivity.- 2.7 Special Clinical Types.- 2.7.1 Follicular Type.- 2.7.2 Inhalative (Hand) Eczema.- 2.8 Correlations Between Distribution and Pathomechanism.- 2.9 Complications Caused by Living Agents.- 2.9.1 Staphylococcal Infections.- 2.9.2 Viral Infections.- 2.9.3 Dermatophytosis and Candida.- 2.9.4 Scabies and House Dust Mite.- 2.9.5 Pityrosporon Orbiculare.- 2.10 Complication of the Malfunctioning Immunomechanisms.- 2.10.1 Atopic Erythroderma.- 2.10.2 Some Types of Cutaneous Lymphoma.- 2.10.3 Alopecia Areata and Vitiligo.- 2.11 Other Complications.- 2.11.1 Atopic Cataract.- 2.12 Associated Conditions; Proven Correlations.- 2.12.1 Atopic Correlations.- 2.12.2 Bronchial Asthma.- 2.12.3 Atopic Rhinoconjunctivitis.- 2.12.4 Oral Symptoms.- 2.12.5 Gastrointestinal Symptoms.- 2.13 Xerosis-Ichthyosis Group.- 2.14 Probable Correlations.- 2.14.1 Drug Reactions of the Immediate Type.- 2.14.2 Systemic Diseases (Related to Impaired Cell-Mediated Immunity).- 2.14.3 Certain Types of Urticaria.- 2.15 Possible Correlations.- 2.15.1 Some Genetic Disorders with Eczematous Lesions.- 2.15.2 Adult Celiac Disease/Dermatitis Herpetiformis.- 2.15.3 Other Conditions.- 2.16 Coexistence of AD with Common Skin Diseases.- References.- 3 Itch.- 3.1 Short Survey.- 3.1.1 Itch and Pain.- 3.1.2 Mediator of Itch.- 3.1.3 Nonchemical Stimuli.- 3.1.4 Itch and Late Cutaneous Reactions.- 3.2 Role of Itch in AD.- 3.2.1 Itch as the Essential Symptom of AD.- References.- 4 Histopathological and Laboratory Findings.- 4.1 Histopathological Findings.- 4.2 Laboratory Findings.- References.- 5 Pathomechanism: Genetic and Immunological Factors.- 5.1 Genetic Factors.- 5.1.1 Mode of Inheritance.- 5.1.2 Transmission of IgE and Other Features.- 5.1.3 Practical Consequences for the Clinician.- 5.2 Atopic Allergens.- 5.2.1 General Remarks.- 5.2.2 Skin Testing.- 5.2.3 Inhalants: Pollen.- 5.2.4 Inhalants: Animal Hair.- 5.2.5 Inhalants: Human Dandruff.- 5.2.6 Inhalants: House Dust and House Dust Mites.- 5.2.7 Inhalants: Molds.- 5.2.8 Other Inhalants.- 5.2.9 Inhalants Eliciting Contact Reaction.- 5.3 Foods.- 5.3.1 General Remarks.- 5.3.2 Food Reactivity.- 5.3.3 Frequent Food Allergens.- 5.3.4 Skin Reactivity.- 5.3.5 Challenge Tests.- 5.3.6 Late and Non-IgE-Mediated Food Reactions.- 5.3.7 Concluding Remarks.- 5.4 Other Allergens from Living Agents.- 5.4.1 Staphylococci and Other Bacteria.- 5.4.2 Dermatophytes and Candida.- 5.4.3 Scabies Mite, Insects, and Helminths.- 5.5 The Atopic Antibody.- 5.5.1 General Remarks.- 5.5.2 IgE in AD.- 5.5.3 RAST.- 5.5.4 Non-IgE Antibodies.- 5.5.5 Evaluation of Immediate Type Skin Reactions.- 5.6 Contact Reactivity.- 5.6.1 Allergic Contact Dermatitis.- 5.6.2 Irritative Contact Dermatitis.- 5.7 Delayed (Tuberculin-Type) Reactivity.- 5.7.1 In Vivo Reactivity.- 5.7.2 In Vitro Reactivity.- 5.7.3 Leukocytes and Monocytes.- 5.7.4 Antigen-Presenting Cells.- 5.7.5 Skin Infiltrate.- 5.7.6 Anti-Infectious Resistance.- 5.7.7 Cell-Mediated Immunity in Respiratory Atopies.- 5.8 Other Reaction Types.- 5.9 Concluding Remarks.- References.- 6 Pathomechanism: Cells and Mediators.- 6.1 Mast Cells and Histamine.- 6.1.1 Mast Cells.- 6.1.2 Histamine.- 6.1.3 Histamine Inhibition.- 6.2 Eosinophils and Their Products.- 6.3 Cyclic Nucleotides.- 6.3.1 Introduction.- 6.3.2 Conditions in Atopy/AD.- 6.3.3 Concluding Remarks.- 6.4 Eicosanoids.- 6.4.1 Prostaglandins.- 6.5 Complement.- 6.6 Other Mediators.- 6.6.1 Acetylcholine.- 6.6.2 Kinins.- 6.6.3 Miscellaneous.- References.- 7 Pathomechanism: The Altered Skin.- 7.1 Itch.- 7.2 Alteration of Skin Structure and Some Consequences.- 7.2.1 Epidermodermal Changes.- 7.3 Water Exchange.- 7.3.1 Sweat Secretion.- 7.3.2 Transepidermal Water Loss.- 7.3.3 Sebum Excretion.- 7.3.4 Skin Dryness.- 7.4 Paradoxical Vascular Responses.- 7.4.1 White Dermographism.- 7.4.2 Nicotinate Reactions.- 7.4.3 Delayed Blanch and Comments.- 7.4.4 Further Vascular Changes.- 7.5 Other Alterations.- 7.5.1 Pilomotor Reaction.- 7.5.2 Endocrine Alterations.- 7.6 Concluding Remarks.- References.- 8 Pathomechanism: Attempt at Synthesis.- 8.1 Animal Models.- 8.2 Attempt at Synthesis.- References.- 9 Factors Influencing the Course of AD.- 9.1 Seasonal Dependence.- 9.2 Climatic Factors.- 9.3 Some Environmental Factors.- 9.4 Socioeconomic Environment.- 9.5 Occupation.- 9.6 Psychological Factors.- 9.7 Other Factors.- 9.7.1 Military Service and Sports.- 9.7.2 Hormonal Influences.- 9.7.3 Infections.- 9.7.4 Problems with Schooling in Young AD Patients.- References.- 10 Diagnosis and Grading (Severity).- 10.1 Diagnostic Criteria.- 10.2 Differential Diagnosis.- 10.3 Grading (Severity).- References.- 11 Prophylaxis.- 11.1 Food Avoidance.- 11.1.1 Sensitization in Utero.- 11.1.2 Breast Feeding.- 11.1.3 Avoidance Diets.- 11.2 Inhalant Allergens.- 11.3 Occupational Prophylaxis.- 11.4 Other Measures.- References.- 12 Management of AD.- 12.1 Specific and Immunological Therapy.- 12.2 General Measures.- 12.2.1 Climatotherapy.- 12.2.2 Hospitalization.- 12.3 Systemic Therapy.- 12.3.1 Antipruritics.- 12.3.2 Anti-Inflammatory Agents.- 12.3.3 Light Therapy.- 12.3.4 Chromones.- 12.3.5 Essential Fatty Acids.- 12.3.6 Anti-Infectious Agents.- 12.4 Topical Therapy.- 12.4.1 Antipruritics and Tars.- 12.4.2 Topical Corticosteroids.- 12.4.3 Treatment of Acute Eczematous Reaction.- 12.4.4 Measures Against Dryness.- 12.4.5 Antibacterial and Antimycotic Agents.- 12.4.6 Special Points for Infantile Eczema.- 12.4.7 Newer Topical Therapy.- 12.5 Concluding Remarks.- References.