Atopic dermatitis (AD) is one of the most common chronic dermatological diseases. It has affected up to a fifth of schoolchildren and their caregivers. It will alter not only children’s physical health, but also worsen the quality of life among children and their family. This global public health problem also increased the financial and social burden to healthcare system in the past decades. Educational intervention has been proved to be an adjunct to current treatment to restore the altered quality of life and skin condition effectively. It could be simply carried out by trained nurses in the routine practice to educate patients about proper AD management. However, such intervention is seldom mentioned in the local setting. Therefore, it is essential to establish an effective evidence-based guideline of nursing consultation in order to enhance patients’ clinical outcomes. The objectives of this study are to search and synthesize current literatures systematically in educational interventions for AD children for reducing disease severity and improving quality of life, to assess the implementation potential of identified educational interventions, to develop an evidence-based guideline of nursing consultation for providing better skin care to the AD children and to develop the implementation and evaluation plan the proposed intervention. Nursing consultation session for AD children is proposed in this study. The target population and setting are AD children aged from 4-16 years attending to one of the local public dermatological outpatient clinics. Evidence and relevant data are yielded from eight high-quality studies. The potential of implementing the proposed intervention is assessed based on the transferability of the findings, feasibility and the cost-benefit ratio. An evidence-based guideline is eventually developed with the best evidence-based findings. At last, an implementation plan and evaluation plan for the proposed guideline are well designed. This evidence-based guideline is designed to improve the quality of life and reduce the severity of skin condition of AD children. It is recommended to establish to all dermatological outpatient clinics locally. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Faculty of Health Sciences, WITS University, as partial fulfillment for the requirements of the degree of Master of Medicine in Dermatology Johannesburg 2017 / Introduction: Atopic Dermatitis (AD) is a chronic relapsing inflammatory skin condition affecting 5-20% of children under 11 years of age, characterised by intense pruritus, redness and discomfort. Research suggests that AD has been shown in quality of life assessments to be rated among the worst in term of its effect on sleep. There is no research on the effects of sleep loss on the natural history and time course of skin disorders either, especially in South Africa. Aims: The objectives of this study were: 1. to describe the various sleep disturbances associated with AD in children up to and including 12 years of age and 2. to compare the characteristics of children with sleep problems to those without sleep problems in AD Patients and Methods: This was a prospective observational / descriptive hospital based study conducted at the paediatric dermatology outpatient department at Chris Hani Baragwanath Academic Hospital (CHBAH). Questionnaire technique was used consisting of the children’s sleep habits questionnaire (CSHQ), a useful parent-reported instrument validated to identify both behaviourally based and medically based sleep problems in 4-12 years old school age children. Results: The prevalence of sleep problems in paediatric patients with AD was found to be 61.3%. There was no significant difference between males and females. Snoring as well as apnoea and snorting were significantly different in the rhinitis versus non-rhinitis group. The overall sleep disturbance rate was significantly different in those with rhinitis versus those without. Conclusions: While Atopic Dermatitis is often regarded by health professionals as a minor problem, in this study, 61.3% of children with AD have disturbed sleep. / MT2017

Atopic eczema is a common condition that can interfere with social function, sleep and employment. Its persistence and accompanying pruritis may be stressful and frustrating for patients (Zug and McKay 1996 : 1243). The purpose of this randomised, double-blind, placebo-controlled study was to evaluate the efficacy of a homoeopathic complex (Arsenicum album 12CH, Graphites 12CH, Petroleum 12CH, Rhus toxicodendron 12CH, Sulphur 12CH and Urtica urens 12CH), in the treatment of atopic eczema in terms of its clinical manifestations and the impact on the quality of life of the patient. Thirty patients between the ages of eighteen and sixty years who met the Diagnostic criteria (Appendix A), were selected to participate in this study. Simple random sampling was used to divide them into two equal groups of fifteen i.e. the treatment group (Group 1) and the placebo group (Group 2). The trial lasted three months; at the initial consultation patients filled in the Clinical Evaluation Index (Appendix C), the Patients’ Perception questionnaire (Appendix D) and the General Well Being Schedule (Appendix E). Patients then received their three months supply of medication or placebo. Patients returned after three weeks and filled in the questionnaires and repeated this procedure every two weeks until the end of the trial. This amounted to six consultations per patient. Statistical evaluation of the data obtained from the questionnaires were analysed using the SPSS ver. 9 package. The Friedman test and Wilcoxon signed rank test were used to analyse the intra group comparisons. These are non parametric tests. The Mann-Whitney U-test was used for the inter group comparison. Both groups showed improvements with regards to all three questionnaires. The placebo group showed consistent improvement throughout the study. Therefore, statistically there was no difference between the two groups. The results of this study demonstrated that the use of a homoeopathic complex (Arsenicum album 12CH, Graphites 12CH, Petroleum 12CH, Rhus toxicodendron 12CH, Sulphur 12CH and Urtica urens 12CH) was no more effective than the placebo in the treatment of atopic eczema. / Dr. M. R. A. Moiloa Dr. D. Naude Dr. C. Hall

Skin and nasal bacterial dysbiosis is common in children with atopic dermatitis (AD). However, there is limited data of these bacterial changes in sub-Saharan children with AD. Therefore, this study investigated the bacterial alterations in skin and nasal bacterial communities in AD compared to healthy children in rural and urban South African settings. Staphylococcus aureus was more common in children with AD (cases) than healthy children (controls). S. aureus carriage was also associated with increased disease severity. Using spa typing, we also showed that cases and controls were colonised by distinct spa types. This led us to comprehensively explore genomic differences of S. aureus in cases and controls using whole-genome sequencing. Here, we showed that S. aureus strains from cases and controls had distinct genomic features, with cases harbouring genes associated with antibiotic resistance, DNA damage repair and virulence while controls had genes associated with adhesion. Recent reports indicate the potential role of coagulase-negative Staphylococcus (CoNS) in AD pathology. This study found that CoNS and S. aureus were commonly co-carried on nonlesional skin among cases (regardless of location) and anterior nares among urban cases than the control group. The carriage of S. capitis on nonlesional skin and anterior nares was positively associated with more severe disease in both rural and urban cases. 16S rDNA amplicon sequencing analysis revealed that bacterial diversity was higher on the nonlesional skin and anterior nares of controls. Bacterial community structure differed on lesional skin, nonlesional skin and anterior nares based on AD disease status. The relative abundance of Streptococcus, Granulicatela, Veillonella and Prevotella was high in lesional skin specimens, Anoxybacillus and Cutibacterium on nonlesional skin, and Staphylococcus, Veillonella and Sphingomonas in the anterior nares among cases Overall, the findings presented in this thesis indicate that S. aureus and other CoNS, particularly S. capitis, may predominate among cases and are associated with increased disease severity. However, the increased relative abundance of genera such as Streptococcus, especially among skin samples, indicates that other bacterial genera may be contributing to disease activity on lesional skin in AD than the traditionally reported Staphylococcus.

M.A. (Clinical Psychology) / The purpose of this study was to determine whether a behavioural intervention could reduce scratching behaviour in atopic dermatitis. The literature dealing with the psychological aspects, and existing approaches to the treatment of atopic dermatitis and related dermatoses was reviewed. It was hypothesized that if subjects with atopic dermatitis were able to reduce their scratching behaviour they would show a corresponding reduction in size of identified lesions. In order to test these hypotheses, SUbjects with atopic dermatitis participated in a self-control programme lasting between eight and ten weeks. Of the seven subj ects that originally started the programme, four completed it. SUbjects' self-monitoring details reflected changes in scratching behaviour, and a specially designed grid was used to measure changes in lesion size. Inspection of the data showed that two SUbjects eliminated their scratching behaviour and lesions entirely; the other two showed marked reduction. The results of this study indicate that self-control procedures could be usefully applied as adjuncts to the conventional dermatological management of atopic dermatitis.

No description available.

Atopic dermatitis, AD (synonym eczema) is a chronic inflammatory skin disease. It affects between 10 to 20% of children and 1 to 3% of adults worldwide. It is an important cause of morbidity and is estimated to cost £465 million per annum to the UK. AD is part of a family of Th-2 driven diseases and is often the first of these atopic diseases to manifest. The development of AD is often followed by asthma and allergic rhinitis later in life (a phenomenon known as the ‘atopic march’). Up to 50% of moderate to severe AD cases have been associated with genetic mutations affecting the epidermal barrier protein filaggrin. Filaggrin aggregates keratin filaments during terminal keratinocyte differentiation, allowing normal epidermal stratification. The role of filaggrin in maintaining a functional skin barrier is further supported by a clinical study conducted by ourselves. This is the first clinical study on a European cohort (58 participants) which showed that FLG mutations were associated with experimentally demonstrable defects of skin barrier function (increased baseline transepidermal water loss), more so following exposure to a chemical irritant. However, the majority of patients with AD, especially the milder cases, do not have FLG mutations. Some of the wild-type patients in our study were noticed to have accumulation of the large filaggrin proprotein and a lack of filaggrin monomers, indicating defective proteolysis of profilaggrin into the functional monomers. Our study also found disproportionately raised protease inhibitory activities amongst the AD participants. This inappropriately raised protease inhibition may interfere with profilaggrin proteolysis, leading to the development of AD in some wild-type patients. Having demonstrated that deficiency of filaggrin monomers is associated with a defective skin barrier, we focused on the function of filaggrin in the skin and attempted to improve the skin barrier function. In addition to keratin aggregation, filaggrin constitutes the natural moisturizing factors in the epidermis following its natural breakdown into amino acids. We note that filaggrin is disproportionately rich in amino acid histidine, implying that this amino acid may have a particular significance in maintaining a functional epidermal barrier. Using an in-house skin-equivalent model, we have shown that by increasing the histidine content in the cell culture media, we could increase the expression of filaggrin monomers and reduce the penetration of a fluorescent dye into the skin-equivalents. The latter indicates improved barrier function. Finally, we conducted a pilot human study which showed that histidine, when applied to mechanically damaged skin in AD and healthy participants, was associated with a faster recovery of the skin barrier function. These studies suggest that histidine is of therapeutic benefits in AD. A histidine-based treatment may be developed as an alternative to current anti-inflammatory and immunosuppressive agents used to treat AD.

In general, AD is diagnosed based on Hanifin and Rajka's diagnostic criteria or the UK working diagnostic criteria. The atopic status of study participants was evaluated clinically by (1) the presence of atopic symptoms including allergie rhinitis, asthma or hyperactive airway disease in patients, parents, and/or siblings, (2) measuring the concentrations of total and allergen-specific IgE in their peripheral blood, and/or (3) positive skin prick tests to common aeroallergens or food allergens. The severity of AD was assessed either clinically by validated disease scores, objective serum parameters such as serum chemokine levels, or physiological parameters such as nocturnal wrist movements. Quality of life (QoL) is assessed with the Cantonese version of the Children's Dermatology Life Quality Index (CDLQI). Although not a gold standard, ail assessment tools were compared against SCORAD. / Research Hypotheses or aims: (1) To investigate if AD severity as determined by a 12-month-severity score correlates with a validated acute severity score. The research aims to establish a chronic severity scores for local use in AD research. (2) To explore if correlations exist between objective and subjective symptoms. (3) To evaluate if quality of life (QoL) correlates with disease severity. (4) To assess if age and gender may affect quality of life. (5) To explore if serum markers (CTACK, IL-18, BDNF, and substance P.) correlate with disease severity or quality of life score. (6) To evaluate if urine LTE4 as a non-serum marker correlates with disease severity. (7) To evaluate if nocturnal wrist movements correlate with various clinical and laboratory markers. (8) To evaluate if skin hydration (SH) and transepidermal water loss (TEWL) correlate with severity and QoL. (9) In a final chapter, we give a number of clinical studies to illustrate the application of these methods in clinical research. / The objectives of the MD thesis are to explore various clinical scores, quality of life evaluation, laboratory tests, and mechano-physiological parameters as assessment tools for the evaluation of AD. The research hypotheses are that many aspects of the disease can be objectively measured by these new scores and markers. The application of some of these assessment tools in clinical trials will be described. In all of the studies reported, I am the principal investigator and the first author of the publications in indexed medical journals. / Kam Lun Ellis Hon. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3419. / Thesis (M.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 192-213). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Thesis (M. Med. Sc.)--University of Hong Kong, 2008.