Introdução: A dermatite atópica (DA) é uma doença cutânea inflamatória crônica que cursa em surtos. Possui manifestação clínica variável, mas o prurido e a xerose são características frequentes, e pode estar associada a outras manifestações extra-cutâneas de atopia. Pacientes com DA apresentam maior risco de infecções por bactérias e vírus, destacando-se a erupção variceliforme de Kaposi, causada por herpes simples. A DA mostra-se como exemplo de dermatose com comprometimento da barreira cutânea, aliado a disfunção imunológica. São descritas alterações das proteínas da barreira cutânea na DA (filagrina e claudinas ), relacionadas ao maior risco de infecção . Objetivo: Avaliar a expressão de proteínas relacionadas à barreira cutânea como a filagrina, e as claudinas -1 e -4 na pele de pacientes adultos com dermatite atópica, acompanhados no Departamento de Dermatologia da Faculdade de Medicina da Universidade de São Paulo. Métodos: 32 indivíduos com diagnóstico de DA (estabelecido pelos critérios de Hanifin & Rajka) e 23 controles (indivíduos sem DA), maiores de 18 anos, foram submetidos a biópsias cutâneas. Os indivíduos com DA foram biopsiados em dois pontos, tanto na pele lesada, quanto na pele não-lesada. O material obtido foi analisado por imuno-histoquímica, através de marcadores específicos para filagrina, claudina-1 e claudina-4. As lâminas foram digitalizadas pelo Panoramic Scan - 3DHistech - Hungria, e as imagens analisadas pelo software Image Pro Plus 4,5, quanto à intensidade da expressão do marcador. A espessura média da epiderme do local estudado foi também avaliada. O grupo com DA foi também analisado quanto à gravidade da doença (EASI), níveis séricos de IgE e grau de eosinofilia. Resultados: Houve redução da expressão da filagrina na pele de doentes de DA em relação aos controles, tanto na pele com lesão quanto na pele sem lesão. Demonstrou-se correlação inversa na expressão da filagrina, tanto com relação à gravidade da doença quanto à espessura da epiderme. A análise das claudinas -1 e -4 demonstrou redução de ambas na pele dos doentes de DA, mas não houve correlação com a gravidade, espessura da epiderme, níveis de IgE sérica ou eosinofilia. Conclusão: No adulto com dermatite atópica, existe redução da expressão das proteínas relacionadas à barreira cutânea, como a filagrina e as claudinas -1 e -4. A redução da expressão da filagrina relacionou-se inversamente com a gravidade da doença, e com a espessura da epiderme, sugerindo cronicidade das lesões. Houve redução da expressão das claudinas -1 e -4, sem relação com a gravidade da doença, espessura da epiderme, eosinofilia ou com os níveis séricos de IgE / Introduction: Atopic dermatitis (AD) is a chronic, inflammatory dermatosis with ocasional flares. Its clinical features are variable, but pruritus and xerosis are frequent, and the disease may be associated to extracutaneous atopy. Patients with AD have increased risk for bacterial or viral infection, with emphasis on eczema herpeticum due to herpes simplex. AD is an example of a compromised skin barrier, allied to na imune dysfunction. There are reports on efective proteins of the skin barrier (filaggrin and claudins), related to increased risk for infection. Objectives: To evaluate the expression of proteins related to the skin barrier, such filaggrin and claudins-1 and-4 in the skin of adults with AD, followed at the Department of Dermatology, University of Sao Paulo Medical School. Methods: 32 individuals diagnosed as AD, according to Hanifin & Rajka\'s criteria, and 23 non-atopic controls, above the age of 18, were biopsied. Individuals with AD were biopsied in two different sites (lesional and nonlesional skin). The specimens were analyzed by immunohistochemistry through specific markers for filaggrin, claudins 1 and 4. The slides were scanned utilizing Panoramic Scan - 3DHistech - Hungary, and images analyzed by Image Pro Plus 4,5 for the intensity of each marker. The mean epidermal thickness was also evaluated. AD patients were also analyzed for disease severity (EASI), circulating IgE levels and eosinophilia. Results: In lesional and nonlesional skin of AD patients there was a reduced expression of filaggrin, when compared to nonatopic controls. There was an inverse correlation of filaggrin expression with disease severity and epidermal thickness. In the skin of AD individuals, there was reduced expression of claudins 1-and-4, which did not correlate with disease severity, epidermal thickness or eosinophilia. Conclusion: In adults with AD, there is reduced expression of skin barrier proteins, such as filaggrin, claudins 1 and 4. The reduction of filaggrin expression had an inverse correlation with disease severity and epidermal thickness, suggesting disease chronicity. There was reduction of claudins 1 and 4, with no relation with disease severity, epidermal thickness, circulating IgE levels or eosinophilia

A dermatite atópica (DA) é uma dermatose inflamatória crônica que persiste no adulto em 40% dos casos. Foram avaliados 75 adultos com DA, utilizando um questionário geral (SF-36) e um específico (DLQI). O escore de gravidade empregado foi o EASI, e o prurido e a insônia foram avaliados por medidas subjetivas. Os aspectos emocionais da QV na DA foram os mais comprometidos, e quatro grupos, segundo o EASI e o SF-36 foram estabelecidos: I (16/75)-doença leve e menor comprometimento da QV; II (19/75)-doença leve e maior comprometimento da QV, com predomínio do sexo feminino; III (7/75)-doença grave e menor comprometimento da QV; IV (33/75)-doença grave e maior comprometimento da QV. Sugerimos que a QV deve ser cuidadosamente considerada quando utilizada como instrumento exclusivo de avaliação na DA no adulto / INTRODUCTION: Atopic dermatitis AD) is a chronic, inflammatory and pruritic dermatosis with an increasing prevalence in the last 30 years. It affects 2-7% of the adults, and may persist in adult life in 40% of the cases. Adults with AD suffer an impact generated with this disease in the physical and especially in the emotional aspects in their daily activities, social and familial dynamics, leading to financial and self-esteem losses. The aim of this study was to analyze the quality of life (QV) of these patients. METHODS: Seventy-five adult patients with AD were evaluated, utilizing a generic (SF-36) and a specific (DLQI)questionnaire. EASI was the severity score chosen, and pruritus and insomnia were evaluated by subjective measures. Patients were divided into four distinct groups, according to EASI and SF-36. RESULTS: The most compromised domains were related to the emotional aspects in SF-36, and symptoms and feelings in DLQI. Four groups, according to EASI and SF-36 were established: I (16/75)-mild disease and less QV compromise; II (19/75)-mild disease and more QV compromise, with predominance of women; III (7/75)-severe disease and less QV compromise; IV (33/75)-severe disease and more QV compromise. These groups did not show any correlation with age, educational level, income and time length of the disease. CONCLUSIONS: We suggest that QV must be carefully evaluated, when utilized as exclusive evaluation instrument in adult AD, once individual emotional aspects may masquerade its analysis.

Ching, Ka Wai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves [69-80]). / Abstract also in Chinese. / Abstract (in English) --- p.ii / Abstract (in Chinese) --- p.v / Acknowledgement --- p.viii / Table of Contents --- p.ix / List of Tables --- p.xii / List of Figures --- p.xiii / Glossary of Terms and Abbreviations --- p.xv / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Introduction of Atopic Eczema (AE) --- p.1 / Chapter 1.1.1 --- Definition and classification of AE --- p.1 / Chapter 1.1.2 --- Epidemiology --- p.3 / Chapter 1.1.2.1 --- The hygiene hypothesis --- p.5 / Chapter 1.2 --- Pathogenesis and Etiology --- p.6 / Chapter 1.2.1 --- Biphasic type-1/type-2 T-helper lymphocyte (Thl/Th2) immunological responses --- p.6 / Chapter 1.2.2 --- Nature and involvements of immunoglobin E (IgE) --- p.8 / Chapter 1.2.3 --- Microbial colonization --- p.9 / Chapter 1.2.4 --- Cytokines involvement --- p.10 / Chapter 1.2.5 --- Pruritus inducing neurotrophic factors --- p.11 / Chapter 1.2.6 --- "Food allergens, aeroallergens" --- p.12 / Chapter 1.2.7 --- Dysregulation of innate immune system --- p.13 / Chapter 1.2.7.1 --- Dysregulation of antimicrobial peptides --- p.14 / Chapter 1.2.7.2 --- Skin barrier impairment --- p.14 / Chapter 1.2.8 --- Genetic predisposition --- p.15 / Chapter 1.3 --- Assessments of Atopic Eczema (AE) --- p.17 / Chapter 1.3.1 --- AE severity assessment --- p.17 / Chapter 1.3.1.1 --- Scoring of atopic dermatitis (SCORAD) system --- p.17 / Chapter 1.3.1.2 --- Nottingham eczema severity score (NESS) --- p.20 / Chapter 1.3.2 --- Dermatological parameter - skin hydration (SH) and transepidermal water loss (TEWL) --- p.22 / Chapter 1.4 --- Chitinase (CHIA) --- p.22 / Chapter 1.4.1 --- Chitin and CHIA --- p.22 / Chapter 1.4.2 --- Association of acid mammalian chitinase (AMCase) with asthma --- p.23 / Chapter 1.4.3 --- Hygiene hypothesis implies: AMCase and allergy relationship --- p.24 / Chapter Chapter 2: --- Hypothesis and Objectives --- p.25 / Chapter 2.1 --- Hypothesis - based on CHIA involvements in canine AE --- p.25 / Chapter 2.2 --- Hypothesis --- p.25 / Chapter 2.3 --- Objective 226}0ؤ based on AMCase single nucleotide polymorphism (SNPs) in asthma susceptibility --- p.25 / Chapter 2.4 --- Objectives --- p.27 / Chapter Chapter 3: --- Methodology --- p.28 / Chapter 3.1 --- Recruitment of cases and controls --- p.28 / Chapter 3.2 --- Assessment of clinical parameters --- p.29 / Chapter 3.2.1 --- Scoring of atopic dermatitis (SCORAD) system --- p.29 / Chapter 3.2.2 --- Nottingham eczema severity score (NESS) --- p.29 / Chapter 3.2.3 --- Dermatologic parameters --- p.29 / Chapter 3.2.3.1 --- Cutaneous bacterial colonization --- p.29 / Chapter 3.2.3.2 --- Skin hydration (SH) and transepidermal water loss (TEWL) --- p.30 / Chapter 3.3 --- Peripheral blood collection and genomic deoxyribonucleic acid (DNA) extraction --- p.30 / Chapter 3.4 --- Acid mammalian chitinase (AMCase) polymorphism genotyping --- p.31 / Chapter 3.4.1 --- Polymerase chain reactions (PCR) amplification of AMCase gene --- p.31 / Chapter 3.4.1.1 --- List of PCR reagents --- p.32 / Chapter 3.4.1.2 --- Electrophoresis reagents --- p.33 / Chapter 3.4.2 --- Restriction fragment length polymorphism (RFLP) analysis of AMCase and confirmation with direct sequencing --- p.33 / Chapter 3.5 --- Statistical analysis --- p.34 / Chapter Chapter 4: --- Results and Data Analysis --- p.36 / Chapter 4.1 --- Results --- p.36 / Chapter 4.1.1 --- Demographic data of cases and controls --- p.36 / Chapter 4.1.2 --- PCR amplification and RFLP analysis of AMCase gene --- p.37 / Chapter 4.1.3 --- PCR cycle sequencing of the PCR fragments --- p.40 / Chapter 4.2 --- Data analysis --- p.41 / Chapter 4.2.1 --- Data overview --- p.41 / Chapter 4.2.2 --- Genotypes distribution of AMCase polymorphisms --- p.43 / Chapter 4.2.2.1 --- Allele frequency comparison of AMCase single nucleotide polymorphism (SNPs) by chi-square --- p.43 / Chapter 4.2.2.2 --- Allele frequency comparison of AMCase SNPs by logistic regression analysis --- p.44 / Chapter 4.2.3 --- Haplotype frequency estimation via maximum likelihood algorithm --- p.45 / Chapter 4.2.4 --- Association of AMCase polymorphism with Atopic Eczema (AE) clinical parameters --- p.47 / Chapter 4.2.4.1 --- Peripheral blood eosinophil counts --- p.48 / Chapter 4.2.4.2 --- Serum immunoglobin E (IgE) level --- p.49 / Chapter 4.2.4.3 --- Dermatologic factors --- p.49 / Chapter 4.2.4.3.1 --- Cutaneous Staphylococcus aureus colonization --- p.49 / Chapter 4.2.4.3.2 --- Skin hydration (SH) and transepidermal water loss (TEWL) --- p.50 / Chapter Chapter 5: --- Discussion --- p.52 / Chapter 5.1 --- Data overview --- p.52 / Chapter 5.2 --- AMCase rs3806448 polymorphism was significantly different among AE cases and controls --- p.53 / Chapter 5.2.1 --- Allele frequency comparison of AMCase SNPs polymorphisms by chi-square --- p.53 / Chapter 5.2.2 --- Allele frequency comparison of AMCase SNPs polymorphisms by logistic regression analysis --- p.54 / Chapter 5.2.3 --- The possible genetic modification by rs3806448 homozygous recessive genotype --- p.55 / Chapter 5.3 --- "Significant difference of haplotype frequency, 2212 among case-control comparison" --- p.56 / Chapter 5.4 --- Strong associations between AMCase SNPs polymorphisms and clinical parameters of AE --- p.57 / Chapter 5.4.1 --- Peripheral blood eosinophil counts --- p.57 / Chapter 5.4.2 --- Dermatologic factors --- p.58 / Chapter 5.4.2.1 --- Cutaneous Staphylococcus aureus colonization --- p.58 / Chapter 5.4.2.2 --- Skin hydration (SH) and transepidermal water loss (TEWL) --- p.59 / Chapter 5.5 --- Limitation of the present study --- p.59 / Chapter Chapter 6: --- Conclusion and Future Prospect --- p.62 / Chapter 6.1 --- Conclusion --- p.62 / Chapter 6.2 --- Future prospect --- p.62 / Chapter Chapter 7: --- Appendices --- p.64 / Chapter Chapter 8: --- References --- p.69

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

A dermatite atópica (DA) é uma dermatose inflamatória crônica que persiste no adulto em 40% dos casos. Foram avaliados 75 adultos com DA, utilizando um questionário geral (SF-36) e um específico (DLQI). O escore de gravidade empregado foi o EASI, e o prurido e a insônia foram avaliados por medidas subjetivas. Os aspectos emocionais da QV na DA foram os mais comprometidos, e quatro grupos, segundo o EASI e o SF-36 foram estabelecidos: I (16/75)-doença leve e menor comprometimento da QV; II (19/75)-doença leve e maior comprometimento da QV, com predomínio do sexo feminino; III (7/75)-doença grave e menor comprometimento da QV; IV (33/75)-doença grave e maior comprometimento da QV. Sugerimos que a QV deve ser cuidadosamente considerada quando utilizada como instrumento exclusivo de avaliação na DA no adulto / INTRODUCTION: Atopic dermatitis AD) is a chronic, inflammatory and pruritic dermatosis with an increasing prevalence in the last 30 years. It affects 2-7% of the adults, and may persist in adult life in 40% of the cases. Adults with AD suffer an impact generated with this disease in the physical and especially in the emotional aspects in their daily activities, social and familial dynamics, leading to financial and self-esteem losses. The aim of this study was to analyze the quality of life (QV) of these patients. METHODS: Seventy-five adult patients with AD were evaluated, utilizing a generic (SF-36) and a specific (DLQI)questionnaire. EASI was the severity score chosen, and pruritus and insomnia were evaluated by subjective measures. Patients were divided into four distinct groups, according to EASI and SF-36. RESULTS: The most compromised domains were related to the emotional aspects in SF-36, and symptoms and feelings in DLQI. Four groups, according to EASI and SF-36 were established: I (16/75)-mild disease and less QV compromise; II (19/75)-mild disease and more QV compromise, with predominance of women; III (7/75)-severe disease and less QV compromise; IV (33/75)-severe disease and more QV compromise. These groups did not show any correlation with age, educational level, income and time length of the disease. CONCLUSIONS: We suggest that QV must be carefully evaluated, when utilized as exclusive evaluation instrument in adult AD, once individual emotional aspects may masquerade its analysis.

Background: Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE). Objectives: To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE. Methods: Based on a systematic literature review, we developed an evidence-based severity-score-oriented treatment algorithm for AE and compared its effectiveness to that of an individualised symptom-oriented treatment (individual therapy) in a randomised controlled trial. Sixty-three participants were randomised to algorithm (n = 32) or individual therapy (n = 31) and treated accordingly for 12 months. Study end points included difference between baseline SCORAD and mean SCORAD under treatment (primary end point), quality of life and treatment utilisation. Analysis was by intention to treat (registration: ClinicalTrials.gov:NCT00148746). Results: No statistically significant differences in clinical or subjective response were observed between groups. Treatment following the algorithm and individual treatment both effectively controlled AE. Mean SCORAD reductions were 47% (95% confidence interval, CI = 38–55; algorithm) and 42% (95% CI = 29–54; individual). Clinical response was paralleled by improved quality of life in both groups. Physicians adhered to the algorithm option in 93% of their treatment decisions. Conclusion: Treatment following an evidence-based algorithm is an effective and applicable concept for the management of AE but does not show clear advantages compared to individualised treatment in a dermatological setting. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.