Nickel sensitivity and the course of atopic dermatitis in adulthood

[Adulthood atopic dermatitis: epidemiology, clinical symptoms, provoking and prognostic factors]

The prevalence of atopic diseases, including allergic rhinitis, asthma bronchiale and atopic dermatitis is increasing both in children and adults at different parts of the world. Atopic dermatitis is a chronic inflammatory skin disease affecting mostly children, but the atopic trait continues, not only for later respiratory allergies, but also for skin symptoms in adulthood. In this form dry skin, flexural lichenification, head and neck dermatitis, hand dermatitis are typical. The exact etiology of atopic dermatitis is unknown, in the background interactions of genetical predisposition, skin barrier defects and immunological and environmental factors can be verified. In the complex approach of atopic dermatitis, a pivotal role is ascribed to the evaluation and possibly the elimination of provoking factors, like gender, family structure, clothing, aero-, alimentary and contact allergens, psychosocial stress, migration, infections, and personal home environment. Authors review clinical manifestations, triggering and prognostic factors of the adulthood atopic dermatitis.

Contact sensitivity and atopic dermatitis: association with prognosis, a follow-up study in 801 atopic patients

The influence of contact sensitivities on the course of atopic dermatitis (AD) is not known. The objective of the study is to find the course of AD in atopic patients with and without contact sensitivities. A total of 801 atopic patients were studied and patch tested in 1983/84. A questionnaire focusing on the occurrence of dermatitis was sent to these patients 16 years later. During the follow up the number of symptom-free patients increased from 36.7% to 40.7%. In patients with positive patch-test reactions, 30.1% were symptom free in 1983/84 and 38.3% at the follow up (P= 0.001). Among those with positive patch-test reactions to fragrance mix and/or balsam of Peru, the number of symptom-free patients had increased the most: from 26.9% to 42.6% (P= 0.0095), and a similar tendency was seen among those with nickel allergy. The occurrence of dermatitis did not change among patients without contact sensitivities. Thus, the study concluded that contact allergy does not impair the prognosis of dermatitis in atopic patients.

Prognosis and prognostic factors in adult patients with atopic dermatitis: a long-term follow-up questionnaire study

BACKGROUND

Atopic dermatitis (AD) is a chronic relapsing skin disease. Several investigations concerning the long-term prognosis of AD among children and teenagers have been performed but there are only few data among adults.

OBJECTIVES

To investigate the prognosis and prognostic factors in adult patients with AD by a long-term follow-up (25-38 years). The prognostic factors were defined as those factors of importance for the persistence of AD.

PATIENTS AND METHODS

A follow-up questionnaire was sent in November/December 1998 to 922 AD patients examined in our outpatient clinic between 1960 and 1973 among 1366 registered patients with AD. The patients were aged 20 years or older when they visited the clinic and 45 years or older when they answered the follow-up questionnaire.

RESULTS

The response rate was 90.4%. The age range at the time of follow-up was 45-86 years (mean 55 years). Of the 833 patients who responded, 59% reported AD at some time during the last 12 months, which we defined as persistent AD. The mean value of clearance rate per person-years was 18%. One of the most important factors associated with persistence of AD was a head and neck dermatitis with or without other AD locations at the time of examination according to the old patient records.

CONCLUSIONS

This study showed that the majority of adults with AD still had AD when they became older. This applies particularly if negative prognostic factors existed.

Corrosion of three experimental AgMn-based casting alloys

OBJECTIVE

Alloys based on AgMn are being evaluated in our laboratory for their possible use as an alternative to Type III dental alloys. They respond to heat treatment and develop hardness values comparable to that of Type III alloys. The objective of the present research was to evaluate their corrosion characteristics.

METHODS

The three experimental silver-based alloys of the following composition (at%): (1) 63Ag37Mn, (2) 60Ag35Mn5Au and (3) 60Ag35Mn5Pd, were tested in their peak-hardened condition. Following 0.5 h open-circuit potential (OCP) measurement of each alloy in a phosphated buffer saline (PBS) solution, its current-potential profile was generated by the cyclic voltammetry technique within -1300 and +200 mV (SCE) at 1 mV s-1. In a separate test, the OCP of each alloy was monitored over a 24 h period.

RESULTS

Each of the three alloys showed ennoblement of their OCP over time due to dissolution of Mn and consequent enrichment with Ag (Au or Pd). At 24 h, the two ternary alloys were the most noble followed by the binary alloy. With respect to the cyclic voltammetry, oxidation of Ag was noted during forward scans at around 0 mV. The reverse scan was associated with a reduction current peak between -37 and -128 mV. The values for this peak, which is a measure of Ag oxidation, were highest (11.5 mA cm-2) for the binary alloy followed by the Au- (2.9 mA cm-2) and Pd-containing (0.04 mA cm-2) alloys, respectively. This indicates that, for equivalent concentration, Pd is more effective in reducing Ag corrosion than Au.

SIGNIFICANCE

Alloys based on the AgMn system are as hard as Type III dental alloys. Information on the corrosion characteristics of the AgMn-based alloys presented here is of value in further development of this alloy system.

Potential efficacy of low metal diets and dental metal elimination in the management of atopic dermatitis: an open clinical study

We performed an open clinical study on the effects of low metal diets and/or dental metal elimination on 27 patients with moderate to severe atopic dermatitis (AD), who showed positive patch tests for metal allergens and/or clinical exacerbation by oral provocation tests with metal salts. All the patients were recommended to ingest low metal diets for 3 months and/or undergo dental metal elimination. Marked or moderate improvement was noted in 18 patients (67%); 7 patients (26%) showed marked improvement and 11 patients (41%), moderate improvement. Nine patients (33%) showed minimal improvement or no change. In the patients who showed marked or moderate improvement, we observed statistically significant decreases (p < 0.05) in both peripheral blood eosinophil counts and serum LDH levels after 3 months of treatment. The present study suggests that restriction of ingested metal allergens to which patients have positive patch tests and/or oral challenge tests may be useful in the management of some patients with AD who have metal sensitivity.

Atopic dermatitis, nickel sensitivity and xerosis as risk factors for hand eczema in women

Knowledge of the relationship between a history of atopic dermatitis and nickel sensitivity as risk factors for hand eczema is limited. Our objective was to study the relative importance of atopic manifestations and nickel sensitivity as risk factors for hand eczema in women. From women referred for patch testing with a dental series, 100 consecutive nickel-positive and 95 nickel-negative patients were studied. A history of atopic manifestations and a history of 5 symptoms of hand eczema, i.e., dry erythemas, maculopapules, vesicles, erosions and hyperkeratoses were recorded. A history of atopic dermatitis was found to increase the risk of the 5 symptoms of hand eczema and sick leave due to hand eczema highly significantly. Nickel sensitivity increased only the risk of vesicles and erosions. Xerosis increased the risk of dry erythemas and vesicles. We concluded that a history of atopic dermatitis was more important than nickel sensitivity as a risk factor for hand eczema in women.