A novel mutation in IL36RN underpins childhood pustular dermatosis

Background

Chronic pustular dermatoses are severe and debilitating autoinflammatory conditions that can have a monogenic basis. Their clinical features are, however, complex with considerable overlap. Null and missense mutations in the genes encoding interleukin (IL)‐1 family (IL‐1 and IL‐36) anti‐inflammatory receptor antagonist (Ra) cytokines can underlie the development of severe pustular dermatoses.

Objective

We present a clinical and genetic study of four children of Pakistani descent with similar clinical presentations and treatment course, each of whom suffers from a severe pustular dermatosis, initially described as a pustular variant of psoriasis. We use DNA sequencing to refine the diagnosis of two of the children studied.

Methods

Bidirectional Sanger sequencing was performed on the coding regions of the IL‐1Ra and IL‐36Ra genes (IL1RN and IL36RN, respectively), for the four affected children and their parents.

Results

We identified a novel homozygous missense mutation in IL36RN in two siblings, and showed the molecular basis of the condition to be both distinct from psoriasis and distinct between the two families studied.

Conclusions

We describe a novel mutation which underpins the diagnosis of childhood pustular dermatosis. Molecular diagnostics can be used to aid the clinical diagnosis and potential treatment of autoinflammatory conditions.

The treatment of severe atopic dermatitis in childhood with narrowband ultraviolet B phototherapy

BACKGROUND

There is a lack of data regarding the use of narrowband ultraviolet B (NB-UVB) phototherapy in children with atopic dermatitis (AD). Many centres use this mode of treatment for children with AD; however, there have only been two previous studies observing the effect of NB-UVB in children with AD.

AIM

We undertook a retrospective review of children with severe eczema who had undergone NB-UVB consecutively in our department between 1999 and 2005.

METHODS

All children with AD who had undergone NB-UVB consecutively in our department between 1999 and 2005 were identified from the phototherapy database. Their clinical notes were reviewed for information on age, sex, skin type, minimal erythema dose (MED), adjuvant therapy, previous therapy, adverse effects, number of exposures, cumulative dose, response to treatment and length of remission.

RESULTS

In total, 50 children (83%) completed more than 10 exposures of NB-UVB. Complete clearance or minimal residual activity was achieved in 20 children (40%). A good improvement was achieved in a further 10 children (23%), and a moderate improvement in 13 (26%). Children with MEDs > 390 mJ/cm2 were more likely to clear, and this was found to be statistically significant (P = 0.02). Overall, the treatment was well tolerated and the median length of remission was 3 months.

CONCLUSION

NB-UVB is an effective treatment for children with severe AD. Children with MEDs > 390 mJ/cm2 are more likely to clear. Further studies are needed to evaluate the efficacy of NB-UVB and long-term safety in treating children with severe AD.

Photodynamic therapy for superficial basal cell carcinoma and Bowen's disease

Photodynamic therapy (PDT) is an effective treatment for superficial basal cell carcinoma (BCCs) and Bowen's disease. Several studies have reported complete response rates of 80-95% and an excellent cosmetic outcome. Bowen's disease and superficial basal cell carcinomas characteristically affect older patients who may also have associated difficulties with mobility. Using a portable PDT light source we were able to deliver PDT in a community setting with the aim of providing a more convenient service for patients. This randomised study confirmed that community delivered PDT is a viable treatment option and can be administered safely in the community by a trained dermatology nurse. The results from patient questionnaires suggest that community delivered PDT is more convenient to the patient, and also cost effective.

Allergic contact dermatitis in children: should pattern of dermatitis determine referral? A retrospective study of 500 children tested between 1995 and 2004 in one U.K. centre

BACKGROUND

Allergic contact dermatitis (ACD) increases with age, and a prevalence of between 13.3% and 24.5% has been reported. Patch testing infants may be particularly difficult, and false-positive reactions may occur.

OBJECTIVES

The purpose of this retrospective study was to determine whether the site of primary dermatitis in children could predict a diagnosis of ACD. The current frequency of sensitization in children was also evaluated and the main sensitizing substances among children were verified.

METHODS

Between 1995 and 2004, 500 children were patch tested and entered on to the patch test database at Leeds General Infirmary. Analysis of the database included identifying the presenting patterns of eczema and reviewing the patch test results for each child.

RESULTS

Of the children, 133 (27%) had one or more positive patch test result. The effect of age on the likelihood of a positive patch test was highly significant (P < 0.001). Girls were significantly more likely to have a positive patch test compared with boys: odds ratio for a positive test 0.62 (95% confidence interval 0.41-0.95; P = 0.029). Type IV allergy to nickel (33%) was the most frequent finding. Reactions to fragrance mix (18%), cobalt (11%), mercapto chemicals, Myroxylon pereirae and p-phenylenediamine (each 8%) were the next most common. No statistical significance was found in the relationship between the site of primary dermatosis and a positive patch test result.

CONCLUSIONS

The pattern of presenting dermatitis in children should not determine referral for patch testing. Any child with persistent eczema should be referred for patch testing.

Contact dermatoses in healthcare workers: reduction in type I latex allergy in a UK centre

Natural rubber latex (NRL) allergy has been recognized as a public health concern. NRL allergy frequently occurs in healthcare professionals. In this retrospective study we report the changing frequency of Type I NRL allergy amongst healthcare workers suffering from hand dermatitis referred to our department between 1996 and 2003. We identified 224 healthcare workers from the patch test database with a diagnosis of hand dermatitis who had undergone NRL skin prick testing (SPT). We report the SPT results, patch test results and diagnoses for each individual. The percentage of positive SPT to NRL in healthcare workers decreased from 62% in 1996 to 10% in 2003. Type IV allergy to fragrance mix (13%) was the most frequent cause of allergic contact dermatitis. Thiuram mix (8%) and carba mix (4%) were the most frequent indicators of type IV allergy to chemicals in rubber gloves. Fragrance allergy was the most frequent type IV allergen found in healthcare workers with hand dermatitis. We conclude that hand care preparations free from fragrance allergens should be available in all areas of clinical work.