This study demonstrated that the EASI can be learned quickly and utilized reliably in the assessment of severity and extent of AD. There was consistency among the evaluators between consecutive days of evaluation. These results support the use of the EASI in clinical trials of therapeutic agents for AD.

The density and fine structure of the peripheral nerve system in various skin lesions of 64 patients with atopic dermatitis (AD) was quantitatively analyzed by immunohistochemical staining with antibodies directed against protein gene product (PGP) and substance P (SP). The density of PGP-positive peripheral nerves was 2.5 x 10(3) microns2/delta s (delta s = 0.24 mm2 selected area) in early acute lesions, 3.8 x 10(3) microns2/delta s in subacute lesions, 4.9 x 10(3) microns2/delta s in lichenified lesions and 7.1 x 10(3) microns2/delta s in prurigo lesions of AD. The density of nerve fibers in subacute, lichenified and prurigo lesions was significantly higher than in uninvolved skin of AD patients (2.0 x 10(3) microns2/delta s). Electron microscopically, bulging of axons with many mitochondria and a loss of their surrounding sheath of Schwann cells suggests that the free nerve endings in skin lesions of AD are in an active state of excitation. Many pinocytotic vesicles in the periphery of basal keratinocytes facing nerve endings which contained many neurovesicles suggests reciprocal effects between keratinocytes and nerve endings. The number of SP-positive nerve fibers in AD lesions was far less than one-tenth of the number of PGP-positive nerve fibers.

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To ascertain the prevalence of childhood and adolescent atopic dermatitis in a Japanese population, we clinically observed the total body of 5 to 6-year-old children (994 cases), 7 to 9-year-old children (1,240 cases), 10 to 12-year-old children (1,152 cases), 13 to 15-year-old children (1,670 cases), and 16 to 18-year-old adolescents (2,159 cases). The examination was performed in the spring of 1994-96, when exacerbation of childhood and adolescent atopic dermatitis most frequently occurs in Japan. Atopic dermatitis was observed in 24% of the 5 to 6-year group, in 19% of the 7 to 9-year group, in 15% of the 10 to 12-year group, in 14% of the 13 to 15-year group, and in 11% of the 16 to 18-year group. The prevalence of atopic dermatitis in 9 to 12-year-old children was two times and in 18-year-old adolescents five times as high as in similar age groups examined 20 years ago.

Recalcitrant erythema on the face of 21 adult patients with atopic dermatitis was histologically examined. All patients had been applying topical corticosteroids to the facial erythema for three years or more. The histopathology of the recalcitrant facial erythema was not homogeneous. Thus, the facial erythema was roughly classified into three categories: 1) erythema which mainly showed eczematous changes, 2) erythema which mainly showed steroid-induced rosacea-like changes, and 3) erythema which showed both eczematous changes and steroid-induced rosacea-like changes. The majority (75%) of recalcitrant facial erythema belonged to the third category.

Deposition of eosinophil granule major basic protein (MBP) often occurs in acute and chronic lesions of atopic dermatitis, but it is not clear what the factors may be that are related to the MBP deposition in some skin lesions of the disease. The purpose of this study was to determine whether a personal or family history of respiratory atopy is related to the intensity of MBP deposition in acute lesions. We immunohistochemically stained biopsy specimens from acute, non-oozing indurated erythematous lesions of atopic dermatitis with BMK-13, a monoclonal antibody which recognizes MBP. The subjects were 40 adult patients with atopic dermatitis. Of the 40 patients, 22 had a personal history of respiratory atopy, 8 had a family history of respiratory atopy, and 10 had neither a personal nor a family history of respiratory atopy. Deposition of MBP was observed in the specimens from 24 (60%) of the 40 patients examined. Furthermore, there were great individual differences in the intensity of MBP deposition. A strong MBP deposition was often seen in specimens from patients with atopic dermatitis who had a personal or family history of respiratory atopy, but was absent in specimens from those patients with atopic dermatitis who had neither a personal nor a family history of respiratory atopy. We conclude that a strong MBP deposition seems to occur in acute lesions of those patients with atopic dermatitis who have a predisposition to respiratory atopy.

To investigate the prevalence of infantile and early childhood eczema in a Japanese population, we clinically inspected the entire bodies of 4-month-old infants (341 cases), 10-month-old infants (339 cases) and 3-year-old children (341 cases). The examination was performed in spring, when exacerbations of infantile and childhood eczema most frequently occur in Japan. Eczema was observed in 30-31% of the infants, and in 20% of the 3-year-old children. The prevalence was almost the same as in similar age groups that we examined 20 years ago.

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