Aetiopathogenesis of atopic dermatitis

Jordaan, H.F.; Todd, Gail; Sinclair, Werner; Green, Robin J.

doi:10.7196/samj.8840

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…Atopic dermatitis There is increasing evidence that this is due to a defect in the barrier function of the skin. 3 In many atopic individuals, the genital area is spared, but vulval lichen simplex chronicus may be a manifestation of atopic dermatitis, either as isolated vulval disease or in association with disease at other sites. 4 Irritant contact dermatitis This is the commonest type of eczema to affect the vulva.…”

Section: Aetiologymentioning

confidence: 99%

2016 European guideline for the management of vulval conditions

Meijden

Boffa

Harmsel

et al. 2017

Acad Dermatol Venereol

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Vulval conditions may present to a variety of clinicians, such as dermatologists, gynaecologists and general practitioners.Women with these conditions are best managed by a multidisciplinary approach, which includes clear referral pathways between disciplines or access to a specialist multidisciplinary vulval service. Informed consent is a prerequisite for all examinations, investigations and treatments. Consent is particularly important for intimate examinations of the anogenital area, and a chaperone should be offered in all cases. All efforts should be made to maintain a patient's dignity. Depending on symptoms and risk factors, screening for sexually transmitted infections (STI) should be considered. If the patient presents with vulval itch, particularly if also complaining of increased vaginal discharge, vulvaginal candidiasis should be excluded. Sexual dysfunction should be considered in all patients with vulval complaints, either as the cause of the symptoms or secondary to symptoms, and assessed if appropriate. This guideline covers several aspects, such as diagnosis and treatment, of the more common vulval conditions (relatively) often encountered at vulval clinics, i.e. vulval dermatitis (eczema), psoriasis, lichen simplex chronicus, lichen sclerosus, lichen planus, vulvodynia and vulval intraepithelial neoplasia (VIN).

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Section: Aetiologymentioning

confidence: 99%

2016 European guideline for the management of vulval conditions

Meijden

Boffa

Harmsel

et al. 2017

Acad Dermatol Venereol

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“…Atopic dermatitis (AD) in both humans and dogs is influenced by both genetic and environmental factors as the aetiopathogenesis is very complex [3, 4]. The prevalence of AD in humans has nearly tripled during the past three decades in industrialized countries [5], and the trend seems to be similar in dogs.…”

Section: Introductionmentioning

confidence: 99%

Environmental and phenotype-related risk factors for owner-reported allergic/atopic skin symptoms and for canine atopic dermatitis verified by veterinarian in a Finnish dog population

2017

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The aim of this cross-sectional study was to observe whether environmental factors and phenotypic traits are associated with owner-reported skin problems and with veterinary diagnosed canine atopic dermatitis (CAD). Data were collected using the validated online DOGRISK questionnaire. Out of the data that the questionnaire provides for analysis, focus was first turned towards addressing questions regarding ‘Atopy/allergy (skin symptoms)’ using a total of 8643 dogs: 1585 dogs with owner-reported allergic/atopic skin symptoms and 7058 dogs without. A subsequent analysis compared dogs with veterinary-verified CAD (n = 322) as a case group against the 7058 dogs without owner-reported skin symptoms. The association between 21 factors related to the environment, canine phenotypes and breed groups within both populations were analysed using univariable and multivariable logistic regression. The environmental factors that showed a significant inverse association with the risk of owner-reported allergic/atopic skin symptoms were as following: whether the dog was living in a detached house, whether there were other dogs in the household, and whether the dog was born in the current household. Having over 50% white colour in the coat and living in an extremely clean household were significantly associated with an increased risk of owner-reported allergic/atopic skin symptoms. The five breeds demonstrating the highest proportion of owner-reported allergic/atopic skin symptoms were West Highland white terrier, Boxer, English bulldog, Dalmatian and French bulldog. The Fédération Cynologique Internationale dog breed groups 3 (Terriers) and 6 (Scent hounds and related breeds) showed a significantly higher risk for owner-reported allergic/atopic skin symptoms than mixed breed dogs. In the second population, the inverse association was observed between the risk of CAD and the presence of other dogs in the household, and whether the dog had been born in the current household. The results indicate that some environmental factors and canine phenotypes are associated with CAD and owner-reported skin symptoms, but they still do not prove causality.

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“…Concomitant or causative food allergy should be considered in those patients with a convincing history of food allergy and those with moderate-to-severe eczema that does not respond to appropriate and adequate topical treatment. [5] The diagnostic workup for IgE-mediated food allergy in the setting of eczema is the same as for IgE-mediated food allergy without eczema. Patients being worked up for eczema flares alone should be referred for full allergy assessment prior to considering any dietary modification.…”

Section: Atopic Dermatitis (Ad)mentioning

confidence: 99%

Non-IgE-mediated food allergies

Terblanche

Lang

Gray³

et al. 2014

S Afr Med J

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Non-imunoglobulin E (IgE)-mediated conditions include combined IgE and cell-mediated conditions such as atopic dermatitis (AD) and eosinophilic oesophagitis (EoE), and pure T-cell-mediated conditions such as food protein-induced enterocolitis syndrome (FPIES), allergic proctocolitis and enteropathy syndromes. Diagnostic tests in non-IgE-mediated food allergyDiagnosing mixed or non-IgE-mediated allergy is challenging. A clear cause-effect relationship between exposure to the suspected food and symptoms is not always possible, as symptoms develop over time and are more chronic in nature. Skin-prick tests (SPTs) and specific IgE (sIgE) to the allergen are usually negative. An elimination diet may be necessary to diagnose non-IgE-mediated type food allergy. The suspected allergen should be excluded from the diet for 2 -6 weeks under dietetic guidance to assess for improvement of symptoms. After symptom improvement, a rechallenge is necessary to definitively prove causal relation.Endoscopy with biopsies to show bowel inflammation is often helpful especially in EoE. Currently evidence for atopy patch testing (APT) is not convincing. [1][2][3] Combined IgE-and cell-mediated food allergic conditions Atopic dermatitis (AD)AD is associated with food allergy in 35% of children with moderateto-severe skin rash.[4] The majority of reactions are IgE-mediated and in those with reactions, approximately 10% (i.e. 3 -4% of total) have isolated flares of eczema without any IgE-mediated symptoms. The prevalence is much lower in patients with less severe disease and in adults.Investigations for food allergy are not routine in all cases of AD. Concomitant or causative food allergy should be considered in those patients with a convincing history of food allergy and those with moderate-to-severe eczema that does not respond to appropriate and adequate topical treatment.[5] The diagnostic workup for IgE-mediated food allergy in the setting of eczema is the same as for IgE-mediated food allergy without eczema. Patients being worked up for eczema flares alone should be referred for full allergy assessment prior to considering any dietary modification. Eczema patients are often multiply sensitised, but tolerant to those foods, so the diagnostic workup for food allergy triggering isolated flares of eczema centres primarily on elimination and rechallenge testing to prove causality. Eosinophilic oesophagitis (EoE)Multiple food allergens are implicated in this disorder manifested by feeding disorders, reflux symptoms, vomiting, dysphagia and food impaction. [1,6] The variety of symptoms is experienced mostly after eating. In children, the age of presentation influences the complex of symptoms. Very young children present with feeding difficulties and failure to thrive, older children present with vomiting and abdominal pain, and teenagers with dysphagia and food impaction. [7,8] Other allergic diseases are often present. Food allergens and aeroallergens may play a significant role in the pathophysiology. SPT, sIgE and APT may be used to help i...

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Aetiopathogenesis of atopic dermatitis

Cited by 12 publications

References 28 publications

2016 European guideline for the management of vulval conditions

2016 European guideline for the management of vulval conditions

Environmental and phenotype-related risk factors for owner-reported allergic/atopic skin symptoms and for canine atopic dermatitis verified by veterinarian in a Finnish dog population

Non-IgE-mediated food allergies

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