THE OFFICIAL PATIENT’S SOURCEBOOK
on
TOPIC ERMATITIS J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Atopic Dermatitis: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83159-9 1. Atopic Dermatitis-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
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Dedication To the healthcare professionals dedicating their time and efforts to the study of atopic dermatitis.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to atopic dermatitis. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to atopic dermatitis, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Acne
·
The Official Patient's Sourcebook on Acne Rosacea
·
The Official Patient's Sourcebook on Behçet Syndrome
·
The Official Patient's Sourcebook on Epidermolysis Bullosa
·
The Official Patient's Sourcebook on Lichen Sclerosus
·
The Official Patient's Sourcebook on Lyme Disease
·
The Official Patient's Sourcebook on Psoriasis
·
The Official Patient's Sourcebook on Raynaud's Phenomenon
·
The Official Patient's Sourcebook on Scleroderma
·
The Official Patient's Sourcebook on Sjogren's Syndrome
·
The Official Patient's Sourcebook on Vitiligo
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON ATOPIC DERMATITIS: GUIDELINES . 9
Overview............................................................................................................... 9 What Is Atopic Dermatitis? ............................................................................... 10 Types of Eczema (Dermatitis) ............................................................................ 12 Symptoms of Atopic Dermatitis ......................................................................... 12 Stages of Atopic Dermatitis................................................................................ 14 Diagnosing Atopic Dermatitis ........................................................................... 15 Treating Atopic Dermatitis ................................................................................ 20 Skin Care............................................................................................................. 20 Treating Atopic Dermatitis in Infants and Children ......................................... 21 Medications and Phototherapy ........................................................................... 21 Tips for Working with Your Doctor ................................................................... 23 Atopic Dermatitis and Quality of Life................................................................ 24 Controlling Atopic Dermatitis ........................................................................... 25 Current Research ................................................................................................ 25 Additional Resources .......................................................................................... 28 More Guideline Sources ..................................................................................... 29 Vocabulary Builder............................................................................................. 36
CHAPTER 2. SEEKING GUIDANCE ....................................................... 41
Overview............................................................................................................. 41 Associations and Atopic Dermatitis................................................................... 41 Finding More Associations................................................................................. 44 Finding Doctors.................................................................................................. 46 Finding a Dermatologist..................................................................................... 47 Selecting Your Doctor ........................................................................................ 48 Working with Your Doctor ................................................................................ 48 Broader Health-Related Resources ..................................................................... 50
CHAPTER 3. CLINICAL TRIALS AND ATOPIC DERMATITIS ................. 51
Overview............................................................................................................. 51 Recent Trials on Atopic Dermatitis.................................................................... 54 Benefits and Risks............................................................................................... 55 Keeping Current on Clinical Trials.................................................................... 58 General References.............................................................................................. 59 Vocabulary Builder............................................................................................. 60
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 61 CHAPTER 4. STUDIES ON ATOPIC DERMATITIS................................... 63
Overview............................................................................................................. 63 The Combined Health Information Database ..................................................... 63 Federally-Funded Research on Atopic Dermatitis ............................................. 72 E-Journals: PubMed Central .............................................................................. 77 The National Library of Medicine: PubMed ...................................................... 77 Vocabulary Builder............................................................................................. 87
CHAPTER 5. PATENTS ON ATOPIC DERMATITIS ................................. 95
Overview............................................................................................................. 95 Patents on Atopic Dermatitis ............................................................................. 96 Patent Applications on Atopic Dermatitis ....................................................... 101 Keeping Current ............................................................................................... 102 Vocabulary Builder........................................................................................... 103
CHAPTER 6. BOOKS ON ATOPIC DERMATITIS ................................... 105
Overview........................................................................................................... 105 Book Summaries: Federal Agencies .................................................................. 105 Book Summaries: Online Booksellers ............................................................... 107 The National Library of Medicine Book Index ................................................. 108 Chapters on Atopic Dermatitis......................................................................... 111 General Home References ................................................................................. 113
CHAPTER 7. MULTIMEDIA ON ATOPIC DERMATITIS ........................ 115
Overview........................................................................................................... 115 Bibliography: Multimedia on Atopic Dermatitis ............................................. 115 Vocabulary Builder........................................................................................... 118
CHAPTER 8. PERIODICALS AND NEWS ON ATOPIC DERMATITIS ..... 121
Overview........................................................................................................... 121 News Services & Press Releases ....................................................................... 121 Newsletter Articles ........................................................................................... 131 Academic Periodicals covering Atopic Dermatitis ........................................... 134 Vocabulary Builder........................................................................................... 135
CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 137
Overview........................................................................................................... 137 NIH Guidelines................................................................................................. 137 NIH Databases.................................................................................................. 138 Other Commercial Databases ........................................................................... 143 The Genome Project and Atopic Dermatitis..................................................... 143 Specialized References....................................................................................... 148 Vocabulary Builder........................................................................................... 149
CHAPTER 10. DISSERTATIONS ON ATOPIC DERMATITIS .................. 151
Overview........................................................................................................... 151
Contents
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Dissertations on Atopic Dermatitis.................................................................. 151 Keeping Current ............................................................................................... 152
PART III. APPENDICES .................................................. 153 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 155
Overview........................................................................................................... 155 Your Medications: The Basics .......................................................................... 156 Learning More about Your Medications .......................................................... 157 Commercial Databases...................................................................................... 160 Contraindications and Interactions (Hidden Dangers) ................................... 161 A Final Warning .............................................................................................. 162 General References............................................................................................ 163 Vocabulary Builder........................................................................................... 164
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 165
Overview........................................................................................................... 165 What Is CAM? ................................................................................................. 165 What Are the Domains of Alternative Medicine?............................................ 166 Can Alternatives Affect My Treatment? ......................................................... 169 Finding CAM References on Atopic Dermatitis .............................................. 170 Additional Web Resources................................................................................ 181 General References............................................................................................ 189
APPENDIX C. RESEARCHING NUTRITION ......................................... 191
Overview........................................................................................................... 191 Food and Nutrition: General Principles........................................................... 192 Finding Studies on Atopic Dermatitis ............................................................. 196 Federal Resources on Nutrition........................................................................ 200 Additional Web Resources................................................................................ 201 Vocabulary Builder........................................................................................... 201
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 203
Overview........................................................................................................... 203 Preparation ....................................................................................................... 203 Finding a Local Medical Library ...................................................................... 204 Medical Libraries Open to the Public............................................................... 204
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 211
Overview........................................................................................................... 211 Your Rights as a Patient................................................................................... 211 Patient Responsibilities .................................................................................... 215 Choosing an Insurance Plan............................................................................. 216 Medicare and Medicaid .................................................................................... 218 NORD’s Medication Assistance Programs ..................................................... 221 Additional Resources ........................................................................................ 222
ONLINE GLOSSARIES.................................................... 225
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Contents
Online Dictionary Directories.......................................................................... 228
ATOPIC DERMATITIS GLOSSARY ............................ 229 General Dictionaries and Glossaries ................................................................ 245
INDEX................................................................................... 247
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don't know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Atopic Dermatitis
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor's offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Atopic Dermatitis has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to atopic dermatitis, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on atopic dermatitis. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on atopic dermatitis should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching atopic dermatitis (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to atopic dermatitis. It also gives you sources of information that can help you find a doctor in your local area specializing in treating atopic dermatitis. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with atopic dermatitis. Part II moves on to advanced research dedicated to atopic dermatitis. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on atopic dermatitis. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with atopic dermatitis or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with atopic dermatitis. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with atopic dermatitis.
Scope While this sourcebook covers atopic dermatitis, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that atopic dermatitis is often considered a synonym or a condition closely related to the following: ·
Atopic Eczema
·
Atopic Neurodermatitis
4
Atopic Dermatitis
·
Besnier Prurigo
·
Besnier's Prurigo
·
Constitutional Dermatitis
·
Constitutional Eczema
·
Dermatitis - Atopic
·
Disseminated Neurodermatitis
·
Eczema
·
Eczema - Atopic
·
Eczema - Infantile
·
Infantile Eczema
In addition to synonyms and related conditions, physicians may refer to atopic dermatitis using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world's illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for atopic dermatitis:4 ·
691 atopic dermatitis and related conditions
·
691.0 diaper or napkin rash
·
691.8 other atopic dermatitis and related conditions
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to atopic dermatitis. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson's approach to understanding and 4 This list is based on the official version of the World Health Organization's 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with atopic dermatitis will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with atopic dermatitis is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of atopic dermatitis, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
7
PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on atopic dermatitis. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of atopic dermatitis to you or even given you a pamphlet or brochure describing atopic dermatitis. Now you are searching for more indepth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON ATOPIC DERMATITIS: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on atopic dermatitis. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on atopic dermatitis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on atopic dermatitis. Originally founded in 1887, the NIH is one of the world's foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world's most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Atopic Dermatitis
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with atopic dermatitis and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc. ) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines at http://www.nih.gov/niams/healthinfo/
Among those listed above, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is especially noteworthy. The mission of NIAMS, a part of the National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. The NIAMS provides the following guideline concerning atopic dermatitis.6
What Is Atopic Dermatitis?7 Atopic dermatitis is a chronic (long-lasting) disease that affects the skin. The word “dermatitis” means inflammation of the skin. “Atopic” refers to a group of diseases that are hereditary (that is, run in families) and often occur together, including asthma, allergies such as hay fever, and atopic dermatitis. In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, cracking, weeping, crusting, and scaling. Atopic dermatitis most often affects infants and young children, but 6 This and other passages are adapted from the NIH and NIAMS (http://www.niams.nih.gov/hi/index.htm). “Adapted” signifies that the text is reproduced with attribution, with some or no editorial adjustments. 7 Adapted from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): http://www.niams.nih.gov/hi/topics/dermatitis/index.html.
Guidelines 11
it can continue into adulthood or first show up later in life. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis will experience a permanent remission of the disease when they get older, although their skin often remains dry and easily irritated. Environmental factors can bring on symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait. Atopic dermatitis is often referred to as “eczema,” which is a general term for the many types of dermatitis. Atopic dermatitis is the most common of the many types of eczema. Several have very similar symptoms. Types of eczema are described in the box below. Atopic dermatitis is very common. It affects males and females equally and accounts for 10 to 20 percent of all referrals to dermatologists (doctors who specialize in the care and treatment of skin diseases). Atopic dermatitis occurs most often in infants and children and its onset decreases substantially with age. Scientists estimate that 65 percent of patients develop symptoms in the first year of life, and 90 percent develop symptoms before the age of 5. Onset after age 30 is less common and often occurs after exposure of skin to harsh conditions. People who live in urban areas and in climates with low humidity seem to be at an increased risk for developing atopic dermatitis. Although it is difficult to identify exactly how many people are affected by atopic dermatitis, an estimated 10 percent of infants and young children experience symptoms of the disease. Roughly 60 percent of these infants continue to have one or more symptoms of atopic dermatitis into adulthood. This means that more than 15 million people in the United States have symptoms of the disease. The cause of atopic dermatitis is not known, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. Evidence suggests the disease is associated with other so-called atopic disorders such as hay fever and asthma, which many people with atopic dermatitis also have. In addition, many children who outgrow the symptoms of atopic dermatitis go on to develop hay fever or asthma. Although one disorder does not cause another, they may be related, thereby giving researchers clues to understanding atopic dermatitis. In the past, doctors thought that atopic dermatitis was caused by an emotional disorder. We now know that emotional factors, such as stress, can
12 Atopic Dermatitis
make the condition worse, but they do not cause the disease. Also, atopic dermatitis is not contagious; it cannot be passed from one person to another.
Types of Eczema (Dermatitis) ·
Atopic dermatitis: a chronic skin disease characterized by itchy, inflamed skin
·
Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, a cleaning agent, or other chemical
·
Allergic contact eczema (dermatitis): a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions
·
Seborrheic eczema: yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body
·
Nummular eczema: coin-shaped patches of irritated skin—most common on the arms, back, buttocks, and lower legs—that may be crusted, scaling, and extremely itchy
·
Neurodermatitis: scaly patches of skin on the head, lower legs, wrists, or forearms caused by a localized itch (such as an insect bite) that becomes intensely irritated when scratched
·
Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems
·
Dyshidrotic eczema: irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn
Symptoms of Atopic Dermatitis Symptoms vary from person to person. The most common symptoms are dry, itchy skin; cracks behind the ears; and rashes on the cheeks, arms, and legs. The itchy feeling is an important factor in atopic dermatitis, because scratching and rubbing in response to itching worsen the skin inflammation characteristic of this disease. People with atopic dermatitis seem to be more sensitive to itching and feel the need to scratch longer in response. They develop what is referred to as “the itch-scratch cycle”: The extreme itchiness of the skin causes the person to scratch, which in turn worsens the itch, and
Guidelines 13
so on. Itching is particularly a problem during sleep, when conscious control of scratching decreases and the absence of other outside stimuli makes the itchiness more noticeable. The way the skin is affected by atopic dermatitis can be changed by patterns of scratching and resulting skin infections. Some people with the disease develop red, scaling skin where the immune system in the skin is becoming very activated. Others develop thick and leathery skin as a result of constant scratching and rubbing. This condition is called lichenification. Still others develop papules, or small raised bumps, on their skin. When the papules are scratched, they may open (excoriations) and become crusty and infected. The box below lists common skin features of the disease. These conditions can also be found in people without atopic dermatitis or with other types of skin disorders. Atopic dermatitis may also affect the skin around the eyes, the eyelids, and the eyebrows and lashes. Scratching and rubbing the eye area can cause the skin to change in appearance. Some people with atopic dermatitis develop an extra fold of skin under their eyes, called an atopic pleat or DennieMorgan fold. Other people may have hyperpigmented eyelids, meaning that the skin on their eyelids darkens from inflammation or hay fever (allergic shiners). Patchy eyebrows and eyelashes may also result from scratching or rubbing. Researchers have noted differences in the skin of people with atopic dermatitis that may contribute to the symptoms of the disease. The epidermis, which is the outermost layer of skin, is divided into two parts: The inner part contains moist, living cells, and the outer part, known as the horny layer or stratum corneum, contains dry, flattened, dead cells. Under normal conditions the stratum corneum acts as a barrier, keeping the rest of the skin from drying out and protecting other layers of skin from damage caused by irritants and infections. When this barrier is damaged, irritants act more intensely on the skin. The skin of a person with atopic dermatitis loses too much moisture from the epidermal layer, allowing the skin to become very dry and reducing its protective abilities. In addition, the patient’s skin is very susceptible to recurring infections, such as staphylococcal and streptococcal bacterial skin infections and warts, herpes simplex, and molluscum contagiosum (skin disorders caused by a viruses). Skin features of atopic dermatitis:
14 Atopic Dermatitis
·
Lichenification: thick, leathery skin resulting from constant scratching and rubbing
·
Papules: small raised bumps that may open when scratched, becoming crusty and infected
·
Ichthyosis: dry, rectangular scales on the skin
·
Keratosis pilaris: small, rough bumps, generally on the face, upper arms, and thighs
·
Hyperlinear palms: increased number of skin creases on the palms
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Urticaria: hives (red, raised bumps), often after exposure to an allergen, at the beginning of flares, or after exercise or a hot bath
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Cheilitis: inflammation of the skin on and around the lips
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Atopic pleat (Dennie-Morgan fold): an extra fold of skin that develops under the eye
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Hyperpigmented eyelids: eyelids that have become darker in color from inflammation or hay fever
Stages of Atopic Dermatitis Atopic dermatitis is more common in infancy and childhood. It affects each child differently, in terms of both onset and severity of symptoms. In infants, atopic dermatitis typically begins around 6 to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash, which can progress to red, scaling, oozing skin. The skin may become infected. Once the infant becomes more mobile and begins crawling, exposed areas such as knees and elbows may also be affected. An infant with atopic dermatitis may be restless and irritable because of the itching and discomfort of the disease. Many infants get better by 18 months of age, although they remain at greater than normal risk for dry skin or hand eczema later in life. In childhood, the rash tends to occur behind the knees and inside the elbows; on the sides of the neck; and on the wrists, ankles, and hands. Often, the rash begins with papules that become hard and scaly when scratched. The skin around the lips may be inflamed, and constant licking of the area may lead to small, painful cracks in the skin around the mouth. Severe cases of atopic dermatitis may affect growth, and the child may be shorter than average. The disease may go into remission. The length of a remission varies, and it may last months or even years. In some children, the disease gets better for a long time only to come back at the onset of puberty when hormones, stress,
Guidelines 15
and the use of irritating skin care products or cosmetics may cause the disease to flare. Although a number of people who developed atopic dermatitis as children also experience symptoms as adults, it is unusual (but possible) for the disease to show up first in adulthood. The pattern in adults is similar to that seen in children; that is, the disease may be widespread or limited to a more restricted form. In some adults, only the hands or feet may be affected and become dry, itchy, red, and cracked. Sleep patterns and work performance may be affected, and long-term use of medications to treat the atopic dermatitis may cause complications. Adults with atopic dermatitis also have a predisposition toward irritant contact dermatitis, especially if they are in occupations involving frequent hand wetting or hand washing or exposure to chemicals. Some people develop a rash around their nipples. These localized symptoms are difficult to treat, and people often do not tell their doctor because of modesty or embarrassment. Adults may also develop cataracts that are difficult to detect because they cause no symptoms. Therefore, the doctor may recommend regular eye exams.
Diagnosing Atopic Dermatitis Currently, there is no test to diagnose atopic dermatitis and no single symptom or feature used to identify the disease. Each patient experiences a unique combination of symptoms, and the symptoms and severity of the disease may vary over time. The doctor will base his or her diagnosis on the symptoms the patient experiences and may need to see the patient several times to make an accurate diagnosis. It is important for the doctor to rule out other diseases and conditions that might cause skin irritation. In some cases, the family doctor or pediatrician may refer the patient to a dermatologist or allergist (allergy specialist) for further evaluation. Several tools help the doctor better understand a patient’s symptoms and their possible causes. The most valuable diagnostic tool is a thorough medical history, which provides important clues. The doctor may ask about family history of allergic disease; whether the patient also has diseases such as hay fever or asthma; and about exposure to irritants, sleep disturbances, any foods that seem to be related to skin flares, previous treatments for skinrelated symptoms, use of steroids, and the effect of symptoms on schoolwork, career, or social life. Sometimes it is necessary to do a biopsy of the skin or patch testing to see if the skin immune system overreacts to certain chemicals or preservatives in skin creams. A preliminary diagnosis of
16 Atopic Dermatitis
atopic dermatitis can be made if the patient has three or more features from each of two categories: major features and minor features. Some of these features are listed in the box below. Skin scratch/prick tests (scratching or pricking the skin with a needle that contains a small amount of a suspected allergen) and blood tests for airborne allergens generally are not as useful in the diagnosis of atopic dermatitis as a medical history and careful observation of symptoms. However, they may occasionally help the doctor rule out or confirm a specific allergen that might be considered important in diagnosis. Although negative results on skin tests are reliable and may help rule out the possibility that certain substances cause skin inflammation in the patient, positive skin scratch/prick test results are difficult to interpret in people with atopic dermatitis and are often inaccurate. Blood tests, including measurements of certain antibodies to allergens, are not recommended in most cases because they have a high rate of false positives and are expensive. In some cases, where the type of dermatitis is unclear, blood tests to check the level of eosinophils (a type of white blood cell) or IgE (an antibody whose levels are often high in atopic dermatitis) are helpful.
Major and Minor Features of Atopic Dermatitis Major features: ·
Intense itching
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Characteristic rash in locations typical of the disease
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Chronic or repeatedly occurring symptoms
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Personal or family history of atopic disorders (eczema, hay fever, asthma)
Some minor features: ·
Early age of onset
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Dry, rough skin
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High levels of immunoglobulin E (IgE), an antibody, in the blood
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Ichthyosis
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Hyperlinear palms
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Keratosis pilaris
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Hand or foot dermatitis
Guidelines 17
·
Cheilitis
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Nipple eczema
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Susceptibility to skin infection
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Positive allergy skin tests
Exacerbating Factors Many factors or conditions can make symptoms of atopic dermatitis worse, further triggering the already overactive immune system in the skin, aggravating the itch-scratch cycle, and increasing damage to the skin. These exacerbating factors can be broken down into two main categories: irritants and allergens. Emotional factors and some infections can also influence atopic dermatitis. Irritants are substances that directly affect the skin and, when used in high enough concentrations with long enough contact, cause the skin to become red and itchy or to burn. Specific irritants affect people with atopic dermatitis to different degrees. Over time, many patients and their families learn to identify the irritants most troublesome to them. For example, wool or synthetic fibers may affect some patients. Also, rough or poorly fitting clothing can rub the skin, trigger inflammation, and cause the itch-scratch cycle to begin. Soaps and detergents may have a drying effect and worsen itching, and some perfumes and cosmetics may irritate the skin. Exposure to certain substances, such as chlorine, mineral oil, or solvents, or to irritants, such as dust or sand, may also make the condition worse. Cigarette smoke may irritate the eyelids. Because irritants vary from one person to another, each person has to determine for himself or herself what substances or circumstances cause the disease to flare. Common irritants: ·
Wool or synthetic fibers
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Soaps and detergents
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Some perfumes and cosmetics
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Substances such as chlorine, mineral oil, or solvents
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Dust or sand
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Cigarette smoke
18 Atopic Dermatitis
Allergens are substances from foods, plants, or animals that inflame the skin because the immune system overreacts to the substance. Inflammation occurs even when the person is exposed to small amounts of the substance for a limited time. Some examples of allergens are pollen and dog or cat dander (tiny particles from the animal’s skin or hair). When people with atopic dermatitis come into contact with an irritant or allergen they are sensitive to, inflammation-producing cells come into the skin from elsewhere in the body. These cells release chemicals that cause itching and redness. As the person scratches and rubs the skin in response, further damage occurs. Some doctors and scientists believe that certain foods act as allergens and may trigger atopic dermatitis or cause it to become worse. Other researchers think that food allergens play a role in only a limited number of cases of atopic dermatitis, primarily in infants and children. An allergic reaction to food can cause skin inflammation (generally hives), gastrointestinal symptoms (vomiting, diarrhea), upper respiratory tract symptoms (congestion, sneezing), and wheezing. The most common allergenic (allergycausing) foods are eggs, peanuts, milk, fish, soy products, and wheat. Although the data remain inconclusive, some studies suggest that mothers of children with a family history of atopic diseases should avoid eating commonly allergenic foods themselves during late pregnancy and (if breast feeding) while they are breast feeding the baby. Although not all researchers agree, some think that breast feeding the infant for at least 4 months may have a protective effect for the child. Currently, no reliable laboratory test identifies a food allergy, including skin or blood tests. If a food allergy is suspected, it may be helpful to keep a careful diary of everything the patient eats, noting any reactions. Identifying the food allergen may be difficult if the patient is also being exposed to other allergens, and may require supervision by an allergist. One helpful way to explore the possibility of a food allergy is to eliminate the suspected food and then, if improvement is noticed, reintroduce it into the diet under carefully controlled conditions. If this causes no symptoms or if there has been no improvement in 2 weeks of eliminating that food, other foods may be eliminated in turn. Changing the diet of a person who has atopic dermatitis may not always relieve symptoms. A change may be helpful, however, when a patient’s medical history and specific symptoms strongly suggest a food allergy. It is up to the patient and his or her family and physician to judge whether the dietary restrictions outweigh the impact of the disease itself. Restricted diets often are emotionally and financially difficult for patients and their families
Guidelines 19
to follow. Unless properly monitored, diets with many restrictions can also contribute to nutritional problems in children. Other types of allergens called aeroallergens (because they are present in the air) may also play a role in atopic dermatitis. Common aeroallergens are dust mites, pollens, molds, and dander from animal hair or skin. These aeroallergens, particularly the house dust mite, may worsen the symptoms of atopic dermatitis in some people. Although some researchers think that aeroallergens are an important contributing factor to atopic dermatitis, others do not think that they are significant. Scientists also don’t understand the way aeroallergens affect the skin—whether the aeroallergen is inhaled by the patient or the aeroallergen actually penetrates the patient’s skin. No reliable test is available that determines whether a specific aeroallergen is an exacerbating factor in any given individual. If the doctor suspects that an aeroallergen is contributing to the symptoms a person is experiencing, the doctor may recommend ways to reduce exposure to the aeroallergen. For example, the presence of the house dust mite can be limited by encasing mattresses and pillows in special dust-proof covers, frequently washing bedding in hot water, and removing carpeting. However, there is no way to completely rid the environment of aeroallergens. In addition to irritants and allergens, other factors—such as emotional issues, temperature and climate, and skin infections—play a role in atopic dermatitis. Although the disease itself is not caused by emotional factors or personality, it can be made worse by stress, anger, and frustration. Interpersonal problems or major life changes, such as divorce, job changes, or the death of a loved one, can also make the disease worse. Often, emotional stress seems to trigger a flare of the disease. Bathing without proper moisturizing afterward is a common factor that triggers a flare of atopic dermatitis. The low humidity of winter or the dry year-round climate of some geographic areas can make the disease worse, as can overheated indoor areas and long or hot baths and showers. Alternately sweating and chilling can trigger a flare in some people. Bacterial infections can also trigger or increase the severity of atopic dermatitis. If a patient experiences a sudden flare of illness, the doctor may check for a viral infection (such as herpes simplex) or fungal infection (such as ringworm or athlete’s foot). More information on skin infections is presented in the next section of this booklet.
20 Atopic Dermatitis
Treating Atopic Dermatitis Treatment involves a partnership among the patient, family members, and doctor. The doctor will suggest a treatment plan based on the patient’s age, symptoms, and general health. The patient and the patient’s family play a large role in the success of the treatment plan by carefully following the doctor’s instructions. Some of the primary components of treatment programs are described below. Most patients can be successfully treated with proper skin care and lifestyle changes and do not require the more intensive treatments discussed. The doctor has three main goals in treating atopic dermatitis: healing the skin and keeping it healthy, preventing flares, and treating symptoms when they do occur. Much of caring for the skin and preventing flares has to do with developing skin care routines, identifying exacerbating factors, and avoiding circumstances that trigger the skin’s immune system and the itchscratch cycle. It is important for the patient and his or her family to note any changes in skin condition in response to treatment, and to be persistent in identifying the most effective treatment strategy.
Skin Care Healing the skin and keeping it healthy are of primary importance as part of both preventing further damage and enhancing quality of life. Developing and sticking with a daily skin care routine is critical to preventing flares. Key factors are proper bathing and the application of lubricants, such as creams or ointments, within 3 minutes of bathing. People with atopic dermatitis should avoid hot or long (more than 10 to 15 minutes) baths and showers. A lukewarm bath helps to cleanse and moisturize the skin without drying it excessively. Because soaps can be drying to the skin, the doctor may recommend limited use of a mild bar soap or nonsoap cleanser. Bath oils are not usually helpful. Once the bath is finished, the patient should air-dry the skin, or pat it dry gently (avoiding rubbing or brisk drying), and apply a lubricant immediately. Lubrication restores the skin’s moisture, increases the rate of healing, and establishes a barrier against further drying and irritation. Several kinds of lubricants can be used. Lotions have a high water or alcohol content and evaporate more quickly, so they generally are not the best choice. Creams and ointments work better at healing the skin. Tar preparations can be very helpful in healing very dry, lichenified areas.
Guidelines 21
Whatever preparation is chosen, it should be as free of fragrances and chemicals as possible. Another key to protecting and restoring the skin is taking steps to avoid repeated skin infections. Although it may not be possible to avoid infection altogether, the effect of an infection may be minimized if it is identified and treated early. People with atopic dermatitis and their families should learn to recognize signs of skin infections, including tiny pustules (pus-filled bumps) on arms and legs, appearance of oozing areas, or crusty yellow blisters. If symptoms of a skin infection develop, the doctor should be consulted and treatment should begin as soon as possible.
Treating Atopic Dermatitis in Infants and Children ·
Give brief, lukewarm baths.
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Apply lubricant immediately following the bath.
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Keep child’s fingernails filed short.
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Select soft cotton fabrics when choosing clothing.
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Consider using antihistamines to reduce scratching at night.
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Keep the child cool; avoid situations where overheating occurs.
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Learn to recognize skin infections and seek treatment promptly.
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Attempt to distract the child with activities to keep him or her from scratching.
Medications and Phototherapy If a flare of atopic dermatitis does occur, several methods can be used to treat the symptoms. The doctor will select a treatment according to the age of the patient and the severity of the symptoms. With proper treatment, most symptoms can be brought under control within 3 weeks. If symptoms fail to respond, this may be due to a flare that is stronger than the medication can handle, a treatment program that is not fully effective for a particular individual, or the presence of trigger factors that were not addressed in the initial treatment program. These factors can include a reaction to a medication, infection, or emotional stress. Continued symptoms may also occur because the patient is not following the treatment program instructions.
22 Atopic Dermatitis
Corticosteroid creams and ointments are the most frequently used treatment. Sometimes over-the-counter preparations are used, but in many cases the doctor will prescribe a stronger corticosteroid cream or ointment. The doctor will take into account the patient’s age, location of the skin to be treated, severity of the symptoms, and type of preparation (cream or ointment) when prescribing a medication. Sometimes the base used in certain brands of corticosteroid creams and ointments is irritating for a particular patient. Side effects of repeated or long-term use of topical corticosteroids can include thinning of the skin, infections, growth suppression (in children), and stretch marks on the skin. Some treatments reduce specific symptoms of the disease. Antibiotics to treat skin infections may be applied directly to the skin in an ointment, but are usually more effective when taken by mouth. Certain antihistamines that cause drowsiness can reduce nighttime scratching and allow more restful sleep when taken at bedtime. This effect can be particularly helpful for patients whose nighttime scratching makes the disease worse. If viral or fungal infections are present, the doctor may also prescribe medications to treat those infections. Phototherapy (treatment with light) that uses ultraviolet A or B light waves, or both together, can be an effective treatment for mild to moderate dermatitis in older children (over 12 years old) and adults. Photochemotherapy, a combination of ultraviolet light therapy and a drug called psoralen, can also be used in cases that are resistant to phototherapy alone. Possible long-term side effects of this treatment include premature skin aging and skin cancer. If the doctor thinks that phototherapy may be useful to treat the symptoms of atopic dermatitis, he or she will use the minimum exposure necessary and monitor the skin carefully. When other treatments are not effective, the doctor may prescribe systemic corticosteroids: drugs that are taken by mouth or injected into muscle instead of being applied directly to the skin. An example of a commonly prescribed corticosteroid is prednisone. Typically, these medications are used only in resistant cases and only given for short periods of time. The side effects of systemic corticosteroids can include skin damage, thinned or weakened bones, high blood pressure, high blood sugar, infections, and cataracts. It can be dangerous to suddenly stop taking corticosteroids, so it is very important that the doctor and patient work together in changing the corticosteroid dose. In adults, immunosuppressive drugs, such as cyclosporine, are also used to treat severe cases of atopic dermatitis that have failed to respond to any
Guidelines 23
other forms of therapy. Immunosuppressive drugs restrain the overactive immune system by blocking the production of some immune cells and curbing the action of others. The side effects of cyclosporine can include high blood pressure, nausea, vomiting, kidney problems, headaches, tingling or numbness, and a possible increased risk of cancer and infections. There is a risk of relapse after the drug is stopped. Because of their toxic side effects, systemic corticosteroids and immunosuppressive drugs are used only in severe cases and then for as short a period of time as possible. Patients requiring systemic corticosteroids should be referred to dermatologists or allergists specializing in the care of atopic dermatitis to help identify trigger factors and alternative therapies. In rare cases, when no other treatments have been successful, the patient may have to be hospitalized. A 5- to 7-day stay in the hospital allows intensive skin care and reduces the patient’s exposure to irritants and allergens and the stresses of day-to-day life. Under these conditions, the symptoms usually clear quickly if environmental factors play a role or if the patient is not able to carry out adequate skin care at home. A number of promising experimental medications are being tested for atopic dermatitis. These medications affect the immune system and offer additional options for patients with difficult-to-treat symptoms. Researchers are also actively pursuing the development of alternative treatments for atopic dermatitis.
Tips for Working with Your Doctor ·
Provide complete, accurate medical information about yourself or your child.
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Make a list of your questions and concerns in advance.
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Be honest and share your point of view with the doctor.
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Ask for clarification or further explanation if you need it.
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Talk to other members of the health care team, such as nurses, therapists, or pharmacists.
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Don’t hesitate to discuss sensitive subjects with your doctor.
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Discuss changes to any medical treatment or medications with your doctor before making them.
24 Atopic Dermatitis
Atopic Dermatitis and Quality of Life Despite the symptoms caused by atopic dermatitis, it is possible for people with the disorder to maintain a high quality of life. The key to quality of life lies in education, awareness, and developing a partnership among patient, family, and doctor. Good communication (see “Tips for Working With Your Doctor”) is essential, both within the family and among the patient, the family, and the doctor. It is important that the doctor provide understandable information about the disease and its symptoms to the patient and family and demonstrate any treatment measures recommended to ensure that they will be properly carried out. When a child has atopic dermatitis, the entire family may be affected. It is important that families have additional support to help them cope with the stress and frustration associated with the disease. The child may be fussy and difficult, and often is unable to keep from scratching and rubbing the skin. Distracting the child and providing as many activities that keep the hands busy is key, but requires much effort and work on the part of the parents or caregivers. Another issue families face is the social and emotional stress associated with disfigurement caused by atopic dermatitis. The child may face difficulty in school or other social relationships and may need additional support and encouragement from family members. Adults with atopic dermatitis can enhance their quality of life by caring regularly for their skin and being mindful of other effects of the disease and how to treat them. Adults should develop a skin care regimen as part of their daily routine, which can be adapted as circumstances and skin conditions change. Stress management and relaxation techniques may help decrease the likelihood of flares due to emotional stress. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial. Chronic anxiety and depression may be relieved by short-term psychological therapy. Recognizing the situations when scratching is most likely to occur may also help. For example, many patients find that they scratch more when they are idle, so structured activity that keeps the hands occupied may prevent further damage to the skin. Occupational counseling also may be helpful to identify or change career goals if a job involves contact with irritants or involves frequent hand washing, such as kitchen work or auto mechanics.
Guidelines 25
Controlling Atopic Dermatitis ·
Prevent scratching or rubbing whenever possible.
·
Protect skin from excessive moisture, irritants, and rough clothing.
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Maintain a cool, stable temperature and consistent humidity levels.
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Limit exposure to dust, cigarette smoke, pollens, and animal dander.
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Recognize and limit emotional stress.
Current Research Research on atopic dermatitis is active. Scientists, including some supported by NIAMS and other institutes of NIH, are working to better understand what causes the disease and how it can be managed, treated, and, ultimately, prevented. Some promising avenues of research are described below.
Genetics Although atopic dermatitis runs in families, the role of genetics remains unclear. It does appear that more than one gene is involved in the development of the disease. Researchers suspect that atopic dermatitis may be caused by environmental factors acting in people who are genetically predisposed to the disease. Research has helped shed light on the patterns of inheritance of atopic dermatitis. Studies show that children are at increased risk for developing the disorder if there is a family history of other atopic disease, such as hay fever or asthma. The risk is significantly higher if both parents have an atopic disease. In addition, studies of identical twins, who have the exact same genes, show that in an estimated 80 to 90 percent of cases, if one twin has an atopic disease, the other does also. Fraternal (nonidentical) twins, who have only some genes in common, are no more likely than two other people in the general population to both have an atopic disease. These findings suggest that genes play an important role in determining who gets the disease.
26 Atopic Dermatitis
Biochemical Abnormalities Scientists suspect that changes in the skin’s protective barrier make people with atopic dermatitis more sensitive to irritants. Such people have lower levels of fatty acids (substances that provide moisture and elasticity) in their skin, which causes dryness and reduces the skin’s ability to control inflammation. Other research evidence points to a possible defect in a type of white blood cell called a monocyte. In people with atopic dermatitis, monocytes appear to play a role in the decreased production of an immune system hormone called interferon gamma (IFN- ), which helps regulate allergic reactions. This defect may cause exaggerated immune and inflammatory responses in the blood and tissues of people with atopic dermatitis.
Faulty Regulation of Immunoglobulin E (IgE) IgE is a type of antibody that controls the immune system’s allergic response. An antibody is a special protein produced by the immune system that recognizes and helps fight and destroy viruses, bacteria, and other foreign substances that invade the body. Normally, IgE is present in very small amounts, but levels are high in 80 to 90 percent of people with atopic dermatitis. Researchers suspect that IgE may play a role in the disease. In allergic diseases, IgE antibodies are produced in response to different allergens. When an allergen comes into contact with IgE on specialized immune cells, the cells release various chemicals, including histamine. These chemicals cause the symptoms of an allergic reaction, such as wheezing, sneezing, runny eyes, and itching. Scientists originally thought the release of histamine played an important role in the development of atopic dermatitis. However, the release of histamine and other chemicals alone cannot explain the typical longer term symptoms of the disease. Research is underway to identify factors that may explain why too much IgE is produced and how it plays a role in the disease. Immune System Imbalance Researchers also think that an imbalance in the immune system may contribute to the development of atopic dermatitis. It appears that the part of the immune system responsible for stimulating IgE is overactive, and the part that makes IFN-g and handles skin viral and fungal infections is
Guidelines 27
underactive. Indeed, the skin of people with atopic dermatitis shows increased susceptibility to skin infections. This imbalance appears to result in the skin’s inability to prevent dermatitis, or inflammation, even in areas of skin that appear normal. Hyperactivity of one type of immune cell in the skin, called a Langerhans cell, may be involved in atopic dermatitis. Langerhans cells are responsible for picking up viruses, bacteria, allergens, and other foreign substances that invade the body and delivering them to other cells in the immune defense system. Langerhans cells appear to be hyperactive in the skin of people with atopic diseases. Certain Langerhans cells are particularly potent at activating white blood cells called T cells in atopic skin, which produce proteins that promote allergic response. This function results in an exaggerated response of the skin to tiny amounts of allergens.
Treatments Scientists are also focusing on identifying new treatments for atopic dermatitis, including biologic agents, fatty acid supplements, and new forms of phototherapy. Researchers are working to understand how ultraviolet light affects the skin immune system in healthy and diseased skin. They are also investigating biologic agents, including several aimed at modifying the response of the immune system. A biologic agent is a new type of drug based on molecules that occur naturally in the body. One promising treatment is the use of the proteins IFN- and thymopentin (and similar agents) to reestablish balance in the immune system. Researchers also continue to look for immunosuppressive drugs that may help treat severe atopic dermatitis. Clinical trials are underway with a drug called FK506, which is applied to the skin rather than taken orally. Two antiinflammatory drugs called phosphodiesterase inhibitors, currently in clinical trials, also appear promising as treatments for atopic dermatitis. These drugs affect multiple cells and cell functions and may prove to be an effective alternative to corticosteroids in the treatment of atopic dermatitis. Several experimental treatments are being evaluated that attempt to replace substances that are deficient in people with atopic dermatitis. Evening primrose oil is a substance rich in gamma-linolenic acid, one of the fatty acids that is decreased in the skin of people with atopic dermatitis. Studies to date using evening primrose oil have yielded contradictory results. Clinical trials with another substance, a dietary fatty acid supplement called eicosapentenoic acid, have resulted in only slight improvement. There is also
28 Atopic Dermatitis
a great deal of interest in the use of Chinese herbs and herbal teas to treat the disease. Studies to date do show some benefit, but not without concerns about toxicity and the risks of suppression of the immune system. Hope for the Future Although the symptoms of atopic dermatitis can be difficult and uncomfortable, the disease can be successfully managed. People with atopic dermatitis, as well as their families, can lead healthy, normal lives. As scientists learn more about atopic dermatitis and what causes it, they continue to move closer to effective treatments, and perhaps, ultimately, a cure.
Additional Resources National Eczema Association 1221 SW Yamhill, Suite 303 Portland, OR 97205 (503) 228-4430 This is a national, patient-oriented association devoted to eczema. It publishes a newsletter and an eight-page brochure on atopic dermatitis, provides educational materials, offers resource services for people with atopic dermatitis, and provides referrals to atopic dermatitis research centers. American Academy of Dermatology P.O. Box 4014 Schaumburg, IL 60168 (847) 330-0230 (888) 462-DERM (3376) (toll free) http://www.aad.org/ This national, professional association for dermatologists publishes a pamphlet on atopic eczema/dermatitis, and information sources. Single copies are free. The academy can also provide physician referrals.
Guidelines 29
American Academy of Allergy, Asthma, and Immunology 611 East Wells Street Milwaukee, WI 53202 (414) 272-6071 http://www.aaaai.org/ This national professional association for allergists and clinical immunologists publishes pamphlets about allergies and atopic dermatitis. The academy can also provide physician referrals for evaluation of allergies.
More Guideline Sources The guideline above on atopic dermatitis is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to atopic dermatitis. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with atopic dermatitis. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas.
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results.
30 Atopic Dermatitis
We recommend, therefore, that you use this method only if you have a very targeted search.
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on atopic dermatitis and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
FAQs About Eczema, The Source: Newport News, VA: Inflammatory Skin Disease Institute (ISDI). 2002. 8 p. Contact: Available from Inflammatory Skin Disease Institute. P.O. Box 1074, Newport News, VA 23601. (757) 223-0795. Fax (757) 595-1842. Email:
[email protected]. Website: www.isdionline.org. PRICE: Contact organization for pricing information. Summary: This brochure uses a question and answer format to provide people who have eczema with information on the causes, diagnosis, and treatment of this common noncontagious skin disorder. Eczema, also known as atopic dermatitis, causes the skin to become dry, itchy, and inflamed. Eczema is most common in infants and young children, but it can occur in older people. Sites commonly affected include the face, scalp, neck, forearms, and legs. Although the exact cause of eczema is unknown, scientists believe it is a genetic disorder involving the immune system and influenced by environmental factors. Although symptoms usually improve as childhood progresses, some people will experience eczema flare ups throughout their lives. Factors that can trigger an eczema flare up include dry skin, irritants, allergens, stress, heat and sweating, and infections. Eating foods such as milk, eggs, peanuts, soy, wheat, and seafood can also cause a flare up of eczema. Keeping the skin moist is important in protecting the skin from invasive agents which may trigger a flare up. Diagnosis is based on the medical history and a physical examination. An eczema flare up can be treated with topical steroid creams and ointments, oral steroids, antihistamines, wet and cool compresses, antibiotics, and tar preparations. There is no cure for eczema,
Guidelines 31
but it can be controlled with proper preventive measures and treatment of flare ups. People who have eczema are prone to developing dry sensitive skin, and they are at risk of developing widespread infections. ·
Handout on Health: Atopic Dermatitis Source: Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1999. 40 p. Contact: Available from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (877) 226-4267 or (301) 495-4484. Fax (301) 718-6366. TTY (301) 565-2966. E-mail:
[email protected]. Website: www.niams.nih.gov. Price: 1 to 25 copies free. Order Number: AR-68 HH (booklet), or AR-68L HH (large print). Summary: This booklet provides people who have atopic dermatitis and their families and caregivers with information on the symptoms, diagnosis, and treatment of this chronic skin disease, which makes the skin extremely itchy and inflamed. Atopic dermatitis most often affects infants and young children, but it can continue into adulthood. It affects males and females equally, and its onset decreases substantially with age. Atopic dermatitis is the most common of the many types of eczema. Although the cause is unknown, the disease seems to result from a combination of genetic and environmental factors. Symptoms vary from person to person, but the most common symptoms are dry, itchy skin; cracks behind the ears; and rashes on the cheeks, arms, and legs. Other common features of atopic dermatitis include lichenification, papules, ichthyosis, keratosis pilaris, hyperlinear palms, urticaria, cheilitis, atopic pleat, and hyperpigmented eyelids. The features of atopic dermatitis depend on whether an infant, a child, or an adult is affected. Diagnosis involves obtaining a thorough medical history and observing symptoms. Skin scratch/prick tests and blood tests for airborne allergens may occasionally help the doctor rule out or confirm a specific allergen that might be important in diagnosis. Many factors can make atopic dermatitis symptoms worse. These factors can be classified as irritants or allergens. Irritants are substances that directly affect the skin, whereas allergens are substances from foods, plants, or animals that inflame the skin. Other factors, including emotional issues, temperature and climate, and skin infections, also have a role in atopic dermatitis. Treatment involves proper skin care, lifestyle changes, and medications and phototherapy. People who have atopic dermatitis can maintain a high quality of life despite their symptoms. Research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and other components of the National Institutes of Health focuses on genetics,
32 Atopic Dermatitis
biochemical abnormalities, faulty regulation of immunoglobulin E, immune system imbalance, and treatment. The booklet also lists additional resources. ·
Eczema in Children: A Guide for Parents Source: San Ramon, CA: Health Information Network (HIN), Inc. 1999. 28 p.
Contact: Available from Health Information Network (HIN), Inc. 231 Market Place, No. 331, San Ramon, CA 94583. (800) HIN-1947. Website: HINbooks.com. PRICE: $2.95 plus shipping and handling. ISBN 1885274092. Order Number: 1015. Summary: This illustrated booklet helps parents learn about eczema in children. This inflammatory skin condition, also known as atopic dermatitis, causes reddening, scaling, and sometimes intense itching. When eczema is present, the skin may look dry and flaky. Eczema, which tends to run in families, may first appear during infancy or early childhood. The condition most likely affects the skin around the joints. Scratching makes the eczema worse, and the worse the skin becomes, the more it itches. Keeping the skin from drying out will help decrease the itch. The booklet offers tips on avoiding dry skin, such as applying moisturizing creams or ointments, dressing the child in long pants and long sleeved tops to retain moisture, and avoiding skin irritants. In addition, the booklet provides guidelines on reducing scratching and using medications such as antihistamines and ointments for itching. Other topics include the connection between food, medication, and environmental allergies and eczema. The booklet concludes with a glossary of terms. ·
Atopic Dermatitis in Children Source: Portland, OR: National Eczema Association for Science and Education. 1998. 8 p. Contact: Available from National Eczema Association for Science and Education. 1220 SW Morrison Street, Suite 433, Portland, OR 97205-2235. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail:
[email protected]. Website: www.eczema-assn.org. PRICE: Single copy free; $25.00 per 100, plus shipping and handling. Summary: This pamphlet uses a question and answer format to provide parents of children who have atopic dermatitis, or eczema, with information on this skin condition, which affects up to 10 percent of children. The pamphlet identifies factors that contribute to the diagnosis of eczema, including the time of onset, the presence of itching, the appearance and location of a rash, and hereditary factors. Although the
Guidelines 33
exact cause of eczema is not known, it occurs when certain factors trigger reactive inflammatory cells in the skin. Trigger factors include dry skin, irritants, stress, heat and sweating, infections, and allergens. The pamphlet presents suggestions for avoiding these factors and identifies moisturizers, corticosteroids, antibiotics, antihistamines, and tar preparations as medicines that may used to treat eczema. Other topics include whether a child will outgrow eczema and whether it will affect his or her career choice. ·
All About Atopic Dermatitis Source: Portland, OR: National Eczema Association for Science and Education. 1998. 8 p. Contact: Available from National Eczema Association for Science and Education. 1220 SW Morrison Street, Suite 433, Portland, OR 97205-2235. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail:
[email protected]. Website: www.eczema-assn.org. PRICE: Single copy free; $25.00 per 100 plus shipping and handling. Summary: This pamphlet uses a question and answer format to provide people who have atopic dermatitis (AD) with information on this disease, which causes itchy, inflamed skin. AD, the most severe and chronic kind of eczema, almost always begins in childhood and is not contagious. Children affected by AD may have asthma and hay fever at the same time, or one or both of these conditions may develop later. Although the problem may fade during childhood, people with AD have a lifelong tendency toward dry skin, occupational skin disease, skin infections, eye problems, disruptions in family and social relationships, and loss of work. The pamphlet identifies the trigger factors for AD, including irritants and other allergens. Food allergies can cause flareups, as can airborne allergens, emotional stress, exposure to extreme cold or hot temperatures, or sudden changes in temperature. The pamphlet offers suggestions for managing flareups, dry skin, and infections. It also provides tips on treating and controlling AD, including establishing a skin care routine, recognizing stressful situations and events, learning stress management techniques, being aware of scratching, and controlling one's environment. 4 figures.
·
Eczema/Atopic Dermatitis Source: Schaumburg, IL: American Academy of Dermatology. 1995. 6 p. Contact: American Academy of Dermatology, 930 North Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014.
34 Atopic Dermatitis
Summary: This pamphlet for the general public discusses a special type of eczema known as atopic dermatitis or atopic eczema. The symptoms of this condition are described, focusing on the features of the skin if the disease starts in infancy and if it continues beyond infancy. In addition, the pamphlet answers questions about atopic dermatitis, including whether certain foods or environmental substances may trigger attacks, whether skin tests are of value in finding the cause, and what can be done to treat the condition. 3 photographs. ·
Food Allergy and Atopic Dermatitis Source: Fairfax, VA: Food Allergy and Anaphylaxis Network. 2000. 12 p. Contact: Available from Food Allergy and Anaphylaxis Network (FAAN). 10400 Eaton Place, Suite 107, Fairfax, VA 22030-2208. (800) 9294040. Fax (703) 691-2713. E-mail:
[email protected]. Website: www.foodallergy.org. PRICE: $3.00 plus shipping and handling. Summary: It is estimated that up to 10 percent of young children have eczema or atopic dermatitis and one in three children with significant atopic dermatitis have food allergies. This booklet discusses food allergies and atopic dermatitis, defined as a nonscarring allergic skin disease caused by a number of factors; food is one factor. This disease is not contagious. With proper management, it can be controlled, and children can grow to be self confident and enjoy the friendship of others. This booklet offers tips and other sources of information to help parents of the child with food allergy and atopic dermatitis. The booklet covers symptoms, causes, drug therapy, complications, prevention strategies, what happens as the child gets older, and tips for keeping atopic dermatitis under control in the areas of general management, school, baths, laundry, and food allergy. Atopic dermatitis is caused by inflammation of the skin and the skin's inability to retain adequate moisture. Certain substances or factors can cause atopic dermatitis to flare, including irritants such as wool, skin infections, dry skin, low humidity, heat, sweating, or emotional stress; and allergens, such as dust mites, pollens and molds, or foods. Atopic dermatitis cannot be cured, but can be controlled with consistent treatment and avoidance of substances or factors that cause it to flare. Prescription antihistamines can be used to help treat the itching that accompanies this disease, and steroid ointments can help stop the inflammation in the skin. To keep atopic dermatitis under control it is important to avoid or reduce exposure to irritants and allergens, and to moisturize the skin. The booklet stresses that raising a child with atopic dermatitis and food allergies requires extra time, planning, and the help of a doctor that the parent feels comfortable talking with. The booklet concludes with a list of
Guidelines 35
additional sources of information, including the Food Allergy Network, and organizations through which readers can locate a board certified allergist, find allergy free food products, and get information about other allergy products.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “atopic dermatitis” or synonyms. The following was recently posted: ·
Disease management of atopic dermatitis: a practice parameter. Source: American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology/Joint Council of Allergy, Asthma and Immunology.; 1997 September; 15 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0670&sSearch_string=atopic+dermatitis
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Atopic Dermatitis Summary: Information about atopic dermatitis (or eczema) -- a chronic disease that causes extremely itchy, inflamed skin. Symptoms and treatments are discussed. Source: Federal Consumer Information Center, U.S. General Services Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5978
36 Atopic Dermatitis
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to atopic dermatitis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
·
Family Village: http://www.familyvillage.wisc.edu/specific.htm
·
Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
·
Med Help International: http://www.medhelp.org/HealthTopics/A.html
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
·
Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
·
WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter:
Guidelines 37
Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen
38 Atopic Dermatitis
family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Chronic: Persisting over a long period of time. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Dermatitis: Inflammation of the skin. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Ichthyosis: A group of cutaneous disorders characterized by increased or aberrant keratinization, resulting in noninflammatory scaling of the skin. Many different metaphors have been used to describe the appearance and texture of the skin in the various types and stages of ichthyosis, e.g. alligator, collodion, crocodile, fish, and porcupine skin. Most ichthyoses are genetically determined, while some may be acquired and develop in association with various systemic diseases or be a prominent feature in certain genetic syndromes. The term is commonly used alone to refer to i.
Guidelines 39
vulgaris. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Keratosis: Any horny growth such as a wart or callus. [NIH] Lichenification: Hypertrophy of the epidermis, resulting in thickening of the skin with exaggeration of the normal skin markings, giving the skin a leathery barklike appearance, which is caused by prolonged rubbing or scratching. It may arise on seemingly normal skin, or it may develop at the site of another pruritic cutaneous disorder. [EU] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Neurodermatitis: An extremely variable eczematous dermatosis presumed to be a cutaneous response to prolonged vigorous scratching, rubbing, or pinching to relieve intense pruritus, having the potential to produce polymorphic lesions at the same or different times, and varying in severity, course, and morphologic expression in different individuals. It is believed by some authorities to be a psychogenic disorder. The term is also used to refer to lichen simplex chronicus (circumscribed n.) and sometimes to atopic dermatitis (disseminated n.). [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Papule: A small circumscribed, superficial, solid elevation of the skin. [EU]
40 Atopic Dermatitis
Particle: A tiny mass of material. [EU] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Photochemotherapy: Therapy using oral or topical photosensitizing agents with subsequent exposure to light. [NIH] Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated patches and severe itching; hives. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
Seeking Guidance 41
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with atopic dermatitis. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with atopic dermatitis. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Atopic Dermatitis As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
42 Atopic Dermatitis
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Academy of Allergy Asthma and Immunology Address: American Academy of Allergy Asthma and Immunology 611 East Wells Street, Milwaukee, WI 53202 Telephone: (414) 272-6071 Toll-free: (800) 822-2762 Fax: (414) 276-3349 Email:
[email protected] Web Site: http://www.aaaai.or Background: The American Academy of Allergy, Asthma and Immunology (AAAAI) is an international, not-for-profit professional medical specialty organization representing allergists, clinical immunologists, allied health professionals, and other physicians with a special interest in allergy and immunology. Established in 1943 by the merger of the American Association for the Study of Allergy and the Association for the Study of Asthma and Allied Conditions, the AAAAI is dedicated to advancing the knowledge and practice of allergy, fostering the education of students and the public, encouraging union and cooperation among those working in the field, and promoting and stimulating research and the study of allergic diseases. The AAAAI is currently organized into several major 'interest sections' consisting of Asthma, Rhinitis, and Other Respiratory Diseases; Basic and Clinical Immunology; Dermatologic Diseases; Environmental and Occupational Disorders; Food and Drug Reactions and Anaphylaxis; and Mechanisms of Allergy. The AAAAI also engages in patient advocacy and lobbying activities, provides physician referrals, engages in patient education, and provides a variety of informational materials. The Academy currently has more than 5,400 members in the United States, Canada, and over 40 additional countries. Relevant area(s) of interest: Dermatitis, Atopic
Seeking Guidance 43
·
National Eczema Association for Science and Education Address: National Eczema Association for Science and Education 1221 South West Yamhill, Suite 303, Portland, OR 97205 Telephone: (503) 228-4430 Toll-free: (800) 818- 754 Fax: (503) 273-8778 Background: The National Eczema Association for Science and Education (NEA) is a nonprofit organization dedicated to informing, educating, and providing resources for individuals affected by eczema; increase public awareness of the disease; support research to discover the cause, treatment, and cure of atopic dermatitis-eczema; and represent individuals with eczema in order to help improve their quality of life. Atopic Dermatitis-Eczema is a disease that causes itchy, inflamed skin that most typically affects the insides of the elbows, backs of the knees and the face, but can cover most of the body. NEA was established in 1988 in Portland, Oregon by a group of affected individuals, nurses, doctors, and others concerned with the enormous social, medical, and economic consequences of this disease. NEA is governed by a Board of Directors. The Association is guided by a Scientific Advisory Committee comprised of physicians and scientists who donate their time and expertise. Consisting of 3,000 members and eight chapters, the Association produces educational materials including a brochure entitled 'All About Atopic Dermatitis,' a video entitled 'Suffering in Silence,' and a newsletter entitled 'The Advocate.' Programs and activities include a support group, patient advocacy, patient networking, education, and the support of research. Relevant area(s) of interest: Dermatitis, Atopic, Eczema
·
National Eczema Society Address: National Eczema Society 163 Eversholt Street, London, NW1 1BU, United Kingdom Telephone: 0171 388 4097 Toll-free: (800) 818- 754 Fax: 0171 388 588 Background: The National Eczema Society is a self-help organization dedicated to improving the quality of life for people with eczema, other skin diseases, related conditions, and their care providers. Eczema is an inflammation of the skin that results in itchy, scaling rashes on affected areas of the skin. Established in 1975, the Society works primarily to empower people with eczema to receive the quality of treatment and care that they have a right to expect. The Society also works to identify and seeks to resolve issues that affect the interests of affected individuals;
44 Atopic Dermatitis
raise awareness about the rights and needs of affected individuals; and campaign actively on behalf of affected individuals. In addition, the Society assists in the development and funding of patient-centered training programs aimed at health professionals to improve their knowledge and understanding of eczema's treatment and management. The Society also works to develop a systematic and comprehensive program of research into the causes of, and cure for, eczema. The Association produces educational materials including a quarterly journal entitled 'Exchange,' brochures, fact sheets, and booklets. Relevant area(s) of interest: Dermatitis, Atopic, Eczema
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about atopic dermatitis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “atopic dermatitis” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
Seeking Guidance 45
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “atopic dermatitis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “atopic dermatitis” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with atopic dermatitis. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “atopic dermatitis” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. The following Internet sites may be of particular interest: ·
Medhelp.org www.medhelp.org/HealthTopics/Atopic_Dermatitis.html
46 Atopic Dermatitis
·
American Academy of Dermatologists www.aad.org/pamphlets/eczema.html
·
Allergy Society of South Africa allergysa.org/dermatitis2.htm
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with atopic dermatitis must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan's list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 47
http://www.abms.org/newsearch.asp.11 You can also contact the ABMS by phone at 1-866-ASK-ABMS. ·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA's Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Finding a Dermatologist To find a dermatologist in your area, you can use the “Find a Dermatologist” search engine provided by the American Academy of Dermatology. With a membership of 13,000, the American Academy of Dermatology represents virtually all practicing dermatologists in the United States and Canada. Type the following Web address into your browser to begin your search: http://www.aad.org/DermSearch/index.html. To search for dermatologists by U.S. state, enter your state into the search box and click “Search.” To search for dermatologists practicing outside the U.S., select “international members.” Enter your country and click the “Search” button.
While board certification is a good measure of a doctor's knowledge, it is possible to receive quality care from doctors who are not board certified.
11
48 Atopic Dermatitis
Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about atopic dermatitis?
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Really listen to my questions?
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Answer in terms I understood?
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Show respect for me?
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Ask me questions?
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Make me feel comfortable?
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Address the health problem(s) I came with?
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Ask me my preferences about different kinds of treatments for atopic dermatitis?
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Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 49
·
Bring a “health history” list with you (and keep it up to date).
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Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
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Tell your doctor about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don't, your doctor will assume that you understood everything that was said.
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Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
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Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
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Ask your doctor to draw pictures if you think that this would help you understand.
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Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
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Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
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Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
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After leaving the doctor's office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
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Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
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Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
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Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Clinical Trials 51
CHAPTER 3. CLINICAL TRIALS AND ATOPIC DERMATITIS Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning atopic dermatitis.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for atopic dermatitis is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
52 Atopic Dermatitis
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on atopic dermatitis.
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Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for atopic dermatitis compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors' offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on atopic dermatitis carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on atopic dermatitis. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham
Clinical Trials 53
treatment.” This treatment, like a placebo, has no effect on atopic dermatitis and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how atopic dermatitis develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for atopic dermatitis. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial's investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
54 Atopic Dermatitis
surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Atopic Dermatitis The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to atopic dermatitis.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
Cytokine Production Patterns in Patients with Systemic Mastocytosis Compared with Atopic Dermatitis and Healthy Individuals Condition(s): Atopic Dermatitis; Healthy; Mastocytosis Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: Cytokine Production Patterns in Patients with Systemic Mastocytosis Compared with Atopic Dermatitis and Healthy Individuals Summary: This study will examine how mast cells (cells involved in allergic reactions) migrate and multiply in the skin of patients with mastocytosis, a condition characterized by too many mast cells in the body. The mast cells tend to multiply in the skin, causing dark, itchy skin spots known as urticaria pigmentosa. This study will determine if the skin of patients with mastocytosis produces chemicals called cytokines that cause mast cells to migrate to the skin and multiply. The findings will be compared with those from normal volunteers and patients with atopic dermatitis, a skin disease characterized by recurrent
16
These are listed at www.ClinicalTrials.gov.
Clinical Trials 55
itchy rash usually seen in people with a family history of allergies. Healthy volunteers, patients with mastocytosis and patients with atopic dermatitis 18 years of age and older may be eligible for this study. Participants will have the following tests and procedures: - Suction blisters - Two to eight small blisters will be raised on the forearm using gentle suction. The fluid in the blisters will be collected with a syringe to study the chemicals produced by the skin. The tops of the blisters may be removed for research. - Template study - Patients with high cytokine content in the blister fluid may have a template study. For this procedure, a plastic block (template) with holes matching the blister sites is placed over the blistered area. The wells of the template are filled with salt water and the fluid is removed with a syringe at 3, 8 and/or 24 hours. Patients are hospitalized for 24 hours for this study. - Skin biopsy - A skin biopsy will be done to correlate cytokine levels with the number of mast cells in the skin. An area of skin is numbed with an anesthetic and a small circular area about the size of a pencil eraser is removed, using a sharp cookie cutter-type instrument. - Blood draw - About 4 tablespoons of blood will be drawn to compare the chemicals in the blood with those in the blister fluid. The blood will also be analyzed for a complete blood count, clotting factors and substances that may be elevated in people with allergies. Study Type: Observational Contact(s): Maryland; National Institute of Allergy and Infectious Diseases (NIAID), 9000 Rockville Pike Bethesda, Maryland, 20892, United States Web Site: http://clinicaltrials.gov/ct/gui/c/w2r/show/NCT00001760
Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for atopic dermatitis. Although only half of the participants in a clinical trial
This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f2 91. 17
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receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over. ·
If the treatment is effective, then it may improve health or prevent diseases or disorders.
·
Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
·
People who take part in trials contribute to scientific discoveries that may help other people with atopic dermatitis. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial's risks and benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital's Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully
Clinical Trials 57
monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient's Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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Know whether you participated in the treatment group or the control group (once the study has been completed). What about Costs?
In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should
58 Atopic Dermatitis
find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don't have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for atopic dermatitis? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment's possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has
Clinical Trials 59
developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “atopic dermatitis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
·
For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today's Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
·
A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub;
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ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna ·
The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
·
The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
·
Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
·
Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
·
Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Mastocytosis: A group of diseases resulting from proliferation of mast cells. [NIH]
Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH]
61
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on atopic dermatitis. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on atopic dermatitis. In Part II, as in Part I, our objective is not to interpret the latest advances on atopic dermatitis or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with atopic dermatitis is suggested.
Studies 63
CHAPTER 4. STUDIES ON ATOPIC DERMATITIS Overview Every year, academic studies are published on atopic dermatitis or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on atopic dermatitis. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on atopic dermatitis and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and atopic dermatitis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “atopic dermatitis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
Managing Atopic Dermatitis in Children and Adults Source: Nurse Practitioner. 25(4): 58-59,63-64,69-70,73,76,79-81. April 2000. Summary: This journal article provides nurse practitioners with information on the epidemiology, pathogenesis, clinical features, diagnosis, complications, and treatment of atopic dermatitis. This common skin inflammation, which is characterized by intense pruritus, is most common in children. The prevalence of atopic dermatitis has tripled in the past 30 years, and the condition affects about 10 percent of the U.S. population at some point in their lifetime. Although the etiology of atopic dermatitis is not well understood, it appears to be linked to a combination of genetic and environmental factors, and it is usually associated with other atopic diseases such as asthma and hay fever. The initial clinical feature of atopic dermatitis is skin dryness and roughness. Erythema, papules, and pruritus may develop after additional irritation. The pattern of atopic dermatitis lesions varies by age. A definitive diagnosis in children and adults depends on identifying the nature and distribution of the lesions and on eliciting a personal or family history of the disease. Although no cure exists, atopic dermatitis often resolves spontaneously and can be controlled through proper management. Avoiding factors that precipitate or exacerbate inflammation, including aeroallergens, food allergens, and irritants, is key to preventing disease flares. In children and adults, hydration and topical corticosteroids are the mainstays of therapy. Recalcitrant disease may be treated with ultraviolet light therapy or psoralen phototherapy and cyclosporin. Current advances in understanding the immunologic basis of the disease have led to the development of highly effective new treatments. Using patient education and support, the clinician can help adults and children successfully manage their disease. The article includes a continuing education test. 2 figures, 4 tables, and 42 references. (AA-M).
·
Patient Education: A Dozen Ways To Treat Atopic Dermatitis Source: Nurse Practitioner. 25(4): 74. April 2000.
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Summary: This journal article provides people who have atopic dermatitis with suggestions on treating this skin condition. Tips include taking a daily 15 to 20 minute bath, patting away excess water and applying moisturizer or a prescribed skin medication, using only gentle skin cleansers, using sunscreen to avoid sunburn, and reapplying moisturizer throughout the day. Other suggestions include washing new clothing before wearing it to remove irritating chemicals; wearing clothing that allows air to pass freely to the skin; working and sleeping in comfortable surroundings; keeping fingernails short, smooth, and clean; considering the use of antihistamines to reduce the urge to itch; and rinsing the skin off and applying a moisturizer after swimming or using a hot tub. ·
Atopic Dermatitis: A Review of Diagnosis and Treatment Source: American Family Physician. 60(4): 1191-1198. September 15, 1999. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 9066000. E-mail:
[email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the diagnosis and treatment of atopic dermatitis. This chronic inflammation of the skin occurs in people of all ages but is more common in children. The pathogenesis of atopic dermatitis is unknown, but the disease seems to result from genetic susceptibility, immune dysfunction, and epidermal barrier dysfunction. Foods, irritating chemicals, and aeroallergens may play a role in the pathogenesis and exacerbation of the disease. Diagnosis is based on the findings of the medical history and the physical examination. No specific laboratory findings or histologic features define the disease. The diagnostic features of atopic dermatitis include pruritus and xerosis. Attempts to relieve the itch by scratching simply worsen the rash, creating a vicious cycle. Staphylococcal and streptococcal infections are common complications of atopic lesions. Treatment should be directed at limiting itching, repairing the skin, and decreasing inflammation when necessary. Lubricants, antihistamines, and topical corticosteroids are the mainstays of therapy. When required, oral corticosteroids can be used. Tar preparations have anti-inflammatory and antipruritic effects on the lesions of atopic dermatitis; however, the disadvantages of tars are their odor and dark, staining color. If pruritus does not respond to treatment, other diagnoses, such as bacterial overgrowth or viral infections, should be considered. Treatment options are available for refractory atopic dermatitis, but these measures should be reserved for use in unique situations and typically require consultation with a dermatologist or an allergist. These options
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include phototherapy, leukotriene inhibitors, and immunosuppressants and antineoplastics. 5 figures, 2 tables, and 29 references. (AA-M). ·
Atopic Dermatitis Source: Postgraduate Medicine. 101(3):101-105, 108-109,112,117; March 1997. Summary: This journal article for health professionals presents an overview of atopic dermatitis. Possible causative factors are identified. A combination of inherited genetic susceptibility and exposure to environmental irritants is the likely cause of this condition. Patient characteristics are presented, focusing on the cutaneous changes that patients may experience throughout their life and the problems that may accompany atopic dermatitis. Precipitating factors are discussed, including moisture-related, contact-related, temperature-related, and emotional factors. In addition, methods of treating atopic dermatitis are described, including oral antihistamines, histamine antagonists, antianxiety agents, topical tricyclic compounds, topical and systemic corticosteroids, tar-containing preparations, herbal therapy, phototherapy, immunotherapy, and antiasthma and antiallergy agents. 6 references, 5 figures, and 2 tables.
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Atopic Dermatitis: How To Incorporate Advances in Management Source: Postgraduate Medicine. 109(6): 119-121,123-127. June 2001. Summary: This journal article provides health professionals with information on the etiology, symptoms, diagnosis, and treatment of atopic dermatitis. This genetically determined, distinctive eczematous condition usually occurs in people who have a personal or family history of asthma or seasonal or perennial allergic rhinitis. The condition is becoming increasingly common in northern, industrialized, temperate countries. Factors implicated in the increased prevalence of the disorder include environmental pollutants, food additives, a decrease in breast feeding, and lifestyles involving primarily indoor living. The rash of atopic dermatitis consists of red, elevated, scaly, and often excoriated and oozing plaques. Scratching and rubbing act as triggers that cause flare, spread the skin disease, and account for papular eruptions. The pattern of the rash can be helpful in making the diagnosis, and age of onset is a key factor when evaluating a patient who may have atopic dermatitis. Diagnostic criteria for atopic dermatitis published by the United Kingdom Working Party in 1994 require a pruritic skin condition and three additional criteria, including a history of flexural dermatitis or dermatitis on the cheeks of children under 10 years old, a personal history of asthma or hay fever or atopy in a first degree relative if the
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patient is less than 4 years old, generalized xerosis in the last year, and visible flexural eczema or eczema on the cheek or forehead, or both, and on the extensor extremities if the patient is less than 4 years old. The final criterion is onset before 2 years of age. Although positive radioallergosorbent or prick tests to various foodstuffs can be documented for the majority of patients with atopic dermatitis, very few of these reactions appear to be relevant. Treatment of atopic dermatitis consists of using proper bathing techniques and applying topical corticosteroids. Antihistamines may be useful in promoting sleep in some patients. Patients who have a widespread or severe rash may need systemic corticosteroids. A new drug, tacrolimus ointment, was recently approved for treatment of atopic eczema. Other alternatives for severe cases of the disease include ultraviolet B, psoralen plus ultraviolet A, cyclosporine, azathioprine, and methotrexate. 2 figures, 2 tables, and 12 references. ·
Superficial Fungal Infection of the Skin: Where and How It Appears Help Determine Therapy Source: Postgraduate Medicine. 109(1): 117-120,123-126,131-132. January 2001. Summary: This journal article provides health professionals with information on the features, diagnosis, and management of tinea pedis, tinea corporis, tinea cruris, tinea versicolor, tinea capitis, tinea faciei, tinea manuum, cutaneous candidiasis, and onychomycosis. Tinea pedis, the most common fungal infection of the skin, involves the plantar surface and interdigital spaces of the foot and can include inflammatory and noninflammatory lesions. Differential diagnosis of tinea pedis includes acrodermatitis continua, candidiasis, contact dermatitis, eczema, erythrasma, psoriasis, pustular bacterids, pyoderma, and secondary syphilis. Tinea pedis usually responds to topical agents such as econazole nitrate, ketoconazole, and terbinafine hydrochloride. Tinea corporis, commonly referred to as ringworm of the body, is dermatophytosis of the glabrous skin of the trunk and extremities. This condition typically develops after inappropriate topical corticosteroid therapy. Treatment involves topical therapy. Tinea cruris, or jock itch, is a dermatophytosis of the proximal medial thigh and buttock. Differential diagnosis includes mechanical intertrigo and candidiasis. Treatment involves topical therapy. Tinea versicolor, or pityriasis versicolor, is typically found in regions of the body that have sebaceous glands. The characteristic finding is skin depigmentation. Differential diagnosis includes vitiligo, tinea corporis, pityriasis rosea, pityriasis alba, and secondary syphilis. Topical therapies such as terbinafine, econazole, ketoconazole, and selenium
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sulfide lotion or shampoo are effective topical therapies. Tinea capitis, which is a dermatophytic infection of the head and scalp, can have a range of clinical presentations. Differential diagnosis includes seborrheic dermatitis, dandruff, scalp psoriasis, atopic dermatitis, and alopecia areata. An oral agent such as griseofulvin is usually needed to successfully treat this condition. Tinea faciei is dermatophytosis of the nonbearded areas of the face. This infection responds to topical therapy. Tinea manuum, an unusual dermatophytic infection of the interdigital and palmar surfaces, may coexist with other fungal infections. Differential diagnosis includes pompholyx, eczema, secondary syphilis, and callus formation. Although the condition responds to topical therapy, it may recur if untreated onychomycosis is present. Cutaneous candidiasis, a skin infection caused by Candida albicans and other species, often presents with erythema, cracking, or maceration. Topical agents commonly used to treat this condition include nystatin, ketoconazole, miconazole nitrate, and clotrimazole. Onychomycosis, a fungal infection of the nail unit, has a wide variety of clinical presentations. Differential diagnosis includes psoriasis, lichen planus, alopecia areata, subungual tumors and warts, and bacterial infections. Oral agents are more successful than topical agents. The article also discusses the topical and systemic agents used to treat cutaneous fungal infections. Topical agents include imidazoles, allylamines, and polyenes. Systemic agents include griseofulvin, ketoconazole, itraconazole, terbinafine, and fluconazole. 16 figures, 2 tables, and 21 references. ·
Atopic Dermatitis: How To Recognize, How To Treat Source: Consultant. 40(13): 2220s-2220t,2221-2222,2224-2226,2228-2230, 2232-2233. November 2000. Summary: This journal article provides health professionals with information on the epidemiology, etiology, diagnosis, differential diagnosis, and treatment of atopic dermatitis (AD). This chronic, relapsing, pruritic skin disease is caused by immune system and environmental factors. The prevalence of AD has been increasing since the 1940s. Although the pathogenesis of AD is multifactorial, recent research emphasizes an immunologic component in its origin. The pathogenesis of AD appears to be similar to that of asthma. Another etiologic factor is that more than 90 percent of AD skin lesions are supercolonized with Staphylococcus aureus. Three of five major criteria-pruritus, a history of atopy, characteristic eczematous changes, early age of onset, and chronic or chronically relapsing dermatitis--are essential for a diagnosis of AD. Associated features include xerosis, allergic shiners, keratosis pilaris, palmar and plantar hyperlinearity, anterior neck fold,
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Dennie-Morgan lines, periorbital milia, anterior capsular cataracts, keratoconus, white dermatographism, thermal sweating abnormalities, and facial pallor. AD is a clinical diagnosis, so a complete skin assessment is crucial. Skin biopsy and laboratory tests may only help to rule out look alike disorders such as seborrheic dermatitis, allergic contact dermatitis, dermatophytosis, immunodeficiency syndromes, neoplastic disease, nummular dermatitis, and scabies. Hydration, avoidance of irritants, and topical corticosteroids are standard therapies. AD response to cyclosporine is rapid, but the drug's side effect profile is significant. Tacrolimus, an immunosuppressive agent used in liver and kidney transplantation, has shown promise in the treatment of AD. 10 figures, 4 tables, and 15 references. (AA-M). ·
Atopic Dermatitis: Perspectives on a Manageable Disease Source: Postgraduate Medicine. 106(4): 49-55. October 1, 1999. Summary: This journal article provides health professionals with information on atopic dermatitis, including its pathogenesis, aggravating factors, clinical features, and treatment. Atopic dermatitis, which is a form of eczema, is characterized by itchy, dry, inflamed skin. Immune dysregulation appears to have an important role in the etiology of this skin disease. Several aggravating factors have been identified, including food allergens, airborne allergens, irritants, microbes, and stress. Food challenge is the most reliable method for determining food hypersensitivity in patients who have atopic dermatitis. The most common foods that cause hypersensitivity are eggs, milk, fish, shellfish, cornstarch, peanuts, and soybeans. Eliminating airborne allergens such as dust mites, animal dander, and pollen may dramatically improve the clinical condition of some patients. Skin irritants, particularly detergents, wool, synthetic fabrics, solvents, and perspiration, may exacerbate atopic dermatitis. Agents that promote drying of the skin should be minimized. People who have atopic dermatitis are prone to skin infection, so some clinicians occasionally prescribe an empirical course of systemic antibiotics. Although emotional stressors do not cause atopic dermatitis, they may exacerbate symptoms. The earliest clinical features of atopic dermatitis are dryness and roughness of the skin. Lesions typically show papulation rather than exudation. Diagnosis is based on a physical examination of the lesions. Options for treating atopic dermatitis include applying emollients; using topical corticosteroids, antihistamines, and immunosuppressive drugs; and undergoing ultraviolet light therapy and psoralen phototherapy. Treatment of atopic dermatitis should be tailored to the individual according to the severity of the disease. 3 figures, 2 tables, and 20 references.
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Managing Atopic Dermatitis Source: Dermatology Nursing. 11(3): 171-176,179-187. June 1999. Summary: This journal article provides health professionals with information on the natural history and management of atopic dermatitis (AD). Atopy, pruritus, and eczema are the three essential features required to fulfill the criteria for a diagnosis of AD. The nurse can assume an important role in managing AD after the diagnosis has been made. The main goals in managing AD are to prevent scratching and to suppress the resulting eczematous inflammation. Education on and reinforcement of these goals can be assigned to environmental, personal, and pharmacotherapy considerations. Environmental considerations focus on ambient temperature and humidity, and allergen, irritant, and work or hobby exposures. Personal considerations involve reviewing bathing habits, dealing with emotional stress, detecting and treating Staphylococcus aureus infections, avoiding exposure to people who have viral infections, identifying and treating seborrhea and chronic dermatophytic or yeast infections, and avoiding food triggers. Pharmacotherapy considerations focus on all prescribed and nonprescribed medications applied to the skin, all systemic medications being taken, and the proper use of topical and systemic medications. A multiple choice examination following the article tests the reader's achievement of the objectives outlined at the beginning of the article. 2 tables and 92 references.
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Atopic Dermatitis in Childhood Source: Dermatology Nursing. 10(1): 30-33. February 1998. Summary: This journal article provides nurses with information on the treatment of atopic dermatitis (AD), commonly called eczema, in childhood. AD is a genetically determined disorder affecting 10 percent of the U.S. pediatric population. Although the exact cause of AD is unknown, it most likely results from an interaction of genetic and environmental factors. AD is a therapeutic challenge because it involves identifying flare and trigger factors, such as irritants, reduced humidity, excessive sweating, allergies, infections, and emotional stress. Topical or systemic antibiotics may be used to suppress the heavy colonies of noninvasive staphylococci present on atopic skin. Emotional stress must be addressed when a child's disease is severe and difficult to control. Treatment involves using emollients, topical steroids, and oral antihistamines. Hospitalization is indicated if the child has a severe recalcitrant flare, eczema herpeticum, or exfoliate dermatitis. Families of children who have AD may benefit from attending a support group. The
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article includes a handout that may be reproduced for patient education. 4 figures, 1 table, and 5 references. ·
Recent Developments in the Treatment of Atopic Eczema Source: Journal of the American Academy of Dermatology. 36(6):983-994; June 1997. Summary: This journal article for health professionals reports on recent developments in the treatment of atopic dermatitis (AD) or eczema, which is a common, chronically relapsing skin disease with a genetic predisposition and unknown cause. Recent progress in the understanding of the pathophysiologic characteristics of AD has prompted new therapeutic strategies. The article evaluates the effectiveness of phototherapy, cytokines such as interferons and interleukins, and immunosuppressive drugs such as cyclosporine and FK506. In addition, some new and promising but still experimental approaches are discussed, including experimental immunotherapies, Chinese herbal therapy, essential fatty acid supplementation, mast cell stabilizing agents, and topical immunoglobulin G preparations. 154 references and 6 tables. (AA-M).
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Eczematous Dermatitis: A Practical Review Source: American Family Physician. 54(4):1243-1250. September 5, 1996. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 9066000. E-mail:
[email protected]. Website: www.aafp.org. Summary: This journal article for dermatologists discusses various types eczematous dermatitis and their treatment. Eczematous dermatitis can interfere with social function, sleep, and employment, and that its persistence and accompanying pruritus may be stressful and frustrating for patients. The most common and best characterized type of eczema, atopic dermatitis, appears to be increasing in incidence. The authors suggest that other common eczematous dermatoses, particularly allergic dermatitis and irritant contact dermatitis, must be accurately diagnosed, since improvement and resolution rely on appropriate diagnosis and avoidance of pertinent triggering factors. Principles of treatment include general skin care, patient education about avoidance of irritants, skin hydration and the use of topical corticosteroids when necessary. Use of systemic corticosteroids is not generally recommended for the treatment of chronic eczematous dermatitis. (AA-M).
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Living With Eczema: The Dermatology Patient Source: British Journal of Nursing. 5(10):600-604,606-609; 1996. Summary: This journal article for health professionals presents an overview of eczema. The prevalence of all forms of eczema is unknown, but there is evidence that atopic eczema is increasing. Types of eczema are identified, including exogenous forms such as contact irritant eczema, contact allergic eczema, and photosensitive eczema; endogenous forms such as atopic eczema, seborrhoeic eczema, discoid eczema, gravitational eczema, and pompholyx; and unclassified or mixed forms such as asteototic eczema, lichen simplex, and juvenile plantar dermatosis. The clinical and histological features of eczema are described. The role of nursing care in the management of eczema is discussed in terms of the nursing assessment; the needs of children, young adults, adults, and the elderly with eczema; and the management of eczema. First-line treatments are discussed, including avoiding provoking factors, bathing, applying emollients, treating bacterial infections, and using topical corticosteroids and occlusive techniques. Other treatment considerations that nurses should discuss with patients are highlighted, including sensitivity to house dust mites, the role of diet in initiating or perpetuating atopic eczema, and the use of systemic treatments. 12 references, 6 figures, and 4 tables. (AA-M).
Federally-Funded Research on Atopic Dermatitis The U.S. Government supports a variety of research studies relating to atopic dermatitis and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to atopic dermatitis and related conditions.
18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore atopic dermatitis and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for atopic dermatitis: ·
Project Title: Characterization of an Animal Model of Atopic Dermatitis Principal Investigator & Institution: Chan, Lawrence S.; Assistant Professor; Dermatology; Northwestern University 303 E Chicago Ave Chicago, Il 60611 Timing: Fiscal Year 2001; Project Start 0-MAR-2001; Project End 8-FEB2004 Summary: (Taken from the application): Atopic dermatitis is a chronic, inflammatory skin disease that affects about 20% children between ages 3 and 11. The prevalence of atopic, dermatitis is increasing, particularly in the industrialized nations. Atopic dermatitis is characterized by pruritic skin rash clinically, T lymphocyte and mast cell infiltration histopathologically, and elevation of total serum IgE serologically. Although usually non-fatal, atopic dermatitis can cause significant morbidity. Clinical and laboratory data from studying of human patients suggests that atopic dermatitis may be caused by an imbalance of excessive activation of Th2-type lymphocytes over Thl-type lymphocytes, resulting in a Th2-biased immune response. However, the step-by-step immunological sequence of events accounting for the initiation, progression, and maintenance of the disease remain unclear. Furthermore, currently there is no available experimental animal model of atopic derrnatitis for dissecting these step-by-step events. The PI, Lawrence S. Chan, M.D., was trained as a fellow in Immuno-dermatology under Dr. Kevin D. Cooper, a cellular immunologist at the Univ. of Michigan. For the current proposal, the PI aims at characterizing a transgenic (Tg) mouse model that the PI has recently created. This experimental mouse model was generated by transgenically introduced critical Th2 cytokine IL-4 to the basal epidermis of Tg mice and the affected Tg mice has identical clinical, histopathological, microbiological, and serological characteristics as human atopic dermatitis. With the availability of this newly created mouse disease model, the PI can now move forward to further characterize this experimental model of atopic dermatitis with the following specific aims: 1). Determining the
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correlation of epidermal IL-4 in vivo protein expression and total serum IgE levels with clinical phenotype. 2). Determining the inflammatory cell types of skin lesions. 3). Characterizing the cytokine profiles of skin lesions. By parallel studying the natural history of atopic dermatitis and the immunological parameters, including lesional inflammatory cell and T cell subsets, lesional T cell cytokines, adhesion molecules, and total serum IgE, the PI aims at delineating the step-by-step immune events accounting for the initiation, progression, and maintenance of the disease. The likelihood of achieving these aims is supported by the PI's past experience in these areas of investigation and the assistance of Dr. Stephen D. Miller, an experienced cellular immunologist and the coinvestigator of the project. Delineating the characteristics of atopic dermatitis in this mouse disease model may shed light to the pathogenesis of atopic dermatitis in human patients, thereby lead to eventual target-specific immunological treatments for human patients suffering from atopic dermatitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Function of Fceri on Epidermal Langerhans Cells Principal Investigator & Institution: Borkowski, Teresa A.; Professor; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2000; Project Start 1-SEP-1997; Project End 1-AUG2001 Summary: Langerhans cells (LC) are the principal antigen presenting cells of the skin, and the outpost of the immune system. Jurgens recently demonstrated that crosslinking FcepsilonRI, the high affinity IgE receptor on LC induces phosphorylation of tyrosine and calcium flux in LC. The phenotypic and functional consequences of crosslinking FcepsiolonRI and LC are unknown, however, a functional role for IgE receptors on LC has been suggested, particularly in atopic dermatitis. The purpose of these studies is to determine the functional significance of high affinity IgE receptors on LC and dendritic cells (DC), and to determine if activation of LC and DC via FcepsilonRI plays a role in the pathogenesis of atopic dermatitis. The specific aims of this proposal are to examine the phenotypic and functional consequences of crosslinking FcepsilonRI on LC an DC and determine if the phenotypic and functional characteristics of LC activated via FcepsilonRI reflect those of LC found in lesions of atopic dermatitis. Normal LC and DC will be activated by crosslinking FcepsilonRIalpha, and activation will be confirmed by demonstrating phosphorylation of tyrosine residue and calcium flux following receptor crosslinking. The phenotype of activated LC and DC will be determined
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by multicolor flow cytometry. Functional consequences of activation will be determined by measuring the magnitude as well as the type of T cell response (Th1 vs Th2), generated by the presentation of antigen to T cells by activated LC or DC. The type of T cell response will be determined by flow cytometry for intracellular cytokine production and will be correlated to cytokine secretion as determined by ELISA. Clinical studies will compare the phenotypic and functional characteristics of LC and DC from atopic and normal subjects, and determine if activated LC or DC are henotypically and functionally similar to LC or DC from atopic donors. Once a functional role for high affinity IgE receptors on LC and DC is established, later studies will focus on the mechanisms of signal transduction via FcepsilonRI itself, and clinical studies will seek to develop therapeutic strategies to treat atopic dermatitis by inhibiting the activation of LC and DC via FcepsilonRI. Through these studies, the candidate will gain new expertise in the fields of signal transduction, molecular biology and allergy, which along with her current expertise in dermatology and cellular immunology will facilitate her long term goals to study the immunologic mechanisms of atopic dermatitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: International Symposium on Atopic Dermatitis Principal Investigator & Institution: Hanifin, Jon M.; Professor; National Eczema Assn for Science & Educ for Science and Education Portland, or 97205 Timing: Fiscal Year 2001; Project Start 1-MAY-2001; Project End 0-APR2002 Summary: This conference is being convened to bring together an international group of investigators in the field of atopic dermatitis. The objectives of the Symposium are to: 1) Provide a forum for presenting and discussing important research on atopic dermatitis (AD); 2) Assemble a cadre of recognized international experts from the fields of dermatology, allergy, molecular genetics, epidemiology and immunobiology to develop a comprehensive overview of the condition at the molecular, cellular, tissue, and population levels; 3) Encourage agreement on definitions and criteria for future genetic, epidemiologic and clinical investigations; 4) Identify a list of key research topics that deserve priority consideration by NIH Institutes, investigators. and public/ private sector funders; 5) Examine the impact of atopic disease on the prevalence, incidence, and costs of occupational dermatoses, specifically allergic contact dermatitis/hand eczema; 6) Improve the public awareness regarding the scope and prevalence of AD and the range of therapeutic options that are currently available to treat the
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condition in all of its clinical manifestations. Provide particular emphasis on the special problems faced by non-Caucasian populations with eczema/atopic dermatitis. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Topical Cyclosporin A for Dermatitis and Psoriasis Principal Investigator & Institution: Rothbard, Jonathan B.; ; Cellgate, Inc. 552 Del Rey Ave Sunnyvale, Ca 94085 Timing: Fiscal Year 2001; Project Start 2-SEP-2001; Project End 1-AUG2002 Summary: (Verbatim) The protective outer layer of the skin, the stratum corneum, serves to exclude therapeutic drugs like cyclosporin A (CsA). Preliminary experiments have unambiguously established that short polymers of arginine cross the stratum corneum of murine and human skin to enter the epidermal and dermal tissue. Similar penetration into all layers of the skin was observed when short polymers of arginine were conjugated to CsA, which in unconjugated form fails to penetrate skin. These conjugates reached infiltrating T cells in the dermis of inflamed skin. Related conjugates using a releasable linker provided therapeutically active CsA conjugates, thus providing a means of focally delivering systemically toxic drugs for the treatment of psoriasis and dermatitis while alleviating the problem of systemic toxicity. The goal of this proposal is to select a lead CsA -transporter conjugate for further development. This will entail the synthesis and evaluation of a series of GsA-transporter conjugates comprising a set of transporters with a range of tissue penetrating ability. A labeled subset will be assessed for tissue penetration and a corresponding releasable subset will be evaluated in vitro by assaying their ability to inhibit secretion of Il-2 by activated T cells and in vivo using an animal model of contact dermatitis. PROPOSED COMMERCIAL APPLICATION: Current topical therapies for dermatitis and psoriasis all have fundamental problems. When administered orally, immunosuppressants can be effective, and by, intralesional injection, CsA dramatically reduces or clears psoriatic lesions. CsA is not currently used to treat dermatitis and is used only in severe cases of psoriasis because of systemic toxicity. The proposed conjugates are expected to provide the first highly efficacious topical treatments for atopic/contact dermatitis and psoriasis, which together total >20 million US patients. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “atopic dermatitis” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for atopic dermatitis in the PubMed Central database: ·
Drug points:Fever associated with cyclosporin for treating atopic dermatitis by M D Thomas and L J Cook; 1998 November 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28712
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Molecular Analysis of Malassezia Microflora on the Skin of Atopic Dermatitis Patients and Healthy Subjects by Takashi Sugita, Hajime Suto, Tetsushi Unno, Ryoji Tsuboi, Hideoki Ogawa, Takako Shinoda, and Akemi Nishikawa; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88376&ren dertype=external
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Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema by K S Thomas, S Armstrong, A Avery, A Li Wan Po, C O'Neill, S Young, and H C Williams; 2002 March 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=100318
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19
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references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with atopic dermatitis, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “atopic dermatitis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “atopic dermatitis” (hyperlinks lead to article summaries): ·
Optimal management of atopic dermatitis. Author(s): Abeck D, Strom K. Source: American Journal of Clinical Dermatology. 2000 JanuaryFebruary; 1(1): 41-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11702304&dopt=Abstract
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Oral administration of persimmon leaf extract ameliorates skin symptoms and transepidermal water loss in atopic dermatitis model mice, NC/Nga. Author(s): Matsumoto M, Kotani M, Fujita A, Higa S, Kishimoto T, Suemura M, Tanaka T. Source: The British Journal of Dermatology. 2002 February; 146(2): 221-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11903231&dopt=Abstract
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Pharmacophysiology of atopic dermatitis. Author(s): Hanifin JM. Source: Clin Rev Allergy. 1986 February; 4(1): 43-65. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3008974&dopt=Abstract
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Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis. Author(s): Berth-Jones J, Graham-Brown RA.
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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Source: Lancet. 1993 June 19; 341(8860): 1557-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8099640&dopt=Abstract ·
Practical approaches to the treatment of atopic dermatitis. Author(s): Charlesworth EN. Source: Allergy Proc. 1994 November-December; 15(6): 269-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7721074&dopt=Abstract
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Pseudo-atopic dermatitis. Contact dermatitis due to chrome sensitivity simulating atopic dermatitis. Author(s): Shanon J. Source: Dermatologica. 1965; 131(3): 176-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5866873&dopt=Abstract
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Psychobiological aspects of atopic dermatitis: an overview. Author(s): Buske-Kirschbaum A, Geiben A, Hellhammer D. Source: Psychotherapy and Psychosomatics. 2001 January-February; 70(1): 6-16. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11150933&dopt=Abstract
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Psychosocial characterization of patients with atopic dermatitis in conventional versus alternative-medical therapy. Author(s): Zschocke I, Stein B, Tanno S, Beckmann S, Augustin M. Source: Forschende Komplementarmedizin. 1999 April; 6 Suppl 2: 22-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10352378&dopt=Abstract
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Recent developments in the management of patients with atopic dermatitis. Author(s): Rasmussen JE. Source: The Journal of Allergy and Clinical Immunology. 1984 December; 74(6): 771-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6501746&dopt=Abstract
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Supplementation with evening primrose oil in atopic dermatitis: effect on fatty acids in neutrophils and epidermis. Author(s): Schafer L, Kragballe K.
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Source: Lipids. 1991 July; 26(7): 557-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1943500&dopt=Abstract ·
Systemic therapy of atopic dermatitis. Author(s): Sidbury R, Hanifin JM. Source: Clinical and Experimental Dermatology. 2000 October; 25(7): 55966. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11122228&dopt=Abstract
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The effect of antibacterial soap with 1.5% triclocarban on Staphylococcus aureus in patients with atopic dermatitis. Author(s): Breneman DL, Hanifin JM, Berge CA, Keswick BH, Neumann PB. Source: Cutis. 2000 October; 66(4): 296-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11109156&dopt=Abstract
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The effect of gamma-linolenic acid on clinical status, red cell fatty acid composition and membrane microviscosity in infants with atopic dermatitis. Author(s): Biagi PL, Bordoni A, Hrelia S, Celadon M, Ricci GP, Cannella V, Patrizi A, Specchia F, Masi M. Source: Drugs Exp Clin Res. 1994; 20(2): 77-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7924900&dopt=Abstract
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The effect on atopic dermatitis of supplementation with selenium and vitamin E. Author(s): Fairris GM, Perkins PJ, Lloyd B, Hinks L, Clayton BE. Source: Acta Dermato-Venereologica. 1989; 69(4): 359-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2568065&dopt=Abstract
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The effects of rice bran broth bathing in patients with atopic dermatitis. Author(s): Fujiwaki T, Furusho K. Source: Acta Paediatr Jpn. 1992 October; 34(5): 505-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1442022&dopt=Abstract
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The practical management of atopic dermatitis in children. Author(s): Halbert AR. Source: Pediatric Annals. 1996 February; 25(2): 72-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8822030&dopt=Abstract
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The prevalence of common skin conditions in Australian school students: 2. Atopic dermatitis. Author(s): Marks R, Kilkenny M, Plunkett A, Merlin K. Source: The British Journal of Dermatology. 1999 March; 140(3): 468-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10233268&dopt=Abstract
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The relationship between the psychological and immunological state in patients with atopic dermatitis. Author(s): Hashiro M, Okumura M. Source: Journal of Dermatological Science. 1998 March; 16(3): 231-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9651821&dopt=Abstract
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The therapeutic effect of evening primrose oil in atopic dermatitis patients with dry scaly skin lesions is associated with the normalization of serum gamma-interferon levels. Author(s): Yoon S, Lee J, Lee S. Source: Skin Pharmacology and Applied Skin Physiology. 2002 JanuaryFebruary; 15(1): 20-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11803254&dopt=Abstract
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Time-course studies of immediate and delayed immune reactivity in patients with atopic dermatitis treated with herbal drugs. Author(s): Soderberg U, Windelborg Nielsen B, Schade Larsen C, Schiotz PO, Thestrup-Pedersen K. Source: Allergy. 1990 November; 45(8): 559-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1705106&dopt=Abstract
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Treatment of atopic dermatitis in children: the importance of skin care and environmental control. Author(s): Ganir EM, Capulong MC, Tahara K, Akasawa A, Iikura Y.
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Source: Acta Paediatr Jpn. 1996 December; 38(6): 702-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9002315&dopt=Abstract ·
Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention. Author(s): Ehlers A, Stangier U, Gieler U. Source: J Consult Clin Psychol. 1995 August; 63(4): 624-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7673540&dopt=Abstract
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Treatment of refractory cases of atopic dermatitis with acidic hotspring bathing. Author(s): Kubota K, Machida I, Tamura K, Take H, Kurabayashi H, Akiba T, Tamura J. Source: Acta Dermato-Venereologica. 1997 November; 77(6): 452-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9394980&dopt=Abstract
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Use of alternative medicine by patients with atopic dermatitis and psoriasis. Author(s): Jensen P. Source: Acta Dermato-Venereologica. 1990; 70(5): 421-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1980977&dopt=Abstract
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Vegetarian diet ameliorates symptoms of atopic dermatitis through reduction of the number of peripheral eosinophils and of PGE2 synthesis by monocytes. Author(s): Tanaka T, Kouda K, Kotani M, Takeuchi A, Tabei T, Masamoto Y, Nakamura H, Takigawa M, Suemura M, Takeuchi H, Kouda M. Source: J Physiol Anthropol Appl Human Sci. 2001 November; 20(6): 35361. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11840688&dopt=Abstract
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What is the cost of atopic dermatitis in preschool children? Author(s): Emerson RM, Williams HC, Allen BR.
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Source: The British Journal of Dermatology. 2001 March; 144(3): 514-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11260008&dopt=Abstract ·
A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Author(s): Sheehan MP, Atherton DJ. Source: The British Journal of Dermatology. 1992 February; 126(2): 179-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1536784&dopt=Abstract
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A double-blind placebo-controlled study of thymostimulin (TP-1) for the treatment of atopic eczema. Author(s): Harper JI, Mason UA, White TR, Staughton RC, Hobbs JR. Source: The British Journal of Dermatology. 1991 October; 125(4): 368-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1835403&dopt=Abstract
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Association of immunological changes with clinical efficacy in atopic eczema patients treated with traditional Chinese herbal therapy (Zemaphyte). Author(s): Latchman Y, Banerjee P, Poulter LW, Rustin M, Brostoff J. Source: International Archives of Allergy and Immunology. 1996 March; 109(3): 243-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8620093&dopt=Abstract
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Atopic eczema between rationality and irrationality. Author(s): Ruzicka T. Source: Archives of Dermatology. 1998 November; 134(11): 1462-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9828885&dopt=Abstract
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Atopic eczema: problems and solutions in childhood and the teenage years. Author(s): Donald S. Source: Prof Care Mother Child. 1997; 7(5): 129-34. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9439218&dopt=Abstract
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Bath psoralen-ultraviolet A therapy in atopic eczema. Author(s): de Kort WJ, van Weelden H. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2000 May; 14(3): 172-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11032059&dopt=Abstract
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Changes in CD23 expression of blood and skin in atopic eczema after Chinese herbal therapy. Author(s): Banerjee P, Xu XJ, Poulter LW, Rustin MH. Source: Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology. 1998 March; 28(3): 306-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9543080&dopt=Abstract
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Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. Author(s): Henz BM, Jablonska S, van de Kerkhof PC, Stingl G, Blaszczyk M, Vandervalk PG, Veenhuizen R, Muggli R, Raederstorff D. Source: The British Journal of Dermatology. 1999 April; 140(4): 685-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10233322&dopt=Abstract
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Efficacy of traditional Chinese herbal therapy in vitro. A model system for atopic eczema: inhibition of CD23 expression on blood monocytes. Author(s): Latchman Y, Bungy GA, Atherton DJ, Rustin MH, Brostoff J. Source: The British Journal of Dermatology. 1995 April; 132(4): 592-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7748751&dopt=Abstract
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Evaluation of massage with essential oils on childhood atopic eczema. Author(s): Anderson C, Lis-Balchin M, Kirk-Smith M. Source: Phytotherapy Research : Ptr. 2000 September; 14(6): 452-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10960901&dopt=Abstract
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Evening primrose oil and atopic eczema. Author(s): Berth-Jones J, Thompson J, Graham-Brown RA. Source: Lancet. 1995 February 25; 345(8948): 520. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7861894&dopt=Abstract
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Failure of oral zinc supplementation in atopic eczema. Author(s): Ewing CI, Gibbs AC, Ashcroft C, David TJ. Source: European Journal of Clinical Nutrition. 1991 October; 45(10): 50710. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1782922&dopt=Abstract
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Follow-up of adult patients with atopic eczema treated with Chinese herbal therapy for 1 year. Author(s): Sheehan MP, Stevens H, Ostlere LS, Atherton DJ, Brostoff J, Rustin MH. Source: Clinical and Experimental Dermatology. 1995 March; 20(2): 13640. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8565248&dopt=Abstract
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Hypnotic skin analgesy in healthy individuals and patients with atopic eczema. Author(s): Hajek P, Radil T, Jakoubek B. Source: Homeost Health Dis. 1991 October; 33(3): 156-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1818683&dopt=Abstract
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Modulation by Chinese herbal therapy of immune mechanisms in the skin of patients with atopic eczema. Author(s): Xu XJ, Banerjee P, Rustin MH, Poulter LW. Source: The British Journal of Dermatology. 1997 January; 136(1): 54-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9039295&dopt=Abstract
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Novel unconventional therapeutic approaches to atopic eczema. Author(s): Worm M, Henz BM. Source: Dermatology (Basel, Switzerland). 2000; 201(3): 191-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11096188&dopt=Abstract
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One-year follow up of children treated with Chinese medicinal herbs for atopic eczema. Author(s): Sheehan MP, Atherton DJ.
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Source: The British Journal of Dermatology. 1994 April; 130(4): 488-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8186115&dopt=Abstract ·
Proof of efficacy of Kamillosan(R) cream in atopic eczema. Author(s): Patzelt-Wenczler R, Ponce-Poschl E. Source: European Journal of Medical Research. 2000 April 19; 5(4): 171-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10799352&dopt=Abstract
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Reversible dilated cardiomyopathy following treatment of atopic eczema with Chinese herbal medicine. Author(s): Ferguson JE, Chalmers RJ, Rowlands DJ. Source: The British Journal of Dermatology. 1997 April; 136(4): 592-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9155965&dopt=Abstract
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Skin care in atopic eczema. Author(s): Forsdyke H, Watts J. Source: Prof Nurse. 1994 October; 10(1): 36-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7972179&dopt=Abstract
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Systematic review of treatments for atopic eczema. Author(s): Hoare C, Li Wan Po A, Williams H. Source: Health Technology Assessment (Winchester, England). 2000; 4(37): 1-191. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11134919&dopt=Abstract
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The efficacy of traditional Chinese herbal therapy in atopic eczema. Author(s): Latchman Y, Whittle B, Rustin M, Atherton DJ, Brostoff J. Source: International Archives of Allergy and Immunology. 1994 July; 104(3): 222-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8032233&dopt=Abstract
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Treatment of atopic eczema with evening primrose oil: rationale and clinical results. Author(s): Kerscher MJ, Korting HC.
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Source: Clin Investig. 1992 February; 70(2): 167-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1318129&dopt=Abstract ·
Treatment of atopic eczema with traditional Chinese medicinal plants. Author(s): Atherton DJ, Sheehan MP, Rustin MH, Whittle B, Guy G. Source: Pediatric Dermatology. 1992 December; 9(4): 373-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1492062&dopt=Abstract
Vocabulary Builder Acrodermatitis: Inflammation involving the skin of the extremities, especially the hands and feet. Several forms are known, some idiopathic and some hereditary. The infantile form is called Gianotti-Crosti syndrome. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining,
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lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Biogenesis: The origin of life. It includes studies of the potential basis for life in organic compounds but excludes studies of the development of altered forms of life through mutation and natural selection, which is EVOLUTION. [NIH]
Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
Depigmentation: Removal or loss of pigment, especially melanin. [EU] Dermatophytosis: Any superficial fungal infection caused by a dermatophyte and involving the stratum corneum of the skin, hair, and nails. The term broadly comprises onychophytosis and the various form of tinea (ringworm), sometimes being used specifically to designate tinea pedis (athlete's foot). Called also epidermomycosis. [EU] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Dinitrofluorobenzene: Irritants and reagents for labeling terminal amino acid groups. [NIH] Discoid: Shaped like a disk. [EU] Disinfectant: An agent that disinfects; applied particularly to agents used
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on inanimate objects. [EU] Econazole: A broad spectrum antimycotic with some action against Gram positive bacteria. It is used topically in dermatomycoses also orally and parenterally. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Eosinophilia: The formation and accumulation of an abnormally large number of eosinophils in the blood. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Erythrasma: A chronic, superficial bacterial infection of the skin involving the body folds and toe webs, sometimes becoming generalized, caused by Corynebacterium minutissimum, and characterized by the presence of sharply demarcated, dry, brown, slightly scaly, and slowly spreading patches. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Griseofulvin: An antifungal antibiotic. Griseofulvin may be given by mouth in the treatment of tinea infections. [NIH] Hydration: The condition of being combined with water. [EU] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU]
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Immunosuppressant: An agent capable of suppressing immune responses. [EU]
Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Interferons: Proteins secreted by vertebrate cells in response to a wide variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intertrigo: A superficial dermatitis occurring on apposed skin surfaces, such as the axillae, creases of the neck, intergluteal fold, groin, between the toes, and beneath pendulous breasts, with obesity being a predisposing factor, caused by moisture, friction, warmth, and sweat retention, and characterized by erythema, maceration, burning, itching, and sometimes erosions, fissures, and exudations and secondary infections. Called also eczema intertrigo. [EU] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Ketoconazole: Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lenses: Pieces of glass or other transparent materials used for magnification or increased visual acuity. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a
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major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Maceration: The softening of a solid by soaking. In histology, the softening of a tissue by soaking, especially in acids, until the connective tissue fibres are so dissolved that the tissue components can be teased apart. In obstetrics, the degenerative changes with discoloration and softening of tissues, and eventual disintegration, of a fetus retained in the uterus after its death. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Miconazole: An imidazole antifungal agent that is used topically and by intravenous infusion. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neutrophil: Having an affinity for neutral dyes. [EU] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]
Ophthalmic: Pertaining to the eye. [EU] Oxazolone: Immunologic adjuvant and sensitizing agent. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 - oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Pallor: A clinical manifestation consisting of an unnatural paleness of the skin. [NIH] Perennial: Lasting through the year of for several years. [EU] Periorbital: Situated around the orbit, or eye socket. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH]
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Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Pityriasis: A name originally applied to a group of skin diseases characterized by the formation of fine, branny scales, but now used only with a modifier. [EU] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: 1. itching; an unpleasant cutaneous sensation that provokes the desire to rub or scratch the skin to obtain relief. 2. any of various conditions marked by itching, the specific site or type being indicated by a modifying term. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Pyoderma: Any purulent skin disease. Called also pyodermia. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Refractory: Not readily yielding to treatment. [EU] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and
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secondary bacterial infection. Called also the itch and seven-year itch. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sensitization: 1. administration of antigen to induce a primary immune response; priming; immunization. 2. exposure to allergen that results in the development of hypersensitivity. 3. the coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Translating: Conversion from one language to another language. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU]
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Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Venereology: A branch of medicine which deals with sexually transmitted disease. [NIH] Vitiligo: A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. [NIH]
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CHAPTER 5. PATENTS ON ATOPIC DERMATITIS Overview You can learn about innovations relating to atopic dermatitis by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with atopic dermatitis within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with atopic dermatitis. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
23Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Atopic Dermatitis By performing a patent search focusing on atopic dermatitis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on atopic dermatitis: ·
Method for detection of atopic dermatitis Inventor(s): Ito; Makoto (Fukuoka, JP), Okino; Nozomu (Fukuoka, JP) Assignee(s): Takara Shuzo Co., Ltd. (Kyoto-fu, JP) Patent Number: 6,043,046 Date filed: July 22, 1998 Abstract: The present invention relates to a method for detection of atopic dermatitis, and to a kit for use in the detection of atopic dermatitis. The present invention is useful in cases where it is difficult or almost impossible to distinguish atopic dermatitis from other allergoses when detected by the conventional methods, or where it is difficult to macroscopically distinguish atopic dermatitis from other dermatopathies. Moreover, the detection method of the present invention is also useful as a method of primary screening for atopic dermatitis. Excerpt(s): The present invention relates to a simple method for detection of atopic dermatitis, and to a kit for use in the method. ... Conventionally, atopic dermatitis has been diagnosed macroscopically or through detailed questioning on mainly clinical symptoms, such as morphologic features and distribution of skin rash, because there have been reported no detection methods for this disease. Clinical examination results are only used for references. For example, serum IgE levels are measured in clinical examination, a high IgE level providing a basis for the diagnosis of atopic dermatitis. It should be noted, however, that elevated IgE levels are observed not only in atopic dermatitis but also in other diseases including allergoses, such as bronchial asthma and allergic rhinitis; parasitic diseases; liver diseases, such as hepatitis, cirrhosis and primary hepatoma; and autoimmune diseases, such as systemic lupus erythematosus. Therefore, a high IgE value is not always directly
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associated with atopic dermatitis. On the contrary, there has been reported that a significant ratio of patients with atopic dermatitis have perfectly normal serum IgE levels. ... Other methods of clinical examination include allergen detection tests, such as peripheral blood eosinophilic leukocyte counting, RAST method (antigen-specific IgE quantitation), scratch test, prick test, and patch test, none of which are necessarily specific to atopic dermatitis. Web site: http://www.delphion.com/details?pn=US06043046__ ·
Anti-atopic dermatitis composition Inventor(s): Matsuda; Michio (Kushiro, JP), Takeuchi; Sechiko (Hiroshima, JP), Nagura; Taizo (Obihiro, JP), Aritsuka; Tsutomu (Obihiro, JP), Sayama; Kouji (Obihiro, JP) Assignee(s): Nippon Tensaiseito Kabushiki Kaisha (Tokyo, JP) Patent Number: 5,994,326 Date filed: August 11, 1998 Abstract: The present invention relates to an anti-atopic dermatitis composition containing raffinose as the effective ingredient that can be satisfactorily administered to babies and infants for a long term. Excerpt(s): The present invention relates to an anti-atopic dermatitis composition; more specifically, the present invention relates to a composition for preventing or therapeutically treating atopic dermatitis, the composition containing raffinose an (oligosaccharide) as the effective ingredient. ... Since Matsuda et al. have reported domestically in Japan that the above noted combination treatment is also effective for 70 to 80% of relatively severe patients with atopic dermatitis (Michio Matsuda and Makoto Takahashi, Allergy in Clinics, Vol.56, pp.768-772, 1991), such combination treatment has been introduced into the Guideline for Treatment of Allergic Diseases (Michio Matsuda, Guideline for Treatment of Allergic Diseases, edited by Souhei Makino, Life Science Medica, Tokyo, 1993). ... However, it has never been known that raffinose is effective for preventing and treating atopic dermatitis or it has absolutely never been reported that the action is verified at clinical tests for human subjects, including in vitro experiments and in vivo experiments in experimental animals. Web site: http://www.delphion.com/details?pn=US05994326__
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Topical and systemic application of buspirone or derivatives thereof for treating atopic dermatitis Inventor(s): Sharpe; Richard J. (Gloucester, MA), Arndt; Kenneth A. (Newton Centre, MA), Galli; Stephen J. (Winchester, MA) Assignee(s): Beth Israel Deaconess Medical Center, Inc. (Boston, MA) Patent Number: 5,637,314 Date filed: June 7, 1995 Abstract: A method for treating atopic dermatitis, hayfever, asthma and pruritis that includes topical or systemic application of an effective amount of buspirone or a buspirone derivative or its pharmaceutically acceptable salt, other than a quaternary salt, optionally in a pharmaceutically-acceptable diluent or carrier. Excerpt(s): This invention is in the area of the treatment of atopic dermatitis using buspirone or its pharmaceutically acceptable salt or derivative. This application claims priority to Ser. No. 08/037,225, filed Mar. 26, 1993, now allowed and Ser. No. 08/037,271, filed on Mar.26, 1993, now U.S. Pat. No. 5,484,788. ... Atopic dermatitis is a chronic inflammatory skin disorder exhibited by individuals with a hereditary predisposition to a lowered cutaneous threshold to pruritis, often accompanied by allergic rhinitis, hay fever, and asthma, and primarily characterized by extreme itching, leading to scratching and rubbing that in turn results in the typical lesions of eczema. In infants (infantile eczema), there is a predilection for occurrence of the cheeks, which may extend to other areas of the body; in children, adolescents and adults, it is found chiefly on the flexural surfaces (flexural eczema), especially on the antecubital and popiteal areas, and on the neck, eyelids, and wrists and behind the ears. ... In atopic dermatitis, and eczema in general, immunologically mediated leukocyte infiltration (particularly infiltration of mononuclear cells, lymphocytes, neutrophils, and eosinophils) into the skin significantly contributes to the pathogenesis of these diseases. Chronic eczema also is associated with significant hyperproliferation of the epidermis. Web site: http://www.delphion.com/details?pn=US05637314__
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·
Composition for topical treatment of psoriasis and atopic dermatitis comprising a xanthine derivative Inventor(s): Eitan; Anat (Even Yehuah, IL), Nachman; Rachel (Tel-Aviv, IL), Cohen; Sasson (Tel-Aviv, IL) Assignee(s): Teva Pharmaceutical Industries, Ltd. (Jerusalem, IL), Ramot University for Applied Research and Industrial Development, Ltd. (TelAviv, IL) Patent Number: 5,565,462 Date filed: June 21, 1994 Abstract: Use of a compound selected from the group consisting of pentoxifylline, propentofylline and torbafylline for topical treatment of psoriasis or atopic dermatitis and pharmaceutical compositions comprising them. Excerpt(s): This invention relates to topical pharmaceutical compositions for and a method of treating inflammatory and proliferative skin diseases such as psoriasis and atopic dermatitis. ... Atopic dermatitis is a chronic skin condition of unknown etiology, and which may be continuous from infancy to adulthood. There is about 4% incidence of atopic dermatitis from birth to 7 years (Halpern et al., J. Allergy Clin. Immunol. 51:139-151 (1973). In childhood, it is characterized by papules, erythema, thickening and lichenification. In the adolescent, the main symptoms are thickening and lichenification with erythema and scaling. Pruritis is a general feature of the disease. Systemic therapy includes antihistamine drugs and steroids, but the latter are reserved for unmanageable cases and used for the shortest period possible. Topical therapy includes fluorinated and fluorochlorinated corticosteroid preparations, but striae and cataracts are likely complications. Clearly there is as yet no satisfactory and safe drug treatment for atopic dermatitis. ... Xanthine derivatives have been proposed for the treatment of psoriasis and atopic dermatitis. U.S. Pat. No. 4,141,976 proposes certain pharmaceutical preparations for the topical treatment of psoriasis. Among the compounds described are certain substituted alkylxanthine derivatives and substituted thioxanthines. However data demonstrating effectiveness is shown only for RO 20-1724 (d,1-4-(3-butoxy-4-methoxybenzyl)-2-imidazolidinone, which is not a xanthine derivative. There is no data showing that the xanthine derivatives are effective therapeutics when topically administered to patients suffering from proliferative skin disease. Web site: http://www.delphion.com/details?pn=US05565462__
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Method for treating atopic dermatitis Inventor(s): Capetola; Robert J. (Doylestown, PA), Rosenthale; Marvin E. (Princeton, NJ) Assignee(s): Ortho Pharmaceutical Corporation (Raritan, NJ) Patent Number: 4,444,780 Date filed: August 30, 1982 Abstract: A method for treating atopic dermatitis with cyproheptadine or its acid addition salt is described. Excerpt(s): This invention relates to a new therapeutic method for the treatment of atopic dermatitis. In particular it relates to a method for treating atopic dermatitis by the topical administration of cyproheptadine, a non-steroidal antihistaminic compound. ... Eczematous and immunologic skin diseases are among the most common of all clinical afflictions. They constitute a great physical and economic impact on society and at times these conditions can be devastating to the afflicted individual. Among all dermatological diseases, atopic dermatitis is one of the most common with a prevalence between 2% and 3% in children 1-5 years old and 0.7% for all ages. Approximately 120,000-150,000 new cases of atopic dermatitis occur each year in the United States. More importantly the only effective medications that offer at least partial control of the disease are the steroids. However, widespread use of steroids can lead to skin atrophy. It has been found that cyproheptadine uniquely interrupts the most important pathophysiological events that occur in atopic dermatitis and thus offers a novel and rational approach to the treatment of atopic dermatitis. ... Atopic dermatitis is a chronic disorder that can be thought of as the cutaneous manifestation of the atopic state. Atopy is a generalized term used to describe hypersensitivity diseases such as asthma, eczematous dermatitis and allergic rhinitis. Atopic persons have certain immunologic abnormalities similar to asthmatics. For example, elevated IgE levels are found in most patients with atopic dermatitis and the highest levels have been found in those patients with atopic dermatitis coexisting with allergic respiratory disease. Also patients with atopic dermatitis have elevated numbers of skin mast cells and most of the biochemical events leading to mediator release from IgE-sensitized mast cells are identical to the events occurring in the lung. Although the specific antigen necessary for bridging and activating receptive IgE antibodies on the surface of mast cells is not known, the mediators released are responsible for many of the signs and symptoms in atopic dermatitis. The major mediators released are histamine, which causes pruritis, vascular leakage leading to edema and smooth muscle contractions and products of the lipoxygenase pathway
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such as leukotriene B which specifically attracts inflammatory cells to the injured site and the leukotrienes C and D which can also cause smooth muscle contraction as well as increase vascular permeability. Patients with atopic dermatitis have a lowered threshhold to itch stimuli such as histamine, they have a tendency for vasoconstriction and, as previously mentioned, the disease is a chronic cutaneous inflammatory disorder which propagates the above symptoms. Thus an ideal agent for the treatment of atopic dermatitis would: (1) Be an effective antagonist of skin anaphylactic reactions, such as the passive cutaneous anaphylaxis reaction in rats; (2) Block the action of histamine at the receptor level thus relieving the itch stimuli that can lead to scratching and subsequent infection; (3) Block calcium-mediated excitation-contraction coupling on the vasculature which would relieve the vasoconstrictor tendency in atopic patients; and (4) Inhibit the lipoxygenase enzyme and thus prevent the increases in vascular permeability induced by the leukotrienes C and D as well as attenuate the influx of inflammatory cells induced by the chemoattractant, leukotriene B. The methods used to describe the unique topical antiallergic profile of cyproheptadine and the results obtained are described below. Web site: http://www.delphion.com/details?pn=US04444780__
Patent Applications on Atopic Dermatitis As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to atopic dermatitis: ·
Atopic dermatitis treatment method Inventor(s): Paslin, David A. ; (San Mateo, CA) Correspondence: Wilson Sonsini Goodrich & Rosati; 650 Page Mill Road; Palo Alto; CA; 943041050 Patent Application Number: 20020009489 Date filed: August 1, 2001 Abstract: Compositions are provided for treating atopic dermatitis, other atopic diseases and other inflammatory or allergic skin disorders. The compositions include proteins from Molluscum Contagiosum Virus (MCV), or fragments, variants, analogs, and derivatives thereof which
24
This has been a common practice outside the United States prior to December 2000.
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exhibit AD inhibiting activity. Examples of MCV proteins which exhibit AD inhibiting activity include MC148P1, MC148P2, MC148P3, other MC148P type proteins, and fragments, variants, analogs, and derivatives of MC148P1, MC148P2, MC148P3, and other MC148P type-proteins which possess AD inhibiting activity. The fragments, variants, analogs and derivatives may be less than 100 % homologous to MCV proteings so long as they are sufficiently homologous such that AD inhibiting activity is preserved. Excerpt(s): The present invention relates to the treatment of inflammatory and/or allergic skin disorders and more particularly to the treatment of Atopic Dermatitis using compositions which include a protein derived from Molluscum Contagiosum Virus (MCV). ... Atopic Dermatitis (AD) is a genetically determined, reaginically (IgE) associated, chronic disease of the skin affecting approximately 8 million adults and children in the United States. In AD, the skin is dry, easily irritated, subject to immediate hypersensitivity type of allergic responses, typically scaly, often thickened, commonly red, frequently infected, sometimes exudative and above all itchy. Among adults with AD, coexisting respiratory allergy (allergic rhinitis and/or asthma), has been reported to range from 63 % to 85 %. ... The invention relates to compositions for treating atopic dermatitis (AD), other atopic diseases (including asthma, allergic rhinitis, hives) and other inflammatory and/or allergic disorders of the skin. The compositions according to the present invention include proteins from Molluscum Contagiosum Virus (MCV), or fragments, variants, analogs, and derivatives thereof which exhibit AD inhibiting activity. Examples of MCV proteins which exhibit AD inhibiting activity include MC148P1, MC148P2, MC148P3, other MC148P type proteins, and fragments, variants, analogs, and derivatives of MC148P1, MC148P2, MC148P3, and other MC148P type proteins which possess AD inhibiting activity. The fragments, variants, analogs and derivatives may be less than 100 % homologous to MC148P1, MC148P2, MC184P3 so long as they are sufficiently homologous such that AD inhibiting activity is preserved. Collectively, the above MCV proteins, fragments, variants, analogs and derivatives are referred to herein as MC 148 proteins (MC 148P). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with atopic dermatitis, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web
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address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “atopic dermatitis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on atopic dermatitis. You can also use this procedure to view pending patent applications concerning atopic dermatitis. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Anaphylactic: Pertaining to anaphylaxis. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Buspirone: An anxiolytic agent and a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds. Its structure is unrelated to those of the benzodiazepines, but it has an efficacy comparable to diazepam. [NIH]
Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Cyproheptadine: A serotonin antagonist and a histamine H1 blocker used as antipruritic, appetite stimulant, antiallergic, and for the post-gastrectomy dumping syndrome, etc. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious
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agents. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH]
Quaternary: 1. fourth in order. 2. containing four elements or groups. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU]
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CHAPTER 6. BOOKS ON ATOPIC DERMATITIS Overview This chapter provides bibliographic book references relating to atopic dermatitis. You have many options to locate books on atopic dermatitis. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on atopic dermatitis include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “atopic dermatitis” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on atopic dermatitis:
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·
Epidemiology, Causes and Prevention of Skin Diseases Source: Oxford, England, Blackwell Science Ltd., 370 p., 1997. Contact: Blackwell Science, Inc., Commerce Place, 350 Main Street, Malden, MA 02148-5018. (800) 759-6102; (617) 388-8250. FAX: (617) 3888255. Summary: Epidemiology, Causes and Prevention of Skin Diseases covers the state of the art in this field for dermatologists who are interested in epidemiology and prevention, and for epidemiologists interested in skin disease. For students training in dermatology, this book was designed to familiarize the reader with the aspects of epidemiology and prevention, as they will be major themes in medicine in the next century. The first section, Epidemiology and Prevention, devotes five chapters to (1) an introduction; (2) the epidemiological bases for dermatology; (3) prevention, advantages, and limitations of screening; (4) evaluation of the quality of life in dermatology as applied to psoriasis; and (5) the study of genetic diseases. The second section discusses the (1) epidemiology of skin cancers, (2) sun exposure and skin cancers, (3) other environmental risk factors for skin cancers, (4) cutaneous melanoma and oral contraceptives, (5) epidemiology of melanocytic naevi, (6) prevention of melanoma, and (7) virus and skin cancers. The final section focuses on inflammatory dermatoses, including (1) psoriasis, (2) atopic dermatitis, (3) fungal skin diseases, (4) viral and bacterial skin diseases, (5) disorders due to drugs and chemical agents, and (6) other inflammatory dermatoses.
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Food Allergy Book: The Foods That Cause You Pain and Discomfort and How to Take Them Out of Your Diet Source: St. Paul, MN: ACA Publications, Inc. 1995. 202 p. Contact: Available from ACA Publications, Inc. 1690 University Avenue West, Suite 450, St. Paul, MN 55104. (800) 649-3523 or (612) 649-3523. Fax (612) 649-3509. PRICE: $12.95. ISBN: 0963154478. Summary: This book provides information about identifying and managing food allergies. The author describes the role that food allergy may play in migraine headache, sinus congestion and headache, stuffy nose, persistent cough, recurring sore throats, canker sores, wheezing, hives, eczema, persistent muscle and joint aching, recurring abdominal pain, diarrhea, tiredness, and irritability. The author reviews the hows and whys of food allergy and describes how certain commonly eaten foods can cause illness. Specific chapters discuss citrus, monosodium glutamate (MSG), low-calorie sweeteners, refined sugar, an adult and child allergy elimination diet, living with a restricted diet, reading food
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labels, shopping, meal planning and preparation, snack foods, and eating out in restaurants. A final chapter outlines a recommended diet for identifying and eliminating food allergy triggers. The book concludes with a bibliography and a subject index. 32 references.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to atopic dermatitis (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Asthma und Allergie : verhaltensmedizinische Grundlagen und Anwendungen ; ISBN: 3801706893; http://www.amazon.com/exec/obidos/ASIN/3801706893/icongroupin terna
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Atopic dermatitis by Georg Rajka; ISBN: 0721674488; http://www.amazon.com/exec/obidos/ASIN/0721674488/icongroupin terna
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Atopic Dermatitis by Thomas Bieber (Editor), Donald Y. M. Leung (Editor) (2002); ISBN: 0824707427; http://www.amazon.com/exec/obidos/ASIN/0824707427/icongroupin terna
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Atopic Dermatitis by Kristian Thestrup Pedersen, Tim J. David (2002); ISBN: 185317145X; http://www.amazon.com/exec/obidos/ASIN/185317145X/icongroupi nterna
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Atopic Dermatitis : From Pathogenesis to Treatment (Medical Intelligence Unit) by Donald Y. M., Md., Ph.D. Leung (Editor) (1995); ISBN: 0412101912; http://www.amazon.com/exec/obidos/ASIN/0412101912/icongroupin terna
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Atopic Dermatitis: The Epidemiology, Causes and Prevention of Atopic Eczema by Hywel C. Williams (Editor); ISBN: 0521570751; http://www.amazon.com/exec/obidos/ASIN/0521570751/icongroupin terna
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Essential Aspects of Atopic Dermatitis by Georg Rajka (1989); ISBN: 0387511652; http://www.amazon.com/exec/obidos/ASIN/0387511652/icongroupin terna
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Handbook of Atopic Eczema by T. Ruzicka, et al (1991); ISBN: 0387529926; http://www.amazon.com/exec/obidos/ASIN/0387529926/icongroupin terna
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Handbook of Atopic Eczema (1991); ISBN: 3540529926; http://www.amazon.com/exec/obidos/ASIN/3540529926/icongroupin terna
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Immunological and Pharmacological Aspects of Atopic and Contact Eczema (Pharmacology and the Skin, Vol 4) by Cird Galderma Symposium on Advances in Skin Pharmacology 1990 Cannes (1991); ISBN: 3805554338; http://www.amazon.com/exec/obidos/ASIN/3805554338/icongroupin terna
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The Atopy Syndrome in the Third Millennium (Current Problems in Dermatology, Vol. 28) by Brunello Wuthrich (Editor) (1999); ISBN: 3805566557; http://www.amazon.com/exec/obidos/ASIN/3805566557/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “atopic dermatitis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of
25
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Allergic diseases of skin. Author: J.S. Pasricha; Year: 1981; New Delhi: Oxford & IBH Pub. Co., c1981
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Allergic skin disease: a multidisciplinary approach. Author: edited by Donald Y. M. Leung, Malcolm W. Greaves; Year: 2000; New York: Marcel Dekker, c2000; ISBN: 0824702875 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824702875/icongroupin terna
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Atopic dermatitis: from pathogenesis to treatment. Author: Donald Y.M. Leung; Year: 1996; New York: Chapman & Hall; Austin: R.G. Landes, c1996; ISBN: 0412101912 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0412101912/icongroupin terna
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Atopic dermatitis: the epidemiology, causes and prevention of atopic eczema. Author: edited by Hywel C. Williams; Year: 2000; Cambridge; New York, NY, USA: Cambridge University Press, 2000; ISBN: 0521570751(hardback) http://www.amazon.com/exec/obidos/ASIN/0521570751/icongroupin terna
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Atopic dermatitis and hypnosis: an investigation of physiologic stigmata before, during and after hypnosis. Author: West, James Robert, 1910-; Year: 1960; [Minneapolis] 1960
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Atopic dermatitis. Author: editor, Lasse R. Braathen; Year: 1989; Stockholm, Sweden: Distributed by the Almqvist & Wiksell Periodical Co., [1989]
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Atopic dermatitis. Author: Raif S. Geha, topic editor; Year: 1986; New York, NY: Elsevier Science Pub., [c1986]
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Atopic dermatitis. Author: Rajka, Georg; Year: 1975; London, Philadelphia, Saunders, 1975; ISBN: 0721674488 http://www.amazon.com/exec/obidos/ASIN/0721674488/icongroupin terna
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Atopic palmoplantar eczema. Author: Hans Joachim Schwanitz; Year: 1988; Berlin; New York: Springer-Verlag, c1988; ISBN: 0387178635 (U.S.: pbk.) http://www.amazon.com/exec/obidos/ASIN/0387178635/icongroupin terna
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Atopic skin disease: a manual for practitioners. Author: Christopher Bridgett, Peter Norén, and Richard Staughton; Year: 1996; Petersfield,
information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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UK; Bristol, PA, USA: Wrightson Biomedical Pub., c1996; ISBN: 1871816327 http://www.amazon.com/exec/obidos/ASIN/1871816327/icongroupin terna ·
Canine allergic inhalant dermatitis. Edited by Sue Drum. Anderson, Warren; Year: 1973; [n. p., c1973]
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Colour atlas of allergic skin disorders. Author: Rino Cerio, William F. Jackson; Year: 1992; London, England: Wolfe Pub., 1992; ISBN: 0723417970
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Contact dermatitis and atopic eczema. Author: [by Gordon C. Sauer]; Year: 1977; Kansas City, Mo.: American family physician, 1977
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Cyclosporin A and the skin. Author: edited by Klaus Wolff; Year: 1992; London; New York: Royal Society of Medicine Services, 1992; ISBN: 1853151807
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Deoxyribonucleic acid hypersensitivity in cutaneous disease. Author: Fardal, Richard Wayne, 1933-; Year: 1964; [Minneapolis] 1964
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Essential aspects of atopic dermatitis. Author: Georg Rajka; Year: 1989; Berlin; New York: Springer-Verlag, c1989; ISBN: 0387511652 (U.S.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0387511652/icongroupin terna
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Hand eczema and long-term prognosis in atopic dermatitis. Author: by Ingela Rystedt; Year: 1985; Stockholm, Sweden: Distributed by Almqvist & Wiksell Periodical Co., 1985; ISBN: 9172228814 (pbk.)
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Handbook of atopic eczema. Author: T. Ruzicka, J. Ring, B. Przybilla (eds.); Year: 1991; Berlin; New York: Springer-Verlag, c1991; ISBN: 3540529926 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540529926/icongroupin terna
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Immunoglobulin E in atopic dermatitis. Author: by Sven Öhman; Year: 1971; Uppsala, Sweden: [s.n.], 1971
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Immunological and pharmacological aspects of atopic and contact eczema. Author: 9th CIRD Galderma Symposium on Advances in Skin Pharmacology, Cannes, October 4-6, 1990; volume editor, J.M. Czernielewski; Year: 1991; Basel; New York: Karger, 1991; ISBN: 3805554338 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3805554338/icongroupin terna
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Immunological investigations of patients with atopic dermatitis. Author: Anders Hovmark; Year: 1979; Stockholm: [s.n.], 1979
Author:
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Immunology and drug therapy of allergic skin diseases. Author: Carla A.F.M. Bruijnzeel-Koomen, Edward F. Knol, editors; Year: 2000; Basel; Boston: Birkhäuser Verlag, c2000; ISBN: 3764359706 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/3764359706/icongroupin terna
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International Symposium on Atopic Dermatitis. Author: guest editor, Georg Rajka; Year: 1992; Oslo: Scandinavian University Press, c1992
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Management of atopic dermatitis: current status and future possibilities. Author: editor, Jon Hanifin; Year: 1996; Copenhagen: Munksgaard, 1996
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Managing Staphylococcus aureus in eczema: proceedings of a Round Table discussion held at The Royal Society of Medicine, London, on 16 April 1998. Author: edited by F.D.R. Hobbs; Year: 1999; London: Royal Society of Medicine Press, c1999; ISBN: 1853153621
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New trends in allergy IV: together with environmental allergy and allergotoxicology III. Author: J. Ring, H. Behrendt, D. Vieluf (eds.); foreword by Robert Huber; Year: 1996; Berlin; New York: Springer, 1996; ISBN: 3540611207 (hard cover: alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540611207/icongroupin terna
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Treatment of atopic dermatitis. ; Year: 1999; Oslo, Norway: Norwegian Medicines Control Authority; Uppsala, Sweden: Medical Products Agency, [1999]
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Tuohilampi questionnaire for epidemiological studies of contact dermatitis and atopy. Author: Päivikki Susitaival ... [et al.]; Year: 1996; Helsinki: Finnish Institute of Occupational Health, 1996; ISBN: 9518021473
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Vascular effects of parenteral mecholyl (acetyl-beta-methylcholine) in atopic dermatitis. Author: Clark, Lealand L., 1931-; Year: 1960; [Minneapolis] 1960
Chapters on Atopic Dermatitis Frequently, atopic dermatitis will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with atopic dermatitis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and atopic dermatitis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where
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“You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “atopic dermatitis” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on atopic dermatitis: ·
Skin Disorders Source: in Mosby 's Patient Teaching Guides. St. Louis, MO: Mosby -Year Book, Inc. 1995. p. 113-33. Contact: Mosby -Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO. 63146. ISBN: 0815158629. Summary: This section of Mosby 's Patient Teaching Guides examines the following skin disorders: acne; cystic acne; rosacea ; the prevention of skin cancers such as basal cell carcinoma; malignant melanoma; contact dermatitis; atopic dermatitis; psoriasis and etretinate treatment; and scabies. Burn injuries and postoperative wound care at home are also addressed. Each section, where applicable, provides an explanation of the ailment, risk factors, diagnosis and treatment, and prevention tips.
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Chapter 124: Atopic Dermatitis (Atopic Eczema) Source: in Freedberg, I.M., et al., eds. Fitzpatrick's Dermatology in General Medicine. 5th ed., Vol. 1. New York, NY: McGraw-Hill. 1999. p. 1464-1480. Contact: Available from McGraw-Hill Customer Services. P.O. Box 548, Blacklick, OH 43004-0548. (800) 262-4729 or (877) 833-5524. Fax (614) 7593749 or (614) 759-3641. E-mail:
[email protected]. PRICE: $395.00 plus shipping and handling. ISBN: 0070219435. Summary: This chapter provides health professionals with information on the historical aspects, epidemiology, genetics, clinical manifestations, differential diagnosis, immunopathogenesis, management, and prognosis of atopic dermatitis (AD). AD is a chronically relapsing skin disease that occurs most often during early infancy and childhood. The increased prevalence of AD is thought to involve factors such as increased exposure to pollutants, indoor allergens, and a decline in breastfeeding. Although the precise means by which AD is familially transmitted remains uncertain, some studies suggest an autosomal dominant inheritance pattern. The diagnosis of AD is based on a constellation of clinical features, including intensive pruritus, cutaneous reactivity, eye problems, and cutaneous infections. The differential diagnosis of AD involves distinguishing AD from other inflammatory skin diseases, immunodeficiencies, skin malignancies, genetic disorders, metabolic
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disorders, and infectious diseases and infestations. Although serum immunoglobulin (Ig) E levels are elevated in many patients who have AD, a direct relationship of IgE to implicated allergens and the clinical exacerbation of AD has been difficult to establish. Various studies have investigated the role of foods, aeroallergens, and microbial products in AD. Other studies have examined the immunopathogenesis of AD by investigating peripheral blood cells, T helper cells, cytokine expression, and similarities in the allergic inflammation of asthma and AD. Data suggest that antigen or superantigen exposure, allergen-induced IgE synthesis and T helper 2 cell-like expansion, mast cell degranulation, and keratinocyte injury may contribute to chronic AD skin inflammation and possibly to nonspecific cutaneous hyperresponsiveness. Management of AD involves individualizing a treatment plan to address each patient's skin disease reaction pattern. Options include cutaneous hydration; topical glucocorticoid treatment; identification and elimination of triggering factors such as allergens, emotional stress, and infectious agents; and use of antihistamines and tar preparations. Methods of treating poorly controlled AD include wet dressings and occlusion, systemic glucocorticoids, ultraviolet light, and hospitalization. Unproven or evolving treatments include allergen immunotherapy, interferons, cyclosporine and FK-506, extracorporeal photopheresis, and phosphodiesterase inhibitors. Factors that correlate with a poor prognosis include widespread AD in childhood, associated allergic rhinitis and asthma, family history of AD in parents or siblings, early age at onset of AD, and female sex. 10 figures, 3 tables, and 178 references.
General Home References In addition to references for atopic dermatitis, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Encyclopedia of Skin and Skin Disorders (The Facts on File Library of Health and Living) by Carol Turkington, Jeffrey S. Dover; Hardcover - 448 pages, 2nd edition (June 2002), Facts on File, Inc.; ISBN: 0816047766; http://www.amazon.com/exec/obidos/ASIN/0816047766/icongroupinterna · Your Skin from A to Z by Jerome Z. Litt, M.D.; Paperback (March 2002), Barricade Books; ISBN: 1569802165; http://www.amazon.com/exec/obidos/ASIN/1569802165/icongroupinterna
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· American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
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CHAPTER 7. MULTIMEDIA ON ATOPIC DERMATITIS Overview Information on atopic dermatitis can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on atopic dermatitis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Bibliography: Multimedia on Atopic Dermatitis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in atopic dermatitis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on atopic dermatitis. For more information, follow the hyperlink indicated: ·
Acne, perioral dermatitis and rosacea; Contact dermatitis; Infestations. Source: produced for the Canadian Association of Professors of Dermatology by Roberta Ongley; Biomedical Communications,
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University of British Columbia; Year: 1993; Format: Videorecording; [Vancouver, B.C.]: The University, c1993 ·
Allergic contact dermatitis : examples and approaches. Source: presented by Ernst Epstein, Howard I. Maibach, Marion B. Sulzberger; produced by the Institute for Dermatologic Communication and Education; Year: 1973; Format: Slide; San Francisco: The Institute, c1973
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Atopic dermatitis. Source: Marion B. Sulzberger, Rudolf L. Baer; produced by Institute for Dermatologic Communication and Education; Year: 1975; Format: Videorecording; San Francisco: The Institute, c1975
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Atopic dermatitis. Source: M. Eric Gershwin ... [et al.]; Year: 1982; Format: Slide; [New York]: Medcom, c1982
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Atopic dermatitis. Source: Marion B. Sulzberger, Rudolf L. Baer; produced by Institute for Dermatologic Communication and Education; Year: 1975; Format: Slide; San Francisco: The Institute, c1975
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Chronic actinic dermatitis. Source: Henry W. Lim; Year: 1996; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1996
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Community pharmacists' role in preventing and treating insect, pesticide, and sun-induced medical problems. Source: [presented by] the Medical University of South Carolina, College of Pharmacy and Health Communications Network; Year: 1991; Format: Videorecording; Charleston, S.C.: The University, c1991
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Dermatitis herpetiformis. Source: presented by the Department of Medicine, Emory University, School of Medicine [and] the Emory Medical Television Network; Year: 1989; Format: Videorecording; Atlanta, Ga.: The University, c1989
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Dermatitis herpetiformis. Source: presented by the Department of Medicine, Emory University, School of Medicine; Year: 1983; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1983
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Dermatologic allergy. Source: from the New York Skin and Cancer Unit of the Post Graduate Hospital and Medical School; by Frances Pascher and Abram Kanof ; Year: 1944; Format: Motion picture; United States: [s.n., 1944]
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Dermatoses and pregnancy. Source: Stephen I. Katz; Year: 1972; Format: Slide; New York: Medcom, c1972
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Dermatoses in blacks. Source: Georgia Regional Medical Television Network; Year: 1972; Format: Videorecording; [Atlanta: The Network; for loan or sale by Calhoun (A. W.) Medical Library, 1972]
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Diagnostic patch test technique. Source: produced by Communications for Management, Inc. International, in association with the AAD
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Department of Education; Year: 1988; Format: Videorecording; Evanston, IL: American Academy of Dermatology, c1988 ·
Latex allergy : stop the reaction. Source: produced by Coastal Video Communications Corp; Year: 1997; Format: Videorecording; Virginia Beach, VA: Coastal Video Communications Corp., c1997
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Management of atopic dermititis. Source: produced by UT-TV, Houston; Year: 1992; Format: Videorecording; [Houston, Tex.: UT-TV, 1992]
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Mystery of contact dermatitis : putting the pieces together. Source: American Academy of Dermatology; Year: 1988; Format: Videorecording; Schaumberg, IL: The Academy, 1988
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Occupational dermatoses. Source: NIOSH, National Institute for Occupational Safety and Health, Division of Training and Manpower Development; Year: 1981; Format: Slide; [Atlanta, Ga.]: The Institute, [1981]
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Occupational skin diseases. Source: James Nethercott; Year: 1977; Format: Videorecording; Toronto: IMS, Faculty of Medicine, University of Toronto, c1977
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Pediatric dermatology II : inflammatory dermatoses. Source: produced by the Marion & Roberta Sulzberger Institute for Dermatologic Communication and Education; Year: 1988; Format: Slide; [Evanston, Ill.]: American Academy of Dermatology, Committee on Audiovisual Education, c1988
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Pediatric dermatology, part II. Source: Gunter Kahn; Year: 1973; Format: Slide; [New York]: Medcom, c1973
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Pediatric dermatoses. Source: American Academy of Dermatology, and Institute for Dermatologic Communication and Education; Year: 1975; Format: Slide; [Evanston, Ill.]: The Academy, c1975
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Prevention of occupational dermatoses for construction. Source: presented by the Industrial Commission of Ohio, Division of Safety and Hygiene; produced by Battelle for SH; Year: 1983; Format: Slide; [Columbus, Ohio]: The Commission, c1983
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Prevention of occupational dermatoses. Source: presented by the Industrial Commission of Ohio, Division of Safety and Hygiene; produced by Battelle for SH; Year: 1983; Format: Slide; [Columbus, Ohio]: The Commission, c1983
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Prevention of poison ivy & poison oak. Source: William L. Epstein; Year: 1996; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1996
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Psoriasis; Papulosquamous diseases; Atopic dermatitis; Common pediatric skin problems. Source: produced for the Canadian Association of Professors of Dermatology by Roberta Ongley; Biomedical Communications, University of British Columbia; Year: 1993; Format: Videorecording; [Vancouver, B.C.]: The University, c1993
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Skin diseases of agricultural workers. Source: Institute of Agricultural Medicine and Environmental Health, Department of Preventive Medicine and Environmental Health, College of Medicine, the University of Iowa; Year: 1980; Format: Slide; Iowa City, Iowa: The University, c1980
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Skin diseases of the feet. Source: Richard C. Gibbs; Year: 1973; Format: Slide; New York: Medcom, c1973
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Some common dermatoses. Source: American Academy of Dermatology, and Institute for Dermatologic Communication and Education; Year: 1974; Format: Slide; New York: New York University Medical Center; [Evanston, Ill.: for sale by the Academy], c1974
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Southwest Allergy Forum. Source: CME Conference Video, Inc.; sponsored by the University of Texas Health Science Center at San Antonio, April 6-9, 1995; Year: 1995; Format: Videorecording; Mt. Laurel, NJ: CME Conference Video, 1995
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Therapeutic use of ACTH in human disease. Source: produced by Audio Productions, Inc.; presented by the Armour Laboratories; Year: 1951; Format: Motion picture; United States: The Laboratories, c1951
Vocabulary Builder Abdominal: Pertaining to the abdomen. [EU] Acne: An inflammatory disease of the pilosebaceous unit, the specific type usually being indicated by a modifying term; frequently used alone to designate common acne, or acne vulgaris. [EU] ACTH: Adrenocorticotropic hormone. [EU] Auditory: Pertaining to the sense of hearing. [EU] Blindness: The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Etretinate: An oral retinoid used in the treatment of keratotic genodermatosis, lichen planus, and psoriasis. Beneficial effects have also
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been claimed in the prophylaxis of epithelial neoplasia. The compound may be teratogenic. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Hyperkeratosis: 1. hypertrophy of the corneous layer of the skin. 2a. any of various conditions marked by hyperkeratosis. 2b. a disease of cattle marked by thickening and wringling of the hide and formation of papillary outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hypopigmentation: A condition caused by a deficiency in melanin formation or a loss of pre-existing melanin or melanocytes. It can be complete or partial and may result from trauma, inflammation, and certain infections. [NIH] Keratitis: Inflammation of the cornea. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Perioral: Situated or occurring around the mouth. [EU] Postoperative: Occurring after a surgical operation. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU]
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CHAPTER 8. PERIODICALS AND NEWS ON ATOPIC DERMATITIS Overview Keeping up on the news relating to atopic dermatitis can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on atopic dermatitis. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover atopic dermatitis beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on atopic dermatitis is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “atopic dermatitis” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Long-Term Study Supports Safety of Protopic(R) for Atopic Dermatitis Treatment In Children Summary: Deerfield, Ill., May 17 /PRNewswire/ -- Data presented at the 60th Annual Meeting of the American Academy of Dermatology further validated the safety of Protopic(R) (tacrolimus ointment) for long-term intermittent treatment of children with atopic dermatitis. "This study evaluated the risk of adverse events over time and most importantly found no long indication that Protopic has immunosuppressive effects in patients treated up to three years," said Amy Paller, MD, lead investigator, Professor of Dermatology and Pediatrics and Chief of the Division of Dermatology at Children's Memorial Hospital of Northwestern University Medical School in Chicago, Illinois. Tacrolimus ointment is the first in a new class of prescription drugs called topical immunomodulators, or TIMs, to be developed in more than 40 years for the treatment of eczema. The FDA approved the nonsteroidal alternative in December 2000 for short-term and intermittent long-term therapy to treat the signs and symptoms of moderate to severe eczema in patients for whom conventional treatment is deemed inadvisable because of the potential risks associated with them, or when patients are not adequately responsive to or intolerant of conventional therapies. The thirty-month, multicenter study included 389 male and female patients two to 15 years old with varying degrees of atopic dermatitis. Patients in the study applied Protopic 0.1 percent concentration ointment twice daily to all affected areas of the skin until one week after symptoms cleared. Among the patients treated, 246 completed two-year follow-up and 57 completed three- year follow-up. The common adverse events included: skin burning, pruritis or an itching sensation, and skin redness.
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These events were generally of short duration and decreased after a few days of treatment. "This study strengthens Protopic's important role in the mix of safe, effective treatment options available to the medical community for children with eczema," said Ira D. Lawrence, senior vice president, research and development. In some cases of eczema the itching and redness is so vast and intense that sufferers will scratch themselves until they bleed, increasing the risk of secondary infection. The majority of eczema cases are diagnosed in early childhood. While 40 percent of children suffering from eczema outgrow the disease, others live with it throughout their lives. Conventional therapies for eczema have been limited and variable outcomes have been reported. Routine treatment frequently includes the use of steroid creams applied to the skin. Steroids have been associated with side effects including skin thinning, stretch marks and skin discoloration. Physician and patient satisfaction has been disappointing. Protopic is available in two concentrations for adults, 0.03 percent and 0.1 percent. For children ages two to 15, only the 0.03 percent concentration is indicated. Similar to other dermatological products currently on the market, patients should practice safe sun techniques to avoid direct exposure to natural or artificial sunlight when using Protopic. Fujisawa Healthcare, Inc. headquarters in Deerfield, Illinois, develops, manufactures and markets proprietary pharmaceutical products in the United States and abroad. Fujisawa Healthcare, Inc., is a subsidiary of Fujisawa Pharmaceutical Co., Ltd., based in Osaka, Japan. Fujisawa Pharmaceutical Co., Ltd., founded in 1894, is a leading pharmaceutical manufacturer and is actively developing its international operations in North America, Europe and Asia. Additional information on Fujisawa Healthcare, Inc., and its products can be found on the company's web site at http://www.fujisawa.com .
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Reuters The Reuters' Medical News database can be very useful in exploring news archives relating to atopic dermatitis. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “atopic dermatitis” (or synonyms). The following was recently listed in this archive for atopic dermatitis: ·
Fujisawa launches eczema drug in UK Source: Reuters Industry Breifing Date: April 16, 2002 http://www.reuters.gov/archive/2002/04/16/business/links/20020416 inds011.html
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Pimecrolimus shows promise as maintenance therapy for atopic dermatitis Source: Reuters Industry Breifing Date: March 07, 2002 http://www.reuters.gov/archive/2002/03/07/business/links/20020307 clin023.html
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Fujisawa says EU approved eczema drug Source: Reuters Industry Breifing Date: March 06, 2002 http://www.reuters.gov/archive/2002/03/06/business/links/20020306 rglt001.html
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FDA approves pimecrolimus for treatment of atopic dermatitis Source: Reuters Medical News Date: December 14, 2001 http://www.reuters.gov/archive/2001/12/14/professional/links/20011 214rglt002.html
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Novartis' Elidel eczema treatment approved by FDA Source: Reuters Industry Breifing Date: December 13, 2001 http://www.reuters.gov/archive/2001/12/13/business/links/20011213 rglt005.html
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PhotoMedex excimer laser earns FDA clearance for eczema Source: Reuters Industry Breifing Date: August 14, 2001 http://www.reuters.gov/archive/2001/08/14/business/links/20010814 rglt005.html
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Mycophenolate mofetil shows promise in treatment of atopic dermatitis Source: Reuters Industry Breifing Date: July 26, 2001 http://www.reuters.gov/archive/2001/07/26/business/links/20010726 drgd002.html
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PhotoMedex seeks FDA approval for laser to treat atopic dermatitis Source: Reuters Industry Breifing Date: May 16, 2001 http://www.reuters.gov/archive/2001/05/16/business/links/20010516 rglt008.html
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Atrix files IND to study Atrisone as atopic dermatitis therapy Source: Reuters Industry Breifing Date: May 07, 2001 http://www.reuters.gov/archive/2001/05/07/business/links/20010507 rglt003.html
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Topical tacrolimus targets epidermal antigen-presenting cells in atopic dermatitis Source: Reuters Medical News Date: April 06, 2001 http://www.reuters.gov/archive/2001/04/06/professional/links/20010 406drgd004.html
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CCR4+ cells increased in blood and lesional skin of atopic dermatitis patients Source: Reuters Medical News Date: March 05, 2001 http://www.reuters.gov/archive/2001/03/05/professional/links/20010 305clin003.html
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Occlusive bedding reduces eczema severity in patients with atopic dermatitis Source: Reuters Medical News Date: February 23, 2001 http://www.reuters.gov/archive/2001/02/23/professional/links/20010 223clin020.html
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Distinct immune effects of psychological stress seen in atopic dermatitis patients Source: Reuters Medical News Date: February 16, 2001 http://www.reuters.gov/archive/2001/02/16/professional/links/20010 216clin012.html
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Oolong tea improves recalcitrant atopic dermatitis in some patients Source: Reuters Medical News Date: January 26, 2001 http://www.reuters.gov/archive/2001/01/26/professional/links/20010 126clin015.html
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Oolong tea may relieve symptoms of atopic dermatitis Source: Reuters Health eLine Date: January 25, 2001 http://www.reuters.gov/archive/2001/01/25/eline/links/20010125elin 001.html
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Novartis files new eczema treatment with FDA Source: Reuters Industry Breifing Date: December 18, 2000 http://www.reuters.gov/archive/2000/12/18/business/links/20001218 inds003.html
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Nonsteroid drug promising for treatment of atopic dermatitis, psoriasis Source: Reuters Industry Breifing Date: October 16, 2000 http://www.reuters.gov/archive/2000/10/16/business/links/20001016 drgd001.html
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Novartis eczema drug effective in clinical trials Source: Reuters Industry Breifing Date: October 13, 2000 http://www.reuters.gov/archive/2000/10/13/business/links/20001013 drgd003.html
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Serum CD30 levels correlate with disease activity in atopic dermatitis patients Source: Reuters Industry Breifing Date: July 05, 2000 http://www.reuters.gov/archive/2000/07/05/business/links/20000705 clin008.html
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Body-weight-independent use of cyclosporine effective for atopic dermatitis Source: Reuters Medical News Date: May 09, 2000 http://www.reuters.gov/archive/2000/05/09/professional/links/20000 509clin007.html
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Children with atopic dermatitis at high risk of asthma Source: Reuters Medical News Date: April 10, 2000 http://www.reuters.gov/archive/2000/04/10/professional/links/20000 410clin011.html
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Birth month affects prevalence of atopic dermatitis during school years Source: Reuters Medical News Date: July 19, 1999 http://www.reuters.gov/archive/1999/07/19/professional/links/19990 719epid001.html
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FDA approves cream for infant atopic dermatitis Source: Reuters Medical News Date: June 21, 1999 http://www.reuters.gov/archive/1999/06/21/professional/links/19990 621rglt002.html
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Topical sodium cromoglycate therapy effective for atopic dermatitis in children Source: Reuters Medical News Date: December 28, 1998 http://www.reuters.gov/archive/1998/12/28/professional/links/19981 228clin015.html
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Topical tacrolimus may be a "breakthrough" for children with atopic dermatitis Source: Reuters Medical News Date: November 04, 1998 http://www.reuters.gov/archive/1998/11/04/professional/links/19981 104clin005.html
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Asthma risk in children may be predicted by atopic dermatitis in infancy Source: Reuters Medical News Date: September 02, 1998 http://www.reuters.gov/archive/1998/09/02/professional/links/19980 902epid006.html
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Photopheresis, UVA1 Radiation Effectively Treat Severe Atopic Dermatitis Source: Reuters Medical News Date: April 20, 1998 http://www.reuters.gov/archive/1998/04/20/professional/links/19980 420clin002.html
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Food Hypersensitivity Common In Children With Atopic Dermatitis Source: Reuters Medical News Date: February 18, 1998 http://www.reuters.gov/archive/1998/02/18/professional/links/19980 218clin005.html
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Tacrolimus Ointment Safe, Effective Against Atopic Dermatitis Source: Reuters Medical News Date: February 06, 1998 http://www.reuters.gov/archive/1998/02/06/professional/links/19980 206drgd002.html
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Tacrolimus Provides Symptomatic Relief In Atopic Dermatitis Patients Source: Reuters Medical News Date: September 18, 1997 http://www.reuters.gov/archive/1997/09/18/professional/links/19970 918clin005.html
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Thalidomide Effective In Pediatric Atopic Dermatitis Source: Reuters Medical News Date: June 17, 1997 http://www.reuters.gov/archive/1997/06/17/professional/links/19970 617clin012.html
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Transplant Rejection Drug Effectively Treats Atopic Dermatitis Source: Reuters Medical News Date: April 22, 1997 http://www.reuters.gov/archive/1997/04/22/professional/links/19970 422clin004.html
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Soluble E-Selectin: A Marker Of Disease Activity In Atopic Dermatitis Patients Source: Reuters Medical News Date: March 21, 1997 http://www.reuters.gov/archive/1997/03/21/professional/links/19970 321clin004.html
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Gamma Interferon For Atopic Dermatitis: Phase II Results Encouraging Source: Reuters Medical News Date: February 27, 1997 http://www.reuters.gov/archive/1997/02/27/professional/links/19970 227drgd001.html
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Persistent Atopic Dermatitis Improved By Prolonged Antifungal Therapy Source: Reuters Medical News Date: October 25, 1996 http://www.reuters.gov/archive/1996/10/25/professional/links/19961 025clin008.html
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Connective Therapeutics Plans Interferon Trial For Atopic Dermatitis Source: Reuters Medical News Date: September 05, 1996 http://www.reuters.gov/archive/1996/09/05/professional/links/19960 905xxxx003.html
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Household Measures Against Dust Mites Reduce Incidence Of Atopic Dermatitis Source: Reuters Medical News Date: January 09, 1996 http://www.reuters.gov/archive/1996/01/09/professional/links/19960 109clin007.html
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New Developments In Atopic Dermatitis A Highlight At Allergy Conference Source: Reuters Medical News Date: November 17, 1995 http://www.reuters.gov/archive/1995/11/17/professional/links/19951 117clin009.html
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Atopic Dermatitis Causes Sleep Disturbances In Children That Affect Behavior Source: Reuters Medical News Date: August 14, 1995 http://www.reuters.gov/archive/1995/08/14/professional/links/19950 814clin007.html
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Cytokines Show Promise For Treatment Of Atopic Dermatitis Source: Reuters Medical News Date: June 05, 1995 http://www.reuters.gov/archive/1995/06/05/professional/links/19950 605clin006.html
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at
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http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “atopic dermatitis” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “atopic dermatitis” (or synonyms). If you know the name of a company that is relevant to atopic dermatitis, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “atopic dermatitis” (or synonyms).
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Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “atopic dermatitis” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on atopic dermatitis: ·
Allergist's View of Atopic Dermatitis Source: The Advocate. 12(4): 1-2,7. 4th Quarter 2000. Contact: Available from National Eczema Association for Science and Education (NEASE). 1220 SW Morrison, Suite 433, Portland, OR 97205. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail:
[email protected]. Website: www.eczema-assn.com. Summary: This newsletter article provides health professionals with information on atopic dermatitis (AD). This common chronic skin disease, which causes an extremely itchy, red rash, affects 1 in 7 young children. AD and allergy are closely related. Many children first develop AD and then develop asthma and allergic rhinitis. Children with AD frequently develop allergic respiratory disease. About 1 out of 3 children with moderate to severe AD has food allergy. Although some allergic reactions to food, such as hives, wheezing, and vomiting, are obvious, food allergies are usually not easy to detect in most children with AD. Standard allergy tests are only partially helpful. The ultimate confirmation of food allergy is possible only through an oral food challenge. A positive reaction to an oral food challenge usually causes an itchy, raised red rash. More severe reactions, including hives, lip or throat swelling, cough, wheezing, vomiting, or abdominal pain, may also occur. Although eliminating an allergy causing food from a child's diet is preferable, it can be difficult to completely eliminate major foods such as egg, milk, wheat, or soy. The most frequent cause of dietary elimination failures is unknowing exposure to small amounts of the offending ingredient in processed foods. The prognosis for outgrowing food
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allergies is very good for most children. Environmental allergens such as pollens, animal dander, and dust mites should be suspected in children with asthma or chronic stuffy, itchy, runny nose or eyes. A skin prick test can be used to evaluate allergy to environmental allergens. The identification and removal of specific allergens can improve AD in these patients. Intensive moisturization is also important in the treatment of AD. ·
Alternative Therapies and Atopic Dermatitis Source: The Advocate. 11(4): 1-2,7. 4th Quarter 1999. Contact: Available from National Eczema Association for Science and Education (NEASE). 1220 SW Morrison, Suite 433, Portland, OR 97205. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail:
[email protected]. Website: www.eczema-assn.com. Summary: This newsletter article provides people who have atopic dermatitis with information on alternative therapies for this skin condition, including acupuncture, acupressure, chiropractic, Chinese traditional medicine, homeopathic medicine, naturopathic medicine, and dietary supplements. All of these methods seem to have worked for some people who have tried them, and all have failed for some. Currently, there is very little scientific evidence that alternative therapies work for significant numbers of persons. Problems with alternative treatments include lack of knowledge about the conditions of their use, their limitations, and their potential side effects. With nonregulated remedies, the consumer may have little or no recourse if there is a problem. With nonstandard treatments, quality may vary widely from one manufacturer or practitioner to another, and the actual ingredients of a product may be unknown. In addition, few alternative remedies have been tested under conditions that would allow researchers to publish their findings in a reputable scientific journal. This means that direct information on alternative remedies is limited to the testimony of individuals. The article provides guidelines for people who want to try alternative remedies.
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Skin Disease: Eczema Source: Harvard Health Letter. 26(6): 7. April 2001. Contact: Available from Harvard Health Letter. P.O. Box 380, Department BI, Boston, MA 02117. (800) 829-9045 or (617) 432-1485. Email:
[email protected]. Summary: This newsletter article provides people who have eczema with information on its causes, symptoms, and treatment. The terms eczema and dermatitis are used interchangeably to describe almost any itchy
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rash. People who go to the doctor for eczema or dermatitis usually do so because they have atopic dermatitis. This chronic, hereditary condition that mainly affects children presents as a red, scaly rash. The prevalence of atopic dermatitis in the United States is 12 percent to 15 percent. People who have atopic dermatitis often have family members who suffer from asthma or other allergy based atopic disorders. Specific foods and stress can trigger an attack. Self treatment involves using a combination of moisturizers to alleviate dryness and nonprescription steroid creams to reduce itching, avoiding irritants and common allergens, bathing in warm water, and limiting the use of soap. Topical steroids are the mainstay of treatment for difficult cases. Alternatives to steroid treatments are cyclosporine and tacrolimus. Cyclosporine can cause kidney damage and is not as effective as topical cream or ointment. Tacrolimus is more potent than cyclosporine, works when applied topically, and does not have severe adverse effects. 1 figure. ·
Phototherapy for Atopic Dermatitis Source: The Advocate. 13(2): 1-2. Second Quarter 2001. Contact: Available from National Eczema Association for Science and Education (NEASE). 1220 SW Morrison, Suite 433, Portland, OR 97205. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail:
[email protected]. Website: www.eczema-assn.com. Summary: This newsletter article provides people who have atopic dermatitis (AD) with information on the use of phototherapy in the treatment of this skin disorder. Ultraviolet (UV) light is useful for treating skin diseases because it causes chemical changes in skin cells. The idea of treatment is to cause controlled damage to these cells so that the skin's natural healing capacities are activated. Short term adverse effects of UV radiation are local inflammation and cell destruction. Long term risks of UV radiation can be cell changes that may cause cancer. Total exposure over time is an important factor. Medical UV therapy is produced by special lamps that emit light of precise wavelengths and energies. People should undergo UV therapy under the close supervision of a physician. Types of UV therapy available include psoralen plus UVA (PUVA) and UVB. Although PUVA or photochemotherapy is very effective for treating psoriasis, it has limited usefulness in treating AD. UVB is shorter than UVA, so it penetrates the skin better and can be used therapeutically without the need for psoralen. Narrow band UVB is the newest approach to UV therapy. Climatotherapy is a special type of phototherapy that uses the natural light of the sun, often in conjunction with special baths and other methods, to treat AD.
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Tacrolimus: A Promising New Therapy for Eczema/Atopic Dermatitis Source: The Advocate. 11(2): 1-2,9. 2nd Quarter 1999. Contact: Available from National Eczema Association for Science and Education (NEASE). 1220 SW Morrison, Suite 433, Portland, OR 97205. (800) 818-7546 or (503) 228-4430. Fax (503) 224-3363. E-mail:
[email protected]. Website: www.eczema-assn.com. Summary: This newsletter article provides people who have eczema or atopic dermatitis with information on a new agent to treatment atopic dermatitis. This agent, known as tacrolimus, was first isolated from a fungus found in Japanese soil. Tacrolimus, an immunosuppressant, decreases the production and release of cytokines. Atopic dermatitis includes an immune component, so it seems logical that an immunosuppressive drug should help treat this skin condition characterized by pruritus, lichenification, and dry, flaky, red, and swollen skin. Scratching makes the condition worse by releasing increasing amounts of cytokines and antibodies. Traditional therapies for atopic dermatitis include corticosteroids and antihistamines; however, corticosteroids have side effects that increase with chronic use, and antihistamines target only one aspect of the inflammation process. Cyclosporine is another immunosuppressant drug that works similarly to tacrolimus, but its side effects do not justify its systemic use in atopic dermatitis. Clinical trials have demonstrated the safety and efficacy of topical tacrolimus use in people who have atopic dermatitis. Topical tacrolimus is not commercially available in the United States, but once clinical trials are concluded and the drug is approved for use by the Food and Drug Administration, the drug should become widely used in the therapy of atopic dermatitis. 6 references.
Academic Periodicals covering Atopic Dermatitis Academic periodicals can be a highly technical yet valuable source of information on atopic dermatitis. We have compiled the following list of periodicals known to publish articles relating to atopic dermatitis and which are currently indexed within the National Library of Medicine's PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on atopic dermatitis published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical's name into the search box to find the latest studies published.
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If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on atopic dermatitis: ·
Acta Dermato-Venereologica. (Acta Derm Venereol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Dermato-Venereologica&dispmax=20&dispstart=0
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Archives of Disease in Childhood. (Arch Dis Child) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ar chives+of+Disease+in+Childhood&dispmax=20&dispstart=0
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Bmj (Clinical Research Ed. . (BMJ) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=B mj+(Clinical+Research+Ed.+&dispmax=20&dispstart=0
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Forschende Komplementarmedizin. (Forsch Komplementarmed) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Fo rschende+Komplementarmedizin&dispmax=20&dispstart=0
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Postgraduate Medicine. (Postgrad Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Po stgraduate+Medicine&dispmax=20&dispstart=0
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The Journal of Investigative Dermatology. (J Invest Dermatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Th e+Journal+of+Investigative+Dermatology&dispmax=20&dispstart=0
Vocabulary Builder Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are
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characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.nih.gov/niams/healthinfo/
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 27 See http://www.nlm.nih.gov/databases/databases.html. 26
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat atopic dermatitis, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and atopic dermatitis using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “atopic dermatitis” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with atopic dermatitis. The following is a sample result:
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·
FAN Flashbacks: More Coping Strategies Source: Fairfax, VA: Food Allergy and Anaphylaxis Network (FAAN). 1996. 20 p. Contact: Available from Food Allergy and Anaphylaxis Network (FAAN). 10400 Eaton Place, Suite 107, Fairfax, VA 22030. (800) 929-4040 or (703) 691-3179. Fax (703) 691-2713. E-mail:
[email protected]. Web site: http://www.foodallergy.org/. Price: $2.00 each. Summary: This brochure reprints relevant information on specific topics from previous issues of Food Allergy News, the newsletter of the Food Allergy and Anaphylaxis Network. This brochure is the second of two brochures that cover a variety of coping strategies for people with food allergies. Articles are reprinted on topics including accessing a support group; feeding a child with food allergy who is also a picky eater; managing the psychosocial problems that may accompany a food allergy in adolescence; how parents can help an adolescent deal with the harassment and teasing of his or her peers regarding the food allergy; the problem of atopic dermatitis and its role as a cause of sleep disturbance; planning ahead as a strategy to cope with a food allergy emergency; contacting food manufacturers to obtain or provide information about a particular food; the availability of a video, 'Alexander, the Elephant Who Couldn't Eat Peanuts,' to help with educating children about food allergies and anaphylactic shock; getting ready for college and balancing dorm life and food allergies; balancing the needs of young children, particularly strategies for day care centers and play groups; suggestions for healthy nutrition during pregnancy and breastfeeding; suggestions for handling family life and meal times when only one child has food allergies; and the potential psychological consequences of a severe allergic reaction in a child. The brochure includes the address, telephone numbers, and email addresses for the Food Allergy and Anaphylaxis Network, a national nonprofit organization established to help families living with food allergies and to increase public awareness about food allergies and anaphylaxis. (AA-M).
The NLM Gateway28 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for 28
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
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many of NLM's information resources or databases.29 One target audience for the Gateway is the Internet user who is new to NLM's online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.30 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “atopic dermatitis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 8823 Books / Periodicals / Audio Visual 111 Consumer Health 18 Meeting Abstracts 10 Other Collections 1 Total 8963
HSTAT31 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.32 HSTAT's audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 30 Other users may find the Gateway useful for an overall search of NLM's information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 31 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 32 The HSTAT URL is http://hstat.nlm.nih.gov/. 29
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clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ's Put Prevention Into Practice.33 Simply search by “atopic dermatitis” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists34 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.36 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 35 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 36 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 33
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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center's MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Atopic Dermatitis With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to atopic dermatitis. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for
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Biotechnology Information (NCBI).37 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI's Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “atopic dermatitis” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for atopic dermatitis: ·
Deafness, Neural, with Atypical Atopic Dermatitis Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?221700
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Cancer: Uncontrolled cell division. Examples: Breast And Ovarian Cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
37
Physician Guidelines and Databases 145
Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn's disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich's ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson's disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI).
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These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI's Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “atopic dermatitis” (or synonyms) and click “Go.”
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Jablonski's Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database38 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database39 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB's mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “atopic dermatitis” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to nonAdapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 39 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 38
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professionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in atopic dermatitis (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Atlas of Clinical Dermatology by Du Vivier; Hardcover, 3rd edition (June 3, 2002), Churchill Livingstone; ISBN: 0443072205; http://www.amazon.com/exec/obidos/ASIN/0443072205/icongroupinterna · Clinical Dermatology by John A. Hunter, et al; Paperback, 3rd edition (June 2002), Blackwell Science Inc; ISBN: 0632059168; http://www.amazon.com/exec/obidos/ASIN/0632059168/icongroupinterna · Clinical Dermatology: A Color Guide to Diagnosis and Therapy by Thomas P. Habif; Hardcover, 4th edition (July 15, 2002), Mosby-Year Book; ISBN: 0323013198; http://www.amazon.com/exec/obidos/ASIN/0323013198/icongroupinterna · Common Skin Diseases by Thomas F. Poyner; Paperback - 176 pages, 1st edition (March 15, 2000), Blackwell Science Inc.; ISBN: 0632051345; http://www.amazon.com/exec/obidos/ASIN/0071054480/icongroupinterna · Dermatology (Pocket Brain) by Kimberly N. Jones; Hardcover (March 2002); ISBN: 0967783925; http://www.amazon.com/exec/obidos/ASIN/0967783925/icongroupinterna · Dermatology for Clinicians by Massad G. Joseph; Hardcover - 320 pages (June 5, 2002), CRC Press-Parthenon Publishers; ISBN: 1842141260; http://www.amazon.com/exec/obidos/ASIN/1842141260/icongroupinterna · Essential Dermatopathology by Ronald P. Rapini; Hardcover (August 2002), Mosby-Year Book; ISBN: 0323011985; http://www.amazon.com/exec/obidos/ASIN/0323011985/icongroupinterna · Evidence-Based Dermatology by Maibach; Hardcover (March 2002), B C Decker; ISBN: 1550091727; http://www.amazon.com/exec/obidos/ASIN/1550091727/icongroupinterna · A Multi-Cultural Atlas of Skin Conditions by Darya Samolis, Yuri N. Perjamutrov; Paperback - 120 pages (March 19, 2002); ISBN: 1873413424; http://www.amazon.com/exec/obidos/ASIN/1873413424/icongroupinterna
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· Treatment of Skin Disease by Mark Lebwohl, et al; Hardcover - 600 pages, 1st edition (March 27, 2002), Mosby, Inc.; ISBN: 0723431981; http://www.amazon.com/exec/obidos/ASIN/0723431981/icongroupinterna
Vocabulary Builder Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU]
Dissertations 151
CHAPTER 10. DISSERTATIONS ON ATOPIC DERMATITIS Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master's dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to atopic dermatitis. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Atopic Dermatitis ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to atopic dermatitis. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with atopic dermatitis: ·
Pityrosporum Ovale (malassezia Furfur) and Atopic Dermatitis by Lintu, Paivi Johanna; Md from Turun Yliopisto (finland), 2000 http://wwwlib.umi.com/dissertations/fullcit/f1170129
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Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to atopic dermatitis is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
153
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with atopic dermatitis and related conditions.
Researching Your Medications 155
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with atopic dermatitis. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internetbased databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for atopic dermatitis. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of atopic dermatitis. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
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Your Medications: The Basics40 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of atopic dermatitis. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with atopic dermatitis take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for atopic dermatitis. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
40
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 157
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for atopic dermatitis). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the
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medications your doctor has recommended for atopic dermatitis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration's (FDA) Drug Approvals database.41 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of atopic dermatitis. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to atopic dermatitis: Coal Tar ·
Topical - U.S. Brands: Alphosyl; Aquatar; Estar; Fototar; Lavatar; Medotar; Psorigel; Taraphilic; Tarbonis http://www.nlm.nih.gov/medlineplus/druginfo/coaltartopical20 2158.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
41
Researching Your Medications 159
Corticosteroids ·
Dental - U.S. Brands: Kenalog in Orabase; Orabase-HCA; Oracort; Oralone http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsd ental202010.html
·
Inhalation - U.S. Brands: AeroBid; AeroBid-M; Azmacort; Beclovent; Decadron Respihaler; Pulmicort Respules; Pulmicort Turbuhaler; Vanceril; Vanceril 84 mcg Double Strength http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsi nhalation202011.html
·
Nasal - U.S. Brands: Beconase; Beconase AQ; Dexacort Turbinaire; Flonase; Nasacort; Nasacort AQ; Nasalide; Nasarel; Nasonex; Rhinocort; Vancenase; Vancenase AQ 84 mcg; Vancenase pockethaler http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsn asal202012.html
·
Ophthalmic - U.S. Brands: AK-Dex; AK-Pred; AK-Tate; Baldex; Decadron; Dexair; Dexotic; Econopred; Econopred Plus; Eflone; Flarex; Fluor-Op; FML Forte; FML Liquifilm; FML S.O.P.; HMS Liquifilm; Inflamase Forte; Inflamase Mild; I-Pred; Lite Pred; Maxidex; Ocu-Dex; Ocu-Pred; Ocu-Pr http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso phthalmic202013.html
·
Otic - U.S. Brands: Decadron http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidso tic202014.html
·
Rectal - U.S. Brands: Anucort-HC; Anu-Med HC; Anuprep HC; Anusol-HC; Anutone-HC; Anuzone-HC; Cort-Dome; Cortenema; Cortifoam; Hemorrhoidal HC; Hemril-HC Uniserts; Proctocort; Proctosol-HC; Rectosol-HC http://www.nlm.nih.gov/medlineplus/druginfo/corticosteroidsr ectal203366.html
Doxepin ·
Topical - U.S. Brands: Zonalon http://www.nlm.nih.gov/medlineplus/druginfo/doxepintopical2 02751.html
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Methoxsalen ·
Systemic - U.S. Brands: 8-MOP; Oxsoralen-Ultra http://www.nlm.nih.gov/medlineplus/druginfo/methoxsalensys temic202357.html
Resorcinol ·
Topical - U.S. Brands: RA http://www.nlm.nih.gov/medlineplus/druginfo/resorcinoltopica l202507.html
Tacrolimus ·
Topical - U.S. Brands: Protopic http://www.nlm.nih.gov/medlineplus/druginfo/tacrolimustopic al500279.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor's office. Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters' database as associated with atopic dermatitis (including those with contraindications):42 ·
Cyclosporine http://www.reutershealth.com/atoz/html/Cyclosporine.htm
·
Cyclosporine(Cyclosporin A) http://www.reutershealth.com/atoz/html/Cyclosporine(Cyclosporin_ A).htm
·
Interferon Gamma-1b http://www.reutershealth.com/atoz/html/Interferon_Gamma-1b.htm
·
Nortriptyline HCl http://www.reutershealth.com/atoz/html/Nortriptyline_HCl.htm
42
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 161
·
Rofecoxib http://www.reutershealth.com/atoz/html/Rofecoxib.htm
·
Tacrolimus http://www.reutershealth.com/atoz/html/Tacrolimus.htm
Mosby's GenRx Mosby's GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with atopic dermatitis--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat atopic dermatitis or potentially create deleterious side effects in patients with atopic dermatitis. You should ask your physician about any
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contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it's especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with atopic dermatitis. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with atopic dermatitis. The FDA warns patients to watch out for43: ·
Secret formulas (real scientists share what they know)
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
43
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Amazing breakthroughs or miracle cures (real breakthroughs don't happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn't true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Comprehensive Dermatologic Drug Therapy by Stephen E. Wolverton (Editor); Paperback - 656 pages (March 15, 2001), W B Saunders Co; ISBN: 0721677282; http://www.amazon.com/exec/obidos/ASIN/0721677282/icongroupinterna
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Drug Eruption Reference Manual 2000, Millennium Edition by Jerome Z. Litt, M.D. (Editor); Paperback - 662 pages (April 15, 2000), Parthenon Pub Group; ISBN: 185070788X; http://www.amazon.com/exec/obidos/ASIN/185070788X/icongroupinterna
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Pocket Guide to Medications Used in Dermatology by Andrew J. Scheman, David L. Severson; Paperback - 230 pages, 6th edition (June 15, 1999), Lippincott Williams & Wilkins Publishers; ISBN: 0781721008; http://www.amazon.com/exec/obidos/ASIN/0781721008/icongroupinterna
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Complete Guide to Prescription and Nonprescription Drugs 2001 (Complete Guide to Prescription and Nonprescription Drugs, 2001) by H. Winter Griffith, Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/039952634X/icongroupinterna
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The Essential Guide to Prescription Drugs, 2001 by James J. Rybacki, James W. Long; Paperback - 1274 pages (2001), Harper Resource; ISBN: 0060958162; http://www.amazon.com/exec/obidos/ASIN/0060958162/icongroupinterna
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Handbook of Commonly Prescribed Drugs by G. John Digregorio, Edward J. Barbieri; Paperback 16th edition (2001), Medical Surveillance; ISBN: 0942447417; http://www.amazon.com/exec/obidos/ASIN/0942447417/icongroupinterna
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Johns Hopkins Complete Home Encyclopedia of Drugs 2nd ed. by Simeon Margolis (Ed.), Johns Hopkins; Hardcover - 835 pages (2000), Rebus; ISBN: 0929661583; http://www.amazon.com/exec/obidos/ASIN/0929661583/icongroupinterna
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Medical Pocket Reference: Drugs 2002 by Springhouse Paperback 1st edition (2001), Lippincott Williams & Wilkins Publishers; ISBN: 1582550964; http://www.amazon.com/exec/obidos/ASIN/1582550964/icongroupinterna
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PDR by Medical Economics Staff, Medical Economics Staff Hardcover 3506 pages 55th edition (2000), Medical Economics Company; ISBN: 1563633752; http://www.amazon.com/exec/obidos/ASIN/1563633752/icongroupinterna
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Pharmacy Simplified: A Glossary of Terms by James Grogan; Paperback 432 pages, 1st edition (2001), Delmar Publishers; ISBN: 0766828581; http://www.amazon.com/exec/obidos/ASIN/0766828581/icongroupinterna
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Physician Federal Desk Reference by Christine B. Fraizer; Paperback 2nd edition (2001), Medicode Inc; ISBN: 1563373971; http://www.amazon.com/exec/obidos/ASIN/1563373971/icongroupinterna
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Physician's Desk Reference Supplements Paperback - 300 pages, 53 edition (1999), ISBN: 1563632950; http://www.amazon.com/exec/obidos/ASIN/1563632950/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Inhalation: The drawing of air or other substances into the lungs. [EU] Liquifilm: A thin liquid layer of coating. [EU] Methoxsalen: A naturally occurring furocoumarin compound found in several species of plants, including Psoralea corylifolia. It is a photoactive substance that forms DNA adducts in the presence of ultraviolet A irradiation. [NIH] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to atopic dermatitis. Finally, at the conclusion of this chapter, we will provide a list of readings on atopic dermatitis from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine's (NCCAM) overview of complementary and alternative medicine.
What Is CAM?44 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?45 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India's traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body's defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine's use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body's systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient's recovery and that healing is promoted when the body's energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.46
46
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Atopic Dermatitis Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for atopic dermatitis. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required. The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “atopic dermatitis” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Trial of Oolong Tea in the Management of Recalcitrant Atopic Dermatitis Source: Archives of Dermatology. 137: 42-43. January 2001.
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Summary: This journal article describes an open trial of oolong tea for the treatment of recalcitrant atopic dermatitis (AD). The participants were 121 patients, aged 16 to 58 years, who had been receiving standard treatment for AD for at least 6 months. There were 20 mild cases, 74 moderate cases, and 27 severe cases of AD. The patients were asked to drink oolong tea made from a 10 g tea bag placed in 1,000 ml of boiling water and steeped for 5 minutes. The tea was then divided into three equal servings and consumed daily after three regular meals for 6 months. Patients were asked to maintain their regular dermatological treatment throughout the trial. Photographs of two or three representative sites were taken at baseline and at 1 and 6 months, and the severity of pruritis was assessed on a 6-point Likert-like scale ranging from marked improvement (greater than 50 percent improved) to worsened. One hundred eighteen patients completed the study. After 1 month of treatment, 74 patients (63 percent) showed marked to moderate improvement of their condition. The beneficial effect was first noticed after 1-2 weeks of treatment. At 6 months, 64 patients (54 percent) still showed a good response to treatment. The authors suggest that the therapeutic effects of oolong tea in recalcitrant AD may be due to the antiallergic properties of tea polyphenols. The article has 1 figure, 1 table, and 5 references. ·
Novel Unconventional Therapeutic Approaches to Atopic Eczema Source: Dermatology. 201: 191-195. 2000. Summary: This journal article discusses four unconventional treatments for atopic dermatitis (AD): gamma-linolenic acid, Chinese herbal tea, elimination diets, and bioresonance. The therapeutic value of gammalinolenic acid for the treatment of AD has been studied in several placebo-controlled studies in adults and children. Although none showed a significant advantage of gamma-linolenic acid over placebo, these studies have been criticized on several methodological grounds. A more recent study designed to overcome these flaws also failed to yield unequivocal answers. Studies of Chinese herbal teas have produced inconsistent results regarding efficacy, but suggest that these preparations may have potentially serious adverse effects. Diets eliminating allergens, pseudoallergens, metal salts, and sodium also have been tested. With the exceptions of elimination diets in selected patients with proven food allergy or pseudoallergy, none have been clearly shown to be effective for AD. Bioresonance, which has been proposed as a treatment for allergic diseases, was shown to be no more effective than sham treatment in a double-blind, placebo-controlled trial involving children with AD. The article has 1 figure, 1 table, and 43 references.
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Use of Acupuncture in the Management of Skin Diseases Source: Alternative Medicine Journal. 2(6): 29-34. November-December 1995. Summary: This journal article summarizes the author's experience with acupuncture as a treatment for skin diseases, and describes efforts to develop a technique that would be effective for most skin diseases. After trying several approaches and point combinations, the author found a technique that is simple to administer and can be used for all skin diseases that respond to acupuncture, including rosacea, eczema, psoriasis, acne, alopecia areata, warts, atopic dermatitis, and eczema solar. It uses a limited number of points and short stimulation time, and can be performed without a traditional Chinese medicine diagnosis. This article describes the treatment protocol, presents the results from 50 patients with various skin diseases treated with the protocol, and provides case examples and photographs illustrating the success of this technique. It also explores a possible explanation for acupuncture's effects in skin diseases. The article has 10 figures, 5 tables, and 5 references.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine's databases to allow patients to search for articles that specifically relate to atopic dermatitis and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “atopic dermatitis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to atopic dermatitis: ·
A controlled trial of traditional Chinese herbal medicine in Chinese patients with recalcitrant atopic dermatitis. Author(s): Fung AY, Look PC, Chong LY, But PP, Wong E. Source: International Journal of Dermatology. 1999 May; 38(5): 387-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10369553&dopt=Abstract
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A randomized, double-blind, placebo-controlled trial to investigate the efficacy and safety of a Chinese herbal product (P07P) for the treatment of canine atopic dermatitis. Author(s): Nagle TM, Torres SM, Horne KL, Grover R, Stevens MT.
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Source: Veterinary Dermatology. 2001 October; 12(5): 265-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11906651&dopt=Abstract ·
A trial of oolong tea in the management of recalcitrant atopic dermatitis. Author(s): Uehara M, Sugiura H, Sakurai K. Source: Archives of Dermatology. 2001 January; 137(1): 42-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11176659&dopt=Abstract
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Advances in the treatment of atopic dermatitis with special regard to children. Author(s): Oranje AP, Wolkerstorfer A. Source: Current Problems in Dermatology. 1999; 28: 56-63. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10374051&dopt=Abstract
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Alternative therapy for atopic dermatitis and psoriasis: patientreported motivation, information source and effect. Author(s): Jensen P. Source: Acta Dermato-Venereologica. 1990; 70(5): 425-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1980978&dopt=Abstract
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Alternative treatments for atopic dermatitis: a selected review. Author(s): Vender RB. Source: Skin Therapy Letter. 2002 February; 7(2): 1-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12007013&dopt=Abstract
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An overview of atopic dermatitis: toward a bio-behavioural integration. Author(s): Faulstich ME, Williamson DA. Source: Journal of Psychosomatic Research. 1985; 29(6): 647-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3910807&dopt=Abstract
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Antimicrobial effects of acidic hot-spring water on Staphylococcus aureus strains isolated from atopic dermatitis patients. Author(s): Akiyama H, Yamasaki O, Tada J, Kubota K, Arata J.
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Source: Journal of Dermatological Science. 2000 November; 24(2): 112-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11064246&dopt=Abstract ·
Antipruritic and antidermatitic effect of extract and compounds of Impatiens balsamina L. in atopic dermatitis model NC mice. Author(s): Oku H, Ishiguro K. Source: Phytotherapy Research : Ptr. 2001 September; 15(6): 506-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11536380&dopt=Abstract
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Atopic dermatitis and essential fatty acids: a biochemical basis for atopy? Author(s): Wright S. Source: Acta Derm Venereol Suppl (Stockh). 1985; 114: 143-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3890448&dopt=Abstract
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Atopic dermatitis symptoms decreased in children following massage therapy. Author(s): Schachner L, Field T, Hernandez-Reif M, Duarte AM, Krasnegor J. Source: Pediatric Dermatology. 1998 September-October; 15(5): 390-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9796594&dopt=Abstract
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Atopic dermatitis. Special clinical complications. Author(s): Hanifin JM. Source: Postgraduate Medicine. 1983 September; 74(3): 188-93, 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6193504&dopt=Abstract
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Atopic dermatitis: recent trends in pathogenesis and therapy. Author(s): Cooper KD. Source: The Journal of Investigative Dermatology. 1994 January; 102(1): 128-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8288906&dopt=Abstract
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Bactericidal activity of manganese and iodide ions against Staphylococcus aureus: a possible treatment for acute atopic dermatitis. Author(s): Inoue T, Inoue S, Kubota K.
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Source: Acta Dermato-Venereologica. 1999 September; 79(5): 360-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10494711&dopt=Abstract ·
Balneophototherapy--combined treatment of psoriasis vulgaris and atopic dermatitis with salt water baths and artificial ultraviolet radiation. Author(s): Gambichler T, Kuster W, Kreuter A, Altmeyer P, Hoffmann K. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2000 September; 14(5): 425-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11305394&dopt=Abstract
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Biochemical and immunologic mechanisms in atopic dermatitis: new targets for emerging therapies. Author(s): Hanifin JM, Chan S. Source: Journal of the American Academy of Dermatology. 1999 July; 41(1): 72-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10411415&dopt=Abstract
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Biofeedback training in atopic dermatitis. Author(s): Jaffe P, Haynes S, Wilson C. Source: Southern Medical Journal. 1977 October; 70(10): 1249. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=910181&dopt=Abstract
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Biofeedback treatment of atopic dermatitis: controlled case studies of eight cases. Author(s): Haynes SN, Wilson CC, Jaffe PG, Britton BT. Source: Biofeedback Self Regul. 1979 September; 4(3): 195-209. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=486586&dopt=Abstract
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Cataract progression in patients with atopic dermatitis. Author(s): Nagaki Y, Hayasaka S, Kadoi C.
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Source: Journal of Cataract and Refractive Surgery. 1999 January; 25(1): 96-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9888084&dopt=Abstract ·
Chinese herbs and atopic dermatitis. Author(s): Rustin MH, Atherton DJ. Source: Lancet. 1994 February 19; 343(8895): 489. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7905996&dopt=Abstract
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Chinese herbs and atopic dermatitis. Author(s): Liu HN, Jaw SK, Wong CK. Source: Lancet. 1993 November 6; 342(8880): 1175-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7901499&dopt=Abstract
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Climatotherapy of atopic dermatitis at the Dead Sea: demographic evaluation and cost-effectiveness. Author(s): Harari M, Shani J, Seidl V, Hristakieva E. Source: International Journal of Dermatology. 2000 January; 39(1): 59-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10651969&dopt=Abstract
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Clinical effects of specific immunotheraphy in children with atopic dermatitis. Author(s): Trofimowicz A, Rzepecka E, Hofman J. Source: Rocz Akad Med Bialymst. 1995; 40(2): 414-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8834626&dopt=Abstract
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Clinical efficacy and immunoregulatory and neurohumoral effects of MM therapy in patients with atopic dermatitis. Author(s): Adaskevich VP. Source: Crit Rev Biomed Eng. 2000; 28(5-6): 11-21. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11211977&dopt=Abstract
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Comparison of immunopharmacological actions of 8 kinds of kampohozais clinically used in atopic dermatitis on delayed-type
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hypersensitivity in mice. Author(s): Nose M, Sakushima J, Harada D, Ogihara Y. Source: Biol Pharm Bull. 1999 January; 22(1): 48-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9989661&dopt=Abstract ·
Dependence on very hot hot-spring bathing in a refractory case of atopic dermatitis. Author(s): Kubota K, Tamura K, Take H, Kurabayashi H, Mori M, Shirakura T. Source: J Med. 1994; 25(5): 333-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7730738&dopt=Abstract
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Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study. Author(s): Soyland E, Funk J, Rajka G, Sandberg M, Thune P, Rustad L, Helland S, Middelfart K, Odu S, Falk ES, et al. Source: The British Journal of Dermatology. 1994 June; 130(6): 757-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8011502&dopt=Abstract
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Differences in efficacy between intention-to-treat and per-protocol analyses for patients with psoriasis vulgaris and atopic dermatitis: clinical and pharmacoeconomic implications. Author(s): Schiffner R, Schiffner-Rohe J, Gerstenhauer M, Hofstadter F, Landthaler M, Stolz W. Source: The British Journal of Dermatology. 2001 June; 144(6): 1154-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11422035&dopt=Abstract
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Disease management of atopic dermatitis: a practice parameter. Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Work Group on Atopic Dermatitis. Author(s): Leung DY, Hanifin JM, Charlesworth EN, Li JT, Bernstein IL, Berger WE, Blessing-Moore J, Fineman S, Lee FE, Nicklas RA, Spector SL.
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Source: Ann Allergy Asthma Immunol. 1997 September; 79(3): 197-211. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9305225&dopt=Abstract ·
Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis. Author(s): Bjorneboe A, Soyland E, Bjorneboe GE, Rajka G, Drevon CA. Source: The British Journal of Dermatology. 1987 October; 117(4): 463-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2823859&dopt=Abstract
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Effect of n-3 fatty acid supplement to patients with atopic dermatitis. Author(s): Bjorneboe A, Soyland E, Bjorneboe GE, Rajka G, Drevon CA. Source: J Intern Med Suppl. 1989; 225(731): 233-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2650695&dopt=Abstract
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Effect of topically applied evening primrose oil on epidermal barrier function in atopic dermatitis as a function of vehicle. Author(s): Gehring W, Bopp R, Rippke F, Gloor M. Source: Arzneimittel-Forschung. 1999 July; 49(7): 635-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10442214&dopt=Abstract
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Effects of linoleic acid supplements on atopic dermatitis. Author(s): Gimenez-Arnau A, Barranco C, Alberola M, Wale C, Serrano S, Buchanan MR, Camarasa JG. Source: Advances in Experimental Medicine and Biology. 1997; 433: 2859. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9561153&dopt=Abstract
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Efficacy and safety of a soy-protein-formula for feeding babies with atopic dermatitis and cow's milk hypersensitivity. Author(s): Cantani A, Ferrara M, Ragno V, Businco L. Source: Riv Eur Sci Med Farmacol. 1990 December; 12(6): 311-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2132284&dopt=Abstract
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Efficacy of hyperbaric oxygenation in atopic dermatitis. Author(s): Olszanski R, Pachut M, Sicko Z, Sztaba-Kania M, Wilkowska A. Source: Bull Inst Marit Trop Med Gdynia. 1992; 43(1-4): 79-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1345603&dopt=Abstract
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Efficacy of Shiunko for the treatment of atopic dermatitis. Author(s): Higaki S, Kitagawa T, Morohashi M, Yamagishi T. Source: J Int Med Res. 1999 May-June; 27(3): 143-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10505304&dopt=Abstract
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Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Author(s): Sheehan MP, Rustin MH, Atherton DJ, Buckley C, Harris DW, Brostoff J, Ostlere L, Dawson A, Harris DJ. Source: Lancet. 1992 July 4; 340(8810): 13-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1351600&dopt=Abstract
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Efficacy trial of bioresonance in children with atopic dermatitis. Author(s): Schoni MH, Nikolaizik WH, Schoni-Affolter F. Source: International Archives of Allergy and Immunology. 1997 March; 112(3): 238-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9066509&dopt=Abstract
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Emotional dysfunction, child-family relationships and childhood atopic dermatitis. Author(s): Howlett S. Source: The British Journal of Dermatology. 1999 March; 140(3): 381-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10233254&dopt=Abstract
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Epogam evening primrose oil treatment in atopic dermatitis and asthma. Author(s): Hederos CA, Berg A.
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Source: Archives of Disease in Childhood. 1996 December; 75(6): 494-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9014601&dopt=Abstract ·
Essential fatty acid supplementation in atopic dermatitis. Author(s): Shield MJ, Wilson AM, Horrobin DF, Morse PF. Source: Lancet. 1993 August 7; 342(8867): 377-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8101623&dopt=Abstract
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Evening primrose oil. Does not show promise in atopic dermatitis. Author(s): Berth-Jones J, Graham-Brown RA. Source: Bmj (Clinical Research Ed.). 1994 November 26; 309(6966): 1437. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7819863&dopt=Abstract
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Food immediate-contact hypersensitivity (FICH) and elimination diet in young children with atopic dermatitis. Preliminary results in 107 children. Author(s): Oranje AP, Aarsen RS, Mulder PG, van Toorenenbergen AW, Liefaard G, Dieges PH. Source: Acta Derm Venereol Suppl (Stockh). 1992; 176: 41-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1476034&dopt=Abstract
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Hypnotherapy as a treatment for atopic dermatitis in adults and children. Author(s): Stewart AC, Thomas SE. Source: The British Journal of Dermatology. 1995 May; 132(5): 778-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7772485&dopt=Abstract
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In vitro lymphocyte stimulation by concanavalin A and with histamine as a co-mitogen in dogs with atopic dermatitis. Author(s): Wilkie JS. Source: Veterinary Immunology and Immunopathology. 1991 March; 28(1): 67-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1675821&dopt=Abstract
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Inhibitory effect of Byakko-ka-ninjin-to on itch in a mouse model of atopic dermatitis. Author(s): Tohda C, Sugahara H, Kuraishi Y, Komatsu K. Source: Phytotherapy Research : Ptr. 2000 May; 14(3): 192-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10815013&dopt=Abstract
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Involvement of complement in atopic dermatitis. Author(s): Kapp A, Schopf E. Source: Acta Derm Venereol Suppl (Stockh). 1985; 114: 152-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3923750&dopt=Abstract
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Natural history of food hypersensitivity in children with atopic dermatitis. Author(s): Sampson HA, Scanlon SM. Source: The Journal of Pediatrics. 1989 July; 115(1): 23-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2738792&dopt=Abstract
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New successful treatment with disinfectant for atopic dermatitis. Author(s): Sugimoto K, Kuroki H, Kanazawa M, Kurosaki T, Abe H, Takahashi Y, Ishiwada N, Nezu Y, Hoshioka A, Toba T. Source: Dermatology (Basel, Switzerland). 1997; 195 Suppl 2: 62-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9403258&dopt=Abstract
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New therapeutic approaches in atopic dermatitis. Author(s): Cooper KD. Source: Clin Rev Allergy. 1993 Winter; 11(4): 543-59. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8143265&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html The following is a specific Web list relating to atopic dermatitis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Eczema Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Eczema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Eczema Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000267.html
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Alternative Therapy Massage Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Massag ecm.html Mind&Body Medicine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/MindB odyMedicinecm.html Traditional Chinese medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 85,00.html ·
Herbs and Supplements Angelica Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Aristocort Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Aspirin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000267.html Betula Alternative names: Birch; Betula sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Borago Alternative names: Borage; Borago officinalis Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Chamomile
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Comfrey Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Coumadin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000267.html Eicosapentaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Evening Primrose Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Evening Primrose Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Evening Primrose Alternative names: Oenothera biennis, Sun Drop Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/EveningPri mrosech.html Evening Primrose Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000267.html Gamma-Linolenic Acid
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Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Gamma-Linolenic Acid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000267.html Gamma-Linolenic Acid (GLA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gam maLinolenicAcidGLAcs.html GLA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gam maLinolenicAcidGLAcs.html GLA (Gamma-Linolenic Acid) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000111.html Grapefruit Seed Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Grapefruit_Seed_Extract .htm Herbal Medicine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Hydrocortisone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Licorice Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Marshmallow Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Oenothera biennis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/EveningPri mrosech.html Peppermint Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Red Clover Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Red Clover Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000267.html Salicylates Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Sun Drop Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/EveningPri mrosech.html Thymus Extracts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Thymus_Extracts.htm Tocopheryl Acetate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Trental Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000267.html Witch Hazel Alternative names: Hamamelis virginiana Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Witch_Hazel.htm Witch Hazel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Eczema.htm Yarrow Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html Yellow Dock Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html ·
Related Conditions
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Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Allergies.htm Dermatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Derma titiscc.html Irritable Bowel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Irritable_Bowel.htm Skin Disorders, Dermatitis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Derma titiscc.html Skin Disorders, Eczema Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Eczem acc.html
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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Skin Cancer Answer by I. William Lane, et al; Paperback - 160 pages (February 1999), Avery Penguin Putnam; ISBN: 0895298651; http://www.amazon.com/exec/obidos/ASIN/0895298651/icongroupinterna · Smart Medicine for Your Skin: A Comprehensive Guide to Understanding Conventional and Alternative Therapies to Heal Common Skin Problems by Jeanette Jacknin, M.D.; Paperback - 414 pages (August 6, 2001), Avery Penguin Putnam; ISBN: 1583330984; http://www.amazon.com/exec/obidos/ASIN/1583330984/icongroupinterna · Alternative Medicine for Dummies by James Dillard (Author); Audio Cassette, Abridged edition (1998), Harper Audio; ISBN: 0694520659; http://www.amazon.com/exec/obidos/ASIN/0694520659/icongroupinterna ·
Complementary and Alternative Medicine Secrets by W. Kohatsu (Editor); Hardcover (2001), Hanley & Belfus; ISBN: 1560534400; http://www.amazon.com/exec/obidos/ASIN/1560534400/icongroupinterna
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Dictionary of Alternative Medicine by J. C. Segen; Paperback-2nd edition (2001), Appleton & Lange; ISBN: 0838516211; http://www.amazon.com/exec/obidos/ASIN/0838516211/icongroupinterna
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Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, MD, et al; Hardcover - 352 pages (2001), Simon & Schuster; ISBN: 0684863375; http://www.amazon.com/exec/obidos/ASIN/0684863375/icongroupinterna
· Encyclopedia of Natural Medicine, Revised 2nd Edition by Michael T. Murray, Joseph E. Pizzorno; Paperback - 960 pages, 2nd Rev edition (1997), Prima Publishing; ISBN: 0761511571; http://www.amazon.com/exec/obidos/ASIN/0761511571/icongroupinterna ·
Integrative Medicine: An Introduction to the Art & Science of Healing by Andrew Weil (Author); Audio Cassette, Unabridged edition (2001),
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Sounds True; ISBN: 1564558541; http://www.amazon.com/exec/obidos/ASIN/1564558541/icongroupinterna ·
New Encyclopedia of Herbs & Their Uses by Deni Bown; Hardcover - 448 pages, Revised edition (2001), DK Publishing; ISBN: 078948031X; http://www.amazon.com/exec/obidos/ASIN/078948031X/icongroupinterna
· Textbook of Complementary and Alternative Medicine by Wayne B. Jonas; Hardcover (2003), Lippincott, Williams & Wilkins; ISBN: 0683044370; http://www.amazon.com/exec/obidos/ASIN/0683044370/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with atopic dermatitis. Any dietary recommendation is based on a patient's age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with atopic dermatitis may be given different recommendations. Some recommendations may be directly related to atopic dermatitis, while others may be more related to the patient's general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of atopic dermatitis. We will then show you how to find studies dedicated specifically to nutrition and atopic dermatitis.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
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Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
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Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
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Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
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Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body's immune system to fight various diseases, strengthens body tissue, and improves the body's use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
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Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
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Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body's use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
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Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
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Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:47 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
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DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
47
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
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RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?48
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”49 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.50 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where the use of plant products, in particular, has a long tradition. However, the This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 49 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 50 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 48
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overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Atopic Dermatitis The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.51 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back periodically as this database is frequently updated. More studies can be Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
51
Researching Nutrition 197
found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “atopic dermatitis” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “atopic dermatitis” (or a synonym): ·
Intestinal involvement in atopic disease. Author(s): Department of Paediatrics, University of Turku, 20520 Turku (Finland) Source: Isolauri, E. Journal-of-the-Royal-Society-of-Medicine,Supplement (United Kingdom). (1997). volume 90(30) page 15-20. mankind eczema skin diseases intestines microbial flora probiotics therapy food allergies immunoglobulins antigens immunological diseases atopy Summary: genre humain eczema maladie de la peau intestin flore microbienne probiotique therapeutique allergie alimentaire immunoglobuline antigene maladie immunologique atopie
Additional physician-oriented references include: ·
A look at complementary medicine's role in eczema. Author(s): National Eczema Society, London. Source: Ransome, S Community-Nurse. 1999 March; 5(2): 27-8 1351-1416
·
Acute nicotine poisoning associated with a traditional remedy for eczema. Author(s): St Mary's NHS Trust, Praed Street, London W2 1NY.
[email protected] Source: Davies, P Levy, S Pahari, A Martinez, D Arch-Dis-Child. 2001 December; 85(6): 500-2 1468-2044
·
Additive benefits of EFAs in dogs with atopic dermatitis after partial response to antihistamine therapy. Author(s): Animal Medical Centre, Chorlton, Manchester. Source: Paterson, S J-Small-Anim-Pract. 1995 September; 36(9): 389-94 0022-4510
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·
Atopic dermatitis and food allergy. Author(s): Department of Allergology and Clinical Immunology, University Clinic, Faculty of Medicine, University of Navarra, Pamplona, Spain. Source: Resano, A Crespo, E Fernandez Benitez, M Sanz, M L Oehling, A J-Investig-Allergol-Clin-Immunol. 1998 Sep-October; 8(5): 271-6 10189068
·
Atopic eczema: how to tackle the most common atopic symptom. Author(s): Department of Pediatric Pneumology and Immunology, Charite-Virchow Klinikum, Humboldt-University of Berlin, Germany. Source: Wahn, U Staab, D Nilsson, L Pediatr-Allergy-Immunol. 1999; 10(12 Suppl): 19-23 0905-6157
·
Children with atopic eczema. I: Clinical response to food elimination and subsequent double-blind food challenge. Author(s): Department of Immunology, University College and Middlesex Hospital School of Medicine, London. Source: Sloper, K S Wadsworth, J Brostoff, J Q-J-Med. 1991 August; 80(292): 677-93 0033-5622
·
Children with atopic eczema. II: Immunological findings associated with dietary manipulations. Author(s): Department of Immunology, University College and Middlesex Hospital School of Medicine, London. Source: Sloper, K S Wadsworth, J Brostoff, J Q-J-Med. 1991 August; 80(292): 695-705 0033-5622
·
Clinical efficacy of topical glucocorticoid preparations and other types of dermatics in inflammatory diseases, particularly in atopic dermatitis. Author(s): Universitats-Hautklinik, Freiburg i.Br., BRD. Source: Niedner, R Schopf, E Curr-Probl-Dermatol. 1993; 21157-69 00702064
·
Clinical observations on the treatment of 182 cases of acute, subacute and chronic eczema with shizhen san. Author(s): Second Dalian People's Hospital. Source: Zhou, S J-Tradit-Chin-Med. 1998 June; 18(2): 118-21 0254-6272
·
Comparison of immunopharmacological actions of 8 kinds of kampohozais clinically used in atopic dermatitis on delayed-type hypersensitivity in mice. Author(s): Department of Pharmacognosy and Plant Chemistry, Faculty of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan. Source: Nose, M Sakushima, J Harada, D Ogihara, Y Biol-Pharm-Bull. 1999 January; 22(1): 48-54 0918-6158
Researching Nutrition 199
·
Cutaneous lymphocyte-associated antigen expression in children with atopic dermatitis and non-atopic healthy children. Author(s): Department of Immunology, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia. Source: Campbell, D E Kemp, A S Pediatr-Allergy-Immunol. 1999 November; 10(4): 253-7 0905-6157
·
Cytokine network and dysregulated apoptosis in atopic dermatitis. Author(s): Swiss Institute of Allergy and Asthma Research, Davos, Switzerland.
[email protected] Source: Akdis, M Trautmann, A Klunker, S Blaser, K Akdis, C A ActaOdontol-Scand. 2001 June; 59(3): 178-82 0001-6357
·
Determination of total and specific IgE to antigens from food allergens in children with atopic dermatitis using fluorimetric method of 3M Diagnostic Systems. Author(s): Department of Pediatric Allergology, Medical Academy, Bialystok. Source: Kuczynska, Z Stasiak Barmuta, A Rzepecka, E Tobolczyk, J Hofman, J Pneumonol-Alergol-Pol. 1992; 60 Suppl 125-8 0867-7077
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Diet and atopic eczema. Source: Neild, V Mod-Midwife. 1994 April; 4(4): 22 0963-276X
·
Eczema: a rational approach. Author(s): Addenbrooke's Hospital, Cambridge. Source: Woodrow, S Norris, P Practitioner. 1996 November; 240(1568): 628-30, 632-3 0032-6518
·
Effect of dietetic therapy on serum immunoglobulin level in patients with chronic eczema [Hypoallergenic diet]. Source: SamsoNovember, M.A. Kalinina, A.A. Vopr-Pitan. Moskva : "Meditsina". Mar/April 1982. (2) page 12-15. 0042-8833
·
Eosinophil protein X and eosinophil cationic protein as indicators of intestinal inflammation in infants with atopic eczema and food allergy. Author(s): Medical School, University of Tampere, Finland. Source: Majamaa, H Laine, S Miettinen, A Clin-Exp-Allergy. 1999 November; 29(11): 1502-6 0954-7894
·
Evening primrose oil in the treatment of atopic eczema: effect on clinical status, plasma phospholipid fatty acids and circulating blood prostaglandins. Author(s): Department of Physiology, University of Turku, Finland. Source: Schalin Karrila, M Mattila, L Jansen, C T Uotila, P Br-J-Dermatol. 1987 July; 117(1): 11-9 0007-0963
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·
Flare responses of atopic eczema patients analysed with true colour images. Author(s): Department of Dermatology, University of ErlangenNurnberg, Germany. Source: Rukwied, R Nischik, M Forster, C Heyer, G Handwerker, H O Inflamm-Res. 1997 September; 46(9): 336-41 1023-3830
·
Food allergy and atopic eczema. Author(s): Dermatology Clinic, Ludwig-Maximilians University, Munich, West Germany. Source: Przybilla, B Ring, J Semin-Dermatol. 1990 September; 9(3): 220-5 0278-145X
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS's gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture's Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration's Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
·
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Researching Nutrition 201
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
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Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 203
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM's interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.52
52
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):53 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
53
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 205
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 207
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke's Hospital Health Sciences Library (St. Luke's Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
Finding Medical Libraries 209
·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
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South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children's Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
Your Rights and Insurance 211
APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with atopic dermatitis faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.54 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
54Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women's health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women's healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan's network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 213
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
214 Atopic Dermatitis
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers' ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
Your Rights and Insurance 215
healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient's Bill of Rights is available from the American Hospital Association.55
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”56 In a healthcare system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan's internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
55 To order your free copy of the Patient's Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient's Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 56 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.57 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.58 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer's human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 58 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 57
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3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan's summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse's employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer's plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan's notice. Be sure to follow up with your plan sponsor if you don't receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer's human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan's decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation's largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 219
contact information on how to find more in-depth information about Medicaid.59
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
59
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 221
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare's premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.60 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
60
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:61 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient's Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
61
Your Rights and Insurance 223
·
Veteran's Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
Online Glossaries 225
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to atopic dermatitis and keep them on file. The NIH, in particular, suggests that patients with atopic dermatitis visit the following Web sites in the ADAM Medical Encyclopedia:
226 Atopic Dermatitis
·
Basic Guidelines for Atopic Dermatitis Atopic dermatitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000853.htm
·
Signs & Symptoms for Atopic Dermatitis Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Blisters Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003939.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Dry skin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003250.htm Dry, leathery skin areas Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003250.htm Ear discharges/bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003042.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Itching Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm
Online Glossaries 227
Itchy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin lesion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin lesions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin redness or inflammation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin, abnormally dark or light Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003242.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Vesicle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003939.htm ·
Diagnostics and Tests for Atopic Dermatitis Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm
228 Atopic Dermatitis
Skin lesion biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003840.htm ·
Background Topics for Atopic Dermatitis Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Hypersensitivity reaction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000821.htm Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
Glossary 229
ATOPIC DERMATITIS GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Acne: An inflammatory disease of the pilosebaceous unit, the specific type usually being indicated by a modifying term; frequently used alone to designate common acne, or acne vulgaris. [EU] Acrodermatitis: Inflammation involving the skin of the extremities, especially the hands and feet. Several forms are known, some idiopathic and some hereditary. The infantile form is called Gianotti-Crosti syndrome. [NIH] ACTH: Adrenocorticotropic hormone. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU]
230 Atopic Dermatitis
Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antipruritic: Relieving or preventing itching. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples
Glossary 231
include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biogenesis: The origin of life. It includes studies of the potential basis for life in organic compounds but excludes studies of the development of altered forms of life through mutation and natural selection, which is evolution. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Blindness: The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. [NIH] Buspirone: An anxiolytic agent and a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds. Its structure is unrelated to those of the benzodiazepines, but it has an efficacy comparable to diazepam. [NIH]
Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU]
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Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Chlorine: A greenish-yellow, diatomic gas that is a member of the halogen family of elements. It has the atomic symbol Cl, atomic number 17, and atomic weight 70.906. It is a powerful irritant that can cause fatal pulmonary edema. Chlorine is used in manufacturing, as a reagent in synthetic chemistry, for water purification, and in the production of chlorinated lime, which is used in fabric bleaching. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Contractility: stimulus. [EU]
Capacity for becoming short in response to a suitable
Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cyproheptadine: A serotonin antagonist and a histamine H1 blocker used as antipruritic, appetite stimulant, antiallergic, and for the post-gastrectomy dumping syndrome, etc. [NIH]
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Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
Depigmentation: Removal or loss of pigment, especially melanin. [EU] Dermatitis: Inflammation of the skin. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dermatophytosis: Any superficial fungal infection caused by a dermatophyte and involving the stratum corneum of the skin, hair, and nails. The term broadly comprises onychophytosis and the various form of tinea (ringworm), sometimes being used specifically to designate tinea pedis (athlete's foot). Called also epidermomycosis. [EU] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dinitrofluorobenzene: Irritants and reagents for labeling terminal amino acid groups. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Econazole: A broad spectrum antimycotic with some action against Gram positive bacteria. It is used topically in dermatomycoses also orally and parenterally. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH]
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Emollient: Softening or soothing; called also malactic. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Eosinophilia: The formation and accumulation of an abnormally large number of eosinophils in the blood. [EU] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epithelium: The covering of internal and external surfaces of the body, including the lining of vessels and other small cavities. It consists of cells joined by small amounts of cementing substances. Epithelium is classified into types on the basis of the number of layers deep and the shape of the superficial cells. [EU] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Erythrasma: A chronic, superficial bacterial infection of the skin involving the body folds and toe webs, sometimes becoming generalized, caused by Corynebacterium minutissimum, and characterized by the presence of sharply demarcated, dry, brown, slightly scaly, and slowly spreading patches. [EU] Etretinate: An oral retinoid used in the treatment of keratotic genodermatosis, lichen planus, and psoriasis. Beneficial effects have also been claimed in the prophylaxis of epithelial neoplasia. The compound may be teratogenic. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU]
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Extracorporeal: Situated or occurring outside the body. [EU] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Griseofulvin: An antifungal antibiotic. Griseofulvin may be given by mouth in the treatment of tinea infections. [NIH] Hepatitis: Inflammation of the liver. [EU] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperkeratosis: 1. hypertrophy of the corneous layer of the skin. 2a. any of various conditions marked by hyperkeratosis. 2b. a disease of cattle marked by thickening and wringling of the hide and formation of papillary
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outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypopigmentation: A condition caused by a deficiency in melanin formation or a loss of pre-existing melanin or melanocytes. It can be complete or partial and may result from trauma, inflammation, and certain infections. [NIH] Ichthyosis: A group of cutaneous disorders characterized by increased or aberrant keratinization, resulting in noninflammatory scaling of the skin. Many different metaphors have been used to describe the appearance and texture of the skin in the various types and stages of ichthyosis, e.g. alligator, collodion, crocodile, fish, and porcupine skin. Most ichthyoses are genetically determined, while some may be acquired and develop in association with various systemic diseases or be a prominent feature in certain genetic syndromes. The term is commonly used alone to refer to i. vulgaris. [EU] Immunosuppressant: An agent capable of suppressing immune responses. [EU]
Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Integumentary: Pertaining to or composed of skin. [EU] Interferons:
Proteins secreted by vertebrate cells in response to a wide
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variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intertrigo: A superficial dermatitis occurring on apposed skin surfaces, such as the axillae, creases of the neck, intergluteal fold, groin, between the toes, and beneath pendulous breasts, with obesity being a predisposing factor, caused by moisture, friction, warmth, and sweat retention, and characterized by erythema, maceration, burning, itching, and sometimes erosions, fissures, and exudations and secondary infections. Called also eczema intertrigo. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Itraconazole: An antifungal agent that has been used in the treatment of histoplasmosis, blastomycosis, cryptococcal meningitis, and aspergillosis. [NIH]
Keratitis: Inflammation of the cornea. [EU] Keratosis: Any horny growth such as a wart or callus. [NIH] Ketoconazole: Broad spectrum antifungal agent used for long periods at high doses, especially in immunosuppressed patients. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leukotrienes:
A family of biologically active compounds derived from
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arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Lichenification: Hypertrophy of the epidermis, resulting in thickening of the skin with exaggeration of the normal skin markings, giving the skin a leathery barklike appearance, which is caused by prolonged rubbing or scratching. It may arise on seemingly normal skin, or it may develop at the site of another pruritic cutaneous disorder. [EU] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5-lipoxygenase, arachidonate 12lipoxygenase, and arachidonate 15-lipoxygenASE. EC 1.13.11.12. [NIH] Liquifilm: A thin liquid layer of coating. [EU] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]
Maceration: The softening of a solid by soaking. In histology, the softening of a tissue by soaking, especially in acids, until the connective tissue fibres are so dissolved that the tissue components can be teased apart. In obstetrics, the degenerative changes with discoloration and softening of tissues, and eventual disintegration, of a fetus retained in the uterus after its death. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU]
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Mastocytosis: A group of diseases resulting from proliferation of mast cells. [NIH]
Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Methoxsalen: A naturally occurring furocoumarin compound found in several species of plants, including Psoralea corylifolia. It is a photoactive substance that forms DNA adducts in the presence of ultraviolet A irradiation. [NIH] Miconazole: An imidazole antifungal agent that is used topically and by intravenous infusion. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neurodermatitis: An extremely variable eczematous dermatosis presumed to be a cutaneous response to prolonged vigorous scratching, rubbing, or pinching to relieve intense pruritus, having the potential to produce polymorphic lesions at the same or different times, and varying in severity, course, and morphologic expression in different individuals. It is believed by some authorities to be a psychogenic disorder. The term is also used to refer to lichen simplex chronicus (circumscribed n.) and sometimes to atopic dermatitis (disseminated n.). [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH]
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Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]
Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Ophthalmic: Pertaining to the eye. [EU] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxazolone: Immunologic adjuvant and sensitizing agent. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 - oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Pallor: A clinical manifestation consisting of an unnatural paleness of the skin. [NIH] Papule: A small circumscribed, superficial, solid elevation of the skin. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Particle: A tiny mass of material. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH] Perennial: Lasting through the year of for several years. [EU] Perioral: Situated or occurring around the mouth. [EU] Periorbital: Situated around the orbit, or eye socket. [EU] Perspiration: Sweating; the functional secretion of sweat. [EU]
Glossary 241
Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photochemotherapy: Therapy using oral or topical photosensitizing agents with subsequent exposure to light. [NIH] Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Pityriasis: A name originally applied to a group of skin diseases characterized by the formation of fine, branny scales, but now used only with a modifier. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Postoperative: Occurring after a surgical operation. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH]
Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Prostaglandins: A group of compounds derived from unsaturated 20carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: 1. itching; an unpleasant cutaneous sensation that provokes the
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desire to rub or scratch the skin to obtain relief. 2. any of various conditions marked by itching, the specific site or type being indicated by a modifying term. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Pulmonary: Pertaining to the lungs. [EU] Pyoderma: Any purulent skin disease. Called also pyodermia. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Refractory: Not readily yielding to treatment. [EU] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Respiratory: Pertaining to respiration. [EU] Rhinitis: Inflammation of the mucous membrane of the nose. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Scabies: A contagious dermatitis of humans and various wild and domestic animals caused by the itch mite, Sarcoptes scabiei, transmitted by close contact, and characterized by a papular eruption over tiny, raised sinuous burrows (cuniculi) produced by digging into the upper layer of the epidermis by the egg-laying female mite, which is accompanied by intense pruritus and sometimes associated with eczema from scratching and secondary bacterial infection. Called also the itch and seven-year itch. [EU]
Glossary 243
Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Sensitization: 1. administration of antigen to induce a primary immune response; priming; immunization. 2. exposure to allergen that results in the development of hypersensitivity. 3. the coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH]
Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU] Subacute: Somewhat acute; between acute and chronic. [EU]
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Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxic: Pertaining to, due to, or of the nature of a poison or toxin; manifesting the symptoms of severe infection. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Translating: Conversion from one language to another language. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Urticaria: Pathology: a transient condition of the skin, usually caused by an allergic reaction, characterized by pale or reddened irregular, elevated
Glossary 245
patches and severe itching; hives. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: The diminution of the calibre of vessels, especially constriction of arterioles leading to decreased blood flow to a part. [EU] Venereology: A branch of medicine which deals with sexually transmitted disease. [NIH] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Vitiligo: A disorder consisting of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
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Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
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A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
246 Atopic Dermatitis
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Dorland's Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland's Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland's Pocket Medical Dictionary (Dorland's Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni's Illustrated Medical Dictionary (Melloni's Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman's Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman's Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
Index 247
INDEX A Abdominal....................................106, 131 Acne ............................112, 118, 172, 229 Acrodermatitis........................................67 Adolescence ................140, 149, 229, 240 Adverse ...............................122, 133, 171 Allergen .....12, 14, 16, 18, 26, 31, 70, 93, 97, 113, 243 Alopecia.........................................68, 172 Anaphylactic ................................101, 140 Anaphylaxis .................101, 103, 140, 229 Anemia ................................................145 Antiallergic ...................101, 103, 171, 232 Antibacterial...........................................80 Antibiotic ..........................89, 91, 235, 240 Antibody .......16, 26, 60, 87, 93, 104, 230, 233, 235, 239, 243 Antifungal...89, 90, 91, 235, 237, 239, 240 Antigen .......37, 74, 93, 97, 100, 104, 113, 125, 199, 229, 230, 235, 239, 243 Antihistamine .................................99, 197 Antineoplastic ................................91, 239 Antipruritic..............................65, 103, 232 Anxiety...................................................24 Arginine .................................................76 Atrophy ........................................100, 145 B Baths ...................19, 20, 21, 34, 133, 175 Biochemical ...........................32, 100, 174 Biopsy................................15, 55, 69, 228 Blister.....................................................55 Bronchial................................................96 Buspirone ..............................................98 C Candidiasis ..............................67, 89, 235 Capsules..............................................195 Carbohydrate.......................................194 Carcinoma ...........................................112 Cardiomyopathy ....................................86 Cataract .........................................37, 232 Cheilitis ..................................................31 Chlorine .................................................17 Cholesterol ....................40, 192, 194, 243 Cirrhosis ................................................96 Citrus ...................................................106 Clotrimazole...........................................68 Congestion ......................18, 89, 106, 234 Conjugated ............................................76 Criterion .................................................67
Cutaneous ....... 38, 39, 66, 67, 88, 92, 98, 100, 104, 106, 110, 112, 231, 236, 237, 238, 239, 241 Cyproheptadine .................................. 100 Cytokines .......................... 54, 71, 74, 134 D Degenerative ........................ 91, 193, 238 Dendritic................................................ 74 Depigmentation....................... 67, 94, 245 Dermatology.................... 73, 75, 106, 117 Dermatophytosis ............................. 67, 69 Dermatosis.............................. 39, 72, 239 Diarrhea ................................ 18, 106, 192 Discoid .................................................. 72 E Econazole ............................................. 67 Edema........................... 38, 100, 232, 233 Elasticity................................................ 26 Emollient ....................................... 39, 240 Endogenous............................ 38, 72, 233 Enzyme ......... 88, 101, 103, 232, 234, 238 Eosinophils.................. 16, 82, 89, 98, 234 Epidemiological........................... 106, 111 Epidermal..... 13, 40, 65, 74, 76, 125, 178, 245 Erythema...... 38, 68, 90, 93, 99, 233, 237, 244 Erythrasma............................................ 67 Etretinate............................................. 112 Excitation .................................... 101, 234 Exogenous ................ 38, 72, 89, 233, 234 Extracorporeal .................................... 113 F Facial .............................................. 14, 69 Fatal ........................................ 38, 73, 232 Fluconazole........................................... 68 Fungus .................................. 88, 134, 231 G Gastrointestinal ....... 18, 38, 104, 235, 238 Griseofulvin ........................................... 68 H Hepatitis ................................................ 96 Herpes .................................... 13, 19, 235 Homologous.......................... 93, 102, 243 Hormones ... 14, 40, 60, 92, 233, 242, 243 Hydration................................. 64, 71, 113 Hyperbaric............................. 89, 179, 235 Hyperkeratosis ............................ 119, 235 Hypersensitivity ....... 37, 69, 93, 100, 102, 104, 110, 177, 178, 180, 181, 198, 229, 238, 243
248 Atopic Dermatitis
I Ichthyosis.................................31, 38, 236 Immersion............................................231 Immunosuppressant ..............91, 134, 239 Immunotherapy..............................66, 113 Infantile ....................................87, 98, 229 Infiltration .........................................73, 98 Inhalation .....................................202, 241 Interferons .....................................71, 113 Interleukins ............................................71 Intermittent...........................................122 Intertrigo ..................................67, 90, 237 Intestines .............................................197 Invasive .................................................30 Irritants..13, 15, 17, 19, 23, 24, 25, 26, 30, 31, 32, 33, 34, 39, 64, 66, 69, 70, 71, 133, 237 Itraconazole ...........................................68 K Keratosis..........................................31, 68 Ketoconazole.........................................67 L Lesion ............89, 103, 227, 228, 234, 235 Leukotrienes ........................................101 Lichenification......13, 31, 38, 99, 134, 233 Lip ........................................................131 Lipoxygenase ......................100, 104, 238 Lubrication .....................................39, 238 Lupus .....................................................96 M Malignant ....... 87, 90, 112, 118, 119, 144, 230, 232, 237, 239 Mastocytosis..........................................54 Mediator...............................................100 Melanoma............106, 112, 119, 144, 239 Methotrexate..........................................67 Miconazole ............................................68 Microbiological.......................................73 Molecular ..75, 92, 94, 138, 142, 144, 242, 244 Monocytes .................................26, 82, 84 N Nasal ...........................................104, 238 Nausea ..................................................23 Neoplastic ..............................................69 Niacin...................................................193 Nicotine................................................197 Nipples...................................................15 Nummular ..............................................69 Nystatin....................................68, 91, 240 O Ointments ......................20, 22, 30, 32, 34 Overdose .............................................193 Oxygenation ..........................91, 179, 240 P Pallor .....................................................69
Parasitic ................................................ 96 Parenteral ........................................... 111 Pentoxifylline......................................... 99 Perennial............................................... 66 Periorbital.............................................. 69 Perspiration........................................... 69 Pharmacists .................................. 23, 116 Phenotype............................... 74, 91, 241 Phosphorylation .................................... 74 Photochemotherapy............................ 133 Phototherapy ... 22, 27, 31, 64, 66, 69, 71, 133 Pityriasis................................................ 67 Poisoning ............................................ 197 Postoperative ...................................... 112 Potassium ........................................... 194 Predisposition ........................... 15, 71, 98 Prednisone............................................ 22 Prevalence ...... 64, 66, 68, 72, 73, 75, 81, 100, 112, 127, 133 Prostaglandins .................................... 199 Proteins.... 27, 60, 87, 101, 102, 192, 194, 230, 233 Proximal ................................................ 67 Pruritic........... 38, 39, 66, 68, 73, 233, 238 Pruritus..... 39, 64, 65, 68, 70, 71, 92, 112, 134, 239, 241, 242 Psoriasis ...... 67, 76, 82, 92, 99, 106, 112, 118, 126, 133, 172, 173, 175, 177, 234, 242 Puberty.................................................. 14 Pulmonary..................... 38, 104, 232, 238 Pustular................................................. 67 Pyoderma.............................................. 67 Q Quaternary ............................................ 98 R Receptor ......... 74, 87, 101, 103, 230, 231 Refractory ............................... 65, 82, 177 Remission ....................................... 11, 14 Respiratory....... 18, 37, 88, 100, 102, 131, 229, 231 Rhinitis ...... 66, 96, 98, 100, 102, 113, 131 S Scabies ......................................... 69, 112 Secretion..... 75, 76, 90, 93, 237, 240, 243 Selenium ................................. 67, 80, 194 Serum ......... 73, 81, 93, 96, 113, 199, 243 Sneezing ......................................... 18, 26 Soaps.................................................... 20 Species ..... 68, 91, 93, 164, 239, 240, 243 Steroid............... 30, 34, 92, 123, 133, 242 Subacute............................................. 198 Suction .................................................. 55 Sunburn ................................................ 65 Symptomatic ............................... 104, 244
Index 249
Syphilis ..................................................67 Systemic .....22, 23, 37, 38, 66, 67, 68, 69, 70, 71, 72, 76, 88, 96, 98, 104, 113, 134, 229, 231, 236, 241, 243 T Tacrolimus .....67, 122, 125, 127, 133, 134 Thermal .................................................69 Thermoregulation ................................192 Thyroxine.............................................194 Toxic ..23, 76, 93, 193, 202, 240, 243, 244 Toxicity ............................................28, 76 Transplantation......................................69
Tricyclic ................................................. 66 Tyrosine ................................................ 74 U Urticaria............................. 31, 37, 54, 229 V Vascular .................... 37, 87, 92, 100, 229 Vasoconstriction ................................. 101 Viral......... 19, 22, 26, 40, 65, 70, 106, 245 Viruses .......... 13, 26, 27, 90, 91, 237, 239 Vitiligo ................................................... 67 W Warts....................................... 13, 68, 172
250 Atopic Dermatitis
