Atopic dermatitis (AD), with the prevalence rate of around 10 to 15%, is characterized by an intensely pruritic skin lesions with typical distribution and morphology. Recently, AD is divided into extrinsic type (ADe) and intrinsic type (ADi) according to the laboratory findings and associated diseases. ADe is well-known for high IgE level, positive response to food- or aero-allergens, whereas ADi has clinically similar skin lesions and distribution patterns of AD with normal serum IgE levels, negative in vitro test for environmental or food allergens and without associated atopic diseases. To instrumentally evaluate the differences of skin involvement and functions between ADi and ADe, we checked the transepidermal water loss (TEWL), capacitance and pH in both types of childhood AD and age-matched control. The proportion of ADi was around 20% in all AD patients (10/51). Our experiment suggested possible differences between ADi and ADe. Antecubital fossa is a famous involvement site of childhood type of AD, where both types of AD patients showed higher TEWL and decreased capacitance. ADe patients showed increased TEWL in all sites and lower hydration in 4 sites, whereas ADi patients showed no significant differences of TEWL and hydration in forehead, cheek, and back of leg.
Adolescent ; Case-Control Studies ; Child ; Comparative Study ; Dermatitis, Allergic Contact/immunology ; Dermatitis, Allergic Contact/physiopathology ; Dermatitis, Atopic/classification ; Dermatitis, Atopic/immunology ; Dermatitis, Atopic/physiopathology* ; Electric Capacitance* ; Female ; Human ; Hydrogen-Ion Concentration* ; Immunoglobulin E/immunology ; Male ; Skin/physiopathology* ; Water Loss, Insensible*

Atopic eczema is a commonly encountered chronic skin condition in primary care. In this article, we share a holistic, structured approach, which is grounded on the chronic and atopic nature of the condition - planned reviews, patient empowerment, a written action plan for chronic and fare management, and trigger avoidance. Common pitfalls in management are insufficient emphases on scheduled reviews and patient empowerment, as well as neglect in the care of the loss of the epidermal barrier during acute flares.
Chronic Disease ; Dermatitis, Atopic ; diagnosis ; physiopathology ; therapy ; Dermatology ; methods ; Education, Medical, Continuing ; Humans ; Inflammation ; Primary Health Care ; methods ; Skin ; pathology

In humans, skin barrier dysfunction is thought to be responsible for enhanced penetration of allergens. Similar to conditions seen in humans, canine atopic dermatitis (CAD) is characterized by derangement of corneocytes and disorganization of intercellular lipids in the stratum corenum (SC) with decreased ceramide levels. This study was designed to evaluate the effects of a moisturizer containing ceramide on dogs with CAD. Dogs (n = 20, 3~8 years old) with mild to moderate clinical signs were recruited and applied a moisturizer containing ceramide for 4 weeks. Transepidermal water loss (TEWL), skin hydration, pruritus index for canine atopic dermatitis (PICAD) scores, and canine atopic dermatitis extent and severity index (CADESI) scores of all dogs were evaluated. Skin samples from five dogs were also examined with transmission electron microscopy (TEM) using ruthenium tetroxide. TEWL, PICAD, and CADESI values decreased (p < 0.05) and skin hydration increased dramatically over time (p < 0.05). Electron micrographs showed that the skin barrier of all five dogs was partially restored (p < 0.05). In conclusion, these results demonstrated that moisturizer containing ceramide was effective for treating skin barrier dysfunction and CAD symptoms.
Animals ; Ceramides/*therapeutic use ; Cholesterol/*therapeutic use ; Dermatitis, Atopic/complications/drug therapy/physiopathology/*veterinary ; Dog Diseases/*drug therapy/etiology/physiopathology ; Dogs ; Emollients/*therapeutic use ; Epidermis/drug effects/physiopathology/ultrastructure ; Fatty Acids, Nonesterified/*therapeutic use ; Female ; Male ; Microscopy, Electron, Transmission/veterinary ; Pruritus/drug therapy/etiology/physiopathology/veterinary ; Republic of Korea ; Ruthenium Compounds/chemistry ; Water Loss, Insensible/drug effects