Basal serum cortisol and adrenocorticotropic hormone levels in patients with atopic dermatitis
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Certain studies suggest that percutaneous absorption of topical steroids may cause suppression of hypothalamic-pituitary-adrenal axis (HPAA) in atopic dermatitis (AD) patients. This study aimed to investigate the basal serum cortisol, adrenocorticotropic hormone (ACTH), and IgE levels in patients with AD and their correlation with the disease severity.Levels of basal serum cortisol, ACTH, and IgE were assessed by ELISA in 31 patients with AD and 31 controls. Clinical severity of AD was evaluated by the scoring of atopic dermatitis (SCORAD) index.No statistical difference was observed between the two groups for basal serum cortisol and ACTH levels. The serum IgE level was significantly higher in the AD group. The SCORAD index was correlated with serum IgE level.Basal serum cortisol and ACTH levels are normal in AD patients. Serum IgE level is significantly higher in AD patients and is correlated with the disease severity.Keywords:
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Atopic dermatitis is one of the most prevalent chronic inflammatory skin diseases, which can vastly influence the patients quality of life. Objective assessment of severity is required to select adequate therapy and evaluate its effectiveness. Heterogeneous clinical manifestations with greatly varying severity make it difficult to assess the severity of atopic dermatitis. More than twenty methods are developed for the assessment of this diseases severity. SCORAD, oSCORAD and EASI are the most elementary and reliable methods allowing to define the severity of atopic dermatitis relatively quickly and accurately. Each of these three methods has its own particularities, that could be advantages or disadvantages depending on circumstances.
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Quality of Life and Disease Severity Are Correlated in Patients with Atopic DermatitisQuantification of quality of life (QOL) related to disease severity is important in patients with atopic dermatitis (AD), because the assessment provides additional information to the traditional objective clinical scoring systems.To document the impact of AD on QOL for both children and adults as well as to quantify the relationship with disease severity, QOL assessments were performed over a 6-month period on 415 patients with AD.A questionnaire derived from the Infants' Dermatitis Quality of Life Index (IDQOL), the Children's Dermatology Life Quality Index (CDLQI) and the Dermatology Life Quality Index (DLQI) was used to determine the QOL for 71 infants, 197 children and 147 adults, respectively.To measure AD severity, both the Rajka & Langeland scoring system and the Scoring of Atopic Dermatitis (SCORAD) index were used.The mean scores were as follows: 7.7 ± 5.5 for IDQOL, 6.6 ± 6.3 for CDLQI, and 10.7 ± 7.9 for DLQI.In conclusion, these QOL scores are correlated with AD severity scores as estimated by the Rajka & Langeland severity score and the SCORAD.The outcome of the QOL instruments in this study demonstrates that atopic dermatitis of both children and adults affects their QOL.
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Background: OX40 ligand (OX40L) and OX40 are members of the tumor necrosis factor (TNF) and TNF receptor (TNFR) super families respectively. Recent studies have indicated the critical involvement of OX40/OX40L interaction in the pathogenesis of atopic dermatitis. To our knowledge, no data could be cited in literature concerning OX40L levels in serum or in other biological fluids of atopic dermatitis children. Objective: This study was done to explore the expression of OX40L in the serum of atopic dermatitis children with respect to disease activity and severity. Methods: This follow-up, case-control longitudinal study was conducted on 64 children as a stratified non-random sample; 34 with atopic dermatitis and 30 healthy children. Serum concentrations of OX40L were measured by sandwich enzyme immunoassay. The severity of atopic dermatitis was assessed according to the Leicester Sign Score (LSS), Simple Scoring System (SSS), Scoring Atopic Dermatitis (SCORAD) index, and Objective SCORAD. Results: Serum OX40L levels (pg/ml) in atopic dermatitis patients were significantly elevated as compared to controls (176.6 ± 45.9) whether during flare (1007 ± 241.5) or quiescence (699 ± 198.5). There were significant positive correlations between serum OX40L levels and each of the LSS, SSS and SCORAD indices of atopic dermatitis disease severity, while it was insignificant regarding the objective SCORAD. However, when atopic dermatitis children were classified according to the objective SCORAD index of severity into mild, moderate and severe, it was found that the mean serum level in the severe group was significantly higher than the corresponding values of the mild or the moderate group. OX40L levels did not correlate with serum total IgE or absolute eosinophils count. Serum total LDH levels correlated positively with each of the serum OX40L levels and the LSS and SCORAD indices of severity. Conclusions: Serum OX40L level is an objective reliable marker of atopic dermatitis severity in children. It may be useful for follow up and may help to improve research and management of this disease. Blockade of interactions between OX40 on Th2 cells and OX40L on activated dendritic cells using an OX40L-specific monoclonal antibody could represent a novel strategy for the treatment of atopic dermatitis. Keywords: Atopic dermatitis, LSS, OX40, OX40L, SCORAD, SSS, TNF Egypt J Pediatr Allergy Immunol 2009;7(1):15-22
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Recently, we could show that IL-31 serum levels are significantly increased in adult patients with atopic dermatitis compared with skin healthy controls. However, the regulation of IL-31 in children with atopic dermatitis so far is not clear. Thus, we analyzed IL-31 serum levels together with IL-4, IL-13, ECP, and total IgE levels in 60 children with extrinsic, in five children with intrinsic atopic dermatitis, and 20 non-atopic healthy children. Further, we determined the SCORAD score, sleeplessness, and pruritus severity in all children with atopic dermatitis. IL-31 was significantly increased in children with the intrinsic and extrinsic type of atopic dermatitis compared with non-atopic healthy children (p < 0.05-0.001). Further, IL-31 serum levels significantly correlated with SCORAD score (p < 0.01), sleeplessness (p < 0.05), IL-4, and IL-13 levels (p < 0.01) in children with extrinsic atopic dermatitis. There was no correlation of IL-31 with pruritus, total IgE Ab, and ECP levels, whereas ECP levels significantly correlated with the SCORAD score in children with extrinsic atopic dermatitis. Together, IL-31 represents an interesting cytokine especially with regard to the severity of the inflammatory process indicated by the correlation of IL-31 with SCORAD score and Th2 cytokines including IL-4 and IL-13 in children with extrinsic atopic dermatitis.
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Introduction: Atopic dermatitis is an enigmatic chronically relapsing dermatosis which is difficult to quantify. Present scoring systems have their inherent limitations.Aims and Objectives: To evaluate and compare the scoring systems SCORAD and SASSAD for atopic dermatitis and to correlate values with clinical and hematological parameters.Materials and Methods: Fifty patients of atopic dermatitis were selected and assessed at presentation and at four weeks using SCORAD and SASSAD. Appropriate haematological investigations were done at the time of assessments. The data obtained was assessed statistically.Results: The changes in both the SCORAD and SASSAD correlated with the changes in clinical and hematological profile.Conclusion: SCORAD seems to be a better scoring system as it addresses both the subjective and objective parameters.
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Atopic dermatitis (AD - atopic eczema) is a chronic inflammatory dermatosis resulting from complex genetic, epigenetic and environmental interactions with an overlapping defect in the epidermal barrier.AD is one of the most common inflammatory dermatoses in children and adults.The aim of the study was to assess the relationship between serum basal tryptase (sBT) and total IgE (tIgE) level in blood serum and the severity of lesions (SCORAD; SCORing atopic dermatitis).The study was performed in the group of adult patients (57 people, F/M: 30/27; average age: 37.5 years) and in the control group (10 people, K/M: 6/4; average age: 44 years). Diagnosis of atopic dermatitis was established by a dermatologist-allergist specialist based on the criteria of Hanifin and Rajka. The severity of lesions was determined on the SCORAD scale (SCORing atopic dermatitis).The distribution of tryptase concentration did not differ statistically significantly between patients with various disease severity and the control group also the severity of skin lesions was significantly higher (p<0.001) in patients whose tIgE level exceeded 3500 IU / ml. Conclusion. sBT did not prove to be a useful biomarker in assessing.sBT did not prove to be a useful biomarker in assessing severity of AD. The present study demonstrated that in the patients with atopic dermatitis the concentration of total IgE was correlated with severity of the disease symptoms.
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The Objective Severity Assessment of Atopic Dermatitis (OSAAD) score is a recently developed scale for evaluation of severity of atopic dermatitis, constructed from the assessment of epidermal barrier function, and properties using noninvasive bioengineering methods and computer-assisted estimates of disease extent. The method has been validated for use in infants and children with atopic dermatitis and compared with a referent scoring system.The aim of the present study was to test the validity, reliability and sensitivity of the OSAAD score as an objective tool for the assessment of the severity of atopic dermatitis in adult patients.Thirty-two adult patients with atopic dermatitis were included in the study. To assess the validity of the OSAAD score we tested it against the Severity Scoring of Atopic Dermatitis (SCORAD) index of the European Task Force on Atopic Dermatitis as a referent clinical severity scale, and the serum levels of interleukin (IL)-16 as a laboratory variable for monitoring the activity of atopic dermatitis. Responsiveness to change was assessed in a longitudinal study comparing OSAAD, SCORAD and serum levels of IL-16 before and after treatment. To test the reliability of the OSAAD score we studied the interobserver variability of the score recorded by three independent board-certified dermatologists in 16 patients and compared it with SCORAD.We report a significant correlation between the OSAAD and the SCORAD index as an acknowledged referent severity scale. The OSAAD score correlated significantly with the serum levels of IL-16 in the acute stage of atopic dermatitis. In a longitudinal study, the OSAAD score decreased significantly, parallel with improvement of the skin findings and a significant decrease in the SCORAD score and IL-16 serum levels. We report improved interobserver variability for the OSAAD score compared with SCORAD.This is the first study validating the OSAAD score as a sensitive and reliable tool for the assessment of the severity of atopic dermatitis in adult patients.
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Objectives The purpose of this study is to report the clinical effects of herbal medicine on atopic dermatitis. Methods This nine clinical studies were done by those people who were visited the Oriental Hospital and all of them were diagnosed as atopic dermatitis. We treated the atopic dermatitis patients with herbal medicine(Saenghyeoryunbueum), and we checked SCORAD score and observed the wounds those patients had. Results The patients' wounds were improved and SCORAD score was decreased. Conclusions Herbal medicine(Saenghyeoryunbueum) is an effective in the treatment of atopic dermatitis, and it helped to improve regenerating the skin in the body. The further studies might be also needed.
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Transepidermal water loss
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