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The Secret of Nin: A Novel Neural-Immunological Network Potentially Integral to Immunologic Function in Human Skin
Published in Brian J. Nickoloff, Dermal Immune System, 2019
The skin is both a paradigm for many internal immune responses as well as the most accessible organ for their study. What, then, is the role of the skin in neural-immunological interactions? The fact that pruritis (a neurological phenomenon) often correlates with cutaneous inflammation, and the relationship between anxiety and stress and the natural evolution of certain forms of urticaria, rosacea, eczema, and psoriasis (Figure 1) suggest that these two systems may be closely allied.1 Yet, even structural data implicating functional intimacy between cutaneous nerves and resident immune cells have, until now, been lacking. It is indeed ironic that pruritis, a most significant form of dermatologic morbidity and a symptom that may drive patients to traumatically remove the superficial layers of integument, or in extreme cases, even commit self-destructive acts, has no universally accepted cellular or molecular basis. Unfortunately, the term “neurodermatitis” has traditionally suggested excoriation related to neurosis, rather than neurogenic pruritis resulting from interactions between immune mechanisms and neuroreceptors. Such issues are not trivial, and raise a critical issue: is there a structural basis for interaction between the cutaneous neural network and the immune system of skin (skin-associated lymphoid tissue: SALT)?
Face
Published in Robin Lewallen, Adele Clark, Steven R. Feldman, Clinical Handbook of Contact Dermatitis, 2014
Monica Huynh, Michael P. Sheehan, Michael Chung, Matthew Zirwas, Steven R. Feldman
The term aerosolized contact allergens (aeroallergens) should not be restricted to such things as animal dander, dust mites, and pollens, which more frequently drive Type I hypersensitivity reactions. Aeroallergens also include fragrances (Figures 3.1 and 3.2), plant allergens, and things that become temporarily aerosolized during repair or manufacturing processes. Aeroallergens have been classically reported to present as facial dermatitis with a distinct cutoff along the shirt collar. Aeroallergens are also sometimes contributors to a phototoxic or photoallergic reaction. Sparing under the chin or behind the ears is a clue to photo-exacerbation. Patients with aeroallergen-driven facial dermatitis frequently have an underlying atopy. The “headlight” sign, which refers to the presence of facial dermatitis that dramatically spares the nose, may be useful clinically to suggest such patients (Figure 3.3).2 It has been reported in patients with atopic dermatitis and neurodermatitis.
The History of Eczema and Atopic Dermatitis
Published in Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld, Atopic Dermatitis and Eczematous Disorders, 2014
Douglas Altchek, Donald Rudikoff
The terms ‘acute neurodermatitis’ and ‘wet neurodermatitis’ were used for years. Another concept was the ‘neurodermatitic reaction’ which attempted to describe a histological response seen in atopic dermatitis, exudative dermatitis, and lichenoid chronic dermatitis.
A systematic review of evidence based treatments for lichen simplex chronicus
Published in Journal of Dermatological Treatment, 2021
Michelle C. Juarez, Shawn G. Kwatra
We conducted a systematic review of the literature for clinical studies on medical treatments for LSC in accordance with the PRISMA guidelines (Figure 1). With the help of a medical information specialist, we sought studies published after 1970 using the following databases: PubMed, Embase, Scopus, and the Cochrane Library. The following search terms were used: “neurodermatitis,” “dermatoneurosis,” “lichen simplex,” “neurodermatosis,” “neurodermatitides.” Bibliographies of relevant publications were also searched for additional studies meeting inclusion criteria. We selected studies that concerned LSC, were written in the English language, and dealt with human subjects. Randomized-controlled trials (RCTs), observational cohort studies, and multi-patient case series were included. We excluded studies with fewer than 5 patients, studies that did not specify outcomes of the treatment, studies that assessed non-medical treatments, and studies in which only abstracts were available or we could not obtain access. Each article was assigned a level of evidence (LOE) according to the Oxford Center for Evidence-based Medicine (4).
Repeated Corneal Cross-linking (CXL) in Keratoconus Progression After Primary Treatment: Updated Perspectives
Published in Seminars in Ophthalmology, 2021
Argyrios Tzamalis, Asterios Diafas, Riccardo Vinciguerra, Nikolaos Ziakas, George Kymionis
Moving on from case reports to larger cohorts, Antoun et al. published a case series, in which the efficacy of Repeated-CXL was examined. They described the course of seven eyes in a total of 221 (3.17%) that demonstrated progression after primary CXL (9 months - 4 years later) and underwent a repeated epi-off procedure.37 The main risk factors for keratoconus progression identified by the authors, were allergic conjunctivitis and abnormal eye rubbing, due to possible biomechanical and biochemical alterations of the cornea. Six eyes had keratoconus and one eye suffered from post-LASIK ectasia. In all these cases, keratoconus remained sTable 1 year later without any reported complications, strengthening the opinion that repeated-CXL is indeed a therapeutic option.37 Repeated-CXL has also been previously used by Hoyer et al., utilizing the Dresden protocol, on three patients with exacerbated neurodermatitis that demonstrated keratoconus progression, all in the first or second postoperative year after the initial CXL.32,33 However, the authors do not comment on the postoperative course after repeated treatment.
Wet-wrap therapy with halometasone cream for severe adult atopic dermatitis
Published in Postgraduate Medicine, 2018
Wei Xu, Yan Li, Zeyu Chen, Teng Liu, Shan Wang, Linfeng Li
The current study showed that WWT twice daily for 1 week effectively alleviated the skin lesions of adult patients with severe AD. WWT was first used to treat pediatric AD in 1970 and its effectiveness and safety on pediatric AD has been widely reported [15]. Now, WWT has already been considered as an effective and safe therapy to treated severe pediatric AD [16]. Similar to our findings, previous studies have also shown that WWT is effective and safe for adult AD. Bingham and colleagues investigated the effectiveness of 1-day WWT on 331 patients aged 15–95 years with various types of dermatitis, such as AD, eczema, and neurodermatitis, and they found that pruritus was attenuated in 98.2% of the patients [7]. They believed WWT could be used to effectively relieve common symptoms of skin diseases, such as pruritus and skin inflammation. In a recent study, Albarrán and colleagues found that WWT was effective and safe on 5 patients who had severe AD and showed resistance to systematic glucocorticoids and immunosuppressants and 2 patients with nodular prurigo [17]. According to the current European Task Force Atopic dermatitis/European Academy of Dermatology and Venereology guidelines for AD, WWT is recommended for pediatric and adult moderate-severe AD and acute exudative eczema [4].