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Andreas Wollenberg - One of the best experts on this subject based on the ideXlab platform.
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efficacy of a skin care cream with trpv1 inhibitor 4 t butylcyclohexanol in the topical therapy of Perioral Dermatitis
Journal of Cosmetic Dermatology, 2020Co-Authors: Jerome Srour, Markus Reinholz, Julia Bengel, Teresa Linden, Zorica Jovanovic, Dennis Roggenkamp, Christoph Rothenberger, Gitta Neufang, Andreas WollenbergAbstract:Background Perioral Dermatitis is a clinically distinctive reaction pattern of facial Dermatitis, including redness, dryness, burning, pruritus and skin tightness. A gold standard treatment remains unclear. Objectives Our study evaluates the clinical value of a skin care cream with the transient receptor potential vanilloid type 1 inhibitor 4‐t‐butylcyclohexanol in POD patients over 8 weeks. Methods This open, unblinded 8‐week clinical trial included 48 patients. A skin care cream containing 4‐t‐butylcyclohexanol was applied over a period of 8 weeks. Standardized questionnaires were used at baseline, 4 and 8 weeks, for history documentation, objective and subjective severity scores, and quality of life assessments. Six different skin physiology parameters were assessed at all timepoints. Results The Perioral Dermatitis severity score decreased significantly during the treatment period. This was mirrored by significantly lower patients’ subjective numerical rating score and an improved quality of life score. Transepidermal water loss, stratum corneum hydration and skin erythema improved significantly during the treatment period. Conclusion This transient receptor potential vanilloid type 1 inhibitor‐based skin care cream improved subjective and objective parameters of Perioral Dermatitis. Decreased transepidermal water loss values and increased stratum corneum hydration demonstrate a restored skin barrier function. Consequently, the topical inhibition of these receptors is a promising management option for POD.
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efficacy and safety results of a drug free cosmetic fluid for Perioral Dermatitis the toleriane fluide efficacy in Perioral Dermatitis tolpod study
Annals of Dermatology, 2014Co-Authors: Laura Maximiliane Ehmann, Markus Reinholz, Tanja Maier, Martin Lang, Andreas WollenbergAbstract:Background: Perioral Dermatitis (POD) is a common inflammatory skin disease without standard therapy. Objective: We sought to evaluate the clinical value of a soothing fluid for the treatment of POD. Methods: We included 51 patients with POD in this 8-week clinical trial. The Toleriane Fluide Efficacy in Perioral Dermatitis (TOLPOD) study had an open-label design and involved twice-daily application of Toleriane Fluide, a soothing cosmetic fluid. Clinical assessment of POD was performed with a predefined questionnaire including the POD severity index (PODSI). Control visits were made after 4 and 8 weeks of treatment. Results: The results were compared with those of a historical control group treated with a vehicle cream. Patients treated with the soothing fluid showed a continuous and significant improvement of the PODSI over time. The improvement of PODSI observed with the soothing fluid was better, but not significantly better, than that observed in the historical controls. In addition, the subjective complaints of patients such as disease burden, itching, distension of the skin, and appearance improved during treatment. Conclusion: A soothing fluid could be a clinically useful treatment option for POD. (Ann Dermatol 26(4) 462∼468, 2014)
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a randomized double blind vehicle controlled study of 1 pimecrolimus cream in adult patients with Perioral Dermatitis
Journal of The American Academy of Dermatology, 2008Co-Authors: T Schwarz, Inga Kreiselmaier, Thomas Bieber, Diamant Thaci, Jan C Simon, Michael Meurer, T Werfel, Torsten Zuberbier, Thomas A Luger, Andreas WollenbergAbstract:Background Perioral Dermatitis (POD) is a common dermatosis without standard therapy. Objective We sought to evaluate pimecrolimus cream 1% in POD. Methods We conducted a multicenter, randomized, double-blind, parallel-group study in adult patients with POD treated twice daily with pimecrolimus cream 1% or vehicle until clearance for up to 4 weeks. Follow-up took place 4 and 8 weeks after treatment. Results Patients treated with pimecrolimus had an average POD Severity Index score of 2.6 compared with 3.5 for patients treated with vehicle. Both groups had baseline scores of 5.2. The between-group difference was 0.9 (95% confidence level 0.4, 1.4, P = .0011). Patients with history of topical corticosteroids benefited most. Pimecrolimus-treated patients reported greater improvement in quality of life. There were no group differences regarding safety. Limitations Pimecrolimus vehicle is not a true placebo. Conclusions Pimecrolimus rapidly improves clinical symptoms and quality of life of patients with POD, being most effective in corticosteroid-induced POD.
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pimecrolimus cream 1 efficacy in Perioral Dermatitis results of a randomized double blind vehicle controlled study in 40 patients
Journal of The European Academy of Dermatology and Venereology, 2007Co-Authors: T Oppel, T Pavicic, S Kamann, Matthias Brautigam, Andreas WollenbergAbstract:Background Perioral Dermatitis (POD) is a common skin disease and difficult to treat. Pimecrolimus cream (1%) successfully controls atopic eczema. Objective Our aim was to investigate its efficacy in POD. Study design Single-centre, randomized, double-blind, vehicle-controlled study including 40 POD patients with a 4-week treatment and a 4-week follow-up. Efficacy was assessed by a novel Perioral Dermatitis Severity Index (PODSI) and Finlay's Dermatology Life Quality Index (DLQI). Setting Outpatient clinics of a large dermatological hospital in Munich, Germany. Results During treatment, the PODSI was significantly lower in the pimecrolimus group compared with vehicle (P = 0.005–0.02) whereas at follow-up, no significant differences were observed. At week 2, the responder rates (≥ 50% PODSI improvement) were 50% with pimecrolimus cream (1%) and 25% with vehicle (P = 0.095). DLQI was improved in pimecrolimus group compared with vehicle. Conclusion Results suggest that pimecrolimus cream (1%) effectively treats acute-stage POD.
Markus Reinholz - One of the best experts on this subject based on the ideXlab platform.
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efficacy of a skin care cream with trpv1 inhibitor 4 t butylcyclohexanol in the topical therapy of Perioral Dermatitis
Journal of Cosmetic Dermatology, 2020Co-Authors: Jerome Srour, Markus Reinholz, Julia Bengel, Teresa Linden, Zorica Jovanovic, Dennis Roggenkamp, Christoph Rothenberger, Gitta Neufang, Andreas WollenbergAbstract:Background Perioral Dermatitis is a clinically distinctive reaction pattern of facial Dermatitis, including redness, dryness, burning, pruritus and skin tightness. A gold standard treatment remains unclear. Objectives Our study evaluates the clinical value of a skin care cream with the transient receptor potential vanilloid type 1 inhibitor 4‐t‐butylcyclohexanol in POD patients over 8 weeks. Methods This open, unblinded 8‐week clinical trial included 48 patients. A skin care cream containing 4‐t‐butylcyclohexanol was applied over a period of 8 weeks. Standardized questionnaires were used at baseline, 4 and 8 weeks, for history documentation, objective and subjective severity scores, and quality of life assessments. Six different skin physiology parameters were assessed at all timepoints. Results The Perioral Dermatitis severity score decreased significantly during the treatment period. This was mirrored by significantly lower patients’ subjective numerical rating score and an improved quality of life score. Transepidermal water loss, stratum corneum hydration and skin erythema improved significantly during the treatment period. Conclusion This transient receptor potential vanilloid type 1 inhibitor‐based skin care cream improved subjective and objective parameters of Perioral Dermatitis. Decreased transepidermal water loss values and increased stratum corneum hydration demonstrate a restored skin barrier function. Consequently, the topical inhibition of these receptors is a promising management option for POD.
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rosacea and Perioral Dermatitis a single center retrospective analysis of the clinical presentation of 1032 patients
Journal Der Deutschen Dermatologischen Gesellschaft, 2020Co-Authors: Andreas Hoepfner, Enklajd Marsela, Benjamin M Clannerengelshofen, Orsolya N Horvath, Miklos Sardy, Lars E French, Markus ReinholzAbstract:Background Rosacea is a common chronic inflammatory cutaneous disorder affecting nearly 5.5 % of the adult population. Our aim was to evaluate the prevalence and epidemiology of rosacea and Perioral Dermatitis (POD) in an ambulatory care setting. Methods We retrospectively analyzed medical data of patients with a confirmed diagnosis of rosacea or Perioral Dermatitis (POD) presenting at our university hospital outpatient clinic during a 3‐year period. Results Out of 1032 patients, 81.5 % were diagnosed with rosacea and 18.5 % with POD. Overall prevalence was 1.4 % for rosacea and 0.3 % for POD. 69.3 % of the analyzed patients were female. Overall mean age was 49.3 ± 7.7 (1–92) years; the women’s average age was less than the men’s. Patients with POD were younger and predominantly female, whereas patients with phymatous rosacea were older and predominantly male. The most common phenotypes were papulopustular rosacea (68.4 %), erythematotelangiectatic rosacea (22.5 %), and phymatous rosacea (8.0 %). Special forms of rosacea were diagnosed in 15.8 % of the patients; the most frequent were ocular rosacea (6.9 %) and steroid‐induced rosacea (5.4 %). Conclusions The large patient cohort analyzed in our study provides a good estimate of the frequency of the rosacea subtypes, special forms and of Perioral Dermatitis in a hospital‐based outpatient care setting.
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efficacy and safety results of a drug free cosmetic fluid for Perioral Dermatitis the toleriane fluide efficacy in Perioral Dermatitis tolpod study
Annals of Dermatology, 2014Co-Authors: Laura Maximiliane Ehmann, Markus Reinholz, Tanja Maier, Martin Lang, Andreas WollenbergAbstract:Background: Perioral Dermatitis (POD) is a common inflammatory skin disease without standard therapy. Objective: We sought to evaluate the clinical value of a soothing fluid for the treatment of POD. Methods: We included 51 patients with POD in this 8-week clinical trial. The Toleriane Fluide Efficacy in Perioral Dermatitis (TOLPOD) study had an open-label design and involved twice-daily application of Toleriane Fluide, a soothing cosmetic fluid. Clinical assessment of POD was performed with a predefined questionnaire including the POD severity index (PODSI). Control visits were made after 4 and 8 weeks of treatment. Results: The results were compared with those of a historical control group treated with a vehicle cream. Patients treated with the soothing fluid showed a continuous and significant improvement of the PODSI over time. The improvement of PODSI observed with the soothing fluid was better, but not significantly better, than that observed in the historical controls. In addition, the subjective complaints of patients such as disease burden, itching, distension of the skin, and appearance improved during treatment. Conclusion: A soothing fluid could be a clinically useful treatment option for POD. (Ann Dermatol 26(4) 462∼468, 2014)
Hagen Tronnier - One of the best experts on this subject based on the ideXlab platform.
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epithelial barrier function and atopic diathesis in rosacea and Perioral Dermatitis
British Journal of Dermatology, 2004Co-Authors: Thomas Dirschka, Hagen Tronnier, Regina FolsterholstAbstract:Summary Background Rosacea and Perioral Dermatitis (PD) are common dermatoses, the aetiology and pathogenesis of which remain speculative. Objectives To investigate skin barrier function and features of atopy in both diseases. Methods We studied 75 patients with rosacea and 75 with PD. Transepidermal water loss (TEWL) was measured in three regions of the face (lateral chin, perinasal cheek, side of the nose) and the patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX1). The control group consisted of 125 individuals with no history of rosacea, PD or active atopic disease. Results In patients with PD, TEWL was significantly increased (P < 0·001) at all measurement points in comparison with the rosacea and control groups. Significantly (P < 0·001) higher values were also found regarding history and clinical signs of an atopic diathesis, prick test reactivity and specific IgE against aeroallergens. Conclusions PD is characterized by a skin barrier disorder of facial skin. It differs from rosacea in that it involves a significantly increased TEWL and features of an atopic diathesis. However, it remains disputed as to whether PD is an individual skin disease or a subtype of rosacea in atopic patients.
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topical cosmetics and Perioral Dermatitis
Journal Der Deutschen Dermatologischen Gesellschaft, 2004Co-Authors: Thomas Dirschka, Klaus Weber, Hagen TronnierAbstract:Summary Background: Perioral Dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. Both cosmetics and topical corticosteroids have been implicated. Patients and methods: 75 patients with PD and 125 randomly selected control patients with negative PD records were included in a questionnaire-based study focusing on cosmetics, their use, and topical corticosteroids. The patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX 1). Results: There were no significant (p < 0.05) differences in facial skin cleansing between the two groups except for night-time cleansing, which was performed more often in the patient group. The use of skin care products yielded significant differences between the patient and control group in respect to skin care in the morning and the use of day creams. Otherwise, the groups did not differ in their skin care regime (number of skin care products used, type of product, frequency of care). The mean monthly expenditure on cosmetic products did not differ significantly between the two groups. 25.3 % of the patients used topical corticosteroids which were initiated in all cases after the onset of the rash. Significantly (p < 0.001) higher values were found in the patient group regarding history of atopic diseases (49.3 % vs. 15.2 %), prick test reactivity (≥ 2 reactive prick tests: 49.3 % vs. 8.0 %), and specific IgE against aeroallergens (CAP SX1 classes ≥ 2: 50.7 % vs. 15.2 %). Conclusions: The often heard argument that PD results mainly from external factors is no longer tenable. A variable interaction between external (e.g. cosmetics) and intrinsic factors (e.g. atopic constitution) appears to lead to PD, perhaps by subclinical repetitive irritation and final overtaxing of the reparative capacity of the epithelial barrier function. Zusammenfassung Hintergrund: Die Periorale Dermatitis (PD) ist eine Hautkrankheit, deren Atiologie und Pathogenese bislang ungeklart sind. Kosmetika und/oder Kortikosteroide wurden jedoch angeschuldigt, eine wichtige Rolle bei der Auslosung der Erkrankung zu spielen. Patienten/Methodik: 75 Patienten und 125 zufallig ausgewahlte Kontrollpersonen, die nie an PD litten, wurden im Rahmen einer auf Fragebogen basierenden Untersuchung hinsichtlich der Bedeutung topischer kosmetischer Produkte, kosmetischer Gewohnheiten und Kortikoide untersucht. Die Patienten wurden hinsichtlich klinischer Atopiekriterien, Prickteste und Messungen des spezifischen IgE gegen eine Mischung von Aeroallergenen untersucht. Ergebnisse: Es ergaben sich mit Ausnahme der abendlichen Reinigung, die in der Patientengruppe haufiger durchgefuhrt wurde, keine signifikanten (p < 0,05) Unterschiede in der Gesichtsreinigung zwischen beiden Gruppen. Beim Gebrauch von Hautpflegeprodukten ergaben sich signifikante Unterschiede zwischen Patienten- und Kontrollgruppe hinsichtlich der morgendlichen Hautpflege und dem Gebrauch von Tagescreme. Ansonsten unterschieden sich die Gruppen nicht im Pflegeverhalten (Anzahl der Hautpflegeprodukte, Art der Produkte, Anwendungsfrequenz). Die durchschnittlichen monatlichen Ausgaben fur kosmetische Produkte unterschieden sich nicht signifikant zwischen beiden Gruppen. 25,3 % der Patienten verwendeten topische Kortikoide, die in allen Fallen erst nach Beginn der Hautveranderungen eingesetzt wurden. Signifikante Unterschiede (p < 0,001) zwischen beiden Gruppen bestanden ferner hinsichtlich der Anamnese atopischer Erkrankungen (49,3 % vs. 15,2 %), reaktiver Prickteste (≥ 2 positive Prickteste: 49,3 % vs. 8,0 %) und dem Nachweis spezifischer IgE gegen Aeroallergene (CAP SX 1 ≥ 2 Klassen: 50,7 % vs. 15,2 %). Schlusfolgerungen: Die oft vertretene Meinung, das die PD vornehmlich durch ausere Faktoren ausgelost sei, ist nicht mehr haltbar. Vielmehr mus ein Wechselspiel zwischen externen Ursachen (z. B. kosmetischen Produkten) und intrinsischen Faktoren (z. B. atopischer Diathese) als Ursache der PD angenommen werden, moglicherweise basierend auf einer repetitiven subklinischen Irritation und schlieslich einer Uberforderung der Reparaturmechanismen der Hautbarriere.
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impaired skin barrier and atopic diathesis in Perioral Dermatitis
Journal Der Deutschen Dermatologischen Gesellschaft, 2003Co-Authors: Thomas Dirschka, Christiane Szliska, Jochen Jackowski, Hagen TronnierAbstract:Summary Background: Perioral Dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. We investigated skin barrier function and various markers of the atopic diathesis to elucidate their impact on the development of Perioral Dermatitis. Patients and methods: Forty patients (24 to 69 years of age) with PD were evaluated. Transepidermal water loss was measured in three regions of the face (lateral chin, perinasal cheek and side of the nose) and the patients were assessed for clinical criteria for atopy. Prick tests were performed, and specific IgE against a mixture of aeroallergens (CAP SX1) was measured. The control group consisted of 62 individuals (20 to 68 years of age) without a history of PD or active disease. Results: Transepidermal water loss was significantly increased (P < 0.001) on all regions of the face in the patient over the control group. Significantly (P < 0.001) higher values were also found for the patient group regarding history (52.5 % vs. 17.7 %) and clinical signs of atopic diathesis (≥ 4 features: 72.5 % vs. 0 %), prick test reactivity (≥ 2 reactive prick tests: 60 % vs. 12.9 %), and specific IgE against aeroallergens (CAP SX1 classes ≥ 2: 60.0 % vs. 17.7 %). Conclusions: Our findings emphasize the relevance of impaired skin barrier function as a pathogenic factor in the causation of Perioral Dermatitis. The susceptibility of atopic skin to irritants increases as soon as the skin becomes eczematous. Therefore, we propose that atopic diathesis serves as an intensifier, supporting development and continued presence of Perioral Dermatitis after nonspecific irritant mechanisms have induced impaired skin barrier function. Zusammenfassung Hintergrund: Die Periorale Dermatitis ist eine sehr haufige dermatologische Erkrankung, deren Atiologie und Pathogenese jedoch immer noch umstritten sind. Wir haben die Barrierefunktion der Haut und verschiedene Merkmale atopischer Konstitution im Hinblick auf ihren Einflus auf die Entstehung der Perioralen Dermatitis untersucht. Patienten und Methodik: Bei 40 Patienten im Alter von 24 bis 69 Jahren, die an einer Perioralen Dermatitis litten, haben wir Messungen des transepidermalen Wasserverlustes und klinische Untersuchungen von Atopiekriterien sowie Prickteste und Bestimmungen des spezifischen IgE gegen eine Mischung von Aeroallergenen (CAP SX1) durchgefuhrt. 62 Personen im Alter von 20 bis 68 Jahren, die nie an einer Perioralen Dermatitis litten, dienten als Kontrollgruppe. Ergebnisse: Der transepidermale Wasserverlust war in der Patientengruppe signifikant erhoht (P < 0,001). Signifikante (P < 0,001) Unterschiede zwischen beiden Gruppen bestanden ferner hinsichtlich der Anamnese (52,5 % vs. 17,7 %) und der klinischen Zeichen von Atopie (≥ 4 Atopiemerkmale: 72,5 % vs. 0 %), der reaktiven Pricktests (≥ 2 positive Pricktests: 60 % vs. 12,9 %) und dem Nachweis spezifischer IgE gegen Aeroallergene (CAP SX1 ≥ 2 Klassen: 60 % vs. 17,7 %). Schlusfolgerungen: Unsere Untersuchungen heben die Bedeutung einer gestorten Hautbarriere als pathogenetischen Faktor fur die Entstehung der Perioralen Dermatitis hervor. Die Empfindlichkeit der atopischen Haut gegenuber irritativen Mechanismen erhoht sich, sobald die Haut ekzematisiert. Deshalb gehen wir davon aus, das eine atopische Konstitution eine Verstarkerfunktion ausubt und die Entstehung und Aufrechterhaltung einer Perioralen Dermatitis fordert, nachdem unspezifische irritativen Mechanismen die Barrierestorung ausgelost haben.
Jens Thormann - One of the best experts on this subject based on the ideXlab platform.
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topical metronidazole in the treatment of Perioral Dermatitis
Journal of The American Academy of Dermatology, 1991Co-Authors: Niels K Veien, Jan Mikael Munkvad, Aksel Otkjaer Nielsen, Annmarie Niordson, Dorrit Stahl, Jens ThormannAbstract:The twice-daily topical application of 1% metronidazole cream was compared with 250 mg oral tetracycline, taken twice daily, in the treatment of Perioral Dermatitis in a prospective, double-blind, double-dummy, randomized, multicenter trial. One hundred eight patients were treated for 8 weeks. At the end of this time the median number of papules in the metronidazole-treated group was reduced to 8% of the initial number, and the median number in the group treated with tetracycline was reduced to 0% of the initial number. Although both treatments were effective, oral tetracycline was significantly more effective than topical metronidazole.
Thomas Dirschka - One of the best experts on this subject based on the ideXlab platform.
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epithelial barrier function and atopic diathesis in rosacea and Perioral Dermatitis
British Journal of Dermatology, 2004Co-Authors: Thomas Dirschka, Hagen Tronnier, Regina FolsterholstAbstract:Summary Background Rosacea and Perioral Dermatitis (PD) are common dermatoses, the aetiology and pathogenesis of which remain speculative. Objectives To investigate skin barrier function and features of atopy in both diseases. Methods We studied 75 patients with rosacea and 75 with PD. Transepidermal water loss (TEWL) was measured in three regions of the face (lateral chin, perinasal cheek, side of the nose) and the patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX1). The control group consisted of 125 individuals with no history of rosacea, PD or active atopic disease. Results In patients with PD, TEWL was significantly increased (P < 0·001) at all measurement points in comparison with the rosacea and control groups. Significantly (P < 0·001) higher values were also found regarding history and clinical signs of an atopic diathesis, prick test reactivity and specific IgE against aeroallergens. Conclusions PD is characterized by a skin barrier disorder of facial skin. It differs from rosacea in that it involves a significantly increased TEWL and features of an atopic diathesis. However, it remains disputed as to whether PD is an individual skin disease or a subtype of rosacea in atopic patients.
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topical cosmetics and Perioral Dermatitis
Journal Der Deutschen Dermatologischen Gesellschaft, 2004Co-Authors: Thomas Dirschka, Klaus Weber, Hagen TronnierAbstract:Summary Background: Perioral Dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. Both cosmetics and topical corticosteroids have been implicated. Patients and methods: 75 patients with PD and 125 randomly selected control patients with negative PD records were included in a questionnaire-based study focusing on cosmetics, their use, and topical corticosteroids. The patients were assessed for atopy by clinical criteria, prick tests and specific IgE against a mixture of aeroallergens (CAP SX 1). Results: There were no significant (p < 0.05) differences in facial skin cleansing between the two groups except for night-time cleansing, which was performed more often in the patient group. The use of skin care products yielded significant differences between the patient and control group in respect to skin care in the morning and the use of day creams. Otherwise, the groups did not differ in their skin care regime (number of skin care products used, type of product, frequency of care). The mean monthly expenditure on cosmetic products did not differ significantly between the two groups. 25.3 % of the patients used topical corticosteroids which were initiated in all cases after the onset of the rash. Significantly (p < 0.001) higher values were found in the patient group regarding history of atopic diseases (49.3 % vs. 15.2 %), prick test reactivity (≥ 2 reactive prick tests: 49.3 % vs. 8.0 %), and specific IgE against aeroallergens (CAP SX1 classes ≥ 2: 50.7 % vs. 15.2 %). Conclusions: The often heard argument that PD results mainly from external factors is no longer tenable. A variable interaction between external (e.g. cosmetics) and intrinsic factors (e.g. atopic constitution) appears to lead to PD, perhaps by subclinical repetitive irritation and final overtaxing of the reparative capacity of the epithelial barrier function. Zusammenfassung Hintergrund: Die Periorale Dermatitis (PD) ist eine Hautkrankheit, deren Atiologie und Pathogenese bislang ungeklart sind. Kosmetika und/oder Kortikosteroide wurden jedoch angeschuldigt, eine wichtige Rolle bei der Auslosung der Erkrankung zu spielen. Patienten/Methodik: 75 Patienten und 125 zufallig ausgewahlte Kontrollpersonen, die nie an PD litten, wurden im Rahmen einer auf Fragebogen basierenden Untersuchung hinsichtlich der Bedeutung topischer kosmetischer Produkte, kosmetischer Gewohnheiten und Kortikoide untersucht. Die Patienten wurden hinsichtlich klinischer Atopiekriterien, Prickteste und Messungen des spezifischen IgE gegen eine Mischung von Aeroallergenen untersucht. Ergebnisse: Es ergaben sich mit Ausnahme der abendlichen Reinigung, die in der Patientengruppe haufiger durchgefuhrt wurde, keine signifikanten (p < 0,05) Unterschiede in der Gesichtsreinigung zwischen beiden Gruppen. Beim Gebrauch von Hautpflegeprodukten ergaben sich signifikante Unterschiede zwischen Patienten- und Kontrollgruppe hinsichtlich der morgendlichen Hautpflege und dem Gebrauch von Tagescreme. Ansonsten unterschieden sich die Gruppen nicht im Pflegeverhalten (Anzahl der Hautpflegeprodukte, Art der Produkte, Anwendungsfrequenz). Die durchschnittlichen monatlichen Ausgaben fur kosmetische Produkte unterschieden sich nicht signifikant zwischen beiden Gruppen. 25,3 % der Patienten verwendeten topische Kortikoide, die in allen Fallen erst nach Beginn der Hautveranderungen eingesetzt wurden. Signifikante Unterschiede (p < 0,001) zwischen beiden Gruppen bestanden ferner hinsichtlich der Anamnese atopischer Erkrankungen (49,3 % vs. 15,2 %), reaktiver Prickteste (≥ 2 positive Prickteste: 49,3 % vs. 8,0 %) und dem Nachweis spezifischer IgE gegen Aeroallergene (CAP SX 1 ≥ 2 Klassen: 50,7 % vs. 15,2 %). Schlusfolgerungen: Die oft vertretene Meinung, das die PD vornehmlich durch ausere Faktoren ausgelost sei, ist nicht mehr haltbar. Vielmehr mus ein Wechselspiel zwischen externen Ursachen (z. B. kosmetischen Produkten) und intrinsischen Faktoren (z. B. atopischer Diathese) als Ursache der PD angenommen werden, moglicherweise basierend auf einer repetitiven subklinischen Irritation und schlieslich einer Uberforderung der Reparaturmechanismen der Hautbarriere.
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impaired skin barrier and atopic diathesis in Perioral Dermatitis
Journal Der Deutschen Dermatologischen Gesellschaft, 2003Co-Authors: Thomas Dirschka, Christiane Szliska, Jochen Jackowski, Hagen TronnierAbstract:Summary Background: Perioral Dermatitis (PD) is a common dermatological disease whose aetiology and pathogenesis remain speculative. We investigated skin barrier function and various markers of the atopic diathesis to elucidate their impact on the development of Perioral Dermatitis. Patients and methods: Forty patients (24 to 69 years of age) with PD were evaluated. Transepidermal water loss was measured in three regions of the face (lateral chin, perinasal cheek and side of the nose) and the patients were assessed for clinical criteria for atopy. Prick tests were performed, and specific IgE against a mixture of aeroallergens (CAP SX1) was measured. The control group consisted of 62 individuals (20 to 68 years of age) without a history of PD or active disease. Results: Transepidermal water loss was significantly increased (P < 0.001) on all regions of the face in the patient over the control group. Significantly (P < 0.001) higher values were also found for the patient group regarding history (52.5 % vs. 17.7 %) and clinical signs of atopic diathesis (≥ 4 features: 72.5 % vs. 0 %), prick test reactivity (≥ 2 reactive prick tests: 60 % vs. 12.9 %), and specific IgE against aeroallergens (CAP SX1 classes ≥ 2: 60.0 % vs. 17.7 %). Conclusions: Our findings emphasize the relevance of impaired skin barrier function as a pathogenic factor in the causation of Perioral Dermatitis. The susceptibility of atopic skin to irritants increases as soon as the skin becomes eczematous. Therefore, we propose that atopic diathesis serves as an intensifier, supporting development and continued presence of Perioral Dermatitis after nonspecific irritant mechanisms have induced impaired skin barrier function. Zusammenfassung Hintergrund: Die Periorale Dermatitis ist eine sehr haufige dermatologische Erkrankung, deren Atiologie und Pathogenese jedoch immer noch umstritten sind. Wir haben die Barrierefunktion der Haut und verschiedene Merkmale atopischer Konstitution im Hinblick auf ihren Einflus auf die Entstehung der Perioralen Dermatitis untersucht. Patienten und Methodik: Bei 40 Patienten im Alter von 24 bis 69 Jahren, die an einer Perioralen Dermatitis litten, haben wir Messungen des transepidermalen Wasserverlustes und klinische Untersuchungen von Atopiekriterien sowie Prickteste und Bestimmungen des spezifischen IgE gegen eine Mischung von Aeroallergenen (CAP SX1) durchgefuhrt. 62 Personen im Alter von 20 bis 68 Jahren, die nie an einer Perioralen Dermatitis litten, dienten als Kontrollgruppe. Ergebnisse: Der transepidermale Wasserverlust war in der Patientengruppe signifikant erhoht (P < 0,001). Signifikante (P < 0,001) Unterschiede zwischen beiden Gruppen bestanden ferner hinsichtlich der Anamnese (52,5 % vs. 17,7 %) und der klinischen Zeichen von Atopie (≥ 4 Atopiemerkmale: 72,5 % vs. 0 %), der reaktiven Pricktests (≥ 2 positive Pricktests: 60 % vs. 12,9 %) und dem Nachweis spezifischer IgE gegen Aeroallergene (CAP SX1 ≥ 2 Klassen: 60 % vs. 17,7 %). Schlusfolgerungen: Unsere Untersuchungen heben die Bedeutung einer gestorten Hautbarriere als pathogenetischen Faktor fur die Entstehung der Perioralen Dermatitis hervor. Die Empfindlichkeit der atopischen Haut gegenuber irritativen Mechanismen erhoht sich, sobald die Haut ekzematisiert. Deshalb gehen wir davon aus, das eine atopische Konstitution eine Verstarkerfunktion ausubt und die Entstehung und Aufrechterhaltung einer Perioralen Dermatitis fordert, nachdem unspezifische irritativen Mechanismen die Barrierestorung ausgelost haben.