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Sporting activities may exert positive and negative health effects. This applies not only to the cardiovascular and musculoskeletal system, but also to skin. During sporting activities a person is exposed to environmental factors such as temperature, irradiation, and allergens. These factors may play a key role in the development of skin diseases. Mechanical trauma is caused by acute injury as well as chronic damage. Infectious skin diseases caused by viruses, bacteria or fungi can be transmitted by body contact or the use of communal showers or locker rooms. Intake of performance-enhancing substances may provoke skin changes such as striae distensae, androgenetic alopecia, hypertrichosis and acne. Preexisting skin diseases such as psoriasis, lichen planus, vitiligo, polymorphous light eruption, lupus erythematosus, porphyria, urticaria, and acne rosacea may be aggravated by sporting activities. On the other hand, physical exercise has a therapeutic potential which has hardly been exploited by dermatologists. Especially in chronic skin diseases positive effects have been observed. Therapeutic use of team sports has been shown to decrease suffering, depression, and emotional disturbances and increase life quality in patients with atopic eczema, psoriasis, and venous leg ulcers.
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PMID:[Sports as a risk factor and therapeutic principle in dermatology]. 1196 1

We present two Japanese cases of involutional lipoatrophy. The first case is that of a 30-year-old woman, who first appeared at our hospital complaining of a localized, well-demarcated depression, approximately 3 x 4 cm in size, normal to slightly erythematous in coloration, on the lateral side of the left upper arm (Fig. 1a). The condition was asymptomatic, and she had noticed this anomaly a month prior to consultation. She received intramuscular injections of corticosteroids of unknown dosage at the affected site for the treatment of allergic rhinitis 4 months prior to her present consultation. The second patient, a 23-year-old woman, appeared at our hospital complaining of a similar macule 4 x 4 cm in size, which she noticed several weeks prior to her most recent consultation. She had no history of injury or injection at the site before the development of the condition (Fig. 1b). She had been under treatment for atopic dermatitis since early childhood and was treated only with topical applications of white petrolatum containing 2% salicylic acid for the past several years. In order to rule out the possibility of acquired partial lipodystrophy associated with localized scleroderma, lupus profundus and the other connective tissue diseases, a histological examination was performed for both patients. Histopathological analysis of the region exhibited a well-defined fat lobule composed of numerous small adipocytes (Fig. 1c) embedded in hyaline connective tissue. Edema and dilated capillaries were noticeable in the subcutaneous tissue surrounding the area. Inflammatory cells were not prominent, although mononuclear cells were observed in both patients. No epidermal change was seen in either patient. Direct and indirect immunofluorescence studies revealed no deposits of immunoreactants in the skin of either patient. Immunohistochemical studies with the antibody against macrophage (anti-CD68 antigen; DAKO.) showed that positive cells were scattered around blood vessels and shrunken lipocytes in the subcutaneous tissues (Fig. 1d). Most of these cells in the fat lobules were also positive for mucin stains such as Alcian blue. No abnormal findings came to light in the ordinary hematological and blood chemistry examinations of both patients. The autoantibody screening tests using antinuclear, anti-DNA, anticentromere, and anti-Scl-70 antibodies were negative in both patients.
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PMID:Two Japanese cases of localized involutional lipoatrophy. 1201 Mar 46

Tacrolimus is a potent inhibitor of immune mechanisms. It belongs to the macrolactam group. It inhibits the release of both Th1 and Th2 cytokines. It proves to be efficacious after topical application in the treatment of atopic dermatitis. In this indication, tacrolimus challenges topical corticosteroids. Irritation risks are present. The local immuno-depression can boost disseminated infections including herpes. The risk to promote photocarcinogenesis on the long term, and that bound to chronic resorption remain theoretical concerns that have not been assessed so far.
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PMID:[Drug of month. Topical tacrolimus (Protopic)]. 1240 29

We examined natural killer (NK) activity in 128 patients with atopic dermatitis (AD) to investigate the relationships between NK activity and severity of dermatitis, duration of disease, and mental states. The results showed the following: 1) No relationship was shown between severity of dermatitis and NK activity, neither between NK activity nor eosinophilic counts nor serum IgE. 2) Patients with longer duration of AD lesions showed significantly lower NK activity (P=0.036). The significant relationship was recognized between severity of dermatitis and the duration of disease (P=0.014). 3) No relationships were recognized between NK activity and mental states evaluated using the Profile Of Mood States (POMS) questionnaire, as tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue and confusion. From a psychoneuroimmunological viewpoint, chronic stress as having AD might influence the lower NK activity of patients with longer duration of AD.
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PMID:[Natural killer cell activity among patients with atopic dermatitis]. 1468 39

This article describes the development of a questionnaire that assesses problems in adapting to chronic skin disorders, the Adjustment to Chronic Skin Diseases Questionnaire. Patients (N = 442) with different skin disorders completed the original item pool. Principal-components analysis suggested a 6-factor solution that was largely replicated with 2 additional samples of 192 patients with psoriasis or atopic dermatitis and 165 patients with atopic dermatitis. Four of the subscales showed very good internal consistencies, retest reliabilities, and sufficient correlations with expert ratings: Social Anxiety/Avoidance, Itch-Scratch Cycle, Helplessness, and Anxious-Depressive Mood. Two short additional subscales, Impact on Quality of Life and Deficit in Active Coping, showed moderate internal consistencies, but good retest reliabilities. Correlations of the subscales with measures of depression, anxiety, and coping, and meaningful differences between dermatological subgroups support their construct validity. A treatment study showed that changes in some of the subscales correlated with changes in the severity of the skin condition.
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PMID:Measuring adjustment to chronic skin disorders: validation of a self-report measure. 1469 48

The aim of the investigation was to compare psychological symptoms and health-related quality of life of dermatology patients and healthy controls. The sample consisted of 333 consecutively recruited patients from four dermatology outpatient clinics, 172 hospitalized dermatological patients from two university hospitals and 293 matched healthy controls. All patients and controls completed Beck's Depression Inventory, the Brief Symptom Inventory and the Dermatology Life Quality Index. Hospitalized patients were more distressed than outpatients and healthy controls and reported greater impairment of disease-related quality of life than outpatients. More hospitalized patients had suicidal thoughts and were characterized as having severe to moderate depression compared with outpatients and controls. Female patients and younger patients were generally more distressed than male patients and older patients, and patients with atopic dermatitis and psoriasis were more distressed than patients with urticaria and eczemas. Disease-related impairment of quality of life was the main predictor of psychological symptoms, when controlling for diagnosis, age, gender, disease duration and disease severity. Although older age was associated with fewer psychological symptoms, our data suggest that skin disease affects quality of life equally in young and older patients. The findings highlight the importance of recognizing disease-related psychological problems and possible psychiatric comorbidity of dermatology patients, especially among patients with atopic dermatitis and psoriasis.
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PMID:Psychological symptoms and quality of life of dermatology outpatients and hospitalized dermatology patients. 1520 37

Although the link between atopic dermatitis (AD) and emotional disturbance is well known, there have been only a few studies assessing the extent of these disturbances in affected children and the problems experienced by their parents. Furthermore, these studies are mostly from western countries, where atopic dermatitis is seen in a more severe form than in India. The purpose of this study was to determine whether there is an excess of psychological disorders in Indian children with AD as compared to healthy controls and whether their mothers showed higher levels of emotional or mental distress than a comparison group. Twenty-two children, aged 3-9 years, with atopic dermatitis, twenty age and sex matched controls, and their mothers were selected for the study. The personalities of the mothers were assessed from a standard and valid questionnaire, the Hindi adaptation of Personality Trait Inventory, which explored nine areas of the maternal personality and mental distress as well as negative traits of some of these. The two groups were compared using the Chi-square test. To assess the psychopathology of the children, the mothers were made to answer parts of a valid, well-developed questionnaire, the Childhood Psychopathology Measurement Schedule, which enabled the assessment of the following factors: low intelligence with behaviour disorders, conduct disorders, anxiety, and depression. The means of each factor in both the groups were compared using the Students' t-test. Out of all the maternal personality traits, an increased number of mothers of affected children, 13 (59%) were found to be submissive as compared to the mothers of the controls i.e. 2 (10%), which was statistically significant (p<0.01). The children with AD had a higher frequency of low intelligence with behaviour disorders (5.9+/-2.9) as compared to controls and also of conduct disorders (2.1+/-1.4), which were both statistically significant (p<0.01). The results of this pilot study, although small in number, suggest that increased psychological disorders are observed in Indian children with AD as compared to controls, despite the fact that the disease is of a milder variety in this country as compared to its western counterparts. More mothers of children with AD were submissive, which could contribute to the psychological disorders and maintenance of eczema in the children. We suggest that children with AD may benefit if such psychological dimensions are considered as a part of their treatment.
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PMID:Psychological disturbances in Indian children with atopic eczema. 1523 82

Atopic conditions include allergic rhinitis, atopic eczema, allergic conjunctivitis and asthma. Doctors and patients can choose from a variety of antiallergy medications, testifying that no one medication will suffice to treat all symptoms and that each has a different side-effect profile. Antiallergy medications target histamine receptors, as histamine release contributes to the unpleasant symptoms of itching, tearing, runny nose and skin urticaria. The ideal antihistamine would control the symptoms of atopic disease but cause very few side effects. Traditionally, unwanted effects include drowsiness and somnolence due to CNS depression, and digestive tract problems such as loss of appetite, nausea, vomiting and constipation or diarrhea. Some antihistamines also have anticholinergic effects that are mediated by muscarinic receptors. These atropine-like actions, which can affect the cardiovascular system, are sufficiently prominent in some drugs to be manifest during clinical usage. Epinastine hydrochloride minimally penetrates the blood/brain barrier and has almost no effect on the muscarinic receptors. This drug is marketed as having very few CNS-depressant side effects, few drug interactions and gastrointestinal side effects, and a low risk of cardiotoxicity.
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PMID:Epinastine hydrochloride for atopic disease. 1551 Feb 39

In patients with atopic dermatitis (AD), psychosomatic factors are important elements in treating the condition. In this study, we surveyed 51 outpatients with AD who consulted the Department of Dermatology of Fujita Health University Hospital using a questionnaire involving present illness/treatment history regarding AD to analyze psychosomatic factors. The severity of AD was evaluated using the severity classification described by Yoshiike et al. Four psychological tests were used to examine depression, anxiety, personality, and upbringing experiences during childhood. Beck Depression Inventory (BDI) was used as a scale for depression, Self-rating Anxiety Scale (SAS) as a scale for anxiety, the Temperament and Character Inventory (TCI) as a scale for the personality tendency, and the Parental Bonding Instrument (PBI) as a scale for upbringing experiences during childhood. The BDI and SAS scores were high in the severe AD group. Among patients with the same grade of AD, the BDI and SAS scores were higher in the low IgE RIST group. In the patients with AD, the BDI scores were significantly higher than those in the healthy controls (P<0.05). In clinical practice, the treatment of AD should include psychosomatic approaches.
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PMID:Psychosomatic analysis of atopic dermatitis using a psychological test. 1586 60

The role of stress on the triggering-off of flares of atopic dermatitis (AD) is the subject of a consensus. It is understandable because biochemical mediators are known to affect the cells implied in AD. The role of more complex psychological factors (depression, anxiety, and familial interaction) is highly probable but difficult to demonstrate. The psychological impact of AD is obviously severe. Psychotherapy provides beneficial effects on the impact but also on pruritus and scratching. Its effect on the AD lesions has rarely been studied but has been observed in many cases. Psychotropics can be useful but they should be handled with care in infants.
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PMID:[Atopic dermatitis and psychological factors]. 1598 2


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