RESUMEN
BACKGROUND: Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. Scratching due to pruritus is an important mechanism in the exacerbation of AD but is difficult to document in the home environment. OBJECTIVES: To evaluate whether nocturnal wrist activities, defined as average acceleration in the early hours of sleep, were correlated with components of the SCORing Atopic Dermatitis (SCORAD) index and various AD-associated chemokine markers. METHODS: Patients with AD aged under 18 years were recruited and the severity of eczema was assessed with the SCORAD index. Concentrations of plasma AD-associated chemokines [cutaneous T-cell attracting cytokine (CTACK); macrophage-derived chemokine (MDC); thymus and activation regulated chemokine (TARC)], interleukin (IL)-18, serum total IgE, and eosinophil counts were measured in these patients. Healthy children with noninflammatory and nonitchy skin conditions as well as healthy children of staff volunteers were recruited as controls. All children were instructed to wear the DigiTrac monitor on their dominant wrist before sleeping. The monitor was programmed to record limb motion between 22.00 and 08.00 h the following morning. RESULTS: Twenty-four Chinese children with AD (mean +/- SD age 12.6 +/- 3.7 years) and 15 normal children (mean +/- SD age 11.9 +/- 3.4 years) were recruited. The median (interquartile range) SCORAD was 54.8 (32.8-70.2). Plasma concentrations in pg mL(-1) of CTACK, MDC, TARC and IL-18 in the patients were 105 (92-172), 1648 (973-4214), 258 (100-850) and 415 (304-539), respectively. When compared with controls, most wrist activities occurred at frequencies between 1 and 3 Hz. These activities were most consistent over the first 3 h of sleeping and correlated significantly with disease severity, extent, intensity, and AD-associated chemokine markers CTACK, MDC and TARC. However, there was no significant correlation between wrist activities and the subjective symptom of pruritus or sleep loss. CONCLUSIONS: This is the first study to demonstrate that wrist activities, nonintrusively measured by the DigiTrac monitor at home, are closely correlated with the objective clinical scores and levels of peripheral blood chemokine markers for AD but not with the reported symptoms of pruritus or sleep loss. We propose that wrist activities between 1 and 3 Hz for the first 3 h are a good indicator of AD severity in children and should substitute for the pruritus and sleep-loss components of the SCORAD.
Asunto(s)
Quimiocinas/sangre , Dermatitis Atópica/fisiopatología , Movimiento , Sueño , Muñeca/fisiopatología , Adolescente , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Dermatitis Atópica/sangre , Dermatitis Atópica/complicaciones , Femenino , Humanos , Masculino , Prurito/sangre , Prurito/etiología , Prurito/fisiopatología , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/sangre , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatologíaRESUMEN
INTRODUCTION: Staphylococcus aureus colonisation/infection is common in children with atopic dermatitis (AD). MATERIALS AND METHODS: We evaluated the nasal and body swabs of Chinese children with moderate-to-severe AD as assessed using SCORing-Atopic-Dermatitis (SCORAD) score. Swabs were taken from the right nostril, 5 flexural sites (anterior neck, antecubital fossae and popliteal fossae) and the skin area most severely affected (with oozing/crusting) for bacteriologic culture. RESULTS: Fifty-five children (30 males and 25 females) were evaluated. Moderate-to-heavy growth of S. aureus was present in 12 (22%) of the nasal swabs, and in 1 or more flexural swabs of 32 (58%) of these children. Only 7 (35%) out of the 20 patients who had swabs taken from the worst skin area had moderate-to-heavy growth of S. aureus. Significant nasal S. aureus colonisation was associated with higher total (P=0.029) and objective SCORAD scores (P=0.040), more extensive disease (P=0.025), the presence of oozing or crusting (P=0.023) and higher eosinophil counts (P=0.038). All specimens of methicillin-sensitive S. aureus were sensitive to cloxacillin and 71% to erythromycin. Methicillin-resistant S. aureus (MRSA), sensitive to vancomycin, was only isolated in 1 patient. CONCLUSIONS: In this study, S. aureus is a principal pathogen. Cloxacillin and first-generation cephalosporins have a favourable sensitivity profile even in children with moderate and severe atopic dermatitis. The anterior nares are an important harbour for S. aureus and significant nasal S. aureus colonisation was clinically associated with more extensive lesions and the presence of oozing or crusting.