Indian Pediatrics 2003; 40:793

Atopic Dermatitis


It was interesting to read a well compiled article on Atopic dermatitis(1). I would like to add a few points, that may be of value to practicing pediatricians.

The criteria adopted by Hanafin and Rajka do form a benchmark for the diagnosis of atopic dermatitis but, in practice the criteria proposed by the U.K. Working Group(2) is easier to use to arrive at a diagnosis. The criteria go as follows; Itchy skin condition (obligatory); p1us three more of the following: history of flexural involvement, history of asthma/hay fever, history of generalized dry skin, onset of rash under the age of 2 years, or visible flexural dermatitis.

The authors have mentioned that the severe form of atopic dermatitis is rare in India, but, most of the studies that have been cited, come from a single geographical area, and the reason for this is that no validated studies have been published from other parts of India. In practice, one does come across quite severe cases, which require treatment with calcineurin inhibitors like cyclosporin and tacrolimus, or immunosuppresants like azathioprine.

While discussing emollients and cleansers, it would be worthwhile to suggest that the patients avoid the ones containing lanolin, which is a known sensitizer in atopics. The OTC preparations used on babies contain lanolin, albeit the fact that these cosmetics carry no labelling in India. Besides, the physician would well avoid neomycin containing preparations, as neomycin is a known contact sensitizer in atopics.

Rajesh Sankar,
Consultant Dermatologist,
Cochin Hospital,
Kochi, India.

References
1. Sarkar R, Kanuwar AJ. Atopic dermatitis. Indian Pediatr, 2002; 39: 922-930.

2. Williams HC, Burney PGJ, Pembroke AC, Hay RJ. The U.K. Working Party’s diagnostic crlteria for atopic dermatitis. III. Independent hospital validation. Br J Dermatol 1994; 131: 406-416.

 



http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7342686&dopt=Abstract

Acta Pharmacol Toxicol (Copenh). 1981 Oct;49(4):259-65. Related Articles,Links

Methyl mercury decomposition in mice treated with antibiotics.

Seko Y, Miura T, Takahashi M, Koyama T.

The role of intestinal flora in the decomposition and faecal excretion of methyl mercury was studied in mice treated with antibiotics. The antibiotics, neomycin sulfate and chloramphenicol, were given to mice in drinking water for six days before intraperitoneal administration of methyl mercuric chloride (MMC), and intestinal microorganisms were thereby reduced. Inorganic and organic mercury were determined separately for faeces, intestinal contents and organs. On the fourth day after the mercury administration, the percentage ratios of inorganic mercury to total mercury in the contents of the caecum and large intestine were less in the mice treated with antibiotics, at 37% and 39%, respectively, than in the control mice (66% and 65%, respectively). Administration of the antibiotics reduced the excretion of inorganic mercury in the faeces to 26% of that of control mice and also reduced the excretion of total mercury to 60%. Reduction of intestinal microorganisms by the antibiotics was assumed to have caused the reduced decomposition of methyl mercury in the caecal contents and the reduced excretion of total mercury in the faeces.

PMID: 7342686 [PubMed - indexed for MEDLINE]



http://tinyurl.com/2w8f5c

Mercury, lead, and zinc in baby teeth of children with autism versus
controls
Adams JB, Romdalvik J, Ramanujam VM, Legator MS.
Chemical and Materials Engineering, Arizona State University, Tempe,
Arizona, USA.

This study determined the level of mercury, lead, and zinc in baby teeth of children with autism spectrum disorder (n = 15, age 6.1 +/- 2.2 yr) and typically developing children (n = 11, age = 7 +/- 1.7 yr). Children with autism had significantly (2.1-fold) higher levels of mercury but similar levels of lead and similar levels of zinc. Children with autism also had significantly higher usage of oral antibiotics during their first 12 mo of life, and possibly higher usage of oral antibiotics during their first 36 mo of life. Baby teeth are a good measure of cumulative exposure to toxic metals during fetal development and early infancy, so this study suggests that children with autism had a higher body burden of mercury during fetal/infant development. Antibiotic use is known to almost completely inhibit excretion of mercury in rats due to alteration of gut flora. Thus, higher use of oral antibiotics in the children with autism may have reduced their ability to excrete mercury, and hence may partially explain the higher level in baby teeth. Higher usage of oral antibiotics in infancy may also partially explain the high incidence of chronic gastrointestinal problems in individuals with autism.

PMID: 17497416 [PubMed - indexed for MEDLINE]