P = 0.522
A 70
P < 0.001
P = 0.037
P = 0.002
65 60
56.2
53.5
STAI
55
49.9 50
45.5
45 40 35 30
Serum IgE
100 ≤ (n = 255)
< 100 (n = 13)
< 100 (n = 13)
100 ≤ (n = 255)
TA
B
SA
P = 0.202
P < 0.001
70
P = 0.239
65
P = 0.086
60 55
STAI
1. Hara M, Watanabe M, Tagami H. Jacquet erosive diaper dermatitis in a young girl with urinary incontinence. Pediatr Dermatol 1991; 8: 160-1. 2. Virgili A, Corazza M, Califano A. Diaper dermatitis in an adult. A case of erythema papuloerosive of Sevestre and Jacquet. J Reprod Med 1998; 43: 949-51. 3. Van L, Harting M, Rosen T. Jacquet erosive diaper dermatitis: a complication of adult urinary incontinence. Cutis 2008; 82: 72-4. 4. Rodriguez-Poblador J, González-Castro U, Herranz-Martínez S, Luelmo-Aguilar J. Jacquet erosive diaper dermatitis after surgery for Hirschsprung disease. Pediatr Dermatol 1998; 15: 46-7. 5. Robson KJ, Maughan JA, Purcell SD, Petersen MJ, Haefner HK, Lowe L. Erosive papulonodular dermatosis associated with topical benzocaine: a report of two cases and evidence that granuloma gluteale, pseudoverrucous papules, and Jacquet’s erosive dermatitis are a disease spectrum. J Am Acad Dermatol 2006; 55: S74-80. 6. Buckingham KW, Berg RW. Etiologic factors in diaper dermatitis: the role of feces. Pediatr Dermatol 1986; 3: 107-12. 7. Berg RW, Buckingham KW, Stewart RL. Etiologic factors in diaper dermatitis: the role of urine. Pediatr Dermatol 1986; 3: 102-6. 8. Maruani A, Lorette G, Barbarot S, et al. Re-emergence of papulonodular napkin dermatitis with use of reusable diapers: report of 5 cases. Eur J Dermatol 2013; 23: 246-9. 9. Markham T, Kennedy F, Collins P. Topical sucralfate for erosive irritant diaper dermatitis. Arch Dermatol 2000; 136: 1199-200. 10. Paradisi A, Capizzi R, Ghitti F, Lanza-Silveri S, Rendeli C, Guerriero C. Jacquet erosive diaper dermatitis: a therapeutic challenge. Clin Exp Dermatol 2009; 34: e385-6.
52.5
50.0
50
48.8 45.6
45
doi:10.1684/ejd.2014.2279
40 35 30
Serum IgE
Psychological aspects of patients with intrinsic atopic dermatitis
< 200 (n = 28)
200 ≤ (n = 240)
TA
EJD, vol. 24, n◦ 2, March-April 2014
200 ≤ (n = 240)
SA
P = 0.295
C
P = 0.024 P = 0.032
70
P = 0.121 65 60
57.3
55
STAI
Atopic dermatitis (AD) is classified into the IgE-high extrinsic and IgE-normal intrinsic types. While extrinsic AD is the classical type with high prevalence, intrinsic AD occupies approximately 20% of total AD with female predominance [1]. The skin barrier is perturbed in the extrinsic, but not intrinsic type [1], and thus filaggrin gene mutations are not a feature of intrinsic AD [2]. While the two types have comparable frequencies of circulating Th2 cells, intrinsic AD shows a significantly increased frequency of circulating interferon-␥-producing Th1 cells and lesional Th17 cells [2, 3]. We have shown that metal allergy may induce such an immunological state in intrinsic AD [1, 4]. In addition, we speculated that some itch-related factors, such as anxiety, might exacerbate intrinsic AD because of the refractory pruritus. The pathogenic role of the psychological factors in patients with AD remains controversial [5, 6]. There has been no report focusing on the impact of anxiety on intrinsic AD. To reveal the anxiety profile, the state-trait anxiety inventory (STAI) [7] is a useful questionnaire, which enables us to evaluate both state anxiety (SA) and trait anxiety (TA). We have previously shown that anxiety is significantly higher among subjects with AD than normal subjects, and TA was higher than SA in the AD group [8, 9]. Here, we sought to investigate the relationship between anxiety and intrinsic AD. Enrolled in this study were 268 Japanese AD patients, most of whom received our inpatient AD educational program. The diagnosis of AD was made according to the criteria of
< 200 (n = 28)
49.0
50
51.6 45.9
45 40 35 30
Serum IgE
< 100 (n = 8)
100 ≤ (n = 118)
TA
< 100 (n = 8)
100 ≤ (n = 118)
SA
Figure 1. Trait anxiety (TA) and State anxiety (SA) in the two groups of AD patients. The patients were divided into: (A) the IgE levels
A 70
P < 0.001
P = 0.037
P = 0.002
65 60
56.2
53.5
STAI
55
49.9 50
45.5
45 40 35 30
Serum IgE
100 ≤ (n = 255)
< 100 (n = 13)
< 100 (n = 13)
100 ≤ (n = 255)
TA
B
SA
P = 0.202
P < 0.001
70
P = 0.239
65
P = 0.086
60 55
STAI
1. Hara M, Watanabe M, Tagami H. Jacquet erosive diaper dermatitis in a young girl with urinary incontinence. Pediatr Dermatol 1991; 8: 160-1. 2. Virgili A, Corazza M, Califano A. Diaper dermatitis in an adult. A case of erythema papuloerosive of Sevestre and Jacquet. J Reprod Med 1998; 43: 949-51. 3. Van L, Harting M, Rosen T. Jacquet erosive diaper dermatitis: a complication of adult urinary incontinence. Cutis 2008; 82: 72-4. 4. Rodriguez-Poblador J, González-Castro U, Herranz-Martínez S, Luelmo-Aguilar J. Jacquet erosive diaper dermatitis after surgery for Hirschsprung disease. Pediatr Dermatol 1998; 15: 46-7. 5. Robson KJ, Maughan JA, Purcell SD, Petersen MJ, Haefner HK, Lowe L. Erosive papulonodular dermatosis associated with topical benzocaine: a report of two cases and evidence that granuloma gluteale, pseudoverrucous papules, and Jacquet’s erosive dermatitis are a disease spectrum. J Am Acad Dermatol 2006; 55: S74-80. 6. Buckingham KW, Berg RW. Etiologic factors in diaper dermatitis: the role of feces. Pediatr Dermatol 1986; 3: 107-12. 7. Berg RW, Buckingham KW, Stewart RL. Etiologic factors in diaper dermatitis: the role of urine. Pediatr Dermatol 1986; 3: 102-6. 8. Maruani A, Lorette G, Barbarot S, et al. Re-emergence of papulonodular napkin dermatitis with use of reusable diapers: report of 5 cases. Eur J Dermatol 2013; 23: 246-9. 9. Markham T, Kennedy F, Collins P. Topical sucralfate for erosive irritant diaper dermatitis. Arch Dermatol 2000; 136: 1199-200. 10. Paradisi A, Capizzi R, Ghitti F, Lanza-Silveri S, Rendeli C, Guerriero C. Jacquet erosive diaper dermatitis: a therapeutic challenge. Clin Exp Dermatol 2009; 34: e385-6.
52.5
50.0
50
48.8 45.6
45
doi:10.1684/ejd.2014.2279
40 35 30
Serum IgE
Psychological aspects of patients with intrinsic atopic dermatitis
< 200 (n = 28)
200 ≤ (n = 240)
TA
EJD, vol. 24, n◦ 2, March-April 2014
200 ≤ (n = 240)
SA
P = 0.295
C
P = 0.024 P = 0.032
70
P = 0.121 65 60
57.3
55
STAI
Atopic dermatitis (AD) is classified into the IgE-high extrinsic and IgE-normal intrinsic types. While extrinsic AD is the classical type with high prevalence, intrinsic AD occupies approximately 20% of total AD with female predominance [1]. The skin barrier is perturbed in the extrinsic, but not intrinsic type [1], and thus filaggrin gene mutations are not a feature of intrinsic AD [2]. While the two types have comparable frequencies of circulating Th2 cells, intrinsic AD shows a significantly increased frequency of circulating interferon-␥-producing Th1 cells and lesional Th17 cells [2, 3]. We have shown that metal allergy may induce such an immunological state in intrinsic AD [1, 4]. In addition, we speculated that some itch-related factors, such as anxiety, might exacerbate intrinsic AD because of the refractory pruritus. The pathogenic role of the psychological factors in patients with AD remains controversial [5, 6]. There has been no report focusing on the impact of anxiety on intrinsic AD. To reveal the anxiety profile, the state-trait anxiety inventory (STAI) [7] is a useful questionnaire, which enables us to evaluate both state anxiety (SA) and trait anxiety (TA). We have previously shown that anxiety is significantly higher among subjects with AD than normal subjects, and TA was higher than SA in the AD group [8, 9]. Here, we sought to investigate the relationship between anxiety and intrinsic AD. Enrolled in this study were 268 Japanese AD patients, most of whom received our inpatient AD educational program. The diagnosis of AD was made according to the criteria of
< 200 (n = 28)
49.0
50
51.6 45.9
45 40 35 30
Serum IgE
< 100 (n = 8)
100 ≤ (n = 118)
TA
< 100 (n = 8)
100 ≤ (n = 118)
SA
Figure 1. Trait anxiety (TA) and State anxiety (SA) in the two groups of AD patients. The patients were divided into: (A) the IgE levels
