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Allergic skin diseases in tropical areas

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GRF 2nd One Health Summit 2013: Presentation by Peter Schmid-Grendelmeier, Allergy Unit Dept. Of Dermatology University Hospital Zuerich Switzerland …

GRF 2nd One Health Summit 2013: Presentation by Peter Schmid-Grendelmeier, Allergy Unit Dept. Of Dermatology University Hospital Zuerich Switzerland

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  • 1. Allergic skin diseases in tropical areas Peter Schmid-Grendelmeier Allergy Unit Dept. Of Dermatology University Hospital Zuerich Switzerland
  • 2. Dept. Of Dermatology University Hospital Zuerich Switzerland
  • 3. RDTC
  • 4. UGANDA KENYA KCMC RWANDA BURUNDI Moshi Moshi TANZANIA Pemba Dar es Salaam DCR AA I ML W ZAMBIA
  • 5. Regional Dermatology Training Centre Training programm for „Dermatology officers“ from 14 Nations from East/Southern Africa (Commonwealth) 2-years long Curriculum: Dermatology STI / HIV Leprosy Public Health Teaching methods
  • 6. Atopic dermatitis in Zuerich, SWitzerland Atopic dermatitis in Kilombero Region, Tanzania
  • 7. What about Atopic dermatitis in Cape Region South Africa ?
  • 8. Validation of the U.K. diagnostic criteria for atopic eczema in a Xhosa speaking South-African population Charmers DA et al Brit J Dermatol 2007 Brit J Dermatol 2007 Validity of the full question-based version of the U.K. diagnostic criteria Sensitivity 43.7% (95% CI 26.3-62.3) Specificity 97.9% (97.3-98.4) PPV 18.4% (95% CI 10.4-28.9) NPV 99.4% (95% CI 99.0-99.6) Visible flexural eczema alone Sensitivity 81.2% (95% CI 63.5-92.7) Validation of ISAAC and the U.K. diagnostic criteria for atopic Specificity 99.0% (95% CI 98.6-99.3), dermatitis in Ethiopian children PPV 48.1% (95% CI 34.3-62.1) Haileamlak A et al. Brit J Dermatol 2005 NPV 99.8% (95% CI 99.5-99.9)
  • 9. Validation of the U.K. diagnostic criteria for atopic eczema in a Xhosa speaking South-African population Charmers DA et al Brit J Dermatol 2007 Brit J Dermatol 2007 Validity of the full question-based version of the U.K. diagnostic criteria Sensitivity 43.7% (95% CI 26.3-62.3) Specificity 97.9% (97.3-98.4) PPV 18.4% (95% CI 10.4-28.9) NPV 99.4% (95% CI 99.0-99.6) Visible flexural eczema alone Sensitivity 81.2% (95% CI 63.5-92.7) Specificity 99.0% (95% CI 98.6-99.3), PPV 48.1% (95% CI 34.3-62.1) NPV 99.8% (95% CI 99.5-99.9)
  • 10. Validation of the U.K. diagnostic criteria for atopic eczema in a Flexural population Xhosa speaking South-Africaneczema as Charmers DA et al Brit J Dermatol 2007 the Brit J Dermatol 2007 key diagnostic Feature Of Atopic Eczema
  • 11. Additional discriminating clinical features in AD 19 (11.1%) White demographism 0 Facial erythema 0 23 (15.5%) 52 (30.4%) Infraorbital folds 10 (6.9%) Hertoghe's sign 36 4 (2.8%) 33 (19.3%) Periorbital darkening 2 (1.4%) Dry skin 133 (77.8%) 11 (7.6%) 56 (32.7%) Palmar hyperlinearity 16 (11.4%) Retroauricular intertrigo* Nummular eczema* 30 (17.5%) 2 (1.4%) 3 (2.1%) 21 (12.3%) 43 (25.1%) Pytiriasis alba* 11 (7.6%) 38 (22.2%) Napkin rash* 1 (0.7%) Papular lichenoid lesions* 0 93 (54.4%) 11 (7.6%) 20 * minor criteria 40 60 Non AD (644pers.) 80 100 With AD (771pts.) , KSasagawa-Tagahashi-type Masenga J et al) 120 140
  • 12. Additional discriminating clinical features in AD 19 (11.1%) White demographism 0 Facial erythema 0 23 (15.5%) 52 (30.4%) Infraorbital folds 10 (6.9%) Hertoghe's sign 36 4 (2.8%) Dry skin Palmar hyperlinearitiy 33 (19.3%) Periorbital darkening 2 (1.4%) Dry skin 133 (77.8%) 11 (7.6%) 56 (32.7%) Palmar hyperlinearity 16 (11.4%) Retroauricular intertrigo* Nummular eczema* 30 (17.5%) 2 (1.4%) 3 (2.1%) 21 (12.3%) Papular lichenoid lesions* 43 (25.1%) Pytiriasis alba* 11 (7.6%) 38 (22.2%) Napkin rash* 1 (0.7%) Papular lichenoid lesions* 0 93 (54.4%) 11 (7.6%) 20 * minor criteria 40 60 Non AD (644pers.) 80 100 With AD (771pts.) , KSasagawa-Tagahashi-type Masenga J et al 120 140
  • 13. Papular lichenoid lesions
  • 14. Palmar hyperlinearity
  • 15. Worldwide Variation of Asthma, allergic rhinitis and atopic dermatitis ISAAC Study, Lancet 1998
  • 16. Worldwide Variation of Asthma, allergic rhinitis and atopic dermatitis ISAAC Study, Lancet 1998
  • 17. Worldwide Variation of Asthma, allergic rhinitis and atopic dermatitis ISAAC Study, Lancet 1998
  • 18. Prevalence of AD in childhood in SubSaharan Africa Study Nation Yemaneberhan H Ethiopia Number Prevalence Source 12876 3.1 % Clin Exp Allergy 2004 Nornuka EN Nigeria 1026 8.5 % Int J Dermatol 2004 Oguunyi I et al Nigeria 1048 absent Ped Dermatol 2005 Sibanda EN Simbabwe 12042 6.9% Int Arch Allergy Immunol 2004 Mercer MJ South Africa 4947 11.9 % Pediat Allergy Immunol RDTC Tanzania 3427 4.9 % in prep RDTC Zambia 185 8.61 % in prep RDTC Swaziland 350 9.14 % in prep
  • 19. Prevalence of AD has increased between ISAAC I and II
  • 20. Prevalence of AD has increased between ISAAC I and II
  • 21. Brit J Dermatol 2005; 152: 202
  • 22. Brit J Dermatol 2005; 152: 202
  • 23. Hygiene hypothesis dos not fit for atopic eczema Infections may worsen AE Early antibiotic intervention may worsen AE Brit J Dermatol 2005; 152: 202
  • 24. 306 children with AD; prevalnece 4.4 % 426 controls aged in Jimma, Southwest Ethiopa J Allergy Clin Immunol 2005;115:370
  • 25. J Allergy Clin Immunol 2005;115:370
  • 26. J Allergy Clin Immunol 2005;115:370
  • 27. Askaris J Allergy Clin Immunol 2005;115:370
  • 28. Associated factors with AD in SubSaharan Africa Associated with asthma and wheezing positive SPT parasite infestation (Trichuris) urbanization De Souza East Arican Med J 1992 Haileamlak A J Allergy Clin Immunol 2005 South african childhood atopic eczema working group South African Med J 2005 Dinkela A et al Int J Dermatol 2007
  • 29. Staphylococci in AD Increased skin permeability Upregulation of IL-31 Increased expression of CLA
  • 30. Staphylococci in AD Increased skin permeability Prolongation and Upregulation of IL-31 worsening of AD
  • 31. Staphylococci in AD Increased skin permeability Prolongation and Upregulation of IL-31 worsening of AD Sepsis and Death
  • 32. Atopic dermatitis in Zuerich, SWitzerland Atopic dermatitis in Kilombero Region, Tanzania Infectious agents play an important role In AD - direct effects - Senstizitation - for therapeutic approach
  • 33. What about Atopic dermatitis in Cape Region South Africa ?
  • 34. Xhosa speaking population in South Africa With atopic eczema 72 patients with atopic eczema (found in 3069 participants) Mean age 17.8 years (12-51 years Female: Male 52.4 : 47.6 Fatema Esmail Gail Todd Dept of Dermatology Groote Schur Hospital
  • 35. Pollen measurement in Tanzania / South Africa Goal of the study: Unknown data Climate changes in Africa ISAAC Questionaire Hard data
  • 36. Xhosa speaking population in South Africa Goal of the study: What are the sensitization patterns In AD patients ?
  • 37. Xhosa speaking population in South Africa With atopic eczema Sensitization patterns in Atopic Eczema 72 patients with atopic eczema (found in 3069 participants) Mean age 17.8 years (12-51 years Female: Male 52.4 : 47.6
  • 38. Xhosa speaking population in South Africa With atopic eczema Sensitization patterns in Atopic Eczema 72 patients with atopic eczema Mean age 17.8 years (12-51 years Female: Male 52.4 : 47.6 Mean Total Serum IgE: 7284.3 kU/l
  • 39. Xhosa speaking population in South Africa With atopic eczema Sensitization patterns in Atopic Eczema 72 patients with atopic eczema (found in 3069 participants) Mean age 17.8 years (12-51 years Female: Male 52.4 : 47.6 Mean Total Serum IgE: 7284.3 kU/l (2 - > 5000 kU/L) (max 31‘000 kU/l)
  • 40. Xhosa speaking population in South Africa With atopic eczema Specific IgE by ISAC 35 30 25 20 15 10 5 31.4 29.5 26.4 21.3 3.45 3.25 3.12 3.09 1.7 1.39 1.27 0.91 0.82 17 0.56 0.53 0.32 0.32 0.3 0.28 4.55 2.22 3.07 0 1.44 1.04 0.99 0.66 0.89 0 14.8 0.4612.3 0.25 0 0.65 0 0.78 0.92 2.07 0 0.82 0.7 0 0.74 0.99 0.36 0.57 0 0 0 5.8 0.25 8.3 4.58 3.55 3.54 0 2.01 1.82 0.7 1.14 0.79 0 0.55 11.7 0 0 0.96 0 0 Der p Der f 1 Bla g 2 Bla g 5 Phl p 1 Ph l 5 Fel d 1 Bos b Gal d Pen a 1 1,2, 4 1-3 1 3.6 2.72 3.29 0 2.12 2.36 0.98 1.57 1.35 0 0.81 0.4 0.5 1.14 0.34
  • 41. Xhosa speaking population in South Africa With atopic eczema Specific IgE by ISAC 35 30 25 31.4 29.5 26.4 21.3 20 15 10 5 3.45 3.25 3.12 3.09 1.7 1.39 1.27 0.91 0.82 17 0.56 0.53 0.32 0.32 0.3 0.28 4.55 2.22 3.07 0 1.44 1.04 0.99 0.66 0.89 0 14.8 0.4612.3 0.25 0 0.65 0 0.78 0.92 2.07 0 0.82 0.7 0 0.74 0.99 0.36 0.57 0 0 0 5.8 0.25 8.3 4.58 3.55 3.54 0 2.01 1.82 0.7 1.14 0.79 0 0.55 11.7 0 0 0.96 0 0 Der p Der f 1 Bla g 2 Bla g 5 Phl p 1 Ph l 5 Fel d 1 Bos b Gal d Pen a 1 1,2, 4 1-3 1 House dust mites Cockroaches Grass pollen Cat 3.6 2.72 3.29 0 2.12 2.36 0.98 1.57 1.35 0 0.81 0.4 0.5 1.14 0.34
  • 42. Xhosa speaking population in South Africa With atopic eczema Specific IgE by ISAC 35 30 25 31.4 29.5 26.4 21.3 20 15 10 5 3.45 3.25 3.12 3.09 1.7 1.39 1.27 0.91 0.82 17 0.56 0.53 0.32 0.32 0.3 0.28 4.55 2.22 3.07 0 1.44 1.04 0.99 0.66 0.89 0 14.8 0.4612.3 0.25 0 0.65 0 0.78 0.92 2.07 0 0.82 0.7 0 0.74 0.99 0.36 0.57 0 0 0 5.8 0.25 8.3 4.58 3.55 3.54 0 2.01 1.82 0.7 1.14 0.79 0 0.55 11.7 0 0 0.96 0 0 Der p Der f 1 Bla g 2 Bla g 5 Phl p 1 Ph l 5 Fel d 1 Bos b Gal d Pen a 1 1,2, 4 1-3 1 House dust mites Cockroaches Grass pollen Cat Milk Egg Tropo myosin 3.6 2.72 3.29 0 2.12 2.36 0.98 1.57 1.35 0 0.81 0.4 0.5 1.14 0.34
  • 43. Tropomyosin Crossallergy Anisakis Mites Cockroachs Seafood
  • 44. Reasons of foot dermatitis
  • 45. Reasons of foot dermatitis
  • 46. Reasons of foot dermatitis
  • 47. Reasons of foot dermatitis
  • 48. Contact allergy to Thiuram Mix
  • 49. „Patch test series in 158 patients at the RDTC inTanzania 1. Nickel Sulfate 2. Thiuram Mix 3. Mercapto Mix 4. Wood mix 5. p-Phenylendiamin PPDA 6. PPD-Mix 7. Potassium dichromat 8. Fragrance -Mix 9. Balsam of Peru 10. Cobalt chloride 11. Colophony 12. Thiomersal 13. Neomycine sulfate Entemesi et al J int Dermatol (in press)
  • 50. 27-years female
  • 51. 27-years female Contact allergy to Colonphony senitization
  • 52. Travel souvenirs
  • 53. Travel souvenirs Henna-Tattoo Lawsonia insermis L.
  • 54. le Contact allergy to Henna-Tattoo (due to Para-phenylen-Diamin PPD) Blair J, Brodell RT, Nedorost ST. Postgrad Med. 2004
  • 55. le Contact allergy to Henna-Tattoo (due to Para-phenylen-Diamin PPD) Blair J, Brodell RT, Nedorost ST. Postgrad Med. 2004
  • 56. Contact allergy to PPDA senitization
  • 57. TEN due Trimethoprim
  • 58. Dr. Shiang-Ju, the local host and Dr Philippe Eigenmann, Organizer, opening the meeting
  • 59. More than 200 highly interested doctors listening in Gabarone
  • 60. Proff. Antonella Murano and Adnan Custovic with the president of AllSA
  • 61. The faculty at AllSA meeting in South Africa
  • 62. T H A N K Y OU
  • 63. H T A N K Y OU Dept of Dermatology Groote Schur Hospital SNF GA2LEN Ulrich-Müller-Foundation Fatema Esmail Gail Todd Allergy unit Zuerich Barbra Fischer Susanne Haug Nada Juricevic Antonie Roll Brunello Wüthrich Günter Burg Swiss Institute of Allergy Research SIAF, Davos Sabine Zeller Beate Rückert Reto Crameri Axel Trautmann Cezmi Akdis Kurt Blaser Regional Dermatology Hospital, Ifakara, Training Centre Tanzania Moshi, Tanzania St Francis Disctrict Swiss Tropcial Institute Basel Almuth Dinklea Julia Ferie Christop Hatz Elisante Masenga Henning Grossmann
  • 64. 14. International CME for Dermatology and STI in the tropics 12.-14. January 2010 RDTC Moshi, Tanzania
  • 65. 14. International CME for Dermatology and STI in the tropics 12.-14. January 2014 RDTC Moshi, Tanzania