Quantitative evaluation of itch is important in assessing the treatment efficacy of atopic dermatitis (AD). Especially for the judgment of a specific anti-pruritic therapy, itch measurement should be performed according to unified standard criteria worldwide. From this viewpoint the recent advances in the evaluation of itch were presented in the talk. The validation and harmonization studies of the scales to quantify itch such as verbal rating scale (VRS), visual analogue scale (VAS) and numerical rating scale (NRS) were cited and mentioned. In the latter part of the talk, the development and validation study of the Japanese version of the 5D-Itch scale (5D-J) were presented. 5D was created as a self-administered questionnaire consisting of 5 domains of itch such as duration, degree, direction, disability and distribution. The 5D-J was produced following the standard protocols of forward/backward translation with pretest. A total of 169 adult patients with AD participated in the study to test the reliability, validity and responsiveness of the 5D-J. The 5D-J score correlated significantly with VAS score of itch intensity (r=0.666, p<0.0001), with SCORAD score of the skin lesion (r=0.385, p<0.0001), and with DLQI score (r=0.671, p<0.0001). Among the 5 domains of the questionnaire, “degree” domain showed a strong correlation with VAS, “degree” and “distribution” domains showed a relatively high correlation with SCORAD, and “degree” and “disability” domains showed a strong correlation with DLQI. Internal consistency and test-retest reliability were satisfactory. Changes in 5D-J score over the course of 4 to 12 weeks correlated well with those of VAS suggesting a good responsiveness. Patients' evaluation revealed that it took 3.5 +/- 2.1 minutes to complete 5D-J and they found it easier to express the extent of itch compared to VAS. We conclude that the 5D-J is a reliable tool to measure itch in adult patients with AD.Skin Research, Suppl. 23:1-6, 2015

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Questioning about itchiness to patients with pruritic diseases are time-consuming, because complain of when and how they experience itching is so various. It was attempted, therefore, to create standard questions to evaluate itchiness that occurs from morning to night in daily life. Ten questions were selected and applied to 50 new patients with atopic dermatitis. Answers were obtained by six points in verbs. Global itch evaluation was also tested for comparison. Individual ten evaluations were well correlated with global evaluation in some but not others. Correlations between individual questions were tested. Here also, good correlations were obtained in some but not others. To accomplish multiple questions, test for validity and reliability are necessary.Skin Research, Suppl. 23:7-8, 2015

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Skin Research, Suppl. 23: 9, 2015

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Atopic dermatitis is a chronic skin disease which is associated with pruritus.
Topical steroid is a basic treatment. Most of the patients can reach to the goal which is described in the clinical guideline by Japanese Dermatological Association as below.
(1) No symptom or mild symptom without daily disturbance or heavy treatment (2) chronic mild symptom without long flare.
However, some of the patients reach to severe or almost severe condition because of bad adherence or other reasons. In this lecture, I am going to introduce my experience of oral ciclosporin for atopic dermatitis. I also compare my experience with guideline of ciclosporin treatment. Ciclosporin treatment is not a first line treatment but one of good option for severe cases.Skin Research, Suppl. 23: 10-12, 2015

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We have executed tight control of severe atopic dermatitis after established a patient educational system since 2009. The concept of tight control is accurate proactive therapy with the aim of zero-control. The method is initial rapid normalization of both all skin lesion and serum biomarker, thymus and activation-regulated chemokine (TARC), level by intensive topical corticosteroid application followed with maintaining their normal status by gradually decreased frequency of topical medication. The prognosis of severe atopic dermatitis of both infants and adults has been much improved. Particularly for infant, not only clinical but also laboratory findings have been improved compared with 1990s' data of those whose eczema was not controlled under wait-and-see strategy. Persistent cases have obviously decreased in number and elevation ratio of serum total and food-specific IgE level has diminished. These results strongly suggest the favorable effect of this strategy to eczema and atopic diathesis. In atopic dermatitis topical anti-inflammatory therapy is not only a conservative alleviating treatment but also to be a possible disease-modifying strategy with preventing persistent refractory disease course by execution of tight control.Skin Research, Suppl. 23: 13-18, 2015

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Recent studies have suggested that atopic dermatitis (AD) and/or epidermal barrier dysfunction in infancy contribute to the development of allergic sensitization and other allergic diseases, so called “allergic march”. Is it possible to prevent the development of allergic march by application of moisturizer to neonates or early intervention to infantile atopic dermatitis?
Retrospective chart survey was applied for all 26 infants under a year old admitted for treatment of severe atopic dermatitis to our hospital. Incidence of food allergy at 18 months of age in the early intervention group who was admitted before 5 months old was significantly lower than that of the late intervention group who was admitted at 5 months old or later (50% vs 100%, p<0.01). Another retrospective study of child patients with moderate to severe AD revealed that the serum total IgE level, egg white- and milk-specific total IgE level were significantly decreased in the patients with proactive therapy during the maintenance phase compared with the reactive treatment group. The short duration of skin barrier dysfunction in the early intervention group or the complete suppression of skin inflammation in the proactive treatment group might have preventive effect on the trans epidermal sensitization.
We performed a prospective, randomized controlled trial to investigate whether protecting the skin barrier with a moisturizer during the neonatal period prevents development of AD and allergic sensitization. An emulsion-type moisturizer was applied daily during the first 32 weeks of life to 59 of 118 neonates at high risk for AD (based on having a parent or sibling with AD) who were enrolled in this study. The onset of AD/eczema (eczematous symptoms lasting >2 weeks) was assessed by a dermatology specialist on the basis of the modified Hanifin and Rajka criteria. Approximately 32% fewer neonates who received the moisturizer had AD/eczema by week 32 than control subjects (p=0.012, log-rank test).
Daily application of moisturizer to neonates and in early infancy reduces the risk of AD/eczema in infants and may prevent the development of allergic march.Skin Research, Suppl. 23: 19-22, 2015

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Recently, the application of moisturizers has been thought to protect the skin barriers in early infancy and prevent allergen skin sensitization and the allergic march. To clarify the factors related to allergen sensitization in infancy, a prospective birth cohort study of 268 newborn infants with a family history of allergies was set up in Chiba, Japan from 2010 to 2012. We found that subjects with eczema on the face before the age of 3 months, who were breast-fed, with colonization of Staphylococcus aureus on the face, or who had a family history of allergic diseases were more likely to be sensitized to egg whites at 1 year of age, suggesting that skin care which could especially prevent the development of face eczema before the age of three months and that it may prevent sensitization to egg white allergy. On the other hand, subjects with face eczema who were younger than 3 months of age, with only limited exposure to house dust mites were more likely to be sensitized to house dust mites at 1 year of age, suggesting that skin care for subjects with a high exposure to house dust mites may not prevent sensitization to house dust mites. In conclusion, not only face eczema in early infancy, but also other factors, such as the types of allergens, types of feeding or the amount of allergens in the environment may all play a role in allergen sensitization. Therefore, skin care alone in early infancy may not necessarily prevent the allergic march.Skin Research, Suppl. 23: 23-24, 2015

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We introduced here an airborne contact dermatitis due to Japanese cedar pollen in the spring and autumn season. The Japanese cedar pollen dermatitis (JCPD) rash has a characteristic appearance which is similar to an urticarial erythema eruption without papules. The scratch-patch-test using JCPD is useful for diagnosing JCPD. We also introduced a therapy and prevention for JCPD.Skin Research, Suppl. 23: 25-28, 2015

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Skin Research, Suppl. 23: 29, 2015

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Itch is one the major symptoms of atopic dermatitis (AD). Itch-induced scratching exacerbates skin lesion. Nocturnal itch causes sleep disturbance which markedly reduces quality of life of patients and their guardians. However, development of new anti-pruritus agents still remains in slow pace. In this talk, I will summarize the effects of standard treatments on atopic itch. I will also mention about the emerging anti-pruritus therapies for AD published in the literature.Skin Research, Suppl. 23: 30-32, 2015

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Atopic dermatitis is common inflammatory skin disease. Although topical therapy forms the basis of treatment, some are intractable. Recently, ultraviolet irradiation has been employed to such intractable cases, and yielded a favorable clinical effect. The aim of this study was to investigate the efficacy and safety of the treatment with targeted 308-nm excimer light in atopic dermatitis and prurigo nodularis.
This is an observational study, and summarized the information of subjects with atopic dermatitis treated with 308-nm excimer light. Seventeen patients with atopic dermatitis, who showed resistance to topical steroid and oral antihistamines, were enrolled to this study. Irradiation was started from 150 or 300 mJ/cm2. If there was no adverse event, irradiation dose was occasionally increased by 20%. Irradiation with 308-nm excimer light was performed once a week for 2 months. Treatment effects are evaluated before treatment and 2 months after the initiation of treatment.
The results of this study suggest that 308-nm excimer light irradiation is effective in the treatment of atopic dermatitis. The 308-nm excimer light irradiation treatment would be worth trying to atopic dermatitis.Skin Research, Suppl. 23: 33-34, 2015

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Skin Research, Suppl. 23: 35, 2015

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The itching affects the whole body in patients with severe atopic dermatitis (AD), and induces intensive scratching of the skin lesions. Scratch exacerbates the dermatitis discharging chemical mediators in skin. Here we explaine the efficacy of a second-generation antihistamine to ameliorate the scratching behavior in AD.
The damaged skin by scratching and eczematous inflammation release a massive amount of the proinflammatory cytokines from the epidermis into the systemic circulation targeting to the distant organs, causing several organ involvements including systemic sclerotic changes of the arteries. We explain the concept of “inflammatory skin march”.Skin Research, Suppl. 23: 36-38, 2015

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