Papers by Elian Brenninkmeijer
International Journal of Surgery Case Reports, 2012
British Journal of Dermatology, 2008
For the treatment of a chronic disease like atopic dermatitis, sustained tolerability and efficac... more For the treatment of a chronic disease like atopic dermatitis, sustained tolerability and efficacy of the applied medication are essential. The present open-label, noncomparative study was conducted to obtain information on the long-term safety and efficacy of 0.1% tacrolimus ointment. Patients aged 2 years or older with an affected body surface area of more than 5%, who previously participated in a clinical trial on tacrolimus ointment, were eligible for this study. The treatment area was defined by the investigator at study entry. Both children and adults applied continuously or intermittently 0.1% tacrolimus ointment twice daily during episodes of active disease plus an additional week after remission over a follow-up period of up to 4 years. The intent-to-treat population comprised 782 patients, with a median age of 22 years (range 2-72). Patients remained in the study for up to 4 years. Approximately half of the patients discontinued the study prematurely; the median follow-up was 1422 days. Median tacrolimus ointment use was 31.2 g during the first week; ointment use decreased during the first year and then remained stable for the remainder of the study. The median cumulative tacrolimus use was 271.5 g at month 6, 462.5 g at month 12, 739.9 g at month 24, 1029.3 g at month 36 and 1320.8 g at month 48. Altogether 51.8% of patients discontinued the study prematurely; the main reasons were withdrawal of consent (13.3%), loss to follow-up (11.3%) and lack of efficacy (9.4%). Adverse events led to study discontinuation in 3.7% of the patients. The most frequent application site events were skin burning and pruritus. These events were most often reported in adult patients during the initial treatment period; prevalence decreased after the first week and remained at a low level throughout the study. Nonapplication site events occurred with stable incidences throughout the study period. In general, calculated daily hazard rates did not indicate an increased risk of adverse events with prolonged treatment. The total affected body surface area decreased substantially upon onset of treatment and efficacy of treatment was maintained until the end of the study with smaller but continuous improvements throughout the follow-up period. Overall, 75% of the patients and 76% of the investigators rated their satisfaction with the treatment as excellent, very good or good at the end of the study or at the time of premature discontinuation. The safety profile of intermittent or continuous long-term application of 0.1% tacrolimus ointment for up to 4 years was consistent with that which has been established from shorter studies and gave no reason for concern. In addition, 0.1% tacrolimus ointment demonstrated sustained efficacy as reflected by the expression of high satisfaction with treatment by both patients and investigators.
http://isrctn.org/>, 2013
Clinical, Cosmetic and Investigational Dermatology, 2021
Journal of the American Academy of Dermatology, 2008
Pediatric Dermatology, 2009
Journal of the American Academy of Dermatology, 2008
Background: Atopic dermatitis (AD) has been divided into the ''extrinsic'' and ''intrinsic'' type... more Background: Atopic dermatitis (AD) has been divided into the ''extrinsic'' and ''intrinsic'' type, in which ''intrinsic AD'' is characterized by the absence of allergen-specific IgE. Still, there is no consensus whether this ''intrinsic type'' of AD, which we denominate as atopiform dermatitis (AFD), is a distinct entity. Objective: A case-control study was performed to compare the clinical and diagnostic features of AD and AFD. Methods: Patients with a clinical diagnosis of AD were selected. Cases did not have demonstrable allergenspecific IgE. Matched control subjects were tested positive for allergen-specific IgE. Patients were evaluated for medical history, quality of life, disease severity, and Hanifin and Rajka, U.K. and Millennium diagnostic criteria. Results: Eight percent (n = 34) of the selected patients had, in fact, AFD. Female predominance, absence of atopic diseases, later onset of disease, and milder disease severity were observed in AFD. A history of atopy, recurrent conjunctivitis, palmar hyperlinearity, keratosis pilaris, pityriasis alba, and hand and/or food eczema were significantly less present in AFD. Dennie-Morgan fold was positively associated with AFD. Limitations: Not all patients with negative allergen-specific IgE participated and a relatively small number of AFD patients were studied. Conclusions: In addition to the absence of allergen-specific IgE, our findings support that AFD is an entity distinct from AD. With a distinction shown between AFD and AD, patient groups will be better defined and more homogeneous. Implications of this distinction will be of importance for preventive and therapeutic advice; diagnostic processes; and for future research.
The Journal of Hand Surgery, 2010
Purpose Raynaud's phenomenon is a vasospastic disorder of the palmar and digital vessels of the h... more Purpose Raynaud's phenomenon is a vasospastic disorder of the palmar and digital vessels of the hand and feet that can lead to ischemic ulcers, pain, and loss of function. This study is a review of patients I have injected with botulinum toxin type A for patients with Raynaud's phenomenon. Methods Raynaud's patients were injected with 50 to 100 units of onabotulinumtoxinA to improve perfusion of the digits. An institutional review board-approved retrospective review was undertaken to analyze outcomes. Laser Doppler scans were performed before and after injection to quantitatively measure perfusion. Results A total of 14 men and 19 women with Raynaud's phenomenon were injected with onabotulinumtoxinA. All but 5 patients experienced improved vascularity and relief of pain. Laser Doppler scans illustrated notable improvement in perfusion. Five patients had repeat injections for recurrent pain. Conclusions Botulinum toxin appears to improve perfusion of the hand after direct injection around the neurovascular bundles. Further investigations are warranted to identify the exact mode of action in relieving vasospasm and alleviating pain.
Experimental Dermatology, 2010
Please cite this paper as: Atopic eczema or atopiform dermatitis. Experimental Dermatology 2010.:... more Please cite this paper as: Atopic eczema or atopiform dermatitis. Experimental Dermatology 2010.: Age period prevalence of atopic eczema (AE), a very common skin disease, has increased during the past decennia. This expansion seems to be ending in wealthy countries, while an increase is observed in developing nations, for which there is no firm explanation. Recent steps in understanding AE are the detection of skin barrier related filaggrin null mutations in approximately 25% of patients and the recognition of IL‐31 as a molecule possibly involved in the itch (pruritus). Also interesting are the recognition of thymus and activation‐regulated chemokine (TARC) and proliferating‐inducing ligand (APRIL), as being associated with AE severity and activity. Immunocentric and corneocentric views on pathogenesis (the inside‐outside paradigm) and the diagnostic entity atopiform dermatitis (AFD) are discussed here. We emphasize that diagnosing AE is not simple but challenging. We accentuate t...
British Journal of Dermatology, 2008
Rationale: Atopic dermatitis/eczema (AD) has a wide spectrum of dermatological manifestations and... more Rationale: Atopic dermatitis/eczema (AD) has a wide spectrum of dermatological manifestations and despite various validated sets of diagnostic criteria that have been developed over the past decades, there is disagreement about its definition. Nevertheless, clinical studies require valid diagnostic criteria for reliable and reproducible results. Objective: to summarize the evidence concerning the validity of diagnostic criteria for AD. Methods: All data sources were identified through searches on MEDLINE, EMBASE and Cochrane databases. the Quality Assessment of Diagnostic Accuracy tool (QUADAS) was used. Results are presented in a receiver operating characteristic (RoC) plot. Results: out of the 20 articles that met the criteria, 27 validation studies were identified. In two studies concerning Hanifin and Rajka diagnostic criteria, sensitivity and specificity ranged from 87.9% to 96.0% and from 77.6% to 93.8%, respectively. Nineteen validation studies of the U.K. diagnostic criteria showed sensitivity and specificity ranging from 10% to 100% and 89.3% to 99.1%, respectively. three validation studies concerning the Schultz-Larsen criteria showed sensitivity from 88% to 94.4% and specificity from 77.6% to 95.9%. In one article concerning the criteria of Diepgen, the sensitivity ranged from 83.0% to 87.7% and the specificity from 83.9% to 87.0%. one article studied the Kang and tian criteria and reported 95.5% sensitivity and 100% specificity. one article validating the International Study of Asthma and Allergies in Childhood (ISAAC) criteria showed a positive and negative predictive value of 48.8% and 91.1%, respectively. Conclusion: With this systematic review of the existing sets of diagnostic criteria for AD a varying number of validation studies with varying methodological quality was found. the U.K. diagnostic criteria are the most extensively validated. However, improvement of methodological design for validation studies and uniformity in well validated and applicable diagnostic criteria are needed to improve future intervention studies and to compare study results.
British Journal of Dermatology, 2010
Expert Review of Dermatology, 2011
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Papers by Elian Brenninkmeijer