ATOPIC DERMATITIS-LIKE SKIN DISEASE IN PEDIATRIC HEART TRANSPLANT PATIENTS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Atopic dermatitis (AD) is a pruritic, inflammatory, relapsing skin disease frequently manifest in infancy or early childhood. The term atopy suggests a genetic IgE mediated hypersensitivity to environmental allergens.(1) Histologically, dermal inflammation with T cells, macrophages and eosinophils may be present.(3,4,5) Immunologically, a Th2 lymphocyte cytokine profile consisting of increased IL-4, IL-5, IL-10, and IL-13, and decreased levels of interferon gamma (IFN-gamma) is observed. (2) Recently topical tacrolimus (Protopic), an approved therapy for AD in children and adults, has become an alternative treatment to corticosteroids. Severe AD, which is refractory to conservative measures sometimes requires the use of a systemic immunomodulator, such as cyclosporine. (6) Oral cyclosporine (5-10 mg/kg/day) and oral tacrolimus (0.2-0.4 mg/kg/day) are commonly used in pediatric transplant patients because of their efficacy in suppressing organ rejection.(7) However, even with systemic immunomodulation, these children often develop a rash that appears consistent with AD. Our goal is to clinically evaluate this rash to determine if it is atopic determatitis or another entity. Initially, a questionnaire and a review of medical records will be used to determine family history of atopy, patient history of skin disease, and therapeutic regimen. The clinical examination will include a physical examination, punch biopsy, and bacterial swab. A blood draw for the examination of specific IgE levels and cytokine analysis will be coordinated with the patients' routine pediatric cardiology care. The GCRC will aid this project by providing space for the clinical exmination. Ideally, this will streamline the data collection process and provide a comfortable atmosphere for our pediatric patients.