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Research Article
Usefulness of Sweat Management for Patients with Adult Atopic
Dermatitis, regardless of Sweat Allergy: A Pilot Study
Sakae Kaneko,1Hiroyuki Murota,2Susumu Murata,1Ichiro Katayama,2and Eishin Morita1
1Department of Dermatology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
2Department of Dermatology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
Correspondence should be addressed to Sakae Kaneko; kanekos@med.shimane-u.ac.jp
Received June ; Revised December ; Accepted December ; Published January
Academic Editor: Adam Reich
Copyright © Sakae Kaneko et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Sweat is an aggravating factor in atopic dermatitis (AD), regardless of age. Sweat allergy may be involved in AD
aggravated by sweating. Objective. We investigated whether sweat exacerbates adult AD symptoms and examined the extent of sweat
allergy’s involvement. Method. We asked AD patients ( men, women; mean age: . years) to record the extent to which
sweat aggravated their symptoms on a -point numerical scale. Participant responses were compared with histamine release tests
(HRT). Furthermore, of the patients received instructions on methods of sweat management, and their outcomes were evaluated
on a -point scale. Results. Sweat HRT results were class ≥ in patients, but HRT results were not correlated with the patients’
self-assessments of symptom aggravation by sweat. One month aer receiving sweat management instructions, a low mean score
of . was obtained regarding whether active sweating was good, but a high mean score of . was obtained in response to whether
the sweat management instructions had been helpful. Conclusion. Our investigation showed that patients’ negative impressions of
sweat might derive from crude personal experiences that are typically linked to sweating. Sweat management for patients with adult
atopic dermatitis was extremely useful regardless of sweat allergy.
1. Introduction
Atopic dermatitis (AD) is a chronic relapsing eczematous
skin disease characterized by pruritus and inammation and
is accompanied by cutaneous physiological dysfunction [].
Numerous AD-triggering factors are known, such as irritants,
aeroallergens, food, microbial organisms, and sweat/sweating
[]. Skin testing with autologous sweat is positive in most
patients with AD [, ], and the clinical symptoms of children
with AD improve signicantly during the summer if they
take showers at school [, ]. Semipuried sweat antigen
from normal adults induced histamine release from the
basophils of % of patients with AD and % of patients
with cholinergic urticaria in Japan [, ]. e histamine
releaseinducedbysemipuriedsweatantigenismediated
by specic immunoglobulin E (IgE) [, ]. Sweat histamine
release tests (HRTs; Allerport, Kyowa Medex Co., Ltd.,
Tokyo, Japan) are covered by the Japanese health insurance
system.emainsweatantigenisMGL, produced as
a minor immunological antigen of Malassezia globosa with
posttranslational modication, cleaved, and secreted as a
kDa major histamine-releasing sweat (Malassezia) antigen
[].
In the present study, we investigated whether sweat plays
a role in exacerbating adult AD symptoms and examined the
extent to which sweat allergy is involved.
2. Materials and Methods
2.1. Subjects. All patients were recruited from Shimane Uni-
versity Hospital between April and March before
they start sweating. We enrolled patients with AD that was
diagnosedfollowingtheJapaneseDermatologicalAssocia-
tion’s criteria. e enrolled patients included men and
women (mean age, . years; mean serum IgE, IU/mL)
who received an HRT (Allerport, Kyowa Medex Co., Ltd.,
Tokyo, Japan). Histamine release percentage was (antigen
specic histamine release amount – nonspecic histamine
release amount)/(total histamine release amount −nonspe-
cic histamine release amount) ×. HRT class does not
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Volume 2017, Article ID 8746745, 4 pages
https://doi.org/10.1155/2017/8746745
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exceed histamine release cuto (histamine release percentage
%) stimulated by any antigen concentration sample. HRT
class exceed histamine release cuto stimulated by the
darkest antigen concentration sample. HRT class exceed
histamine release cuto stimulated by the darkest antigen
sampleandseconddarkantigenconcentration.HRTclass
exceed histamine release cuto stimulated by the darkest
antigen sample, second dark antigen, and third dark antigen
concentration. HRT class exceed histamine release cuto
stimulated by the thinnest antigen concentration sample.
Eczema Area and Severity Index (EASI) developed by the
EASI Evaluator Group (maximum points) is used in this
study [].
2.2. Study Design. We asked the AD patients to record
the extent to which sweat aggravated their symptoms. e
participants recorded their responses using a -point numer-
ical scale, on which a score of indicated that sweat was
the greatest aggravating factor. Participant responses were
compared with the classes of results obtained from the HRT
of blood samples.
In a second component to this study, we also instructed
of the patients on methods of dealing with sweat (sweat
management). We subsequently evaluated the outcomes of
this instruction on a -point numerical scale. is study was
approved by the ethical committee of Shimane University and
thedeanoftheFacultyofMedicine(approvalnumber).
Inthecourseofoursweatmanagementinstructions,we
explained that it was ne to sweat profusely but additionally
requested that patients do at least one of the following: ()
shower at least once during the day (as soon as they sweat,
not since they came home), () wash the aected areas of
their skin with water, () apply wet wipes made of so
dough to irritated parts of their skin, and/or (4)change
their clothes when they became soaked with sweat. One
month aer this sweat management instruction, its outcomes
were determined via a questionnaire that used a -point
numerical scale.
2.3. Statistical Analysis. Spearman’s rank correlation test was
used to compare variables between groups. All analyses
were performed using STATA version (StataCorp, College
Station, TX, USA). A 𝑝value <. was considered statisti-
cally signicant. Continuous values are reported as means ±
standard deviations.
3. Results
In the HRT positive control test (anti-IgE antibody), of the
participants tested negative and were excluded from the
analysis; both these participants were women. A mean sweat
HRT class of 1.44 ± 1.61 was recorded. During treatment,
patients were asked to respond to the following question
on a scale of – with a score of indicating the greatest
degree of aggravation: “To what extent does sweat aggravate
your symptoms?” e mean of the patient scores was 5.85 ±
2.43. Blood was also collected, and correlations between the
original HRT results for sweat and patient responses were
Large
Small
0
2
4
6
8
10
01234
Contribution of sweat on
symptom aggravation
HRT class
F : e relationship between patients’ perceived symptom
aggravation due to sweat and histamine release test (HRT) results
(𝑁=32). Spearman’s rank correlation coecient revealed no
correlations (rs = −0.102,𝑝 = 0.286).
tested using Spearman’s rank correlation coecient. As can
be seen in Figure , no correlation was observed.
Subsequently, of the patients received guidance about
the importance of sweating as a bodily function, having the
opportunity to sweat on a daily basis, and taking measures
to prevent excess sweat on the skin. Regarding the patients’
motivations to sweat on a daily basis, of the participants
(one-third of the group) consciously worked up a sweat. With
regard to avoiding excess sweat on the skin, patients took
showers, washed the aected areas with water, and used
wipesoneasilyaggravatedareas.
Onemonthaereducationonsweatmanagementwas
provided, patients were asked to rate the following two
statements. e rst statement was “It was good to sweat,”
for which a mean response score of 4.63 ± 2.20 was recorded.
e second statement was “e countermeasures for sweating
were helpful,” for which the mean score was 7.04 ± 1.73.
Spearman’s rank correlation test showed a positive correlation
between these values (Figure ). But there was no signicant
relation of EASI between before and aer education on sweat
management (𝑁=24:before10.8± 4.8,aer10.7±5.2). e
reasonmightbethatpatientsweremildcasesandobservation
period was short.
Furthermore, a negative correlation was found between
the patients’ impressions of sweating and the results of
the sweat HRT (Figure ). Patients with high HRT results
(positive reaction against semipuried protein derived from
healthy adults) did not have a favorable impression of sweat-
ing. However, many patients still thought that our sweating
education was helpful (Figure ), and no correlation was
found between HRT class and patients’ impressions of the
measures against excess sweat on the skin (Figure ).
4. Discussion
Patients may oen be directed to avoid sweating based on the
belief that sweat is an exacerbating factor for AD. Sweating
plays key roles in skin homeostasis, antimicrobial [], and
moisturizing eects [] and in skin surface pH regulation
BioMed Research International
0
2
4
6
8
10
0246810
Favorable
Bad
Favorable
Bad
Impact of sweat management
Impact of sweating on symptoms
F : e relationship between perception of sweat and the
degree of helpfulness provided by sweat management instructions at
month aer the instructions (𝑁=24). Spearman’s rank correlation
test showed a strong correlation between these values (rs = 0.348,
𝑝 = 0.0475).
Favorable
Bad
0
2
4
6
8
10
01234
HRT class
Impact of sweating on symptoms
F : e relationship between human sweat histamine release
test (HRT) class and the perception of sweat at month aer sweat
management (𝑁=23). Spearman’s rank correlation test indicated a
signicant correlation (rs = −0.411,𝑝 = 0.0271).
[]. Skin care with daily showering at an elementary school
was found to be eective for the treatment of atopic dermatitis
[]. However, few studies have evaluated the impact of sweat
education on the awareness of patients with AD. erefore,
we conducted a pilot study to investigate the impact of
educationonsweating.Wefoundnocorrelationbetween
the result of HRTs against sweat antigen and the degree
of a bad impression of sweat. Additionally, there was no
evident correlation between the degree of a bad impression
of sweat and the self-perceived extent of sweating aer
sweat management (Spearman’s rank correlation test: rs =
0.0323,𝑝 = 0.438). erefore, this does not indicate that
excess sweating aggravates the symptom of AD. We also
analyzed HRTs against sweat in the group that received
sweat management education. e measurement results of
HRTs were not aected by receiving sweat management
instructions (Spearman’s rank correlation test: rs = 0.0131,
𝑝 = 0.498). In fact, patients with a bad impression of sweat
showed high HRT results.
However, many patients still thought that taking mea-
sures against excess sweating was good. Furthermore, no
correlation was found between the results of the HRT and
patients’ favorable impression of countermeasures against
sweating.us,weconcludedthatitwasworthwhileto
oer proper guidance about sweat to patients with AD.
Unexpectedly, several subjects in our study are likely to think
that sweating is good for relieving their skin symptoms.
is might further be interpreted as suggesting that sweating
could be a mitigating factor in some cases, rather than an
aggravating factor.
In addition, we administered a separate questionnaire
survey to patients. In this questionnaire, patients were asked,
“Have you received guidance on what you should do aer
sweating?” No bad impressions were found in taking mea-
sures to avoid sweat on the skin. We found that three-fourths
of those surveyed have in fact been given such advice [].
is result also indicates that patient guidance for sweating
management is quite important.
In general, sweat has been thought to aggravate AD
by allergic reaction against the Malassezia antigen or by
impaired skin homeostasis due to decreased sweating. Our
study found that patients’ impression of “sweat is bad”
might have come from crude personal experiences which are
ordinarily linked with sweating (e.g., associations between
sweating and hot environments, exercise, and nervousness).
5. Conclusions
Sweat management for patients with adult atopic dermatitis
was extremely useful, regardless of sweat (Malassezia) aller-
giesorbadimpressionforsweating.
Competing Interests
e authors declare no conict of interests.
Acknowledgments
is work was supported in part by Health and Labor
Sciences Research Grants (Research on Intractable Diseases)
fromtheJapaneseMinistryofHealth,LaborandWelfare.An
earlier version of this work was presented as an abstract at the
rd Eastern Asia Dermatology Congress, Jeju, .
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