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Sample records for atopic dermatitis part

  1. Atopic dermatitis

    MedlinePlus

    ... People with atopic dermatitis often have asthma or seasonal allergies. There is often a family history of allergies such as asthma, hay fever, or eczema. People with atopic dermatitis often test ...

  2. Atopic Dermatitis

    MedlinePlus

    ... when conscious control of scratching is lost. The appearance of the skin that is affected by atopic ... social and emotional stress associated with changes in appearance caused by atopic dermatitis. The child may face ...

  3. Guidelines for treatment of atopic eczema (atopic dermatitis) Part II.

    PubMed

    Ring, J; Alomar, A; Bieber, T; Deleuran, M; Fink-Wagner, A; Gelmetti, C; Gieler, U; Lipozencic, J; Luger, T; Oranje, A P; Schäfer, T; Schwennesen, T; Seidenari, S; Simon, D; Ständer, S; Stingl, G; Szalai, S; Szepietowski, J C; Taïeb, A; Werfel, T; Wollenberg, A; Darsow, U

    2012-09-01

    The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies. PMID:22813359

  4. Guidelines for treatment of atopic eczema (atopic dermatitis) part I.

    PubMed

    Ring, J; Alomar, A; Bieber, T; Deleuran, M; Fink-Wagner, A; Gelmetti, C; Gieler, U; Lipozencic, J; Luger, T; Oranje, A P; Schäfer, T; Schwennesen, T; Seidenari, S; Simon, D; Ständer, S; Stingl, G; Szalai, S; Szepietowski, J C; Taïeb, A; Werfel, T; Wollenberg, A; Darsow, U

    2012-08-01

    The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies. PMID:22805051

  5. Atopic dermatitis

    PubMed Central

    2011-01-01

    Atopic dermatitis (AD) is a common, chronic skin disorder that can significantly impact the quality of life of affected individuals as well as their families. Although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental and infectious agents, and immune abnormalities. There are no specific diagnostic tests for AD; therefore, the diagnosis is based on specific clinical criteria that take into account the patient’s history and clinical manifestations. Successful management of the disorder requires a multifaceted approach that involves education, optimal skin care practices, anti-inflammatory treatment with topical corticosteroids and/or topical calcineurin inhibitors (TCIs), the use of first-generation antihistamines to help manage sleep disturbances, and the treatment of skin infections. Systemic corticosteroids may also be used, but are generally reserved for the acute treatment of severe flare-ups. Topical corticosteroids are the first-line pharmacologic treatments for AD, and evidence suggests that these agents may also be beneficial for the prophylaxis of disease flare-ups. Although the prognosis for patients with AD is generally favourable, those patients with severe, widespread disease and concomitant atopic conditions, such as asthma and allergic rhinitis, are likely to experience poorer outcomes. PMID:22166055

  6. Atopic dermatitis.

    PubMed

    Weidinger, Stephan; Novak, Natalija

    2016-03-12

    Atopic dermatitis (also known as atopic eczema) is a chronic inflammatory skin disease that is characterised by intense itching and recurrent eczematous lesions. Although it most often starts in infancy and affects two of ten children, it is also highly prevalent in adults. It is the leading non-fatal health burden attributable to skin diseases, inflicts a substantial psychosocial burden on patients and their relatives, and increases the risk of food allergy, asthma, allergic rhinitis, other immune-mediated inflammatory diseases, and mental health disorders. Originally regarded as a childhood disorder mediated by an imbalance towards a T-helper-2 response and exaggerated IgE responses to allergens, it is now recognised as a lifelong disposition with variable clinical manifestations and expressivity, in which defects of the epidermal barrier are central. Present prevention and treatment focus on restoration of epidermal barrier function, which is best achieved through the use of emollients. Topical corticosteroids are still the first-line therapy for acute flares, but they are also used proactively along with topical calcineurin inhibitors to maintain remission. Non-specific immunosuppressive drugs are used in severe refractory cases, but targeted disease-modifying drugs are being developed. We need to improve understanding of the heterogeneity of the disease and its subtypes, the role of atopy and autoimmunity, the mechanisms behind disease-associated itch, and the comparative effectiveness and safety of therapies. PMID:26377142

  7. A practical overview of pediatric atopic dermatitis, part 1: epidemiology and pathogenesis.

    PubMed

    Silverberg, Nanette B

    2016-04-01

    Atopic dermatitis (AD) is a multisystem inflammatory disorder that is part of the spectrum of atopy, a series of conditions in which hyperreactivity and allergic symptoms are triggered by a series of causes including environmental allergens and irritants. Atopic dermatitis affects approximately one-quarter of children in developed countries and can have a negative impact on quality of life. In part 1 of this series addressing AD, the epidemiology and pathogenesis of AD are reviewed with an overview of skin barrier function. Later parts will address triggers, AD grading, differential diagnosis, comorbidities, and treatment options. PMID:27163911

  8. Eczema and Atopic Dermatitis

    MedlinePlus

    ... extra ingredients. A good, cheap moisturizer is plain petroleum jelly (such as Vaseline). Use moisturizers that are ... a flare-up? SourceSome information taken from: National Institutes of Health. Handout on Health: Atopic Dermatitis. Accessed ...

  9. Eczema (Atopic Dermatitis) Complications

    MedlinePlus

    ... Diseases Asthma Food Allergy Immune System Methicillin-Resistant Staphylococcus Aureus (MRSA) National Library of Medicine, MedlinePlus ​ Javascript ... atopic dermatitis. Bacterial Infections Scanning electron micrograph of Staphylococcus aureus bacteria. Credit: NIAID A major health risk ...

  10. Atopic dermatitis: allergic dermatitis or neuroimmune dermatitis?*

    PubMed Central

    Gaspar, Neide Kalil; Aidé, Márcia Kalil

    2016-01-01

    Advances in knowledge of neurocellulars relations have provided new directions in the understanding and treatment of numerous conditions, including atopic dermatitis. It is known that emotional, physical, chemical or biological stimuli can generate more accentuated responses in atopic patients than in non-atopic individuals; however, the complex network of control covered by these influences, especially by neuropeptides and neurotrophins, and their genetic relations, still keep secrets to be revealed. Itching and airway hyperresponsiveness, the main aspects of atopy, are associated with disruption of the neurosensory network activity. Increased epidermal innervation and production of neurotrophins, neuropeptides, cytokines and proteases, in addition to their relations with the sensory receptors in an epidermis with poor lipid mantle, are the aspects currently covered for understanding atopic dermatitis. PMID:27579744

  11. Atopic dermatitis: an overview.

    PubMed

    Berke, Rebecca; Singh, Arshdeep; Guralnick, Mark

    2012-07-01

    Atopic dermatitis, also known as atopic eczema, is a chronic pruritic skin condition affecting approximately 17.8 million persons in the United States. It can lead to significant morbidity. A simplified version of the U.K. Working Party's Diagnostic Criteria can help make the diagnosis. Asking about the presence and frequency of symptoms can allow physicians to grade the severity of the disease and response to treatment. Management consists of relieving symptoms and lengthening time between flare-ups. Regular, liberal use of emollients is recommended. The primary pharmacologic treatment is topical corticosteroids. Twice-daily or more frequent application has not been shown to be more effective than once-daily application. A maintenance regimen of topical corticosteroids may reduce relapse rates in patients who have recurrent moderate to severe atopic dermatitis. Pimecrolimus and tacrolimus are calcineurin inhibitors that are recommended as second-line treatment for persons with moderate to severe atopic dermatitis and who are at risk of atrophy from topical corticosteroids. Although the U.S. Food and Drug Administration has issued a boxed warning about a possible link between these medications and skin malignancies and lymphoma, studies have not demonstrated a clear link. Topical and oral antibiotics may be used to treat secondary bacterial infections, but are not effective in preventing atopic dermatitis flare-ups. The effectiveness of alternative therapies, such as Chinese herbal preparations, homeopathy, hypnotherapy/biofeedback, and massage therapy, has not been established. PMID:22962911

  12. Fabrics for atopic dermatitis.

    PubMed

    Mason, Rupert

    2008-01-01

    The type of fabric worn by sufferers from atopic dermatitis should not exacerbate the condition but, if possible, help to control it. Synthetic fabrics and wool tend to produce itching and irritate the skin. Cotton is traditionally recommended but its structure contains short fibres which expand and contract, causing a rubbing movement that can irritate delicate skin. Dyes used in cotton garments can increase the potential of a sensitivity reaction. Cotton is also prone to bacterial and fungal attack. Silk garments are often closely woven which impedes the flow of air, and some people are allergic to the sericin protein in silk. Published studies suggest that a specially treated silk material (DermaSilk), which is loosely knitted, has had the sericin removed and has a microbial agent (AEM 5772/5) permanently bonded to it, is well tolerated and has beneficial effects on the skin of children and adults with atopic dermatitis. Atopic dermatitis often becomes infected, commonly with Staphylococcus aureus. Some studies have investigated the use of clothing materials impregnated with substances such as silver, which has antimicrobial properties. However, these are still unproven and there are concerns about bacterial resistance and the local and environmental effects of silver. The use of the antimicrobial AEM 5772/5, which does not transfer to the skin of the patient, is a new development in the control of atopic dermatitis. Further studies are needed to determine whether an antimicrobial shield bonded to clothing material will reduce the colonisation of atopic skin by S. aureus. PMID:18512638

  13. Eczema (Atopic Dermatitis) Diagnosis

    MedlinePlus

    ... the NIAID Institute of Allergy and Infectious Diseases web site to work incorrectly. Please visit your browser settings and turn JavaScript on. Read more information on enabling JavaScript. Skip Content Marketing Share this: Main Content Area Eczema (Atopic Dermatitis) ...

  14. Eczema (Atopic Dermatitis) Symptoms

    MedlinePlus

    ... the NIAID Institute of Allergy and Infectious Diseases web site to work incorrectly. Please visit your browser settings and turn JavaScript on. Read more information on enabling JavaScript. Skip Content Marketing Share this: Main Content Area Eczema (Atopic Dermatitis) ...

  15. Diet in dermatology: Part I. Atopic dermatitis, acne, and nonmelanoma skin cancer.

    PubMed

    Bronsnick, Tara; Murzaku, Era Caterina; Rao, Babar K

    2014-12-01

    Patients commonly inquire about dietary modifications as a means to prevent or manage skin disease. Answering these questions is often challenging, given the vast and conflicting evidence that exists on this topic. This 2-part continuing medical education article summarizes the evidence to date to enable physicians to answer patients' questions in an evidence-based manner. Part I includes atopic dermatitis, acne, and nonmelanoma skin cancer. The role of dietary supplementation, dietary exclusion, food allergy, maternal diet, and breastfeeding in the development and/or prevention of atopic dermatitis is summarized. The dermatoendocrinologic mechanism for the effects of glycemic index/glycemic load and milk on acne is described, as well as related clinical evidence for dietary modifications. Finally, evidence and recommendations for restriction or supplementation of dietary factors in the prevention of nonmelanoma skin cancer, including fat, vitamins A, C, D, and E, and selenium, are reported. PMID:25454036

  16. [Etiopathogenesis of atopic dermatitis].

    PubMed

    Oehling, A; Jerez, J

    1975-01-01

    There is a wide variety of criteria in regard to the etiology of atopic dermatitis of neurodermitis. The allergic factor may play a very important role in its etiology. There is neither a general agreement on the importance of food allergy in this regard. Broadly considered, these patients may evoke intense positive reactions to intradermal tests to food and inhalative allergens, nevertheless it will be possible to establish that the lesions appear or disappear after the exposure of suppression of the antigens which evoked the positive reaction. On this basis, many dermatologists deny the allergic etiology in atopic dermatitis, even though in most instances no food skin tests are performed. In this study, 110 patients, both children and adults of both sexes, suffering from atopic dermatitis are investigated. The onset in most of the cases is before the age of six months, following the ages between 1-10 years; the groups between 6 months and one year, and 10-20 years followed a descending order per decade until 70 years. 60.9% of the cases showed food allergy to one or more food items. In 39% of the cases, no food allergy was found. The food-stuffs more commonly involved were: milk (37.7%), egg (26.3%) and fish (20.9%), followed by coca, wheat flour, seafood, fruits, vegetables and meat. A remission of the reaction followed the suppression of the allergen. Intestinal parasitosis is evaluated in relation to atopic dermatitis. 30.9% of the 110 cases were affected with intestinal parasitosis, being the most common the flagelates (lamblias), protozoa (amoeba) and nematodes (ascaris, tricocephalus and oxijrus). Finally, a concurrence is found between atopic dermatitis and other allergic diseases in 81 cases (73.6%), being bronchial asthma and asthmatic bronchitis the most frequent, and allergic rhinitis, urticaria and Quincke's edema less frequent. PMID:1180202

  17. Microbiome and pediatric atopic dermatitis.

    PubMed

    Powers, Claire E; McShane, Diana B; Gilligan, Peter H; Burkhart, Craig N; Morrell, Dean S

    2015-12-01

    Atopic dermatitis is a chronic inflammatory skin condition with drastic impacts on pediatric health. The pathogenesis of this common disease is not well understood, and the complex role of the skin microbiome in the pathogenesis and progression of atopic dermatitis is being elucidated. Skin commensal organisms promote normal immune system functions and prevent the colonization of pathogens. Alterations in the skin microbiome may lead to increased Staphylococcus aureus colonization and atopic dermatitis progression. Despite the evidence for their important role, probiotics have not been deemed efficacious for the treatment of atopic dermatitis, although studies suggest that probiotics may be effective at preventing the development of atopic dermatitis when given to young infants. This review will cover the most recent published work on the microbiome and pediatric atopic dermatitis. PMID:26388516

  18. Atopic dermatitis and nutrition.

    PubMed

    Finch, Justin; Munhutu, M N; Whitaker-Worth, Diane L

    2010-01-01

    Atopic dermatitis, a chronic disease with no cure, currently affects almost one-fifth of the population of industrialized nations. Treatment can be challenging for physicians and patients alike. Children are commonly affected, making it even more difficult to find safe therapeutic options, especially in severe disease. Interest in diet and nutrition has increased during the last few years. Nutritional interventions are both intriguing and accessible for many patients. Given the recent expansion of the field of nutrition in the realm of medicine and in popular culture, it is important for the dermatologist to be knowledgeable about the risks and benefits of nutritional interventions. This contribution reviews the current literature on the role of nutrition in atopic dermatitis, from dietary restriction to dietary supplementation, from traditional interventions such as vitamins and minerals to the emerging fields of probiotics and essential fatty acids, and from the prenatal period through infancy and adulthood. PMID:21034985

  19. Which plant for which skin disease? Part 1: Atopic dermatitis, psoriasis, acne, condyloma and herpes simplex.

    PubMed

    Reuter, Juliane; Wölfle, Ute; Weckesser, Steffi; Schempp, Christoph

    2010-10-01

    Plant extracts and isolated compounds are increasingly used in cosmetics and food supplements to improve skin conditions. We first introduce the positive plant monographs with dermatological relevance of the former German Commission E. Subsequently clinical studies with botanicals for atopic dermatitis, psoriasis, acne, condylomata acuminata and herpes simplex are discussed. The best studies have been conducted with atopic dermatitis and psoriasis patients. Mahonia aquifolium, Hypericum perforatum, Glycyrrhiza glabra and certain traditional Chinese therapies have been shown to be effective in the treatment of atopic dermatitis. Mahonia aquifolium, Indigo naturalis and Capsicum frutescens are effective treatments for psoriasis. Green tea extract and tea tree oil have been investigated in the treatment of acne. Podophyllin and green tea extract are effective treatments for condylomata acuminata. Balm mint and a combination of sage and rhubarb have been shown to be effective in the treatment of herpes simplex in proof of concept studies. PMID:20707875

  20. Atopic dermatitis - self-care

    MedlinePlus

    ... St. Louis, MO: Elsevier Saunders; 2016:chap 5. James WD, Berger TG, Elston DM. Atopic dermatitis, eczema, and noninfectious immunodeficiency disordersIn: James WD, Berger TG, Elston DM, eds. Andrews' Diseases ...

  1. Eczema (Atopic Dermatitis)Treatment

    MedlinePlus

    ... Read more information on enabling JavaScript. Skip Content Marketing Share this: ... at Home You and your doctor should discuss the best treatment plan and medications for your atopic dermatitis. But taking ...

  2. Protein Linked to Atopic Dermatitis

    MedlinePlus

    ... is elevated in mice with atopic dermatitis. The factors involved in this regulation, however, aren’t well understood. Past work led by Dr. Arup Indra at Oregon State University showed that COUP-TF interacting protein 2 (Ctip2) ...

  3. Traditional Smallpox Vaccines and Atopic Dermatitis

    MedlinePlus

    ... the traditional vaccine for people with atopic dermatitis/eczema, or for their close contacts? Yes. In the ... emergency. Why should someone who has atopic dermatitis/eczema and their family members not receive the vaccine? ...

  4. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

    PubMed Central

    Kim, Jung Eun; Kim, Hyun Jeong; Lew, Bark-Lynn; Lee, Kyung Ho; Hong, Seung Phil; Jang, Yong Hyun; Park, Kui Young; Seo, Seong Jun; Bae, Jung Min; Choi, Eung Ho; Suhr, Ki Beom; Lee, Seung Chul; Ko, Hyun Chang; Park, Young Lip; Son, Sang Wook; Seo, Young Jun; Lee, Yang Won; Cho, Sang Hyun; Park, Chun Wook

    2015-01-01

    Background Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. Objective We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. Methods We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. Results The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. Conclusion We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs. PMID:26512172

  5. Advances in understanding and managing atopic dermatitis

    PubMed Central

    Barton, Michael; Sidbury, Robert

    2015-01-01

    Atopic dermatitis is a chronic, pruritic skin disease characterized by an improperly functioning skin barrier and immune dysregulation. We review proposed atopic dermatitis pathomechanisms, emphasizing how these impact current perspectives on natural history, role of allergic sensitization, and future therapeutic targets. PMID:26918129

  6. Oxidative Stress in Atopic Dermatitis

    PubMed Central

    Ji, Hongxiu; Li, Xiao-Kang

    2016-01-01

    Atopic dermatitis (AD) is a chronic pruritic skin disorder affecting many people especially young children. It is a disease caused by the combination of genetic predisposition, immune dysregulation, and skin barrier defect. In recent years, emerging evidence suggests oxidative stress may play an important role in many skin diseases and skin aging, possibly including AD. In this review, we give an update on scientific progress linking oxidative stress to AD and discuss future treatment strategies for better disease control and improved quality of life for AD patients. PMID:27006746

  7. Serotonergic Markers in Atopic Dermatitis.

    PubMed

    Rasul, Aram; El-Nour, Husameldin; Lonne-Rahm, Sol-Britt; Fransson, Oscar; Johansson, Charlotta; Johansson, Björn; Zubeidi, Marwe; Seeberg, Emma; Djurfeldt, Diana Radu; Azmitia, Efrain C; Nordlind, Klas

    2016-08-23

    Stress and anxiety may worsen atopic dermatitis (AD) through the serotonin system. Serotonergic expression was measured in 28 patients with AD in relation to extent of the disease (SCORing of Atopic Dermatitis; SCORAD), pruritus intensity (visual analogue scale; VAS), anxiety traits (Swedish Universities Scales of Personality; SSP) and depression (Montgomery-Åsberg Depression Rating Scale-Self assessment; MADRS-S). Biopsies were taken from lesional and non-lesional AD skin, and investigated for expression of serotonin, its receptors 5-HT1A and 5-HT2, and serotonin transporter protein (SERT), using immunohistochemistry. 5-HT1AR-immunoreactivity (ir) was higher in lesional skin in apical epidermis and in mast cell-like cells in dermis, and 5-HT2AR-ir in apical epidermis and on blood vessels. In contrast, a basement membrane 5-HT2AR-ir signal was higher in non-lesional skin. The distribution of SERT-ir in the basal epidermal layer was higher in lesional skin. Positive and negative correlations were found between serotonergic markers and SCORAD, inflammation, pruritus intensity, anxiety traits, and depression score, indicating that serotonergic mechanisms are involved in AD. PMID:26831833

  8. An Alternative Approach to Atopic Dermatitis: Part I—Case-Series Presentation

    PubMed Central

    2004-01-01

    Atopic dermatitis (AD) is a complex disease of obscure pathogenesis. A substantial portion of AD patients treated with conventional therapy become intractable after several cycles of recurrence. Over the last 20 years we have developed an alternative approach to treat many of these patients by diet and Kampo herbal medicine. However, as our approach is highly individualized and the Kampo formulae sometimes complicated, it is not easy to provide evidence to establish usefulness of this approach. In this Review, to demonstrate the effectiveness of the method of individualized Kampo therapy, results are presented for a series of patients who had failed with conventional therapy but were treated afterwards in our institution. Based on these data, we contend that there exist a definite subgroup of AD patients in whom conventional therapy fails, but the ‘Diet and Kampo’ approach succeeds, to heal. Therefore, this approach should be considered seriously as a second-line treatment for AD patients. In the Discussion, we review the evidential status of the current conventional strategies for AD treatment in general, and then specifically discuss the possibility of integrating Kampo regimens into it, taking our case-series presented here as evidential basis. We emphasize that Kampo therapy for AD is more ‘art’ than technology, for which expertise is an essential pre-requisite. PMID:15257326

  9. Influences of Environmental Chemicals on Atopic Dermatitis

    PubMed Central

    2015-01-01

    Atopic dermatitis is a chronic inflammatory skin condition including severe pruritus, xerosis, visible eczematous skin lesions that mainly begin early in life. Atopic dermatitis exerts a profound impact on the quality of life of patients and their families. The estimated lifetime prevalence of atopic dermatitis has increased 2~3 fold during over the past 30 years, especially in urban areas in industrialized countries, emphasizing the importance of life-style and environment in the pathogenesis of atopic diseases. While the interplay of individual genetic predisposition and environmental factors contribute to the development of atopic dermatitis, the recent increase in the prevalence of atopic dermatitis might be attributed to increased exposure to various environmental factors rather than alterations in human genome. In recent decades, there has been an increasing exposure to chemicals from a variety of sources. In this study, the effects of various environmental chemicals we face in everyday life - air pollutants, contact allergens and skin irritants, ingredients in cosmetics and personal care products, and food additives - on the prevalence and severity of atopic dermatitis are reviewed. PMID:26191377

  10. Atopic Dermatitis: Update for Pediatricians.

    PubMed

    Grey, Katherine; Maguiness, Sheilagh

    2016-08-01

    Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder present in up to 20% of children. Recent advances implicate skin barrier dysfunction as central to disease pathogenesis. Genetic defects in the filaggrin gene, the product of which is important for maintaining the epidermal barrier, are a strong predisposing factor in the development of AD. In addition to reducing identifiable triggers, treatment should focus on the four clinical characteristics of eczema: emollients for dry skin, topical anti-inflammatory agents to reduce inflammation and itch, and strategies to reduce infection/colonization, which can include diluted bleach baths. New studies demonstrate that early emollient application from birth may prevent development of AD. [Pediatr Ann. 2016;45(8):e280-e286.]. PMID:27517355

  11. Difficult to control atopic dermatitis.

    PubMed

    Darsow, Ulf; Wollenberg, Andreas; Simon, Dagmar; Taïeb, Alain; Werfel, Thomas; Oranje, Arnold; Gelmetti, Carlo; Svensson, Ake; Deleuran, Mette; Calza, Anne-Marie; Giusti, Francesca; Lübbe, Jann; Seidenari, Stefania; Ring, Johannes

    2013-01-01

    Difficult to control atopic dermatitis (AD) presents a therapeutic challenge and often requires combinations of topical and systemic treatment. Anti-inflammatory treatment of severe AD most commonly includes topical glucocorticosteroids and topical calcineurin antagonists used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, the topical calcineurin inhibitors tacrolimus and pimecrolimus are preferred in certain locations. Systemic anti-inflammatory treatment is an option for severe refractory cases. Microbial colonization and superinfection contribute to disease exacerbation and thus justify additional antimicrobial / antiseptic treatment. Systemic antihistamines (H1) may relieve pruritus but do not have sufficient effect on eczema. Adjuvant therapy includes UV irradiation preferably of UVA1 wavelength. "Eczema school" educational programs have been proven to be helpful. PMID:23663504

  12. Biological Treatments in Atopic Dermatitis

    PubMed Central

    Montes-Torres, Andrea; Llamas-Velasco, Mar; Pérez-Plaza, Alejandra; Solano-López, Guillermo; Sánchez-Pérez, Javier

    2015-01-01

    Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases that affect both children and adults with a prevalence of 30% and 10%, respectively. Even though most of patients respond satisfactory to topical anti-inflammatory drugs, about 10% require one or more systemic treatments to achieve good control of their illness. The progressive and increasingly detailed knowledge in the immunopathogenesis of AD has allowed research on new therapeutic targets with very promising results in the field of biological therapy. In this article, we will review the different biological treatments with a focus on novel drugs. Their mechanism of action, current status and results from clinical trials and observational studies will be specified. PMID:26239349

  13. Biological Treatments in Atopic Dermatitis.

    PubMed

    Montes-Torres, Andrea; Llamas-Velasco, Mar; Pérez-Plaza, Alejandra; Solano-López, Guillermo; Sánchez-Pérez, Javier

    2015-01-01

    Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases that affect both children and adults with a prevalence of 30% and 10%, respectively. Even though most of patients respond satisfactory to topical anti-inflammatory drugs, about 10% require one or more systemic treatments to achieve good control of their illness. The progressive and increasingly detailed knowledge in the immunopathogenesis of AD has allowed research on new therapeutic targets with very promising results in the field of biological therapy. In this article, we will review the different biological treatments with a focus on novel drugs. Their mechanism of action, current status and results from clinical trials and observational studies will be specified. PMID:26239349

  14. [Atopic dermatitis of the adult].

    PubMed

    Hello, M; Aubert, H; Bernier, C; Néel, A; Barbarot, S

    2016-02-01

    Atopic dermatitis (AD) of the adult is a common skin disease. Its prevalence has greatly increased during the past decades. AD is commonly associated with other atopic disorders. Its impact on quality of life is often underestimated. Various immunopathologic mechanisms are involved in AD: innate epidermal barrier dysfunction due to filaggrin gene mutations, innate and adaptative abnormalities of the immune system (an initial Th2 phase precedes a chronic Th1 phase), intestinal and cutaneous microbiomes dysbiosis, and environmental factors. Diagnosis of AD is clinical and there is no predictive biomarker of future severity. The main differential diagnoses are: scabies, psoriasis, cutaneous adverse reaction, cutaneous T cell lymphoma, primary immunodeficiency, and Netherton's syndrome. Therapeutic management is challenging and should integrate a therapeutic education program. Topical corticosteroids are the first line treatment, including a preliminary assessment of possible topical corticosteroids phobia. Systemic treatments are recommended in severe, chronic and resistant AD, after careful evaluation in a reference centre. Dupilumab, an IL4/IL13 inhibitor, might be the first effective targeted therapy in AD, whereas therapies that specifically target the mechanisms of pruritus represent an exciting perspective. PMID:26617291

  15. Use of textiles in atopic dermatitis: care of atopic dermatitis.

    PubMed

    Ricci, G; Patrizi, A; Bellini, F; Medri, M

    2006-01-01

    Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease which usually starts during the first years of life. In the management of AD, the correct approach requires a combination of multiple treatments to identify and eliminate trigger factors, and to improve the alteration of the skin barrier. In this article we try to explain the importance of skin care in the management of AD in relation to the use of textiles: they may be useful to improve disrupted skin but they are also a possible cause of triggering or worsening the lesions. Garments are in direct contact with the skin all day long, and for this reason it is important to carefully choose suitable fabrics in atopic subjects who have disrupted skin. Owing to their hygienic properties fabrics produced from natural fibres are preferential. Wool fibres are frequently used in human clothes but are irritant in direct contact with the skin. Wool fibre has frequently been shown to be irritant to the skin of atopic patients, and for this reason wool intolerance was included as a minor criterion in the diagnostic criteria of AD by Hanifin and Rajka in 1980. Cotton is the most commonly used textile for patients with AD; it has wide acceptability as clothing material because of its natural abundance and inherent properties like good folding endurance, better conduction of heat, easy dyeability and excellent moisture absorption. Silk fabrics help to maintain the body temperature by reducing the excessive sweating and moisture loss that can worsen xerosis. However, the type of silk fabric generally used for clothes is not particularly useful in the care and dressing of children with AD since it reduces transpiration and may cause discomfort when in direct contact with the skin. A new type of silk fabric made of transpiring and slightly elastic woven silk is now commercially available (Microair Dermasilk) and may be used for the skin care of children with AD. The presence of increased bacterial colonization

  16. Specific Immunotherapy in Atopic Dermatitis

    PubMed Central

    Lee, Jungsoo; Park, Chang Ook

    2015-01-01

    Allergen specific immunotherapy (SIT) using house dust mite (HDM) extracts has been performed mainly with patients of asthma and allergic rhinitis. In the meanwhile, there has been a long debate on the efficacy of SIT in atopic dermatitis (AD) with only a few double-blind placebo-controlled trials. However, several randomized controlled trials of SIT in AD revealed significant improvement of clinical symptoms and also, positive result was shown by a following meta-analysis study of these trials. In order to predict and evaluate the treatment outcome, finding a biomarker that can predict treatment responses and treatment end-points is critical but it is very challenging at the same time due to the complexity of causes and mechanisms of AD. Other considerations including standardization of the easiest and safest treatment protocol and optimizing the treatment preparations should be studied as well. This review summarizes the basics of SIT in AD including the brief mechanisms, treatment methods and schedules, and also highlights the clinical efficacy of SIT in AD along with mild, controllable adverse reactions. Immunologic effects and studies of various biomarkers are also introduced and finally, future considerations with upcoming studies on SIT were discussed. PMID:25749758

  17. Adult atopic dermatitis: a review.

    PubMed

    Napolitano, Maddalena; Megna, Matteo; Patruno, Cataldo; Gisondi, Paolo; Ayala, Fabio; Balato, Nicola

    2016-08-01

    Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease which predominantly affects children usually clearing up during or after childhood. However, AD may persist with a chronic recurrent course until adulthood, being recalcitrant to any treatment strategy. Moreover, in some patients AD is not present during childhood but starts later in life (i.e. after 16 years of age) being defined late-onset AD. Even if AD incidence is increasing worldwide with cases in which clinical manifestations first appeared or persisted during adolescence and adulthood raising, especially in industrialized countries, studies on adult AD are still scant. Since this subgroup of AD patients often has a nonflexural rash distribution, and atypical morphologic variants and validated diagnostic criteria are lacking, there is no clear consensus on the diagnostic work-up that should be performed when evaluating adult patients with AD. In this review the many aspects of work-up in adult patients with AD, such as diagnostic criteria, epidemiology, quality of life and pathogenesis are discussed. PMID:25658440

  18. Retinal detachment associated with atopic dermatitis.

    PubMed Central

    Takahashi, M; Suzuma, K; Inaba, I; Ogura, Y; Yoneda, K; Okamoto, H

    1996-01-01

    BACKGROUND: Retinal detachment associated with atopic dermatitis, one of the most common forms of dermatitis in Japan, has markedly increased in Japan in the past 10 years. To clarify pathogenic mechanisms of retinal detachment in such cases, we retrospectively studied clinical characteristics of retinal detachment associated with atopic dermatitis. METHODS: We examined the records of 80 patients (89 eyes) who had retinal detachment associated with atopic dermatitis. The patients were classified into three groups according to lens status: group A, eyes with clear lenses (40 eyes); group B, eyes with cataract (38 eyes), and group C, aphakic or pseudophakic eyes (11 eyes). RESULTS: No significant differences were noted in the ratio of males to females, age distribution, refractive error, or characteristic of retinal detachment among the three groups. The types of retinal breaks, however, were different in eyes with and without lens changes. While atrophic holes were dominant in group A, retinal dialysis was mainly seen in groups B and C. CONCLUSION: These findings suggested that anterior vitreoretinal traction may play an important role in the pathogenesis of retinal breaks in eyes with atopic cataract and that the same pathological process may affect the formation of cataract and tractional retinal breaks in patients with atopic dermatitis. PMID:8664234

  19. The effects of treatment on itch in atopic dermatitis

    PubMed Central

    Yarbrough, Kevin B.; Neuhaus, Kristin J.; Simpson, Eric L.

    2015-01-01

    Pruritus causes significant impairment in the quality of life of patients suffering from atopic dermatitis. Treatments for itch in atopic dermatitis range from simple avoidance of pruritus triggers to more complicated systemic therapy. Several treatments aim to target specific mediators of itch in atopic dermatitis, while others improve pruritus by reducing inflammation. Currently, the most effective treatments for atopic dermatitis-associated itch are primarily topical or systemic anti-inflammatory agents. Better management of pruritus in atopic dermatitis is an important goal, and necessitates the development of novel targeted treatments as well as efficient use of current therapies. PMID:23551368

  20. Management of Itch in Atopic Dermatitis

    PubMed Central

    Hong, Judith; Buddenkotte, Joerg; Berger, Timothy G.; Steinhoff, Martin

    2013-01-01

    Atopic dermatitis is a common, pruritic, inflammatory skin disorder. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its management remains a challenge for physicians. The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch. Modern management consists of anti-inflammatory, occasionally antiseptic, as well as antipruritic therapies to address the epidermal barrier as well as immunomodulation or infection. Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds. In addition, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management. This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis. PMID:21767767

  1. Skin barrier in atopic dermatitis: beyond filaggrin.

    PubMed

    Zaniboni, Mariana Colombini; Samorano, Luciana Paula; Orfali, Raquel Leão; Aoki, Valéria

    2016-01-01

    Atopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis, where changes in skin barrier and imbalance of the immune system are relevant factors. The skin forms a mechanic and immune barrier, regulating water loss from the internal to the external environment, and protecting the individual from external aggressions, such as microorganisms, ultraviolet radiation and physical trauma. Main components of the skin barrier are located in the outer layers of the epidermis (such as filaggrin), the proteins that form the tight junction (TJ) and components of the innate immune system. Recent data involving skin barrier reveal new information regarding its structure and its role in the mechanic-immunological defense; atopic dermatitis (AD) is an example of a disease related to dysfunctions associated with this complex. PMID:27579743

  2. Skin barrier in atopic dermatitis: beyond filaggrin*

    PubMed Central

    Zaniboni, Mariana Colombini; Samorano, Luciana Paula; Orfali, Raquel Leão; Aoki, Valéria

    2016-01-01

    Atopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis, where changes in skin barrier and imbalance of the immune system are relevant factors. The skin forms a mechanic and immune barrier, regulating water loss from the internal to the external environment, and protecting the individual from external aggressions, such as microorganisms, ultraviolet radiation and physical trauma. Main components of the skin barrier are located in the outer layers of the epidermis (such as filaggrin), the proteins that form the tight junction (TJ) and components of the innate immune system. Recent data involving skin barrier reveal new information regarding its structure and its role in the mechanic-immunological defense; atopic dermatitis (AD) is an example of a disease related to dysfunctions associated with this complex. PMID:27579743

  3. New Developments in Biomarkers for Atopic Dermatitis

    PubMed Central

    Thijs, Judith L.; van Seggelen, Wouter; Bruijnzeel-Koomen, Carla; de Bruin-Weller, Marjolein; Hijnen, DirkJan

    2015-01-01

    The application of biomarkers in medicine is evolving. Biomarkers do not only give us a better understanding of pathogenesis, but also increase treatment efficacy and safety, further enabling more precise clinical care. This paper focuses on the current use of biomarkers in atopic dermatitis, new developments and future perspectives. Biomarkers can be used for many different purposes, including the objective determination of disease severity, confirmation of clinical diagnosis, and to predict response to treatment. In atopic dermatitis, many biomarkers have been investigated as a marker for disease severity. Currently serum thymus and activation-regulated chemokine (TARC) is the superior biomarker for assessing disease severity. However, we have recently shown that the use of a panel of serum biomarkers is more suitable for assessing disease severity than an individual biomarker. In this overview, we will discuss alternative sources for biomarkers, such as saliva and capillary blood, which can increase the user friendliness of biomarkers in atopic dermatitis (AD). Both methods offer simple, non-invasive and cost effective alternatives to venous blood. This provides great translational and clinical potential. Biomarkers will play an increasingly important role in AD research and personalized medicine. The use of biomarkers will enhance the efficacy of AD treatment by facilitating the individualization of therapy targeting the patients’ specific biological signature and also by providing tools for predicting and monitoring of therapeutic response. PMID:26239250

  4. Economic Impact of Atopic Dermatitis in Korean Patients

    PubMed Central

    Kim, Chulmin; Park, Kui Young; Ahn, Seohee; Kim, Dong Ha; Li, Kapsok; Kim, Do Won; Kim, Moon-Beom; Jo, Sun-Jin; Yim, Hyeon Woo

    2015-01-01

    Background Atopic dermatitis is a global public health concern owing to its increasing prevalence and socioeconomic burden. However, few studies have assessed the economic impact of atopic dermatitis in Korea. Objective We conducted a cost analysis of atopic dermatitis and evaluated its economic impacts on individual annual disease burden, quality of life, and changes in medical expenses with respect to changes in health related-quality of life. Methods The cost analysis of atopic dermatitis was performed by reviewing the home accounting records of 32 patients. The economic impact of the disease was evaluated by analyzing questionnaires. To handle uncertainties, we compared the results with the data released by the Health Insurance Review & Assessment Board on medical costs claimed by healthcare facilities. Results The direct cost of atopic dermatitis per patient during the 3-month study period was 541,280 Korean won (KRW), and expenditures on other atopic dermatitis-related products were 120,313 KRW. The extrapolated annual direct cost (including expenditures on other atopic dermatitis-related products) per patient was 2,646,372 KRW. The estimated annual indirect cost was 1,507,068 KRW. Thus, the annual cost of illness of atopic dermatitis (i.e., direct+indirect costs) was estimated to be 4,153,440 KRW. Conclusion The annual total social cost of atopic dermatitis on a national level is estimated to be 5.8 trillion KRW. PMID:26082587

  5. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment

    PubMed Central

    Kim, Jung Eun; Kim, Hyun Jeong; Lew, Bark-Lynn; Lee, Kyung Ho; Hong, Seung Phil; Jang, Yong Hyun; Park, Kui Young; Seo, Seong Jun; Bae, Jung Min; Choi, Eung Ho; Suhr, Ki Beom; Lee, Seung Chul; Ko, Hyun Chang; Park, Young Lip; Son, Sang Wook; Seo, Young Jun; Lee, Yang Won; Cho, Sang Hyun; Park, Chun Wook

    2015-01-01

    Background Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. Objective We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. Methods We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. Results Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. Conclusion This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented. PMID:26512171

  6. Prevalence and features of canine atopic dermatitis in Hungary.

    PubMed

    Tarpataki, Noémi; Pápa, Kinga; Reiczigel, J; Vajdovich, P; Vörösi, K

    2006-09-01

    Medical records of 600 dogs diagnosed with atopic dermatitis were reviewed and evaluated with reference to history, geographical distribution, breed predilection, clinical signs and positive reactions to allergens as determined by intradermal skin testing (IDT) manufactured by Artuvetrin Laboratories. In 66.6% of dogs, the age of onset of atopic dermatitis was between 4 months and 3 years. Dogs living in the garden suburb of Budapest were more sensitive to house dust mites, fleas and moulds, and dogs from the western part of Hungary were more sensitive to weeds than to other allergens (p < 0.01). Positive reactions were most common to Dermatophagoides farinae followed by human dander. The breed distribution found in the present study was consistent with that reported in the literature, except for the breeds Hungarian Vizsla, Pumi, French bulldog, Doberman Pinscher and Bobtail which were over-represented among atopic dogs compared to the breed distribution of the general dog population of a large city in Hungary. Breeds with verified adverse reaction to food were Cocker spaniels, French bulldogs, Bullmastiffs, Bull terriers, St. Bernards, Tervurens, West Highland White terriers and American Staffordshire terriers (p < 0.05). The clinical signs of atopic dermatitis and their occurrence are in accordance with the data described in the literature. PMID:17020139

  7. [Place of immunosuppressors in atopic dermatitis].

    PubMed

    de Prost, Yves

    2012-03-01

    Use of immunosuppressors in the treatment of atopic dermatitis is an important innovation that reinforces the therapeutic arsenal in this chronic disease. Two such drugs are used topically for the treatment of atopic dermatitis. Tacrolimus exists in pommade form at a concentration of 0.1% for adults and 0.03% for children. Pimecrolimus, another calcineurine inhibitor with similar efficacy and tolerability, is not marketed in France. These products inhibit cytokine production by antigen-stimulated T lymphocytes. Their clinical efficacy has been demonstrated in many studies in the United States and Europe. They are particularly valuable for patients whose clinical course is marked by disease persistence and frequent flares, which would otherwise require almost continuous topical corticosteroid treatment. Topical calcineurine inhibitors may also have a significant benefit in patients with involvement of sensitive skin areas, such as around the eyes, face, neck and genital area, where systemic absorption and the risk of skin atrophy are particular concerns. The most frequent adverse effects are a local erythema-like reaction with burning and pruritus at the outset of treatment. No significant increase in bacterial or viral infections has been noted by comparison with control groups, and no systemic impact has been reported. However, these drugs should not be used in patients with a history of Kaposi-Juliusberg disease or in patients with herpes. Photoprotection measures must be respected. New trials with tacrolimus show that atopic lesions can be controlled by treating subclinical inflammation twice weekly between flares, thereby preventing flares and prolonging the flare-free interval. This new therapeutic approach is called proactive treatment. The efficacy of oral cyclosporine at 4-5 mg/kg/day in severe forms of atopic dermatitis is now well demonstrated. There is consistent evidence that oral cyclosporin is beneficial in patients whose disease is not adequately

  8. Neuroimmunological Mechanism of Pruritus in Atopic Dermatitis Focused on the Role of Serotonin

    PubMed Central

    Kim, Kwangmi

    2012-01-01

    Although pruritus is the critical symptom of atopic dermatitis that profoundly affect the patients’ quality of life, controlling and management of prurirtus still remains as unmet needs mainly due to the distinctive multifactorial pathogenesis of pruritus in atopic dermatitis. Based on the distinct feature of atopic dermatitis that psychological state of patients substantially influence on the intensity of pruritus, various psychotropic drugs have been used in clinic to relieve pruritus of atopic dermatitis patients. Only several psychotropic drugs were reported to show real antipruritic effects in atopic dermatitis patients including naltrexone, doxepin, trimipramine, bupropion, tandospirone, paroxetine and fluvoxamine. However, the precise mechanisms of antipruritic effect of these psychotropic drugs are still unclear. In human skin, serotonin receptors and serotonin transporter protein are expressed on skin cells such as keratinocytes, melanocytes, dermal fibroblasts, mast cells, T cells, natural killer cells, langerhans cells, and sensory nerve endings. It is noteworthy that serotonergic drugs, as well as serotonin itself, showed immune-modulating effect. Fenfluramine, fluoxetine and 2, 5-dimethoxy-4-iodoamphetamine significantly decreased lymphocyte proliferation. It is still questionable whether these serotonergic drugs exert the immunosuppressive effects via serotonin receptor or serotonin transporter. All these clinical and experimental reports suggest the possibility that antipruritic effects of selective serotonin reuptake inhibitors in atopic dermatitis patients might be at least partly due to their suppressive effect on T cells. Further studies should be conducted to elucidate the precise mechanism of neuroimmunological interaction in pruritus of atopic dermatitis. PMID:24009842

  9. Prevalence of Suicidal Ideation in Patients with Atopic Dermatitis

    ERIC Educational Resources Information Center

    Kimata, Hajime

    2006-01-01

    The prevalence of suicidal ideation in patients with mild, moderate, and severe atopic dermatitis between the age of 15 to 49 years were 0.21%, 6%, and 19.6%, respectively. In addition, the prevalence of homicide-suicidal ideation in mothers or fathers of patients (aged 0-14 years) with mild, moderate, and severe atopic dermatitis were 0.11%,…

  10. Current status of atopic dermatitis in Japan.

    PubMed

    Furue, Masutaka; Chiba, Takahito; Takeuchi, Satoshi

    2011-07-01

    Atopic dermatitis (AD) is a common, chronic or chronically relapsing, severely pruritic, eczematous skin disease. AD is the second most frequently observed skin disease in dermatology clinics in Japan. Prevalence of childhood AD is 12-13% in mainland Japan; however, it is only half that (about 6%) in children from Ishigaki Island, Okinawa. Topical steroids and tacrolimus are the mainstay of treatment. However, the adverse effects and emotional fear of long-term use of topical steroids have induced a "topical steroid phobia" in patients throughout the world. Undertreatment can exacerbate facial/periocular lesions and lead to the development of atopic cataract and retinal detachment due to repeated scratching/rubbing/patting. Overcoming topical steroid phobia is a key issue for the successful treatment of AD through education, understanding and cooperation of patients and their guardians. PMID:22053299

  11. Current status of atopic dermatitis in Japan

    PubMed Central

    Chiba, Takahito; Takeuchi, Satoshi

    2011-01-01

    Atopic dermatitis (AD) is a common, chronic or chronically relapsing, severely pruritic, eczematous skin disease. AD is the second most frequently observed skin disease in dermatology clinics in Japan. Prevalence of childhood AD is 12-13% in mainland Japan; however, it is only half that (about 6%) in children from Ishigaki Island, Okinawa. Topical steroids and tacrolimus are the mainstay of treatment. However, the adverse effects and emotional fear of long-term use of topical steroids have induced a "topical steroid phobia" in patients throughout the world. Undertreatment can exacerbate facial/periocular lesions and lead to the development of atopic cataract and retinal detachment due to repeated scratching/rubbing/patting. Overcoming topical steroid phobia is a key issue for the successful treatment of AD through education, understanding and cooperation of patients and their guardians. PMID:22053299

  12. The Role of Malassezia spp. in Atopic Dermatitis

    PubMed Central

    Glatz, Martin; Bosshard, Philipp P.; Hoetzenecker, Wolfram; Schmid-Grendelmeier, Peter

    2015-01-01

    Malassezia spp. is a genus of lipophilic yeasts and comprises the most common fungi on healthy human skin. Despite its role as a commensal on healthy human skin, Malassezia spp. is attributed a pathogenic role in atopic dermatitis. The mechanisms by which Malassezia spp. may contribute to the pathogenesis of atopic dermatitis are not fully understood. Here, we review the latest findings on the pathogenetic role of Malassezia spp. in atopic dermatitis (AD). For example, Malassezia spp. produces a variety of immunogenic proteins that elicit the production of specific IgE antibodies and may induce the release of pro-inflammatory cytokines. In addition, Malassezia spp. induces auto-reactive T cells that cross-react between fungal proteins and their human counterparts. These mechanisms contribute to skin inflammation in atopic dermatitis and therefore influence the course of this disorder. Finally, we discuss the possible benefit of an anti-Malassezia spp. treatment in patients with atopic dermatitis. PMID:26239555

  13. Atopic Dermatitis; Etio-Pathogenesis, An Overview

    PubMed Central

    Sehgal, Virendra N; Khurana, Ananta; Mendiratta, Vibhu; Saxena, Deepti; Srivastava, Govind; Aggarwal, Ashok K

    2015-01-01

    Atopic dermatitis is a well-recognized clinical entity, several facets of which continue to be mystified. Accordingly, its etio-pathogenesis is largely elusive. It appears to be an outcome of interplay of several undertones, namely: genetics, maternal factor and inheritance, pregnancy/intrauterine, environmental factors, immune dysregulation, immuno-globulins, role of diet, and infection. Besides, recent innovative breakthroughs consisting of nutritional supplementation, the highlights of which were considered worthwhile to take stock of to define its current status. An endeavor to enlighten the audience has been made for their benefit. PMID:26288398

  14. MiRNA in atopic dermatitis

    PubMed Central

    Rudnicka, Lidia; Samochocki, Zbigniew

    2016-01-01

    MicroRNAs are relatively new molecules that have been widely studied in recent years as to determine their exact function in the human body. It is suggested that microRNAs control approx. 30% of all genes, making them one of the largest groups that control the expression of proteins. Various functions of miRNAs have already been described. In skin diseases, there are more and more studies describing an altered expression of microRNAs in the skin or serum. Relatively little is known about the function of these molecules in atopic dermatitis, which prompted us to gather current reports on this subject. PMID:27512348

  15. Atopic dermatitis: epidemiology and pathogenesis update.

    PubMed

    Eichenfield, Lawrence F; Ellis, Charles N; Mancini, Anthony J; Paller, Amy S; Simpson, Eric L

    2012-09-01

    The prevalence of atopic dermatitis (AD) has increased markedly in the United States over the past 5 decades, with current reports varying from 10% to 20% prevalence in US children, and new diagnoses are estimated at almost 11% per year. Recent research in AD pathophysiology and pathogenesis has demonstrated that AD is associated with epidermal barrier dysfunction and that mutations in the filaggrin gene are implicated in barrier defects. These discoveries hold promise for future breakthroughs in the diagnosis and management of AD. PMID:23021783

  16. Atopic Dermatitis; Etio-Pathogenesis, An Overview.

    PubMed

    Sehgal, Virendra N; Khurana, Ananta; Mendiratta, Vibhu; Saxena, Deepti; Srivastava, Govind; Aggarwal, Ashok K

    2015-01-01

    Atopic dermatitis is a well-recognized clinical entity, several facets of which continue to be mystified. Accordingly, its etio-pathogenesis is largely elusive. It appears to be an outcome of interplay of several undertones, namely: genetics, maternal factor and inheritance, pregnancy/intrauterine, environmental factors, immune dysregulation, immuno-globulins, role of diet, and infection. Besides, recent innovative breakthroughs consisting of nutritional supplementation, the highlights of which were considered worthwhile to take stock of to define its current status. An endeavor to enlighten the audience has been made for their benefit. PMID:26288398

  17. Borage oil in the treatment of atopic dermatitis.

    PubMed

    Foster, Rachel H; Hardy, Gil; Alany, Raid G

    2010-01-01

    Nutritional supplementation with omega-6 essential fatty acids (omega-6 EFAs) is of potential interest in the treatment of atopic dermatitis. EFAs play a vital role in skin structure and physiology. EFA deficiency replicates the symptoms of atopic dermatitis, and patients with atopic dermatitis have been reported to have imbalances in EFA levels. Although direct proof is lacking, it has been hypothesized that patients with atopic dermatitis have impaired activity of the delta-6 desaturase enzyme, affecting metabolism of linoleic acid to gamma-linolenic acid (GLA). However, to date, studies of EFA supplementation in atopic dermatitis, most commonly using evening primrose oil, have produced conflicting results. Borage oil is of interest because it contains two to three times more GLA than evening primrose oil. This review identified 12 clinical trials of oral or topical borage oil for treatment of atopic dermatitis and one preventive trial. All studies were controlled and most were randomized and double-blind, but many were small and had other methodological limitations. The results of studies of borage oil for the treatment of atopic dermatitis were highly variable, with the effect reported to be significant in five studies, insignificant in five studies, and mixed in two studies. Borage oil given to at-risk neonates did not prevent development of atopic dermatitis. However, the majority of studies showed at least a small degree of efficacy or were not able to exclude the possibility that the oil produces a small benefit. Overall, the data suggest that nutritional supplementation with borage oil is unlikely to have a major clinical effect but may be useful in some individual patients with less severe atopic dermatitis who are seeking an alternative treatment. Which patients are likely to respond cannot yet be identified. Borage oil is well tolerated in the short term but no long-term tolerability data are available. PMID:20579590

  18. Historical Perspectives on Atopic Dermatitis: Eczema Through the Ages.

    PubMed

    Bhattacharya, Tanya; Strom, Mark A; Lio, Peter A

    2016-07-01

    Throughout history, individuals have had a myriad of dermatologic conditions characterized as chronic pruritic dermatoses. The term atopic dermatitis was not coined until the early 20th century. Many diseases typical of this condition were reported using a variety of eponyms and descriptive terms. Even as the incidence of atopic dermatitis rises, it remains poorly understood in the modern era, and viewing the disease from a historical perspective provides useful insight into its nature. This article highlights the evolution of concepts related to the pathogenesis of and recommended treatments for atopic dermatitis. PMID:27086570

  19. Guidelines of Care for the Management of Atopic Dermatitis Part 4: Prevention of Disease Flares and Use of Adjunctive Therapies and Approaches

    PubMed Central

    Sidbury, Robert; Tom, Wynnis L.; Bergman, James N.; Cooper, Kevin D.; Silverman, Robert A.; Berger, Timothy G.; Chamlin, Sarah L.; Cohen, David E.; Cordoro, Kelly M.; Davis, Dawn M.; Feldman, Steven R.; Hanifin, Jon M.; Krol, Alfons; Margolis, David J.; Paller, Amy S.; Schwarzenberger, Kathryn; Simpson, Eric L.; Williams, Hywel C.; Elmets, Craig A.; Block, Julie; Harrod, Christopher G.; Begolka, Wendy Smith; Eichenfield, Lawrence F.

    2015-01-01

    Atopic dermatitis (AD) is a common, chronic inflammatory dermatosis that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this final section, treatments for flare prevention and adjunctive and complementary therapies and approaches are reviewed. Suggestions on utilization are given based on available evidence. PMID:25264237

  20. Vitamin D and Atopic Dermatitis in Childhood

    PubMed Central

    Vestita, Michelangelo; Filoni, Angela; Congedo, Maurizio; Foti, Caterina

    2015-01-01

    Vitamin D features immunomodulatory effects on both the innate and adaptive immune systems, which may explain the growing evidence connecting vitamin D to allergic diseases. A wealth of studies describing a beneficial effect of vitamin D on atopic dermatitis (AD) prevalence and severity are known. However, observations linking high vitamin D levels to an increased risk of developing AD have also been published, effectively creating a controversy. In this paper, we review the existing literature on the association between AD and vitamin D levels, focusing on childhood. As of today, the role of vitamin D in AD is far from clear; additional studies are particularly needed in order to confirm the promising therapeutic role of vitamin D supplementation in childhood AD. PMID:25973433

  1. Vitamin D and atopic dermatitis in childhood.

    PubMed

    Vestita, Michelangelo; Filoni, Angela; Congedo, Maurizio; Foti, Caterina; Bonamonte, Domenico

    2015-01-01

    Vitamin D features immunomodulatory effects on both the innate and adaptive immune systems, which may explain the growing evidence connecting vitamin D to allergic diseases. A wealth of studies describing a beneficial effect of vitamin D on atopic dermatitis (AD) prevalence and severity are known. However, observations linking high vitamin D levels to an increased risk of developing AD have also been published, effectively creating a controversy. In this paper, we review the existing literature on the association between AD and vitamin D levels, focusing on childhood. As of today, the role of vitamin D in AD is far from clear; additional studies are particularly needed in order to confirm the promising therapeutic role of vitamin D supplementation in childhood AD. PMID:25973433

  2. Role of vasculature in atopic dermatitis.

    PubMed

    Steinhoff, Martin; Steinhoff, Antje; Homey, Bernhard; Luger, Thomas A; Schneider, Stefan W

    2006-07-01

    Atopic dermatitis (AD) lesions are characterized by differences in the activation state of endothelial cells and vascular smooth muscle cells and the release of inflammatory mediators by and toward the vasculature. The vascular system, including endothelial cells and smooth muscle cells, is ultimately involved in clinical symptoms of AD, such as erythema, edema, leukocyte recruitment, and white dermographism. Various mediators and bidirectional neurovascular interactions regulate the inflammatory response during AD. T cell-endothelial cell interactions are a crucial component to establish acute AD. Various immune cells, including monocytes and mast cells, communicate with the endothelium by releasing inflammatory mediators, thereby stimulating inflammatory mediator release from activated endothelial cells. The process of adhesion, tethering, and transmigration of infiltrating cells is a highly regulated and an active communication process between endothelial cells and leukocytes. Endothelial cells play a pivotal role in the pathophysiology of AD and represent future targets for the treatment of AD. PMID:16815154

  3. Topical steroid addiction in atopic dermatitis

    PubMed Central

    Fukaya, Mototsugu; Sato, Kenji; Sato, Mitsuko; Kimata, Hajime; Fujisawa, Shigeki; Dozono, Haruhiko; Yoshizawa, Jun; Minaguchi, Satoko

    2014-01-01

    The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome. PMID:25378953

  4. The Changing Paradigm of Atopic Dermatitis Therapy.

    PubMed

    Friedlander, Sheila F; Simpson, Eric L; Irvine, Alan D; Eichenfield, Lawrence F

    2016-06-01

    The pathophysiology of atopic dermatitis (AD) is complex, and future treatment options will likely be incorporated in a multimodal approach to management. The new, directed therapies that have been developed will likely be used in conjunction with concomitant continuous or intermittent use of standard therapies; the goal is to optimize therapeutic outcomes while minimizing adverse impacts on safety and cost. Current data regarding disease course and expression throughout life suggest that treatment strategies also will need to be adjusted as a patient grows. Research also indicates that interventions begun in infancy-such as the use of emollients-may mitigate or prevent AD signs and symptoms in children at high risk for the disease. Semin Cutan Med Surg 35(supp5):S97-S99. PMID:27526330

  5. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies.

    PubMed

    Eichenfield, Lawrence F; Tom, Wynnis L; Berger, Timothy G; Krol, Alfons; Paller, Amy S; Schwarzenberger, Kathryn; Bergman, James N; Chamlin, Sarah L; Cohen, David E; Cooper, Kevin D; Cordoro, Kelly M; Davis, Dawn M; Feldman, Steven R; Hanifin, Jon M; Margolis, David J; Silverman, Robert A; Simpson, Eric L; Williams, Hywel C; Elmets, Craig A; Block, Julie; Harrod, Christopher G; Smith Begolka, Wendy; Sidbury, Robert

    2014-07-01

    Atopic dermatitis is a common and chronic, pruritic inflammatory skin condition that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this second of 4 sections, treatment of atopic dermatitis with nonpharmacologic interventions and pharmacologic topical therapies are reviewed. Where possible, suggestions on dosing and monitoring are given based on available evidence. PMID:24813302

  6. Possible Antipruritic Mechanism of Cyclosporine A in Atopic Dermatitis.

    PubMed

    Ko, Kyi Chan; Tominaga, Mitsutoshi; Kamata, Yayoi; Umehara, Yoshie; Matsuda, Hironori; Takahashi, Nobuaki; Kina, Katsunari; Ogawa, Mayuko; Ogawa, Hideoki; Takamori, Kenji

    2016-06-15

    Cyclosporine A is an immunosuppressive agent that suppresses pruritus and is currently used in the treatment of patients with severe atopic dermatitis. The aim of this study was to elucidate the antipruritic mechanism of cyclosporine A using a mouse model of atopic dermatitis. Intraperitoneal injection of cyclosporine A (5 mg/kg) significantly reduced epidermal nerve density, number of scratching bouts, dermatitis scores, and transepidermal water loss, as well as decreasing the numbers of inflammatory cells in the dermis and decreasing epidermal thickness. Intraperitoneal injection of cyclosporine A dose-dependently inhibited increased itch-related receptor gene expression, such as interleukin-31 receptor A and neurokinin-1 receptor, in the dorsal root ganglion of atopic dermatitis model mice. Thus, the antipruritic efficacy of cyclosporine A may involve reduced epidermal nerve density and expression levels of itch-related receptor genes in the dorsal root ganglion, as well as improvement in acanthosis and reduction in cutaneous inflammatory cell number. PMID:26671728

  7. Risk factors for developing atopic dermatitis.

    PubMed

    Carson, Charlotte Giwercman

    2013-07-01

    adjustment for demographics, FLG variants R501X and 2282del4 status, parent's AD and pets at home (RR 2.09, 95% CI 1.15-3.80, p=0.016). In addition, there was a significant effect of duration of exclusive breastfeeding (p=0.043), as the relative risk of AD was increased in proportion to increased duration of breastfeeding. The risk associated with exclusive breastfeeding was not explained by the fatty acid composition of mother's milk, though a trend showed higher risk of AD if mother's milk had low concentrations of n-3 fatty acids. In paper III, we found that alcohol intake during pregnancy was associated with a significantly higher risk of developing AD in the offspring, with the effect persisting throughout the whole 7 years follow-up period (HR 1.44, 95% CI 1.05-1.99, p=0.024). The increased risk was still significant after confounder adjustment for mother's education, AD and smoking habits during the 3rd trimester. There was no association between alcohol intake during pregnancy and other atopic endpoints (wheeze episodes, asthma, allergic rhinitis, blood eosinophil count, total IgE, sensitization, cord blood IgE and nasal eosinophilia). However, the underlying explanation was not clear. The thesis is based on data collected as part of the ongoing COPSAC cohort. The cohort is a longitudinal, prospective birth cohort following 411 children born to mothers with asthma. This selection of high-risk children restricts the interpretation of the results and they cannot necessarily be expanded to apply to the general population. PMID:23809981

  8. Probiotics and Atopic Dermatitis: An Overview

    PubMed Central

    Rather, Irfan A.; Bajpai, Vivek K.; Kumar, Sanjay; Lim, Jeongheui; Paek, Woon K.; Park, Yong-Ha

    2016-01-01

    Atopic dermatitis (AD) is a common, recurrent, chronic inflammatory skin disease that is a cause of considerable economic and social burden. Its prevalence varies substantially among different countries with an incidence rate proclaimed to reach up to 20% of children in developed countries and continues to escalate in developing nations. This increased rate of incidence has changed the focus of research on AD toward epidemiology, prevention, and treatment. The effects of probiotics in the prevention and treatment of AD remain elusive. However, evidence from different research groups show that probiotics could have positive effect on AD treatment, if any, that depend on multiple factors, such as specific probiotic strains, time of administration (onset time), duration of exposure, and dosage. However, till date we still lack strong evidence to advocate the use of probiotics in the treatment of AD, and questions remain to be answered considering its clinical use in future. Based on updated information, the processes that facilitate the development of AD and the topic of the administration of probiotics are addressed in this review. PMID:27148196

  9. Probiotics and Atopic Dermatitis: An Overview.

    PubMed

    Rather, Irfan A; Bajpai, Vivek K; Kumar, Sanjay; Lim, Jeongheui; Paek, Woon K; Park, Yong-Ha

    2016-01-01

    Atopic dermatitis (AD) is a common, recurrent, chronic inflammatory skin disease that is a cause of considerable economic and social burden. Its prevalence varies substantially among different countries with an incidence rate proclaimed to reach up to 20% of children in developed countries and continues to escalate in developing nations. This increased rate of incidence has changed the focus of research on AD toward epidemiology, prevention, and treatment. The effects of probiotics in the prevention and treatment of AD remain elusive. However, evidence from different research groups show that probiotics could have positive effect on AD treatment, if any, that depend on multiple factors, such as specific probiotic strains, time of administration (onset time), duration of exposure, and dosage. However, till date we still lack strong evidence to advocate the use of probiotics in the treatment of AD, and questions remain to be answered considering its clinical use in future. Based on updated information, the processes that facilitate the development of AD and the topic of the administration of probiotics are addressed in this review. PMID:27148196

  10. Leukoderma in patients with atopic dermatitis.

    PubMed

    Kuriyama, Sachiko; Kasuya, Akira; Fujiyama, Toshiharu; Tatsuno, Kazuki; Sakabe, Jun-Ichi; Yamaguchi, Hayato; Ito, Taisuke; Tokura, Yoshiki

    2015-02-01

    Atopic dermatitis (AD) is occasionally associated with vitiligo, however, the incidence and conditions of vitiligo or leukoderma, and the characteristics of concurrent AD, remain unclear. We conducted a prospective observational study to investigate the leukoderma-related clinical manifestations and bioparameters of AD. Because vitiligo in AD lesions is occasionally associated with inflammation, we used leukoderma in this study. Enrolled were all AD patients who had been followed up in our AD outpatient clinic and visited within the previous 4 months. During this period, we carefully inspected whether the patients had leukoderma. Eight of 52 patients had leukoderma (15.4%) and were designated as the leukoderma group, and the remaining 44 patients comprised the non-leukoderma group. While the ages were statistically not different between the two groups, female preponderance was significantly observed in the leukoderma group. The leukoderma patients tended to have higher values of SCORAD, CCL17/thymus and activation regulated chemokine and lactate dehydrogenase than the non-leukoderma patients. The leukoderma group was also characterized by a lower frequency of allergic rhinitis and a higher frequency of prurigo lesions. Thus, despite the possession of high AD severity, the leukoderma patients may possibly retain a relatively T-helper 1-skewing state in relation to the development of leukoderma and less association with rhinitis. PMID:25545320

  11. Molecular Genetic of Atopic dermatitis: An Update

    PubMed Central

    Al-Shobaili, Hani A.; Ahmed, Ahmed A.; Alnomair, Naief; Alobead, Zeiad Abdulaziz; Rasheed, Zafar

    2016-01-01

    Atopic dermatitis (AD) is a chronic multifactorial inflammatory skin disease. The pathogenesis of AD remains unclear, but the disease results from dysfunctions of skin barrier and immune response, where both genetic and environmental factors play a key role. Recent studies demonstrate the substantial evidences that show a strong genetic association with AD. As for example, AD patients have a positive family history and have a concordance rate in twins. Moreover, several candidate genes have now been suspected that play a central role in the genetic background of AD. In last decade advanced procedures similar to genome-wide association (GWA) and single nucleotide polymorphism (SNP) have been applied on different population and now it has been clarified that AD is significantly associated with genes of innate/adaptive immune systems, human leukocyte antigens (HLA), cytokines, chemokines, drug-metabolizing genes or various other genes. In this review, we will highlight the recent advancements in the molecular genetics of AD, especially on possible functional relevance of genetic variants discovered to date. PMID:27004062

  12. Abnormal skin barrier in the etiopathogenesis of atopic dermatitis

    PubMed Central

    Elias, Peter M.; Schmuth, Matthias

    2010-01-01

    Purpose of review Many recent studies have revealed the key roles played by Th1/Th2 cell dysregulation, IgE production, mast cell hyperactivity, and dendritic cell signaling in the pathogenesis of atopic dermatitis. Accordingly, current therapy has been largely directed towards ameliorating Th2-mediated inflammation and/or pruritus. We will review here emerging evidence that the inflammation in atopic dermatitis results from inherited and acquired insults to the barrier and the therapeutic implications of this new paradigm. Recent findings Recent molecular genetic studies have shown a strong association between mutations in FILAGGRIN and atopic dermatitis, particularly in Northern Europeans. But additional acquired stressors to the barrier are required to initiate inflammation. Sustained hapten access through a defective barrier stimulates a Th1 → Th2 shift in immunophenotype, which in turn further aggravates the barrier. Secondary Staphylococcus aureus colonization not only amplifies inflammation but also further stresses the barrier in atopic dermatitis. Summary These results suggest a new ‘outside-to-inside, back to outside’ paradigm for the pathogenesis of atopic dermatitis. This new concept is providing impetus for the development of new categories of ‘barrier repair’ therapy. PMID:19550302

  13. [Keeping dogs indoor aggravates infantile atopic dermatitis].

    PubMed

    Endo, K; Hizawa, T; Fukuzumi, T; Kataoka, Y

    1999-12-01

    We had a two-month-old girl with severe dermatitis since birth. Her serum RAST to HD, Df and Dp were 1.06, 0.03 and 0.01 Ua/ml respectively. A Yorkshire terrier were kept at her mother's parents' home where the patient had lived for a month since birth. Her eczema, which became markedly aggravated whenever she visited there, improved after the elimination of the dog. We investigated the relationship between keeping dogs and infantile atopic dermatitis. We studied 368 patients under the age of two years (211 boys and 157 girls). Skin symptoms were graded globally mild, moderate or severe. Total serum IgE and specific antibody titer to dog dander were measured. We asked them whether they kept dogs and specifically, where they kept dogs, outdoor, indoor, in their own house, or in their grandparents' house. 197 patients had no contact with dogs, 90 patients kept dogs outdoor and 81 patients did indoor. The positive rate of RAST (> or = 0.7 Ua/ml) to dog dander was 6.1%, 17.8% and 46.9% respectively in these three groups. There were strong statistical differences between three groups. On the other hand, among the 81 patients who kept indoor, the RAST positive rates were almost same regarding where the dogs were kept, in their own house or their grandparents' house. Interestingly this difference happens only with patients under the age of 3 months. Patients older than 4 months showed no significant differences in the positive RAST rates, whether they kept dogs indoor or outdoor. This suggests the sensitization occurs before the age of 3 months. Speaking of symptoms, patients who kept dogs indoor showed significantly more severe symptoms than patients who had no contact with dogs and patients who kept dogs outdoor. There was no significant difference between the symptoms of patients who had no contact with dogs and those of patients who kept dogs outdoor. This implies the patient's symptom will improve only by moving the dog out of the house. PMID:10666918

  14. [Severe atopic dermatitis caused by rare immunodeficiency in childhood].

    PubMed

    Wolsk, Helene Mygind; Marquart, Hanne V; Laub, Bodil; Gniadecki, Robert; Nysom, Karsten; Ifversen, Marianne

    2015-12-14

    Two children are presented with autosomal recessive hyper IgE syndrome caused by a mutation in the dedicator of cytokinesis 8 gene (DOCK8). The manifestations are typically severe atopic dermatitis, food allergies, elevated serum IgE concentration, viral skin infections and risk of malignancies. DOCK8 deficiency was first reported in 2009, following the death of the oldest sibling. The youngest sibling was cured after allogenic stem cell transplantation. This case report illustrates the need of awareness of primary immunodeficiency in children with atypical manifestation of atopic dermatitis in combination with recurrent infections. PMID:26692033

  15. [How I prevent...exacerbation of atopic dermatitis].

    PubMed

    Xhauflaire-Uhoda, E; Piérard-Franchimont, C; Nikkels, A F; Piérard, G E

    2006-01-01

    Atopic dermatitis is under the influence of series of environmental factors. The contact with unsuited cleaning agents and rough textiles can exacerbate pruritus and inflammation. Preventive and adjuvant measures can thus help the care procedures of the disease. Appropriate hygiene measures and the use of emollients are particularly helpful. Clothing measures are also in place. Undergarments and pyjamas made of knitted natural silk are available. Other measures, sometimes corresponding to anecdotal claims--antihistamines, thermal cures, unconventional medicine, probiotics, chinese herbals, essential fatty acids--have not proven their preventive efficacy in atopic dermatitis. PMID:17020235

  16. The effect of nematode administration on canine atopic dermatitis.

    PubMed

    Mueller, R S; Specht, L; Helmer, M; Epe, C; Wolken, S; Denk, D; Majzoub, M; Sauter-Luis, C

    2011-09-27

    Canine atopic dermatitis is a common disease and is considered as an animal model of the human disease. Immunomodulation by helminths is reported in several species. The aim of this study was to determine whether nematodes have an immunomodulatory effect on atopic dermatitis in dogs. In the pilot study, 12 atopic dogs were infected with either embryonated eggs of Trichuris vulpis (500 and 2500 eggs in 3 dogs each) or L3 larvae of Uncinaria stenocephala (100, 500 and 2500 eggs in 2 dogs each), respectively, for 3 months. Pruritus was evaluated with visual analogue scales and clinical lesions with the canine atopic dermatitis extent and severity index (CADESI). Skin biopsies were obtained for histopathology at the beginning and end of the study. In the subsequent placebo-controlled, double-blinded, randomised study, 21 dogs received either 2500 embryonated T. vulpis eggs or placebo and were evaluated similarly. In addition, allergen-specific serum IgE concentrations were determined. All dogs in the pilot study improved in their lesion scores, most in their pruritus scores. The cutaneous inflammatory infiltrate did not change significantly. In the subsequent randomised study, there was no significant difference between placebo and Trichuris administration in regard to pruritus or CADESI. IgE concentrations also did not change significantly. Infection with T. vulpis did not significantly change clinical signs of canine atopic dermatitis. PMID:21621922

  17. Review of Critical Issues in the Pathogenesis of Atopic Dermatitis.

    PubMed

    Irvine, Alan D; Eichenfield, Lawrence F; Friedlander, Sheila F; Simpson, Eric L

    2016-06-01

    About a decade age, loss-of-function mutations in the filaggrin molecule were first implicated in the pathogenesis of ichthyosis vulgaris and, subsequently, of atopic dermatitis and other atopic diseases. Since then, intensive study of the role of filaggrin null mutations have led to other milestones in understanding the pathologic pathways in these diseases, including the initiation, maintenance, and promotion of the disease processes. The result has been new and emerging clinical and pharmacologic strategies for early identification of and intervention in atopic diseases. Semin Cutan Med Surg 35(supp5):S89-S91. PMID:27525507

  18. Treatment strategies for atopic dermatitis: optimizing the available therapeutic options.

    PubMed

    Paller, Amy S; Simpson, Eric L; Eichenfield, Lawrence F; Ellis, Charles N; Mancini, Anthony J

    2012-09-01

    Bathing and moisturization to control dryness, applications of topical anti-inflammatory agents (including corticosteroids and calcineurin inhibitors [TCIs]) to control flares, minimization of the risk for infection, and relief of pruritus are the cornerstones of effective therapy for atopic dermatitis. Education of parents and patients is crucial to enhance adherence. Strategies for reduced Staphylococcus aureus colonization may help control re-emergence of flares following cessation of antimicrobial treatment for infection; these include dilute bleach baths and minimizing the risk for contamination of topical agents. In severe, refractory cases, more aggressive therapy with systemic immunosuppressants may be considered, but appropriate laboratory testing must be included as part of patient monitoring during treatment. The value of adjuvant therapy with wet wraps to "cool down" particularly erythematous and pruritic flares is becoming increasingly recognized. PMID:23021780

  19. Histamine induces proliferation in keratinocytes from atopic dermatitis patients

    PubMed Central

    Glatzer, Franziska; Gschwandtner, Maria; Ehling, Sarah; Rossbach, Kristine; Janik, Katrin; Klos, Andreas; Bäumer, Wolfgang; Kietzmann, Manfred; Werfel, Thomas; Gutzmer, Ralf

    2015-01-01

    Background Epidermal hyperproliferation resulting in acanthosis is an important clinical observation in atopic dermatitis and its underlying mechanisms are not completely understood by now. Objective Since elevated levels of histamine are present in lesional skin, we investigated the effect of histamine, especially with regard to H4R activation, on the proliferation of human and murine keratinocytes. Methods The expression of H4R on human and murine keratinocytes was detected by real-time PCR. Keratinocyte proliferation was evaluated by different in vitro cell proliferation assays, scratch assays and measurement of epidermal thickness of murine skin. Results We detected H4R mRNA on foreskin keratinocytes and on outer root sheath keratinocytes; H4R mRNA was more abundant in keratinocytes from patients with atopic dermatitis as compared to non-atopic donors. Stimulation of foreskin keratinocytes, atopic dermatitis outer root sheath keratinocytes and H4R transfected HaCaT cells with histamine and H4R agonist resulted in an increase of proliferation, which was blocked with the H4R-specific antagonist JNJ7777120. Abdominal epidermis of H4R-deficient mice was significantly thinner and the in vitro proliferation of keratinocytes derived from H4R-deficient mice was lower compared to control mice. Interestingly, we only detected H4R expression on murine keratinocytes after stimulation with lipopolysaccharide and peptidoglycane. Conclusion The H4R is highly expressed on keratinocytes from atopic dermatitis patients and its stimulation induces keratinocyte proliferation. This might represent a mechanism that contributes to the epidermal hyperplasia observed in atopic dermatitis. PMID:23932072

  20. Minor criteria for atopic dermatitis in children.

    PubMed

    Wahab, M A; Rahman, M H; Khondker, L; Hawlader, A R; Ali, A; Hafiz, M A; Ansari, N P

    2011-07-01

    Atopic dermatitis (AD) is a common pruritic, eczematous skin disorder that runs a chronic and relapsing course. Major and minor criteria exist as guideline for arriving at a diagnosis of AD. Minor features vary with ethnicity and genetic background and can be used to aid diagnosis. A descriptive study was conducted including 210 patients of 1-12 years age who had concurrent or past history of AD according to criteria of Hanifin and Rajka. This study was conducted in the department of Dermatology of three different Hospitals of Bangladesh. Out of 33 sub-criteria of Hanifin and Rajka, 20 of which were examined encompassed tendency towards cutaneous infection, environmental factor, high IgE level, intolerance of wool, xerosis, infra-orbital fold, ichthyosis, early age of onset, itch on sweating, palmer hyperlinearity, food hypersensitivity, keratosis pilaris, pityriasis alba, facial erythema, cheilitis, hand eczema, foot eczema, intolerance of lipid solvent, scalp scaling and infra-auricular fissure. Out of 20 examined minor criteria, most common was cutaneous infection in 168(80.0%) patients followed by coursed influenced by environmental factor in 140(66.7%), high IgE level in 126(60.0%), intolerance of wool in 105(50.0%), xerosis in 92(43.8%), infra-orbital fold in 83(39.5%), ichthyosis in 72(34.3%), early age of onset in 65(31.0%), itch on sweating in 56(26.7%), palmary hyperlinearity in 52(24.8%), food hypersensitivity in 40(19.0%), keratosis pilaris in 31(14.8%), pityriasis alba in 30(14.3%), facial erythema in 25(1.9%), cheilitis in 22(10.5%), hand eczema in 19(9.0%), foot eczema in 16(7.6%), intolerance of lipid solvent in 14(6.7% ), scalp scaling in 11(5.2%) and infra-auricular fissure in 10(4.8%). These features were present singly or in combination. The result evidenced that minor criteria are many a times important for the diagnosis where major criteria are uncertain. PMID:21804505

  1. Clinical Features of Adult/Adolescent Atopic Dermatitis and Chinese Criteria for Atopic Dermatitis

    PubMed Central

    Liu, Ping; Zhao, Yan; Mu, Zhang-Lei; Lu, Qian-Jin; Zhang, Li; Yao, Xu; Zheng, Min; Tang, Yi-Wen; Lu, Xin-Xiang; Xia, Xiu-Juan; Lin, You-Kun; Li, Yu-Zhen; Tu, Cai-Xia; Yao, Zhi-Rong; Xu, Jin-Hua; Li, Wei; Lai, Wei; Yang, Hui-Min; Xie, Hong-Fu; Han, Xiu-Ping; Xie, Zhi-Qiang; Nong, Xiang; Guo, Zai-Pei; Deng, Dan-Qi; Shi, Tong-Xin; Zhang, Jian-Zhong

    2016-01-01

    Background: Atopic dermatitis (AD) is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczema/AD and to propose Chinese diagnostic criteria for adult/adolescent AD. Methods: A hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients (12 years and over) with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software. Results: A total of 2662 valid questionnaires were collected (1369 male and 1293 female). Of all 2662 patients, 2062 (77.5%) patients had the disease after 12 years old, while only 600 (22.5%) patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine (80.4%) patients had the disease for more than 6 months. One thousand one hundred and forty-four (43.0%) patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight (58.2%) patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients. Conclusion: Late-onset of eczema or AD is

  2. Response to patient-initiated plant extract treatment for atopic dermatitis.

    PubMed

    Strickland, Nicole; Patel, Gopal; Agim, Nnenna G

    2013-01-01

    Ethnomedical practices are increasing in all parts of the world, including many urban centers. We describe a unique case of a 7-year-old girl with atopic dermatitis who was responsive to parent-initiated treatment with the extract of a plant from the Chenopodium genus. A brief discussion raises awareness of such practices to the practicing dermatologist. PMID:23458206

  3. Role of foods in irregular aggravation of atopic dermatitis.

    PubMed

    Uenishi, Toshiaki; Sugiura, Hisashi; Uehara, Masami

    2003-02-01

    Although it is well known that patients with atopic dermatitis often show unpredictable, irregular aggravation of skin lesions, there are no previously published studies examining trigger factors for such unpredictable aggravation. We investigated whether foods play a role in the unpredictable, irregular worsening of atopic dermatitis. The patient group included 195 Japanese adult patients with atopic dermatitis who showed unpredictable, irregular aggravation of skin lesions. They were hospitalized and openly challenged with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. Challenge-positive foods were determined by evaluating the comparable before-after challenge photographs. One to three (average: 1.7) challenge-positive foods were confirmed in 86 (44%) of the 195 patient examined. Predominant offending foods were chocolate, cheese, coffee, yogurt and some Japanese foods such as glutinous rice cake, soy sauce and fermented soybeans. Specific IgE values to the offending foods were mostly negative. Patients were asked to exclude challenge-positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a progressive improvement of the disease. These results suggest that foods play an important role in unpredictable, irregular aggravation of skin lesions in patients with atopic dermatitis. PMID:12692374

  4. Efficacy and safety considerations in topical treatments for atopic dermatitis.

    PubMed

    Nicol, Noreen Heer

    2011-01-01

    As no cure exists for atopic dermatitis, the goals of treatment include reducing symptoms and prolonging periods between flares. Proper skin care can improve skin barrier function, reducing susceptibility to triggers of flares. Topical corticosteroids and topical calcineurin inhibitors may improve symptoms. PMID:22256690

  5. An update on the treatment of canine atopic dermatitis.

    PubMed

    Saridomichelakis, Manolis N; Olivry, Thierry

    2016-01-01

    Canine atopic dermatitis is a common skin disease seen in veterinary clinical practice. Several factors appear to contribute to the cutaneous inflammation and pruritus. The therapeutic strategy should focus on control of those factors that can be identified and for which interventional measures are feasible; these include ectoparasites, bacterial/fungal infection and dietary hypersensitivity. Ectoparasites, particularly fleas, are not the cause of atopic dermatitis, but they are a confounding factor, which can exacerbate pruritus, and preventative measures are therefore indicated. Bacterial and yeast infections are frequently associated with atopic dermatitis and initial systemic and/or topical therapy should be considered, followed by regular topical treatment for preventing relapse. Concurrent dietary hypersensitivity should be investigated by undertaking an elimination/provocation trial, followed by feeding of a hypoallergenic diet where appropriate. Depending on the severity of the clinical signs of atopic dermatitis and the willingness and expectations of owners, symptomatic treatment and/or specific interventional therapy for environmental allergy (allergen avoidance, allergen-specific immunotherapy) may be implemented. Symptomatic treatment includes use of glucocorticoids (systemically or topically), ciclosporin and oclacitinib. Other treatment modalities of lower or less proven efficacy include antihistamines, dextromethorphan, fatty acids, feline interferon-omega, misoprostol, pentoxifylline, specific serotonin re-uptake inhibitors and tricyclic antidepressant drugs. The therapeutic approach should be reviewed at regular intervals and tailored to the individual's needs. A successful long-term outcome can usually be achieved by combining the various treatment approaches in a way that maximises their benefits and minimises their drawbacks. PMID:26586215

  6. Colloidal oatmeal formulations as adjunct treatments in atopic dermatitis.

    PubMed

    Fowler, Joseph F; Nebus, Judith; Wallo, Warren; Eichenfield, Lawrence F

    2012-07-01

    Colloidal oatmeal has been used for decades to soothe and ameliorate atopic dermatitis and other pruritic and/or xerotic dermatoses. In-vitro and/or in-vivo studies have confirmed the anti-inflammatory, barrier repair, and moisturizing properties of this compound. A broad set of studies has been conducted in recent years to assess the effects of colloidal oatmeal as adjunct treatment in the management of atopic dermatitis (AD). This paper will review these studies. In these investigations, patients in all age groups (3 months to 60 years) with mild to moderate atopic dermatitis were included and allowed to continue their prescribed topical medications. These studies found that the daily use of moisturizers and/or cleansers containing colloidal oatmeal significantly improved many clinical outcomes of atopic dermatitis from baseline: investigator's assessment (IGA), eczema area and severity index (EASI), itch, dryness, and quality of life indices. Safety results showed that the formulations were well tolerated in babies, children, and adults with AD. PMID:22777219

  7. Elevated cortisol content in dog hair with atopic dermatitis.

    PubMed

    Park, Seol-Hee; Kim, Sun-A; Shin, Nam-Shik; Hwang, Cheol-Yong

    2016-05-01

    Canine atopic dermatitis (CAD) is a chronic relapsing inflammatory skin disease occurring in 10% of the canine population. Although most studies have focused on the pathophysiological mechanism involved in CAD, the detrimental impact of CAD on quality of life has received only little attention. Hair cortisol analysis is becoming a valuable tool in monitoring chronic stress. To further validate this approach in CAD, we compared the hair cortisol concentration of atopic dogs with that of healthy conditioned dogs. The extent and severity of cutaneous lesions of atopic dermatitis were assessed according to modified CADESI-03 scores. In addition, skin barrier function was evaluated by measuring transepidermal water loss (TEWL) and stratum corneum conductance. The correlation between CAD severity and hair cortisol concentration was evaluated. The level of hair cortisol evaluated by ELISA assay showed that the atopic dermatitis group had significantly increased cortisol levels compared to that of the healthy control group. A significant positive correlation was identified between hair cortisol level and the CADESI score in CAD patients. The TEWL value of the cubital flexor of the forelimb in the atopic group was significantly higher compared to the healthy controls. These findings imply that the hair cortisol analysis can be an effective and objective biomarker in assessment of long-term stress of CAD patients. PMID:27506086

  8. Treating atopic dermatitis: safety, efficacy, and patient acceptability of a ceramide hyaluronic acid emollient foam

    PubMed Central

    Pacha, Omar; Hebert, Adelaide A

    2012-01-01

    Advances in current understanding of the pathophysiology of atopic dermatitis have led to improved targeting of the structural deficiencies in atopic skin. Ceramide deficiency appears to be one of the major alterations in atopic dermatitis and the replenishment of this epidermal component through topically applied ceramide based emollients appears to be safe, well tolerated, and effective. Recently a ceramide hyaluronic acid foam has become commercially available and increasing evidence supports its safety and efficacy in patients who suffer from atopic dermatitis. PMID:22690129

  9. Atopic dermatitis and vitamin D: facts and controversies*

    PubMed Central

    Mesquita, Kleyton de Carvalho; Igreja, Ana Carolina de Souza Machado; Costa, Izelda Maria Carvalho

    2013-01-01

    Patients with atopic dermatitis have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Clinically, this results in an intensely pruriginous and inflamed skin that allows the penetration of irritants and allergens and predisposes patients to colonization and infection by microorganisms. Among the various etiological factors responsible for the increased prevalence of atopic diseases over the past few decades, the role of vitamin D has been emphasized. As the pathogenesis of AD involves a complex interplay of epidermal barrier dysfunction and dysregulated immune response, and vitamin D is involved in both processes, it is reasonable to expect that vitamin D's status could be associated with atopic dermatitis' risk or severity. Such association is suggested by epidemiological and experimental data. In this review, we will discuss the evidence for and against this controversial relationship, emphasizing the possible etiopathogenic mechanisms involved. PMID:24474104

  10. Antibiotic therapy in the management of atopic dermatitis.

    PubMed

    Belloni Fortina, A; Neri, L

    2015-06-01

    Atopic dermatitis (AD), also known as atopic eczema, is a syndrome characterized by a chronic eczematous dermatitis, with associated pruritus, characteristic age-specific morphology and distribution of lesions and recurrent nature. Secondary infections in patients with AD are very common and difficult to treat. S. aureus colonizes almost all eczematous lesions in atopic patients and releases several super-antigens and exotoxins (i.e., toxic shock syndrome toxin-1, enterotoxins A-D, etc.), which sustain inflammatory reactions and promote tachyphylaxis. The topical antibiotics most commonly prescribed for mild/moderate secondary infections are gentamicin, fusidic acid and mupirocine. This article reviews existing therapeutic options and provides guidance for the management of secondary skin infection among patients with AD. PMID:25786482

  11. Atopic dermatitis and vitamin D: facts and controversies.

    PubMed

    Mesquita, Kleyton de Carvalho; Igreja, Ana Carolina de Souza Machado; Costa, Izelda Maria Carvalho

    2013-01-01

    Patients with atopic dermatitis have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Clinically, this results in an intensely pruriginous and inflamed skin that allows the penetration of irritants and allergens and predisposes patients to colonization and infection by microorganisms. Among the various etiological factors responsible for the increased prevalence of atopic diseases over the past few decades, the role of vitamin D has been emphasized. As the pathogenesis of AD involves a complex interplay of epidermal barrier dysfunction and dysregulated immune response, and vitamin D is involved in both processes, it is reasonable to expect that vitamin D's status could be associated with atopic dermatitis' risk or severity. Such association is suggested by epidemiological and experimental data. In this review, we will discuss the evidence for and against this controversial relationship, emphasizing the possible etiopathogenic mechanisms involved. PMID:24474104

  12. Pattern of Bacterial Colonization of Atopic Dermatitis in Saudi Children

    PubMed Central

    Bilal, Jalal Ali; Ahmad, Mohammad Issa; Robaee, Ahmad A. Al; Alzolibani, Abdullateef A.; Shobaili, Hani A. Al; Al-Khowailed, Mohammed Saleh

    2013-01-01

    Background: Atopic dermatitis is an inflammatory skin disorder. Although it is not a life threatening condition, it may become infected with microorganisms, especially in children. Objectives: The aim of this study was to determine bacterial colonisation in children with atopic dermatitis. Methods: A total of 80 children were randomly included in this study. Two swabs were taken from each child, one from the eczematous skin lesion and the other from apparently healthy skin, as a control. Bacteria were isolated and identified on the basis of the colonial morphology, gram staining and the Vitek System. Results: The mean age of children in this study was 1.4 years, with no gender difference (p=0.98) (n=80). A total of 240 bacterial colonies were grown from atopic dermatitis lesions in contrast to 193 colonies from non–lesional skin. Gram–positive cocci were found in 78 (97.5%) lesions and in 77 (96.2%) non–lesional skin. Staphylococci species were significantly detected in the lesions than in the non–lesional skin. Ent. Faecalis, Ent. Faecium, Ent. gallinarium and C. minutissium were significantly isolated from lesions as compared to non–lesional skin, whereas C. xerosis was insignificantly found to be more in the lesions (p=0.21). Gram–negative bacteria were isolated from 7(8.8%) lesions, but none were isolated from non–lesional skin. Recovered species were Pantoea agglomerans, Enterobacter cloacae, Chryseobacterium indologenes and Acinetobacter Iwoffii. Conclusion: Atopic dermatitis in children is complicated with streptococcal and gram–negative bacterial colonisations and the latter was correlated with the severity of the lesions. Enterococci and Corynebacterium species were significant residents. S. aureus remained the chief inhabitant. No causal relationship could be established between the skin microbiota and atopic dermatitis. PMID:24179911

  13. Qualitative vs. quantitative atopic dermatitis criteria - in historical and present perspectives.

    PubMed

    Andersen, R M; Thyssen, J P; Maibach, H I

    2016-04-01

    This review summarizes historical aspects, clinical expression and pathophysiology leading to coining of the terms atopy and atopic dermatitis, current diagnostic criteria and further explore the possibility of developing quantitative diagnostic criteria of atopic dermatitis (AD) based on the importance of atopic features - subjective, objective, and those derived from laboratory tests - the new partly promising AD biomarkers. 'Atopy', introduced in 1923, denoted 'the sense of a strange disease without a precise place in the body'. A decade later, Sulzberger and Hill, first defined 'atopic dermatitis'. The pioneering well-recognized criteria, 'Hanifin & Rajka' (Acta Derm Venereol, 92, 1980, 44), were developed empirically on 'clinical experience' and expert consensus. As opposed to the widely used, rather anamnestic 'UK Criteria' (1994), they have few formal validation studies, but appear to well embrace various atopic phenotypes. Pruritus, xerosis, typical morphology/distribution of dermatitis and tendency to a relapsing/chronic course are common basic features in AD criteria, whereas skin sensitivity, heredity and various ill-defined atopic stigmata also seem to comprise the atopic phenomenon. Specific pheno- and endotypes are now emerging potentially enabling us to better classify patients with AD, but the influence of these on the diagnosis of AD is so far unclear. Few diagnostic models use quantitative scoring systems to establish AD cases from normal population, which, however, may be useful to better study and manage this disease. Long-term prospective observational studies, from which few are available at this point, along with interventional studies, are a perquisite and will provide the best option to improve our understanding of its complex characteristics and etiology. PMID:26538253

  14. The differential diagnosis of atopic dermatitis in childhood.

    PubMed

    Krol, Alfons; Krafchik, Bernice

    2006-01-01

    Atopic is the most common of the dermatitides seen in infancy and childhood, but there are numerous other diseases that can mimic the skin findings. These include seborrheic dermatitis, immunodeficiency, and psoriasis in infancy; scabies, tinea corporis infection, perioral, nummular, contact, and molluscum dermatitis in childhood. It is sometimes extremely difficult to differentiate between ichthyosis and AD, and it is also important to differentiate AD from erythrodermic conditions including acrodermatitis enteropathica, biotin deficiency, and Netherton syndrome. A rare condition in children that may mimic AD is mycosis fungoides. PMID:16669989

  15. Management of Patients with Atopic Dermatitis: The Role of Emollient Therapy

    PubMed Central

    Catherine Mack Correa, M.; Nebus, Judith

    2012-01-01

    Atopic dermatitis is a common inflammatory skin disorder that afflicts a growing number of young children. Genetic, immune, and environmental factors interact in a complex fashion to contribute to disease expression. The compromised stratum corneum found in atopic dermatitis leads to skin barrier dysfunction, which results in aggravation of symptoms by aeroallergens, microbes, and other insults. Infants—whose immune system and epidermal barrier are still developing—display a higher frequency of atopic dermatitis. Management of patients with atopic dermatitis includes maintaining optimal skin care, avoiding allergic triggers, and routinely using emollients to maintain a hydrated stratum corneum and to improve barrier function. Flares of atopic dermatitis are often managed with courses of topical corticosteroids or calcineurin inhibitors. This paper discusses the role of emollients in the management of atopic dermatitis, with particular emphasis on infants and young children. PMID:23008699

  16. [Hypnotherapy of atopic dermatitis in an adult. Case report].

    PubMed

    Perczel, Kristóf; Gál, János

    2016-01-17

    Hypnosis is well known for its modulatory effects on immune and inflammatory processes, and it is a therapeutic option for certain diseases of such pathogenesis. The authors report treatment of an adult patient with extensive atopic dermatitis, who was only minimally responsive to conservative treatment. In a 15 session hypnotherapy the authors combined the use of direct, symptom-oriented suggestive techniques with hypnotic procedures to identify and modify comorbid psychological issues. To monitor the effect of the treatment, patient diaries (quality and quantity of sleep, intensity of pain and itch) and repeated psychometric tests were used. At the end of treatment there were improvements in all measured dimensions (itch, pain, insomnia, activity, anxiety and emotional state) both clinically and psychometrically. The authors conclude, that hypnosis can be an effective adjunctive therapy in atopic dermatitis, and in certain severe cases may constitute a salvage therapy. PMID:26929974

  17. Role of primary and secondary prevention in atopic dermatitis

    PubMed Central

    Michalak, Iwonna; Gutfreund, Katarzyna; Bienias, Wojciech; Matych, Marta; Szewczyk, Anna; Kaszuba, Andrzej

    2015-01-01

    Atopic dermatitis (AD) is a serious epidemiological problem in industrialized countries. The incidence of AD has increased considerably over the last 30 years. Atopic dermatitis is a chronic, recurrent, inflammatory skin disease accompanied by strong itching. It is characterized by typical features depending on age. The parents of children suffering from AD must be prepared to change their lifestyle. They should avoid factors which can promote skin lesions and apply appropriate, regular skin care. The article describes primary prevention of AD as well as prophylactic measures to avoid skin eczema. It presents the role of infections, vaccinations, breastfeeding and the influence of domestic animals, house renovation and moulds on development of AD. The article also describes the significance of the epidermal barrier, skin colonization by microbial agents, pruritus, stress, food and inhalant allergy among people who suffer from AD. PMID:26755903

  18. GUIDELINES OF CARE FOR THE MANAGEMENT OF ATOPIC DERMATITIS

    PubMed Central

    Eichenfield, Lawrence F.; Tom, Wynnis L.; Berger, Timothy G.; Krol, Alfons; Paller, Amy S.; Schwarzenberger, Kathryn; Bergman, James N.; Chamlin, Sarah L.; Cohen, David E.; Cooper, Kevin D.; Cordoro, Kelly M.; Davis, Dawn M.; Feldman, Steven R.; Hanifin, Jon M.; Margolis, David J.; Silverman, Robert A.; Simpson, Eric L.; Williams, Hywel C.; Elmets, Craig A.; Block, Julie; Harrod, Christopher G.; Begolka, Wendy Smith; Sidbury, Robert

    2014-01-01

    Atopic dermatitis (AD) is a common and chronic, pruritic inflammatory skin condition that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this second of four sections, treatment of AD with non-pharmacological interventions and pharmacological topical therapies are reviewed. Where possible, suggestions on dosing and monitoring are given based on available evidence. PMID:24813302

  19. GUIDELINES OF CARE FOR THE MANAGEMENT OF ATOPIC DERMATITIS

    PubMed Central

    Sidbury, Robert; Davis, Dawn M.; Cohen, David E.; Cordoro, Kelly M.; Berger, Timothy G.; Bergman, James N.; Chamlin, Sarah L.; Cooper, Kevin D.; Feldman, Steven R.; Hanifin, Jon M.; Krol, Alfons; Margolis, David J.; Paller, Amy S.; Schwarzenberger, Kathryn; Silverman, Robert A.; Simpson, Eric L.; Tom, Wynnis L.; Williams, Hywel C.; Elmets, Craig A.; Block, Julie; Harrod, Christopher G.; Begolka, Wendy Smith; Eichenfield, Lawrence F.

    2014-01-01

    Atopic dermatitis (AD) is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2-3% of adults. This guideline addresses important clinical questions that arise in AD management and care, providing recommendations based on the available evidence. In this third of four sections, treatment of AD with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option. PMID:24813298

  20. Diagnostic criteria for atopic dermatitis in Thai children.

    PubMed

    Wisuthsarewong, Wanee; Viravan, Suchitra

    2004-12-01

    Atopic dermatitis (AD) is a common skin disease in Thai children. There is no clinical or laboratory gold standard for the diagnosis. It is generally based on the guideline proposed by Hanifin and Rajka. Many studies have shown that some criteria are probably not all that significant in making the diagnosis. This study was designed to evaluate the frequency and diagnostic significance of clinical features of AD in Thai children. The authors studied 108 patients with AD and 103 controls including patients with other skin diseases. The AD group consisted of 60 girls and 48 boys. The mean age was 60.3+/-36.1 months. All previously proposed features were evaluated and the difference infrequency was tested with the chi-square test. History of pruritus, rash on typical distribution, chronically relapsing course, duration more than 6 months, personal or family history of atopy, age of onset before 2 years, recurrent conjunctivitis, itch when sweating, intolerance to rough textile, food and milk intolerance, history of dry skin, seasonal variation, visible dermatitis, dermatitis of a typical distribution, xerosis, ichthyosis vulgaris, foot dermatitis, Dennie-Morgan infraorbital fold, orbital darkening, periorbital dermatitis, pityriasis alba, peri-auricular dermatitis, anterior neck fold, truncal dermatitis, perifollicular accentuation, white dermographism and diffuse scaling of scalp were all significantly more frequent in AD (p < 0.05). A minimum set of diagnostic criteria for AD was derived by using multiple stepwise logistic regression technique. It consisted of history of itchy rash, history of flexural dermatitis, chronicity more than 6 months, and visible xerosis, periorbital dermatitis and perifollicular accentuation. PMID:15822547

  1. The Role of Impaired Epidermal Barrier Function in Atopic Dermatitis.

    PubMed

    Jurakić Tončić, Ružica; Marinović, Branka

    2016-06-01

    Atopic dermatitis (AD) is a chronic, inflammatory, pruritic skin disease with increasing prevalence. The etiopathogenesis of atopic dermatitis is multifactorial and involves a complex interplay of environmental and genetic factors that induce derangements in the structure and function of the epidermal barrier and immune system. Due to great heterogeneity of etiopathogenesis, there is also great variability of clinical presentation, and diagnosis can sometimes be challenging and difficult. Diagnosis mostly relies on clinical features and laboratory tests, but morphology alone cannot reliably establish the diagnosis, so the spectrum of features associated with AD must be considered. Traditionally, patients with AD have been separated into two different subgroups, i.e. intrinsic and extrinsic. Today, most of authors prefer the outside to inside and back to outside hypothesis, suggesting that the primary disorder lies in epidermal structure and function, resulting in inflammation and immunological downstream activation which further provokes secondary barrier abnormalities. In this review, we discuss the structure and function of the epidermal barrier and the role of impaired barrier function in etiopathogenesis of atopic dermatitis. PMID:27477169

  2. Ultraviolet index: a light in atopic dermatitis and vitamin D research?*

    PubMed Central

    Mesquita, Kleyton de Carvalho; Igreja, Ana Carolina de Souza Machado; Costa, Izelda Maria Carvalho

    2016-01-01

    BACKGROUND: The role played by vitamin D in atopic dermatitis is controversial and has been the focus of many studies. The ultraviolet index has not been considered in this type of research. OBJECTIVES: The objectives of the study were to assess 25-hydroxy vitamin D [25(OH)D] serum level in atopic dermatitis patients and control group, to investigate the association between atopic dermatitis clinical severity (using the SCORing Atopic Dermatitis index - SCORAD) and 25(OH)D serum levels, and to evaluate the independent predictors, including Ultraviolet index, SCORAD and 25(OH)D. METHODS: We conducted a cross-sectional study of 106 atopic dermatitis patients. A control group was matched with a subsample of 54 participants with atopic dermatitis. SCORAD index, laboratory tests, and local Ultraviolet index were assessed. RESULTS: The atopic dermatitis patients had serum 25(OH)D levels and mean UVI significantly higher than the control group. Immunoglobulin E and Ultraviolet index were associated with the SCORAD index. Skin type, age and Ultraviolet index were independent predictors of 25(OH)D. CONCLUSIONS: Although statistically significant, the different levels of 25(OH)D between the paired groups may be attributed to the higher mean Ultraviolet index in atopic dermatitis patients. Since Ultraviolet index is an independent predictor of SCORAD index and of 25(OH)D level, it may work as a confounding factor in studies involving atopic dermatitis and 25(OH)D and must be considered in this kind of research. PMID:26982776

  3. Multifactorial skin barrier deficiency and atopic dermatitis: Essential topics to prevent the atopic march.

    PubMed

    Egawa, Gyohei; Kabashima, Kenji

    2016-08-01

    Atopic dermatitis (AD) is the most common inflammatory skin disease in the industrialized world and has multiple causes. Over the past decade, data from both experimental models and patients have highlighted the primary pathogenic role of skin barrier deficiency in patients with AD. Increased access of environmental agents into the skin results in chronic inflammation and contributes to the systemic "atopic (allergic) march." In addition, persistent skin inflammation further attenuates skin barrier function, resulting in a positive feedback loop between the skin epithelium and the immune system that drives pathology. Understanding the mechanisms of skin barrier maintenance is essential for improving management of AD and limiting downstream atopic manifestations. In this article we review the latest developments in our understanding of the pathomechanisms of skin barrier deficiency, with a particular focus on the formation of the stratum corneum, the outermost layer of the skin, which contributes significantly to skin barrier function. PMID:27497277

  4. Grades of Severity and the Validation of an Atopic Dermatitis Assessment Measure (ADAM).

    ERIC Educational Resources Information Center

    Charman, Denise P.; Varigos, George A.

    1999-01-01

    Studied the validity of the Atopic Dermatitis Assessment Measure (D. Charman and others, 1999) with 171 pediatric patients in Australia using partial credit analyses to produce clinically relevant "word pictures" of grades of severity for atopic dermatitis. Discusses implications for measurement in medicine. (SLD)

  5. Interactions between FLG mutations and allergens in atopic dermatitis.

    PubMed

    Li, Ming; Liu, Jiang-Bo; Liu, Qiang; Yao, Mianzhi; Cheng, Ruhong; Xue, Hui; Zhou, Hua; Yao, Zhirong

    2012-12-01

    Filaggrin gene (FLG) mutations and sensitization in patients with atopic dermatitis (AD) have been well documented. However, whether an interaction exists between these mutations and specific sensitization in AD patients is still unknown. The aim of the study was to explore the interaction between FLG mutations and specific sensitization in AD patients. A total of 249 AD outpatients were recruited in the current study. Skin prick tests were conducted to assess the patient's sensitization to specific allergens. FLG mutations were analyzed through comprehensive sequencing. Logistic regression analyses were conducted to determine the interactions between FLG mutations and sensitization present. The mean age of the patients was 3.5 years, and the mean age of onset of AD was 9.6 months. The mean SCORAD of the patients was 25.8. Fourteen types of mutations were identified in the FLG of 64 patients. A total of 24 (9.6 %) and 29 (11.6 %) cases were mutated with 3321delA and K4671X, respectively. Sensitization to at least one type of allergen was detected in 118 patients (47.4 %). Logistic regression analyses showed that FLG mutations presented an interaction with sensitization to peanut and did not interact with the other detected allergens among AD patients. Sensitization to peanut allergens would have an interaction with the mutation of K4671X and the combined mutations in FLG in patients with atopic dermatitis. However, sensitization to the other common allergens might not interact with FLG mutations in the development of atopic dermatitis. PMID:22903496

  6. Leptin and Atopic Dermatitis in Korean Elementary School Children.

    PubMed

    Seo, SungChul; Yoon, Won Suck; Cho, Yunjung; Park, Sang Hee; Choung, Ji Tae; Yoo, Young

    2016-04-01

    The prevalence of atopic dermatitis (AD) and obesity have been increasing considerably in Korean school-children. AD is a chronic pruritic recurrent inflammatory skin disorder. Leptin is secreted by adipocytes which has been suggested to be immunologically active; however, their role in AD has not yet been well understood. A total of 227 subjects out of 2,109 elementary school children were defined as having AD based on the ISAAC questionnaire survey. Ninety subjects with AD, aged between 6 and 12 years, completed scoring of severity of AD (SCORAD), skin prick testing, blood tests for total IgE, eosinophil counts, eosinophil cationic protein (ECP) and lipid profiles. Serum leptin levels were also measured. A subject with atopic AD was defined as an AD patient showing at least 1 positive reaction to allergens in skin prick testing. There were no significant differences in age, body mass index, percentage of breast milk feeding, mode of delivery, prevalence of atopy, and lipid profiles between atopic AD and non-atopic AD subjects. The serum leptin levels (log mean±SD) were significantly higher in non-atopic AD group than in the atopic AD group (0.86±0.57 ng/mL vs 0.53±0.72 ng/mL, p=0.045). Subjects with mild-to-moderate AD showed significantly higher serum leptin levels than those with severe AD (0.77±0.67 ng/mL vs 0.33±0.69 ng/mL, p=0.028). There was a marginal inverse correlation between the SCORAD index and the serum leptin concentration in total AD subjects (r=-0.216, p=0.053). The serum leptin levels were significantly higher in non-atopic AD subjects or mild-to-moderate AD subjects. Leptin did not seem to be associated with IgE-mediated inflammation in AD. Obesity-associated high leptin differed between non-atopic AD and atopic AD subjects. PMID:27090367

  7. Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications

    PubMed Central

    Siegfried, Elaine C.; Hebert, Adelaide A.

    2015-01-01

    Atopic dermatitis (AD) is one of the most common skin diseases affecting infants and children. A smaller subset of adults has persistent or new-onset AD. AD is characterized by pruritus, erythema, induration, and scale, but these features are also typical of several other conditions that can mimic, coexist with, or complicate AD. These include inflammatory skin conditions, infections, infestations, malignancies, genetic disorders, immunodeficiency disorders, nutritional disorders, graft-versus-host disease, and drug eruptions. Familiarity of the spectrum of these diseases and their distinguishing features is critical for correct and timely diagnosis and optimal treatment. PMID:26239454

  8. GUIDELINES OF CARE FOR THE MANAGEMENT OF ATOPIC DERMATITIS

    PubMed Central

    Eichenfield, Lawrence F.; Tom, Wynnis L.; Chamlin, Sarah L.; Feldman, Steven R.; Hanifin, Jon M.; Simpson, Eric L.; Berger, Timothy G.; Bergman, James N.; Cohen, David E.; Cooper, Kevin D.; Cordoro, Kelly M.; Davis, Dawn M.; Krol, Alfons; Margolis, David J.; Paller, Amy S.; Schwarzenberger, Kathryn; Silverman, Robert A.; Williams, Hywel C.; Elmets, Craig A.; Block, Julie; Harrod, Christopher G.; Begolka, Wendy Smith; Sidbury, Robert

    2014-01-01

    Atopic dermatitis (AD) is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2–3% of adults. This guideline addresses important clinical questions that arise in AD management and care, providing updated and expanded recommendations based on the available evidence. In this first of four sections, methods for diagnosis and monitoring of disease, outcomes measures for assessment and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. PMID:24290431

  9. Atopic dermatitis in children: clinical features, pathophysiology, and treatment.

    PubMed

    Lyons, Jonathan J; Milner, Joshua D; Stone, Kelly D

    2015-02-01

    Atopic dermatitis (AD) is a chronic, relapsing, highly pruritic skin condition resulting from disruption of the epithelial barrier and associated immune dysregulation in the skin of genetically predisposed hosts. AD generally develops in early childhood, has a characteristic age-dependent distribution and is commonly associated with elevated IgE, peripheral eosinophilia, and other allergic diseases. Medications such as antihistamines have demonstrated poor efficacy in controlling AD-associated itch. Education of patients regarding the primary underlying defects and provision of a comprehensive skin care plan is essential for disease maintenance and management of flares. PMID:25459583

  10. Update on Epidemiology, Diagnosis, and Disease Course of Atopic Dermatitis.

    PubMed

    Simpson, Eric L; Irvine, Alan D; Eichenfield, Lawrence F; Friedlander, Sheila F

    2016-06-01

    Studies of the prevalence of atopic dermatitis (AD) have provided insights into associated environmental risk factors, demonstrating the complex interactions between the presence of filaggrin (FLG) gene defects and environment. Among other important findings is that elevated transepidermal water loss (TEWL) in newborns is a strong predictor of AD, regardless of FLG status. Recently recognized predictors of disease course and severity include onset of AD signs and symptoms before 12 months of age and the presence of an FLG mutation and concomitant immunoglobulin E sensitization early in life. Semin Cutan Med Surg 35(supp5):S84-S88. PMID:27525380

  11. The Effectiveness of Written Action Plans in Atopic Dermatitis.

    PubMed

    Sauder, Maxwell B; McEvoy, Alana; Sampson, Margaret; Kanigsberg, Nordau; Vaillancourt, Regis; Ramien, Michele L; Zemek, Roger

    2016-03-01

    Atopic dermatitis (AD) is a chronic dermatosis requiring a stepwise and dynamic approach to management. The use of written action plans has been shown to improve outcomes in other chronic diseases that require a similar incremental approach. A systematic review was performed to evaluate the effect of a written eczema action plan (EAP) in AD management and to identify characteristics of effective action plans in children with eczema. Only two trials were identified as eligible, which highlights the need for more research on EAPs. PMID:26776967

  12. Alternative, Complementary, and Forgotten Remedies for Atopic Dermatitis

    PubMed Central

    Goddard, Allison L.; Lio, Peter A.

    2015-01-01

    Atopic dermatitis, perhaps more than other dermatologic diseases, has garnered much attention in the realm of alternative medicine. This may be because its etiopathogenesis is incompletely understood, it is increasingly common, and it waxes and wanes often without clear precipitants, opening up many opportunities for misinterpretation. Herein we explore the evidence for a number of different alternative and complementary therapies, from textiles to vitamin supplements. By definition, none have enough data to be deemed “effective” in a conventional sense, but it is hopeful that some show promising evidence that may one day lead to mainstream acceptance with further research. PMID:26257817

  13. Is Frictional Lichenoid Dermatitis a Minor Variant of Atopic Dermatitis or a Photodermatosis

    PubMed Central

    Sardana, Kabir; Goel, Khushbu; Garg, Vijay Kumar; Goel, Alka; Khanna, Deepshikha; Grover, Chander; Khurana, Nita

    2015-01-01

    Context: Frictional lichenoid dermatitis. Background: Frictional lichenoid dermatitis (FLE) is an entity that is probably under diagnosed and has been variably associated with either friction and/or atopy with a distinctive seasonal variation. Aims and Objectives: To study correlation of FLE with UV index and to assess its association with atopic dermatitis. Materials and Methods: A cross sectional analysis of children with FLE was done, over a period of 6 years in two tertiary hospitals. A detailed history and examination was done to assess the features of atopic dermatitis. The number of cases seen per month was compared with the mean monthly UV index. Two-tailed significance tests using Pearson's coefficient of correlation and T-test were used to interpret the data. (P < 0.05). Results: One hundred seventy-four patients were studied using the UKC criterion 17.2% of the patients had AD while xerosis (40.3%) was the predominant cutaneous finding. The number of patients seen in summer was more than in winter (P < 0.05) but there was no statistical difference between the cases in winter and spring. There was a significant correlation of the number of cases per month with UV index (P = 0.019). Almost 42% of patients gave a history of recurrence. Conclusions: FLE is probably not associated with atopic dermatitis and is likely to be related to the ambient UV index though a larger cohort with meticulous follow up may be needed to draw a final conclusion. Statistical Analysis Used: The Pearson's coefficient of correlation was used for comparing the cases per month with the UV index. The tests of hypothesis used included the paired T-tests. F-test of variance, Welch test, Wilcoxon rank sum test and the Kolmogorov-Smirnov Test. P < 0.05 was considered significant. PMID:25657400

  14. Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations.

    PubMed

    Carr, Warner W

    2013-08-01

    Atopic dermatitis (AD) is an inflammatory skin disease commonly affecting children and managed by pediatricians, primary care physicians, allergists, and dermatologists alike. For many years, the only available topical pharmacological treatment was topical corticosteroids. This changed in 2000-2001, when topical formulations of two calcineurin inhibitors (tacrolimus and pimecrolimus) were approved for short-term or chronic intermittent treatment of AD in patients ≥ 2 years of age, in whom other treatments have been ineffective or contraindicated. These topical calcineurin inhibitors (TCIs) quickly became a popular treatment option due at least in part to concerns over adverse events associated with prolonged topical corticosteroid use, especially in children. However, based on theoretical concerns about a possible risk of lymphoma associated with TCI use, a Boxed Warning was placed on both products in 2006. Since then, despite an extensive body of evidence, no causal relationship has been demonstrated between TCI use and an increased risk of lymphoma; however, the US FDA has concluded that a link cannot be ruled out. In fact, based on post-marketing surveillance of spontaneous, literature, and solicited reports, we report here that the lymphoma incidence in the topical pimecrolimus-exposed population is up to approximately 54-fold less than that seen in the general US population. This review summarizes the mechanism of action of TCIs, the factors that prompted the Boxed Warning, and recent TCI safety and efficacy data. Based on these data, both topical corticosteroids and TCIs should have defined roles in AD management, with TCIs favored for sensitive skin areas (e.g., face) and instances where topical corticosteroids have proven ineffective, thereby minimizing the risk of adverse effects with both drug classes. PMID:23549982

  15. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.

    PubMed

    Eichenfield, Lawrence F; Tom, Wynnis L; Chamlin, Sarah L; Feldman, Steven R; Hanifin, Jon M; Simpson, Eric L; Berger, Timothy G; Bergman, James N; Cohen, David E; Cooper, Kevin D; Cordoro, Kelly M; Davis, Dawn M; Krol, Alfons; Margolis, David J; Paller, Amy S; Schwarzenberger, Kathryn; Silverman, Robert A; Williams, Hywel C; Elmets, Craig A; Block, Julie; Harrod, Christopher G; Smith Begolka, Wendy; Sidbury, Robert

    2014-02-01

    Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed. PMID:24290431

  16. Children with Atopic Dermatitis Should Always be Patch-tested if They Have Hand or Foot Dermatitis.

    PubMed

    Isaksson, Marléne; Olhardt, Sanna; Rådehed, Jeanette; Svensson, Åke

    2015-05-01

    Atopic dermatitis is the most common chronic inflammatory disease among children in industrialised countries. Many factors influence this disease in a negative way and contact allergy is one such factor. The aim of the study was to examine the frequency of contact allergy among children with the diagnosis atopic dermatitis. Contact allergy was found in 22/82 children (26.8%), the most common from Amerchol L101 (11.0%), potassium dichromate (7.3%), and nickel sulfate (4.9%). A statistically significant difference in contact allergy frequency was demonstrated for those with hand and/or foot eczema compared to those without. Children with atopic dermatitis who suffer from hand and/or foot dermatitis should always be patch-tested to evaluate whether they have a relevant contact allergy and thus allergic contact dermatitis. PMID:25367826

  17. Development of atopic dermatitis in the DARC birth cohort.

    PubMed

    Eller, Esben; Kjaer, Henrik Fomsgaard; Høst, Arne; Andersen, Klaus Ejner; Bindslev-Jensen, Carsten

    2010-03-01

    The aim was to describe the relapsing pattern, sensitization and prognosis of atopic dermatitis (AD) in the first 6 yr in a population-based, prospective birth cohort. The DARC cohort includes 562 children with clinical examinations, specific-IgE and skin prick test at all follow-ups. All children were examined for the development of AD using Hanifin-Rajka criteria and for food hypersensitivity by oral challenges. Severity of AD was measured by objective SCORing Atopic Dermatitis (SCORAD). Point-prevalence of AD peaked at 18 months of age (10%) and decreased at 36 and 72 months to slightly below 7%. The 6-yr cumulative incidence was 22.8% and sensitization was found in 43% of children with AD. It was predominately sensitization to foods, however shifting toward inhalant allergens with age. Sensitization at >or=2 follow-ups affected severity, whereas short-term sensitization at one follow-up does not. Children with early, non-IgE mediated (intrinsic) AD outgrew more often their eczema; however if they develop persistent AD, they remain intrinsic. Early long-term sensitization worsens the prognosis, but 38% of all children have a debut later than 18 months of age. Boys had earlier onset of AD than girls. The large number of follow-ups gives a detailed picture of the relapsing pattern and shows that the relapses occur independently of time of onset. We could not establish any clear correlation between elimination diets and AD duration nor severity. PMID:19788539

  18. A study of white dermographism in atopic dermatitis.

    PubMed

    Wong, S S; Edwards, C; Marks, R

    1996-02-01

    Vascular responses of 15 adults with atopic dermatitis (AD), 15 with psoriasis and 15 with normal skin were studied using an automated dermographometer we have designed. The type of colour change, time to onset and the duration of responses were recorded after a constant stroking force was applied to the skin of each subject. Of the 15 patients with atopic dermatitis, 11 had white dermographism (WD) with abnormal looking skin and four had red dermographism (RD) with normal looking skin. All the control subjects had RD. WD in AD had a significantly longer time to onset and shorter duration of response than RD in controls (P < 0.01), whereas RD in AD had a significantly shorter duration of response than RD in controls (P < 0.01). WD in AD changed to RD after topical corticosteroid treatment and this post-treatment RD was quantitatively similar to the RD in AD. We have quantified, for the first time, a subnormal form of RD in clinically normal skin of patients with AD, which is different from that of the RD in normal subjects. We have also shown that WD in AD is altered to this subnormal form of RD after treatment with topical coricosteroids. PMID:8869036

  19. Evaluating Clinical Use of a Ceramide-dominant, Physiologic Lipid-based Topical Emulsion for Atopic Dermatitis

    PubMed Central

    Del Rosso, James Q.; Aversa, Daniel

    2011-01-01

    dermatitis patients using this same barrier repair agent. The treatment approach of using a skin barrier repair cream as an integral and standard component of initial atopic dermatitis therapy, either as monotherapy or as a part of combination topical therapy, is supported by the outcomes observed in this study. This specific ceramide-dominant, physiologic lipid-based product may be used when initiating topical therapy for atopic dermatitis based on results from this and other studies. PMID:21464885

  20. Effects of Cymbidium Root Ethanol Extract on Atopic Dermatitis

    PubMed Central

    Kim, Wan-Joong; Cha, Hae-Sim; Lee, Myung-Hun; Kim, Sun-Young; Kim, Seo Ho; Kim, Tack-Joong

    2016-01-01

    Cymbidium has known antibacterial and antiedema activity and has been used as an ingredient in cosmetics and fragrances. The effects of Cymbidium ethanol extract (CYM) on allergic response and the underlying mechanisms of action have not been reported. Therefore, the purpose of this study was to determine the effect of CYM on allergic responses. Topical application of CYM was effective against immunoglobulin E (IgE)/dinitrophenyl-conjugated bovine serum albumin- (DNP-BSA-) induced degranulation of RBL-2H3 cells and anaphylaxis in ICR mice. An allergic dermatitis-like mouse model was used to evaluate the therapeutic potential of CYM in vivo. Continuous application of 2,4-dinitrochlorobenzene (DNCB) not only induced dermatitis in ICR mice but also aggravated the skin lesioning. However, the application of CYM decreased skin lesion severity, scratching behavior, and IgE levels. In addition, CYM downregulated the expression of the proinflammatory cytokines interleukin- (IL-) 4, IL-13, and tumor necrosis factor- (TNF-) α. Studies of signal transduction pathways showed that CYM suppressed the phosphorylation of spleen tyrosine kinase (Syk), an upstream molecule. It also inhibited the phosphorylation of Akt, phospholipase C- (PLC-) γ, and mitogen-activated protein kinase kinase kinase (MEKK). These results indicate that CYM may be effective in preventing and reducing allergic response and may have therapeutic potential as an antiallergic agent in disorders such as atopic dermatitis. PMID:26981139

  1. Prevalence of fatty liver in non-obese Japanese children with atopic dermatitis.

    PubMed

    Kimata, Hajime

    2005-06-01

    Fatty liver in non-obese Japanese children was observed in 3.2% of non-atopic children and in 17.6% of patients with atopic dermatitis in 2000. The prevalence of fatty liver in non-obese children aged 0-12 years was studied from 2001 to 2003. Subjects were either non-atopic children, or suffering from bronchial asthma, allergic rhinitis, or atopic dermatitis. Fatty liver was studied by abdominal ultrasound scans. The prevalence of fatty liver was increasing annually, and it reached to 12.5% in non-atopic children, 13.1% in patients with bronchial asthma, 13.7% in patients with allergic rhinitis, or 33.9% in patients with atopic dermatitis, in 2003. Since fatty liver in childhood may be a risk factor for lifestyle-related diseases in future, care should be taken to prevent it. PMID:15995275

  2. Skin barrier and immune dysregulation in atopic dermatitis: an evolving story with important clinical implications.

    PubMed

    Czarnowicki, Tali; Krueger, James G; Guttman-Yassky, Emma

    2014-01-01

    Atopic dermatitis is the most common chronic inflammatory skin disease. Its pathogenesis combines barrier defects, immune dysregulation, and increased skin infections; however, the relative contribution of each of these components is yet to be determined. Uninvolved atopic dermatitis skin also displays broad immune and barrier abnormalities, which highlights a role for proactive treatment strategy. The residual disease genomic profile that accompanies clinical resolution provides further support for proactive treatment approaches. Although intrinsic and extrinsic atopic dermatitis subtypes share a common clinical phenotype, they show some important differences in their Th22/Th17 cytokine profile, which opens the door for personalized specific therapeutics for each disease category. PMID:25017523

  3. Useful tools for the management of atopic dermatitis.

    PubMed

    Ricci, Giampaolo; Dondi, Arianna; Patrizi, Annalisa

    2009-01-01

    Eczema, frequently named atopic dermatitis, is the most frequent chronic skin disease of early childhood, with a high prevalence in industrialized countries and a relapsing-remitting course that is responsible for a serious burden on affected children and their families. Even though most facets of this disease are nowadays well known and numerous guidelines are available, some confusion still exists regarding certain aspects. First, several names have been proposed for the disorder. We suggest that the name and definition adopted by the World Allergy Organization should be used: 'eczema,' divided into 'atopic,' when an allergic sensitization can be demonstrated, and 'non-atopic,' in the absence of sensitization. Several diagnostic criteria have been proposed, but at present the two most reliable are the 2003 revision by the American Academy of Dermatology of the Hanifin-Rajka criteria, and those by Williams revised in 2005. To date, 20 different clinical scores have been published to assess the severity; however, only the EASI (Eczema Area and Severity Index), the SCORAD (SCORing Atopic Dermatitis), and the POEM (Patient-Oriented Eczema Measure) seem to have been adequately validated and are recommended for use in clinical practice and trials. The diagnostic tests to identify associated allergy or sensitization include skin-prick tests, determination of the specific IgE in serum using different assays, and atopy patch tests; in the case of suspected food allergy, a food challenge may be necessary to define the diagnosis. To evaluate quality of life, tools exist that allow both the child's and family's impairment to be considered. In addition, several algorithms exist to help decide therapy on a step-wise basis. However, such guidelines and algorithms represent only an aid to the physician and not an obligatory directive, since the ultimate judgment regarding any therapy must be performed by the physician and tailored to individual needs. A clear and validated

  4. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention

    PubMed Central

    Simpson, Eric L.; Chalmers, Joanne R.; Hanifin, Jon M.; Thomas, Kim S.; Cork, Michael J.; McLean, W.H. Irwin; Brown, Sara J.; Chen, Zunqiu; Chen, Yiyi; Williams, Hywel C.

    2014-01-01

    Background Atopic dermatitis (atopic eczema) is a chronic inflammatory skin disease that has reached epidemic proportions in children worldwide and is increasing in prevalence. Because of the significant socioeconomic effect of atopic dermatitis and its effect on the quality of life of children and families, there have been decades of research focused on disease prevention, with limited success. Recent advances in cutaneous biology suggest skin barrier defects might be key initiators of atopic dermatitis and possibly allergic sensitization. Objective Our objective was to test whether skin barrier enhancement from birth represents a feasible strategy for reducing the incidence of atopic dermatitis in high-risk neonates. Methods We performed a randomized controlled trial in the United States and United Kingdom of 124 neonates at high risk for atopic dermatitis. Parents in the intervention arm were instructed to apply full-body emollient therapy at least once per day starting within 3 weeks of birth. Parents in the control arm were asked to use no emollients. The primary feasibility outcome was the percentage of families willing to be randomized. The primary clinical outcome was the cumulative incidence of atopic dermatitis at 6 months, as assessed by a trained investigator. Results Forty-two percent of eligible families agreed to be randomized into the trial. All participating families in the intervention arm found the intervention acceptable. A statistically significant protective effect was found with the use of daily emollient on the cumulative incidence of atopic dermatitis with a relative risk reduction of 50% (relative risk, 0.50; 95% CI, 0.28-0.9; P = .017). There were no emollient-related adverse events and no differences in adverse events between groups. Conclusion The results of this trial demonstrate that emollient therapy from birth represents a feasible, safe, and effective approach for atopic dermatitis prevention. If confirmed in larger trials

  5. Molecular Mechanisms of Cutaneous Inflammatory Disorder: Atopic Dermatitis.

    PubMed

    Kim, Jung Eun; Kim, Jong Sic; Cho, Dae Ho; Park, Hyun Jeong

    2016-01-01

    Atopic dermatitis (AD) is a multifactorial inflammatory skin disease resulting from interactions between genetic susceptibility and environmental factors. The pathogenesis of AD is poorly understood, and the treatment of recalcitrant AD is still challenging. There is accumulating evidence for new gene polymorphisms related to the epidermal barrier function and innate and adaptive immunity in patients with AD. Newly-found T cells and dendritic cell subsets, cytokines, chemokines and signaling pathways have extended our understanding of the molecular pathomechanism underlying AD. Genetic changes caused by environmental factors have been shown to contribute to the pathogenesis of AD. We herein present a review of the genetics, epigenetics, barrier dysfunction and immunological abnormalities in AD with a focus on updated molecular biology. PMID:27483258

  6. Factors contributing to poor treatment outcomes in childhood atopic dermatitis.

    PubMed

    Sokolova, Anna; Smith, Saxon D

    2015-11-01

    Atopic dermatitis (AD) is a chronic relapsing inflammatory disease of the skin and is the most common paediatric dermatological condition. While no cure is available, it can be treated effectively if adherence to a therapeutic plan is maintained. Poor adherence to treatment is common in AD and can lead to treatment failure, which has significant impacts on the patient, family and society. A comprehensive literature search was conducted to identify factors that contribute to poor treatment adherence in childhood AD and to identify possible strategies to remedy these. Identified factors leading to poor treatment adherence include: complexity of treatment regimen, lack of knowledge, impaired quality of life, dissatisfaction with treatment strategies, infrequent follow up, corticosteroid phobia and the use of complementary and alternative medicine. Effective strategies to increase treatment adherence include: caregiver education and utilisation of education adjuncts, optimisation of the patient/caregiver-clinician relationship, early and frequent follow up and improvement of patient and caregiver quality of life. PMID:25817780

  7. Atopic Dermatitis in Children: Clinical Features, Pathophysiology and Treatment

    PubMed Central

    Lyons, Jonathan J.; Milner, Joshua D.; Stone, Kelly D.

    2014-01-01

    Atopic dermatitis (AD) is a chronic, relapsing, highly pruritic skin condition resulting from disruption of the epithelial barrier and associated immune dysregulation in the skin of genetically predisposed hosts. AD generally develops in early childhood, has a characteristic age-dependent distribution and is commonly associated with elevated IgE, peripheral eosinophilia and other allergic diseases. Staphylococcus aureus colonization is common and may contribute to disease progression and severity. Targeted therapies to restore both impaired skin barrier and control inflammation are required for optimal outcomes for patients with moderate to severe disease. Pruritus is universal among patients with AD and has a dominant impact on diminishing quality of life. Medications such as anti-histamines have demonstrated poor efficacy in controlling AD-associated itch. Education of patients regarding the primary underlying defects and provision of a comprehensive skin care plan is essential for disease maintenance and management of flares. PMID:25459583

  8. Mycophenolate Mofetil in Severe Atopic Dermatitis: A Review.

    PubMed

    Prussick, Lisa; Plotnikova, Natalia; Gottlieb, Alice

    2016-06-01

    Atopic Dermatitis (AD) is a chronic inflammatory skin disease that is a significant cause of morbidity, quality-of-life impairment and health-care costs. Although many patients can be treated satisfactorily with topical medications and phototherapy, a smaller subset requires more aggressive systemic therapies. Multiple studies have shown promise for the use of mycophenolate mofetil (MMF) to treat refractory AD. This report summarizes the evidence for use of MMF in the treatment of recalcitrant AD for both children and adults. Familiarity with these studies on the benefits and risks of MMF will enable the clinician and patient to select the most appropriate therapy.

    J Drugs Dermatol. 2016;15(6):715-718. PMID:27272078

  9. Atopic Dermatitis: Drug Delivery Approaches in Disease Management.

    PubMed

    Lalan, Manisha; Baweja, Jitendra; Misra, Ambikanandan

    2015-01-01

    In this review, we describe the very basic of atopic dermatitis (AD), the established management strategies, and the advances in drug delivery approaches for successful therapeutic outcomes. The multifactorial pathophysiology of AD has given rise to the clinician's paradigm of topical and systemic therapy and potential combinations. However, incomplete remission of skin disorders like AD is a major challenge to be overcome. Recurrence is thought to be due to genetic and immunological etiologies and shortcomings in drug delivery. This difficulty has sparked research in nanocarrier-based delivery approaches as well as molecular biology-inspired stratagems to deal with the immunological imbalance and to address insufficiencies of delivery propositions. In this review, we assess various novel drug delivery strategies in terms of their success and utility. We present a brief compilation and assessment of management modalities to sensitize the readers to therapeutic scenario in AD. PMID:26080926

  10. Assessing the New and Emerging Treatments for Atopic Dermatitis.

    PubMed

    Eichenfield, Lawrence F; Friedlander, Sheila F; Simpson, Eric L; Irvine, Alan D

    2016-06-01

    The newer and emerging treatments for atopic dermatitis (AD) focus on blockade of inflammatory cytokines, especially those that derive from T helper cell type 2 (TH2) and are associated with a pathway of immunoglobulin E (IgE) sensitization. Among the proinflammatory cytokines that have been identified as promising therapeutic targets are chemoattractant receptor-homologous molecule expressed on TH2 cells (CRTH2), IgE, thymic stromal lymphopoietin (TSLP), and several monoclonal antibodies that block key cytokine pathways in the innate immune response. Two agents that have been studied in phase III clinical trials are the boronbased phosphodiesterase-4 (PDE-4) inhibitor, crisaborole, and dupilumab, an antibody that inhibits the interleukin-4/ IL-13 receptor α chain. Semin Cutan Med Surg 35(supp5):S92-S96. PMID:27525671

  11. Molecular Mechanisms of Cutaneous Inflammatory Disorder: Atopic Dermatitis

    PubMed Central

    Kim, Jung Eun; Kim, Jong Sic; Cho, Dae Ho; Park, Hyun Jeong

    2016-01-01

    Atopic dermatitis (AD) is a multifactorial inflammatory skin disease resulting from interactions between genetic susceptibility and environmental factors. The pathogenesis of AD is poorly understood, and the treatment of recalcitrant AD is still challenging. There is accumulating evidence for new gene polymorphisms related to the epidermal barrier function and innate and adaptive immunity in patients with AD. Newly-found T cells and dendritic cell subsets, cytokines, chemokines and signaling pathways have extended our understanding of the molecular pathomechanism underlying AD. Genetic changes caused by environmental factors have been shown to contribute to the pathogenesis of AD. We herein present a review of the genetics, epigenetics, barrier dysfunction and immunological abnormalities in AD with a focus on updated molecular biology. PMID:27483258

  12. Colloidal oatmeal formulations and the treatment of atopic dermatitis.

    PubMed

    Fowler, Joseph F

    2014-10-01

    Colloidal oatmeal suspensions are currently available in bath soaps, shampoos, shaving gels, and moisturizing creams, and several studies have been conducted that demonstrate the efficacy and safety of colloidal oatmeal for the treatment of inflammatory skin conditions. The diverse chemical polymorphism of oats translates into numerous clinical utilities for atopic dermatitis (AD) and eczema. Avenanthramides are the principle polyphenolic antioxidants in oats, and they have been shown to assuage inflammation in murine models of contact hypersensitivity and neurogenic inflammation and also reduce pruritogen-induced scratching in a murine itch model. Moreover, avenanthramides are a potent antioxidant. This paper will discuss various studies that have found colloidal oatmeal compounds to be beneficial in the treatment of AD and also as adjunctive treatments for AD. PMID:25607551

  13. Atopic dermatitis: therapeutic concepts evolving from new pathophysiologic insights.

    PubMed

    Jung, Thomas; Stingl, Georg

    2008-12-01

    Recent insights into the relevance of the epidermal barrier function and its interaction with components of the innate and adaptive immune responses in patients with atopic dermatitis (AD) give rise to a number of novel potential treatment options. In particular, the identification of loss-of-function mutations in the barrier protein filaggrin and of a diminished expression of certain antimicrobial peptides in AD skin stimulates new concepts to think beyond the T(H)1/T(H)2 paradigm. This review will focus on these most recent discoveries and will discuss new and corresponding proof-of-concept trials in patients with AD. It will further speculate on novel ways to restore the homeostasis among the 3 major components in AD skin suspected to be clinically relevant. PMID:18992925

  14. Disseminated coxsackievirus A6 affecting children with atopic dermatitis.

    PubMed

    Lynch, M D; Sears, A; Cookson, H; Lew, T; Laftah, Z; Orrin, L; Zuckerman, M; Creamer, D; Higgins, E

    2015-07-01

    Coxsackievirus A6 (CV-A6) is an emerging pathogen that has in recent years been associated with atypical hand, foot and mouth disease. This manifests as a generalized papular or vesicular eruption, which may be associated with fever and systemic disturbance. We report a series of six children presenting to a single centre in the UK with disseminated CV-A6 infection on a background of atopic dermatitis (AD). Our patients exhibited a widespread papular or vesicular eruption in association with exacerbation of AD. Several of our cases mimicked eczema herpeticum, but the extent was more generalized, and individual lesions were discrete rather than clustered and were less circumscribed in character. This series highlights that CV-A6 infection may be encountered in the UK, and should be considered in the differential diagnosis of an acute exacerbation of AD, particularly in children. PMID:25677678

  15. The role of the skin microbiome in atopic dermatitis.

    PubMed

    Williams, Michael R; Gallo, Richard L

    2015-11-01

    Atopic dermatitis (AD) is a common skin disease that affects a large proportion of the population worldwide. The incidence of AD has increased over the last several decades along with AD's burden on the physical and psychological health of the patient and family. However, current advances in understanding the mechanisms behind the pathophysiology of AD are leading to a hopeful outlook for the future. Staphylococcus aureus (S. aureus) colonization on AD skin has been directly correlated to disease severity but the functions of other members of the skin bacterial community may be equally important. Applying knowledge gained from understanding the role of the skin microbiome in maintaining normal skin immune function, and addressing the detrimental consequences of microbial dysbiosis in driving inflammation, is a promising direction for development of new treatments. This review discusses current preclinical and clinical research focused on determining how the skin microbiome may influence the development of AD. PMID:26404536

  16. Nutrient Intake and Food Restriction in Children with Atopic Dermatitis

    PubMed Central

    Lim, Hyunjin; Kim, Ran; Sim, Jiyeon; Park, Eunah; Ahn, Kangmo; Kim, Jihyun

    2013-01-01

    This study was performed to investigate the status of food restriction and the list of restricted foods in children with moderate to severe atopic dermatitis (AD), and to find out the effect of food restriction on the changes in nutrient intake and the severity of the disease. Sixty two patient children aged 12 months to 13 years presenting AD with a SCORing of Atopic Dermatitis (SCORAD) index between 20 and 50 were enrolled. The presence of food limitation, and list of restricted foods were surveyed through the caretakers and the patients were divided into 3 groups by the number of restricted food: non-restricted group, one to three restricted group, and more than three restricted group. Dietary intake was assessed for 3 months using a food frequency questionnaire (FFQ). Half of the subjects restricted foods. The restriction was higher in the order of soda, food additives, walnut, peanut, and other nuts as a single food item; and shellfish and crustacean group, processed foods, nuts, milk & dairy products, and meats as a food group. More than three restricted group ingested more fruits and less fish and meats, resulting in high consumption of vitamin C (p = 0.027). No significant difference in the ratio of nutrient intake by the number of restricted foods was observed in other nutrients. Significant improvement of AD symptom was observed in non-restricted group (p = 0.036) and one to three restricted group (p = 0.003). It is necessary to provide proper nutrition information and systematic and continuous nutrition management for balanced nutrient intake and disease improvement in children with AD. PMID:23429834

  17. Nutrient intake and food restriction in children with atopic dermatitis.

    PubMed

    Lim, Hyunjin; Song, Kyunghee; Kim, Ran; Sim, Jiyeon; Park, Eunah; Ahn, Kangmo; Kim, Jihyun; Han, Youngshin

    2013-01-01

    This study was performed to investigate the status of food restriction and the list of restricted foods in children with moderate to severe atopic dermatitis (AD), and to find out the effect of food restriction on the changes in nutrient intake and the severity of the disease. Sixty two patient children aged 12 months to 13 years presenting AD with a SCORing of Atopic Dermatitis (SCORAD) index between 20 and 50 were enrolled. The presence of food limitation, and list of restricted foods were surveyed through the caretakers and the patients were divided into 3 groups by the number of restricted food: non-restricted group, one to three restricted group, and more than three restricted group. Dietary intake was assessed for 3 months using a food frequency questionnaire (FFQ). Half of the subjects restricted foods. The restriction was higher in the order of soda, food additives, walnut, peanut, and other nuts as a single food item; and shellfish and crustacean group, processed foods, nuts, milk & dairy products, and meats as a food group. More than three restricted group ingested more fruits and less fish and meats, resulting in high consumption of vitamin C (p = 0.027). No significant difference in the ratio of nutrient intake by the number of restricted foods was observed in other nutrients. Significant improvement of AD symptom was observed in non-restricted group (p = 0.036) and one to three restricted group (p = 0.003). It is necessary to provide proper nutrition information and systematic and continuous nutrition management for balanced nutrient intake and disease improvement in children with AD. PMID:23429834

  18. Topical steroid therapy in atopic dermatitis in theory and practice

    PubMed Central

    Jeziorkowska, Renata; Sysa-Jędrzejowska, Anna

    2015-01-01

    Introduction Topical glucocorticosteroids (GCSs) are commonly used in treatment of atopic dermatitis (AD). Aim To assess the patients’ compliance with the recommended instructions of the therapy. Material and methods The study involved 141 adult AD patients. The clinical course of AD and its treatment with GCSs during the last year were analysed. Results In the periods of exacerbation the lesions involved 10–50% of the skin surface area. Outpatient treatment in specialised dermatological and/or allergology clinics was given to 93% of the study subjects. Sixty-five out of 141 patients regularly attended medical control examinations. Glucocorticosteroids, mostly very potent ones (70.2%), were applied to all the subjects. 66.7% of patients obtained no information about their medications’ anti-inflammatory potential. The substances were applied more frequently than twice daily by 36.4% of the patients. Seventy-two of 141 subjects applied GCSs both temporarily and in the long-term treatment, for 8.3 weeks on average. In the long-term treatment, in which very potent GCSs predominated (70.7%), no one used intermittent therapy. One hundred and thirty patients introduced their own modifications to the instructions concerning GCSs use, among which 37.7% changed the site of application, 58.5% prolonged the duration of application and 49.5% shortened it or occasionally temporarily withdrew the prescribed drug. None of the patients knew the fingertip unit method of dose assessment. Apart from steroid therapy, 56.7% of the patients carried out regular care treatment. Conclusions The AD patients need to be thoroughly educated by the medical staff in the topical GCSs therapy in atopic dermatitis. PMID:26161055

  19. Vitamin D in atopic dermatitis, chronic urticaria and allergic contact dermatitis.

    PubMed

    Quirk, Shannon K; Rainwater, Ellecia; Shure, Anna K; Agrawal, Devendra K

    2016-08-01

    Vitamin D influences allergen-induced pathways in the innate and adaptive immune system, and its potential immunomodulatory role in allergic skin disorders has been explored. This comprehensive review article provides an overview of the role of vitamin D in three common dermatologic conditions: atopic dermatitis (AD), chronic urticaria, and allergic contact dermatitis (ACD). Whereas the literature regarding vitamin D and AD has resulted in mixed findings, several studies have described an inverse relationship between vitamin D levels and AD severity, and improvement in AD with vitamin D supplementation. Similarly, several studies report an inverse relationship between vitamin D levels and severity of chronic urticaria. Although current research in humans remains limited, an increased likelihood of ACD has been demonstrated in vitamin D-deficient mice. Additional well-designed clinical trials will be necessary to determine whether vitamin D supplementation should be recommended for prevention or adjuvant treatment of these common dermatologic conditions. PMID:27014952

  20. High density genotyping study identifies four new susceptibility loci for atopic dermatitis

    PubMed Central

    Ellinghaus, David; Baurecht, Hansjörg; Esparza-Gordillo, Jorge; Rodríguez, Elke; Matanovic, Anja; Marenholz, Ingo; Hübner, Norbert; Schaarschmidt, Heidi; Novak, Natalija; Michel, Sven; Maintz, Laura; Werfel, Thomas; Meyer-Hoffert, Ulf; Hotze, Melanie; Prokisch, Holger; Heim, Katharina; Herder, Christian; Hirota, Tomomitsu; Tamari, Mayumi; Kubo, Michiaki; Takahashi, Atsushi; Nakamura, Yusuke; Tsoi, Lam C; Stuart, Philip; Elder, James T; Sun, Liangdan; Zuo, Xianbo; Yang, Sen; Zhang, Xuejun; Hoffmann, Per; Nöthen, Markus M; Fölster-Holst, Regina; Winkelmann, Juliane; Illig, Thomas; Boehm, Bernhard O; Duerr, Richard H; Büning, Carsten; Brand, Stephan; Glas, Jürgen; McAleer, Maeve A; Fahy, Caoimhe M; Kabesch, Michael; Brown, Sara J; McLean, WH Irwin; Irvine, Alan D; Schreiber, Stefan; Lee, Young-Ae; Franke, Andre; Weidinger, Stephan

    2013-01-01

    Atopic dermatitis is a common inflammatory skin disease with a strong heritable component. Pathogenetic models consider keratinocyte differentiation defects and immune alterations as scaffolds1, and recent data indicate a role for autoreactivity in at least a subgroup of patients2. With filaggrin (FLG) a major locus causing a skin barrier deficiency was identified3. To better define risk variants and identify additional susceptibility loci, we densely genotyped 2,425 German cases and 5,449 controls using the Immunochip array, followed by replication in 7,196 cases and 15,480 controls from Germany, Ireland, Japan and China. We identified 4 new susceptibility loci for atopic dermatitis and replicated previous associations. This brings the number of atopic dermatitis risk loci reported in individuals of European ancestry to 11. We estimate that these susceptibility loci together account for 14.4% of the heritability for atopic dermatitis. PMID:23727859

  1. The potential role of impaired Notch signalling in atopic dermatitis.

    PubMed

    Melnik, Bodo C

    2015-01-01

    This review presents recent evidence of impaired Notch signalling in atopic dermatitis (AD), which is proposed to represent the "a-topic" defect linking both epidermal and immunological barrier dysfunctions in AD. AD epidermis exhibits a marked deficiency of Notch receptors. Mouse models with genetically suppressed Notch signalling exhibit dry skin, signs of scratching, skin barrier abnormalities, increased transepidermal water loss and TH2 cell-mediated immunological changes closely resembling human AD. Notch signals are critically involved in the differentiation of regulatory T cells, in the feedback inhibition of activated innate immunity, in late epidermal differentiation associated with filaggrin- and stratum corneum barrier lipid processing. Most importantly, Notch deficiency induces keratinocyte-mediated release of thymic stromal lymphopoietin (TSLP). TSLP promotes TH2 cell-driven immune responses associated with enhanced production of interleukin (IL)-4 and IL-31. Both TSLP and IL-31 stimulate sensory cutaneous neurons involved in the induction of itch. Notably, Notch1 is a repressor of activator protein-1 (AP-1), which is upregulated in AD epidermis. Without Notch-mediated suppression of AP-1 this transcription factor promotes excess expression of TH2 cell-related cytokines. Impaired Notch signalling negatively affects the homeostasis of aquaporin 3 and of the tight junction component claudin-1, thus explains disturbed skin barrier function with increased transepidermal water loss and Staphylococcus aureus colonisation as well as increased cutaneous susceptibility for viral infections. Thus, accumulating evidence links deficient Notch signalling to key pathological features of AD. PMID:24853951

  2. Erythrodermic atopic dermatitis with late onset–case presentation

    PubMed Central

    Lancrajan, C; Bumbacea, R

    2010-01-01

    Atopic dermatitis is a chronic inflammatory disease, usually associated with a personal or family history of atopic diseases such as AD, allergic rhinitis or asthma that most commonly arise in childhood and present with elevated IgE serum in up to 85% of patients. The severity of AD is based on the extent of affected areas, itch intensity and appearance of skin lesions. Here, we present the case of a 21–year–old female patient with generalized erythematous eczematous skin lesions, flexural lichenifications accompanied by intense pruritus, painful fissures and erosions resulting from scratching. She also presented erythematous plaques with thin scales on the scalp. The patient had no personal or familial history of AD, allergic rhinitis or asthma and the onset of cutaneous symptoms presented severe exacerbation in the last 2 months of the last 3 years. The main laboratory findings were–high serum eosinofilia (2,400/µL) and very high total IgE serum (11449UI/L). The flare remission was induced with systemic treatment (corticotherapy, oral H1 antihistamines, and antibiotherapy) and topical therapy (UVB 311nm, topical glucocorticoids and hydration). It is very important to recognize AD as a cause of erythroderma, especially in a patient with a late onset of the disease, in order to treat it promptly and to prevent ulterior recurrences, by educating the patient to have an adequate life style and to treat the recurrences at the very first symptoms. PMID:20302202

  3. Turning the inside out: the microbiology of atopic dermatitis.

    PubMed

    Brüssow, Harald

    2016-07-01

    Allergy is on the rise worldwide. The hygiene hypothesis of atopic diseases linked microbes with atopic dermatitis (AD) both as drivers and modulators of skin pathology. The earlier literature favoured an inside-outside model of AD where an immunological abnormality compounded by a gut microbiota dysbiosis is the primary event. Probiotic intervention trials with lactobacilli and bifidobacteria as well as the application of bifidogenic oligosaccharide prebiotics showed indeed promising clinical results, but no consistent gut microbiota dysbiosis could be linked with AD. An alternative hypothesis known as outside-inside model of AD considers a genetic skin barrier effect compounded by a skin microbiota dysbiosis as primary pathogenic event. Cultivation microbiology has demonstrated strong skin colonization with superantigen-encoding Staphylococcus aureus in AD patients; microbiota and molecular microbiome analyses demonstrated that S. aureus abundance fluctuates and parallels clinical symptoms. In a mouse model, δ-toxin of S. aureus induced mast cell degranulation, leading to AD-like symptoms. Mutant mice developing AD symptoms showed increased skin colonization with S. aureus; antibiotic treatment alleviated the symptoms. Clinical trials showed that various treatments reducing S. aureus skin load also reduced AD symptoms, suggesting S. aureus as a potential critical driver of AD and a target for antimicrobial interventions other than antibiotics. PMID:26373255

  4. A pilot study of silver-loaded cellulose fabric with incorporated seaweed for the treatment of atopic dermatitis.

    PubMed

    Park, K Y; Jang, W S; Yang, G W; Rho, Y H; Kim, B J; Mun, S K; Kim, C W; Kim, M N

    2012-07-01

    Because clothing has the longest and most direct contact with human skin, it is important to carefully choose suitable fabrics for atopic patients who have disrupted skin. To evaluate the clinical effectiveness and biophysical properties of a newly developed silver-loaded cellulose fabric with incorporated seaweed, we enrolled 12 subjects with mild to moderate atopic dermatitis into a clinical control study. The subjects wore a two-piece garment (top and leggings), each piece of which was divided into two parts: one side was made of SkinDoctor(®) fabric, and the other of 100% cotton. Treatment efficacy was measured with the modified SCORing Atopic Dermatitis (mSCORAD) index, transepidermal water loss (TEWL) and the patients' subjective impressions. All three of these measures had significantly better scores on the side covered with SkinDoctor. These results suggest that SkinDoctor is a beneficial fabric that can improve the comfort of patients with AD. PMID:22439868

  5. Personalized Immunomodulatory Therapy for Atopic Dermatitis: An Allergist's View

    PubMed Central

    2015-01-01

    The current standard medical therapy for atopic dermatitis (AD) mainly focuses on symptomatic relief by controlling skin inflammation with topical corticosteroids and/or topical calcineurin inhibitors. However, the clinical efficacy of pharmacological therapy is often disappointing to both patients and physicians. The terminology of AD contains a historical meaning of eczematous dermatitis caused by hypersensitivity reaction to environmental inhalant or food allergen. Complex interrelationships among genetic abnormalities, environmental triggers, skin barrier defects, and immune dysfunction resulting in a vicious domino-circle seem to be involved in the development and maintenance of AD. In the viewpoint of AD as an allergic disease, complete avoidance of clinically relevant allergen or induction of specific immune tolerance through administrations of allergen (allergen immunotherapy) can provide clinical remission by breaking the vicious domino-circle maintaining a chronic disease state. In recent clinical studies, monoclonal antibodies including the anti-interleukin-4 receptor antibody and anti-B cell antibody induced significant clinical improvements in patients with AD. The detailed characteristics of immune dysfunction are heterogeneous among patients with AD. Therefore, a personalized combination of immunomodulatory therapies to reduce hypersensitivity (allergen immunotherapy) and correct immune dysfunction (monoclonal antibody therapy) could be a reasonable therapeutic approach for patients with AD. Future immunomodulatory therapies for AD should be developed to achieve long-term treatment-free clinical remission by induction of immune tolerance. PMID:26273148

  6. Exacerbation of atopic dermatitis after bacillus Calmette-Guérin vaccination.

    PubMed Central

    Dalton, S J; Haeney, M R; Patel, L; David, T J

    1998-01-01

    In two children with atopic dermatitis, routine vaccination with bacillus Calmette-Guérin (BCG) was followed by severe exacerbation of skin disease. If the sequence is cause and effect, a possible mechanism is stimulation of a Th2 lymphocyte cytokine profile by the vaccine, with migration of activated lymphocytes to inflamed skin. In children with active atopic dermatitis, BCG vaccination is best deferred until remission. PMID:9659324

  7. Barrier-Restoring Therapies in Atopic Dermatitis: Current Approaches and Future Perspectives

    PubMed Central

    Valdman-Grinshpoun, Y.; Ben-Amitai, D.; Zvulunov, A.

    2012-01-01

    Atopic dermatitis is a multifactorial, chronic relapsing, inflammatory disease, characterized by xerosis, eczematous lesions, and pruritus. The latter usually leads to an “itch-scratch” cycle that may compromise the epidermal barrier. Skin barrier abnormalities in atopic dermatitis may result from mutations in the gene encoding for filaggrin, which plays an important role in the formation of cornified cytosol. Barrier abnormalities render the skin more permeable to irritants, allergens, and microorganisms. Treatment of atopic dermatitis must be directed to control the itching, suppress the inflammation, and restore the skin barrier. Emollients, both creams and ointments, improve the barrier function of stratum corneum by providing it with water and lipids. Studies on atopic dermatitis and barrier repair treatment show that adequate lipid replacement therapy reduces the inflammation and restores epidermal function. Efforts directed to develop immunomodulators that interfere with cytokine-induced skin barrier dysfunction, provide a promising strategy for treatment of atopic dermatitis. Moreover, an impressive proliferation of more than 80 clinical studies focusing on topical treatments in atopic dermatitis led to growing expectations for better therapies. PMID:22956938

  8. Production and secretion of interferon-gamma (IFN-gamma) in children with atopic dermatitis.

    PubMed Central

    Tang, M; Kemp, A

    1994-01-01

    IFN-gamma is known to be a major inhibitor of IgE synthesis in vitro. Recent studies demonstrating reduced production of IFN-gamma in children and adults with atopic dermatitis and elevated serum IgE suggest a similar role for this cytokine in vivo. The reasons for this reduced IFN-gamma production are not known. One possibility is that atopic individuals have a reduced population of cells producing IFN-gamma in vivo. Using a fluorescence-labelled antibody to detect intracellular IFN-gamma, the percentage of IFN-gamma-producing cells was determined in children with atopic dermatitis and in non-atopic controls. Children with atopic dermatitis had a greater percentage of IFN-gamma-producing cells in unstimulated cultures compared with controls, indicating in vivo activation of lymphocytes in the atopic group. This could reflect the significant degree of inflammation present in these children, or the presence of bacterial infection or colonization. Although secretion of IFN-gamma after stimulation with phorbol myristate acetate (PMA)/Ca was significantly lower in children with atopic dermatitis compared with controls, the percentage of IFN-gamma-producing cells in the stimulated cultures from this group was equivalent to controls. This demonstrates that the reduced ability of atopic children to secrete IFN-gamma in vitro does not relate to a lack of IFN-gamma-producing cells, but to a difference in the regulation of IFN-gamma production beyond the stage of signal transduction. PMID:8287610

  9. Lactobacillus reuteri modulates cytokines production in exhaled breath condensate of children with atopic dermatitis.

    PubMed

    Miniello, Vito Leonardo; Brunetti, Luigia; Tesse, Riccardina; Natile, Miria; Armenio, Lucio; Francavilla, Ruggiero

    2010-05-01

    We measured the concentration of interferon-gamma and interleukin-4 in the exhaled breath condensate of children with atopic and nonallergic dermatitis receiving a probiotic supplementation (Lactobacillus reuteri ATCC 55730) or placebo for 8 weeks. We demonstrated that the levels of these cytokines increased and decreased respectively only in atopic subjects receiving active treatment. Our data suggest that the oral administration of a specific probiotic strain in patients with atopic dermatitis can modulate in vivo the cytokine pattern at a different site from intestine. PMID:20639717

  10. Quantitative determination of 12-hydroxyeicosatetraenoic acids by chiral liquid chromatography tandem mass spectrometry in a murine atopic dermatitis model

    PubMed Central

    Hong, Seong-Ho; Han, Ji Eun; Ko, Ji-Seung; Do, Sun Hee

    2015-01-01

    Atopic dermatitis, one of the most important skin diseases, is characterized by both skin barrier impairment and immunological abnormalities. Although several studies have demonstrated the significant relationship between atopic dermatitis and immunological abnormalities, the role of hydroxyeicosatetraenoic acids (HETE) in atopic dermatitis remains unknown. To develop chiral methods for characterization of 12-HETE enantiomers in a 1-chloro-2,4-dinitrochlorobenzene (DNCB)-induced atopic dermatitis mouse model and evaluate the effects of 12-HETE on atopic dermatitis, BALB/c mice were treated with either DNCB or acetone/olive oil (AOO) to induce atopic dermatitis, after which 12(R)- and 12(S)-HETEs in the plasma, skin, spleen, and lymph nodes were quantified by chiral liquid chromatography-tandem mass spectrometry. 12(R)- and 12(S)-HETEs in biological samples of DNCB-induced atopic dermatitis mice increased significantly compared with the AOO group, reflecting the involvement of 12(R)- and 12(S)-HETEs in atopic dermatitis. These findings indicate that 12(R)- and 12(S)-HETEs could be a useful guide for understanding the pathogenesis of atopic dermatitis. PMID:25797298

  11. Atopic dermatitis: molecular mechanisms, clinical aspects and new therapeutical approaches.

    PubMed

    Galli, E; Cicconi, R; Rossi, P; Casati, A; Brunetti, E; Mancino, G

    2003-03-01

    Atopic dermatitis (AD) is a genetically determinated, chronic inflammatory skin disorder associated with cutaneous erythema and severe pruritus, affecting 10-15% of children with increasing incidence and socio-economical relevance. Frequently, AD is associated with development of allergic rhinitis and/or asthma later in childhood. In most of patients AD is associated with a sensitization to food and/or environmental allergens and increased serum-IgE, while only a fewer percentage missed links to the classical atopic diathesis. Currently investigated pathogenetic aspects of AD include imbalanced Th1/Th2 responses, altered prostaglandin metabolism, intrinsic defects in the keratinocyte function, delayed eosinophil apoptosis, and IgE-mediated facilitated antigen presentation by epidermal dendritic cells. An inflammatory response of the two-phase-type and the effects of staphylococcal superantigens (SAgs) are also reported. At present a standardized cure of AD and a consensus on therapeutical approach of the severe form of the disease have not been established. Current management of AD is directed to the reduction of cutaneous inflammation and infection, mainly by S. aureus, and to the elimination of exacerbating factors (irritants, allergens, emotional stresses). Since patient with AD show abnormalities in immunoregulation, therapy directed to adjustment of their immune function could represent an alternative approach, particularly in the severe form of the disease. In this review, we analyse the clinical and genetic aspects of AD, the related molecular mechanisms, and the immunobiology of the disease, focusing our attention on current treatments and future perspectives on this topic. PMID:12630559

  12. Cellular and molecular immunologic mechanisms in patients with atopic dermatitis.

    PubMed

    Werfel, Thomas; Allam, Jean-Pierre; Biedermann, Tilo; Eyerich, Kilian; Gilles, Stefanie; Guttman-Yassky, Emma; Hoetzenecker, Wolfram; Knol, Edward; Simon, Hans-Uwe; Wollenberg, Andreas; Bieber, Thomas; Lauener, Roger; Schmid-Grendelmeier, Peter; Traidl-Hoffmann, Claudia; Akdis, Cezmi A

    2016-08-01

    Atopic dermatitis (AD) is a complex skin disease frequently associated with other diseases of the atopic diathesis. Recent evidence supports the concept that AD can also recognize other comorbidities, such as chronic inflammatory bowel or cardiovascular diseases. These comorbidities might result from chronic cutaneous inflammation or from a common, yet-to-be-defined immunologic background leading to immune deviations. The activation of immune cells and their migration to the skin play an essential role in the pathogenesis of AD. In patients with AD, an underlying immune deviation might result in higher susceptibility of the skin to environmental factors. There is a high unmet medical need to define immunologic endotypes of AD because it has significant implications on upcoming stratification of the phenotype of AD and the resulting targeted therapies in the development of precision medicine. This review article emphasizes studies on environmental factors affecting AD development and novel biological agents used in the treatment of AD. Best evidence of the clinical efficacy of novel immunologic approaches using biological agents in patients with AD is available for the anti-IL-4 receptor α-chain antibody dupilumab, but a number of studies are currently ongoing with other specific antagonists to immune system players. These targeted molecules can be expressed on or drive the cellular players infiltrating the skin (eg, T lymphocytes, dendritic cells, or eosinophils). Such approaches can have immunomodulatory and thereby beneficial clinical effects on the overall skin condition, as well as on the underlying immune deviation that might play a role in comorbidities. An effect of these immunologic treatments on pruritus and the disturbed microbiome in patients with AD has other potential consequences for treatment. PMID:27497276

  13. Histamine Modulates Sweating and Affects Clinical Manifestations of Atopic Dermatitis.

    PubMed

    Takahashi, Aya; Tani, Saki; Murota, Hiroyuki; Katayama, Ichiro

    2016-01-01

    Many factors such as food or environmental allergens, bacteria, fungi, and mental stress aggravate the condition of atopic dermatitis (AD) eczema. Sweating can also exacerbate AD, and patients are aware of that. In the past, it has been reported that contamination of skin surface antigens by sweat induces acute allergic reactions and that sweating functions of AD patients via axonal reflexes are decreased. Histamine demonstrably inhibits acetylcholine-induced sweating in both mice and humans via histamine H1 receptor-mediated signaling. In sweat glands, acetylcholine inactivates glycogen synthase kinase 3β (GSK3β), a kinase involved in endocytosis and secretion, whereas simultaneous stimulation with histamine activates GSK3β and inhibits sweat secretion. Thus, histamine might be involved in the mechanism of abnormal skin dryness in patients with AD via decreasing sweat secretion. On another front, some patients secrete sweat normally. Patients with regular sweating are prone to develop skin disorders such as papules or erythema by residual sweat left on the skin surface. Patients with decreased sweating are prone to develop disorders characterized by xerosis, lichenoid changes, prurigo by elevated skin temperature, skin dryness, and compromised skin conditions. Careful inspection of skin manifestations provides a good indication of a patient's ability to sweat. PMID:27584962

  14. Equivalence evaluation of moisturizers in atopic dermatitis patients.

    PubMed

    Tamura, Mai; Kawasaki, Hiroshi; Masunaga, Takuji; Ebihara, Tamotsu

    2015-01-01

    Skin care with moisturizers to compensate for dry skin and decreased barrier function, and to prevent recurrence of inflammation is thought to be very important for management of atopic dermatitis. However, many patients cannot continue the use of moisturizing medications because of unpleasantness. Cosmetics may be able to compensate for such deficiencies. To evaluate the usefulness of cosmetics in maintenance of the skin in remission, we conducted a clinical trial using moisturizing cosmetics of a phospholipid preparation that showed good moisture-retaining effect in dry skin. The utility of moisturizing cosmetics was evaluated by skin findings, subjective symptoms, adverse events, moisture content of the stratum corneum, transepidermal water loss (TEWL), and a questionnaire on feel of use in comparison with a heparinoid preparation as a control product. Degree of improvement in skin findings, dryness and desquamation score, pruritus score, TEWL, and moisture content were nearly the same as with the control product. The result indicated that the moisturizing cosmetic was of equivalent effect compared with the heparinoid control preparation. PMID:26753433

  15. Treatment of Atopic Dermatitis with a Low-histamine Diet.

    PubMed

    Chung, Bo Young; Cho, Soo Ick; Ahn, In Su; Lee, Hee Bong; Kim, Hye One; Park, Chun Wook; Lee, Cheol Heon

    2011-09-01

    Atopic dermatitis (AD) has numerous trigger factors. The question of whether foods can aggravate AD remains open to debate. Although a number of published papers have detailed the relationship between food allergies and AD, little research has examined the question of how food intolerance affects AD. For the purposes of this study, a six-year-old Korean boy with AD was admitted to the hospital for evaluation of the possibility of food, particularly pork, as a triggering factor in his skin disease. He had a history of worsening of symptoms when eating pork. Total serum IgE concentration was 157 IU/ml. House dust was class 2.2 (1.5 IU/ml) in MAST. All other MAST items were negative. In an oral food challenge test, he showed a positive result after eating 200 g of pork, but did not show a positive result after eating 60 g of pork. After discharge, we attempted to keep him on a balanced diet that included various types of food and prohibited him from eating food that contains a high level of histamine. After keeping the patient on a balanced and low-histamine dietary regimen, his AD symptoms showed improvement and have not worsened for more than seven months. A low-histamine, balanced diet could be helpful for AD patients having symptoms that resemble histamine intolerance in which their AD symptoms worsened after intake of histamine-rich foods, but in which food allergy tests are negative. PMID:22028584

  16. Tryptanthrin ameliorates atopic dermatitis through down-regulation of TSLP.

    PubMed

    Han, Na-Ra; Moon, Phil-Dong; Kim, Hyung-Min; Jeong, Hyun-Ja

    2014-01-15

    Atopic dermatitis (AD) is a common skin disease that greatly worsens quality of life. Thymic stromal lymphopoietin (TSLP) plays a decisive role in the development of AD. The purpose of this study is to examine whether tryptanthrin (TR) would suppress AD through the regulation of TSLP. We analyzed the effect of TR on the level of TSLP from phorbol myristate acetate/calcium ionophore A23187-activated human mast cell line, HMC-1 cells, in 2,4-dinitrofluorobenzene-induced AD-like skin lesions of NC/Nga mice, and in anti-CD3/anti-CD28-stimulated splenocytes. TR significantly suppressed the level of intracellular calcium and the production and mRNA expression of TSLP through the blockade of receptor-interacting protein 2/caspase-1/nuclear factor-κB pathway in the activated HMC-1 cells. TR also significantly suppressed the levels of histidine decarboxylase and IL-1β. Furthermore, TR ameliorated clinical symptoms in the AD model. TR significantly reduced the levels of TSLP, IL-4, IFN-γ, IL-6, TNF-α, thymus and activation-regulated chemokine, and caspase-1 in AD skin lesions. Also, TR significantly reduced the serum levels of histamine and IL-4 in the AD model. Finally, TR significantly inhibited the production of IL-4, IFN-γ, and TNF-α from the stimulated splenocytes. Taken together, TR exhibits the potential to be a therapeutic agent for AD through down-regulation of TSLP. PMID:24295961

  17. Does therapeutic intervention in atopic dermatitis normalize epidermal Notch deficiency?

    PubMed

    Melnik, Bodo C

    2014-10-01

    This viewpoint presents a unifying concept for the treatment of atopic dermatitis (AD) that is based on the improvement of deficient Notch signalling, which appears to represent the fundamental epithelial defect of AD resulting in epidermal and immunological barrier dysfunction. One study of AD patients demonstrated a marked epidermal deficiency of Notch receptors and several mouse models with genetically suppressed Notch signalling exhibit dry skin, signs of scratching, skin barrier abnormalities, increased transepidermal water loss and Th2 cell-mediated immunological changes closely resembling human AD. Notch signalling is critically involved in the differentiation of regulatory T cells, in the feedback inhibition of activated innate immunity, in the repression of activating protein-1 (AP-1), the regulation of late epidermal differentiation associated with filaggrin- and stratum corneum barrier lipid processing, in aquaporin 3- and claudin-1 expression and in keratinocyte-mediated release of thymic stromal lymphopoietin (TSLP), which promotes Th2-driven immune responses with TSLP- and IL-31-mediated stimulation of cutaneous sensory neurons involved in the induction of itch. Translational evidence will be provided that all major therapeutic regimens employed for the treatment of AD such as glucocorticoids, calcineurin inhibitors and UV radiation may converge in the upregulation of impaired Notch signalling, the proposed pathogenic defect of AD. PMID:24889007

  18. Transplantation of human skin microbiota in models of atopic dermatitis

    PubMed Central

    Myles, Ian A.; Williams, Kelli W; Reckhow, Jensen D; Jammeh, Momodou L; Pincus, Nathan B; Sastalla, Inka; Saleem, Danial; Stone, Kelly D; Datta, Sandip K

    2016-01-01

    Atopic dermatitis (AD) is characterized by reduced barrier function, reduced innate immune activation, and susceptibility to Staphylococcus aureus. Host susceptibility factors are suggested by monogenic disorders associated with AD-like phenotypes and can be medically modulated. S. aureus contributes to AD pathogenesis and can be mitigated by antibiotics and bleach baths. Recent work has revealed that the skin microbiome differs significantly between healthy controls and patients with AD, including decreased Gram-negative bacteria in AD. However, little is known about the potential therapeutic benefit of microbiome modulation. To evaluate whether parameters of AD pathogenesis are altered after exposure to different culturable Gram-negative bacteria (CGN) collected from human skin, CGN were collected from healthy controls and patients with AD. Then, effects on cellular and culture-based models of immune, epithelial, and bacterial function were evaluated. Representative strains were evaluated in the MC903 mouse model of AD. We found that CGN taken from healthy volunteers but not from patients with AD were associated with enhanced barrier function, innate immunity activation, and control of S. aureus. Treatment with CGN from healthy controls improved outcomes in a mouse model of AD. These findings suggest that a live-biotherapeutic approach may hold promise for treatment of patients with AD. PMID:27478874

  19. A Review of Multidisciplinary Interventions in Atopic Dermatitis

    PubMed Central

    Spielman, Sara C.; LeBovidge, Jennifer S.; Timmons, Karol G.; Schneider, Lynda C.

    2015-01-01

    Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence for their impact on key outcome measures. We also provided data from our multidisciplinary outpatient program for pediatric AD. Studies included in the review suggest benefits of multidisciplinary interventions as models of treatment or adjuncts to standard medical care, with a positive impact on outcomes including disease severity and itching/scratching. There were limitations to existing studies, including heterogeneous methods used to assess quality of life outcomes across studies and lack of controlled studies assessing the outcome of clinical care programs. Further research will be useful in assessing the impact of multidisciplinary interventions on important outcomes such as treatment adherence and sleep, identifying the elements of multidisciplinary interventions that are most critical for improved outcomes, and identifying the best candidates for multidisciplinary intervention approaches. PMID:26239470

  20. A review on the role of moisturizers for atopic dermatitis.

    PubMed

    Giam, Yoke Chin; Hebert, Adelaide Ann; Dizon, Maria Victoria; Van Bever, Hugo; Tiongco-Recto, Marysia; Kim, Kyu-Han; Soebono, Hardyanto; Munasir, Zakiudin; Diana, Inne Arline; Luk, David Chi Kang

    2016-04-01

    Effective management of atopic dermatitis (AD) involves the treatment of a defective skin barrier. Patients with AD are therefore advised to use moisturizers regularly. To date, there are few comparative studies involving moisturizers in patients with AD, and no classification system exists to objectively determine which types of moisturizers are best suited to specific AD phenotypes. With this in mind, a group of experts from allergy and immunology, adult and pediatric dermatology, and pediatrics centers within Southeast Asia met to review current data and practice, and to develop recommendations regarding the use of moisturizers in patients with AD within the Asia-Pacific region. Chronicity and severity of AD, along with patient age, treatment compliance, and economic background should all be taken into account when selecting an appropriate moisturizer for AD patients. Other considerations include adjuvant properties of the product, cosmetic acceptability, and availability over the counter. Well-defined clinical phenotypes of AD could optimally benefit from specific moisturizers. It is hoped that future studies may identify such differences by means of filaggrin mutation subtypes, confocal microscopic evaluation, pH, transepidermal water loss or presence of allergy specific IgE. Recommendations to improve the regular use of moisturizers among AD patients include measures that focus on treatment compliance, patient and caregiver education, appropriate treatment goals, avoidance of sensitizing agents, and collaboration with other relevant specialists. PMID:27141486

  1. Role of Macrophages in the Pathogenesis of Atopic Dermatitis

    PubMed Central

    Kasraie, Sadaf; Werfel, Thomas

    2013-01-01

    Atopic dermatitis (AD) is one of the most common and most intensively studied chronic inflammatory skin diseases. Several cofactors, such as an impaired skin barrier function, modifications of the immune system, and a complex genetic background, direct the course of AD. Within this complex network, macrophages play a pivotal role in enhanced susceptibility to cutaneous infections and act as central connecting components in the pathogenesis of AD on the cellular level. In AD, macrophages are known to accumulate in acutely and chronically inflamed skin. During the early and short inflammatory phase, macrophages exert proinflammatory functions like antigen-presenting phagocytosis and the production of inflammatory cytokines and growth factors that facilitate the resolution of inflammation. However, persistence of pro-inflammatory activity and altered function of macrophages result in the development of chronic inflammatory diseases such as AD. The exact mechanism of macrophages activation in these processes is not yet completely understood. Further studies should be performed to clarify the dysregulated mechanism of macrophages activation in AD, and this would allow us to target these cells with versatile functions for therapeutic purpose and improve and control the disease. In this paper, we highlight the new findings on dysregulated function of macrophages and the importance of these cells in the pathogenesis of AD in general and the contribution of these cells in enhanced susceptibility against microbial infections in particular. PMID:23533313

  2. IL-4 and IL-13 Inhibition in Atopic Dermatitis.

    PubMed

    Matsunaga, Matthew C; Yamauchi, Paul S

    2016-08-01

    Atopic dermatitis (AD) is a chronic, prevalent, multi-factorial condition that affects infants, children, and adults. Beyond topical therapy, a variety of systemic agents such as steroids, methotrexate, cyclosporine, azathioprine, mycophenoloic acid, and other agents are utilized to treat moderate to severe AD. However, these agents are associated with potential long term adverse events and organ toxicity. There is an unmet need for a safer, long-term systemic agent to adequately control moderate to severe AD. The role of the Th2 cytokines, IL-4 and IL-13, in AD has led to the development of biologic agents to treat AD. The aim of this article is to review the role of IL-4 and IL-13 in the pathogenesis of AD and discuss some of the clinical trial data that target and inhibit IL-4 and IL-13 in positively altering the course and outcome of AD.

    J Drugs Dermatol. 2016;15(8):925-929. PMID:27537991

  3. Sphingolipids and Antimicrobial Peptides: Function and Roles in Atopic Dermatitis

    PubMed Central

    Park, Kyungho; Lee, Sinhee; Lee, Yong-Moon

    2013-01-01

    Inflammatory skin diseases such as atopic dermatitis (AD) and rosacea were complicated by barrier abrogation and deficiency in innate immunity. The first defender of epidermal innate immune response is the antimicrobial peptides (AMPs) that exhibit a broad-spectrum antimicrobial activity against multiple pathogens, including Gram-positive and Gram-negative bacteria, viruses, and fungi. The deficiency of these AMPs in the skin of AD fails to protect our body against virulent pathogen infections. In contrast to AD where there is a suppression of AMPs, rosacea is characterized by overexpression of cathelicidin antimicrobial peptide (CAMP), the products of which result in chronic epidermal inflammation. In this regard, AMP generation that is controlled by a key ceramide metabolite S1P-dependent mechanism could be considered as alternate therapeutic approaches to treat these skin disorders, i.e., Increased S1P levels strongly stimulated the CAMP expression which elevated the antimicrobial activity against multiple pathogens resulting the improved AD patient skin. PMID:24244808

  4. A review on the role of moisturizers for atopic dermatitis

    PubMed Central

    Hebert, Adelaide Ann; Dizon, Maria Victoria; Van Bever, Hugo; Tiongco-Recto, Marysia; Kim, Kyu-Han; Soebono, Hardyanto; Munasir, Zakiudin; Diana, Inne Arline; Luk, David Chi Kang

    2016-01-01

    Effective management of atopic dermatitis (AD) involves the treatment of a defective skin barrier. Patients with AD are therefore advised to use moisturizers regularly. To date, there are few comparative studies involving moisturizers in patients with AD, and no classification system exists to objectively determine which types of moisturizers are best suited to specific AD phenotypes. With this in mind, a group of experts from allergy and immunology, adult and pediatric dermatology, and pediatrics centers within Southeast Asia met to review current data and practice, and to develop recommendations regarding the use of moisturizers in patients with AD within the Asia-Pacific region. Chronicity and severity of AD, along with patient age, treatment compliance, and economic background should all be taken into account when selecting an appropriate moisturizer for AD patients. Other considerations include adjuvant properties of the product, cosmetic acceptability, and availability over the counter. Well-defined clinical phenotypes of AD could optimally benefit from specific moisturizers. It is hoped that future studies may identify such differences by means of filaggrin mutation subtypes, confocal microscopic evaluation, pH, transepidermal water loss or presence of allergy specific IgE. Recommendations to improve the regular use of moisturizers among AD patients include measures that focus on treatment compliance, patient and caregiver education, appropriate treatment goals, avoidance of sensitizing agents, and collaboration with other relevant specialists. PMID:27141486

  5. [Examination of effectiveness of olopatadine hydrochloride in atopic dermatitis].

    PubMed

    Shimizu, Tadamichi; Mashiko, Maki; Shimizu, Hiroshi

    2005-02-01

    Subjective/objective symptoms (itching, papula, erythema, lichenification, desquamation, scratching, erosion) and the levels of IgE, LDH, interleukin (IL) -6, thymus and activation-regulated chemokine (TARC) were compared before and after administering olopatadine hydrochloride (ALLELOCK tablets) to 17 atopic dermatitis (AD) patients. Subject/objective symptoms improved significantly after administering the agent, and the total dosage of the combined topical steroids was also significantly decreased after administration (p<0.05), although IgE, IL-6 and LDH levels did not change, TARC was significantly decreased (p<0.05). The correlation between the levels of IgE, IL-6, LDH and TARC before and after the administration was examined. There was a positive correlation between IgE and TARC (r=0.62, p<0.01) and between IL-6 and TARC (r=0.78, p<0.01). Olopatadine hydrochloride is therefore useful in improving the symptoms in AD, and TARC may be used as an indicator of the symptom improvement. PMID:15864020

  6. Multidisciplinary interventions in the management of atopic dermatitis.

    PubMed

    LeBovidge, Jennifer S; Elverson, Wendy; Timmons, Karol G; Hawryluk, Elena B; Rea, Corinna; Lee, Margaret; Schneider, Lynda C

    2016-08-01

    Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep disruption, dietary and nutritional concerns, and psychological stress associated with the disease and its management. Multidisciplinary approaches to AD care have been developed in appreciation of the complex interplay among biological, psychological, behavioral, and dietary factors that affect disease control and the wide range of knowledge, skills, and support that patients and families require to effectively manage and cope with this condition. Common components of multidisciplinary treatment approaches include medical evaluation and management by an AD specialist, education and nursing care, psychological and behavioral support, and nutritional assessment and guidance. Models of care include both clinical programs and structured educational groups provided as adjuncts to standard clinical care. Available evidence suggests beneficial effects of multidisciplinary interventions in improving disease severity and quality of life, particularly for patients with moderate-to-severe disease. Additional research is needed to identify the best candidates for the various multidisciplinary approaches and evaluate the cost-effectiveness of these programs. PMID:27497275

  7. Coated textiles in the treatment of atopic dermatitis.

    PubMed

    Haug, S; Roll, A; Schmid-Grendelmeier, P; Johansen, P; Wüthrich, B; Kündig, T M; Senti, G

    2006-01-01

    Atopic dermatitis (AD) is a chronic inflammatory skin disease with increasing prevalence over the last few decades. Various factors are known to aggravate the disease. In particular, wool and synthetic fabrics with harsh textile fibres, aggressive detergents and climatic factors may exacerbate AD. Cutaneous superinfection, particularly with Staphylococcus aureus, is also recognized as an important factor in the elicitation and maintenance of skin inflammation and acute exacerbations of AD. The severity of AD correlates with S. aureus colonization of the skin. Beside the treatment of AD patients with creams and emollients, new developments in the textile industry may have therapeutic implications. Silk or silvercoated textiles show antimicrobial properties that can significantly reduce the burden of S. aureus, leading to a positive effect on AD. Silver products have been used as wound dressing, whereby silver has antiseptic properties, and drug resistance is hardly found. Padycare textiles consist of micromesh material containing woven silver filaments with a total silver content of 20%. In vitro studies of these silver-coated textiles demonstrated a significant decrease in S. aureus and Pseudomonas aeruginosa as well as Candida albicans. Silk has been increasingly implemented in medical treatment of AD thanks to its unique smoothness that reduces irritation. Silk can be coated with antimicrobials (Dermasilk). The combination of the smoothness of silk with an antimicrobial finish appears to make an ideal textile for patients suffering from AD. PMID:16766886

  8. Silk fabrics in the management of atopic dermatitis.

    PubMed

    Ricci, Giampaolo; Neri, Iria; Ricci, Lorenza; Patrizi, Annalisa

    2012-03-01

    Many factors may worsen atopic dermatitis (AD) including sweating, skin infections, food, inhalant allergens, climatic conditions, stress, and chemical or physical irritants. Especially in children, clothing can be an effective barrier against flare-inducing factors and persistent scratching, allowing more rapid improvement of the eczematous lesions. On the contrary, some fabrics used for clothing may exacerbate skin conditions due to their rough fibers, such as wool and nylon. Conventional silk has smooth fibers that are generally woven for textiles in the manufacturing of clothes, but this material is not particularly useful in the management of children with AD since it reduces transpiration and may cause discomfort. Herein, we evaluate the data concerning a special silk fabric (MICROAIR DermaSilk®) shown to be suitable for patients with AD. The unique properties of this knitted silk allow the skin to breathe and lack irritative potential. Moreover, this fabric is treated with a water-resistant antimicrobial finish known as AEGIS AEM 5772/5. This novel knitted silk fabric appears to be useful in managing children with AD due to its non-irritating and antibacterial features. Additionally, a synthetic silk-like fabric (DermaTherapy®) has received US FDA clearance as a Class I medical device and is commercially available as bedding; their use by AD patients has shown interesting results. PMID:22446819

  9. Acute Pustular Dermatosis, Following Topical Treatment With Pimecrolimus, in a Child Affected With Atopic and Contact Hand Dermatitis.

    PubMed

    Poddighe, Dimitri; Brazzelli, Valeria; Licari, Amelia; Marseglia, Gian Luigi

    2016-01-01

    Atopic dermatitis is considered an important risk factor for chronic hand dermatitis, which can be seen in children too. Pimecrolimus cream 1% is approved to treat atopic dermatitis in children aged 2 years or older. In adults, this drug has been used for some clinical indications other than atopic dermatitis, such as chronic hand dermatitis. Here, we describe an adverse drug reaction in a 2-year-old child affected with atopic dermatitis, who was treated with topical pimecrolimus in order to ameliorate her concomitant hand dermatitis. The use of topical pimecrolimus led to a previously undescribed hand pustular dermatosis, being consistent with a form of pustular leukocytoclastic vasculitis, which required the permanent discontinuation of topical pimecrolimus. PMID:26997932

  10. Acute Pustular Dermatosis, Following Topical Treatment With Pimecrolimus, in a Child Affected With Atopic and Contact Hand Dermatitis

    PubMed Central

    Brazzelli, Valeria; Licari, Amelia; Marseglia, Gian Luigi

    2016-01-01

    Atopic dermatitis is considered an important risk factor for chronic hand dermatitis, which can be seen in children too. Pimecrolimus cream 1% is approved to treat atopic dermatitis in children aged 2 years or older. In adults, this drug has been used for some clinical indications other than atopic dermatitis, such as chronic hand dermatitis. Here, we describe an adverse drug reaction in a 2-year-old child affected with atopic dermatitis, who was treated with topical pimecrolimus in order to ameliorate her concomitant hand dermatitis. The use of topical pimecrolimus led to a previously undescribed hand pustular dermatosis, being consistent with a form of pustular leukocytoclastic vasculitis, which required the permanent discontinuation of topical pimecrolimus. PMID:26997932

  11. The potential role of allergen-specific sublingual immunotherapy in atopic dermatitis.

    PubMed

    Mastrandrea, Fulvio

    2004-01-01

    Atopic dermatitis is a chronic inflammatory skin disease associated with increasing prevalence, morbidity, and cost in developed Western countries. Frequently associated with respiratory allergy during adulthood, atopic dermatitis often represents the first phenotypic appearance of atopy in early childhood when the allergic 'march' starts and progressively moves toward food allergy, asthma, and rhinitis. At present, a consistent body of evidence supports the view that atopic dermatitis may represent the skin compartmentalization of a systemic allergic inflammation. Lymphocytes infiltrating early lesional skin express a T helper (Th) 2 pattern of cytokine secretion (increased levels of interleukin [IL]-4 and/or IL-13 and decreased levels of interferon-gamma) as well as the typical Th2-type chemokine receptor CCR4, specific to the thymus and activation-regulated chemokines. Keratinocytes from patients with atopic dermatitis produce thymic stromal lymphopoietin, a novel cytokine that supports the early lymphocyte development in mouse models, and activates dendritic cells involved in the pathogenesis of allergic diseases in humans. Increased levels of circulating hemopoietic precursor cells have been reported in atopic dermatitis, as in allergic asthma and rhinitis. Furthermore, the recognition of CD34+ hemopoietic precursor cells, and evidence for cellular differentiation/maturational events occurring within atopic dermatitis skin lesion infiltrates, are consistent with the recent reinterpretation of the Th2/Th1 paradigm, where Th2 cells appear to belong to the early stages and Th1 to the ultimate stages of a linear, rather than divergent, pattern of lymphoid differentiation. This more detailed understanding of the immunologic derangements contributing to the atopic dermatitis pathogenesis has led to growing interest in allergen-specific immunotherapy for the disease. Due to the complexity intrinsic to atopic dermatitis and the lack of consensus-based guidelines for

  12. Topical calcineurin inhibitors in the treatment of atopic dermatitis - an update on safety issues.

    PubMed

    Czarnecka-Operacz, Magdalena; Jenerowicz, Dorota

    2012-03-01

    Atopic dermatitis is a common chronic skin disorder whose management is complex. Topical corticosteroids have been the mainstay of atopic dermatitis treatment for more than 50 years but have multiple side effects. Topical calcineurin inhibitors including tacrolimus and pimecrolimus are safe and efficacious in atopic dermatitis. In 2005 the FDA issued "black box" warnings for pimecrolimus cream and tacrolimus ointment because of potential safety risks, including skin cancers and lymphomas. However, these concerns are not supported by current data. Topical calcineurin inhibitors are particularly indicated for treating patients with atopic dermatitis in whom topical corticosteroid therapy cannot be employed or may cause irreversible side effects. They can be used advantageously in problem zones. A novel regimen of proactive treatment has been shown to prevent, delay and reduce exacerbations of atopic dermatitis. Therapy with topical calcineurin inhibitors should be managed by an experienced specialist and each patient should receive proper education on how to use them and what possible unwanted effects may be expected. PMID:21974750

  13. Psychoneuroimmunology of Psychological Stress and Atopic Dermatitis: Pathophysiologic and Therapeutic Updates

    PubMed Central

    SUÁREZ, Andrea L.; FERAMISCO, Jamison D.; KOO, John; STEINHOFF, Martin

    2013-01-01

    Atopic dermatitis is a chronic inflammatory skin disease characterized by impaired epidermal barrier function, inflammatory infiltration, extensive pruritus and a clinical course defined by symptomatic flares and remissions. The mechanisms of disease exacerbation are still poorly understood. Clinical occurrence of atopic dermatitis is often associated with psychological stress. In response to stress, upregulation of neuropeptide mediators in the brain, endocrine organs, and peripheral nervous system directly affect immune and resident cells in the skin. Lesional and non-lesional skin of patients with atopic dermatitis demonstrates increased mast cells and mast cell-nerve fiber contacts. In the setting of stress, sensory nerves release neuromediators that regulate inflammatory and immune responses, as well as barrier function. Progress towards elucidating these neuroimmune connections will refine our understanding of how emotional stress influences atopic dermatitis. Moreover, psychopharmacologic agents that modulate neuronal receptors or the amplification circuits of inflammation are attractive options for the treatment of not only atopic dermatitis, but also other stress-mediated inflammatory skin diseases. PMID:22101513

  14. Transient hypogammaglobulinemia and severe atopic dermatitis: Open-label treatment with immunoglobulin in a case series

    PubMed Central

    Lin, Joanna H.; Roberts, Robert; Lim, Kellie J.; Stiehm, E. Richard

    2016-01-01

    Background: We reported on six infants between 5 and 11 months old, with transient hypogammaglobulinemia of infancy and severe refractory atopic dermatitis, who were treated with open-label immunoglobulin (Ig) after conventional therapy failed. All six infants had an IgG level of <225 mg/dL, elevated eosinophil and IgE levels, and no urine or stool protein losses, but they did exhibit hypoalbuminemia. Objective: To evaluate the utility of open-label immunoglobulin in infants with severe atopic dermatitis for whom conventional therapy failed. We reviewed the clinical utility of intravenous immunoglobulin in the treatment of severe atopic dermatitis, the most recent research in the field, and suggested mechanisms for its benefit. Methods: The six infants were identified from a retrospective chart review at the University of California Los Angeles Allergy and Immunology outpatient pediatric clinic. Results: All six patients were treated with 400 mg/kg/month of intravenous immunoglobulin and had normalization of their IgG and albumin levels, and all but one had clinically improved atopic dermatitis. Conclusion: Infants with severe atopic dermatitis who did not respond to conventional therapy avoidance may benefit from intravenous immunoglobulin therapy. PMID:27470901

  15. Food compounds inhibit Staphylococcus aureus bacteria and the toxicity of Staphylococcus Enterotoxin A (SEA) associated with atopic dermatitis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Atopic dermatitis or eczema is characterized by skin rashes and itching is an inflammatory disease that affects 10-20% of children and 1-3% of adults. Staphylococcus aureus bacteria are present on the skin of nearly all patients with atopic dermatitis. Antibiotics that suppress colonization of S. au...

  16. Longitudinal Evaluation of the Skin Microbiome and Association with Microenvironment and Treatment in Canine Atopic Dermatitis.

    PubMed

    Bradley, Charles W; Morris, Daniel O; Rankin, Shelley C; Cain, Christine L; Misic, Ana M; Houser, Timothy; Mauldin, Elizabeth A; Grice, Elizabeth A

    2016-06-01

    Host-microbe interactions may play a fundamental role in the pathogenesis of atopic dermatitis, a chronic relapsing inflammatory skin disorder characterized by universal colonization with Staphylococcus species. To examine the relationship between epidermal barrier function and the cutaneous microbiota in atopic dermatitis, this study used a spontaneous model of canine atopic dermatitis. In a cohort of 14 dogs with canine atopic dermatitis, the skin microbiota were longitudinally evaluated with parallel assessment of skin barrier function at disease flare, during antimicrobial therapy, and post-therapy. Sequencing of the bacterial 16S ribosomal RNA gene showed decreased bacterial diversity and increased proportions of Staphylococcus (S. pseudintermedius in particular) and Corynebacterium species compared with a cohort of healthy control dogs (n = 16). Treatment restored bacterial diversity with decreased proportions of Staphylococcus species, concurrent with decreased canine atopic dermatitis severity. Skin barrier function, as measured by corneometry, pH, and transepidermal water loss also normalized with treatment. Bacterial diversity correlated with transepidermal water loss and pH level but not with corneometry results. These findings provide insights into the relationship between the cutaneous microbiome and skin barrier function in atopic dermatitis, show the impact of antimicrobial therapy on the skin microbiome, and highlight the utility of canine atopic dermatitis as a spontaneous nonrodent model of atopic dermatitis. PMID:26854488

  17. Gender Differences in Depression and Anxiety Among Atopic Dermatitis Patients

    PubMed Central

    Mina, Shaily; Jabeen, Masarat; Singh, Shalini; Verma, Rohit

    2015-01-01

    Background: Dermatological patients invariably suffer one or the other psychological problems which may escalate to the extent of a mental disorder. One of the most common dermatological disorders is atopic dermatitis (AD), but the literature has limited data on gender differences for psychiatric morbidity in such patients. Aims: To evaluate and compare gender differences in the prevalence of depression and anxiety in AD. Materials and Methods: This cross-sectional study with consecutive sampling was done in an outpatient clinic of Dermatology at a Tertiary Care Center. AD subjects giving informed consent were evaluated on a brief semi-structured performa for collecting demographic and clinical information. Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to assess the presence of psychiatric symptoms in these patients. Descriptive analysis was done for the socio-demographic profile and independent sample t-test, Chi-square and Cramer's V test was carried out to find in-between group differences for males and females. Results: A total of 81 patients were included in the final analysis (males = 36, females = 45) with no significant difference in mean age between male and female subjects (36.14 ± 17.62 and 33.98 ± 14.49 years, respectively; P = 0.54). When including moderate to severe grade of depression or anxiety, the current study found prevalence rates of 15% and 12% respectively. Females had significantly more anxiety and depression scores than males (P = 0.04 and P = 0.03 respectively). Conclusions: There is a female preponderance of depression and anxiety disorder in AD patients. PMID:25814727

  18. Helicobacter pylori immunization and atopic dermatitis in South Italian children

    PubMed Central

    Pedullà, Marcella; Fierro, Vincenzo; Del Tufo, Ester; Triassi, Maria; Perrone, Laura

    2014-01-01

    Background The epidemiological decrease of Helicobacter pylori (Hp) infection has been recently associated to the increase of several extra-intestinal allergic disorders. Objective We investigated the role of specific Hp IgG production in the development of IgE or not IgE mediated food allergy (FA) in children affected by atopic dermatitis (AD). Methods From January 2010 to July 2013, 290 South Italian children, aged between 26 and 142 months, were consecutively referred to the Pediatric Clinic of the Pediatric Department at Second University of Naples and were diagnosed as affected by AD. The patients were classified in two groups on the basis of diagnosis of food allergy (88 FA affected and 202 not FA affected) and further divided on the basis of the diagnosis of atopy (63 IgE mediated and 23 not IgE mediated). Hp serum IgG was detected using an enzyme linked immunosorbent assay (ELISA) kit (Wampole® Helicobactor pylori IgG ELISA II, Wampole Laboratories, Cranbury, NJ) and Hp stool antigens using enzyme immunoassay (Premier Platinum HpSa plus, Cincinnati OH). Results We found a statistically significant higher prevalence of Hp serology positivity in not FA vs. FA AD-affected children (p = 0.032) and a significant inverse association between FA and Hp immunization (1/OR 0.32 95% CI 0.11–0.95). Further, we identified an absolute prevalence Hp serology positivity in not-IgE-mediated rather than in IgE-mediated FA AD-affected patients (p = 0.0006). Conclusion We hypothesize that specific Hp IgG production could protect against the development of both FA and atopy in AD-affected children. PMID:25083283

  19. Improvement of Atopic Dermatitis Severity after Reducing Indoor Air Pollutants

    PubMed Central

    Kim, Hye One; Kim, Jin Hye; Cho, Soo Ick; Chung, Bo Young; Ahn, In Su; Lee, Cheol Heon

    2013-01-01

    Background Recent epidemiologic studies have shown that environmental contaminants such as air pollution and tobacco smoke play an important role in the pathophysiology of atopic dermatitis (AD). Objective The aim of this study was to evaluate the relationship between the severity of AD and indoor air pollution. Methods The study population consisted of 425 children from 9 kindergartens, Korea. The authors surveyed the prevalence of AD and evaluated disease severity by the eczema area and severity index (EASI) score and investigator's global assessment (IGA). After measuring indoor air pollution, a program to improve indoor air quality was conducted in 9 kindergartens. Seven months later, the prevalence and disease severity were evaluated. Results The initial prevalence of AD was 8% and the mean EASI score was 2.37. The levels of particulate material 10 (PM10) and carbon dioxide (CO2) were higher in some kindergartens compared to the normal values. Subsequent to the completion of the indoor air quality improvement program, the mean PM10 level was significantly decreased from 182.7 to 73.4 µg/m3. After the completion of the program, the prevalence of AD and the mean EASI were decreased, and the changes were both statistically significant. The mean number of hospital visits decreased from 1.3 per month during the first survey to 0.7 per month during the second survey, which was statistically significant. Conclusion Indoor air pollution could be related to AD. The reduction of PM10 through improving indoor air quality should be considered in kindergartens and schools in order to prevent and relieve AD in children. PMID:24003270

  20. Distinct molecular signatures of mild extrinsic and intrinsic atopic dermatitis.

    PubMed

    Martel, Britta C; Litman, Thomas; Hald, Andreas; Norsgaard, Hanne; Lovato, Paola; Dyring-Andersen, Beatrice; Skov, Lone; Thestrup-Pedersen, Kristian; Skov, Søren; Skak, Kresten; Poulsen, Lars K

    2016-06-01

    Atopic dermatitis (AD) is a common inflammatory skin disease with underlying defects in epidermal function and immune responses. In this study, we used microarray analysis to investigate differences in gene expression in lesional skin from patients with mild extrinsic or intrinsic AD compared to skin from healthy controls and from lesional psoriasis skin. The primary aim was to identify differentially expressed genes involved in skin barrier formation and inflammation, and to compare our results with those reported for patients with moderate and severe AD. In contrast to severe AD, expression of the majority of genes associated with skin barrier formation was unchanged or upregulated in patients with mild AD compared to normal healthy skin. Among these, no significant differences in the expression of filaggrin (FLG) and loricrin at both mRNA and protein level were found in lesional skin from patients with mild AD, despite the presence of heterozygous FLG mutations in the majority of patients with mild extrinsic AD. Several inflammation-associated genes such as S100A9, MMP12, CXCL10 and CCL18 were highly expressed in lesional skin from patients with mild psoriasis and were also increased in patients with mild extrinsic and intrinsic AD similar to previous reports for severe AD. Interestingly, expression of genes involved in inflammatory responses in intrinsic AD resembled that of psoriasis more than that of extrinsic AD. Overall, differences in expression of inflammation-associated genes found among patients with mild intrinsic and extrinsic AD correlated with previous findings for patients with severe intrinsic and extrinsic AD. PMID:26841714

  1. Stigmatization and self-perception in children with atopic dermatitis.

    PubMed

    Chernyshov, Pavel V

    2016-01-01

    Atopic dermatitis (AD) is one of the most common skin diseases. Prevalence of AD is highest in childhood. Because of chronicity and often visible lesions, AD may lead to stigmatization and problems with self-perception. However, problems of self-perception and stigmatization in AD children are poorly studied. Literature data on general tendencies of children's development, clinical course, and epidemiologic tendencies of AD in different age groups make it possible to highlight three main periods in the formation of self-perception and stigmatization. The first period is from early infancy till 3 years of age. The child's problems in this period depend on parental exhaustion, emotional distress, and security of the mother-child attachment. The child's AD may form a kind of vicious circle in which severe AD causes parental distress and exhaustion that in turn lead to exacerbation of AD and psychological problems in children. The second period is from 3 till 10 years of age. During this period, development of AD children may be influenced by teasing, bullying, and avoiding by their peers. However, the majority of children in this age group are very optimistic. The third period is from 10 years till adulthood. Problems related to low self-esteem are characteristic during this period. It is important to identify children with AD and their parents who need psychological help and provide them with needs-based consultation and care. Appropriate treatment, medical consultations, and educational programs may help to reduce emotional problems in AD children and their parents. PMID:27499642

  2. Stigmatization and self-perception in children with atopic dermatitis

    PubMed Central

    Chernyshov, Pavel V

    2016-01-01

    Atopic dermatitis (AD) is one of the most common skin diseases. Prevalence of AD is highest in childhood. Because of chronicity and often visible lesions, AD may lead to stigmatization and problems with self-perception. However, problems of self-perception and stigmatization in AD children are poorly studied. Literature data on general tendencies of children’s development, clinical course, and epidemiologic tendencies of AD in different age groups make it possible to highlight three main periods in the formation of self-perception and stigmatization. The first period is from early infancy till 3 years of age. The child’s problems in this period depend on parental exhaustion, emotional distress, and security of the mother–child attachment. The child’s AD may form a kind of vicious circle in which severe AD causes parental distress and exhaustion that in turn lead to exacerbation of AD and psychological problems in children. The second period is from 3 till 10 years of age. During this period, development of AD children may be influenced by teasing, bullying, and avoiding by their peers. However, the majority of children in this age group are very optimistic. The third period is from 10 years till adulthood. Problems related to low self-esteem are characteristic during this period. It is important to identify children with AD and their parents who need psychological help and provide them with needs-based consultation and care. Appropriate treatment, medical consultations, and educational programs may help to reduce emotional problems in AD children and their parents. PMID:27499642

  3. Atopic Dermatitis: Clinical Connotations, Especially a Focus on Concomitant Atopic Undertones in Immunocompromised/Susceptible Genetic and Metabolic Disorders.

    PubMed

    Sehgal, Virendra N; Khurana, Ananta; Mendiratta, Vibhu; Saxena, Deepti; Srivastava, Govind; Aggarwal, Ashok K; Chatterjee, Kingshuk

    2016-01-01

    Atopic dermatitis (AD) is an intriguing clinical entity. Its clinical connotations are varied, the updates of which are required to be done periodically. An attempt to bring its various facets have been made highlighting its clinical features keeping in view the major and the minor criteria to facilitate the diagnosis, differential diagnosis, complications, and associated dermatoses. The benefit of the current dissertation may percolate to the trainees in dermatology, in addition to revelations that atopic undertones in genetic susceptibility and metabolic disorder may provide substantive insight for the future in the understanding of thus far enigmatic etiopathogenesis of AD. PMID:27293243

  4. Atopic Dermatitis: Clinical Connotations, Especially a Focus on Concomitant Atopic Undertones in Immunocompromised/Susceptible Genetic and Metabolic Disorders

    PubMed Central

    Sehgal, Virendra N; Khurana, Ananta; Mendiratta, Vibhu; Saxena, Deepti; Srivastava, Govind; Aggarwal, Ashok K; Chatterjee, Kingshuk

    2016-01-01

    Atopic dermatitis (AD) is an intriguing clinical entity. Its clinical connotations are varied, the updates of which are required to be done periodically. An attempt to bring its various facets have been made highlighting its clinical features keeping in view the major and the minor criteria to facilitate the diagnosis, differential diagnosis, complications, and associated dermatoses. The benefit of the current dissertation may percolate to the trainees in dermatology, in addition to revelations that atopic undertones in genetic susceptibility and metabolic disorder may provide substantive insight for the future in the understanding of thus far enigmatic etiopathogenesis of AD. PMID:27293243

  5. Fermented rice bran prevents atopic dermatitis in DNCB-treated NC/Nga mice.

    PubMed

    Saba, Evelyn; Lee, Chun Hee; Jeong, Da Hye; Lee, Kija; Kim, Tae-Hwan; Roh, Seong-Soo; Kim, Seung-Hyung; Rhee, Man Hee

    2016-07-01

    The fermentation of natural plants has a favorable effect on the functional and biological activities of living systems. These include anti-oxidative, anti-inflammatory, and anti-platelet aggregation activities. This is attributed to the chemical conversion of the parent plants to functional constituents, which show more potent biological activity. In our study, rice bran along with oriental medicinal plants (Angelicae gigantis, Cnidium officinale, Artemisia princeps, and Camellia sinensis) was fermented by Lactobacillus rhamnosus and Pichia deserticola (FRBE). We evaluated the effects of oral administration of FRBE on atopic dermatitis in 1-chloro-2,4-dinitrobenzene (DNCB)-treated NC/Nga mice. FRBE significantly ameliorated the macroscopic and microscopic appearance of skin lesions in DNCB-induced atopic dermatitis and reduced levels of serum immunoglobulin E and the differential white blood cell count. In addition, it reduced skin thickness compared to that of atopic dermatitis-affected skin. FRBE treatment also reduced mast cell incorporation in skin lesions of atopic dermatitis. The total cell number in dorsal skin tissue and the axillary lymph node increased following DNCB application, and this was normalized by FRBE treatment. Moreover, it decreased the levels of CD8(+) helper T cells and Gr-1(+)/CD11b(+) B cells in peripheral blood mononuclear cells and skin lesions in DNCB-induced atopic dermatitis. Using real-time polymerase chain reaction analysis, we demonstrated that FRBE significantly inhibited mRNA expression of cytokines (e.g., interleukin-5 and interleukin-13) and cyclooxygenase-2 in AD skin lesions. These results suggest that FRBE could be a valuable herbal remedy for the treatment of atopic dermatitis. PMID:27323667

  6. Fermented rice bran prevents atopic dermatitis in DNCB-treated NC/Nga mice

    PubMed Central

    Saba, Evelyn; Lee, Chun Hee; Jeong, Da Hye; Lee, Kija; Kim, Tae-Hwan; Roh, Seong-Soo; Kim, Seung-Hyung; Rhee, Man Hee

    2016-01-01

    Abstract The fermentation of natural plants has a favorable effect on the functional and biological activities of living systems. These include anti-oxidative, anti-inflammatory, and anti-platelet aggregation activities. This is attributed to the chemical conversion of the parent plants to functional constituents, which show more potent biological activity. In our study, rice bran along with oriental medicinal plants (Angelicae gigantis, Cnidium officinale, Artemisia princeps, and Camellia sinensis) was fermented by Lactobacillus rhamnosus and Pichia deserticola (FRBE). We evaluated the effects of oral administration of FRBE on atopic dermatitis in 1-chloro-2,4-dinitrobenzene (DNCB)-treated NC/Nga mice. FRBE significantly ameliorated the macroscopic and microscopic appearance of skin lesions in DNCB-induced atopic dermatitis and reduced levels of serum immunoglobulin E and the differential white blood cell count. In addition, it reduced skin thickness compared to that of atopic dermatitis-affected skin. FRBE treatment also reduced mast cell incorporation in skin lesions of atopic dermatitis. The total cell number in dorsal skin tissue and the axillary lymph node increased following DNCB application, and this was normalized by FRBE treatment. Moreover, it decreased the levels of CD8+ helper T cells and Gr-1+/CD11b+ B cells in peripheral blood mononuclear cells and skin lesions in DNCB-induced atopic dermatitis. Using real-time polymerase chain reaction analysis, we demonstrated that FRBE significantly inhibited mRNA expression of cytokines (e.g., interleukin-5 and interleukin-13) and cyclooxygenase-2 in AD skin lesions. These results suggest that FRBE could be a valuable herbal remedy for the treatment of atopic dermatitis. PMID:27323667

  7. Immunomodulatory Effects of Deokgu Thermomineral Water Balneotherapy on Oxazolone-Induced Atopic Dermatitis Murine Model

    PubMed Central

    Lee, Young Bok; Kim, Su Jin; Park, Sae Mi; Lee, Kyung Ho; Han, Hyung Jin; Yu, Dong Soo; Woo, So Youn; Yun, Seong Taek; Hamm, Se-Yeong; Kim, Hong Jig

    2016-01-01

    Background Although the therapeutic mechanism of balneotherapy for atopic dermatitis has not been clarified, many atopic patients who visit thermomineral springs have shown clinical improvements. Objective This study was aimed to evaluate the immunomodulatory effect of thermomineral water balneotherapy on the atopic dermatitis murine model. Methods The oxazolone-induced atopic dermatitis murine model was used to evaluate the therapeutic effect of balneotherapy with Deokgu thermomineral water compared with distilled water. Histologic evaluation and confocal microscopic imaging were performed to analyze the lesional expression of cluster-of-differentiation (CD)4 and forkhead box p3 (Foxp3). Lesional mRNA expression of interleukin (IL) 33, thymic stromal lymphopoietin (TSLP), and Foxp3 was evaluated by real-time reverse transcription polymerase chain reaction. Results Compared with the distilled water bath group, confocal microscopic evaluation of CD4 and Foxp3 merged images showed increased expression of regulatory T cells in the thermomineral balneotherapy group. The lesional mRNA level of IL-33 showed a reduced trend in the thermomineral balneotherapy group, whereas the level of mRNA of Foxp3 was increased. TSLP showed a decreased trend in both distilled water and thermomineral water bath groups. There was a trend of reduced expression in lesional IL-33 mRNA but increased cell count of CD4+ Foxp3+ regulatory T cells in thermomineral balneotherapy compared with distilled water bath. Conclusion Therefore, thermomineral balneotherapy can be an effective and safe adjuvant therapeutic option for atopic dermatitis. PMID:27081266

  8. Canine and Human Atopic Dermatitis: Two Faces of the Same Host-Microbe Interaction.

    PubMed

    Santoro, Domenico; Rodrigues Hoffmann, Aline

    2016-06-01

    Host-microbe interaction has been suggested to play a critical role in the pathogenesis of atopic dermatitis. The dog has been shown to be the best model to study both pathogenesis and microbiome modifications in atopic dermatitis. Bradley et al. show a significant correlation between microbiome diversity, clinical signs, and skin barrier function in atopic dogs before, during, and after antimicrobial therapy. PMID:27212648

  9. Deficiency of epidermal protein-bound omega-hydroxyceramides in atopic dermatitis.

    PubMed

    Macheleidt, Oliver; Kaiser, Hans Wilhelm; Sandhoff, Konrad

    2002-07-01

    Atopic dermatitis is a common skin disease of unknown etiology with an impaired permeability barrier function. To learn more about the molecular pathology in lesional skin, we analyzed levels of free extractable as well as protein-bound barrier lipids in the epidermis of atopic dermatitis subjects. The amount of protein-bound omega-hydroxyceramides in healthy epidermis comprised 46-53 wt% of total protein-bound lipids, whereas this percentage was decreased to 23-28 wt% in nonlesional areas and even down to 10-25 wt% in affected atopic skin areas of the subjects. Furthermore, the partial amount of free extractable very long chain fatty acids with more than 24 carbon atoms was reduced in affected regions down to 25 wt% and in nonlesional regions of the atopic dermatitis subjects down to 40 wt% compared to healthy controls. This "hydrocarbon chain length deficiency" regarding the barrier lipids in atopic skin was supported by metabolic labeling studies with [14C]-serine in cultured epidermis. The biosynthesis of free glucosylceramides and free ceramides was remarkably decreased in affected skin areas of the atopic subjects compared to healthy control subjects. Especially affected were the de novo syntheses of ceramide 4 (i.e., ceramide EOH, consisting of a very long chain N-acyl omega-hydroxy fatty acid esterified with linoleic acid and 6-hydroxysphingosine as sphingoid base) and ceramide 3 (ceramide NP, consisting of a nonhydroxy N-acyl fatty acid and phytosphingosine). In conclusion, this study revealed that the lesional epidermis in atopic dermatitis has considerable deficiencies within main barrier lipid components, which may contribute to the severely damaged permeability barrier. PMID:12164940

  10. Management of atopic dermatitis: safety and efficacy of phototherapy

    PubMed Central

    Patrizi, Annalisa; Raone, Beatrice; Ravaioli, Giulia Maria

    2015-01-01

    Atopic dermatitis (AD) is a common chronic inflammatory skin disease that can affect all age groups. It is characterized by a relapsing course and a dramatic impact on quality of life for patients. Environmental interventions together with topical devices represent the mainstay of treatment for AD, in particular emollients, corticosteroids, and calcineurin inhibitors. Systemic treatments are reserved for severe cases. Phototherapy represents a valid second-line intervention in those cases where non-pharmacological and topical measures have failed. Different forms of light therapy are available, and have showed varying degrees of beneficial effect against AD: natural sunlight, narrowband (NB)-UVB, broadband (BB)-UVB, UVA, UVA1, cold-light UVA1, UVA and UVB (UVAB), full-spectrum light (including UVA, infrared and visible light), saltwater bath plus UVB (balneophototherapy), Goeckerman therapy (coal tar plus UVB radiation), psoralen plus UVA (PUVA), and other forms of phototherapy. In particular, UVA1 and NB-UVB have gained importance in recent years. This review illustrates the main trials comparing the efficacy and safety of the different forms of phototherapy. No sufficiently large randomized controlled studies have been performed as yet, and no light modality has been defined as superior to all. Parameters and dosing protocols may vary, although clinicians mainly refer to the indications included in the American Academy of Dermatology psoriasis guidelines devised by Menter et al in 2010. The efficacy of phototherapy (considering all forms) in AD has been established in adults and children, as well as for acute (UVA1) and chronic (NB-UVB) cases. Its use is suggested with strength of recommendation B and level of evidence II. Home phototherapy can also be performed; this technique is recommended with strength C and level of evidence III. Phototherapy is generally considered to be safe and well tolerated, with a low but established percentage of short-term and long

  11. Management of atopic dermatitis: safety and efficacy of phototherapy.

    PubMed

    Patrizi, Annalisa; Raone, Beatrice; Ravaioli, Giulia Maria

    2015-01-01

    Atopic dermatitis (AD) is a common chronic inflammatory skin disease that can affect all age groups. It is characterized by a relapsing course and a dramatic impact on quality of life for patients. Environmental interventions together with topical devices represent the mainstay of treatment for AD, in particular emollients, corticosteroids, and calcineurin inhibitors. Systemic treatments are reserved for severe cases. Phototherapy represents a valid second-line intervention in those cases where non-pharmacological and topical measures have failed. Different forms of light therapy are available, and have showed varying degrees of beneficial effect against AD: natural sunlight, narrowband (NB)-UVB, broadband (BB)-UVB, UVA, UVA1, cold-light UVA1, UVA and UVB (UVAB), full-spectrum light (including UVA, infrared and visible light), saltwater bath plus UVB (balneophototherapy), Goeckerman therapy (coal tar plus UVB radiation), psoralen plus UVA (PUVA), and other forms of phototherapy. In particular, UVA1 and NB-UVB have gained importance in recent years. This review illustrates the main trials comparing the efficacy and safety of the different forms of phototherapy. No sufficiently large randomized controlled studies have been performed as yet, and no light modality has been defined as superior to all. Parameters and dosing protocols may vary, although clinicians mainly refer to the indications included in the American Academy of Dermatology psoriasis guidelines devised by Menter et al in 2010. The efficacy of phototherapy (considering all forms) in AD has been established in adults and children, as well as for acute (UVA1) and chronic (NB-UVB) cases. Its use is suggested with strength of recommendation B and level of evidence II. Home phototherapy can also be performed; this technique is recommended with strength C and level of evidence III. Phototherapy is generally considered to be safe and well tolerated, with a low but established percentage of short-term and long

  12. A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion.

    PubMed

    Chen, Jennifer K; Jacob, Sharon E; Nedorost, Susan T; Hanifin, Jon M; Simpson, Eric L; Boguniewicz, Mark; Watsky, Kalman L; Lugo-Somolinos, Aida; Hamann, Carsten R; Eberting, Cheryl Lee; Silverberg, Jonathan I; Thyssen, Jacob P

    2016-01-01

    Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided. PMID:27427820

  13. Prevalence of atopic dermatitis in infants during the first six months of life: authors’ observations

    PubMed Central

    Pasowska, Renata; Dółka, Elżbieta; Blomberg, Agnieszka; Rotsztejn, Helena

    2013-01-01

    Introduction Atopic dermatitis (AD) is a frequent chronic skin disease in infants. It creates great difficulties, both diagnostic and therapeutic. Aim To assess the prevalence of atopic dermatitis in infants during the first 6 months of life. Material and methods The analysis comprised 2256 children at the age of not more than 6 months, treated at the 2nd Department of Paediatrics and Allergology of the Polish Mother's Memorial Hospital in Lodz, Poland, during seven years. Out of all the patients, children with cutaneous changes were isolated, and the location, type and aetiology of changes were assessed. Results Dermal changes were diagnosed in 471 children, including 391 (17.3% of all the patients) with atopic dermatitis. Out of the children with AD, IgE-dependent allergy was identified in 39.9%. Cow's milk protein was the most frequent sensitising allergen. In 71.6% of the infants, cutaneous changes were disseminated and involved at least two areas of the body. All of them were strongly itching. An applied elimination diet, together with anti-allergic medications in some of the children, provided a clear clinical improvement. Conclusions Performed studies demonstrated the prevalence of atopic dermatitis in 17.3% of examined children. The changes in children with AD were disseminated, what was confirmed already at the infantile age. The obtained clinical improvement after the applied therapy indicates a relationship between the observed symptoms and allergic disease. PMID:24353486

  14. Clinical and Immunological Changes of Immunotherapy in Patients with Atopic Dermatitis: Randomized Controlled Trial

    PubMed Central

    Sánchez Caraballo, Jorge Mario; Cardona Villa, Ricardo

    2012-01-01

    Background. Immunotherapy has proven to be an useful tool in the management of allergic respiratory diseases; however, little has been studied in atopic dermatitis. Objective. To evaluate the clinical and immunological impact of immunotherapy with mites allergen extracts in atopic dermatitis. Methods. Patients with atopic dermatitis were assigned with computer-generated randomization to either of the following groups: (a) controls received only topical treatment with steroids and/or tacrolimus and (b) actively treated patients received topical treatment plus immunotherapy. Levels of serum total IgE, mites-specific IgE and IgG4 were assessed at study start and after one year of immunotherapy. Results. 31 patients in the active group and 29 in the control group completed the study. Symptoms and medication scores were significantly reduced in the active group after six months. Three patients in the control group showed new sensitizations to mites, while 3 patients in the active group showed neosensitization to shrimp with negative oral food challenge. We observed significant increase of mites-specific IgG4 levels in active group. Conclusion. Specific allergen immunotherapy induced a tolerogenic IgG4 response to mite allergens associated with favorable clinical effects in atopic dermatitis patients. PMID:23724240

  15. Food Hypersensitivity in Patients Over 14 Years of Age Suffering from Atopic Dermatitis

    PubMed Central

    Čelakovská, Jarmila; Ettler, K; Ettlerová, K; Vaněčková, J

    2014-01-01

    Background: Patients suffering from atopic dermatitis often describe food hypersensitivity. Rising prevalence of food hypersensitivity and severe allergic reactions to foods have been reported, but the data are scarce. Aims and Objectives: Evaluation of food hypersensitivity reactions in patients suffering from atopic dermatitis. Materials and Methods: The dermatological examination was performed in patients of age 14 years and above and the detailed history was taken concerning the food hypersensitivity. Results: A total of 228 patients were examined-72 men, 156 women, average age 26.2 (SD 9.5) years. The food hypersensitivity reactions were recorded in 196 patients from 228 (86%), no reactions were recorded in 32 patients (24%). Foods with the most often recorded reactions are: Nuts (in 35% of patients), tomatoes (in 20%), and kiwi (in 17, 5%), apples and spices (in 16%), tangerines and oranges (in 15%), capsicum (in 13%), fishes (in 12%), celery (in 9%), and chocolate (in 7%). Conclusion: Food hypersensitivity reactions are recorded in 86% of patients suffering from atopic dermatitis. Nuts, tomatoes, and pollen–associated foods play a role in the majority of patients suffering from atopic dermatitis. PMID:24891679

  16. Expression density of receptors to IL-1β in atopic dermatitis.

    PubMed

    Alshevskaya, Alina A; Lopatnikova, Julia A; Krugleeva, Olga L; Nepomnyschih, Vera M; Lukinov, Vitaliy L; Karaulov, Aleksander V; Sennikov, Sergey V

    2016-07-01

    Interleukin 1 (IL-1 β) and the system for regulation of its biological effects play an important role in the development and behavior of inflammatory processes in atopic dermatitis. Notably, cells that are actively involved in the pathological process have altered expression of cytokine receptors. However, standard evaluation of cells by flow cytometry measures only the percentage of cells expressing the appropriate marker, which is not enough for a full assessment of these changes. The aim of this study was to investigate changes in the expression of IL-1β cytokine receptors in patients with atopic dermatitis by both percentage of cells with receptors in various subsets and the absolute number of membrane-bound receptors themselves. It was found that an increase or decrease in the percentage of cells expressing the receptors in subsets of immune cells in patients with atopic dermatitis was not associated with a change in the number of receptors on the cell surface. Moreover, the changes in the percentage of cells and the number of receptors may occur in different directions, as shown for IL-1R2 expression on B cells and IL-1R1 expression for monocytes. Changes in the parameters of IL-1β receptor expressions are associated with disease severity index SCORAD in atopic dermatitis. These findings underline the importance of studying the density of cytokine receptor expression in the pathology. PMID:27267269

  17. The Development of a Practical and Reliable Assessment Measure for Atopic Dermatitis (ADAM).

    ERIC Educational Resources Information Center

    Charman, Denise; Varigos, George; Horne, David J. de L.; Oberklaid, Frank

    1999-01-01

    A study was conducted in Australia to develop a reliable, valid, and practical measure of atopic dermatitis. The test development process and validity evaluation with two doctors and 51 patients are discussed. Results suggest that operational definitions of the scales need to be defined more clearly. The measure satisfies assumptions for a partial…

  18. Structured Parent Education in the Management of Childhood Atopic Dermatitis: The Berlin Model.

    ERIC Educational Resources Information Center

    Wenninger, Kerstin; Kehrt, Rainer; von Ruden, Ursula; Lehmann, Christine; Binder, Christiane; Wahn, Ulrich; Staab, Doris

    2000-01-01

    Describes the goals and content of the Berlin education program for parents and children with atopic dermatitis (AD). Program included six group sessions concerning medical, nutritional, and psychological issues. Program aimed to contribute towards a comprehensive, family-oriented management of childhood AD. Data showed the program had a positive…

  19. Genome-wide Comparative Analysis of Atopic Dermatitis and Psoriasis Gives Insight into Opposing Genetic Mechanisms

    PubMed Central

    Baurecht, Hansjörg; Hotze, Melanie; Brand, Stephan; Büning, Carsten; Cormican, Paul; Corvin, Aiden; Ellinghaus, David; Ellinghaus, Eva; Esparza-Gordillo, Jorge; Fölster-Holst, Regina; Franke, Andre; Gieger, Christian; Hubner, Norbert; Illig, Thomas; Irvine, Alan D.; Kabesch, Michael; Lee, Young A.E.; Lieb, Wolfgang; Marenholz, Ingo; McLean, W.H. Irwin; Morris, Derek W.; Mrowietz, Ulrich; Nair, Rajan; Nöthen, Markus M.; Novak, Natalija; O’Regan, Grainne M.; Schreiber, Stefan; Smith, Catherine; Strauch, Konstantin; Stuart, Philip E.; Trembath, Richard; Tsoi, Lam C.; Weichenthal, Michael; Barker, Jonathan; Elder, James T.; Weidinger, Stephan; Cordell, Heather J.; Brown, Sara J.

    2015-01-01

    Atopic dermatitis and psoriasis are the two most common immune-mediated inflammatory disorders affecting the skin. Genome-wide studies demonstrate a high degree of genetic overlap, but these diseases have mutually exclusive clinical phenotypes and opposing immune mechanisms. Despite their prevalence, atopic dermatitis and psoriasis very rarely co-occur within one individual. By utilizing genome-wide association study and ImmunoChip data from >19,000 individuals and methodologies developed from meta-analysis, we have identified opposing risk alleles at shared loci as well as independent disease-specific loci within the epidermal differentiation complex (chromosome 1q21.3), the Th2 locus control region (chromosome 5q31.1), and the major histocompatibility complex (chromosome 6p21–22). We further identified previously unreported pleiotropic alleles with opposing effects on atopic dermatitis and psoriasis risk in PRKRA and ANXA6/TNIP1. In contrast, there was no evidence for shared loci with effects operating in the same direction on both diseases. Our results show that atopic dermatitis and psoriasis have distinct genetic mechanisms with opposing effects in shared pathways influencing epidermal differentiation and immune response. The statistical analysis methods developed in the conduct of this study have produced additional insight from previously published data sets. The approach is likely to be applicable to the investigation of the genetic basis of other complex traits with overlapping and distinct clinical features. PMID:25574825

  20. Tolerability and cosmetic acceptability of a body wash in atopic dermatitis-prone subjects.

    PubMed

    Brandt, Staci; Meckfessel, Matthew H; Lio, Peter A

    2014-09-01

    Atopic dermatitis is a common skin disease characterized by eczematous eruptions and impaired skin barrier function. Patients, as well as their families, frequently report reductions in quality of life. Pruritus, lack of sleep, and impaired social functioning all contribute to this reduction. A skincare regimen of gentle cleansing and daily moisturization is integral to managing atopic dermatitis. While there are a multitude of reports supporting the use of moisturizers, there is a paucity regarding the use of cleansers, especially cleansers formulated with ingredients known to improve skin hydration. A clinical study was conducted to assess the tolerability and cosmetic acceptability of a body wash formulated with the filaggrin break-down products arginine and pyrrolidone carboxylic acid in subjects with atopic dermatitis-prone skin (Cetaphil® RestoraDerm® Body Wash). The results of this study indicate that Cetaphil RestoraDerm Body Wash was well tolerated, reduced itch, improved quality of life, and was well-liked by subjects with atopic dermatitis-prone skin. PMID:25226012

  1. Systemic sensitization with the protein allergen ovalbumin augments local sensitization in atopic dermatitis

    PubMed Central

    Yoo, Jane; Manicone, Anne M; McGuire, John K; Wang, Ying; Parks, William C

    2014-01-01

    Mouse models of atopic dermatitis based on epicutaneous sensitization have shed light on the role of epicutaneous allergen entry in the development of respiratory and gastrointestinal allergy. However, the contribution of non-cutaneous modes of sensitization to skin diseases has not been evaluated. We assessed if systemic ovalbumin administration, in conjunction with local sensitization, could prime for a robust inflammatory response. Furthermore, we attempted to elucidate important aspects of disease pathogenesis previously unaddressed in mouse models. Mice that underwent intraperitoneal ovalbumin sensitization prior to epicutaneous challenge demonstrated an acute (Th2-polarized) atopic dermatitis-like phenotype upon local challenge. The inflammatory response was strikingly more robust than in mice that underwent epicutaneous sensitization alone. The lesional infiltrate contained a dendritic cell population that corresponded phenotypically with inflammatory dendritic epidermal cells of significance in human disease. Finally, in accordance with observations in human atopic dermatitis, there was an increase in cluster of differentiation (CD) 103 (αE subunit)-expressing CD4+ T lymphocytes. However, the absence of CD103 on approximately 50% of infiltrating cells argues against a primary role for the αEβ7 integrin in tissue homing. In conclusion, we present a mouse model of atopic dermatitis that reveals novel insights into the pathogenesis of this complex disease. PMID:24672255

  2. The Short Stature in Atopic Dermatitis Patients: Are Atopic Children Really Small for Their Age?

    PubMed Central

    Park, Mi Kyung; Park, Kui Young; Li, Kapsok; Hong, Chang Kwun

    2013-01-01

    Background Short stature is sometimes seen in children with atopic dermatitis (AD); however, the topic has never been studied systematically. Objective: The aim of this study was to show whether AD itself affects stature in children and to evaluate the influence of other relevant factors such as genetic background, diet restrictions, and sleep disturbance on the stature of children with AD. Objective The aim of this study was to show whether AD itself affects stature in children and to evaluate the influence of other relevant factors such as genetic background, diet restrictions, and sleep disturbance on the stature of children with AD. Methods The study population included Korean children 7 to 8 years of age who live in one district of Seoul, Korea. We used a questionnaire as an investigating tool to survey genetic backgrounds, environmental factors, and comorbidities. Student's t-test and linear regression were employed for statistical analysis. Results In univariate analysis, the average stature in the AD group was short compared with the normal control group. Parental stature, dietary habit, and sleep patterns were also relevant factors with respect to stature. However, in multivariate analysis, AD itself had no influence on stature. Significant correlations were found for such factors as parental height, sleep disturbance, presence of asthma, and dietary restrictions, in decreasing magnitude. Conclusion These results suggest that AD itself may not be the causative factor for short stature in children with AD. Therefore, consideration of other relevant factors related to short stature in patients with AD will be important for the proper management of the disease. PMID:23467580

  3. Phthalate metabolites in urine and asthma, allergic rhinoconjunctivitis and atopic dermatitis in preschool children.

    PubMed

    Callesen, Michael; Bekö, Gabriel; Weschler, Charles J; Langer, Sarka; Brive, Lena; Clausen, Geo; Toftum, Jørn; Sigsgaard, Torben; Høst, Arne; Jensen, Tina Kold

    2014-07-01

    Phthalate esters are among the most ubiquitous of indoor pollutants and have been associated with various adverse health effects. In the present study we assessed the cross-sectional association between eight different phthalate metabolites in urine and allergic disease in young children. As part of the Danish Indoor Environment and Children's Health study, urine samples were collected from 440 children aged 3-5 years, of whom 222 were healthy controls, 68 were clinically diagnosed with asthma, 76 with rhinoconjunctivitis and 81 with atopic dermatitis (disease subgroups are not mutually exclusive; some children had more than one disease). There were no statistically significant differences in the urine concentrations of phthalate metabolites between cases and healthy controls with the exception of MnBP and MECPP, which were higher in healthy controls compared with the asthma case group. In the crude analysis MnBP and MiBP were negatively associated with asthma. In the analysis adjusted for multiple factors, only a weak positive association between MEP in urine and atopic dermatitis was found; there were no positive associations between any phthalate metabolites in urine and either asthma or rhinoconjunctivitis. These findings appear to contradict earlier studies. Differences may be due to higher exposures to certain phthalates (e.g., BBzP) via non-dietary pathways in earlier studies, phthalates serving as surrogates for an agent associated with asthma (e.g., PVC flooring) in previous studies but not the present study or altered cleaning habits and the use of "allergy friendly" products by parents of children with allergic disease in the current study in contrast to studies conducted earlier. PMID:24388279

  4. Prebiotics Do Not Influence the Severity of Atopic Dermatitis in Infants: A Randomised Controlled Trial

    PubMed Central

    Hill, Martin; Skýba, Tomáš

    2015-01-01

    The objective was to evaluate the effects of a hypoallergenic (HA) formula supplemented with prebiotic galacto-oligosaccharides on the severity of atopic manifestations. A randomised clinical trial was conducted. The control group was infants, fed with hypoallergenic formula and without supplementation. The duration of the study was six months. The primary outcome of the study was a difference in the severity of atopic dermatitis measured using SCORAD (Scoring Atopic Dermatitis) criteria. Secondary outcomes were anthropometry (length, weight, and head circumference), together with the tolerance and incidence of infections. Both groups showed a decrease of average SCORAD values, but no statistically significant difference between the evaluated groups was observed. There were no statistically significant differences in anthropometry, or the tolerance or incidence of infections. Although there is no evidence, that consumption of a hypoallergenic infant formula enriched with prebiotic galacto-oligosaccharides had any effect on SCORAD, it was safe and well tolerated. Trial Registration www.clinicaltrials.gov NCT 02077088 PMID:26571488

  5. Effect of standard medication on quality of life of patients with atopic dermatitis.

    PubMed

    Kawashima, Makoto; Harada, Shotaro

    2007-01-01

    Patients with atopic dermatitis present with debilitating symptoms, including pruritus and subsequent excoriation, which significantly reduces their quality of life (QOL). At present, the standard therapy for atopic dermatitis constitutes a topical steroid and/or a topical immunomodulator, an emollient and an oral antihistamine, although few studies have reported the effect of this treatment regimen on QOL. The current study aimed to verify the efficacy of the standard therapy for both clinical symptom severity and patient QOL, assessed using the validated Skindex-16 questionnaire. Atopic dermatitis patients receiving the standard therapy (n=771) were enrolled in the current phase IV, multicenter, 12-week, open-label study. The Rajka and Langeland scale (used to rate the severity of atopic dermatitis symptoms) and the Skindex-16 QOL questionnaire were completed at weeks 0 (baseline), 4 and 12. Of 415 patients completing the questionnaire at all time points (per-protocol population), 95.2% were prescribed the antihistamine fexofenadine HCl 60 mg. There were significant improvements in symptoms, emotions and functioning scale scores at weeks 4 and 12 compared with baseline (P<0.005). Discomfort associated with itching, as assessed by item 1 on the Skindex-16, improved over the treatment period (score decreased by >or=1 and >or=2 in 75.2% and 50.9% of patients, respectively). Significant (P<0.005) improvements from baseline in global scores were also observed at weeks 4 and 12, and for week 12 compared with week 4. Severity scores improved significantly (P<0.005) from weeks 0-4 and from weeks 4-12. The standard therapy was generally well tolerated with only mild adverse events reported (0.5%). These data suggest that patients with atopic dermatitis and associated pruritus experience significant improvements in both symptom severity and QOL when receiving standard therapy. PMID:17204095

  6. Oleanolic acid acetate inhibits atopic dermatitis and allergic contact dermatitis in a murine model

    SciTech Connect

    Choi, Jin Kyeong; Oh, Hyun-Mee; Lee, Soyoung; Park, Jin-Woo; Khang, Dongwoo; Lee, Seung Woong; Lee, Woo Song; Rho, Mun-Chual; Kim, Sang-Hyun

    2013-05-15

    Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are common allergic and inflammatory skin diseases caused by a combination of eczema, scratching, pruritus, and cutaneous sensitization with allergens. This paper examines whether oleanolic acid acetate (OAA) modulates AD and ACD symptoms by using an existing AD model based on the repeated local exposure of mite extract (Dermatophagoides farinae extract, DFE) and 2,4-dinitrochlorobenzene to the ears of BALB/c mice. In addition, the paper uses a 2,4-dinitrofluorobenzene-sensitized local lymph node assay (LLNA) for the ACD model. The oral administration of OAA over a four-week period attenuated AD symptoms in terms of decreased skin lesions, epidermal thickness, the infiltration of immune cells (CD4{sup +} cells, eosinophils, and mast cells), and serum IgE, IgG2a, and histamine levels. The gene expression of Th1, Th2, Th17, and Th22 cytokines was reduced by OAA in the lymph node and ear tissue, and the LLNA verified that OAA suppressed ACD. The oral administration of OAA over a three-day period attenuated ACD symptoms in terms of ear thickness, lymphocyte proliferation, and serum IgG2a levels. The gene expression of Th1, Th2, and Th17 cytokines was reduced by OAA in the thymus and ear tissue. Finally, to define the underlying mechanism, this paper uses a TNF-α/IFN-γ-activated human keratinocyte (HaCaT) model. OAA inhibited the expression of cytokines and chemokines through the downregulation of NF-κB and MAPKs in HaCaT cells. Taken together, the results indicate that OAA inhibited AD and ACD symptoms, suggesting that OAA may be effective in treating allergic skin disorders. - Highlights: • OAA reduced both acute and chronic AD symptoms. • OAA had a controlling effect on the immune reaction for ACD. • The effect of OAA on allergic skin disorders was comparable to the cyclosporine A. • OAA might be a candidate for the treatment of allergic skin disorders.

  7. Catecholamines levels and parotid secretion in children with chronic atopic dermatitis.

    PubMed

    Crespi, H; Armando, I; Tumilasci, O; Levin, G; Massimo, J; Barontini, M; Perec, C

    1982-06-01

    The purpose of this study was to evaluate the in vivo state of both branches of the autonomic nervous system in children with chronic atopic dermatitis. In 15 patients, age 4 to 11, the following parameters were analyzed: (1) basal plasma levels of epinephrine, norepinephrine, and dopamine; (2) poststimulation (standing and i.v. furosemide administration); (3) basal urinary excretion of epinephrine, norepinephrine, and vainillin mandelic acid; (4) 30 min postfurosemide administration; (5) parotid secretory response to intraoral 0.1 m citric acid: flow rate, saliva pH, and concentrations of bicarbonate, chlorides, inorganic phosphates, total protein, and amylase activity. No differences in plasma and urinary basal levels of the catecholamines were observed. In response to standing, plasma norepinephrine from atopic children showed a greater increase than that seen in normal healthy children. From the salivary factors studied, no differences were found in parotid flow-rate, bicarbonates, chlorides, and inorganic phosphates. Protein concentration as well as amylase activity were significantly decreased in children with atopic dermatitis. These findings suggest that in atopic dermatitis, the beta-sympathetic mediated responses are impaired; on the other hand, parasympathetic mediated responses remain preserved. PMID:7086169

  8. Update on the role of systemic vitamin D in atopic dermatitis.

    PubMed

    Mutgi, Krishna; Koo, John

    2013-01-01

    Atopic dermatitis (AD) is a common chronic inflammatory type of eczema. The underlying cause of AD has not been established. Several studies have shown initial epidermal barrier dysfunction with subsequent immune activation as the underlying mechanism. Recently, in addition to its classical role in calcium homeostasis, vitamin D has been recognized for its effect on immunomodulation. Animal studies, case reports, and randomized clinical trials have suggested that vitamin D, through various mechanisms, may alleviate the symptoms of AD. The majority of these studies indicate an inverse relationship between the severity of atopic dermatitis and vitamin D levels. Furthermore, studies have shown that, in individuals with AD who are deficient in vitamin D, repletion of vitamin D results in decreased severity of disease. We present a review of the present literature that suggests a potentially significant role for vitamin D in the treatment of AD. PMID:22957498

  9. Preparation of hydrogels for atopic dermatitis containing natural herbal extracts by gamma-ray irradiation

    NASA Astrophysics Data System (ADS)

    Lim, Youn-Mook; An, Sung-Jun; Kim, Hae-Kyoung; Kim, Yun-Hye; Youn, Min-Ho; Gwon, Hui-Jeong; Shin, Junhwa; Nho, Young-Chang

    2009-07-01

    Atopic dermatitis (AD) is a familial and chronic inflammatory pruritic skin disease that affects a large number of children and adults in industrialized countries. It is known that one of the prominent features of AD and chronic pruritus is partially due to the histamine released from mast cell. In this work, hydrogel patches with natural herbal extracts were prepared by "freezing and thawing", and a gamma irradiation. It showed eminent healing results as a consequence of long-term moisturizing effects and natural herbal extracts on atopic wounds. Besides its non-toxicity and human harmlessness, it can be easily attached to or detached from the skin without any trace and help patients to feel refreshment when attached. Based on this work, the hydrogel patches we made can be potentially used as an alternative remedy for not only pruritus in AD, but other dermatitis.

  10. Development of atopic dermatitis-like skin disease from the chronic loss of epidermal caspase-8.

    PubMed

    Li, Christopher; Lasse, Samuel; Lee, Pedro; Nakasaki, Manando; Chen, Shih-Wei; Yamasaki, Kenshi; Gallo, Richard L; Jamora, Colin

    2010-12-21

    Atopic dermatitis is an inflammatory skin disease that affects approximately 20% of children worldwide. Left untreated, the barrier function of the skin is compromised, increasing susceptibility to dehydration and infection. Despite its prevalence, its multifactorial nature has complicated the unraveling of its etiology. We found that chronic loss of epidermal caspase-8 recapitulates many aspects of atopic dermatitis, including a spongiotic phenotype whereby intercellular adhesion between epidermal keratinocytes is disrupted, adversely affecting tissue architecture and function. Although spongiosis is generally thought to be secondary to edema, we found that suppression of matrix metalloproteinase-2 activity is sufficient to abrogate this defect. p38 MAPK induces matrix metalloproteinase-2 expression to cleave E-cadherin, which mediates keratinocyte cohesion in the epidermis. Thus, the conditional loss of caspase-8, which we previously found to mimic a wound response, can be used to gain insights into how these same wound-healing processes are commandeered in inflammatory skin diseases. PMID:21135236

  11. Topical Tacrolimus versus Hydrocortisone on Atopic Dermatitis in Paediatric Patients: A Randomized Controlled Trial.

    PubMed

    Rahman, M F; Nandi, A K; Kabir, S; Kamal, M; Basher, M S; Banu, L A

    2015-07-01

    Atopic dermatitis (AD) is a chronic, inflammatory skin disease in early childhood. Atopic dermatitis is familial disease, often coexists with other atopic diseases with multiple risk factors associated with atopic eczema. The disease is more frequent in urban areas compared with rural areas. Changes in nutrition and a decrease in infant breast-feeding and respiratory allergies are contributory factors for the condition. A Randomized Controlled Trial (RCT) was carried to compare the efficacy and safety of Tacrolimus ointment with a topical corticosteroid reference therapy. A total 60 patients aged between 2 to 10 years, having atopic dermatitis for at least one year and comply Hanifin-Rajka criteria were selected using random number table and allocated into study and control groups through randomization. Study group was treated with topical Tacrolimus 0.03% twice daily for three weeks, while the control group was treated with 1% Hydrocortisone acetate for the same period. Both groups had a washed out phase for 2 weeks with a follow up period of 6 weeks. Eczema Area and Severity lndex (EASI) was assessed at baseline and three weeks after treatment. Efficacy was evaluated at each visit by six clinical signs of atopic dermatitis through measurement of the affected surface area and the EASI score in each of four body regions. Before intervention, in study group mean EASI score was 11.29 with a SD of 2.14, while in control group it was 11.05 with a SD of 2.46. Difference was statistically insignificant (p>0.05). At the end of the treatment, in study group mean EASI score was 4.86 with a SD of 1.01, while in control group it was 7.97 with a SD of 1.80. Statistically high significant difference was observed between EASI scores of two groups before and after the treatment (p<0.001). After getting treatment with Tacrolimus, median reduction of EASI score was 56.07 in study group, while getting treatment with Hydrocortisone, median reduction of EASI score was 27

  12. [Holistic-integrated therapy model of neurodermitis constitutionalis atopica (atopic dermatitis)].

    PubMed

    von Uslar, A; Prochazka, P; von Uslar, D

    1989-06-15

    The treatment of atopic dermatitis requires the consideration of numerous psychosomatic aspects, including their respective sociopsychic dimensions. This implicates a holistic concept of therapy as well as the interdisciplinary cooperation of therapists of various disciplines, also involving the patient himself. Taking the patient out of his everyday circumstances can give him the opportunity of developing new concepts and strategies of behavior, which in turn may promote his subsequent (re-)integration into his social environment. PMID:2669401

  13. Use of ustekinumab for severe refractory atopic dermatitis in a young teenager.

    PubMed

    Wlodek, C; Hewitt, H; Kennedy, C T

    2016-08-01

    When conventional systemic immunosuppressive treatments fail in the setting of severe eczema, unlike in psoriasis, there are limited treatment options and only anecdotal evidence to help guide clinicians. There is a growing body of evidence for the use of certain biologic agents for moderate to severe eczema. We report the youngest case to date successfully and safely treated with ustekinumab for severe refractory atopic dermatitis. PMID:27079289

  14. Involuntary autonomy: patients' perceptions of physicians, conventional medicines and risks in the management of atopic dermatitis.

    PubMed

    Noerreslet, Mikkel; Jemec, Gregor B E; Traulsen, Janine M

    2009-11-01

    Consumerism is a major force in western health care. It defines the process in which patients should or do play a more active and central role in making informed choices about health and illness. The talk of patients as consumers is closely linked, and is especially pertinent for patients managing a chronic illness. This article presents findings from a Danish qualitative study that set out to broaden the sociological debate on patients as consumers by including patients' perceptions of conventional medicines. In-depth interviews were carried out with 24 people who medically managed their own or their child's atopic dermatitis. The informants were recruited via the Division of Dermatology in a Danish Hospital which was planning an Information Day on atopic dermatitis (AD). The findings reveal how many of the informants who on the surface appear to match the profile of the so called 'consumer', by being active, critical, informed etc., in fact prefer to consult a patient-centred medical expert (a dermatologist) with good communication skills, who is able to inform, advise and support on issues of managing atopic dermatitis. These people are not seeking more independence but rather a partnership where responsibility for treatment (medicines) is shared. This preference appears to be closely linked with a sense of insecurity about what an outbreak of atopic dermatitis may lead to and insecurity about the medicines. Ultimately, the findings stress that health care politicians and professionals need to reflect upon patient's wants and needs when designing future health care. Turning health care into self-care may not be an appropriate strategy. PMID:19762137

  15. Atopic dermatitis guideline. Position paper from the Latin American Society of Allergy, Asthma and Immunology.

    PubMed

    Sánchez, Jorge; Páez, Bruno; Macías, A; Olmos, C; de Falco, A

    2014-01-01

    As in other regions, the incidence of atopic dermatitis in Latin America has been increasing in recent years. Although there are several clinical guidelines, many of their recommendations cannot be universal since they depend on the characteristics of each region. Thus, we decided to create a consensus guideline on atopic dermatitis applicable in Latin America and other tropical regions, taking into account socio-economic, geographical, cultural and health care system characteristics. The Latin American Society of Allergy Asthma and Immunology (SLAAI) conducted a systematic search for articles related to the pathophysiology, diagnosis and treatment of dermatitis using various electronic resources such as Google, Pubmed, EMBASE (Ovid) and Cochrane data base. We have also looked for all published articles in Latin America on the subject using LILACS (Latin American and Caribbean Literature on Health Sciences) database. Each section was reviewed by at least two members of the committee, and the final version was subsequently approved by all of them, using the Delphi methodology for consensus building. Afterward, the final document was shared for external evaluation with physicians, specialists (allergists, dermatologists and pediatricians), patients and academic institutions such as universities and scientific societies related to the topic. All recommendations made by these groups were taken into account for the final drafting of the document. There are few original studies conducted in Latin America about dermatitis; however, we were able to create a practical guideline for Latin America taking into account the particularities of the region. Moreover, the integral management was highlighted including many of the recommendations from different participants in the health care of this disease (patients, families, primary care physicians and specialists). This practical guide presents a concise approach to the diagnosis and management of atopic dermatitis that can be

  16. Efficacy and tolerance of tacrolimus and pimecrolimus for atopic dermatitis: a meta-analysis.

    PubMed

    Yin, Zhiqiang; Xu, Jiali; Luo, Dan

    2011-11-01

    Tacrolimus ointment and pimecrolimus cream have proved to be suitable for the treatment of atopic dermatitis. We conducted a meta-analysis of the efficacy, adverse events/withdrawal of tacrolimus versus pimecrolimus in the treatment of atopic dermatitis. According to our meta-analysis, 0.1% tacrolimus was more effective than 1% pimecrolimus in the treatment of adult patients and moderate to very severe pediatric patients, and more 0.1% mild pediatric patients treatal with pimecrolimus withdrew from the trials because of a lack of efficacy or the occurrence of adverse events, compared with mild pediatric patients treated with 0.03% tacrolimus. The combined analyses of tacrolimus with pimecrolimus showed that tacrolimus was more effective than pimecrolimus (week 3: RR=0.67, 95%CI=0.56-0.80; week 6/end of study: RR=0.65, 95%CI=0.57-0.75), and fewer tacrolimus-treated patients withdrew because of a lack of efficacy (RR=0.32, 95CI%=0.19-0.53) or the occurrence of adverse events (RR=0.43, 95%CI=0.24-0.75), compared with pimecrolimus-treated patients. In conclusion, tacrolimus has higher efficacy and better tolerance than pimecrolimus in the treatment of atopic dermatitis. PMID:23554715

  17. Reduced secretion of IgA to skin surface of patients with atopic dermatitis.

    PubMed

    Imayama, S; Shimozono, Y; Hoashi, M; Yasumoto, S; Ohta, S; Yoneyama, K; Hori, Y

    1994-08-01

    To investigate whether the secretory form of immunoglobulin A (sIgA) was reduced on the skin surface in atopic dermatitis, the amount of sIgA present in sweat was measured in 40 patients with atopic dermatitis and in 50 healthy volunteers by attaching a cellulose membrane disk (10 x 10 mm) to the inner aspect of the upper arm skin for 24 hours. The secretory form of IgA, which was absorbed to the membrane and accumulated during the period of application, was revealed as dots by an enzyme immunoassay in which antibodies for IgA and for the secretory component were used. The density and number of dots (per mm2/day), which corresponded to the openings of eccrine excretory ducts, were determined with a densitometer. The mean amount of sIgA secreted by those patients was 3.86 +/- 0.71 pg/mm2/day (range, 0 to 21.17 pg/mm2/day), whereas that of the control subjects was significantly higher (p < 0.001), 16.79 +/- 2.80 pg/mm2/day (range, 0.79 to 133.77 pg/mm2/day). This may be related to the high incidence of bacterial and viral skin infections seen in patients with atopic dermatitis, and in addition, to the development of eczematous lesions through a defect in ridding the skin of allergens and/or microorganisms. PMID:8064071

  18. The precipitation of symptoms by common foods in children with atopic dermatitis.

    PubMed

    Steinman, H A; Potter, P C

    1994-01-01

    Atopic dermatitis (AD) is a chronic and disabling condition that has a major impact on financial and social resources of the individual and the community. Its incidence is increasing dramatically, and no cure is available. Pharmacological treatment is only partially effective. The evidence that diet plays a role in children with atopic dermatitis is now irrefutable. Prophylactic measures can prevent or limit the development of AD, and partially restricted diets can modify the disease's course or severity. This study reports the reactions to various foods as perceived by parents of 112 children affected by AD. It demonstrates that many foods exacerbate AD and that reactions are caused by two distinct groups of food. The commonest triggers of cutaneous symptoms are tomatoes, oranges, sweets, pineapple, chocolate, and softdrinks preserved with sulfur dioxide. These foods result in symptoms in 30% to 49% of the children. The traditional IgE reaction type foods, namely egg, fish, milk, and peanut, resulted in reactions in 14% to 25% of the children, and with many non-cutaneous symptoms. The study further shows that allergen avoidance measures are not practiced in our community, and that sound advice is not often proffered. Practical advice on prophylactic dietary preventative measures and dietary management of children with atopic dermatitis is presented. PMID:7806078

  19. The Epithelial Cell-derived Atopic Dermatitis Cytokine TSLP Activates Neurons to Induce Itch

    PubMed Central

    Wilson, Sarah R.; Thé, Lydia; Batia, Lyn M.; Beattie, Katherine; Katibah, George E.; McClain, Shannan P.; Pellegrino, Maurizio; Estandian, Daniel M.; Bautista, Diana M.

    2014-01-01

    Summary Atopic dermatitis (AD) is a chronic itch and inflammatory disorder of the skin that affects one in ten people. Patients suffering from severe AD eventually progress to develop asthma and allergic rhinitis, in a process known as the “atopic march.” Signaling between epithelial cells and innate immune cells via the cytokine Thymic Stromal Lymphopoietin (TSLP) is thought to drive AD and the atopic march. Here we report that epithelial cells directly communicate to cutaneous sensory neurons via TSLP to promote itch. We identify the ORAI1/NFAT calcium signaling pathway as an essential regulator of TSLP release from keratinocytes, the primary epithelial cells of the skin. TSLP then acts directly on a subset of TRPA1-positive sensory neurons to trigger robust itch behaviors. Our results support a new model whereby calcium-dependent TSLP release by keratinocytes activates both primary afferent neurons and immune cells to promote inflammatory responses in the skin and airways. PMID:24094650

  20. Staphylococcus aureus genomic pattern and atopic dermatitis: may factors other than superantigens be involved?

    PubMed

    Rojo, A; Aguinaga, A; Monecke, S; Yuste, J R; Gastaminza, G; España, A

    2014-04-01

    The purpose of this investigation was to compare the genotypic profiles of Staphylococcus aureus isolated from atopic dermatitis (AD) patients and from control subjects, and to study the relationship between clinical severity, immune response, and genomic pattern of S. aureus isolated from AD patients. We selected 32 patients with AD and S. aureus skin colonization and 31 atopic controls with no history of AD who where asymptomatic carriers of S. aureus. Microarray-based genotyping was performed on S. aureus isolates. In AD patients, clinical severity was assessed using the Scoring Atopic Dermatitis index and total IgE levels and staphylococcal superantigen-specific IgE levels (SEA, SEB, SEC, TSST1) were determined. The genes lukE, lukD, splA, splB, ssl8, and sasG were more frequent in isolates from AD patients. CC30 was more common in isolates from atopic controls than in AD patients. There was a correlation between total IgE and clinical severity, but an association between clinical severity, immune response, and the presence of S. aureus superantigen genes, including enterotoxin genes, could not be demonstrated. Finally, a correlation was found between AD severity and other S. aureus genes, such as sasG and scn. S. aureus factors besides superantigens could be related to the worsening and onset of AD. PMID:24162256

  1. Topical application of a vitamin D analogue exacerbates atopic dermatitis and induces the atopic dermatitis-like phenotype in Stat6VT mice.

    PubMed

    Turner, Matthew J; Dasilva-Arnold, Sonia C; Yi, Qiaofang; Mehrotra, Purvi; Kaplan, Mark H; Travers, Jeffrey B

    2013-01-01

    Calcipotriene is a topical vitamin D3 analogue approved for the treatment of plaque and scalp psoriasis. We report the case of a 2-year-old boy whose atopic dermatitis (AD) flared in response to application of calcipotriene 0.005% cream and solution for a mistaken diagnosis of plaque and scalp psoriasis. We investigated whether the patient's eruption was secondary to an allergic contact dermatitis. In the Stat6VT mouse model of AD we tested whether calcipotriene could induce the otherwise-spontaneous AD-like phenotype. Closed patch testing was done on the patient with calcipotriene solution and cream, moisturizing cream, and 51% isopropanol. Stat6VT and wild-type (WT) mice were treated for 7 days with calcipotriene solution or vehicle (isopropanol) applied to the right and left upper back skin, respectively, after which mice were followed longitudinally for 10 weeks. Biopsy specimens from prior treatment sites were then collected for histology and RNA isolation. RNA was analyzed for interleukin (IL-4) expression using quantitative polymerase chain reaction. Patch testing was negative. Stat6VT mice, in contrast to WT mice, developed a persistent eczematous dermatitis at sites of calcipotriene application. Clinical and histologic features and high IL-4 transcript levels were consistent with the spontaneous AD-like phenotype seen in Stat6VT mice. At sites of active disease, calcipotriene can worsen a flare of AD. In Stat6VT mice, calcipotriene can induce the AD-like phenotype. PMID:23889122

  2. [What additional measures should be recommended in atopic dermatitis in children?].

    PubMed

    Boralevi, F

    2005-01-01

    The so-called 'adjuvant' measures are an important part of atopic dermatitis (AD) consultations. The practitioner is the 'expert' in the patients' eyes in prescribing, proposing, counselling and replying to the questions concerning moisturizers, thermal spring water cures, the resort to alternative medical, and vaccinations. Moisturizers are aimed at rapidly restoring water in the epidermis, decreasing the sensitivity to irritants and improving the patients' comfort. The available products are usually composed of water, occlusive agents, humidifiers, varyingly combined with tensioactive agents, preservatives and perfumes... Their short term efficacy has been demonstrated, but no study has shown superiority of one product over another. The recommended treatment is 1 to 2 daily applications of a cream or lotion, selected among the products having demonstrated their efficacy, contained the least amount of irritant or sensitizers, the presentation and cost of which is acceptable to the patient. There are no arguments to recommend moisturizers in the absence of xerosis, nor for prolonged periods of clinical remission. Spring water thermal cures. In France there are many cure centres and the spring waters used are distinguished by their clinical or physical features. Although there are no studies that clearly establish their efficacy in AD, the craze and satisfaction of many patients for spring water thermal cures must be taken into consideration, as well as the educational dimension, in the hopes that a consensus will be reached and that regular assessments be made. Alternative medical practices, such as homeopathy or acupuncture, represent a therapeutic alternative chosen by more than one third of patients with AD. However, no study has sufficiently demonstrated the interest of these alternatives and they cannot therefore be integrated in the validated arsenal of treatments. Used in various oriental countries, Chinese herbs have been the subject of controlled studies

  3. Treatment of childhood atopic dermatitis and economic burden of illness in Asia Pacific countries.

    PubMed

    Lee, Bee Wah; Detzel, Patrick R

    2015-01-01

    Atopic dermatitis (AD) is a common chronic inflammatory skin condition in children. In Asia, the prevalence of AD is increasing, which is largely attributed to environmental and socioeconomic factors including family income, parental education, lifestyle and metropolitan living. Current clinical guidelines recommend a stepped approach in the management of eczema in children, with treatment steps tailored to the severity of the eczema. To address the skin barrier dysfunction, skin hydration and the application of emollients is essential. There is evidence supporting the use of bleach baths as an antimicrobial therapy against Staphylococcus aureus. In patients in whom topical treatment fails, wet wrap therapy may be considered as a treatment option before considering systemic therapies. In the second part of this article, the economic burden of AD is addressed. AD not only negatively impacts the child's quality of life but also that of the whole family and is associated with a burden on health-care costs and society. AD in an infant will lead to frequent additional visits to the pediatrician, to additional and partially expensive treatment costs and, in rare cases, to hospitalization. It is thus of utmost importance to define efficient strategies to not only treat AD but also to decrease the risk of developing the disease. PMID:25925337

  4. Histamine and Skin Barrier: Are Histamine Antagonists Useful for the Prevention or Treatment of Atopic Dermatitis?

    PubMed Central

    De Benedetto, Anna; Yoshida, Takeshi; Fridy, Sade; Park, Joo-Eun S.; Kuo, I.-Hsin; Beck, Lisa A.

    2015-01-01

    Atopic Dermatitis (AD), the most common chronic inflammatory skin disease, is characterized by an overactive immune response to a host of environmental allergens and dry, itchy skin. Over the past decade important discoveries have demonstrated that AD develops in part from genetic and/or acquired defects in the skin barrier. Histamine is an aminergic neurotransmitter involved in physiologic and pathologic processes such as pruritus, inflammation, and vascular leak. Enhanced histamine release has been observed in the skin of patients with AD and antihistamines are often prescribed for their sedating and anti-itch properties. Recent evidence suggests that histamine also inhibits the terminal differentiation of keratinocytes and impairs the skin barrier, raising the question whether histamine might play a role in AD barrier impairment. This, coupled with the notion that histamine’s effects mediated through the recently identified histamine receptor H4R, may be important in allergic inflammation, has renewed interest in this mediator in allergic diseases. In this paper we summarize the current knowledge on histamine and histamine receptor antagonists in AD and skin barrier function. PMID:26239353

  5. The role of filaggrin mutations during pregnancy and postpartum: atopic dermatitis and genital skin diseases.

    PubMed

    Bager, P; Wohlfahrt, J; Boyd, H; Thyssen, J P; Melbye, M

    2016-05-01

    Mutations in the epidermal filaggrin gene (FLG) are associated with skin barrier dysfunction (dry skin, less acidic skin, and fissured skin), and atopic dermatitis (AD) with a severe and persistent course. Because pregnancy and delivery further impairs normal skin barrier functions (immune suppression, mechanical stress), we studied the possible role of FLG mutations on the risk of AD flares, genital infections, and postpartum problems related to perineal trauma. FLG-genotyping was performed in a population-based sample of 1837 women interviewed in the 12th and 30th weeks of pregnancy and 6 months postpartum as part of the Danish National Birth Cohort study 1996-2002. We found that FLG mutations also influence pregnancy-related skin disease; thus, women with FLG mutations had an increased risk of AD flares during pregnancy (OR 10.5, 95% CI 3.6-30.5) and of enduring postpartum physical problems linked to perineal trauma during delivery (OR 11.1, 95% CI 1.1-107.7). PMID:26835886

  6. Double-blind controlled randomised study of lactulose and lignin hydrolysed combination in complex therapy of atopic dermatitis

    PubMed Central

    Perlamutrov, Yuri N.; Olhovskaya, Kira B.; Zakirova, Svetlana A.

    2016-01-01

    Background Atopic dermatitis (AD) is an immune mediated disease with complex pathogenesis characterised by persistency, frequent exacerbations, and inefficacy of existing therapies. Damaged or weakened intestinal microbiocenosis is considered as an important aetiological factor of AD. The aim of this study was to evaluate the efficacy and safety of medical preparation Lactofiltrum (lactulose and sorbent (lignin hydrolysed)) in comparison with placebo in complex with standard therapy of AD. Methods Double-blind, placebo controlled, randomised comparative study of effectiveness and safety of 400 mg lactulose and 120 mg lignin hydrolysed combination as a part of standard combined AD treatment, conducted in parallel groups of patients aged 18–60. Results Comparison of clinical efficacy of Lactofiltrum in combination with the standard treatment has been demonstrated by measuring the following parameters: administration of Lactofiltrum results in 1) distinct clinical improvement in 56.75% of patients, 2) decrease of the mean values of scoring atopic dermatitis (SCORAD) index in 71.94% of patients, 3) elimination of itching in 50% of patients, and 4) life quality improvement for 76.41%. In the placebo group, 1) distinct clinical improvement was observed in 20% of patients, 2) decrease in SCORAD index values observed by 56.98%, 3) itching relief in 15.56%, and 4) life quality improvement by 36.38%. Conclusions Clinical improvement and persistent termination of clinical symptoms provide evidence of effectiveness in use of Lactofiltrum combined with the standard treatment of AD. PMID:27341938

  7. Strong exercise stress exacerbates dermatitis in atopic model mice, NC/Nga mice, while proper exercise reduces it.

    PubMed

    Orita, Kumi; Hiramoto, Keiichi; Inoue, Risa; Sato, Eisuke F; Kobayashi, Hiromi; Ishii, Masamitsu; Inoue, Masayasu

    2010-12-01

    Atopic dermatitis is well known to exacerbate by stress. How the influence of exercise stress on the skin symptoms in patients with atopic dermatitis has not been clarified. The purpose of our research is to investigate how different strength of exercise stress acts on atopic dermatitis. Specific pathogen-free (SPF) and conventional NC/Nga male mice were used for the experiments. Conventional mice but not SPF group spontaneously develop dermal symptom similar to that of patients with atopic dermatitis at their age of 7 weeks. They were given two types of stress, mild (20 m/min for 60 min) or strong exercise (25 m/min for 90 min), using a treadmill four times per day. The dermal symptom of the conventional group was strongly exacerbated by strong exercise but ameliorated by mild exercise. Under the standard experimental conditions, plasma concentrations of α-melanocyte-stimulating hormone (α-MSH), transforming growth factor-β (TGF-β) and substance P in conventional mice increased markedly with concomitant exacerbation of the symptom. The plasma concentrations of these proteins elevated after strong exercise but decreased after mild exercise. Under the conventional conditions, plasma levels of β-endorphin increased with time by some mechanisms enhanced by the mild exercise. These observations suggested that exercise-induced stress significantly affect the symptom of atopic dermatitis in a pivotal manner depending on the plasma levels of TGF-β, α-MSH, substance P and β-endorphin. PMID:21087324

  8. Methicillin-Resistant Staphylococcus aureus Ocular Infection after Corneal Cross-Linking for Keratoconus: Potential Association with Atopic Dermatitis

    PubMed Central

    Fasciani, Romina; Agresta, Antonio; Caristia, Alice; Mosca, Luigi; Scupola, Andrea; Caporossi, Aldo

    2015-01-01

    Purpose. To report the risk of methicillin-resistant Staphylococcus aureus (MRSA) ocular infection after UVA-riboflavin corneal collagen cross-linking in a patient with atopic dermatitis. Methods. A 22-year-old man, with bilateral evolutive keratoconus and atopic dermatitis, underwent UVA-riboflavin corneal cross-linking and presented with rapidly progressive corneal abscesses and cyclitis in the treated eye five days after surgery. The patient was admitted to the hospital and treated with broad-spectrum antimicrobic therapy. Results. The patient had positive cultures for MRSA, exhibiting a strong resistance to antibiotics. Antibiotic therapy was modified and targeted accordingly. The intravitreal reaction is extinguished, but severe damage of ocular structures was unavoidable. Conclusion. Riboflavin/UVA corneal cross-linking is considered a safe procedure and is extremely effective in halting keratoconus' progression. However, this procedure is not devoid of infectious complications, due to known risk factors and/or poor patients' hygiene compliance in the postoperative period. Atopic dermatitis is a common disease among patients with keratoconus and Staphylococcus aureus colonization is commonly found in patients with atopic dermatitis. Therefore, comorbidity with atopic dermatitis should be thoroughly assessed through clinical history before surgery. A clinical evaluation within three days after surgery and the imposition of strict personal hygiene rules are strongly recommended. PMID:25866692

  9. PTPN22 polymorphisms may indicate a role for this gene in atopic dermatitis in West Highland white terriers

    PubMed Central

    2011-01-01

    Background Canine atopic dermatitis is an allergic inflammatory skin disease common in West Highland white terriers. A genome-wide association study for atopic dermatitis in a population of West Highland white terriers identified a 1.3 Mb area of association on CFA17 containing canine protein tyrosine phosphatase non-receptor type 22 (lymphoid) PTPN22. This gene is a potential candidate gene for canine atopic dermatitis as it encodes a lymphoid-specific signalling mediator that regulates T-cell and possibly B-cell activity. Findings Sequencing of PTPN22 in three atopic and three non-atopic West Highland white terriers identified 18 polymorphisms, including five genetic variants with a bioinformatically predicted functional effect. An intronic polymorphic repeat sequence variant was excluded as the cause of the genome-wide association study peak signal, by large-scale genotyping in 72 West Highland white terriers (gene-dropping simulation method, P = 0.01). Conclusions This study identified 18 genetic variants in PTPN22 that might be associated with atopic dermatitis in West Highland white terriers. This preliminary data may direct further study on the role of PTPN22 in this disease. Large scale genotyping and complementary genomic and proteomic assays would be required to assess this possibility. PMID:22208456

  10. The Clinical Efficacy, Safety and Functionality of Anion Textile in the Treatment of Atopic Dermatitis

    PubMed Central

    Kim, Sang Hyun; Hwang, Sung Hwan; Hong, Soon Kwon; Sung, Ho Suk; Park, Sung Wook; Shin, Jeong Hwan

    2012-01-01

    Background Several previous studies have suggested the improvement of atopic dermatitis (AD) in response to special fabrics. In particular, beneficial effects have been reported, following the use of anion textiles. Objective The purpose of this study is to evaluate the effectiveness and safety of an anion textile in patients suffering from AD. Methods We compared an anion textile with a pure cotton textile. Fifty-two atopic patients (n=52) were enrolled and divided into two groups. The patients in the test (n=25) and control (n=19) groups wore undergarments made of an anion textile or pure cotton over a period of 4 weeks. The overall severity of disease was evaluated using the SCORing atopic dermatitis (SCORAD) index, whereas, the treatment efficacy was measured using a Tewameter® (Courage & Khazaka, Cologne, Germany), Mexameter® (Courage & Khazaka) and Corneo meter® (Courage & Khazaka). Results At the end of the study, a significant decrease in the SCORAD index was observed among the patients with AD in the test group (mean SCORAD decreased from 47.2 to 36.1). Similarly, improvements in the mean transepidermal water loss, skin erythema and stratum corneum hydration were significantly greater among the patients with AD in the test group than in the control group. Conclusion Anion textiles may be used to significantly improve the objective and subjective symptoms of AD, and are similar in terms of comfort to cotton textiles. The use of anion textiles may be beneficial in the management of patients with AD. PMID:23197910

  11. An Analysis of the Filaggrin Gene Polymorphism in Korean Atopic Dermatitis Patients

    PubMed Central

    2016-01-01

    Research of the FLG mutation in various ethnic groups revealed non-overlapping mutation patterns. In addition, Japanese and Chinese atopic patients showed somewhat different mutations. These ethnic differences make the research on Korean patients mandatory; however, no systematic research on Korean atopic dermatitis (AD) patients has been performed. This study aims to investigate the genetic polymorphism of FLG in Korean atopic dermatitis patients. The study was made up of three groups including 9 Ichthyosis vulgaris (IV) patients, 50 AD patients and 55 normal controls: the ichthyosis group was incorporated due to the reported association between the FLG mutation and IV. In comparison to other sequencing methods, the overlapping long-range PCR was used. We revealed the genetic polymorphism of filaggrin in Koreans, and at the same time, we discovered nonsense mutations in p.Y1767X and p.K4022X in Korean AD patients. By using FLG sequencing techniques confirmed in this study, new mutations or genetic polymorphisms with ethnic characteristics would be detected and further larger studies of repeat number polymorphisms could be performed. PMID:27366014

  12. Atopic Manifestations: Dermatitis, Allergic Rhinitis and Asthma in Patients With Hypogammaglobulinemia

    PubMed Central

    Dadkhah, Minoo; Aghamohammadi, Asghar; Movahedi, Masoud; Gharagozlou, Mohammad

    2015-01-01

    Background: Most of the hypogammaglobulinemic patients have a clinical history in favor of allergic respiratory disease. Nevertheless, in these patients the importance and prevalence of atopic disorders have not been completely explained. Objectives: This study was aimed to evaluate atopic manifestations (dermatitis, allergic rhinitis and asthma) and pulmonary function in patients with hypogammaglobulinemia. Patients and Methods: We used the international study of asthma and allergies in childhood (ISAAC) questionnaire in forty-five patients diagnosed with hypogammaglobulinemia and spirometry was done in 41 patients older than 5 years. Results: Spirometry results were normal in 21 (51%), and showed obstructive in 15 (37%) and restrictive pattern in 5 (12%) of the 41 patients who were evaluated. By the end of the study, asthma was diagnosed in nine (20%) patients and other atopies (rhinitis and dermatitis) identified in 10 (22%), and four (9%), respectively. Conclusions: Atopic conditions should be investigated in the hypogammaglobulinemic patients and the prevalence in these patients may be higher than in normal population. Also, it is recommended to perform a pulmonary function test as a routine procedure in patients with hypogammaglobulinemia and atopy should be assessed in these patients. PMID:26495093

  13. A Case of IFAP Syndrome with Severe Atopic Dermatitis.

    PubMed

    Araújo, Catarina; Gonçalves-Rocha, Miguel; Resende, Cristina; Vieira, Ana Paula; Brito, Celeste

    2015-01-01

    Introduction. The IFAP syndrome is a rare X-linked genetic disorder characterized by the triad of follicular ichthyosis, atrichia, and photophobia. Case Report. A three-month-old Caucasian, male patient was observed with noncicatricial universal alopecia and persistent eczema from birth. He had dystrophic nails, spiky follicular hyperkeratosis, and photophobia which became apparent at the first year of life. Short stature and psychomotor developmental delay were also noticed. Histopathological examination of skin biopsy on left thigh showed epidermis with irregular acanthosis, lamellar orthokeratotic hyperkeratosis, and hair follicles fulfilled by parakeratotic hyperkeratosis. The chromosomal study showed a karyotype 46, XY. Total IgE was 374 IU/mL. One missense mutation c.1360G>C (p.Ala454Pro) in hemizygosity was detected on the MBTPS2 gene thus confirming the diagnosis of IFAP syndrome. Conclusions. We describe a boy with a typical clinical presentation of IFAP syndrome and severe atopic manifestations. A novel missense mutation c.1360G>C (p.Ala454Pro) in MBTPS2 gene was observed. The phenotypic expression of disease is quantitatively related to a reduced function of a key cellular regulatory system affecting cholesterol and endoplasmic reticulum homeostasis. It can cause epithelial disturbance with failure in differentiation of epidermal structures and abnormal skin permeability barrier. However, no correlation phenotype/genotype could be established. PMID:25685152

  14. Atopic dermatitis-like symptoms in HR-1 hairless mice fed a diet low in magnesium and zinc.

    PubMed

    Makiura, M; Akamatsu, H; Akita, H; Yagami, A; Shimizu, Y; Eiro, H; Kuramoto, M; Suzuki, K; Matsunaga, K

    2004-01-01

    We aimed to develop an animal model for atopic dermatitis. HR-1 hairless mice fed a diet with reduced magnesium and zinc levels were compared with mice fed a standard diet. Skin dryness and wrinkle-like changes, scratching behaviour, decreased skin water content, increased transepidermal water loss and raised blood immunoglobulin E levels were seen in the group receiving the reduced magnesium and zinc diet compared with control mice. There were no significant differences in body weight or the weight of the major organs between the two groups. Haematological examination in both groups was normal apart from increased immunoglobulin E levels in mice fed a reduced magnesium and zinc diet. These mice may be useful models of atopic dermatitis; preparation of the animals is not particularly time consuming, the reproducibility is 100%, and atopic dermatitis symptoms occur even in a specific pathogen-free environment. PMID:15303770

  15. Contagious Itch in Humans. A Study of Visual “Transmission” of Itch in Atopic Dermatitis and Healthy Subjects

    PubMed Central

    Papoiu, A.D.P.; Wang, H.; Coghill, R.C.; Chan, Y-H.; Yosipovitch, G.

    2011-01-01

    Anecdotal evidence suggests “contagious” itch occurs in daily life when we see other people itch and scratch. This phenomenon has not been systematically studied previously, and factors which can amplify itch perception were unknown. We investigated whether exposure to visual cues of itch can induce or intensify itch in healthy and atopic dermatitis subjects. Participants received histamine or a saline control delivered to the forearm and were asked to watch short video clips of people scratching. Spontaneous scratching induced by visual cues was monitored and analyzed. Atopic dermatitis patients reported a higher itch intensity and scratched more frequently while watching itch videos, even in the presence of mock itch stimuli. Human susceptibility to develop itch when exposed to visual cues is confirmed and it appears amplified in atopic dermatitis sufferers. These findings suggest that interpersonal social cues can dramatically alter the subjective sensory experience of itch. PMID:21410682

  16. Gene (mRNA) expression in canine atopic dermatitis: microarray analysis.

    PubMed

    Merryman-Simpson, Annemarie E; Wood, Shona H; Fretwell, Neale; Jones, Paul G; McLaren, William M; McEwan, Neil A; Clements, Dylan N; Carter, Stuart D; Ollier, William E; Nuttall, Tim

    2008-04-01

    Genes potentially involved in the pathology of canine atopic dermatitis (AD) were identified using gene expression microarrays. Total RNA extracted from skin biopsies was hybridized to an Agilent Technologies custom-designed 22K canine array. The arrays were analysed using Genedata Analyst software. Data were corrected for multiple hypothesis testing and tested for significance using the National Institute on Aging array analysis tool. For comparison, data were divided into separate groups: lesional atopic (n = 16), nonlesional atopic (n = 17) and healthy controls (n = 9). Fifty-four genes were differentially expressed at a significance level of 0.05 in canine AD compared to healthy controls. Sixteen genes were differentially expressed in both nonlesional and lesional atopic skin, 26 genes only in nonlesional skin and 12 only in lesional skin. These genes were associated with innate immune and inflammatory responses, cell cycle, apoptosis, barrier formation and transcriptional regulation. The most dysregulated gene in lesional skin was S100A8, which showed an almost 23-fold increase in expression. This is a pro-inflammatory cytokine located in the epidermal differentiation complex. Microarray analysis is a novel technique in canine AD. Significant changes in gene expression were identified in atopic skin. These were relevant to skin barrier formation and the immune response, suggesting that they both participate in AD. Gene expression restricted to lesional skin may be involved in inflammatory changes, whereas those shared or restricted to nonlesional skin may reflect the atopic phenotype. Investigating gene polymorphisms in the targets identified in this study will help improve our understanding of the genetic basis of this disease. PMID:18336422

  17. Efficacy of prolonged ingestion of Lactobacillus acidophilus L-92 in adult patients with atopic dermatitis.

    PubMed

    Yamamoto, Kozo; Yokoyama, Kazuhito; Matsukawa, Takehisa; Kato, Sayaka; Kato, Shinji; Yamada, Kazuhisa; Hirota, Tatsuhiko

    2016-07-01

    To evaluate the safety and efficacy of prolonged ingestion of Lactobacillus acidophilus L-92 (L-92) on skin symptoms in adult atopic dermatitis (AD) patients, a placebo-controlled double-blinded parallel-group comparison study was performed. This included daily administration of heat-killed and dried L-92 or placebo for 24wk in 50 AD patients who were 16yr old or older. The severity of skin symptoms was evaluated at baseline and at 4, 8, 12, 16, 20, and 24wk during the intervention using the investigator global assessment, eczema area and severity index, and scoring atopic dermatitis. Serum cytokine and blood marker levels were also measured at baseline and at 4, 8, 16, and 24wk during the intervention. No adverse events were reported during the study period. Compared with the placebo group, the L-92 group showed significant decreases in investigator global assessment, eczema area and severity index, and scoring atopic dermatitis. Subjective symptoms in adult AD patients were reduced by intake of L-92. Furthermore, it was suggested that sustained ingestion of L-92 resulted in suppression of scratching behavior and maintenance of remission status of skin symptoms. Sixteen weeks after the study commenced, a significant decrease in lactate dehydrogenase and a significant increase in transforming growth factor-β were observed in the L-92 group compared with the placebo group. In the L-92 group, a significant elevation of IL-12 (p70) level at the end of treatment period compared with before the treatment was observed. This study suggested that L-92 suppresses type-2-helper-T-cell-dominant inflammation by activating regulatory T cells and type 1 helper T cells. PMID:27108169

  18. Atopic Dermatitis: A Cross-Sectional (Descriptive) Study of 100 Cases

    PubMed Central

    Sehgal, Virendra N; Srivastava, Govind; Aggarwal, Ashok K; Saxena, Deepti; Chatterjee, Kingshuk; Khurana, Ananta

    2015-01-01

    Background: Atopic dermatitis is a distinct age-related clinical entity. Its etiopathogenesis is largely insubstantial. Nevertheless, it seems to be an outcome of interplay of maternal and inheritance, pregnancy/intrauterine and environmental factors. Besides, immune dysregulation, and nutritional supplements also play essential roles. Its diagnosis has been perpetuated by three or more major/minor criteria. Objectives: An endeavor to study its demographic and clinical pattern in contemporary prospective. Materials and Methods: 100 fresh patients of atopic dermatitis, diagnosed on the basis of an established three or more major and minor criteria, salient presentations of which were recorded in a preset proforma, which also recorded age, duration, age of onset, and sex. Serum immunoglobulin E (IgE) levels were determined by conventional technique. The data thus obtained was analysed to study its clinical pattern and to correlate its severity to IgE levels. Results: Its overall (new and old) prevalence was 0.98%, while that of new patients was 0.24%. 83 (83%) were in the age group of 2-12 years, of which 54 (83.1%) were males and 29 (82.9%) were female, of which 70 (70%) had urban, while 30 (30%) had rural background. Its duration varied from 8 to 192 weeks, with a mean of 76 weeks, and a standard deviation of 21.42 weeks [76 ± 21.42]. Conclusion: Atopic dermatitis is a discrete, overt, age and IgE-related entity frequently displaying varying demographic and clinical connotation. PMID:26538716

  19. Association between polymorphisms in the SPINK5 gene and atopic dermatitis in the Japanese.

    PubMed

    Nishio, Y; Noguchi, E; Shibasaki, M; Kamioka, M; Ichikawa, E; Ichikawa, K; Umebayashi, Y; Otsuka, F; Arinami, T

    2003-10-01

    Atopy, which is characterized by increased levels of immunoglobulin E (IgE) against common environmental allergens, is considered the strongest predisposing factor for asthma and atopic dermatitis (AD). Mutations in the gene encoding serine protease inhibitor Kazal-type 5 (SPINK5) are responsible for Netherton syndrome, a rare skin disorder characterized by greatly elevated IgE levels with atopic manifestations. A recent study of Caucasian AD families showed that maternally derived alleles of the SPINK5 gene are associated with development of AD and asthma, suggesting the parent-of-origin effect for the development of atopic diseases in the SPINK5 gene. We studied the possible association of the SPINK5 gene for the development of atopic diseases by determining the genotypes of five polymorphisms in a Japanese population. Ttransmission disequilibrium tests revealed an association of SPINK5 polymorphisms with AD but not with asthma. Our data indicate that the SPINK5 gene is associated with AD across ethnicities. PMID:14551605

  20. Clinical comparison of human and canine atopic dermatitis using human diagnostic criteria (Japanese Dermatological Association, 2009): proposal of provisional diagnostic criteria for canine atopic dermatitis.

    PubMed

    Terada, Yuri; Nagata, Masahiko; Murayama, Nobuo; Nanko, Hiroko; Furue, Masutaka

    2011-08-01

    Atopic dermatitis (AD) is a common skin disease encountered in both humans and dogs. Canine AD can be used in the analysis of naturally occurring AD; however, details of clinical comparison have been lacking. The purpose of this study is to compare those clinical features using the human diagnostic criteria (Japanese Dermatological Association, 2009). Fifty-one dogs with canine AD were evaluated by the human criteria. Prior to this study, canine AD was basically diagnosed by the fulfillment of two authentic canine AD criteria and a positive reaction against Dermatophagoides farinae in serum immunoglobulin E levels and/or in intradermal tests. Among the human AD criteria items, behavior corresponding to pruritus was observed in all 51 dogs. Skin lesions corresponding to eczematous dermatitis were seen in 50 dogs, and symmetrical distribution of skin lesions was noted in all 51 dogs. A chronic or chronically relapsing course was observed in 50 dogs. Based on these results, the concordance rate for the criteria was 96% (49/51). Differential diagnoses of AD were also investigated in the same manner. The concordance rate for the criteria was 0% (0/69) in scabies, 2% (1/50) in pyoderma, 0% (0/50) in demodicosis, 0% (0/9) in cutaneous lymphoma, 0% (0/2) in ichthyosis, 25% (2/7) in flea allergy, 48% (24/50) in seborrheic dermatitis and 75% (3/4) in food allergy. Canine AD is thus indicated as a valuable counterpart to human AD in clinical aspects. In addition, the human AD criteria could be applicable, with some modification, as provisional diagnostic criteria for canine AD. PMID:21434981

  1. Efficacy versus systemic effects of six topical steroids in the treatment of atopic dermatitis of childhood.

    PubMed

    Queille, C; Pommarede, R; Saurat, J H

    1984-01-01

    Six groups of children suffering from widespread atopic dermatitis were treated once daily with six topical steroids of different potency. Systemic effects were measured by the morning estimation of plasma cortisol. A clear relationship was demonstrated between clinical efficacy of the steroid treatment and degree of reduced adrenal function. This study demonstrated that a rapid and marked therapeutic effect can be obtained with potent topical steroids applied once daily without occlusion, but in children is accompanied by a fall in plasma cortisol. PMID:6494068

  2. Netherton syndrome: report of identical twins presenting with severe atopic dermatitis.

    PubMed

    Kilic, Gurkan; Guler, Nermin; Ones, Ulker; Tamay, Zeynep; Guzel, Pinar

    2006-09-01

    We report the cases of 4-year-old identical twin sisters who presented with severe atopic dermatitis with intractable skin manifestations and multiple food allergies. Netherton syndrome (NS) (OMIM 256500) was suspected due to very high serum IgE levels, growth retardation, severe food allergies and typical hair finding (trichorrhexis invaginata). A definite diagnosis was made by genetic analysis. Our cases are unique in being the first identical twins with NS diagnosed by a novel mutation in the SPINK5 gene. NS should be considered in differential diagnosis in children who have generalized erythema with intractable eczematous lesions and elevated levels of IgE. PMID:16670861

  3. Serum immunoglobulin E concentrations and radioallergosorbent tests in children with atopic dermatitis.

    PubMed

    Church, J A; Kleban, D G; Bellanti, J A

    1976-02-01

    Serum IgE concentrations and the presence of allergen-specific IgE were determined in a series of 23 children with atopic dermatitis. In this group 83% had significantly elevated serum levels of IgE, 91% had coexistent respiratory allergy, 70% had radioallergosorbent test (RAST) evidence of pollen hypersensitivity, and 43% gave a history and demonstrated a RAST score consistent with milk or egg hypersensitivity. In patients with eczema a significant proportion of the elevated serum IgE appears to be antigen specific. PMID:54897

  4. Basis for the barrier abnormality in atopic dermatitis: Outside-inside-outside pathogenic mechanisms

    PubMed Central

    Elias, Peter M.; Hatano, Yutaka; Williams, Mary L.

    2009-01-01

    Until quite recently, the pathogenesis of atopic dermatitis (AD) has been attributed to primary abnormalities of the immune system. Intensive study revealed the key roles played by TH1/TH2 cell dysregulation, IgE production, mast cell hyperactivity, and dendritic cell signaling in the evolution of the chronic, pruritic, inflammatory dermatosis that characterizes AD. Accordingly, current therapy has been largely directed toward ameliorating TH2-mediated inflammation and pruritus. In this review we will assess emerging evidence that inflammation in AD results from inherited and acquired insults to the barrier and the therapeutic implications of this paradigm. PMID:18329087

  5. Modulation of experimental atopic dermatitis by topical application of Gami-Cheongyeul-Sodok-Eum

    PubMed Central

    2013-01-01

    Background Gami-Cheongyeul-Sodok-Eum (GCSE), an herbal formula of traditional Korean medicine, comprises nine herb components. GCSE has various biological activities such as anti-inflammatory, anti-bacterial and anti-viral activities. However, it is still unclear whether GCSE has any immunomodulatory effect on atopic dermatitis (AD). Methods GCSE was treated to primary B cells and CD4+ T cells isolated from atopic mice to compare its inhibitory effects on IgE secretion and cytokine expression. Experimental AD was established by alternative treatment of 2, 4-dinitrochlorobenzene (DNCB) and house dust mite extract to the ears of BALB/c mice. GCSE was topically applied to ears of atopic mice every day for 3 weeks. AD progression was analyzed by measuring ear thickness, serum IgE level, histological examination of ear tissue by H&E staining and cytokine profile of CD4+ T cells and CD19+ B cells by real time PCR and ELISA. Results Treatment of GCSE significantly reduced IgE production and expression of AD associated pathogenic cytokines such as IL-4, IL-5, IL-10, IL-13, IL-17, TNF-α, and IFN-γ by lymphocytes isolated from AD-induced mice. Topical application of GCSE on the ears of AD-induced mice significantly reduced ear thickness, clinical score and lymphocytes infiltration to ears as compared to control group. GCSE treatment also reduced serum IgE level and the levels of major pathogenic cytokines such as IL-4, IL-5, IL-10, IL-13 and IL-17. In addition, GCSE treatment significantly increased Foxp3 expression level. Conclusions The protective effect of GCSE in experimental AD is mediated by inhibition of IgE production, by reduction in the levels of pathogenic cytokines and by induction of Foxp3, all of which are suggesting the beneficial effect of GCSE on modulating atopic dermatitis. PMID:24499290

  6. Therapeutic Effects and Immunomodulation of Suanbo Mineral Water Therapy in a Murine Model of Atopic Dermatitis

    PubMed Central

    Choi, Yoon Jung; Lee, Hye Jin; Lee, Do Hyun; Woo, So Youn; Lee, Kyung Ho; Yun, Seong Taek; Kim, Jong Moon; Kim, Hong Jig

    2013-01-01

    Background Balneotherapy is widely used as an alternative treatment modality for AD. Although the clinical benefit of some mineral waters has been established, their mechanisms of action in alleviating AD are only partly understood. Objective The clinical modification and immunomodulatory or anti-inflammatory effects of mineral water from the Suanbo hot springs on the differentiation and cytokine production of Th1, Th2, and regulatory T cells (Treg) were investigated using spleen, skin tissue, and serum from NC/Nga mice. Methods The therapeutic effects of bathing in mineral water in a Dermatophagoides farinae body extract ointment (Dfb ointment)-induced AD mouse model were assessed by measuring the modified Scoring atopic dermatitis (SCORAD) index scores, transepidermal water loss (TEWL), histological and immunohistochemical changes of the skin lesion, serum levels of interferon (IFN)-γ, interleukin (IL)-4, IL-5 and immunoglobulin E, mRNA expression of IFN-γ, IL-4 and IL-5 of dorsal skin, and helper T cell differentiation in the spleen. Results Bathing in mineral water significantly reduced the modified SCORAD index scores, TEWL, epidermal hyperplasia, and inflammatory cell infiltration. IL-4 production and Th2 cell differentiation showed a decreasing tendency with mineral water bathing, but the Th1 cells did not. On the contrary, differentiation to Treg cells was promoted with mineral water bathing. Conclusion Balneotherapy not only has anti-inflammatory activity, but also shows positive effects on cutaneous barrier homeostasis. These results suggest that the favorable effects of balneotherapy may be mediated by modifying the Th2 response, and possibly in part by inducing Treg cell differentiation. PMID:24371394

  7. HPV16-E7 Expression in skin induces TSLP secretion, type 2 ILC infiltration and atopic dermatitis-like lesions

    PubMed Central

    Bergot, Anne-Sophie; Monnet, Nastasia; Tran, Le Son; Mittal, Deepak; Al-Kouba, Jane; Steptoe, Raymond J.; Grimbaldeston, Michele A.; Frazer, Ian H.; Wells, James W.

    2014-01-01

    Atopic dermatitis is a common pruritic and inflammatory skin disorder with unknown etiology. Most commonly occurring during early childhood, atopic dermatitis is associated with eczematous lesions and lichenification, in which the epidermis becomes hypertrophied resulting in thickening of the skin. In this study, we report an atopic dermatitis-like pathophysiology results in a murine model following the expression of the high-risk Human Papillomavirus (HPV) 16 oncoprotein E7 in keratinocytes under the Keratin 14 promoter. We show that HPV 16 E7 expression in the skin is associated with skin thickening, acanthosis and light spongiosis. Locally, HPV 16 E7 expressing skin secreted high levels of TSLP and contained increased numbers of ILCs. High levels of circulating IgE were associated with increased susceptibility to skin allergy in a model of cutaneous challenge, and to airway bronchiolar inflammation, enhanced airway goblet cell metaplasia and mucus production in a model of atopic march. Surprisingly, skin pathology occurred independently of T-cells and mast cells. Thus, our findings suggest that the expression of a single HPV oncogene in the skin can drive the onset of atopic dermatitis-like pathology through the induction of TSLP and type 2 ILC infiltration. PMID:25601274

  8. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema.

    PubMed

    Lewis-Jones, S

    2006-08-01

    The misery of living with atopic eczema (syn. dermatitis, AD) cannot be overstated for it may have a profoundly negative effect on the health-related quality of life (HRQoL) of children and their family unit in many cases. As it is one of the commonest chronic relapsing childhood dermatosis (UK lifetime prevalence 16-20% by 20 years), with increasing worldwide prevalence, this has major social and financial implications for individuals, healthcare providers and society as a whole. This review explores the impact of AD on the lives of children and their family units and the use of some of the recently developed HRQoL measures, which have enabled investigation and categorisation of the physical, psychological and psycho-social effects of childhood eczema across all aspects of life. These effects include symptoms of itching and soreness, which cause sleeplessness in over 60%. Sleep deprivation leads to tiredness, mood changes and impaired psychosocial functioning of the child and family, particularly at school and work. Embarrassment, comments, teasing and bullying frequently cause social isolation and may lead to depression or school avoidance. The child's lifestyle is often limited, particularly in respect to clothing, holidays, staying with friends, owning pets, swimming or the ability to play or do sports. Restriction of normal family life, difficulties with complicated treatment regimes and increased work in caring for a child with eczema lead to parental exhaustion and feelings of hopelessness, guilt, anger and depression. The hidden costs involved in eczema management can be significant and have particular impact on lower income families. The impairment of quality of life caused by childhood eczema has been shown to be greater than or equal to other common childhood diseases such as asthma and diabetes, emphasising the importance of eczema as a major chronic childhood disease. HRQoL measures are proving to be valuable tools for use in the clinical setting, as

  9. Allergen-Specific Immunotherapy with Monomeric Allergoid in a Mouse Model of Atopic Dermatitis

    PubMed Central

    Babakhin, Alexander; Andreev, Sergey; Nikonova, Alexandra; Shilovsky, Igor; Buzuk, Andrey; Elisyutina, Olga; Fedenko, Elena; Khaitov, Musa

    2015-01-01

    Atopic dermatitis (AD) is a widespread and difficult to treat allergic skin disease and is a tough challenge for healthcare. In this study, we investigated whether allergen-specific immunotherapy (ASIT) with a monomeric allergoid obtained by succinylation of ovalbumin (sOVA) is effective in a mouse model of atopic dermatitis. An experimental model of AD was reproduced by epicutaneous sensitization with ovalbumin (OVA). ASIT was performed with subcutaneous (SC) administration of increasing doses of OVA or sOVA. The levels of anti-OVA antibodies, as well as cytokines, were detected by ELISA. Skin samples from patch areas were taken for histologic examination. ASIT with either OVA or sOVA resulted in a reduction of both the anti-OVA IgE level and the IgG1/IgG2a ratio. Moreover, ASIT with sOVA increased the IFN-γ level in supernatants after splenocyte stimulation with OVA. Histologic analysis of skin samples from the sites of allergen application showed that ASIT improved the histologic picture by decreasing allergic inflammation in comparison with untreated mice. These data suggest that ASIT with a succinylated allergen represents promising approach for the treatment of AD. PMID:26275152

  10. Stress evaluation in adult patients with atopic dermatitis using salivary cortisol.

    PubMed

    Mizawa, Megumi; Yamaguchi, Masaki; Ueda, Chieko; Makino, Teruhiko; Shimizu, Tadamichi

    2013-01-01

    The symptoms of atopic dermatitis (AD) are often aggravated by stress, and AD can also lead to psychological stress due to social isolation and discrimination. The salivary cortisol level reflects psychological stress, and it is a good index to assess chronic stress. In this study, we measured the salivary cortisol levels in patients with AD (n = 30) and compared them with those of healthy control subjects (n = 42). AD patients were also evaluated for general disease severity using the Scoring Atopic Dermatitis (SCORAD) index. The serum levels of TARC, total IgE, and lactate dehydrogenase (LDH) and peripheral blood eosinophil counts were measured by laboratory tests. The Skindex-16 was used as a skin disease-specific, quality of life measure, instrument. The results showed that the saliva cortisol level was significantly higher in AD patients compared to healthy subjects (P < 0.01). The salivary cortisol level was significantly correlated with the SCORAD index (r = 0.42, P < 0.05) while the serum TARC and LDH levels were positively correlated with the SCORAD index. However, no statistically significant correlations were observed between the salivary cortisol level and Skindex-16. These results suggest that the saliva cortisol level is therefore a useful biomarker to evaluate the stress in AD patients. PMID:23971022