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Deleuran M, Thaçi D, Beck LA, de Bruin-Weller M, Blauvelt A, Forman S, Bissonnette R, Reich K, Soong W, Hussain I, Foley P, Hide M, Bouaziz JD, Gelfand JM, Sher L, Schuttelaar MLA, Wang C, Chen Z, Akinlade B, Gadkari A, Eckert L, Davis JD, Rajadhyaksha M, Staudinger H, Graham NMH, Pirozzi G, Ardeleanu M. Dupilumab shows long-term safety and efficacy in patients with moderate to severe atopic dermatitis enrolled in a phase 3 open-label extension study. J Am Acad Dermatol 2019; 82:377-388. [PMID: 31374300 DOI: 10.1016/j.jaad.2019.07.074] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Significant unmet need exists for long-term treatment of moderate to severe atopic dermatitis (AD). OBJECTIVE To assess the long-term safety and efficacy of dupilumab in patients with AD. METHODS This ongoing, multicenter, open-label extension study (NCT01949311) evaluated long-term dupilumab treatment in adults who had previously participated in phase 1 through 3 clinical trials of dupilumab for AD. This analysis examined patients given 300 mg dupilumab weekly for up to 76 weeks at data cutoff (April 2016). Safety was the primary outcome; efficacy was also evaluated. RESULTS Of 1491 enrolled patients (1042.9 patient-years), 92.9% were receiving treatment at cutoff. The safety profile was consistent with previously reported trials (420.4 adverse events/100 patient-years and 8.5 serious adverse events/100 patient-years), with no new safety signals; common adverse events included nasopharyngitis, conjunctivitis, and injection-site reactions. Sustained improvement was seen up to 76 weeks in all efficacy outcomes, including measures of skin inflammation, pruritus, and quality of life. LIMITATIONS Lack of control arm, limited number of patients with 76 weeks or longer of treatment (median follow-up, 24 weeks), and patients not receiving the approved dose regimen of 300 mg every 2 weeks. CONCLUSION The safety and efficacy profile from this study supports the role of dupilumab as continuous long-term treatment for patients with moderate to severe AD.
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Affiliation(s)
| | | | - Lisa A Beck
- University of Rochester Medical Center, Rochester, New York
| | | | | | - Seth Forman
- Forman Dermatology and Skin Cancer Institute, Tampa, Florida
| | | | - Kristian Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Skinflammation Center, Hamburg, Germany; Dermatologikum Berlin, Berlin, Germany
| | - Weily Soong
- Alabama Allergy & Asthma Center, Birmingham, Alabama
| | - Iftikhar Hussain
- Vital Prospects Clinical Research Institute, PC, Tulsa, Oklahoma
| | - Peter Foley
- University of Melbourne, Skin & Cancer Foundation, Inc., Carlton, Australia
| | | | | | | | - Lawrence Sher
- Peninsula Research Associates, Rolling Hills Estates, California
| | - Marie L A Schuttelaar
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Chen Wang
- Regeneron Pharmaceuticals, Inc., Basking Ridge, New Jersey
| | - Zhen Chen
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | | | | | | | - John D Davis
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
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Vermeulen FM, Gerbens LAA, Bosma AL, Apfelbacher CJ, Irvine AD, Arents BWM, Barbarot S, Deleuran M, Eichenfield LF, Manca A, Schmitt J, Vestergaard C, Wall D, Weidinger S, Middelkamp-Hup MA, Spuls PI, Flohr C. TREatment of ATopic eczema (TREAT) Registry Taskforce: consensus on how and when to measure the core dataset for atopic eczema treatment research registries. Br J Dermatol 2019; 181:492-504. [PMID: 30719709 PMCID: PMC6771812 DOI: 10.1111/bjd.17715] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/25/2023]
Abstract
Background Comparative, real‐life and long‐term evidence on the effectiveness and safety of phototherapy and systemic therapy in moderate‐to‐severe atopic eczema (AE) is limited. Such data must come from well‐designed prospective patient registries. Standardization of data collection is needed for direct comparisons and data pooling. Objectives To reach a consensus on how and when to measure the previously defined domain items of the TREatment of ATopic eczema (TREAT) Registry Taskforce core dataset for research registries for paediatric and adult patients with AE. Methods Proposals for the measurement instruments were based on recommendations of the Harmonising Outcome Measures for Eczema (HOME) initiative, the existing AE database of TREATgermany, systematic reviews of the literature and expert opinions. The proposals were discussed at three face‐to‐face consensus meetings, one teleconference and via e‐mail. The frequency of follow‐up visits was determined by an expert survey. Results A total of 16 experts from seven countries participated in the ‘how to measure’ consensus process and 12 external experts were consulted. A consensus was reached for all domain items on how they should be measured by assigning measurement instruments. A minimum follow‐up frequency of initially 4 weeks after commencing treatment, then every 3 months while on treatment and every 6 months while off treatment was defined. Conclusions This core dataset for national AE research registries will aid in the comparability and pooling of data across centres and country borders, and enables international collaboration to assess the long‐term effectiveness and safety of phototherapy and systemic therapy used in patients with AE. What's already known about this topic? Comparable, real‐life and long‐term data on the effectiveness and safety of phototherapy and systemic therapy in patients with atopic eczema (AE) are needed. There is a high diversity of outcomes and instruments used in AE research, which require harmonization to enhance comparability and allow data pooling.
What does this study add? Our taskforce has reached international consensus on how and when to measure core domain items for national AE research registries. This core dataset is now available for use by researchers worldwide and will aid in the collection of unified data.
What are the clinical implications of this work? The data collected through this core dataset will help to gain better insights into the long‐term effectiveness and safety of phototherapy and systemic therapy in AE and will provide important information for clinical practice. Standardization of such data collection at the national level will also allow direct data comparisons and pooling across country borders (e.g. in the analysis of treatment‐related adverse events that require large patient numbers).
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Affiliation(s)
- F M Vermeulen
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - L A A Gerbens
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - A L Bosma
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - A D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - B W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | - M Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, CA, U.S.A
| | - A Manca
- Centre for Health Economics, University of York, York, U.K
| | - J Schmitt
- Centre for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.,University Allergy Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - D Wall
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Irish Skin Foundation, Dublin, Ireland
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M A Middelkamp-Hup
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - P I Spuls
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
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Väkevä L, Niemelä S, Lauha M, Pasternack R, Hannuksela‐Svahn A, Hjerppe A, Joensuu A, Soronen M, Ylianttila L, Pastila R, Kautiainen H, Snellman E, Grönroos M, Karppinen T. Narrowband ultraviolet B phototherapy improves quality of life of psoriasis and atopic dermatitis patients up to 3 months: Results from an observational multicenter study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:332-338. [DOI: 10.1111/phpp.12479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Liisa Väkevä
- Skin and Allergy Hospital Helsinki University Central Hospital Helsinki Finland
| | - Sirkka Niemelä
- Department of Dermatology Turku University Hospital Turku Finland
| | - Meri Lauha
- Department of Dermatology Tampere University Hospital Tampere Finland
| | - Rafael Pasternack
- Department of Dermatology Tampere University Hospital Tampere Finland
| | | | - Anna Hjerppe
- Department of Dermatology Satakunta Central Hospital Pori Finland
| | - Adrienn Joensuu
- Department of Dermatology Kuopio University Hospital Kuopio Finland
| | - Minna Soronen
- Department of Dermatology Oulu University Hospital Oulu Finland
| | | | | | - Hannu Kautiainen
- Unit of Primary Health Care Helsinki University Central Hospital Helsinki Finland
- Unit of Primary Health Care Kuopio University Hospital Kuopio Finland
| | - Erna Snellman
- Department of Dermatology Tampere University Hospital Tampere Finland
- Medical School University of Tampere Tampere Finland
| | - Mari Grönroos
- Department of Dermatology Päijät‐Häme Central Hospital Lahti Finland
| | - Toni Karppinen
- Department of Dermatology Tampere University Hospital Tampere Finland
- Medical School University of Tampere Tampere Finland
- Department of Dermatology Päijät‐Häme Central Hospital Lahti Finland
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Aoki V, Lorenzini D, Orfali RL, Zaniboni MC, de Oliveira ZNP, Rivitti-Machado MC, Takaoka R, Weber MB, Cestari T, Gontijo B, Ramos AMC, Silva CMDR, Cestari SDCP, Souto-Mayor S, Carneiro FR, de Cerqueira AMM, Laczynski C, Pires MC. Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:67-75. [PMID: 31166406 PMCID: PMC6544038 DOI: 10.1590/abd1806-4841.2019940210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/13/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.
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Affiliation(s)
- Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de
São Paulo, São Paulo (SP), Brazil
| | - Daniel Lorenzini
- Dermatology Service, Irmandade Santa Casa de Misericórdia de
Porto Alegre, Porto Alegre (RS), Brazil
| | - Raquel Leão Orfali
- Department of Dermatology, Faculdade de Medicina, Universidade de
São Paulo, São Paulo (SP), Brazil
| | | | | | | | - Roberto Takaoka
- Department of Dermatology, Faculdade de Medicina, Universidade de
São Paulo, São Paulo (SP), Brazil
| | - Magda Blessmann Weber
- Dermatology Service, Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre (RS), Brazil
| | - Tania Cestari
- Dermatology Service, Hospital de Clínicas de Porto Alegre,
Universidade Federal do Rio Grande do Sul, Porto Alegre (RS), Brazil
| | - Bernardo Gontijo
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Andrea Machado Coelho Ramos
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | | | | | - Silvia Souto-Mayor
- Clinic of Dermatology, Department of Medicine, Faculdade de
Medicina da Santa Casa de São Paulo, São Paulo (SP), Brazil
| | | | | | - Cristina Laczynski
- Dermatology Outpatient Clinic, Discipline of Dermatology,
Faculdade de Medicina do ABC, Santo André (SP), Brazil
| | - Mario Cezar Pires
- Dermatology Service, Hospital do Servidor Público Estadual,
São Paulo (SP), Brazil
- Dermatology Service, Complexo Hospitalar Padre Bento, Guarulhos
(SP), Brazil
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Droitcourt C, Barbarot S, Maruani A, Darrieux L, Misery L, Brenaut E, Adamski H, Chabbert C, Vermersch A, Weiborn M, Seneschal J, Taïeb A, Plantin P, Maillard H, Phan A, Skowron F, Viguier M, Staumont-Salle D, Nosbaum A, Soria A, Barbaud A, Oger E, Dupuy A. A new phototherapy regimen during winter as an add-on therapy, coupled with oral vitamin D supplementation, for the long-term control of atopic dermatitis: study protocol for a multicentre, randomized, crossover, pragmatic trial - the PRADA trial. Trials 2019; 20:184. [PMID: 30909923 PMCID: PMC6434814 DOI: 10.1186/s13063-019-3276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/01/2019] [Indexed: 12/05/2022] Open
Abstract
Background Atopic dermatitis is a highly prevalent, chronic, relapsing disease in both adults and children. On the severity spectrum, lower-end patients benefit from small amounts of topical anti-inflammatory treatments (TAT), whereas higher-end patients need systemic immunosuppressants; in-between patients are treated with TAT and phototherapy. The major therapeutic challenge in this population is the long-term control of disease activity, and the current TAT-based pro-active strategy does not meet all their needs. Immunosuppressants are used as long-term control add-on treatments, but they are restricted to the most severely affected patients because of safety concerns. In addition, neither immunosuppressants nor other strategies have been properly evaluated in the long term despite long-term control having been acknowledged as one of the most important core outcome domains to be targeted in atopic dermatitis trials. Safe add-on therapies, rigorously evaluated for long-term control of the disease, are therefore needed. Phototherapy and vitamin D supplementation are both good candidates. Methods This is a multicenter, national, randomized, superiority, crossover trial testing add-on phototherapy (one winter under spaced sessions of phototherapy and one winter under observation) among subjects receiving standard care (i.e., TAT). On the same population, we will test the long-term control provided by oral supplementation of vitamin D versus placebo in a randomized, superiority, double-blind, parallel-group trial. The primary outcomes are (1) repeat measures of the PO-SCORAD severity score over 1 year and (2) cumulate consumption of TAT (number of tubes) during the winter. They will be tested following a hierarchical testing procedure. The secondary outcomes will be measures repeated over 2 years of investigator-based severity scores, patient-reported severity and quality of life scores, serum vitamin D levels, weeks during which the disease is well-controlled, inter-visit cumulate consumption of TAT, and synthetic patient-reported satisfaction at the end of each winter. Discussion This study includes two separate 2-year pragmatic trials designed to evaluate the efficacy of vitamin D supplementation and pro-active phototherapy for primary care atopic dermatitis patients receiving TAT on long-term control of disease activity. The experimental design enables the study of both interventions and exploration of the interaction between vitamin D and phototherapy. A pragmatic trial is particularly suited to the assessment of long-term control. This study explores the possibility of new and safe therapeutic strategies for the control of long-term atopic dermatitis, and is an example of efficacy research that is unlikely to be sponsored by industrialists. A potentially effective low-cost therapeutic strategy for long-term control is essential for patients and public health. Trial registration ClinicalTrials.gov Identifier: NCT02537509, first received: 1 September 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3276-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Droitcourt
- Univ Rennes, Rennes, France. .,Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France. .,INSERM, CIC 1414, 35000, Rennes, France. .,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France.
| | - Sébastien Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000, Nantes, France
| | - Annabel Maruani
- Department of Dermatology, University Hospital Center of Tours, 37000, Tours, France
| | - Laure Darrieux
- Department of Dermatology, Hospital Center of Saint-Brieuc, 22000, Saint-Brieuc, France
| | - Laurent Misery
- Department of Dermatology, University Hospital Center of Brest, 29000, Brest, France
| | - Emilie Brenaut
- Department of Dermatology, University Hospital Center of Brest, 29000, Brest, France
| | - Henri Adamski
- Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France
| | - Cécile Chabbert
- Department of Dermatology, Hospital Center of Perigueux, 24000, Perigueux, France
| | - Annie Vermersch
- Department of Dermatology, Hospital Center of Valenciennes, 62000, Valenciennes, France
| | - Marie Weiborn
- Department of Dermatology, Hospital Center of Valenciennes, 62000, Valenciennes, France
| | - Julien Seneschal
- Department of Dermatology, University Hospital Center of Bordeaux, 33000, Bordeaux, France
| | - Alain Taïeb
- Department of Dermatology, University Hospital Center of Bordeaux, 33000, Bordeaux, France
| | - Patrice Plantin
- Department of Dermatology, Hospital Center of Quimper, 29000, Quimper, France
| | - Hervé Maillard
- Department of Dermatology, Hospital Center of Le Mans, 72000, Angers, France
| | - Alice Phan
- Department of Dermatology, University Hospital Center of Lyon, 69000, Lyon-Bron, France
| | - François Skowron
- Department of Dermatology, Hospital Center of Valence, 26000, Valence, France
| | - Manuelle Viguier
- Department of Dermatology, University Hospital Center of Reims, 51000, Reims, France
| | | | - Audrey Nosbaum
- Department of Dermatology, University Hospital Center of Lyon, 69000, Lyon Sud, France
| | - Angèle Soria
- Department of Dermatology and Allergology, University Hospital Center of Paris-Tenon, 75020, Paris, France
| | - Annick Barbaud
- Department of Dermatology and Allergology, University Hospital Center of Paris-Tenon, 75020, Paris, France
| | - Emmanuel Oger
- Univ Rennes, Rennes, France.,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France
| | - Alain Dupuy
- Univ Rennes, Rennes, France.,Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France.,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France
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Johnson BB, Franco AI, Beck LA, Prezzano JC. Treatment-resistant atopic dermatitis: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:181-192. [PMID: 30962700 PMCID: PMC6432884 DOI: 10.2147/ccid.s163814] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic, relapsing-remitting inflammatory disease that can be challenging to treat. Patients with mild disease are usually managed well with good skin care practices including moisturization and appropriate bathing along with intermittent use of topical therapies such as topical corticosteroids and/or topical calcineurin inhibitors during flares. Patients with frequent flares may benefit from proactive application of topical therapies twice a week to the most troublesome areas. Patients with severe disease often present significant treatment challenges. Systemic therapies are usually required for severe AD but have varying degrees of success and can be associated with side-effect profiles that require counseling and close monitoring. Phototherapy has been shown to have success in treating moderate-to-severe AD, but several factors can limit its utility and efficacy including cost and access. New therapies are in development targeting specific pathways relevant for AD. Dupilumab was the first biologic treatment approved in North America, Europe, and Japan for adults with moderate-to-severe AD. Although this treatment can lead to rapid improvement in the majority of patients, there are inadequate responders. In this review, we discuss the clinical challenges and treatment options for moderate-to-severe refractory AD.
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Affiliation(s)
- Brian B Johnson
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
| | - Abigail I Franco
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
| | - James C Prezzano
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14642, USA,
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Efficacy and safety of dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults: A pooled analysis of two phase 2 clinical trials. J Am Assoc Nurse Pract 2019; 30:529-541. [PMID: 30211823 DOI: 10.1097/jxx.0000000000000088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE There is a need for new treatment options for moderate-to-severe atopic dermatitis (AD) in adults. Dupilumab, a fully human anti-interleukin-4 receptor α monoclonal antibody, has recently been approved for this indication. METHODS A pooled analysis of a phase 2a (NCT01548404) and a phase 2b (NCT01859988) study and a subanalysis of the 2b study evaluated the efficacy and safety of subcutaneous dupilumab 300 mg once weekly (qw) and every 2 weeks (q2w) in adults with moderate-to-severe AD. RESULTS Dupilumab significantly improved clinical outcomes in both analyses at week 12. Itch was significantly improved in the pooled analysis as measured by peak pruritus Numerical Rating Scale, 5-dimension pruritus scale, and SCORing Atopic Dermatitis (SCORAD) Visual Analog Scale (VAS) pruritus scores (all p < .0001 vs. placebo at week 12). Sleep loss was significantly improved (SCORAD VAS sleep loss score; p < .0001 vs. placebo at week 12); similar results were shown for the q2w dose. Dupilumab had an acceptable safety profile. CONCLUSIONS Consistent with previous studies, dupilumab qw and q2w significantly improved signs and symptoms of AD at week 12, including improvements in itch and sleep loss. IMPLICATIONS FOR PRACTICE Subcutaneous dupilumab is an effective new treatment option for adults with moderate-to-severe AD.
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Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, Gieler U, Girolomoni G, Lau S, Muraro A, Czarnecka-Operacz M, Schäfer T, Schmid-Grendelmeier P, Simon D, Szalai Z, Szepietowski JC, Taïeb A, Torrelo A, Werfel T, Ring J. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 2018; 32:657-682. [PMID: 29676534 DOI: 10.1111/jdv.14891] [Citation(s) in RCA: 516] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti-inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long-term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long-term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti-inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.
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Affiliation(s)
- A Wollenberg
- Department Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Klinik Thalkirchner Straße, Munich, Germany
| | - S Barbarot
- Department of Dermatology, Centre Hospitalier Universitaire CHU Nantes, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University Bonn, Bonn, Germany
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M Deleuran
- Department Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Fink-Wagner
- European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Global Allergy and Asthma Patient Platform (GAAPP), Konstanz, Germany
| | - U Gieler
- Department of Dermatology, University of Gießen and Marburg GmbH, Gießen, Germany.,Department of Psychosomatics and Psychotherapy, University of Gießen and Marburg GmbH, Gießen, Germany
| | - G Girolomoni
- Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
| | - S Lau
- Pediatric Pneumology and Immunology, Universitätsmedizin Berlin, Berlin, Germany
| | - A Muraro
- Centro di Specializzazione Regionale per lo Studio e la Cura delle Allergie e delle Intolleranze Alimentari presso l'Azienda Ospedaliera, Università di Padova, Padova, Italy
| | | | - T Schäfer
- Dermatological Practice, Immenstadt, Germany
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University of Zurich, Zurich, Switzerland.,Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - D Simon
- Department Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Z Szalai
- Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Taïeb
- Department of Dermatology and Pediatric Dermatology, Hôpital St André, Bordeaux, France
| | - A Torrelo
- Department of Dermatology, Hospital Niño Jesus, Madrid, Spain
| | - T Werfel
- Department Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - J Ring
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland.,Department Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
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Fujii T, Kitamura Y, Mizuguchi H, Okamoto K, Sanada N, Yamada T, Sugiyama M, Michinaga S, Kitayama M, Fukui H, Takeda N. Effects of irradiation with narrowband-ultraviolet B on up-regulation of histamine H 1 receptor mRNA and induction of apoptosis in HeLa cells and nasal mucosa of rats. J Pharmacol Sci 2018; 138:54-62. [PMID: 30301597 DOI: 10.1016/j.jphs.2018.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 01/01/2023] Open
Abstract
Narrowband-ultraviolet B (NB-UVB) phototherapy is used for the treatment of atopic dermatitis. Previously, we reported that irradiation with 200 mJ/cm2 of 310 nm NB-UVB suppressed phorbol-12-myristate-13-acetate (PMA)-induced up-regulation of histamine H1 receptor (H1R) gene expression without induction of apoptosis in HeLa cells. However, the effect of NB-UVB irradiation on nasal symptoms is still unclear. Here, we show that low dose irradiation with 310 nm NB-UVB alleviates nasal symptoms in toluene 2,4-diisocyanate (TDI)-sensitized allergy model rats. Irradiation with 310 nm NB-UVB suppressed PMA-induced H1R mRNA up-regulation in HeLa cells dose-dependently at doses of 75-200 mJ/cm2 and reversibly at a dose of 150 mJ/cm2 without induction of apoptosis. While, at doses of more than 200 mJ/cm2, irradiation with 310 nm NB-UVB induced apoptosis. Western blot analysis showed that the suppressive effect of NB-UVB irradiation on H1R gene expression was through the inhibition of ERK phosphorylation. In TDI-sensitized rat, intranasal irradiation with 310 nm NB-UVB at an estimated dose of 100 mJ/cm2 once a day for three days suppressed TDI-induced sneezes and up-regulation of H1R mRNA in nasal mucosa without induction of apoptosis. These findings suggest that repeated intranasal irradiation with low dose of NB-UVB could be clinically used as phototherapy of AR.
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Affiliation(s)
- Tatsuya Fujii
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
| | - Yoshiaki Kitamura
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan.
| | - Hiroyuki Mizuguchi
- Laboratory of Pharmacology, Faculty of Pharmacy, Osaka Ohtani University, Osaka, 584-8540, Japan
| | - Kentaro Okamoto
- Molecular Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Nanae Sanada
- Molecular Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Takuya Yamada
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan; Molecular Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Manabu Sugiyama
- Molecular Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Shotaro Michinaga
- Laboratory of Pharmacology, Faculty of Pharmacy, Osaka Ohtani University, Osaka, 584-8540, Japan
| | - Mika Kitayama
- Molecular Pharmacology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Hiroyuki Fukui
- Molecular Studies for Incurable Diseases, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
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60
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Siegfried EC, Jaworski JC, Mina-Osorio P. A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns. Dermatol Ther (Heidelb) 2018; 8:349-377. [PMID: 29858763 PMCID: PMC6109028 DOI: 10.1007/s13555-018-0243-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns. METHODS Searches of Embase (2005-2016) and abstracts from selected meetings (2014-2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity. RESULTS Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids. CONCLUSION This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease. FUNDING Regeneron Pharmaceuticals Inc.
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Affiliation(s)
- Elaine C Siegfried
- Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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61
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Hart PH, Norval M, Byrne SN, Rhodes LE. Exposure to Ultraviolet Radiation in the Modulation of Human Diseases. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2018; 14:55-81. [PMID: 30125148 DOI: 10.1146/annurev-pathmechdis-012418-012809] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This review focuses primarily on the beneficial effects for human health of exposure to ultraviolet radiation (UVR). UVR stimulates anti-inflammatory and immunosuppressive pathways in skin that modulate psoriasis, atopic dermatitis, and vitiligo; suppresses cutaneous lesions of graft-versus-host disease; and regulates some infection and vaccination outcomes. While polymorphic light eruption and the cutaneous photosensitivity of systemic lupus erythematosus are triggered by UVR, polymorphic light eruption also frequently benefits from UVR-induced immunomodulation. For systemic diseases such as multiple sclerosis, type 1 diabetes, asthma, schizophrenia, autism, and cardiovascular disease, any positive consequences of UVR exposure are more speculative, but could occur through the actions of UVR-induced regulatory cells and mediators, including 1,25-dihydroxy vitamin D3, interleukin-10, and nitric oxide. Reduced UVR exposure is a risk factor for the development of several inflammatory, allergic, and autoimmune conditions, including diseases initiated in early life. This suggests that UVR-induced molecules can regulate cell maturation in developing organs.
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Affiliation(s)
- Prue H Hart
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia 6008, Australia;
| | - Mary Norval
- University of Edinburgh Medical School, Edinburgh EH8 9AG, United Kingdom;
| | - Scott N Byrne
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia; .,Westmead Institute for Medical Research, Westmead, New South Wales 2145, Australia
| | - Lesley E Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, and Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom;
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62
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Mori K, Seki T, Kaizu K, Takagi Y, Miyaki M, Ishizaki C, Katayama I. Efficacy of a moisturizer containing a pseudo-ceramide and a eucalyptus extract for Japanese patients with mild atopic dermatitis in the summer. J Cosmet Dermatol 2018; 18:850-856. [PMID: 30084152 DOI: 10.1111/jocd.12735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/08/2018] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Skin moisturizing is advocated to take care of the skin of patients with atopic dermatitis (AD). However, many patients stop using moisturizers in the summer because of excessive sweating and high humidity. OBJECTIVES To examine the efficacy of a moisturizing gel containing a pseudo-ceramide and a eucalyptus extract, which enhances epidermal ceramide synthesis of patients with mild AD in the summer. METHODS We performed a single-blinded 4-week clinical trial of body care on 44 Japanese subjects who had mild AD. They had not applied any moisturizer on their body in the summer. Twenty-seven subjects used the moisturizing gel containing a pseudo-ceramide and a eucalyptus extract twice a day and the 17 other subjects did not use any moisturizer. Prior to and at the end of weeks 2 and 4, the skin conditions of each subject were evaluated. RESULTS During the test period, the atmospheric temperature increased and skin dryness and scaling significantly improved with or without application of the moisturizing gel. However, the improvement in dryness of the treated group was significantly higher than that of the nontreated group. Erythema and itchiness were significantly improved only in the treated group. The skin hydration on the forearm increased significantly only in the treated group. Accompanying those improvements, the quality of life of the subjects, evaluated by Skindex-16® , was significantly improved. CONCLUSION The usage of a moisturizer containing a pseudo-ceramide and a eucalyptus extract is effective for care of the skin of AD subjects even in the summer.
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Affiliation(s)
- Katsura Mori
- Skin Care Product Research, Kao Corporation, Tokyo, Japan
| | - Tsuyoshi Seki
- Skin Care Product Research, Kao Corporation, Tokyo, Japan
| | - Kazuhiro Kaizu
- Skin Care Product Research, Kao Corporation, Tokyo, Japan
| | - Yutaka Takagi
- Skin Care Product Research, Kao Corporation, Tokyo, Japan
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63
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Gerbens LAA, Apfelbacher CJ, Irvine AD, Barbarot S, de Booij RJ, Boyce AE, Deleuran M, Eichenfield LF, Hof MH, Middelkamp-Hup MA, Roberts A, Schmitt J, Vestergaard C, Wall D, Weidinger S, Williamson PR, Flohr C, Spuls PI. TREatment of ATopic eczema (TREAT) Registry Taskforce: an international Delphi exercise to identify a core set of domains and domain items for national atopic eczema photo- and systemic therapy registries. Br J Dermatol 2018; 180:790-801. [PMID: 29761486 PMCID: PMC7379963 DOI: 10.1111/bjd.16714] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Evidence of immunomodulatory therapies to guide clinical management of atopic eczema (AE) is scarce, despite frequent and often off-label use. Patient registries provide valuable evidence for the effects of treatments under real-world conditions that can inform treatment guidelines, give the opportunity for health economic evaluation and the evaluation of quality of care, as well as pharmacogenetic and dynamic research, which cannot be adequately addressed in clinical trials. OBJECTIVES The TREatment of ATopic eczema (TREAT) Registry Taskforce aims to seek international consensus on a core set of domains and items ('what to measure') for AE research registries, using a Delphi approach. METHODS Participants from six stakeholder groups were included: doctors, nurses, nonclinical researchers, patients, industry and regulatory body representatives. The eDelphi comprised three sequential online rounds, requesting participants to rate the importance of each proposed domain item. Participants could add domain items to the proposed list in round 1. A final consensus meeting was held to ratify the core set. RESULTS Participants (n = 479) from 36 countries accessed the eDelphi platform, of whom 86%, 79% and 74% completed rounds 1, 2 and 3, respectively. At the face-to-face consensus meeting attended by 42 participants the final core set was established containing 19 domains with 69 domain items (49 baseline and 20 follow-up items). CONCLUSIONS This core set of domains and items to be captured by national AE systemic therapy registries will standardize data collection and thereby allow direct comparability across registries and facilitate data pooling between countries. Ultimately, it will provide greater insight into the effectiveness, safety and cost-effectiveness of photo- and systemic immunomodulatory therapies.
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Affiliation(s)
- L A A Gerbens
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - A D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | | | - A E Boyce
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - M Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, CA, U.S.A
| | - M H Hof
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - A Roberts
- Contributing patient.,Nottingham Support Group for Carers of Children with Eczema, Nottingham, U.K
| | - J Schmitt
- Center for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.,University Allergy Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - D Wall
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Irish Skin Foundation, Dublin, Ireland
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - P R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, U.K
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
| | - P I Spuls
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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64
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Brown SJ. What progress have we made in the treatment of atopic eczema? Putting the new biological therapies into a wider context. Br J Dermatol 2018; 177:4-6. [PMID: 28731235 DOI: 10.1111/bjd.15646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S J Brown
- Skin Research Group, School of Medicine, University of Dundee, Dundee, DD1 9SY, U.K.,Department of Dermatology, Ninewells Hospital, Dundee, DD1 9SY, U.K
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65
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Boswell K, Cameron H, West J, Fleming C, Ibbotson S, Dawe R, Foerster J. Narrowband ultraviolet B treatment for psoriasis is highly economical and causes significant savings in cost for topical treatments. Br J Dermatol 2018; 179:1148-1156. [PMID: 29901862 DOI: 10.1111/bjd.16716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Narrowband ultraviolet B (NB-UVB) treatment for psoriasis is considered expensive. However, existing data are based on estimates and do not consider indirect cost savings. OBJECTIVES To define the actual costs of NB-UVB incurred by the service provider, as well as treatment-associated cost savings. METHODS We performed data linkage of (i) comprehensive treatment records and (ii) prescribing data for all NB-UVB treatment episodes spanning 6 years in a population of 420 000. We minimized data fluctuation by compiling data from four independent treatment sites, and using drug prescriptions unrelated to psoriasis as a negative control. RESULTS National Health Service Tayside spent an average of £257 per NB-UVB treatment course (mean 257 ± 63, range 150-286, across four independent treatment sites), contrasting sharply with the estimate of £1882 used by the U.K. National Institute for Health and Care Excellence. The cost of topical treatments averaged £128 per patient in the 12 months prior to NB-UVB, accounting for 42% of the overall drug costs incurred by these patients. This was reduced by 40% to £53 per patient over the 12-month period following NB-UVB treatment, while psoriasis-unrelated drug prescription remained unchanged, suggesting disease-specific effects of NB-UVB. The data were not due to site-specific factors, as confirmed by highly similar results observed between treatment sites operated by distinct staff. Finally, we detail all staff hours directly and indirectly involved in treatment, allowing direct translation of cost into other healthcare systems. CONCLUSIONS NB-UVB is a low-cost treatment; cost figures currently used in health technology appraisals are an overestimate based on the data presented here. Creating or extending access to NB-UVB is likely to offer additional savings by delaying or avoiding costly third-line treatments for many patients.
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Affiliation(s)
- K Boswell
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - H Cameron
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - J West
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - C Fleming
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - S Ibbotson
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
| | - R Dawe
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K.,National Managed Clinical Network for Phototherapy (Photonet), NHS Scotland, Dundee, U.K
| | - J Foerster
- University of Dundee, Medical School, Dundee, U.K.,Department of Dermatology and Photobiology Unit, NHS Tayside, Dundee, U.K
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67
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Ibbotson SH. A Perspective on the Use of NB-UVB Phototherapy vs. PUVA Photochemotherapy. Front Med (Lausanne) 2018; 5:184. [PMID: 30013973 PMCID: PMC6036147 DOI: 10.3389/fmed.2018.00184] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/01/2018] [Indexed: 12/22/2022] Open
Abstract
Narrowband UVB (NB-UVB) phototherapy and psoralen-UVA (PUVA) photochemotherapy are widely used phototherapeutic modalities for a range of skin diseases. The main indication for NB-UVB and PUVA therapies is psoriasis, and other key diagnoses include atopic eczema, vitiligo, cutaneous T-cell lymphoma (CTCL), and the photodermatoses. The decision on choice of phototherapy is important and NB-UVB is usually the primary choice. NB-UVB phototherapy is a safe and effective therapy which is usually considered when topical agents have failed. PUVA requires prior psoralen sensitization but remains a highly effective mainstay therapy, often used when NB-UVB fails, there is rapid relapse following NB-UVB or in specific indications, such as pustular or erythrodermic psoriasis. This review will provide a perspective on the main indications for use of NB-UVB and PUVA therapies and provide comparative information on these important dermatological treatments.
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Affiliation(s)
- Sally H. Ibbotson
- Photobiology Unit, Dermatology Department, Ninewells Hospital, University of Dundee School of Medicine, Dundee, United Kingdom
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68
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Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a lifetime prevalence of up to 20% and substantial effects on quality of life. AD is characterized by intense itch, recurrent eczematous lesions and a fluctuating course. AD has a strong heritability component and is closely related to and commonly co-occurs with other atopic diseases (such as asthma and allergic rhinitis). Several pathophysiological mechanisms contribute to AD aetiology and clinical manifestations. Impairment of epidermal barrier function, for example, owing to deficiency in the structural protein filaggrin, can promote inflammation and T cell infiltration. The immune response in AD is skewed towards T helper 2 cell-mediated pathways and can in turn favour epidermal barrier disruption. Other contributing factors to AD onset include dysbiosis of the skin microbiota (in particular overgrowth of Staphylococcus aureus), systemic immune responses (including immunoglobulin E (IgE)-mediated sensitization) and neuroinflammation, which is involved in itch. Current treatments for AD include topical moisturizers and anti-inflammatory agents (such as corticosteroids, calcineurin inhibitors and cAMP-specific 3',5'-cyclic phosphodiesterase 4 (PDE4) inhibitors), phototherapy and systemic immunosuppressants. Translational research has fostered the development of targeted small molecules and biologic therapies, especially for moderate-to-severe disease.
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69
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Nguyen GH, Andersen LK, Davis MDP. Climate change and atopic dermatitis: is there a link? Int J Dermatol 2018; 58:279-282. [PMID: 29873062 DOI: 10.1111/ijd.14016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 02/12/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease with a growing health concern, because of its high prevalence and associated low quality of life. The etiology of AD is multifactorial with interaction between various factors such as genetic predisposition, immune, and importantly, environmental factors. Since climate change is associated with a profound shift in environmental factors, we suggest that AD is being influenced by climate change. This review highlights the effects of ultraviolet light, temperature, humidity, pollens, air pollutants, and their interaction between them contributing to the epidemiology and pathophysiology of AD.
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Affiliation(s)
- Giang Huong Nguyen
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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70
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Ordóñez Rubiano MF, Arenas CM, Chalela JG. UVA-1 phototherapy for the management of atopic dermatitis: a large retrospective study conducted in a low-middle income country. Int J Dermatol 2018; 57:799-803. [PMID: 29700815 DOI: 10.1111/ijd.14011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/20/2018] [Accepted: 04/02/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Medium-dose ultraviolet light A - 1 (UVA-1) phototherapy, given in short courses, has shown efficacy in atopic dermatitis flares; little is known about its use, efficacy, and side effects in prolonged exposure used in the chronic disease despite its extensive use. METHODS A descriptive retrospective study was conducted; convenience sampling of patients with atopic dermatitis treated with UVA-1 phototherapy was made; evaluation of clinical response by SCORAD, adverse effects, and protocols used in each patient were evaluated. RESULTS Patients exposed to UVA-1 phototherapy showed a decrease in the SCORAD (30.1 points) - total cumulative dose-dependent (P < 0.0001) - regardless of multiple variables studied. There were low rates of relapse and adverse effects. The most frequent doses were 30 and 60 J/cm2 , three times per week; patients had similar clinical responses and adverse effects in these groups independent of the other variables studied (P = 0.057). CONCLUSION UVA-1 phototherapy can be an alternative for patients with severe atopic dermatitis even at lower doses than those described in other series (30 J/cm2 ) and not only for acute flares. Cumulative total dose is a variable that affects the clinical response directly. Large prospective studies are needed.
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Affiliation(s)
- María F Ordóñez Rubiano
- Department of Dermatology, Hospital Militar Central, Universidad Militar Nueva Granada, Bogota, Colombia
| | - Claudia M Arenas
- Department of Dermatology, Hospital Militar Central, Universidad Militar Nueva Granada, Bogota, Colombia
| | - Juan G Chalela
- Hospital Universitario Fundación Santa Fe, Bogotá, Colombia
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Glyteer, Soybean Tar, Impairs IL-4/Stat6 Signaling in Murine Bone Marrow-Derived Dendritic Cells: The Basis of Its Therapeutic Effect on Atopic Dermatitis. Int J Mol Sci 2018; 19:ijms19041169. [PMID: 29649105 PMCID: PMC5979322 DOI: 10.3390/ijms19041169] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/22/2023] Open
Abstract
Atopic dermatitis (AD) is a common inflammatory skin disease. Recent studies have revealed the involvement of T helper (Th)2 cytokines including Interleukin 4 (IL-4) in the pathogenesis of AD. Since epidermal Langerhans cells (LCs) and dermal myeloid dendritic cells (DCs) produce CCL17 and CCL22 that chemoattract Th2 cells, interfering with CCL17 and CCL22 production from LCs and dermal myeloid DCs may be beneficial in the treatment of AD. To investigate this, we stimulated murine bone marrow-derived DCs (BMDCs) with IL-4. IL-4 stimulation produced Ccl17 and Ccl22, which was attenuated by soybean tar Glyteer, a known aryl hydrocarbon receptor (Ahr) activator. Notably, Glyteer treatment blocked the nuclear translocation of Stat6 induced by IL-4 stimulation, suggesting that this treatment impairs the IL-4/Stat6 signaling pathway in BMDCs. Unexpectedly, Glyteer treatment did not potently upregulate the expression of Cyp1a1, a specific Ahr-responsive gene, suggesting that its inhibitory machinery for Ccl17 and Ccl22 expression is likely to operate in an Ahr-independent manner. These findings indicate that Glyteer may exhibit therapeutic potential for AD by downregulating the CCL17 and CCL22 production from DCs in a Th2-deviated microenvironment.
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Herzinger T, Berneburg M, Ghoreschi K, Gollnick H, Hölzle E, Hönigsmann H, Lehmann P, Peters T, Röcken M, Scharffetter-Kochanek K, Schwarz T, Simon J, Tanew A, Weichenthal M. S1-Leitlinie zur UV-Phototherapie und Photochemotherapie. J Dtsch Dermatol Ges 2018; 14:e1-e25. [PMID: 27509439 DOI: 10.1111/ddg.12912_g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Die heilsame Wirkung des Sonnenlichts war teilweise schon im Altertum bekannt und fand in der zweiten Hälfte des 19. Jahrhunderts wieder zunehmend Beachtung. Den Beginn der modernen Phototherapien markiert die Entwicklung einer Apparatur zur ultravioletten Bestrahlung der Hauttuberkulose durch Finnsen zu Beginn des zwanzigsten Jahrhunderts. Zur Therapie von Hauterkrankungen finden beinahe ausschließlich die spektralen Bereiche unterhalb des sichtbaren Lichtes (ultraviolett) Anwendung. Seit den 1970er Jahren stehen zunehmend leistungsfähige künstliche Strahlenquellen bereit für die Therapie mit UVB, UVA und die Kombination von UVA mit Photosensibilisatoren (Photochemotherapie). Hohe strukturelle und prozedurale Qualitätsstandards sind unabdingbare Voraussetzung für die Durchführung einer gleichermaßen wirkungsvollen wie auch sicheren Phototherapie. Die Leitlinie formuliert den aktuellen Konsens führender Experten auf dem Gebiet der Phototherapie in Bezug auf die Indikationen für die jeweiligen Therapieverfahren, deren Gegenanzeigen und Nebenwirkungen und insbesondere für die Wahl der korrekten Dosis zu Beginn und im Verlauf einer Therapie sowie das Management von Nebenwirkungen.
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Affiliation(s)
- Thomas Herzinger
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | | | - Harald Gollnick
- Universitätsklinik für Dermatologie und Venerologie, Otto-von-Guericke-Universität Magdeburg
| | - Erhard Hölzle
- Klinik für Dermatologie und Allergologie, Klinikum Oldenburg
| | - Herbert Hönigsmann
- Universitätsklinik für Dermatologie, Allgemeines Krankenhaus der Stadt Wien
| | - Percy Lehmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, HELIOS-Klinikum Wuppertal
| | - Thorsten Peters
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm
| | | | | | | | - Jan Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig
| | - Adrian Tanew
- Universitätsklinik für Dermatologie, Allgemeines Krankenhaus der Stadt Wien
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Clowry J, Molloy K, Nestor L, Edwards K, Salim A, Connolly M, Tobin AM. Narrow-band ultraviolet B phototherapy outcomes in atopic dermatitis-A single-centre retrospective review. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 34:217-219. [PMID: 29080361 DOI: 10.1111/phpp.12365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Julianne Clowry
- Department of Dermatology, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - Kevin Molloy
- Department of Dermatology, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - Laura Nestor
- Department of Dermatology, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - Katherine Edwards
- Department of Dermatology, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - Asad Salim
- Department of Dermatology, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - Maureen Connolly
- Department of Dermatology, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
| | - Anne-Marie Tobin
- Department of Dermatology, Adelaide Meath and National Children's Hospital, Tallaght, Dublin, Ireland
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Simpson EL, Bruin-Weller M, Flohr C, Ardern-Jones MR, Barbarot S, Deleuran M, Bieber T, Vestergaard C, Brown SJ, Cork MJ, Drucker AM, Eichenfield LF, Foelster-Holst R, Guttman-Yassky E, Nosbaum A, Reynolds NJ, Silverberg JI, Schmitt J, Seyger MMB, Spuls PI, Stalder JF, Su JC, Takaoka R, Traidl-Hoffmann C, Thyssen JP, van der Schaft J, Wollenberg A, Irvine AD, Paller AS. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. J Am Acad Dermatol 2017; 77:623-633. [PMID: 28803668 DOI: 10.1016/j.jaad.2017.06.042] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. OBJECTIVE To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. METHODS A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. RESULTS We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. LIMITATIONS Our work is a consensus statement, not a systematic review. CONCLUSION The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
| | - Marjolein Bruin-Weller
- National Expertise Center for Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' National Health Service Foundation Trust and King's College London, London, United Kingdom
| | - Michael R Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Bieber
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | | | - Sara J Brown
- Skin Research Group, School of Medicine, University of Dundee, Dundee, United Kingdom; Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Michael J Cork
- Sheffield Dermatology Research Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Aaron M Drucker
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Regina Foelster-Holst
- Dermatology, Venereology and Allergology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Audrey Nosbaum
- Department of Allergy and Clinical Immunology, University Hospital Lyon Sud, Hospices Civiles de Lyon, Lyon, France
| | - Nick J Reynolds
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Technische Universität Dresden, Dresden, Germany
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - John C Su
- Department of Dermatology, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia; Department of Paediatrics, Monash University, Eastern Health and Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Roberto Takaoka
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia Traidl-Hoffmann
- Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Munich, Germany; CK CARE, Christine-Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jorien van der Schaft
- Department of Dermatology and Allergology, University Medical Centre Utrech, Utrecht, Germany
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Alan D Irvine
- Trinity College Dublin, National Children's Research Centre, Paediatric Dermatology Our Lady's Children's Hospital, Dublin, United Kingdom.
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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75
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Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, Simpson EL, Papp KA, Hong HCH, Rubel D, Foley P, Prens E, Griffiths CEM, Etoh T, Pinto PH, Pujol RM, Szepietowski JC, Ettler K, Kemény L, Zhu X, Akinlade B, Hultsch T, Mastey V, Gadkari A, Eckert L, Amin N, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD, Shumel B. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet 2017; 389:2287-2303. [PMID: 28478972 DOI: 10.1016/s0140-6736(17)31191-1] [Citation(s) in RCA: 762] [Impact Index Per Article: 108.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Dupilumab (an anti-interleukin-4-receptor-α monoclonal antibody) blocks signalling of interleukin 4 and interleukin 13, type 2/Th2 cytokines implicated in numerous allergic diseases ranging from asthma to atopic dermatitis. Previous 16-week monotherapy studies showed that dupilumab substantially improved signs and symptoms of moderate-to-severe atopic dermatitis with acceptable safety, validating the crucial role of interleukin 4 and interleukin 13 in atopic dermatitis pathogenesis. We aimed to evaluate the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids versus placebo with topical corticosteroids in adults with moderate-to-severe atopic dermatitis. METHODS In this 1-year, randomised, double-blinded, placebo-controlled, phase 3 study (LIBERTY AD CHRONOS), adults with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids were enrolled at 161 hospitals, clinics, and academic institutions in 14 countries in Europe, Asia-Pacific, and North America. Patients were randomly assigned (3:1:3) to subcutaneous dupilumab 300 mg once weekly (qw), dupilumab 300 mg every 2 weeks (q2w), or placebo via a central interactive voice/web response system, stratified by severity and global region. All three groups were given concomitant topical corticosteroids with or without topical calcineurin inhibitors where inadvisable for topical corticosteroids. Topical corticosteroids could be tapered, stopped, or restarted on the basis of disease activity. Coprimary endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-point or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week 16. Week 16 efficacy and week 52 safety analyses included all randomised patients; week 52 efficacy included patients who completed treatment by US regulatory submission cutoff. This study is registered with ClinicalTrials.gov, NCT02260986. FINDINGS Between Oct 3, 2014, and July 31, 2015, 740 patients were enrolled: 319 were randomly assigned to dupilumab qw plus topical corticosteroids, 106 to dupilumab q2w plus topical corticosteroids, and 315 to placebo plus topical corticosteroids. 623 (270, 89, and 264, respectively) were evaluable for week 52 efficacy. At week 16, more patients who received dupilumab plus topical corticosteroids achieved the coprimary endpoints of IGA 0/1 (39% [125 patients] who received dupilumab plus topical corticosteroids qw and 39% [41 patients] who received dupilumab q2w plus topical corticosteroids vs 12% [39 patients] who received placebo plus topical corticosteroids; p<0·0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0·0001). Week 52 results were similar. Adverse events were reported in 261 (83%) patients who received dupilumab qw plus topical corticosteroids, 97 (88%) patients who received dupilumab q2w, and 266 (84%) patients who received placebo, and serious adverse events in nine (3%), four (4%), and 16 (5%) patients, respectively. No significant dupilumab-induced laboratory abnormalities were noted. Injection-site reactions and conjunctivitis were more common in patients treated with dupilumab plus topical corticosteroids-treated patients than in patients treated with placebo plus topical corticosteroids. INTERPRETATION Dupilumab added to standard topical corticosteroid treatment for 1 year improved atopic dermatitis signs and symptoms, with acceptable safety. FUNDING Sanofi and Regeneron Pharmaceuticals Inc.
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Affiliation(s)
| | | | - Melinda Gooderham
- SKiN Centre for Dermatology, Queen's University, and Probity Medical Research, Peterborough, ON, Canada
| | - Jennifer C Cather
- Modern Dermatology and Modern Research Associates, and Probity Medical Research, Dallas, TX, USA
| | | | - David Pariser
- Eastern Virginia Medical School and Virginia Clinical Research Inc, Norfolk, VA, USA
| | | | - Kim A Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, ON, Canada
| | - H Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, and Probity Medical Research, Surrey, BC, Canada
| | - Diana Rubel
- Australian National University, Canberra, and Probity Medical Research, Phillip, ACT, Australia
| | - Peter Foley
- The University of Melbourne, Parkville, Skin & Cancer Foundation Inc, Carlton, and Probity Medical Research, Carlton, VIC, Australia
| | - Errol Prens
- Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Christopher E M Griffiths
- The Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Takafumi Etoh
- Tokyo Teishin Postal Services Agency Hospital, Tokyo, Japan
| | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | | | - Karel Ettler
- Dermatology and Venereology, Hradec Kralove, Czech Republic
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Xiaoping Zhu
- Regeneron Pharmaceuticals Inc, Basking Ridge, NJ, USA
| | | | | | - Vera Mastey
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | - Brad Shumel
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
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76
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Fuertes E, Flohr C, Silverberg JI, Standl M, Strachan DP. Global Associations between UVR Exposure and Current Eczema Prevalence in Children from ISAAC Phase Three. J Invest Dermatol 2017; 137:1248-1256. [DOI: 10.1016/j.jid.2017.02.966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/30/2017] [Accepted: 02/12/2017] [Indexed: 11/16/2022]
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Saeki H, Nakahara T, Tanaka A, Kabashima K, Sugaya M, Murota H, Ebihara T, Kataoka Y, Aihara M, Etoh T, Katoh N. Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016. J Dermatol 2017; 43:1117-1145. [PMID: 27076388 DOI: 10.1111/1346-8138.13392] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/01/2022]
Abstract
Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Graduate School of Medicine, Nihon Medical School, Tokyo, Japan
| | - Takeshi Nakahara
- Division of Skin Surface Sensing, Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Tanaka
- Department of Dermatology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tamotsu Ebihara
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Kataoka
- Department of Dermatology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Michiko Aihara
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takafumi Etoh
- Division of Dermatology, Tokyo Teishin Postal Services Agency Hospital, Tokyo, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
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Extract from Periostracum cicadae Inhibits Oxidative Stress and Inflammation Induced by Ultraviolet B Irradiation on HaCaT Keratinocytes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:8325049. [PMID: 28465707 PMCID: PMC5390570 DOI: 10.1155/2017/8325049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 11/18/2022]
Abstract
Periostracum cicadae is widely used for the treatment of skin diseases such as eczema, pruritus, and itching. The current study sought to evaluate the effect of P. cicadae extract on ultraviolet B (UVB) irradiation and identify the mechanisms involved. Photodamage-protective activity of P. cicadae extracts against oxidative challenge was screened using HaCaT keratinocytes. P. cicadae extracts did not affect cell viability but decreased reactive oxygen species (ROS) production. The extract attenuates the expression of interleukin-6 (IL-6), matrix metalloproteinase-2 (MMP-2), and MMP-9 in UVB-treated HaCaT cells. Also, P. cicadae abrogated UVB-induced activation of NF-κB, p53, and activator protein-1 (AP-1). The downmodulation of IL-6 by P. cicadae was inhibited by the p38 inhibitor (SB203580) or JNK inhibitor (SP600125). Moreover, the extract attenuated the expression of NF-κB and induced thrombomodulin in keratinocytes and thereby effectively downregulated inflammatory responses in the skin. The nuclear accumulation and expression of NF-E2-related factor (Nrf2) were increased by P. cicadae treatment. Furthermore, treatment with P. cicadae remarkably ameliorated the skin's structural damage induced by irradiation. This study demonstrates that P. cicadae may protect skin cells against oxidative insult by modulating ROS concentration, IL-6, MMPs generation, antioxidant enzymes activity, and cell signaling pathways.
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79
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Megna M, Napolitano M, Patruno C, Villani A, Balato A, Monfrecola G, Ayala F, Balato N. Systemic Treatment of Adult Atopic Dermatitis: A Review. Dermatol Ther (Heidelb) 2017; 7:1-23. [PMID: 28025775 PMCID: PMC5336433 DOI: 10.1007/s13555-016-0170-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Indexed: 12/17/2022] Open
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease that predominantly affects children. However, it can persist in adulthood and/or start at older ages. Due to its chronic nature and frequently occurring relapses, AD has a substantial effect on patients' quality of life, often requiring long-term systemic treatment, especially in adult patients, who are more frequently refractory to adequate topical treatment with mid- to high-potent corticosteroids and/or calcineurin inhibitors. Therefore, treatment with systemic therapies is often needed to take control of the disease, prevent exacerbations and improve quality of life. However, data regarding systemic treatment effectiveness and long-term safety in adult patients with AD are insufficient. Indeed, standardized international guidelines are lacking, and the treatment approach widely differs among diverse countries. This review focuses on the use of systemic treatments in adult AD patients analyzing published literature.
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Affiliation(s)
- Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy.
| | | | - Cataldo Patruno
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alessia Villani
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Anna Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | | | - Fabio Ayala
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
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80
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Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition that requires a manifold approach to therapy. The goal of therapy is to restore the function of the epidermal barrier and to reduce skin inflammation. This can be achieved with skin moisturization and topical anti-inflammatory agents, such as topical corticosteroids and calcineurin inhibitors. Furthermore, proactive therapy with twice weekly use of both topical corticosteroids and calcineurin inhibitors in previously affected areas has been found to reduce the time to the next eczematous flare. Adjunctive treatment options include wet wrap therapy, anti-histamines, and vitamin D supplementation. Bacterial colonization, in particular Staphylococcus aureus, can contribute to eczematous flares and overt infection. Use of systemic antibiotics in infected lesions is warranted; however, empiric antibiotics use in uninfected lesions is controversial. Local antiseptic measures (i.e., bleach baths) and topical antimicrobial therapies can be considered in patients with high bacterial colonization. Difficult-to-treat AD is a complex clinical problem that may require re-evaluation of the initial diagnosis of AD, especially if the onset of disease occurs in adulthood. It may also necessitate evaluation for contact, food, and inhaled allergens that may exacerbate the underlying AD. There are a host of systemic therapies that have been successful in patients with difficult-to-treat AD, however, these agents are limited by their side effect profiles. Lastly, with further insight into the pathophysiology of AD, new biological agents have been investigated with promising results.
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Affiliation(s)
- Melanie Chong
- Rheumatology, Allergy & Immunology, Winthrop University Hospital, 120 Mineola Blvd, Suite 410, Mineola, NY, 11501, USA.
| | - Luz Fonacier
- Rheumatology, Allergy & Immunology, Winthrop University Hospital, 120 Mineola Blvd, Suite 410, Mineola, NY, 11501, USA
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81
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Patrizi A, Raone B, Ravaioli GM. Safety and Efficacy of Phototherapy in the Management of Eczema. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:319-331. [DOI: 10.1007/978-3-319-56017-5_27] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Ortiz-Salvador JM, Pérez-Ferriols A. Phototherapy in Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:279-286. [PMID: 29124708 DOI: 10.1007/978-3-319-56017-5_23] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. Currently management of AD includes avoidance of triggering factors, skin care aiming to compensate the skin barrier defects, anti-inflammatory therapy (mostly topical corticosteroids and topical calcineurin inhibitors). When these first-line approaches are unsuccessful, systemic treatment or phototherapy ought to be carried out as next line of defence. Current phototherapy modalities for AD include broadband UVB (290-320 nm), narrowband UVB (311-313 nm), UVA-1 therapy (340-400 nm), UVA therapy plus 8-methoxypsoralens (PUVA), 308 nm excimer laser (EL) and Full spectrum light (FSL).
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Affiliation(s)
- José María Ortiz-Salvador
- Dermatology Department, University General Hospital of Valencia, Av. Tres Cruces n°2, 46014, Valencia, Spain.
| | - Amparo Pérez-Ferriols
- Dermatology Department, University General Hospital of Valencia, Av. Tres Cruces n°2, 46014, Valencia, Spain
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Lloyd-Lavery A, Rogers NK, Hatfield SJ, Grindlay D, Barnett R, Thomas KS. What's new in atopic eczema? An analysis of systematic reviews published in 2014. Part 2. Treatment and prevention. Clin Exp Dermatol 2016; 42:3-7. [DOI: 10.1111/ced.12967] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 12/16/2022]
Affiliation(s)
- A. Lloyd-Lavery
- Department of Dermatology; Churchill Hospital; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - N. K. Rogers
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | | | - D. Grindlay
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - R. Barnett
- Department of Dermatology; Churchill Hospital; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - K. S. Thomas
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
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84
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Matsui M, Tanaka K, Higashiguchi N, Okawa H, Yamada Y, Tanaka K, Taira S, Aoyama T, Takanishi M, Natsume C, Takakura Y, Fujita N, Hashimoto T, Fujita T. Protective and therapeutic effects of fucoxanthin against sunburn caused by UV irradiation. J Pharmacol Sci 2016; 132:55-64. [PMID: 27590588 DOI: 10.1016/j.jphs.2016.08.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/17/2022] Open
Abstract
Mild exposure to ultraviolet (UV) radiation is also harmful and hazardous to the skin and often causes a photosensitivity disorder accompanied by sunburn. To understand the action of UV on the skin we performed a microarray analysis to isolate UV-sensitive genes. We show here that UV irradiation promoted sunburn and downregulated filaggrin (Flg); fucoxanthin (FX) exerted a protective effect. In vitro analysis showed that UV irradiation of human dermal fibroblasts caused production of intracellular reactive oxygen species (ROS) without cellular toxicity. ROS production was diminished by N-acetylcysteine (NAC) or FX, but not by retinoic acid (RA). In vivo analysis showed that UV irradiation caused sunburn and Flg downregulation, and that FX, but not NAC, RA or clobetasol, exerted a protective effect. FX stimulated Flg promoter activity in a concentration-dependent manner. Flg promoter deletion and chromatin immunoprecipitation analysis showed that caudal type homeo box transcription factor 1 (Cdx1) was a key factor for Flg induction. Cdx1 was also downregulated in UV-exposed skin. Therefore, our data suggested that the protective effects of FX against UV-induced sunburn might be exerted by promotion of skin barrier formation through induction of Flg, unrelated to quenching of ROS or an RA-like action.
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Affiliation(s)
- Mio Matsui
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan
| | - Kosuke Tanaka
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan
| | | | - Hisato Okawa
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan
| | - Yoichi Yamada
- Infection Control Lab., Ritsumeikan University, Shiga, Japan
| | - Ken Tanaka
- Pharmacognosy Lab., Ritsumeikan University, Shiga, Japan
| | - Soichiro Taira
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan
| | - Tomoko Aoyama
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan
| | | | - Chika Natsume
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan
| | - Yuuki Takakura
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan
| | - Norihisa Fujita
- Pharmacoinformatics Lab., Faculty of Pharmaceutical Sciences, Ritsumeikan University, Shiga, Japan
| | - Takeshi Hashimoto
- Faculty of Sport & Health Sciences, Ritsumeikan University, Shiga, Japan
| | - Takashi Fujita
- Molecular Toxicology Lab., Ritsumeikan University, Shiga, Japan.
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85
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Herzinger T, Berneburg M, Ghoreschi K, Gollnick H, Hölzle E, Hönigsmann H, Lehmann P, Peters T, Röcken M, Scharffetter-Kochanek K, Schwarz T, Simon J, Tanew A, Weichenthal M. S1-Guidelines on UV phototherapy and photochemotherapy. J Dtsch Dermatol Ges 2016; 14:853-76. [DOI: 10.1111/ddg.12912] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Thomas Herzinger
- Department of Dermatology and Allergology; Ludwig Maximilians University; Munich Germany
| | - Mark Berneburg
- Department of Dermatology; University Medical Center; Regensburg Germany
| | | | - Harald Gollnick
- Department of Dermatology and Venereology; University Hospital; Otto von Guericke University; Magdeburg Germany
| | - Erhard Hölzle
- Department of Dermatology and Allergology; Medical Center Oldenburg; Oldenburg Germany
| | | | - Percy Lehmann
- Department of Dermatology; Allergology and Dermatosurgery; HELIOS-Medical Center; Wuppertal Germany
| | - Thorsten Peters
- Department of Dermatology and Allergology; University Medical Center; Ulm Germany
| | | | | | | | - Jan Simon
- Department of Dermatology; Venereology and Allergology; University Medical Center; Leipzig Germany
| | - Adrian Tanew
- Department of Dermatology; General Hospital of Vienna; Vienna Austria
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86
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Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol 2016; 13:15-26. [PMID: 27417220 DOI: 10.1080/1744666x.2016.1212660] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors. Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD. Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.
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Affiliation(s)
- Robert Kantor
- a Department of Dermatology , Northwestern University , Chicago , IL , USA
| | - Jonathan I Silverberg
- b Departments of Dermatology, Preventive Medicine and Medical Social Sciences , Northwestern University , Chicago , IL , USA
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87
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Crall CS, Rork JF, Delano S, Huang JT. Phototherapy in children: Considerations and indications. Clin Dermatol 2016; 34:633-9. [PMID: 27638444 DOI: 10.1016/j.clindermatol.2016.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Phototherapy can be a safe and effective treatment for various skin diseases in children. Special considerations governing the use of this treatment modality in pediatric populations include patient, family, and facility-based factors that are oriented around heightened concerns with regard to safety and tolerability of treatment. Although phototherapy has been found to be effective in a wide range of dermatologic conditions affecting pediatric populations, including psoriasis, atopic dermatitis, pityriasis lichenoides, cutaneous T-cell lymphoma, and vitiligo, there is need for additional research on other conditions in which phototherapy has shown promise.
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Affiliation(s)
- Cary S Crall
- Harvard Medical School, Dermatology Program, Division of Allergy and Immunology, Department of Medicine, Boston Children's Hospital, Boston, MA
| | - Jillian F Rork
- Department of Dermatology, University of Massachusetts School of Medicine, Worcester, MA
| | - Sophia Delano
- Harvard Medical School, Dermatology Program, Division of Allergy and Immunology, Department of Medicine, Boston Children's Hospital, Boston, MA
| | - Jennifer T Huang
- Harvard Medical School, Dermatology Program, Division of Allergy and Immunology, Department of Medicine, Boston Children's Hospital, Boston, MA.
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88
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Abstract
Vitamin D has been suggested to have an important impact on a much wider aspects on human health than calcium homeostasis and mineral metabolism, specifically in the field of human immunology. It has been reported that vitamin D influences the regulation of both innate and adaptive immune systems, which makes the association between vitamin D and allergic diseases a field of interest. Although many studies have sought to determine whether vitamin D has an influence on progression of allergic disease, the impact of vitamin D on atopic dermatitis development and severity remains unclear. In this review, we summarize recent studies relating vitamin D to atopic dermatitis and discuss its possible role in the pathogenesis of allergic skin diseases, emphasizing the need for well-designed, prospective trials on vitamin D supplementation in the context of prevention and treatment for allergic conditions.
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89
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Childhood Atopic Dermatitis in Taiwan. Pediatr Neonatol 2016; 57:89-96. [PMID: 26510770 DOI: 10.1016/j.pedneo.2015.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/03/2015] [Accepted: 08/24/2015] [Indexed: 12/21/2022] Open
Abstract
The prevalence of atopic dermatitis (AD) appears to have increased dramatically over the past decades. It is generally believed that such rapid increase in prevalence cannot be explained fully by genetic factors. Environmental factors might play a role in such an increment. Children with AD are most likely to suffer considerable school absences, family stress, and health care expenditures. Because the onset of AD occurs relatively early in life, identification of early life risk factors and early management for AD to prevent the development of atopic march are of critical importance. However, there is still no consensus on coordinated prevention and management for AD in Taiwan. In this review, we discuss the specific risk factors of AD and important results of recent articles on AD from Taiwan. The management and prevention strategies of AD for Asian skin are also discussed.
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90
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Wollenberg A, Oranje A, Deleuran M, Simon D, Szalai Z, Kunz B, Svensson A, Barbarot S, von Kobyletzki L, Taieb A, de Bruin-Weller M, Werfel T, Trzeciak M, Vestergard C, Ring J, Darsow U. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol 2016; 30:729-47. [DOI: 10.1111/jdv.13599] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/10/2015] [Indexed: 12/27/2022]
Affiliation(s)
- A. Wollenberg
- Department of Dermatology and Allergy; Ludwig-Maximilian-University; Munich Germany
| | - A. Oranje
- Department of Dermatology (Pediatric Dermatology and Hair); Dermicis Skin clinic; Alkmaar and Rotterdam The Netherlands
| | - M. Deleuran
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Z. Szalai
- Heim Pal Childrens Hospital; Budapest Hungary
| | - B. Kunz
- Dermatologikum; Hamburg Germany
| | - A. Svensson
- Department of Dermatology; University Hospital UMAS; Malmö Sweden
| | - S. Barbarot
- Department of Dermatology; University of Nantes; Nantes France
| | | | - A. Taieb
- Service de Dermatologie et Dermatologie Pédiatrique; Centre de référence pour les maladies rares de la peau; INSERM 1035; Université de Bordeaux; Talence France
| | - M. de Bruin-Weller
- Department of Dermatology; University of Utrecht; Utrecht The Netherlands
| | - T. Werfel
- Department of Dermatology; Hautklinik Linden; MHH; Hannover Germany
| | - M. Trzeciak
- Department of Dermatology, Venereology and Allergology; Medical University of Gdansk; Gdansk Poland
| | - C. Vestergard
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - J. Ring
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - U. Darsow
- Department of Dermatology and Allergy Biederstein; Technische Universität München; Munich Germany
- ZAUM - Center of Allergy & Environment; Munich Germany
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91
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Abstract
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.
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Affiliation(s)
- Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Natalija Novak
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
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92
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Galli E, Neri I, Ricci G, Baldo E, Barone M, Belloni Fortina A, Bernardini R, Berti I, Caffarelli C, Calamelli E, Capra L, Carello R, Cipriani F, Comberiati P, Diociaiuti A, El Hachem M, Fontana E, Gruber M, Haddock E, Maiello N, Meglio P, Patrizi A, Peroni D, Scarponi D, Wielander I, Eichenfield LF. Consensus Conference on Clinical Management of pediatric Atopic Dermatitis. Ital J Pediatr 2016; 42:26. [PMID: 26936273 PMCID: PMC4776387 DOI: 10.1186/s13052-016-0229-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/14/2016] [Indexed: 01/01/2023] Open
Abstract
The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.
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Affiliation(s)
- Elena Galli
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
| | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Giampaolo Ricci
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Ermanno Baldo
- Pediatric Department, "S. Maria del Carmine" Hospital of Rovereto, APSS (Provincial Agency for Health Services), Trento, Italy.
| | | | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
| | | | - Irene Berti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
| | - Carlo Caffarelli
- Pediatric Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
| | - Elisabetta Calamelli
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Lucetta Capra
- Department of Medical Sciences, Section of Paediatrics, University of Ferrara, Ferrara, Italy.
| | - Rossella Carello
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
| | - Francesca Cipriani
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | | | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Fontana
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
| | - Michaela Gruber
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy.
| | - Ellen Haddock
- Departments of Pediatrics and Dermatology, School of Medicine, University of California, San Diego, CA, USA.
| | - Nunzia Maiello
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
| | - Paolo Meglio
- Primary Care Pediatrician, Health National Service, Rome, Italy.
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Diego Peroni
- Department of Medical Sciences, Section of Paediatrics, University of Ferrara, Ferrara, Italy.
| | - Dorella Scarponi
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Ingrid Wielander
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy.
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Dermatology, School of Medicine, University of California, San Diego, CA, USA.
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93
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Lauffer F, Ring J. Target-oriented therapy: Emerging drugs for atopic dermatitis. Expert Opin Emerg Drugs 2016; 21:81-9. [DOI: 10.1517/14728214.2016.1146681] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ling T, Clayton T, Crawley J, Exton L, Goulden V, Ibbotson S, McKenna K, Mohd Mustapa M, Rhodes L, Sarkany R, Dawe R, McHenry P, Hughes J, Griffiths M, McDonagh A, Buckley D, Nasr I, Swale V, Duarte Williamson C, Levell N, Leslie T, Mallon E, Wakelin S, Hunasehally P, Cork M, Ungureanu S, Donnelly J, Towers K, Saunders C, Davis R, Brain A, Exton L, Mohd Mustapa M. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015. Br J Dermatol 2016; 174:24-55. [DOI: 10.1111/bjd.14317] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/28/2023]
Affiliation(s)
- T.C. Ling
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - T.H. Clayton
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - J. Crawley
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - V. Goulden
- Department of Dermatology Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA U.K
| | - S. Ibbotson
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
| | - K. McKenna
- Department of Dermatology Belfast City Hospital Belfast BT9 7AB U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - L.E. Rhodes
- Dermatology Research Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - R. Sarkany
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - R.S. Dawe
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
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95
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Bogaczewicz J, Malinowska K, Sysa-Jedrzejowska A, Wozniacka A. Medium-dose ultraviolet A1 phototherapy improves SCORAD index and increases mRNA expression of interleukin-4 without direct effect on human β defensin-1, interleukin-10, and interleukin-31. Int J Dermatol 2016; 55:e380-5. [PMID: 26748443 DOI: 10.1111/ijd.13213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 07/24/2015] [Accepted: 09/22/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Effectiveness of ultraviolet (UV)A1 in flares of atopic dermatitis (AD) is thought to influence the expression of cytokines involved in its pathogenesis. The aim of the study was to investigate whether mRNA expression of human β defensin-1 (hβD-1) correlates with that of interleukin (IL)-4, IL-10, and IL-31 in skin lesions in AD before and after UVA1 phototherapy, to determine whether UVA1 decreases the expression of the aforementioned mediators, and to confirm whether changes in mRNA expression correspond with the clinical efficacy of UVA1. METHODS Twenty-five patients with AD underwent medium-dose UVA1 phototherapy. Before and after UVA1, biopsies from acute skin lesions were studied using reverse transcription and real-time polymerase chain reaction. RESULTS Levels of mRNA hβD-1 correlated with those of IL-10 and IL-31, levels of IL-4 mRNA correlated with those of IL-10 and IL-31, and IL-10 expression correlated with that of IL-31, both before and after UVA1. Phototherapy with UVA1 improved SCORing of Atopic Dermatitis (SCORAD) values, decreased pruritus, and increased expression of IL-4. After UVA1, no difference was found in the mRNA expression of other molecules. The SCORAD index did not correlate with the expression of any examined mRNA either before or after UVA1. CONCLUSIONS hβD-1, IL-4, IL-10, and IL-31 are expressed in acute skin lesions in AD, and their levels correlate with each other. UVA1 improves SCORAD and pruritus and increases the expression of IL-4 without direct effect on other molecules.
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Affiliation(s)
- Jaroslaw Bogaczewicz
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
| | - Karolina Malinowska
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
| | | | - Anna Wozniacka
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
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96
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Chu CY, Lee CH, Shih IH, Chen HC, Huang PH, Yang CY, Wang WJ, Chen YJ, Sheu HM, Wang WM, Lee WR, Lo YH, Dai YS, Wang LF, Tsai TF, Yang CH. Taiwanese Dermatological Association consensus for the management of atopic dermatitis. DERMATOL SIN 2015. [DOI: 10.1016/j.dsi.2015.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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97
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Patrizi A, Raone B, Ravaioli GM. Management of atopic dermatitis: safety and efficacy of phototherapy. Clin Cosmet Investig Dermatol 2015; 8:511-20. [PMID: 26491366 PMCID: PMC4599569 DOI: 10.2147/ccid.s87987] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
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-term adverse effects, with the most common being photodamage, xerosis, erythema, actinic keratosis, sunburn, and tenderness. A carcinogenic risk related to UV radiation has not been excluded. Phototherapy also has some limitations related to costs, availability, and patient compliance. In conclusion, phototherapy is an optimal second-line treatment for AD. It can be used as monotherapy or in combination with systemic drugs, in particular corticosteroids. It must be performed conscientiously, especially in children, and must take into account the patient's features and overall condition.
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Affiliation(s)
- Annalisa Patrizi
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Beatrice Raone
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Giulia Maria Ravaioli
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
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98
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Kim JE, Kim HJ, Lew BL, Lee KH, Hong SP, Jang YH, Park KY, Seo SJ, Bae JM, Choi EH, Suhr KB, Lee SC, Ko HC, Park YL, Son SW, Seo YJ, Lee YW, Cho SH, Park CW, Roh JY. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment. Ann Dermatol 2015; 27:578-92. [PMID: 26512172 PMCID: PMC4622892 DOI: 10.5021/ad.2015.27.5.578] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/12/2015] [Accepted: 08/16/2015] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Jung Eun Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dermatology, Seoul Medical Center, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Ho Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Phil Hong
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ki Beom Suhr
- Department of Dermatology, SA Dermatology Clinic, Daejeon, Korea
| | - Seung Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Chang Ko
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Jun Seo
- Department of Dermatology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
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99
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Kwon TR, Oh CT, Choi EJ, Kim SR, Jang YJ, Ko EJ, Suh D, Yoo KH, Kim BJ. Ultraviolet light-emitting-diode irradiation inhibits TNF-α and IFN-γ-induced expression of ICAM-1 and STAT1 phosphorylation in human keratinocytes. Lasers Surg Med 2015; 47:824-32. [PMID: 26413796 DOI: 10.1002/lsm.22425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Ultraviolet light-emitting diodes (UV-LEDs) are a novel light source for phototherapy. This research investigated the in vitro safety and efficacy of UV-LEDs as a phototherapeutic device for atopic dermatitis (AD). STUDY DESIGN/MATERIALS AND METHODS Human keratinocytes and fibroblasts were irradiated by UV-LEDs with a center wavelength of 310 and 340 nm. We examined the effects of UV-LED irradiation on the suppression of TNF-α/IFN-γ-induced activation of STAT1 and ICAM-1 and on NF-κB expression; we used the following methods: cell viability assay, reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, Western blotting, and immunocytochemistry. RESULTS We observed anti-inflammatory responses through the suppression of TNF-α/IFN-γ-induced expression of TARC and MCP-1/CCL2, IL-1beta, IL-6, and sICAM-1 via blockage of ICAM-1 activation and subsequent activation of STAT1 and NF-κB. The results suggested that UV-LED irradiation inhibited ICAM expression by suppressing TNF-α/IFN-γ-induced NF-κB activation in vitro. CONCLUSION We concluded that novel UV-LED (310 and 340 nm) modalities were effective for the treatment of AD and may be promising for the treatment of inflammatory skin diseases.
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Affiliation(s)
- Tae-Rin Kwon
- Department of Medicine, Graduate, School, Chung-Ang, University, Seoul, Korea
- Department of Dermatology, Chung-Ang, University, College of Medicine, Seoul, Korea
| | - Chang Taek Oh
- Department of Medicine, Graduate, School, Chung-Ang, University, Seoul, Korea
- Department of Dermatology, Chung-Ang, University, College of Medicine, Seoul, Korea
| | - Eun Ja Choi
- Department of Dermatology, Chung-Ang, University, College of Medicine, Seoul, Korea
| | - Soon Re Kim
- Department of Dermatology, Chung-Ang, University, College of Medicine, Seoul, Korea
| | - Yu-Jin Jang
- Department of Dermatology, Chung-Ang, University, College of Medicine, Seoul, Korea
| | - Eun Jung Ko
- Department of Dermatology, Chung-Ang, University, College of Medicine, Seoul, Korea
| | - Daewoong Suh
- Department of Materials Science and Engineering, Seoul National University, Seoul, Korea
| | - Kwang Ho Yoo
- Department of Dermatology, College of Medicine, Catholic Kwandong University, International St.Mary's Hospital, Incheon, Korea
| | - Beom Joon Kim
- Department of Medicine, Graduate, School, Chung-Ang, University, Seoul, Korea
- Department of Dermatology, Chung-Ang, University, College of Medicine, Seoul, Korea
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100
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Fernández-Guarino M, Aboin-Gonzalez S, Barchino L, Velazquez D, Arsuaga C, Lázaro P. Treatment of moderate and severe adult chronic atopic dermatitis with narrow-band UVB and the combination of narrow-band UVB/UVA phototherapy. Dermatol Ther 2015; 29:19-23. [PMID: 26301893 DOI: 10.1111/dth.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The phototherapy is a safe and effective technique for the treatment of adult patients with atopic dermatitis (AD). The treatment of chronic forms of the disease is most often done with narrow-band UVB (NB-UVB). There also exist effective phototherapy options against the AD. The aim of this study was to asses if the combination of NB-UVB with UVA was more effective than the treatment with only NB-UVB against adult chronic AD. We carried out a prospective and observational study. Adult patients with chronic AD with more than 50% of the total body surface area affected (TBSA) were included. The affected TBSA was calculated using the so-called "rule of nines." Patients with a clearance rate >75% of the initial affected TBSA or complete clearance rate were considered as complete response (CR). An analogue scale from 0 to 10 was used to measure the improvement grade of the pruritus. The treatments were repeated three times a week. The initial doses of NB-UVB and UVA were determined by patient's phototype. The treatments were performed using a phototherapy booth (UV7002, Walmann, Villingen-Schwenningen, Germany(®) ) with TL01 and UVA fluorescent lamps. Statistical analysis was performed with SPSS(®) (IBM, New York, NY) for Windows 21.0. A total of 26 patients with adult chronic AD were included in the study, 16 patients were treated with UVB-BE and 10 patients with the combined treatment option NB-UVB/UVA. The mean value of cumulative doses and the mean number of performed treatments were similar between both groups of patients (p > 0.05). The mean value of duration of response was significantly higher in the patients treated only with NB-UVB, 101 versus 6.8 months (p ≥ 0.05). No differences were observed for the patients that showed complete response (p = 0.42) and in the analogue scale of pruritus (p > 0.005). In our study, the patients treated with the combination of NB-UVB and UVA were similar to the patient that were only treated with NB-UVB e. Further prospective and controlled studies have to be performed in order to determine the dosing regimens of phototherapy in adult patients with AD.
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Affiliation(s)
- Montserrat Fernández-Guarino
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - Sonsoles Aboin-Gonzalez
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - Lucia Barchino
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - Diana Velazquez
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - Carmen Arsuaga
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - Pablo Lázaro
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
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