The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis: A Randomized Controlled Study

Avena sativa (Oat), a potential neutraceutical and therapeutic agent: an overview

The aim of the present review article is to summarize the available information related to the availability, production, chemical composition, pharmacological activity, and traditional uses of Avena sativa to highlight its potential to contribute to human health. Oats are now cultivated worldwide and form an important dietary staple for the people in number of countries. Several varieties of oats are available. It is a rich source of protein, contains a number of important minerals, lipids, β-glucan, a mixed-linkage polysaccharide, which forms an important part of oat dietary fiber, and also contains various other phytoconstituents like avenanthramides, an indole alkaloid-gramine, flavonoids, flavonolignans, triterpenoid saponins, sterols, and tocols. Traditionally oats have been in use since long and are considered as stimulant, antispasmodic, antitumor, diuretic, and neurotonic. Oat possesses different pharmacological activities like antioxidant, anti-inflammatory, wound healing, immunomodulatory, antidiabetic, anticholesterolaemic, etc. A wide spectrum of biological activities indicates that oat is a potential therapeutic agent.

Consensus guidelines for the management of atopic dermatitis: an Asia-Pacific perspective

Atopic dermatitis (AD) is a relatively common disease in patients in the Asia-Pacific region. It presents a particular clinical challenge and requires careful clinical management. The chronic nature of AD characterized by flares, exacerbations and periods of quiescence requires a multipronged approach aimed at reducing itch, inflammation and the appearance of secondary lesions. In addition, varying levels of maintenance therapy may be required to avoid exacerbations. Survey data from the region indicate that there is significant variation across the Asia-Pacific with regard to current treatment practices. The management of AD may also be influenced by differing health-care systems, variable climate, access to medical care and cultural diversity. The current consensus guidelines have been developed to provide up-to-date and concise evidence- and experience-based recommendations directed towards general practitioners and general dermatologists in the Asia-Pacific region on the management of pediatric and adult AD.

Management of difficult-to-treat atopic dermatitis

Atopic dermatitis is a complex disorder caused by the interplay between multiple genetic and environmental factors. Particularly in patients with severe disease, the effect is not just an itchy rash but also the secondary effects on the psychological well-being of the patient and their carers, particularly disturbed sleep. The aim of this review is to provide health care professionals with a holistic approach to the management of difficult-to-treat atopic dermatitis, defined as atopic dermatitis seemingly unresponsive to simple moisturizers and mild potency (classes VI and VII) topical corticosteroids. The critical importance of education and advice is emphasized, as is the seminal role of secondary bacterial infection and polyclonal T-cell activation in causing acute flares in patients with severe, generalized disease. In atypical cases or those that do not respond to treatment, alternative diagnoses should be considered.

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

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

Safety and efficacy of personal care products containing colloidal oatmeal

BACKGROUND

Colloidal oatmeal is a natural ingredient used in the formulation of a range of personal care products for relief of skin dryness and itchiness. It is also used as an adjunctive product in atopic dermatitis. The safety of personal care products used on vulnerable skin is of particular importance and the risk of developing further skin irritations and/or allergies should be minimized.

METHODS

In a series of studies, we tested the safety of personal care products containing oatmeal (creams, cleansers, lotions) by assessing their irritant/allergenic potential on repeat insult patch testing, in safety-in-use and ocular studies using subjects with nonsensitive and sensitive skin. We also tested the skin moisturizing and repair properties of an oatmeal-containing skin care product for dry skin.

RESULTS

We found that oatmeal-containing personal care products had very low irritant potential as well as a very low allergenic sensitization potential. Low-level reactions were documented in 1.0% of subjects during the induction phase of repeat insult patch testing; one of 2291 subjects developed a persistent but doubtful low-level reaction involving edema during the challenge phase in repeat insult patch testing. No allergies were reported by 80 subjects after patch testing after in-use application. Sustained skin moisturizing was documented in subjects with dry skin that lasted up to 2 weeks after product discontinuation.

CONCLUSION

Our results demonstrate that colloidal oatmeal is a safe and effective ingredient in personal care products. No allergies were reported by consumers of 445,820 products sold during a 3-year period.

Management of patients with atopic dermatitis: the role of emollient therapy

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

Methods to Assess the Protective Efficacy of Emollients against Climatic and Chemical Aggressors

Exposure to harsh environmental conditions, such as cold and dry climate and chemicals can have an abrasive effect on skin. Skin care products containing ingredients that avert these noxious effects by reinforcement of the barrier function can be tested using in vivo models. The objective is to use in vivo models to assess the efficacy of emollients in protecting skin against climatic and chemical insults. A first model used a stream of cooled air to mimic cold wind. A second used sodium lauryl sulfate (SLS) under patch as chemical aggressor. In the model with simulated wind exposure, the untreated exposed area had a significant decrease in hydration. In contrast, application of an emollient caused a significant increase in hydration that was maintained after wind exposure. In the second model with SLS exposure, application of a barrier cream before SLS patch significantly reduced the dehydrating effect of SLS with a significant difference in variation between both areas. Application of the cream reduced TEWL, indicative of a physical reinforcement of the skin barrier. The two presented test methods, done under standardized conditions, can be used for evaluation of protective effect of emollient, by reinforcing the barrier function against experimentally induced skin dehydration.

Therapeutic implications of a barrier-based pathogenesis of atopic dermatitis

Excessive Th2 cell signaling and IgE production play key roles in the pathogenesis of atopic dermatitis (AD). Yet, recent information suggests that the inflammation in AD instead is initiated by inherited insults to the barrier, including a strong association between mutations in FILAGGRIN and SPINK5 in Netherton syndrome, the latter of which provides an important clue that AD is provoked by excess serine protease activity. But acquired stressors to the barrier may also be required to initiate inflammation in AD, and in addition, microbial colonization by Staphylococcus aureus both amplifies inflammation, but also further stresses the barrier in AD. Therapeutic implications of these insights are as follows: While current therapy has been largely directed toward ameliorating Th2-mediated inflammation and/or pruritus, these therapies are fraught with short-term and potential long-term risks. In contrast, "barrier repair" therapy, with a ceramide-dominant triple-lipid mixture of stratum corneum lipids, is more logical, of proven efficacy, and it provides a far-improved safety profile.

Management of itch in atopic dermatitis

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

A proposal: Atopic Dermatitis Organizer (ADO) guideline for children

Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder in children, with a worldwide cumulative prevalence in children of 8-20%. The number of AD patients is beyond the level that can be dealt with at clinics and it is time to make an effort to reduce the number of AD patients in the community. Thus, caregivers and all persons involved with AD management, including health care providers, educators, technologists and medical policy makers, should understand the development and the management of AD. Although a number of guidelines such as Practical Allergy (PRACTALL) report have been developed and used, community understanding of these is low. This is probably because there are still remarkable differences in management practices between specialists and between countries and most of the reported guidelines have been prepared for physicians. From the viewpoint of providing a basis for a multidisciplinary team approach, easily comprehensible guidelines for organizing treatment of AD, i.e. an Atopic Dermatitis Organizer (ADO), are required. guidelines should be simple and well organized. We suggest an easy approach with a new classification of AD symptoms into early and/or progressive lesions in acute and/or chronic symptoms. The contents of this ADO guideline basically consist of 3 steps approaches: conservative management, topical anti-inflammatory therapy, and systemic anti-inflammatory therapy.

Health outcome measures in atopic dermatitis: a systematic review of trends in disease severity and quality-of-life instruments 1985-2010

BACKGROUND

A number of disease-severity and quality-of-life (QoL) instruments have emerged in atopic dermatitis (AD) in the last decade.

OBJECTIVES

To identify trends in outcomes instruments used in AD clinical trials and to provide a useful summary of the dimensions and validation studies for the most commonly used measures.

METHOD

All randomized control trials (RCTs) from 1985 to 2010 in the treatment of AD were examined.

RESULTS

Among the 791 RCTs reviewed, we identified 20 disease-severity and 14 QoL instruments. Of these outcomes instruments, few have been validated. SCORAD, EASI, IGA and SASSAD were the most commonly used disease-severity instruments and CDLQI, DFI, DLQI and IDQOL were the most frequently used QoL measures.

LIMITATIONS

The small number of RCTs using QoL scales makes identifying trends for QoL instruments difficult.

CONCLUSION

Overall, there is an increase in the use of disease-severity and QoL instruments in AD clinical trials.

Natural peroxisome proliferator-activated receptor-alpha agonist cream demonstrates similar therapeutic response to topical steroids in atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) requires permanent skin care.

OBJECTIVE

A cream containing 2% SO (sunflower oleodistillate), with peroxisome proliferator-activated receptor-alpha (PPAR-α) agonist properties, has been compared to a topical steroid (hydrocortisone butyro-propionate 1 mg/g).

METHODS

An open, randomized study included two groups of 40 children (aged 3 months to 4 years). Group A applied the steroid and group B applied the 2% SO cream, twice a day. SCORAD (SCORing Atopic Dermatitis) was determined at D0, D7 and D21 and quality of life (QoL) at D0 and D21.

RESULTS

SCORAD was similar at D0 (37.2 versus 36.9), D7 (18.9 versus 19.2) (-49% and -48%) and D21 (11 versus 9.4) (-70% and -75%) (p < 0.01 versus D0). The Infant Dermatitis Quality of Life and Dermatitis Family Impact Questionnaire improved similarly by 65%/67% in group A and 72%/75% in group B at D21 (p < 0.01 versus D0).

CONCLUSION

A 2% SO cream has demonstrated therapeutic properties, using clinical scores and QoL, comparable to those of a topical steroid.

On the role of topical glucocorticosteroids in treatment of atopic dermatitis inchildren

The article discusses the role of topical glucocorticosteroids in treatment of children suffering from atopic dermatitis as well as problems of clinical efficacy and safety of application of mometasone furoate (Elocom®) for this dermatosis during the period of exacerbation.

What's new in atopic eczema?

IMPORTANCE OF THE FIELD

Atopic eczema (AE) is a chronic relapsing inflammatory skin condition and one of the most common, potentially debilitating diseases with increasing incidence.

AREAS COVERED IN THIS REVIEW

The complex etiology of AE with multiple systemic and local immunologic and inflammatory responses and interactions between susceptibility genes and environmental factors leading to defects in skin barrier function and eczematous skin lesions is presented. Knowledge of pathogenesis is important for understanding the more innovative treatment approaches discussed.

WHAT THE READER WILL GAIN

Basic therapy consists of hydrating topical treatment and avoidance of specific and unspecific provocation factors. For acute eczematous skin lesions, anti-inflammatory treatment consists mainly of topical glucocorticoids and topical calcineurin inhibitors (tacrolimus and pimecrolimus). Microbial colonization and superinfection may induce skin exacerbation, which can be treated by either topical or systemic antimicrobial treatment. Systemic anti-inflammatory therapy is limited to severe cases and consists of systemic steroids, cyclosporine A or mycophenolate mofetil. Novel anti-inflammatory concepts that go beyond corticosteroids are in the early phases of development. There are targeted therapeutic approaches, such as cytokine and chemokine modulators and it remains to be investigated how effective they will be and what side effects they may carry.

TAKE HOME MESSAGE

Existing treatment modalities such as barrier repair therapy, topical immunosuppressive agents, antiseptic treatment as well as systemic treatment options are discussed. The review aims to summarize the most recent findings of more innovative treatment approaches such as modulation of cytokines or chemokines, modulation of T-cell responses or anti-IgE therapy.

Therapeutic Implications of a Barrier-based Pathogenesis of Atopic Dermatitis

In this review, I first provide relevant background information about normal epidermal barrier structure and function. I then update recent information about how inherited defects in either filaggrin and/or in the serine protease inhibitor, lymphoepithelial Kazal-type inhibitor 1, converge to stimulate the development of atopic dermatitis (AD). Next I explain the multiple mechanisms whereby a primary barrier abnormality in AD can lead to inflammation. Furthermore, I explore how certain acquired stressors, such as a reduced external humidity, high pH soaps/surfactants, psychological stress, as well as secondary Staphylococcus aureus infections initiate or further aggravate AD. Finally, and most importantly, I compare various therapeutic paradigms for AD, highlighting the risks and benefits of glucocorticoids and immunomodulators vs. corrective, lipid replacement therapy.

Pediatric Atopic Dermatitis: A Review of the Medical Management

Objective:

To evaluate the available treatment options for pediatric atopic dermatitis,

Data Sources:

A literature review was performed in MEDLINE (1950-February 2010) using the key word atopic dermatitis. The references identified were evaluated in comparative treatment. The references included in this review were limited to studies conducted in children less than 18 years of age and written in the English language.

Study Selection and Data Extraction:

All of the literature retrieved that was published within the last 5 years (2005-2010) was included in this review. Other pertinent articles published prior to 2005 were also included.

Data Synthesis:

Atopic dermatitis is a chronic inflammatory skin disorder that usually begins during infancy. Potential causes include irritants such as soap and detergents, food allergens, contact allergens, and skin infections. Emollients, moisturizing agents that inhibit water loss and provide a protective coating, are recommended in all patients with atopic dermatitis. Additionally, emollients may reduce the need to use topical corticosteroids. Patients receiving desanide 0.05% plus an emollient achieved significant reductions in severity scores compared to those receiving desonide 0.05% as monotherapy (80% vs 70%; p < 0.01). Topical calcineurin inhibitors are not recommended as first-line therapy in pediatric patients with atopic dermatitis; however, their use in children above 2 years of age who fail to respond to topical corticosteroids may be considered.

Conclusions:

Emollients are recommended in pediatric patients with a diagnosis of atopic dermatitis regardless of symptoms. Topical corticosteroids reduce the inflammation and pruritus associated with atopic dermatitis and are available in several formulations and strengths. Calcineurin inhibitors may be an alternative in children older than 2 years of age who do not respond to topical corticosteroids,

Abnormal skin barrier in the etiopathogenesis of atopic dermatitis

PURPOSE OF REVIEW

Many recent studies have revealed the key roles played by Th1/Th2 cell dysregulation, IgE production, mast cell hyperactivity, and dendritic cell signaling in the pathogenesis of atopic dermatitis. Accordingly, current therapy has been largely directed towards ameliorating Th2-mediated inflammation and/or pruritus. We will review here emerging evidence that the inflammation in atopic dermatitis results from inherited and acquired insults to the barrier and the therapeutic implications of this new paradigm.

RECENT FINDINGS

Recent molecular genetic studies have shown a strong association between mutations in FILAGGRIN and atopic dermatitis, particularly in Northern Europeans. But additional acquired stressors to the barrier are required to initiate inflammation. Sustained hapten access through a defective barrier stimulates a Th1 --> Th2 shift in immunophenotype, which in turn further aggravates the barrier. Secondary Staphylococcus aureus colonization not only amplifies inflammation but also further stresses the barrier in atopic dermatitis.

SUMMARY

These results suggest a new 'outside-to-inside, back to outside' paradigm for the pathogenesis of atopic dermatitis. This new concept is providing impetus for the development of new categories of 'barrier repair' therapy.

Abnormal skin barrier in the etiopathogenesis of atopic dermatitis

Prior studies revealed the key roles played by T-helper type 1 and type 2 (Th1/Th2) cell dysregulation, IgE production, mast cell hyperactivity, and dendritic cell signaling in the evolution of the chronic, pruritic, inflammatory dermatosis that characterizes atopic dermatitis (AD). Accordingly, current therapy has been largely directed toward ameliorating Th2-mediated inflammation and pruritus. This article reviews emerging evidence that the inflammation in AD results from inherited and acquired insults to the barrier, as well as the therapeutic implications of this new paradigm.

Atopic dermatitis and alternative management strategies

PURPOSE OF REVIEW

To discuss the significance of studies published over the previous year regarding the pathogenesis and treatment of atopic dermatitis, including prevention, skin care, environmental modifications, nutrition, education, and anti-inflammatory medications.

RECENT FINDINGS

Recent evidence shows that 42.5% of the caregivers of children with atopic dermatitis had used alternative therapies, most commonly due to fears of topical steroid side-effects and dissatisfaction with conventional treatment. Common questions, such as the potential utility of prenatal probiotics for prevention of atopic dermatitis, as well as the interplay of food allergies and eczema will be discussed in detail. New research continues to show the efficacy and safety of topical calcineurin inhibitors and atopiclair. We will review advances in the understanding of the pathogenesis of atopic dermatitis, and the latest research on therapies available to clinicians to aid them in discussions with their patients.

SUMMARY

Atopic dermatitis impacts negatively the quality of life of both patients and their families. General pediatricians play a pivotal role in the management of this chronic condition. Management should focus on providing sound advice and easing fears regarding topical steroids, as well as pursuing conservative treatments that have the potential to prevent flares.

Avaliação da eficácia e segurança do tacrolimo pomada 0,03% no tratamento da dermatite atópica em pacientes pediátricos

FUNDAMENTOS - Tacrolimo pomada é eficaz no tratamento da dermatite atópica. OBJETIVOS - Avaliar a eficácia e segurança do tacrolimo pomada 0,03% (Protopic®) no tratamento de pacientes pediátricos com dermatite atópica. MÉTODOS - Estudo multicêntrico, aberto e não comparativo. Incluídos 174 pacientes (dois a 10 anos)com dermatite atópica. Utilizou-se tacrolimo duas vezes ao dia, por seis semanas. O critério primário de eficácia foi a melhora clínica > a 90% avaliada pelo médico (Escala de Avaliação Global da Resposta Clínica). Outros critérios de eficácia foram a redução no índice de área e gravidade do eczema (EASI), a redução do percentual de superfície corporal afetada (%BSA) e a avaliação do prurido pelo paciente (escala analógica visual). Segurança foi avaliada pela ocorrência de eventos adversos relatados pelos pais e pacientes ou pelos investigadores. RESULTADOS - Trinta e três por cento dos pacientes apresentaram melhora clínica >90%. Quando avaliado o escore EASI, houve redução de 45,5% (primeira semana) e 61,8% (sexta semana) quando comparado com o basal (p<0,001). Em relação a %BSA, houve redução de 30,4% e 55,5%, na primeira e na sexta semana. Houve redução do prurido em relação ao basal (p<0,001).Os eventos adversos mais comuns foram - queimação e prurido localizados. CONCLUSÃO - Tacrolimo pomada 0,03% é terapia segura e efetiva no tratamento da dermatite atópica leve a grave em pacientes pediátricos.

Emollients improve treatment results with topical corticosteroids in childhood atopic dermatitis: a randomized comparative study

The aim of the study was to investigate whether adding emollients to the standard topical corticosteroid therapy influences the outcome of children with atopic dermatitis. Fifty-two children aged between 2 and 12 yr were divided randomly in two subgroups consisting of 26 children each. Both groups applied 0.1% methylprednisolone aceponate cream on lesional atopic skin once daily for 2 wk and were observed for another 4 wk after treatment discontinuation. Group B used additionally emollients for the whole study period. Patients were evaluated at days 0 (baseline), 7, 14 (end of therapy), 28 and 42 (follow-up). Both groups demonstrated significant improvement of disease severity according to EASI (Eczema Area and Severity Index) scale (group A: 6.8 +/- 3.59 before and 0.87 +/- 1.25 after therapy, p < 0.001; group B: 9.6 +/- 8.39 before and 1.11 +/- 2.37 after therapy, p < 0.001). Xerosis improved significantly better in group B compared to group A, both clinically (group A: 1.38 +/- 0.57 scores before and 1.5 +/- 0.58 scores after therapy, p = 0.11; group B: 1.62 +/- 0.64 scores before and 0.12 +/- 0.33 scores after therapy, p < 0.001), and by corneometry assessment (group A: 41.7 +/- 9.1 units before and 51.3 +/- 11.3 units after therapy, p < 0.001; group B: 38.9 +/- 12.9 units before and 58.2 +/- 13.5 units after therapy, p < 0.001). A trend towards faster resolving of pruritus in group B (group A: 5.44 +/- 2.6 scores before and 3.22 +/- 2.31 scores after therapy, p = 0.001; group B: 5.87 +/- 2.79 scores before and 2.24 +/- 1.59 scores after therapy, p < 0.001) was also observed. In group B, the improvement was maintained for couple of weeks after treatment discontinuation, while in group A recurrence of the disease was noted (EASI at day 42 in group A vs. group B: 5.29 +/- 5.6 vs. 1.25 +/- 1.4, p = 0.01). Similar results were also observed for xerosis (p < 0.001) and pruritus (p = 0.002). Concomitant usage of emollients significantly improves xerosis and pruritus during corticosteroid treatment of atopic dermatitis and enables to maintain clinical improvement after therapy discontinuation.

Clinical Evaluation of the Efficacy of a Barrier Cream Containing Polyvinylpyrrolidone in Chronic Hand Eczema

The management of chronic hand eczema is usually difficult. The aim of this open-label study is to assess the effectiveness and ‘steroid-sparing’ activity of a barrier cream containing polyvinylpyrrolidone in patients with chronic hand eczema. Rescue treatment with topical corticosteroids (TCs) was permitted in the event of eczema worsening, whereas preventive measures were maintained unchanged with respect to those adopted by patients in the past. Among the 207 participants, the main diagnosis was irritant contact dermatitis, followed by allergic contact dermatitis and atopic dermatitis. Nearly half of the patients (49%) applied the barrier cream once or twice a day, while the remaining patients used it three or more times per day. Regardless of rescue therapy with TCs, regular use of the barrier cream caused a progressive significant improvement of eczema severity, as indicated by dermatologists' and patients' assessments. A significant reduction in the amount of the TC applied in the last 3 months and in the number of TC treatment days during the previous 4 weeks was found at the end of 12-week treatment with the barrier cream as compared with baseline. The product was also well-tolerated and accepted by the majority of patients. The results of this study suggest that a barrier cream containing polyvinylpyrrolidone can represent a useful tool in the management of chronic hand eczema and may show steroid-sparing effects.

Quality of life of children with atopic dermatitis and their families

PURPOSE OF THE REVIEW

Over the last few years major advances have been made in the conceptualization of quality of life and new instruments have been developed for assessing the construct in paediatric atopic dermatitis. This review looks at these developments and reports on recently published articles on the impact of the condition on affected children and other members of their family.

RECENT FINDINGS

During the period of the review only one article addressing the impact of treatment for paediatric atopic dermatitis on quality of life could be found. This showed the benefits to the quality of life of parents of treating their children with pimecrolimus cream.

SUMMARY

Given the prevalence of paediatric atopic dermatitis and its impact on affected children and their families it is surprising that so little attention has been devoted to the impact of treatment on quality of life. Where standardized measures are included in studies they generally assess outcomes that are of interest to physicians rather than to patients and their carers.

Oat sensitization in children with atopic dermatitis: prevalence, risks and associated factors

BACKGROUND

Topical treatments of atopic dermatitis (AD) may be responsible for cutaneous allergies. Percutaneous sensitization to oat used in emollients/moisturizers has already been reported. Our objectives were to measure the prevalence of oat sensitization in AD children, to assess its relevance, and to look at related parameters.

METHODS

We recruited prospectively children with AD referred for allergy testing between June 2001 and December 2004. Atopy patch tests (APT) and skin prick tests (SPT) to oat proteins (1%, 3% and 5%) and to the European standard series were performed followed by oral food challenge (OFC) and repeated open application test (ROAT) in the oat-sensitized group.

RESULTS

About 302 children were enrolled. Oat APT and SPT were positive in 14.6% and 19.2% of cases, respectively. Children under 2 years of age were more likely to have positive APT. In oat-sensitized children, OFC and ROAT were positive in 15.6% (five of 32) and 28% (seven of 25) of cases, respectively. Thirty-two percentage of oat cream users had oat-positive atopy patch test (APT) vs 0% in the nonusers group.

CONCLUSIONS

Oat sensitization in AD children seen for allergy testing is higher than expected. It may be the result of repeated applications of cosmetics with oats on a predisposed impaired epidermal barrier. We suggest avoiding topical-containing oat proteins in infants with AD.

Steroid-sparing effect of pimecrolimus cream 1% in children with severe atopic dermatitis

OBJECTIVE

To investigate if pimecrolimus cream 1% reduces the need for steroids in the long-term management of severe pediatric atopic dermatitis (AD).

METHODS

A total of 184 pediatric patients (aged 2-17 years) with a history of severe AD according to Rajka and Langeland were enrolled. Patients were randomized to treatment with pimecrolimus cream or vehicle cream for a 24-week period. Prednicarbate 0.25% was applied as rescue medication.

RESULTS

Patients on pimecrolimus required steroids on a mean of 29% of study days, compared with 35% of patients on vehicle (p = 0.1841). On the head and neck only, the respective figures were 10 versus 19% (p = 0.0009). In patients enrolled with acute severe disease (Investigator's Global Assessment > or = 4), steroids were used on 28% of the days in the pimecrolimus group compared to 45% in the control group (p = 0.0024). On the head and neck, steroids were used on 10% of study days with pimecrolimus versus 30% with vehicle (p < 0.0001).

CONCLUSION

The results indicate that the need for topical steroids on the head and neck is reduced with pimecrolimus cream 1% in the management of severe pediatric AD according to the definition of Rajka and Langeland.

Extracorporeal photopheresis as a treatment for patients with severe, refractory atopic dermatitis

INTRODUCTION

Atopic dermatitis (AD) is a complex disease with a variety of possible treatment regimens. The study objective was to demonstrate that methoxsalen used in conjunction with the Uvar XTS photopheresis system (Therakos, Exton, Pa., USA) is safe and can have a clinical effect on the skin manifestations and the quality of life in patients with severe, refractory AD.

METHODS

Single-arm, open-label treatment using the Uvar XTS photopheresis system. Seven patients (4 male and 3 female, median age: 47 years) with severe (SCORAD >45) AD of at least 12 months duration who in the preceding 12 months had been refractory to all 3 of the first-line therapies for AD, i.e. topical steroids, topical calcineurin inhibitors and one form of phototherapy (UVA, UVB or PUVA), or to one of the second-line therapies like systemic steroids or cyclosporine were included in the study. Treatment consisted of two extracorporeal photopheresis treatments (ExP) on successive days every 2 weeks for a minimum of 12 weeks to a maximum of 20 weeks. Quality of life assessment was performed with the SF-36 Health Survey and the Functional Assessment of Chronic Illness Therapy FACT-G Survey. Clinical improvement was documented with SCORAD assessment.

RESULTS

ExP led to a significant decrease in the SCORAD score from 77.7 after 10 cycles to 55.6. Patients reported that they had begun to notice improvement of their skin conditions after 5 cycles of photopheresis. The FACT-G score showed significant improvement from 64.8 to 72.9 (p < 0.05) and the SF-36 Health Survey showed significant improvement in the emotional well-being subscores (p < 0.05).

CONCLUSIONS

ExP can have a significant therapeutic effect on the skin and quality of life improvement in a selected group of patients with severe AD who are refractory to conventional forms of therapy. However, larger studies are needed to further evaluate its therapeutic potential.