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Okoshi K, Ito S, Matsuoka M, Kinugasa Y, Shimizu E, Tanaka K, Okada J, Nishizaka T, Nagasawa A, Seki T, Iijima M, Abe M, Nemoto O. Combination of a Topical Anti-Inflammatory Drug and a Moisturizer, Both with a Lamellar Structure Containing Synthetic Pseudo-Ceramides, for the Treatment of Patients with Mild-to-Moderate Atopic Dermatitis. Clin Cosmet Investig Dermatol 2024; 17:1569-1578. [PMID: 38974707 PMCID: PMC11227832 DOI: 10.2147/ccid.s467934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024]
Abstract
Purpose Atopic dermatitis is characterized by chronic inflammation and dryness accompanied by severe itching. The combined use of moisturizers and topical anti-inflammatory drugs is essential for alleviating atopic dermatitis. We have developed a topical anti-inflammatory drug with a steroid and a moisturizer with heparinoid, both in lamellar structure-based formulations containing synthetic pseudo-ceramides. Here, assessed the efficacy of this combination in the treatment of atopic dermatitis. Methods We included 22 patients with mild to moderate atopic dermatitis and subjected them to a seven-week treatment with the test formulations, followed by a four-week post-treatment period. Results Clinical findings and the quality of life of participants remarkably improved after one week of treatment. Furthermore, skin hydration and transepidermal water loss considerably improved at weeks one and three, respectively. The Cer [NP]/[NS] ratio, an indicator of epidermal turnover, substantially increased during the treatment period and remained elevated even thereafter. The improvement in stratum corneum function was distinctive in participants with lower barrier function. Conclusion These findings indicated that the combined use of the anti-inflammatory drug and moisturizer, both in lamellar structure-based formulations, is effective in treating atopic dermatitis in patients with fragile barrier function.
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Affiliation(s)
- Keita Okoshi
- Human Health Care Products Research, Kao Corporation, Tokyo, Japan
| | - Shotaro Ito
- Human Health Care Products Research, Kao Corporation, Tokyo, Japan
| | - Megumi Matsuoka
- Human Health Care Products Research, Kao Corporation, Tokyo, Japan
| | | | - Eri Shimizu
- Analytical Science Research, Kao Corporation, Tochigi, Japan
| | - Kosei Tanaka
- Analytical Science Research, Kao Corporation, Tochigi, Japan
| | - Joji Okada
- Skin Care Products Research, Kao Corporation, Tokyo, Japan
| | | | - Azumi Nagasawa
- Human Health Care Products Research, Kao Corporation, Tokyo, Japan
| | - Tsuyoshi Seki
- Human Health Care Products Research, Kao Corporation, Tokyo, Japan
| | - Makoto Iijima
- Human Health Care Products Research, Kao Corporation, Tokyo, Japan
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Celebi Sozener Z, Özbey Yücel Ü, Altiner S, Ozdel Oztürk B, Cerci P, Türk M, Gorgülü Akin B, Akdis M, Yilmaz I, Ozdemir C, Mungan D, Akdis CA. The External Exposome and Allergies: From the Perspective of the Epithelial Barrier Hypothesis. FRONTIERS IN ALLERGY 2022; 3:887672. [PMID: 35873598 PMCID: PMC9304993 DOI: 10.3389/falgy.2022.887672] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction In the last decades, we have seen a rapid increase in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies. The environmental changes caused by industrialization, urbanization and modernization, including dramatic increases in air pollutants such as particulate matter (PM), diesel exhaust, nitrogen dioxide (NO2), ozone (O3), alarming effects of global warming, change and loss of biodiversity, affect both human health and the entire ecosystem. Objective In this review, we aimed to discuss the effects of the external exposome on epithelial barriers and its relationship with the development of allergic diseases by considering the changes in all stakeholders of the outer exposome together, in the light of the recently proposed epithelial barrier hypothesis. Method To reach current, prominent, and comprehensive studies on the subject, PubMed databases were searched. We included the more resounding articles with reliable and strong results. Results Exposure to altered environmental factors such as increased pollution, microplastics, nanoparticles, tobacco smoke, food emulsifiers, detergents, and household cleaners, and climate change, loss and change in microbial biodiversity, modifications in the consumption of dietary fatty acids, the use of emulsifiers, preservatives and the decrease in the antioxidant content of the widely consumed western diet may disrupt the epithelial barriers of the skin, respiratory and gastrointestinal tracts, making us more vulnerable to exogeneous allergens and microbes. Epithelial cell activation, microbial dysbiosis and bacterial translocation disrupt the immune balance and a chronic Th2 inflammation ensues. Conclusion Dramatic increases in air pollution, worrisome effects of global warming, dysbiosis, changing dietary habits and the complex interactions of all these factors affect the epithelial barriers and local and systemic inflammation. We want to draw attention to the emerging health effects of environmental changes and to motivate the public to influence government policies for the well-being of humans and the nature of the earth and the well-being of future generations.
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Affiliation(s)
- Zeynep Celebi Sozener
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
- *Correspondence: Zeynep Celebi Sozener ; orcid.org/0000-0003-4188-0959
| | - Ümüs Özbey Yücel
- Department of Nutrition and Diet, Ankara University, Ankara, Turkey
| | - Seda Altiner
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Betül Ozdel Oztürk
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Eskisehir City Hospital, Eskisehir, Turkey
| | - Murat Türk
- Clinic of Immunology and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Begüm Gorgülü Akin
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Insu Yilmaz
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Erciyes University, Kayseri, Turkey
| | - Cevdet Ozdemir
- Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilsad Mungan
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Cezmi A. Akdis ; orcid.org/0000-0001-8020-019X
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3
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Moisturizer in Patients with Inflammatory Skin Diseases. Medicina (B Aires) 2022; 58:medicina58070888. [PMID: 35888607 PMCID: PMC9315586 DOI: 10.3390/medicina58070888] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
As interest in skin increases, the cosmetic market is also growing. It is difficult to choose between the numerous types of basic cosmetics on the market. This article aims to provide advice and guidance on which products to recommend according to a patient’s skin condition. Appropriate application of a moisturizer attempts not only to improve the dryness, but also improve the skin’s natural barrier function to protect the skin from internal and external irritants to keep the skin healthy. Moisturizers consist of various ingredients, including occlusive agents, emollients, humectants, lipid mixture, emulsifiers, and preservatives. Pathophysiology of dry skin is also discussed to provide readers with the background they need to choose the right moisturizer for themselves. As moisturizers play an important role as adjuvant in the treatment of common skin diseases, such as atopic dermatitis, contact dermatitis, psoriasis, acne and rosacea, which type of moisturizer is appropriate for each disease was also dealt with. Basic cosmetics, especially moisturizers, should be recommended in consideration of the ingredients, effectiveness and safety of each product, and the skin condition of each patient.
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Celebi Sozener Z, Ozdel Ozturk B, Cerci P, Turk M, Gorgulu Akin B, Akdis M, Altiner S, Ozbey U, Ogulur I, Mitamura Y, Yilmaz I, Nadeau K, Ozdemir C, Mungan D, Akdis CA. Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease. Allergy 2022; 77:1418-1449. [PMID: 35108405 PMCID: PMC9306534 DOI: 10.1111/all.15240] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.
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Affiliation(s)
| | - Betul Ozdel Ozturk
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic DiseasesEskisehir City HospitalEskisehirTurkey
| | - Murat Turk
- Clinic of Immunology and Allergic DiseasesKayseri City HospitalKayseriTurkey
| | - Begum Gorgulu Akin
- Clinic of Immunology and Allergic DiseasesAnkara City HospitalAnkaraTurkey
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Seda Altiner
- Clinic of Internal Medicine Division of Immunology and Allergic DiseasesKahramanmaras Necip Fazil City HospitalKahramanmarasTurkey
| | - Umus Ozbey
- Department of Nutrition and DietAnkara UniversityAnkaraTurkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Insu Yilmaz
- Department of Chest DiseasesDivision of Immunology and Allergic DiseasesErciyes UniversityKayseriTurkey
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of MedicineDivision of Pulmonary and Critical Care MedicineDepartment of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Cevdet Ozdemir
- Institute of Child HealthDepartment of Pediatric Basic SciencesIstanbul UniversityIstanbulTurkey
- Istanbul Faculty of MedicineDepartment of PediatricsDivision of Pediatric Allergy and ImmunologyIstanbul UniversityIstanbulTurkey
| | - Dilsad Mungan
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
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Zerumbone Treatment Upregulates Hyaluronic Acid Synthesis via the MAPK, CREB, STAT3, and NF-κB Signaling Pathways in HaCaT Cells. BIOTECHNOL BIOPROC E 2022. [DOI: 10.1007/s12257-020-0341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Hon KL, Chu S, Leung AKC, Wong A. Atopic Dermatitis: Conventional and Integrative Medicine. Curr Pediatr Rev 2022; 18:84-96. [PMID: 34279204 DOI: 10.2174/1573396317666210716152325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/24/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between conventional, complementary, alternative, and integrative medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shenzhou, Hong Kong.,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| | - Samantha Chu
- Faculty of Medicine, The Chinese University of Hong Kong, Shenzhou, Hong Kong
| | - Alexander K C Leung
- Department of Paediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
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7
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Ferrucci S, Romagnuolo M, Maronese CA, Germiniasi F, Tavecchio S, Angileri L, Casazza G, Marzano AV, Genovese G. Skin barrier status during dupilumab treatment in patients with severe atopic dermatitis. Ther Adv Chronic Dis 2021; 12:20406223211058332. [PMID: 34900210 PMCID: PMC8655442 DOI: 10.1177/20406223211058332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Atopic dermatitis (AD) is a common chronic-relapsing inflammatory skin disease hallmarked by epidermal barrier dysfunction, increased transepidermal water loss (TEWL) and decreased skin hydration. Recent findings on the T helper 2 (Th2)-driven pathogenesis of AD have led to the development of dupilumab, a monoclonal antibody directed against interleukin-4 and interleukin-13 that has been demonstrated to be effective in the treatment of moderate-to-severe AD. The effect of dupilumab on skin barrier dysfunction, however, has not yet been adequately investigated. Objectives: The primary endpoint of this study was to assess the status of the skin barrier in nonlesional skin of patients with severe AD treated with dupilumab, by evaluating the association between the relative variation of TEWL and the achievement of a 75% reduction of EASI (EASI75) over time. Methods: TEWL was measured below the antecubital fossae by means of the Vapometer® at baseline, at week 4 (T4), at week 16 (T16) and at week 32 after dupilumab starting. EASI and NRS-itch were measured at the same time points. Results: Seventy-eight patients with severe AD treated with dupilumab were enrolled. Median TEWL relative variation respect to baseline was significantly higher in patients who achieved EASI75 as compared with those who did not achieve EASI75 at T16 and at T32, but not at T4. Conclusion: During dupilumab treatment, TEWL on nonlesional skin tends to significantly improve 4 months after treatment initiation and could be a good tool for monitoring response to therapy.
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Affiliation(s)
- Silvia Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesca Germiniasi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Simona Tavecchio
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Luisa Angileri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Università degli Studi di Milano, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122 Milan, Italy. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Barnes TM, Mijaljica D, Townley JP, Spada F, Harrison IP. Vehicles for Drug Delivery and Cosmetic Moisturizers: Review and Comparison. Pharmaceutics 2021; 13:2012. [PMID: 34959294 PMCID: PMC8703425 DOI: 10.3390/pharmaceutics13122012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Many dermatological conditions, such as eczema and psoriasis, are treated with topical therapeutic products. Instead of applying the active drug directly onto the skin, it is combined with a vehicle to aid in its delivery across the stratum corneum (SC) and into deeper regions of the skin, namely the epidermis and dermis. Absorption into the systemic circulation is minimized. Topical vehicles are also used as cosmetic moisturizers (often termed emollient therapy) to ameliorate dry skin, which is a cornerstone of the management of various dermatological conditions, including xerosis, eczema, psoriasis, and aging. The most common topical vehicles include ointments, creams, gels, and lotions, among others. It is crucial that topical vehicles are chosen based upon the size and properties (wet/dry, mucous/non-mucous, healthy/diseased) of the skin to be treated in order to optimize application and contact of the product with the skin, as this can have profound impacts on potency, efficacy, and patient compliance. This review examines common topical vehicles used for drug delivery and cosmetic moisturizers, including their formulation, advantages and disadvantages, and effects on the skin. The unique rules imposed by governing regulatory bodies in Australia and around the world, in terms of topical product claims, are also briefly examined.
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Affiliation(s)
| | | | | | | | - Ian P. Harrison
- Department of Scientific Affairs, Ego Pharmaceuticals Pty Ltd., Braeside, VIC 3195, Australia; (T.M.B.); (D.M.); (J.P.T.); (F.S.)
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Funamoto KZ, Furuhashi MA, Muta K, Ozawa N, Nakaoji K, Hamada K, Kikuchi K, Tagami H. Physiological Skin Characteristics of Infants and Children Compared to Those of Women. Cureus 2021; 13:e19904. [PMID: 34976512 PMCID: PMC8712251 DOI: 10.7759/cureus.19904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction There is little information regarding skin conditions in infants and children, especially with respect to age, anatomical sites, and seasonal variations. This study aimed to compare the physiological skin characteristics of infants and children with those of women. Methods This study involved skin measurements and a questionnaire-based survey assessing healthy infants and children aged one month to six years and four months (37 males and 48 females) and 15 healthy women in their twenties in the summer, and healthy infants and children aged two months to six years and seven months (34 males and 45 females) and 15 healthy women in their twenties in the winter. The physiological characteristics of the skin of infants and children were surveyed by age. We excluded infants and children with allergic symptoms at the time of measurement. There were 11 subjects with a history of atopic dermatitis. Results Compared with women, infants and children had lower stratum corneum water content and higher transepidermal water loss (TEWL) at most sites. Minimal sebum secretion was observed throughout the body in infants and children aged ≥1 year. The skin surface pH of infants and children was low throughout the body. The questionnaire revealed that skin issues were most common at the anterior neck and cubital fossa, where TEWL was markedly high. These results suggest that barrier function is less developed in the skin of infants and children than in the skin of women. Conclusions The physiological characteristics of skin varied depending on age, anatomical site, and season; hence, skincare guidance must be provided according to these factors.
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Kritsanaviparkporn C, Sangaphunchai P, Treesirichod A. Efficacy of moisturizers in paediatric atopic dermatitis: A systematic review and meta-analysis of randomised controlled trials. Indian J Dermatol Venereol Leprol 2021; 88:22-31. [PMID: 34623061 DOI: 10.25259/ijdvl_1384_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Topical moisturizer is recommended for atopic dermatitis. AIMS The aim of the study was to investigate the knowledge gap regarding the efficacy of moisturizer in young patients. METHODS A systematic review and meta-analysis were conducted on randomised controlled trials comparing participant's ≤15 years with atopic dermatitis, receiving either topical moisturizer or no moisturizer treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. RESULTS Six trials were included (intervention n= 436; control n= 312). Moisturizer use extended time to flare by 13.52 days (95% confidence interval 0.05-26.99, I2 88%). Greater reduction in risk of relapse was observed during the first month of latency (pooled risk ratio 0.47, 95% confidence interval 0.31-0.72, I2 28%) compared to the second and third months (pooled risk ratio 0.65, 95% confidence interval 0.47-0.91, I2 35% and pooled risk ratio 0.63, 95% confidence interval 0.47-0.83, I2 33%, respectively).Treated patients were 2.68 times more likely to experience a three-six months remission (95% confidence interval1.18-6.09, I2 56%). Moisturizer minimally improved disease severity and quality of life. LIMITATIONS There is a dire need to conduct randomised controlled trialswith more robust and standardised designs. CONCLUSION Moisturizer benefits young patients with atopic dermatitis. However, more research is needed to better estimate its efficacy.
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Affiliation(s)
- Chawan Kritsanaviparkporn
- Department of Paediatrics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
| | - Phoomphut Sangaphunchai
- Department of Paediatrics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
| | - Arucha Treesirichod
- Department of Paediatrics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
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Fujii M. The Pathogenic and Therapeutic Implications of Ceramide Abnormalities in Atopic Dermatitis. Cells 2021; 10:2386. [PMID: 34572035 PMCID: PMC8468445 DOI: 10.3390/cells10092386] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Ceramides play an essential role in forming a permeability barrier in the skin. Atopic dermatitis (AD) is a common chronic skin disease associated with skin barrier dysfunction and immunological abnormalities. In patients with AD, the amount and composition of ceramides in the stratum corneum are altered. This suggests that ceramide abnormalities are involved in the pathogenesis of AD. The mechanism underlying lipid abnormalities in AD has not yet been fully elucidated, but the involvement of Th2 and Th1 cytokines is implicated. Ceramide-dominant emollients have beneficial effects on skin barrier function; thus, they have been approved as an adjunctive barrier repair agent for AD. This review summarizes the current understanding of the mechanisms of ceramide abnormalities in AD. Furthermore, the potential therapeutic approaches for correcting ceramide abnormalities in AD are discussed.
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Affiliation(s)
- Masanori Fujii
- Department of Pharmacology, Division of Pathological Sciences, Kyoto Pharmaceutical University, Kyoto 607-8414, Japan
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12
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Contardi M, Lenzuni M, Fiorentini F, Summa M, Bertorelli R, Suarato G, Athanassiou A. Hydroxycinnamic Acids and Derivatives Formulations for Skin Damages and Disorders: A Review. Pharmaceutics 2021; 13:999. [PMID: 34371691 PMCID: PMC8309026 DOI: 10.3390/pharmaceutics13070999] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023] Open
Abstract
Alterations of skin homeostasis are widely diffused in our everyday life both due to accidental injuries, such as wounds and burns, and physiological conditions, such as late-stage diabetes, dermatitis, or psoriasis. These events are locally characterized by an intense inflammatory response, a high generation of harmful free radicals, or an impairment in the immune response regulation, which can profoundly change the skin tissue' repair process, vulnerability, and functionality. Moreover, diabetes diffusion, antibiotic resistance, and abuse of aggressive soaps and disinfectants following the COVID-19 emergency could be causes for the future spreading of skin disorders. In the last years, hydroxycinnamic acids and derivatives have been investigated and applied in several research fields for their anti-oxidant, anti-inflammatory, and anti-bacterial activities. First, in this study, we give an overview of these natural molecules' current source and applications. Afterwards, we review their potential role as valid alternatives to the current therapies, supporting the management and rebalancing of skin disorders and diseases at different levels. Also, we will introduce the recent advances in the design of biomaterials loaded with these phenolic compounds, specifically suitable for skin disorders treatments. Lastly, we will suggest future perspectives for introducing hydroxycinnamic acids and derivatives in treating skin disorders.
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Affiliation(s)
- Marco Contardi
- Smart Materials, Italian Institute of Technology, 16163 Genoa, Italy; (M.L.); (F.F.); (G.S.)
| | - Martina Lenzuni
- Smart Materials, Italian Institute of Technology, 16163 Genoa, Italy; (M.L.); (F.F.); (G.S.)
- DIBRIS, University of Genoa, 16145 Genoa, Italy
| | - Fabrizio Fiorentini
- Smart Materials, Italian Institute of Technology, 16163 Genoa, Italy; (M.L.); (F.F.); (G.S.)
- DIBRIS, University of Genoa, 16145 Genoa, Italy
| | - Maria Summa
- Translational Pharmacology, Italian Institute of Technology, 16163 Genoa, Italy; (M.S.); (R.B.)
| | - Rosalia Bertorelli
- Translational Pharmacology, Italian Institute of Technology, 16163 Genoa, Italy; (M.S.); (R.B.)
| | - Giulia Suarato
- Smart Materials, Italian Institute of Technology, 16163 Genoa, Italy; (M.L.); (F.F.); (G.S.)
- Translational Pharmacology, Italian Institute of Technology, 16163 Genoa, Italy; (M.S.); (R.B.)
| | - Athanassia Athanassiou
- Smart Materials, Italian Institute of Technology, 16163 Genoa, Italy; (M.L.); (F.F.); (G.S.)
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13
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Hon KLE, Chan VPY, Leung AKC. Experimental Drugs with the Potential to Treat Atopic Eczema. J Exp Pharmacol 2021; 13:487-498. [PMID: 34012301 PMCID: PMC8126870 DOI: 10.2147/jep.s259299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Eczema or atopic dermatitis (AD) is a chronically relapsing dermatosis characterized by pruritus and a significant impact on the quality of life. METHODS The authors undertook a structured search of peer-reviewed research articles from PubMed and Google Scholar. Recent and up-to-date studies relevant to the topic were included. RESULTS This report overviews current treatment and experimental drug for AD. Topical agents including topical phosphodiesterase E4 (PDE4) inhibitors such as crisaborole are efficacious in the treatment of AD with few side effects. Monoclonal antibodies such as dupilumab given subcutaneously are efficacious for more severe disease. Systemic treatment can ameliorate symptoms in severe and recalcitrant AD. New systemic treatment includes several traditional herbal formulations that have undergone clinical trials using modern research methodology to determine their efficacy and safety. AD is associated with many complicating psychosocial issues. Often suboptimal efficacy is due to unrealistic expectations and poor compliance making treatment difficult in spite of effective treatment and efforts in drug discovery. Randomized trials have shown that novel topical and subcutaneous medications are safe and efficacious. Regarding herbs, a methodology for the investigation of herbal medications is often flawed and scientific evidence is lacking. Experimental drugs include various biologics, PDE4 and JAK inhibitors in topical, oral, subcutaneous or intravenous forms are in various phases of trials. CONCLUSION Many novel medications demonstrate efficacy for AD. Experimental drugs include various biologics, PDE4 and JAK inhibitors are in various phases of trials.
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Affiliation(s)
- Kam Lun Ellis Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Hong Kong, People’s Republic of China
| | - Vivian P Y Chan
- Pharmacy Department, The Hong Kong Children’s Hospital, Hong Kong, People’s Republic of China
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and the Alberta Children’s Hospital, Calgary, Alberta, Canada
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14
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Leung AK, Lam JM, Leong KF, Leung AA, Wong AH, Hon KL. Nummular Eczema: An Updated Review. ACTA ACUST UNITED AC 2021; 14:146-155. [DOI: 10.2174/1872213x14666200810152246] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022]
Abstract
Background:
Nummular eczema may mimic diseases that present with annular configuration
and the differential diagnosis is broad.
Objective:
This article aimed to provide an update on the evaluation, diagnosis, and treatment of
nummular eczema.
Methods:
A PubMed search was performed in using the key terms “nummular eczema”, “discoid
eczema”, OR “nummular dermatitis”. The search strategy included meta-analyses, randomized controlled
trials, clinical trials, observational studies, and reviews. The search was restricted to English
literature. The information retrieved from the above search was used in the compilation of the present
article. Patents were searched using the key terms “nummular eczema”, “discoid eczema”, OR
“nummular dermatitis” in www.google.com/patents and www.freepatentsonline.com.
Results:
Nummular eczema is characterized by sharply defined, oval or coin-shaped, erythematous,
eczematous plaques. Typically, the size of the lesion varies from 1 to 10cm in diameter. The
lesions are usually multiple and symmetrically distributed. Sites of predilection include the lower
limbs followed by the upper limbs. The lesions are usually intensely pruritic. The diagnosis is mainly
clinical based on the characteristic round to oval erythematous plaques in a patient with diffusely
dry skin. Nummular eczema should be distinguished from other annular lesions. Dermoscopy
can reveal additional features that can be valuable for correct diagnosis. Biopsy or laboratory tests
are generally not necessary. However, a potassium hydroxide wet-mount examination of skin scrapings
should be performed if tinea corporis is suspected. Because contact allergy is common with
nummular eczema, patch testing should be considered in patients with chronic, recalcitrant nummular
eczema. Avoidance of precipitating factors, optimal skin care, and high or ultra-high potency
topical corticosteroids are the mainstay of therapy. Recent patents related to the management of
nummular eczema are also discussed.
Conclusion:
With proper treatment, nummular eczema can be cleared over a few weeks, although
the course can be chronic and characterized by relapses and remissions. Moisturizing of the skin
and avoidance of identifiable exacerbating factors, such as hot water baths and harsh soaps may reduce
the frequency of recurrence. Diseases that present with annular lesions may mimic nummular
eczema and the differential diagnosis is broad. As such, physicians must be familiar with this condition
so that an accurate diagnosis can be made, and appropriate treatment initiated.
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Affiliation(s)
- Alexander K.C. Leung
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Joseph M. Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Amy A.M. Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H.C. Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam L. Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Kowloon Bay, Kowloon, Hong Kong
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15
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Practical Recommendations for the Topical Treatment of Atopic Dermatitis in South and East Asia. Dermatol Ther (Heidelb) 2020; 11:275-291. [PMID: 33313998 PMCID: PMC7859143 DOI: 10.1007/s13555-020-00467-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction There is some evidence to suggest that the prevalence of atopic dermatitis (AD) in Asia is rising. We have therefore developed an algorithm for the topical treatment of AD throughout South and East Asia for use by primary care physicians, pediatricians and dermatologists. Methods Nine AD experts from South and East Asia and one from Europe developed the algorithm based upon treatment guidelines, relevant literature and local treatment practices. The algorithm outlines current best practice for the use of emollients, topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI), with the intention of simplifying the treatment regimen of mild-to-moderate AD in South and East Asia. Results Patients with AD should bathe and cleanse affected skin to remove crusts and scales daily. Emollients should also be applied daily as a maintenance treatment. When selecting appropriate topical anti-inflammatory treatment for AD flares, several factors should be taken into consideration, including the patient’s age, attitude to treatment options and site of AD lesions. Given the concerns regarding the risk of skin atrophy with use of TCS, a TCI should be used to treat AD lesions in sensitive skin areas: pimecrolimus is recommended for mild-to-moderate AD in these locations, while tacrolimus should be considered for moderate and severe cases. Either pimecrolimus or tacrolimus is recommended for flares in other, non-sensitive body locations. A proactive or intermittent maintenance treatment strategy involving regular emollient use and twice-weekly application of a TCI to previously affected areas is encouraged to reduce the risk of flares. Conclusions The algorithm proposed here is intended to simplify the topical treatment of mild-to-moderate AD in daily practice in South and East Asian countries.
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Jiménez M, Muñoz FC, Cervantes-García D, Cervantes MM, Hernández-Mercado A, Barrón-García B, Moreno Hernández-Duque JL, Rodríguez-Carlos A, Rivas-Santiago B, Salinas E. Protective Effect of Glycomacropeptide on the Atopic Dermatitis-Like Dysfunctional Skin Barrier in Rats. J Med Food 2020; 23:1216-1224. [DOI: 10.1089/jmf.2019.0247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Mariela Jiménez
- Department of Microbiology, Autonomous University of Aguascalientes, Aguascalientes, México
| | - Fabiola C. Muñoz
- Department of Microbiology, Autonomous University of Aguascalientes, Aguascalientes, México
| | - Daniel Cervantes-García
- Department of Microbiology, Autonomous University of Aguascalientes, Aguascalientes, México
- National Council of Science and Technology, Mexico City, México
| | - Maritza M. Cervantes
- Department of Microbiology, Autonomous University of Aguascalientes, Aguascalientes, México
| | | | - Berenice Barrón-García
- Department of Microbiology, Autonomous University of Aguascalientes, Aguascalientes, México
| | | | - Adrián Rodríguez-Carlos
- Medical Research Unit from Zacatecas, Mexican Institute of Social Security, Zacatecas, México
| | - Bruno Rivas-Santiago
- Medical Research Unit from Zacatecas, Mexican Institute of Social Security, Zacatecas, México
| | - Eva Salinas
- Department of Microbiology, Autonomous University of Aguascalientes, Aguascalientes, México
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17
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Takahashi H, Watanabe R, Nishimura K, Moriwaki T. Release of Ceramide Molecules from Ceramide-Containing UV-curable Acrylic Adhesive Gel Sheet Affixed to Human Skin. J Oleo Sci 2020; 69:1307-1315. [PMID: 32908096 DOI: 10.5650/jos.ess20095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ceramide, an intercellular lipid of the stratum corneum, plays an essential role in making the skin barrier. One problem with the use of medical adhesive tape or sheets for skin is that their repeated attachment and detachment may cause some damage to the skin. An attempt has been made to eliminate this problem by mixing ceramide into the adhesive of sheets, and has delivered excellent clinical results. This study aimed to investigate whether ceramide is transferred from the adhesive with added ceramide to the skin. An adhesive sheet was prepared by adding synthetic ceramide (CER) to UV-curable acrylic adhesive gel. After affixing the adhesive sheet to human skin for a certain period, it was peeled off and cut perpendicular to the adhesive surface. Synchrotron micro-infrared spectroscopy of the sectioned samples showed that the ceramide concentration in the gel sheet decreases as the application time to human skin increases. This is thought to be due to the release of CER from the gel sheet.
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Affiliation(s)
- Hiroshi Takahashi
- Division of Pure and Applied Science, Faculty of Science and Technology, Gunma University
| | | | | | - Taro Moriwaki
- Japan Synchrotron Radiation Research Institute (JASRI/Spring-8)
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18
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Chan TC, Wu NL, Wong LS, Cho YT, Yang CY, Yu Y, Lai PJ, Chang YT, Shih IH, Lee CH, Chu CY. Taiwanese Dermatological Association consensus for the management of atopic dermatitis: A 2020 update. J Formos Med Assoc 2020; 120:429-442. [PMID: 32564976 DOI: 10.1016/j.jfma.2020.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/PURPOSE Atopic dermatitis (AD) is a chronic inflammatory disease commonly seen in children and increasingly recognized in adults. With recent advances in the therapeutic development for AD, the Taiwanese Dermatological Association (TDA) established a committee to update the consensus for AD management in Taiwan. This report describes the 2020 updated consensus for the management of AD. METHODS A panel of 11 core members was convened to review and discuss aspects of AD management and draft recommendation during the first two meetings. The 2015 TDA consensus and the 2017 European guideline, along with recent peer-reviewed articles, serve as the foundation for the update. In the third meeting, AD expert dermatologists selected on a national scale were invited to vote on the final statements. A total of 27 dermatologists attended the final meeting. The consensus was achieved when ratings of 7-9 (out of a total score of 9) accounted for ≥ 75% of the total votes. RESULTS Consensus was achieved on the therapeutic options for AD by lines of treatment. A treatment algorithm was presented to illustrate the place of each modality in terms of basic care, acute disease control, and maintenance therapy. Special considerations for the pediatric population, as well as for women during pregnancy and lactation, are discussed. CONCLUSION Topical corticosteroids with long-term emollient-based therapies remain the cornerstone of AD treatment. Systemic treatments are indicated when topical therapies and phototherapy fail to control the disease. The recent approval of dupilumab and emerging targeted therapies are expected to bring significant clinical benefit for patients whose disease is inadequately managed by existing options.
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Affiliation(s)
- Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Nan-Lin Wu
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lai-San Wong
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Chin-Yi Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yu Yu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Po-Ju Lai
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Hsin Shih
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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19
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McClintock SD, Attili D, Dame MK, Richter A, Silvestri SS, Berner MM, Bohm MS, Karpoff K, McCarthy CL, Spence JR, Varani J, Aslam MN. Differentiation of human colon tissue in culture: Effects of calcium on trans-epithelial electrical resistance and tissue cohesive properties. PLoS One 2020; 15:e0222058. [PMID: 32134920 PMCID: PMC7058309 DOI: 10.1371/journal.pone.0222058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background and aims Human colonoid cultures maintained under low-calcium (0.25 mM) conditions undergo differentiation spontaneously and, concomitantly, express a high level of tight junction proteins, but not desmosomal proteins. When calcium is included to a final concentration of 1.5–3.0 mM (provided either as a single agent or as a combination of calcium and additional minerals), there is little change in tight junction protein expression but a strong up-regulation of desmosomal proteins and an increase in desmosome formation. The aim of this study was to assess the functional consequences of calcium-mediated differences in barrier protein expression. Methods Human colonoid-derived epithelial cells were interrogated in transwell culture under low- or high-calcium conditions for monolayer integrity and ion permeability by measuring trans-epithelial electrical resistance (TEER) across the confluent monolayer. Colonoid cohesiveness was assessed in parallel. Results TEER values were high in the low-calcium environment but increased in response to calcium. In addition, colonoid cohesiveness increased substantially with calcium supplementation. In both assays, the response to multi-mineral intervention was greater than the response to calcium alone. Consistent with these findings, several components of tight junctions were expressed at 0.25 mM calcium but these did not increase substantially with supplementation. Cadherin-17 and desmoglein-2, in contrast, were weakly-expressed under low calcium conditions but increased with intervention. Conclusions These findings indicate that low ambient calcium levels are sufficient to support the formation of a permeability barrier in the colonic epithelium. Higher calcium levels promote tissue cohesion and enhance barrier function. These findings may help explain how an adequate calcium intake contributes to colonic health by improving barrier function, even though there is little change in colonic histological features over a wide range of calcium intake levels.
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Affiliation(s)
- Shannon D. McClintock
- Department of Pathology, The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Durga Attili
- Department of Cell & Developmental Biology, The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Michael K. Dame
- Department of Internal Medicine (The Division of Gastroenterology), The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Aliah Richter
- Department of Pathology, The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Sabrina S. Silvestri
- Department of Internal Medicine (The Division of Gastroenterology), The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Maliha M. Berner
- Department of Internal Medicine (The Division of Gastroenterology), The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Margaret S. Bohm
- Department of Internal Medicine (The Division of Gastroenterology), The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Kateryna Karpoff
- Department of Internal Medicine (The Division of Gastroenterology), The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Caroline L. McCarthy
- Department of Internal Medicine (The Division of Gastroenterology), The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Jason R. Spence
- Department of Internal Medicine (The Division of Gastroenterology), The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - James Varani
- Department of Pathology, The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Muhammad N. Aslam
- Department of Pathology, The University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- * E-mail:
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20
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Hon KL, Loo S, Leung AKC, Li JTS, Lee VWY. An overview of drug discovery efforts for eczema: why is this itch so difficult to scratch? Expert Opin Drug Discov 2020; 15:487-498. [PMID: 32050818 DOI: 10.1080/17460441.2020.1722639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Atopic dermatitis (AD) is a type of allergic/inflammatory dermatitis characterized by itch and an impairment in quality of life.Areas covered: Herein, the authors review drug discovery efforts for AD, highlighting the clinical efficacy of novel drugs, with a particular focus on the relief of pruritus. Topical agents include emollients, topical antihistamines, corticosteroids, calcineurin inhibitors and herbs. Recently, topical phosphodiesterase E4 (PDE4) inhibitors like crisaborole have become available and are efficacious for mild to moderate AD with few side effects. For more severe AD, monoclonal antibodies like dupilumab are considered as efficacious subcutaneous treatment options. In severe and recalcitrant AD, systemic treatment can ameliorate AD symptoms.Expert opinion: Many topical and systemic medications have demonstrated therapeutic benefits for AD. Indeed, randomized trials have shown that topical PDE4 inhibitors and subcutaneous dupilumab are safe and efficacious. Objective tools to evaluate itch and gauge treatment efficacy is important, but current methodology relies primarily on clinical scores. AD is a systemic atopic disease with a lot of complicated psychosocial issues. Suboptimal efficacy is often due to poor compliance and unrealistic expectation of curative treatment, rendering treatment difficult despite the existence of effective medications.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,The Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Steven Loo
- The Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joyce T S Li
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vivian W Y Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Shatin, Hong Kong
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21
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Leung AKC, Lam JM, Leong KF. Scabies: A Neglected Global Disease. Curr Pediatr Rev 2020; 16:33-42. [PMID: 31544694 DOI: 10.2174/1573396315666190717114131] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Scabies is a skin disease caused by an obligate human parasite mite Sarcoptes scabiei var. hominis. Children under the age of two and elderly individuals are at the greatest risk. Knowledge of this condition is important for an early diagnosis to be made and treatment to be initiated. OBJECTIVE The review aimed to familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of scabies. METHODS A search was conducted using Pubmed with the built-in "Clinical Queries" tool. The search term "Scabies" was used. The categories of "epidemiology", "diagnosis", "therapy", "prevention" and "prognosis" had a limited scope for primary clinical studies. Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. RESULTS Worldwide, scabies affects 200 to 300 million individuals annually. The average prevalence is estimated to be 5 to 10% in children of developing countries. Transmission usually occurs after close prolonged skin-to-skin contact. Classic scabies is characterized by an erythematous papular eruption, serpiginous burrows, and intense pruritus. Sites of predilection include the webs of the fingers, volar wrists, lateral aspects of fingers, extensor surfaces of elbows and knees, waist, navel, abdomen, buttocks, groins, and, genitals. A clinical diagnosis of classic scabies can be made on the basis of the history and clinical findings. Other clinical variants include crusted scabies, nodular scabies, and bullous scabies. Finding the mite, ova, or fecal pellets on microscopic examination of scrapings taken from skin lesions confirms the diagnosis of scabies infestation. For eradication of scabies mites, the drugs of choice are topical permethrin and oral ivermectin. CONCLUSION Scabies is a highly contagious parasitic cutaneous disease that is stigmatising and debilitating. Increased awareness, accurate diagnosis, and prompt treatment are essential for the effective control of scabies and for the prevention of the spread of the disease.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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22
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Chou WL, Lee TH, Huang TH, Wang PW, Chen YP, Chen CC, Chang ZY, Fang JY, Yang SC. Coenzyme Q 0 From Antrodia cinnamomea Exhibits Drug-Resistant Bacteria Eradication and Keratinocyte Inflammation Mitigation to Ameliorate Infected Atopic Dermatitis in Mouse. Front Pharmacol 2019; 10:1445. [PMID: 31849685 PMCID: PMC6901829 DOI: 10.3389/fphar.2019.01445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022] Open
Abstract
Atopic dermatitis (AD) is an inflammatory skin disease that is usually accompanied by Staphylococcus aureus infection due to cutaneous barrier-function damage. Benzenoid compounds from Antrodia cinnamomea are known to exhibit antibacterial and anti-inflammatory activities. This study sought to investigate the potential of benzenoids for treating bacteria-infected AD. The compounds were screened against methicillin-resistant S. aureus (MRSA). Coenzyme Q0 (CoQ0), a key ingredient in A. cinnamomea, showed the strongest MRSA growth inhibition. We further tested the inhibitory effect of CoQ0 on planktonic and biofilm MRSA. The work was also performed to explore the potential effectiveness of CoQ0 on AD using activated keratinocytes and in vivo experimental AD mice as the models. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of CoQ0 against MRSA were 7.81 μg/ml. CoQ0 was found to eradicate biofilm MRSA efficiently and reduce the biofilm thickness. CoQ0 killed MRSA by inhibiting DNA polymerase and topoisomerases. A proteomic assay showed that CoQ0 also reduced the ribosomal proteins. In the anti-inflammation study, CoQ0 was found to downregulate the expression of interleukin (IL)-6, chemokine (C-C motif) ligand (CCL)5, and CCL17 in HaCaT cells. CoQ0 at 0.5 μg/ml could recover the filaggrin decreased by HaCaT activation to the normal control. We established a bacteria-infected AD-like model in mice using ovalbumin (OVA) and topically applied MRSA. Topical CoQ0 delivery lessened the MRSA presence in the AD-like lesions by >90%. The erythema, barrier function, and epidermal thickness of the AD-like wounds were improved by CoQ0 through the reduction of IL-1β, IL-4, IL-6, IL-10, interferon (IFN)-γ, and by neutrophil infiltration in the lesional skin. CoQ0 is therefore regarded as effective in mitigating AD symptoms associated with bacterial load.
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Affiliation(s)
- Wei-Ling Chou
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tzong-Huei Lee
- Institute of Fisheries Science, National Taiwan University, Taipei, Taiwan
| | - Tse-Hung Huang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pei-Wen Wang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ya-Ping Chen
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Chang Chen
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Zi-Yu Chang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Medicine, Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jia-You Fang
- Pharmaceutics Laboratory, Graduate Institute of Natural Products, Chang Gung University, Taoyuan, Taiwan.,Chinese Herbal Medicine Research Team, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Chun Yang
- Department of Cosmetic Science, Providence University, Taichung, Taiwan
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23
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Bouthillette M, Beccati D, Akthakul A, Ramadurai N, Nashat A, Langer R, Anderson RR, Sakamoto FH. A crosslinked polymer skin barrier film for moderate to severe atopic dermatitis: A pilot study in adults. J Am Acad Dermatol 2019; 82:895-901. [PMID: 31589946 DOI: 10.1016/j.jaad.2019.09.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Occlusive treatments are a mainstay in atopic dermatitis (AD) management but may not be well tolerated or lack compliance. A comfortable, semiocclusive, artificial skin barrier that is well tolerated, provides protection, and reduces water loss is needed. OBJECTIVE To evaluate the potential tolerability and therapeutic benefits of a crosslinked polymer layer (XPL) in adults with AD. METHODS A single-center, open-label pilot study was conducted involving 10 subjects with moderate to severe AD. Subjects applied XPL up to twice daily for 30 days on a selected treatment area. Investigator's Global Assessment, clinical signs of eczema, and pruritus were assessed on days 1, 3, 5, 15, and 30. Film durability and patient satisfaction were also evaluated. RESULTS Investigator's Global Assessment scores improved from moderate to severe at baseline to clear to almost clear in 8 of 9 patients at day 30. Pruritus improved from trace to severe itching (baseline) to all subjects having trace to no itching at day 30. There was 1 adverse event of mild exudative dermatitis. LIMITATIONS The study was limited by small sample size, open-label design, and lack of control. CONCLUSION XPL may be an effective adjuvant in AD treatment. A larger study with a control group is warranted.
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Affiliation(s)
- Melaney Bouthillette
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts.
| | - Daniela Beccati
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Ariya Akthakul
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Nithin Ramadurai
- Shiseido Americas Corporation, Cambridge, Massachusetts; Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Amir Nashat
- Olivo Laboratories, LLC, Watertown, Massachusetts
| | - Robert Langer
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts; David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - R Rox Anderson
- Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Fernanda H Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
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Hon KL, Ng WGG, Kung JSC, Leung PC, Leung TF. Pilot Studies on Two Complementary Bath Products for Atopic Dermatitis Children: Pine-Tar and Tea. MEDICINES 2019; 6:medicines6010008. [PMID: 30626074 PMCID: PMC6473907 DOI: 10.3390/medicines6010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/24/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022]
Abstract
Background: Few standardized bath product clinical trials were performed for atopic dermatitis patients. Pine-tar and green tea extracts are plant-derived products that have been described as having anti-allergic effects which may reduce AD disease severity. Methods: The efficacy of two complementary bath products was studied and compared. Efficacy and acceptability of the bath products were measured by patient general acceptability of treatment (GAT: very good, good, fair or poor), disease severity (SCORAD: SCoring Atopic Dermatitis), quality of life (CDLQI: Children Dermatology Life Quality Index), and pertinent clinical parameters were measured before and after four weeks of treatment. Sample size calculations for further clinical trials were performed. In one group, nine AD patients were subjected to bathing with a pine-tar bath oil for 10–15 min daily for four weeks. In another group, 20 AD subjects bathed with a teabag containing green tea extracts for four weeks. Results: Significant improvements in clinical- and patient-orientated parameters were found in the pine-tar bathing group, but not the tea-bag bathing group. Both groups reported very good/good GAT on the studied products. Teabag bathing was considered not efficacious for further clinical trials. Conclusions: The pilot studies provided preliminary data on the efficacy of pine tar bath oil. We do not document a significant efficacy for bathing with tea extracts. Bathing with pine-tar is potentially a complementary topical treatment with good patient acceptance and adherence, but further evidence-based research for its recommendations is needed.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Jeng Sum C Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Ping Chung Leung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong 00852, China.
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 00852, China.
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Hon KL, Kung JS, Ng WGG, Leung TF. Testing an Ectoin Containing Emollient for Atopic Dermatitis. Curr Pediatr Rev 2019; 15:191-195. [PMID: 30987568 DOI: 10.2174/1573396315666190415144244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 11/22/2022]
Abstract
AIM To describe the methodology in studying patient's acceptability and efficacy of an ectoin containing emollient for atopic dermatitis (AD). METHODS We described the methodology that we used in studying emollients and moisturisers, and patient acceptability of a group of AD patients before and following usage of an ectoin-containing proprietary emollient. These data were also compared with other brand emollients that we previously reported, namely Restoradom®, Ezerra® and Ezerra plus®. RESULTS 30 subjects (50% Male, Mean (SD) age: 9.8 (3.6) years with AD used the trial emollient W for four weeks. AD severity of subjects (by objective SCORAD) was moderate (n=22) and severe (n=8). Compliance was good and patients generally managed to use the moisturisers daily, with individual reports of a 'tingly' sensation by some subjects when applied to inflamed wounds. 63% reported "very good" or "good", whereas 37% reported "fair" or "poor" acceptability of the moisturisers. Following use of the trial emollient, area affected, disease intensity and severity significantly improved, as demonstrated in objective SCORAD (p=0.002). There were also significant improvements in POEM (p=0.035), and PADQLQ scores (p=0.017). For skin measurements, only transepidermal water loss had improved (p=0.035) after the treatment. There was no significant improvement of itch or sleep scores, skin hydration, pH, S. aureus colonization status, or need for use of topical medications. When compared with historical data of other emollients, the mean age of patients on emollient W was younger; efficacy and acceptability among these emollients were similar. CONCLUSION Methodology of emollient research is described. Doctors should provide evidencebased information about the efficacy of emollients. The ectoin-containing proprietary emollient improves disease and quality of life following its use in 4 weeks. Efficacy and acceptability are similar among 4 proprietary emollients.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeng Sum Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Sanyal RD, Pavel AB, Glickman J, Chan TC, Zheng X, Zhang N, Cueto I, Peng X, Estrada Y, Fuentes-Duculan J, Alexis AF, Krueger JG, Guttman-Yassky E. Atopic dermatitis in African American patients is T H2/T H22-skewed with T H1/T H17 attenuation. Ann Allergy Asthma Immunol 2019; 122:99-110.e6. [PMID: 30223113 DOI: 10.1016/j.anai.2018.08.024] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND African Americans (AA) are disproportionately impacted by atopic dermatitis (AD), with increased prevalence and therapeutic challenges unique to this population. Molecular profiling data informing development of targeted therapeutics for AD are derived primarily from European American (EA) patients. These studies are absent in AA, hindering development of effective treatments for this population. OBJECTIVE We sought to characterize the global molecular profile of AD in the skin of AA patients as compared with that of EA AD and healthy controls. METHODS We performed RNA-Seq with reverse transcription polymerase chain reaction validation and immunohistochemistry studies in lesional and nonlesional skin of AA and EA AD patients vs healthy controls. RESULTS African American AD lesions were characterized by greater infiltration of dendritic cells (DCs) marked by the high-affinity immunoglobulin E (IgE) receptor (FcεR1+) compared with EA AD (P < .05). Both AD cohorts showed similarly robust up-regulation of Th2-related (CCL17/18/26) and Th22-related markers (interleukin [IL]-22, S100A8/9/12), but AA AD featured decreased expression of innate immune (tumor necrosis factor [TNF], IL-1β), Th1-related (interferon gamma [IFN-γ], MX1, IL-12RB1), and Th17-related markers (IL-23p19, IL-36G, CXCL1) vs EA AD (P < .05). The Th2 (IL-13) and Th22-related products (IL-22, S100A8/9/12) and serum IgE were significantly correlated with clinical severity (Scoring of Atopic Dermatitis [SCORAD]) in AA. Fillagrin (FLG) was exclusively down-regulated in EA AD, whereas loricrin (LOR) was down-regulated in both AD cohorts and negatively correlated with SCORAD in AA. CONCLUSION The molecular phenotype of AA AD skin is characterized by attenuated Th1 and Th17 but similar Th2/Th22-skewing to EA AD. Our data encourages a personalized medicine approach accounting for phenotype-specific characteristics in future development of targeted therapeutics and clinical trial design for AD.
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Affiliation(s)
- Riana D Sanyal
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ana B Pavel
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacob Glickman
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tom C Chan
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; The Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Xiuzhong Zheng
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Ning Zhang
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Inna Cueto
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Xiangyu Peng
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yeriel Estrada
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Judilyn Fuentes-Duculan
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Andrew F Alexis
- Department of Dermatology, Mount Sinai St. Luke's and Mount Sinai West, New York, New York
| | - James G Krueger
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
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27
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Hon KL, Leong KF, Leung TN, Leung AK. Dismissing the fallacies of childhood eczema management: case scenarios and an overview of best practices. Drugs Context 2018; 7:212547. [PMID: 30532792 PMCID: PMC6281040 DOI: 10.7573/dic.212547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Eczema or atopic dermatitis (AD) is a common relapsing childhood dermatologic illness. Treatment of AD is primarily topical with emollients and corticosteroid/calcineurin inhibitor, which is efficacious for the majority of patients. However, AD is often complicated and difficult to manage in many Asian cities. Effective therapy is impeded by fallacies in the following aspects: (1) mistrust and unrealistic expectations about Western medicine, (2) skin care and allergy treatment, (3) ambiguity about optimal bathing and moisturizing, (4) hesitation and phobias about the usage of adequate topical corticosteroid and immunomodulatory therapies, (5) food and aeroallergen avoidance and dietary supplementation, and (6) complementary and alternative therapies. METHODS AND RESULTS Eleven anonymized case scenarios are described to illustrate issues associated with these fallacies. A literature review is performed and possible solutions to handle or dismiss these fallacies are discussed. CONCLUSIONS The first step in patient care is to accurately assess the patient and the family to evaluate possible concerns, anxiety, and phobias that could impede therapeutic efficacy. Education about the disease should be individualized. Conflicting recommendations on the usage of topical steroid have a detrimental effect on management outcomes, which must be avoided.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Kin Fon Leong
- Institut Pediatrik, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
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28
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Montoro V, Asensio C, Martínez Á, Lorente J, Rodríguez FJ, Montojo J, Gavilanes J, Sarría P, Langdon C, Prades E. Efficacy and safety of fluocinolone acetonide 0.025% otic solution in patients with otic eczema: a randomized, double-blind, placebo-controlled clinical trial. J Int Med Res 2018; 46:4050-4060. [PMID: 30141364 PMCID: PMC6166331 DOI: 10.1177/0300060518765333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To assess the efficacy and safety of fluocinolone acetonide 0.025%
otic solution versus placebo in treating patients with otic
eczema. Methods In this multicentre, randomized, double-blind, parallel-group phase
3 clinical trial, conducted at 12 Spanish centres between March
2012 and March 2013, patients received fluocinolone acetonide
0.025% or placebo otic solution twice daily for 7 days (days
1–7) with an 8-day follow-up (days 9–15). Outcome measures
included change in itching from baseline (day 1) to study days
4–8 and 9–15, and change in otoscopic signs (erythema, oedema,
and scaling) from baseline to the end of treatment (day 8) and
end of follow-up (day 15). Results Patients treated with fluocinolone acetonide 0.025% (n = 66), as
compared with placebo-treated patients (n = 69), showed
significantly higher reductions in itching from baseline to
study days 4–8 and 9–15, and in individual and global otoscopic
signs from baseline to the end of treatment (day 8) and end of
follow-up (day 15). Incidence and severity of adverse events was
similar between the fluocinolone and placebo groups. Conclusions Fluocinolone acetonide 0.025% otic solution, administered twice
daily for 7 days, is an effective and safe treatment for otic
eczema.
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Affiliation(s)
- Victoria Montoro
- Otolaryngology Department, Hospital de Mollet, Mollet del Vallès, Spain
| | - Carlos Asensio
- Otolaryngology Department, Hospital Nuestra señora del Prado, Talavera de la Reina, Spain
| | - Ángel Martínez
- Otolaryngology Department, Hospital Virgen de la Salud, Toledo, Spain
| | - Juan Lorente
- Otolaryngology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Francisco J. Rodríguez
- Otolaryngology Department, Hospital General Universitario Santa María del Rosell, Cartagena, Spain
| | - José Montojo
- Otolaryngology Department, Hospital Universitario de Fuenlabrada, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Javier Gavilanes
- Otolaryngology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain
| | - Pedro Sarría
- Otolaryngology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Cristóbal Langdon
- Otolaryngology Department, Hospital Clinic de Barcelona, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Eduard Prades
- Otolaryngology Department, Hospital Comarcal de Blanes, Blanes, Spain
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29
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Simon D, Nobbe S, Nägeli M, Barysch M, Kunz M, Borelli S, Hasan-Ali O, Wildi E, Gasser UE. Short- and long-term effects of two emollients on itching and skin restoration in xerotic eczema. Dermatol Ther 2018; 31:e12692. [PMID: 30246910 DOI: 10.1111/dth.12692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/30/2017] [Accepted: 07/17/2018] [Indexed: 01/15/2023]
Abstract
Pruritus is associated with various skin diseases, dry skin, and with it an impaired skin barrier function. The study objective was to investigate short-term and long-term effects of two emollients on symptoms and skin barrier functions in xerotic eczema. Randomized, double-blind, study enrolling females/males, with bilateral itching. Two emollients, containing lactic acid and refined almond oil with/without polidocanol were administered on left versus right body sides. Itching severity, skin moisture, lipid content, and pH were assessed on Day 1, within 30-120 min after first administration, and on Days 7 and 14, and compared with baseline assessments. Severity of itching decreased 30 min after first administration of both emollients compared with baseline (p < .0001) and reached a maximum reduction of 63% (p < .0001) and 69% (p < .0001) on Day 14. Skin moisture and lipid content increased after first application, and further ameliorated within 14 days of treatment (p < .0001). Both emollients were tolerated well, and only a few adverse events were reported. This study confirmed the clinical efficacy of the two study emollients to substantially reduce itching already after first administration, and restore skin barrier integrity and thus should be considered as therapeutic approach for xerotic eczema.
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Affiliation(s)
- Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Nobbe
- Dermatologisches Ambulatorium, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Mirjam Nägeli
- Dermatologisches Ambulatorium, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Marjam Barysch
- Dermatologisches Ambulatorium, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Michael Kunz
- Dermatologisches Ambulatorium, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Siegfried Borelli
- Dermatologisches Ambulatorium, Stadtspital Triemli, Zürich, Switzerland
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30
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Hon KL, Leung AKC, Leung TNH, Lee VWY. Investigational drugs for atopic dermatitis. Expert Opin Investig Drugs 2018; 27:637-647. [PMID: 30058384 DOI: 10.1080/13543784.2018.1494723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Many novel medications and herbal medicines have claimed efficacy on atopic dermatitis (AD). AREAS COVERED This review covers evidence on efficacy of topical and oral forms of novel and investigational drugs. Topical agents include emollients, phosphodiesterase E4 (PDE4) inhibitors, and topical herbs. There is little evidence that ceramides or natural moisturizing factors provide relief in AD. PDE4 inhibitors have shown promise as an effective topical treatment for mild-to-moderate AD with minimal adverse events, and dupilumab as an effective subcutaneous agent for the treatment of moderate-to-severe AD in adult patients with little adverse effects. However, only preliminary data are available for dupilumab in children with AD. The long-term effects of dupilumab are also not known. Potential new systemic treatments include a number of herbal concoctions. EXPERT OPINION Randomized, double-blind placebo-controlled trials (RCTs) have demonstrated topical PDE4 inhibitors are effective and safe in the treatment of both children and adults with AD but further evaluations are needed. RCTs have also shown that subcutaneous dupilumab is an effective and safe agent for the treatment of AD in adults. Long-term effects of these topical and systemic investigational drugs are currently unavailable. Regarding herbal medications, scientific methods are often flawed and objective evidence is lacking.
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Affiliation(s)
- Kam Lun Hon
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
| | - Alexander K C Leung
- b Department of Pediatrics, The University of Calgary , Alberta Children's Hospital , Calgary , Canada
| | - Theresa N H Leung
- c Department of Paediatrics and Adolescent Medicine , The University of Hong Kong , Hong Kong
| | - Vivian W Y Lee
- d School of Pharmacy , The Chinese University of Hong Kong , Hong Kong
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31
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Zhu TH, Zhu TR, Tran KA, Sivamani RK, Shi VY. Epithelial barrier dysfunctions in atopic dermatitis: a skin-gut-lung model linking microbiome alteration and immune dysregulation. Br J Dermatol 2018; 179:570-581. [PMID: 29761483 DOI: 10.1111/bjd.16734] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atopic dermatitis is a systemic disorder characterized by abnormal barrier function across multiple organ sites. Causes of epidermal barrier breakdown are complex and driven by a combination of structural, genetic, environmental and immunological factors. In addition, alteration in microflora diversity can influence disease severity, duration, and response to treatment. Clinically, atopic dermatitis can progress from skin disease to food allergy, allergic rhinitis, and later asthma, a phenomenon commonly known as the atopic march. The mechanism by which atopic dermatitis progresses towards gastrointestinal or airway disease remains to be elucidated. OBJECTIVES This review addresses how epithelial dysfunction linking microbiome alteration and immune dysregulation can predispose to the development of the atopic march. METHODS A literature search was conducted using the PubMed database for relevant articles with the keywords 'atopic dermatitis', 'epithelial barrier', 'skin', 'gut', 'lung', 'microbiome' and 'immune dysregulation'. RESULTS Initial disruption in the skin epidermal barrier permits allergen sensitization and colonization by pathogens. This induces a T helper 2 inflammatory response and a thymic stromal lymphopoietin-mediated pathway that further promotes barrier breakdown at distant sites, including the intestinal and respiratory tract. CONCLUSIONS As there are no immediate cures for food allergy or asthma, early intervention aimed at protecting the skin barrier and effective control of local and systemic inflammation may improve long-term outcomes and reduce allergen sensitization in the airway and gut.
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Affiliation(s)
- T H Zhu
- University of Southern California Keck School of Medicine, Los Angeles, CA, U.S.A
| | - T R Zhu
- The Warren Alpert Medical School, Brown University, Providence, RI, U.S.A
| | - K A Tran
- Department of Medicine, University of Arizona, Tucson, AZ, U.S.A
| | - R K Sivamani
- Department of Dermatology, University of California, Davis, Sacramento, CA, U.S.A
| | - V Y Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ, U.S.A
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32
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Mohamad J, Sarig O, Godsel LM, Peled A, Malchin N, Bochner R, Vodo D, Rabinowitz T, Pavlovsky M, Taiber S, Fried M, Eskin-Schwartz M, Assi S, Shomron N, Uitto J, Koetsier JL, Bergman R, Green KJ, Sprecher E. Filaggrin 2 Deficiency Results in Abnormal Cell-Cell Adhesion in the Cornified Cell Layers and Causes Peeling Skin Syndrome Type A. J Invest Dermatol 2018; 138:1736-1743. [PMID: 29758285 DOI: 10.1016/j.jid.2018.04.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 12/31/2022]
Abstract
Peeling skin syndromes form a large and heterogeneous group of inherited disorders characterized by superficial detachment of the epidermal cornified cell layers, often associated with inflammatory features. Here we report on a consanguineous family featuring noninflammatory peeling of the skin exacerbated by exposure to heat and mechanical stress. Whole exome sequencing revealed a homozygous nonsense mutation in FLG2, encoding filaggrin 2, which cosegregated with the disease phenotype in the family. The mutation was found to result in decreased FLG2 RNA levels as well as almost total absence of filaggrin 2 in the patient epidermis. Filaggrin 2 was found to be expressed throughout the cornified cell layers and to colocalize with corneodesmosin that plays a crucial role in maintaining cell-cell adhesion in this region of the epidermis. The absence of filaggrin 2 in the patient skin was associated with markedly decreased corneodesmosin expression, which may contribute to the peeling phenotype displayed by the patients. Accordingly, using the dispase dissociation assay, we showed that FLG2 downregulation interferes with keratinocyte cell-cell adhesion. Of particular interest, this effect was aggravated by temperature elevation, consistent with the clinical phenotype. Restoration of corneodesmosin levels by ectopic expression rescued cell-cell adhesion. Taken together, the present data suggest that filaggrin 2 is essential for normal cell-cell adhesion in the cornified cell layers.
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Affiliation(s)
- Janan Mohamad
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Sarig
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lisa M Godsel
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alon Peled
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia Malchin
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ron Bochner
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Vodo
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Rabinowitz
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Pavlovsky
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shahar Taiber
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Fried
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Eskin-Schwartz
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Siwar Assi
- Research Center for Digestive Disease, Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Noam Shomron
- Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Variantyx, Ltd, Framingham, Massachusetts, USA
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jennifer L Koetsier
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Kathleen J Green
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Hon KL, Kung JSC, Ng WGG, Leung TF. Emollient treatment of atopic dermatitis: latest evidence and clinical considerations. Drugs Context 2018; 7:212530. [PMID: 29692852 PMCID: PMC5908267 DOI: 10.7573/dic.212530] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
Aim To review current classes of emollients in the market, their clinical efficacy in atopic dermatitis (AD) and considerations for choice of an emollient. Methods PubMed Clinical Queries under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews were used as the search engine. Keywords of ‘emollient or moisturizer’ and ‘atopic dermatitis’ were used. Overview of findings Using the keywords of ‘emollient’ and ‘atopic dermatitis’, there were 105 and 36 hits under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow) and Systematic Reviews, respectively. Plant-derived products, animal products and special ingredients were discussed. Selected proprietary products were tabulated. Conclusions A number of proprietary emollients have undergone trials with clinical data available on PubMed-indexed journals. Most moisturizers showed some beneficial effects, but there was generally no evidence that one moisturizer is superior to another. Choosing an appropriate emollient for AD patients would improve acceptability and adherence for emollient treatment. Physician’s recommendation is the primary consideration for patients when selecting a moisturizer/emollient; therefore, doctors should provide evidence-based information about these emollients.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | | | - Wing Gi Gigi Ng
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
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Boiten WA, Berkers T, Absalah S, van Smeden J, Lavrijsen APM, Bouwstra JA. Applying a vernix caseosa based formulation accelerates skin barrier repair by modulating lipid biosynthesis. J Lipid Res 2017; 59:250-260. [PMID: 29217624 DOI: 10.1194/jlr.m079186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/08/2017] [Indexed: 01/02/2023] Open
Abstract
Restoring the lipid homeostasis of the stratum corneum (SC) is a common strategy to enhance skin barrier function. Here, we used a ceramide containing vernix caseosa (VC)-based formulation and were able to accelerate barrier recovery in healthy volunteers. The recovery was examined over 16 days by monitoring trans-epidermal water loss (TEWL) after barrier disruption by tape-stripping. Four skin sites were used to examine the effects of both treatment and barrier recovery. After 16 days, samples were harvested at these sites to examine the SC ceramide composition and lipid organization. Changes in ceramide profiles were identified using principal component analysis. After barrier recovery, the untreated sites showed increased levels of ceramide subclass AS and ceramides with a 34 total carbon-atom chain length, while the mean ceramide chain length was reduced. These changes were diminished by treatment with the studied formulation, which concurrently increased the formulated ceramides. Correlations were observed between SC lipid composition, lipid organization, and TEWL, and changes in the ceramide subclass composition suggest changes in the ceramide biosynthesis. These results suggest that VC-based formulations enhance skin barrier recovery and are attractive candidates to treat skin disorders with impaired barrier properties.
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Affiliation(s)
- Walter A Boiten
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Tineke Berkers
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Samira Absalah
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Jeroen van Smeden
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Adriana P M Lavrijsen
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joke A Bouwstra
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
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Xu S, Kwa M, Lohman ME, Evers-Meltzer R, Silverberg JI. Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-selling Moisturizers. JAMA Dermatol 2017; 153:1099-1105. [PMID: 28877310 DOI: 10.1001/jamadermatol.2017.3046] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Because moisturizer use is critical for the prevention and treatment of numerous dermatological conditions, patients frequently request product recommendations from dermatologists. Objective To determine the product performance characteristics and ingredients of best-selling moisturizers. Design and Setting This cohort study involved publicly available data of the top 100 best-selling whole-body moisturizing products at 3 major online retailers (Amazon, Target, and Walmart). Products marketed for use on a specific body part (eg, face, hands, eyelids) were excluded. Main Outcomes and Measures Pairwise comparisons of median price per ounce on the basis of marketing claims (eg, dermatologist recommended, fragrance free, hypoallergenic) and presence of ingredients represented in the North American Contact Dermatitis Group (NACDG) series were conducted using Wilcoxon rank sum tests. The effect of vehicle type (eg, ointment, lotion, cream, butter) was assessed using the Kruskal-Wallis test. Cross-reactors and botanicals for fragrances were derived from the American Contact Dermatitis Society's Contact Allergen Management Program database. Results A total of 174 unique best-selling moisturizer products were identified, constituting 109 713 reviews as of August 2016. The median price per ounce was $0.59 (range, $0.10-$9.51 per ounce) with a wide range (9400%). The most popular vehicles were lotions (102 [59%]), followed by creams (22 [13%]), oils (21 [12%]), butters (14 [8%]), and ointments (3 [2%]). Only 12% (n = 21) of best-selling moisturizer products were free of NACDG allergens. The 3 most common allergens were fragrance mix (n = 87), paraben mix (n = 75), and tocopherol (n = 74). Products with the claim "dermatologist recommended" had higher median price per ounce ($0.79; interquartile range [IQR], $0.56-$1.27) than products without the claim ($0.59; IQR, $0.34-$0.92). Products with the claim "phthalate free" had higher median price per ounce ($1.38; IQR, $0.86-$1.63) than products without the claim ($0.59; IQR, $0.35-$0.91). Lotions (median, $0.49; IQR, $0.31-0.68) were statistically less expensive per ounce than butters (median, $1.20; IQR, $0.76-$1.63), creams (median, $0.80; IQR, $0.69-$1.25) and oils (median, $1.30; IQR, $0.64-$2.43). For products with a claim of "fragrance free," 18 (45%) had at least 1 fragrance cross-reactor or botanical ingredient. Products without any ingredients in the NACDG (median, $0.83; IQR, $0.47-$1.69) were not statistically more expensive per ounce than products with 1 or more allergens (median, $0.60; IQR, $0.35-$1.06). Conclusions and Relevance Best-selling moisturizers vary widely by price and product characteristics. Given the lack of readily available comparison data on moisturizer efficacy, dermatologists should balance consumer preference, price, and allergenicity in their recommendations.
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Affiliation(s)
- Shuai Xu
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Kwa
- medical student at Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary E Lohman
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel Evers-Meltzer
- School of Medicine, Tulane University, New Orleans, Louisiana.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jonathan I Silverberg
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Medicine Multidisciplinary Eczema Center, Northwestern University, Chicago, Illinois
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Lin TK, Zhong L, Santiago JL. Association between Stress and the HPA Axis in the Atopic Dermatitis. Int J Mol Sci 2017; 18:ijms18102131. [PMID: 29023418 PMCID: PMC5666813 DOI: 10.3390/ijms18102131] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023] Open
Abstract
The hypothalamic–pituitary–adrenal (HPA) axis is one of the body’s neuroendocrine networks that responds to psychological stress (PS). In the skin, there exists a peripheral HPA axis similar to the central axis. Glucocorticoids (GCs) are key effector molecules of the HPA axis and are essential for cutaneous homeostasis. Atopic dermatitis (AD) is a condition typically characterized by a chronic relapsing course that often results in PS. HPA dysfunction is present in AD patients by the decreased response of GCs elevation to stress as compared to those unaffected by AD. Nevertheless, in skin, acute PS activates several metabolic responses that are of immediate benefit to the host. During the acute phase of PS, increased endogenous GCs have been shown to provide benefit rather than by aggravating cutaneous inflammatory dermatoses. However, a chronic T helper cell type 2 (Th2) predominant cytokine profile acts as a negative feedback loop to blunt the HPA axis response in AD. In this article, we reviewed the role of CRF, pro-opiomelanocortin (POMC)-derived peptides, GCs of the HPA, and 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) in AD, with a discussion of the pathogenetic mechanisms of inflammation and skin barrier functions, including antimicrobial defense, and their association with PS.
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Affiliation(s)
- Tzu-Kai Lin
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Lily Zhong
- Citrus Valley Medical Center, West Covina, CA 91790, USA.
| | - Juan Luis Santiago
- Dermatology Service & Translational Research Unit (UIT), Hospital General Universitario de Ciudad Real, Ciudad Real 13005, Spain.
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37
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Fabbrocini G, Rossi A, Thouvenin MD, Peraud C, Mengeaud V, Bacquey A, Saint Aroman M. Fragility of epidermis: acne and post-procedure lesional skin. J Eur Acad Dermatol Venereol 2017; 31 Suppl 6:3-18. [DOI: 10.1111/jdv.14410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/09/2017] [Indexed: 12/15/2022]
Affiliation(s)
- G. Fabbrocini
- Department of Clinical Medicine and Surgery; Section of Dermatology; University of Naples; Naples Italy
| | - A.B. Rossi
- Clinical Skin Research Center; Pierre Fabre Dermo-Cosmétique; Toulouse France
- Dermatology Department; Toulouse University Hospital; Toulouse France
| | - M.-D. Thouvenin
- Clinical Skin Research Center; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - C. Peraud
- Clinical Skin Research Center; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - V. Mengeaud
- Clinical Skin Research Center; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - A. Bacquey
- Clinical Skin Research Center; Pierre Fabre Dermo-Cosmétique; Toulouse France
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Joergensen KM, Jemec GBE. Use of moisturizers among Danish atopic dermatitis patients-which perceived product characteristics associate with long-term adherence? J DERMATOL TREAT 2017; 29:116-122. [PMID: 28782438 DOI: 10.1080/09546634.2017.1358803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify factors perceived as most important regarding choice and continued use of moisturizers for adult patients with AD. METHOD AND MATERIALS Online survey among members of the Atopic eczema society Denmark. RESULTS Among 75 participants, the most commonly tried (89.3%) and preferred (16%) product was Locobase® (Leo Pharma, Denmark). A-derma® (Pierre Fabre, France) had most continued use. The main reason for choosing preferred product was 'Best effect, in my experience' (36%). 'High lipid content' and 'GP/dermatologist suggested product' were considered as important main factors. 'Consistency', 'absorbs fast', and 'nice to wear' were secondary reasons for preferred product. A majority, 81.3% of respondents claimed to be very aware of perfumes and additives, 52% were very aware of allergy certification bodies on the product. CONCLUSION AD patients state that the most important factor when choosing a product is out of personal experience followed by high lipid content and recommended by GP/dermatologist. As secondary reasons 'consistency', 'absorbs fast', and 'nice to wear' were important. Respondents generally use more than one product and are aware of additives. Evidence-based guidance on the choice of emollients is needed. The role of the professionals supporting the patient in navigating this market of emollients is therefore particularly important.
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Affiliation(s)
| | - Gregor B E Jemec
- b Department of Dermatology , Zealand University Hospital , Roskilde , Denmark
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39
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40
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Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease affecting ~10–20% of the general population. AD is characterized by disturbances in epidermal barrier function and hyperactive immune response. Recently, changes in the skin and intestinal microbiome have been analyzed in more detail. The available data suggest a link between disturbed skin microbiome and course of the disease. Flares of the disease are associated with an expansion of Staphylococcus aureus on lesional skin and a substantial loss of biodiversity in skin microbiome. Staphylococci exoproteins and superantigens evoke inflammatory reactions in the host. Skin microbiome includes superficial stratum corneum that is affected by environmental factors such as exposure to germs and cleansing. Available evidence argues for a link between epidermal barrier impairment and disturbances in skin microbiome in AD. In contrast to skin microbiome, intestinal microbiome seems to become stabilized after infancy. There is also a significant heritable component for intestinal microbiome. The microbial taxa, relative percentages and quantities vary remarkably between the different parts of the intestinal tract. Early intestinal microbial colonization may be a critical step for prevention of further development of AD. Skin barrier-aimed topical treatments help to develop a neo-microbiome from deeper compartments. Probiotics, prebiotics and synbiotics have been investigated for the treatment of AD, but further investigations are needed. Targeted treatment options to normalize skin and intestinal microbiome in AD are under investigation.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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41
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Wijesinghe DS, Warncke UO, Diegelmann RF. Human as the Ultimate Wound Healing Model: Strategies for Studies Investigating the Dermal Lipidome. CURRENT DERMATOLOGY REPORTS 2016; 5:244-251. [PMID: 28503364 PMCID: PMC5423676 DOI: 10.1007/s13671-016-0156-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Educate the reader of the multiple roles undertaken by the human epidermal lipidome and the experimental techniques of measuring them. RECENT FINDINGS Damage to skin elicits a wound healing process that is capped by the recreation of the lipid barrier. In addition to barrier function, lipids also undertake an active signaling role during wound healing. Achievement of these multiple functions necessitates a significant complexity and diversity in the lipidome resulting in a composition that is unique to the human skin. As such, any attempts to delineate the function of the lipidome during the wound healing process in humans need to be addressed via studies undertaken in humans. SUMMARY The human cutaneous lipidome is unique and play a functionally significant role in maintaining barrier and regulating wound healing. Modern mass spectrometry and Raman spectroscopy based methods enable the investigation epidermal lipidome with respect to those functions.
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Affiliation(s)
- Dayanjan S Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia 23298
| | - Urszula Osinska Warncke
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research (CCTR), Virginia Commonwealth University Richmond, Virginia 23298
| | - Robert F Diegelmann
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298
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Tenn MW, Ellis AK. The clinical relevance of filaggrin mutations: Effect on allergic disease. Ann Allergy Asthma Immunol 2016; 117:483-489. [PMID: 27788876 DOI: 10.1016/j.anai.2016.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Mark W Tenn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anne K Ellis
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Proksch E, Dähnhardt D, S. Dähnhardt-Pfeiffer, Fölster-Holst R. Epidermale Barrierestörung bei Dermatosen. Hautarzt 2016; 67:907-921. [DOI: 10.1007/s00105-016-3883-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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44
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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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Myles IA, Williams KW, Reckhow JD, Jammeh ML, Pincus NB, Sastalla I, Saleem D, Stone KD, Datta SK. Transplantation of human skin microbiota in models of atopic dermatitis. JCI Insight 2016; 1:86955. [PMID: 27478874 PMCID: PMC4963067 DOI: 10.1172/jci.insight.86955] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/24/2016] [Indexed: 01/23/2023] Open
Abstract
Atopic dermatitis (AD) is characterized by reduced barrier function, reduced innate immune activation, and susceptibility to Staphylococcus aureus. Host susceptibility factors are suggested by monogenic disorders associated with AD-like phenotypes and can be medically modulated. S. aureus contributes to AD pathogenesis and can be mitigated by antibiotics and bleach baths. Recent work has revealed that the skin microbiome differs significantly between healthy controls and patients with AD, including decreased Gram-negative bacteria in AD. However, little is known about the potential therapeutic benefit of microbiome modulation. To evaluate whether parameters of AD pathogenesis are altered after exposure to different culturable Gram-negative bacteria (CGN) collected from human skin, CGN were collected from healthy controls and patients with AD. Then, effects on cellular and culture-based models of immune, epithelial, and bacterial function were evaluated. Representative strains were evaluated in the MC903 mouse model of AD. We found that CGN taken from healthy volunteers but not from patients with AD were associated with enhanced barrier function, innate immunity activation, and control of S. aureus. Treatment with CGN from healthy controls improved outcomes in a mouse model of AD. These findings suggest that a live-biotherapeutic approach may hold promise for treatment of patients with AD.
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Affiliation(s)
- Ian A. Myles
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Kelli W. Williams
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Jensen D. Reckhow
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Momodou L. Jammeh
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Nathan B. Pincus
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Inka Sastalla
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Danial Saleem
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Kelly D. Stone
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
| | - Sandip K. Datta
- Bacterial Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Maryland, USA
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Blume-Peytavi U, Lavender T, Jenerowicz D, Ryumina I, Stalder JF, Torrelo A, Cork MJ. Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care. Pediatr Dermatol 2016; 33:311-21. [PMID: 26919683 PMCID: PMC5069619 DOI: 10.1111/pde.12819] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 10/19/2015] [Accepted: 12/15/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care. METHODS The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients. RESULTS Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies' skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided. CONCLUSION Health care professionals can use these recommendations as the basis of their advice to parents.
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Affiliation(s)
- Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tina Lavender
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Dorota Jenerowicz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Irina Ryumina
- Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russia, Federal State Budget Institution, Moscow, Russia
| | | | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Michael J Cork
- Academic Unit of Dermatology Research, Department of Infection and Immunity, Faculty of Medicine, Dentistry and Health, University of Sheffield Medical School, Sheffield, UK
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Ji H, Li XK. Oxidative Stress in Atopic Dermatitis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:2721469. [PMID: 27006746 PMCID: PMC4781995 DOI: 10.1155/2016/2721469] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/31/2016] [Indexed: 12/19/2022]
Abstract
Atopic dermatitis (AD) is a chronic pruritic skin disorder affecting many people especially young children. It is a disease caused by the combination of genetic predisposition, immune dysregulation, and skin barrier defect. In recent years, emerging evidence suggests oxidative stress may play an important role in many skin diseases and skin aging, possibly including AD. In this review, we give an update on scientific progress linking oxidative stress to AD and discuss future treatment strategies for better disease control and improved quality of life for AD patients.
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Affiliation(s)
- Hongxiu Ji
- Incyte Diagnostics, 1280 116th Avenue NE, Bellevue, WA 98004, USA
| | - Xiao-Kang Li
- Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
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Admani S, Matiz C, Jacob SE. Countering Staphylococcus Overgrowth During Patch Testing in Children with Moderate to Severe Atopic Dermatitis. Pediatr Dermatol 2016; 33:56-61. [PMID: 26645114 DOI: 10.1111/pde.12723] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with moderate to severe atopic dermatitis (AD) often have a concurrent diagnosis of contact dermatitis, but patch testing in these patients presents a unique set of challenges. Barrier impairment and Staphylococcus aureus colonization and infection, along with the sealed occlusion that takes place during the patch testing procedure, can create an optimal environment for bacterial overgrowth. AIMS To identify patients at risk for S. aureus overgrowth during patch testing and provide pre- and peripatch testing interventions to aid clinicians in obtaining the best possible patch test results in this complicated population. MATERIALS AND METHODS A retrospective review was performed of five patients with moderate to severe AD for which S. aureus overgrowth and superinfection complicated patch test evaluation. RESULTS All five patients were able to complete the patch test procedure and all had relevant positive patch test reactions. Complications during patch testing included erythema, oozing, foul odor under the patches, and purulent material at the patch sites. One patient had a culture performed during patch testing that showed methicillin-sensitive S. aureus. DISCUSSION Patch testing can play an important role in the examination and management of patients with refractory AD. CONCLUSIONS Moderate to severe AD and concern regarding S. aureus overgrowth should not preclude patch testing.
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Affiliation(s)
- Shehla Admani
- Department of Dermatology, University of California at San Diego, San Diego, California
| | - Catalina Matiz
- Department of Dermatology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, California
| | - Sharon E Jacob
- Department of Dermatology, Loma Linda University, Loma Linda, California.,Contact Dermatitis Clinic, Loma Linda University, Loma Linda, California
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Danial C, Adeduntan R, Gorell ES, Lucky AW, Paller AS, Bruckner AL, Pope E, Morel KD, Levy ML, Li S, Gilmore ES, Lane AT. Evaluation of Treatments for Pruritus in Epidermolysis Bullosa. Pediatr Dermatol 2015; 32:628-34. [PMID: 25557557 PMCID: PMC5079440 DOI: 10.1111/pde.12486] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pruritus is a common complication in patients with epidermolysis bullosa (EB). There is limited published data about the treatments that individuals with EB use for pruritus. The objective of the current study was to determine quantitatively which treatments individuals with EB have used for pruritus and to evaluate the perceived effectiveness of these treatments in pruritus relief. A questionnaire was developed to evaluate the treatments and therapies used for pruritus in patients of all ages and for all types of EB. Questions about bathing products, moisturizers, topical products, oral medications, dressings, and alternative therapies were included. A 5-point Likert scale (-2 = relieves itch a lot, -1 = relieves itch a little, 0 = no change, 1 = increases itch a little, 2 = increases itch a lot) was used to evaluate perceived effectiveness. Patients from seven North American EB centers were invited to participate. Greasy ointments (53.4%), lotions (45.2%), creams (40.4%), and oral hydroxyzine (39.0%) were the most frequently used treatments for pruritus. Treatments that were used frequently and perceived to be the most effective included creams (mean = -1.1), topical prescription corticosteroids (mean = -1.0), oils (mean = -0.9), oral hydroxyzine (mean = -0.9), topical diphenhydramine (mean = -0.9), and vaporizing rub (menthol, camphor, eucalyptus) (mean = -0.9). Systemic opioids (mean = 0.3), adherent bandages (mean = 0.3), and bleach baths (mean = 0.2) slightly increased pruritus. Randomized controlled trials of therapies will be necessary to develop evidence-based recommendations for control of pruritus in individuals with EB.
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Affiliation(s)
- Christina Danial
- Department of Dermatology, School of Medicine, Stanford University, Palo Alto, California
| | - Rasidat Adeduntan
- Department of Dermatology, School of Medicine, Stanford University, Palo Alto, California
| | - Emily S Gorell
- Department of Dermatology, School of Medicine, Stanford University, Palo Alto, California
| | - Anne W Lucky
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anna L Bruckner
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Elena Pope
- Department of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly D Morel
- Department of Dermatology, Columbia University Medical Center, New York, New York.,Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Moise L Levy
- Department of Dermatology, Dell Children's Medical Center of Central Texas, Austin, Texas
| | - Shufeng Li
- Department of Dermatology, School of Medicine, Stanford University, Palo Alto, California
| | - Elaine S Gilmore
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Alfred T Lane
- Department of Dermatology, School of Medicine, Stanford University, Palo Alto, California
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Esposito S, Patria MF, Spena S, Codecà C, Tagliabue C, Zampiero A, Lelii M, Montinaro V, Pelucchi C, Principi N. Impact of genetic polymorphisms on paediatric atopic dermatitis. Int J Immunopathol Pharmacol 2015; 28:286-95. [DOI: 10.1177/0394632015591997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In order to investigate whether polymorphisms of genes encoding some factors of innate and adaptive immunity play a role in the development of, or protection against atopic dermatitis (AD) and condition its severity, we genotyped 33 candidate genes and 47 single nucleotide polymorphisms (SNPs) using Custom TaqMan Array Microfluidic Cards and an ABI 7900HT analyser (Applied Biosystems, Foster City, CA, USA). The study involved 104 children with AD (29 with mild-to-moderate and 75 with severe disease; 42 girls; mean age ± SD, 5.8 ± 3.3 years) and 119 healthy controls (49 girls; mean age, 4.8 ± 3.0 years). IL10-rs1800872T, TG and MBL2-rs500737AG were all significantly more frequent among the children with AD ( P = 0.015, P = 0.004 and P = 0.030), whereas IL10-rs1800896C and TC were more frequent in those without AD ( P = 0.028 and P = 0.032). The VEGFA-rs2146326A and CTLA4-rs3087243AG SNPs were significantly more frequent in the children with mild/moderate AD than in those with severe AD ( P = 0.048 and P = 0.036). IL10-rs1800872T and TG were significantly more frequent in the children with AD and other allergic diseases than in the controls ( P = 0.014 and P = 0.007), whereas IL10-rs1800896TC and C were more frequent in the controls than in the children with AD and other allergic diseases ( P = 0.0055 and P = 0.0034). These findings show that some of the polymorphisms involved in the immune response are also involved in some aspects of the development and course of AD and, although not conclusive, support the immunological hypothesis of the origin of the inflammatory lesions.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Spena
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Codecà
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zampiero
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Montinaro
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Pelucchi
- Department of Epidemiology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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