1
|
Anheyer M, Cramer H, Ostermann T, Anheyer D. Herbal Medicine in Children and Adults With Atopic Dermatitis: A Systematic Review and Meta-Analysis. Dermatitis 2024. [PMID: 38963342 DOI: 10.1089/derm.2024.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Herbal medicine is widely used for dermatological diseases, particularly atopic dermatitis. This study aims to systematically review existing literature on the efficacy of both topical and systemic herbal interventions for atopic dermatitis across various age groups. Conducting a comprehensive search on MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (Central) until April 12, 2023, only randomized controlled trials (RCTs) were included. The review is reported following the PRISMA guidelines and was conducted in accordance to Cochrane recommendations. Two authors independently extracted details, including demographics, medication, control/placebo groups, outcomes, adverse events, and results, with quality assessment using the Cochrane risk of bias tool 2.0. A meta-analysis, utilizing the random-effects model, was conducted, and publication bias was assessed through funnel plot inspection. The quality of evidence adhered to GRADE working group recommendations. The primary focus was evaluating atopic dermatitis or pruritus severity. The review encompassed 51 RCTs (3763 participants). Of these, 31 RCTs explored 19 distinct herbs and five complex remedies, whereas 20 RCTs (1088 participants) specifically investigated evening primrose oil (EPO). Herbs such as sunflower, licorice, figs, coconut, EPO, indigo naturalis, licorice, mauve, St. John's wort, and a combination of aloe vera and olive oil were found to have evidence of efficacy in the local treatment of atopic dermatitis. A meta-analysis on systemic used EPO, involving 13 RCTs, found no significant difference in atopic dermatitis severity compared with placebo (SMD: 0.14; 95% CI [-0.45; 0.73], 13 RCTs). In conclusion, this review provides a nuanced perspective on herbal substance efficacy for atopic dermatitis. While the EPO meta-analysis failed to show a discernible benefit beyond placebo, individual herbal preparations showed promising results in RCTs included in this review. Nevertheless, larger, methodologically rigorous studies are essential to establish evidence for herbal remedies in atopic dermatitis treatment.
Collapse
Affiliation(s)
- Melanie Anheyer
- From the Department for Pediatric and Adolescent Medicine, Elisabeth Hospital Essen, Essen, Germany
- Professorship of integrative pediatrics, Faculty of Health, University Witten/Herdecke, Witten/Herdecke, Germany
| | - Holger Cramer
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Chair of Research Methodology and Statistics in Psychology, University Witten/Herdecke, Witten/Herdecke, Germany
| | - Dennis Anheyer
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
- Department of Psychology and Psychotherapy, Chair of Research Methodology and Statistics in Psychology, University Witten/Herdecke, Witten/Herdecke, Germany
| |
Collapse
|
2
|
Pham Q, Hrin ML, Ghamrawi RI, Fleischer AB, Taylor SL, Feldman SR. Receptivity to misinformation is associated with a preference for complementary alternative medicine for atopic dermatitis. Int J Dermatol 2024; 63:e119-e120. [PMID: 38572810 DOI: 10.1111/ijd.17143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Quan Pham
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Matthew L Hrin
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rima I Ghamrawi
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alan B Fleischer
- Department of Dermatology, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah L Taylor
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Azhari H, Ng SF, Mohd Razali R, Loo HL. The use of essential oils in atopic dermatitis: a review. Curr Med Res Opin 2024; 40:753-763. [PMID: 38625386 DOI: 10.1080/03007995.2024.2340734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
Atopic dermatitis (AD) has become a common childhood disease that affects a large number of children worldwide and has become a chronic skin disease that causes huge economical and psychological damage to the whole family. Despite the use of steroids, immunosuppressants, and various topical preparation, the prognosis is still poor. Hence, this review aimed to explore the potential of using essential oils (EO) as an active ingredient in managing AD. The review was completed by using Pubmed, Scopus, and Medline to search for relevant articles that study the pathophysiology of AD, the properties of EO, the use of EO in managing AD, and the suitable advanced formulation to incorporate EO. From the review conducted, it was concluded that EO have huge potential in managing AD and can be used as complimentary therapeutic agents in AD treatment. Scientists and industries should venture into commercializing more topical products with EO to help manage AD more effectively.
Collapse
Affiliation(s)
- Hanisah Azhari
- Centre for Drug Delivery Technology and Vaccine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shiow-Fern Ng
- Centre for Drug Delivery Technology and Vaccine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Razifah Mohd Razali
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Terengganu, Terengganu, Malaysia
| | - Hooi Leong Loo
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| |
Collapse
|
4
|
Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol 2024; 132:274-312. [PMID: 38108679 DOI: 10.1016/j.anai.2023.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).
Collapse
Affiliation(s)
- Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Mark Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | | | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Joey Huynh
- Sepulveda VA Medical Center, North Hills, California
| | | | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mary Laura Lind
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona
| | - Peter Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Monica O'Brien
- Tufts University School of Medicine, Boston, Massachusetts
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Gordon H Guyatt
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | | | - Alexandro W L Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Irene X Zhao
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Lina Chen
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Paul Oykhman
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Layla Bakaa
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - David Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| | | | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jay Lieberman
- University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee
| | - David Stukus
- Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elissa Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| |
Collapse
|
5
|
Wang SH, Liang RL, Yang H, Cai XC, Wang J, Sun XY, Chen JL, Wang CX, Jiang WC, Li X. Electroacupuncture for relieving itching in atopic eczema: study protocol for a multicenter, randomized, sham-controlled trial. Front Med (Lausanne) 2023; 10:1320230. [PMID: 38173936 PMCID: PMC10761491 DOI: 10.3389/fmed.2023.1320230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Atopic eczema (AE) is a common atopic inflammatory skin disease affecting 2.1-4.9% of the population in different countries. Pruritus, one of the most burdensome symptoms, is often underestimated for the problems it can cause, creating a vicious loop of itching, scratching, and lichenification. Therefore, further research into practical and safe treatments that relieve itchy symptoms and enhance skin protection is key to overcoming AE. Acupuncture, with or without electrical stimulation, is one of the most commonly used therapeutic measures to treat AE. This trial aimed to objectively evaluate the efficacy and safety of the electroacupuncture (EA) antipruritic technique in AE pruritus and obtain high-level clinical evidence for the popularization and application of EA for AE. Methods and analysis This multicenter, single-blinded, randomized controlled trial is planned to transpire from April 15, 2023, to June 30, 2025. We will recruit 132 participants with AE (44 per group). Participants will be assigned randomly to three equal-sized groups: EA, sham electroacupuncture, and sham acupuncture. Treatment will be administered three times a week during the 2-week intervention phase. The primary outcome measure is the Visual Analog Scale, with a numeric rating scale to evaluate pruritus. Secondary outcome measures include the Eczema Area and Severity Index and Dermatology Life Quality Index. Other outcome measures include physical examination, serum IgE, and safety evaluation. The number, nature, and severity of adverse events will be carefully recorded. Trial registration ClinicalTrials.gov, 22Y11922200. Registered 3 September 2022, https://register.clinicaltrials.gov.
Collapse
Affiliation(s)
- Si-han Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Rui-long Liang
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Han Yang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-ce Cai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-ying Sun
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jia-le Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Chun-xiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Wen-cheng Jiang
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
6
|
Wang MC, Chou YT, Kao MC, Lin QY, Chang SY, Chen HY. Topical Chinese herbal medicine in treating atopic dermatitis (eczema): A systematic review and meta-analysis with core herbs exploration. JOURNAL OF ETHNOPHARMACOLOGY 2023; 317:116790. [PMID: 37328084 DOI: 10.1016/j.jep.2023.116790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/18/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Topical Chinese herbal medicine (CHM) is commonly used to relieve atopic dermatitis (AD); however, the up-to-date evidence concerning the effectiveness of topical CHM on treating AD is lacking. Moreover, the CHM prescriptions are often too complicated to realize the overall mechanisms of CHM, especially when compared to western medicines (WM). AIM OF THE STUDY To evaluate the effectiveness of topical CHM for treating AD by conducting a meta-analysis on randomized clinical trials (RCTs). METHODS Twenty RCTs comparing topical CHM to active control/placebo were included in the final analysis. The primary outcome was the symptom scores changed from baseline and the effectiveness rate was the secondary outcome. Subgroup analysis on different initial symptom severity and the different interventions in control groups was performed. System pharmacology analysis was performed to explore core CHM and possible pharmacological mechanisms of CHM for AD. RESULTS Compared with active/blank placebo, topical CHM seemed more effective (SMD: -0.35, 95 %CI: -0.59 to -0.10, p-value = 0.005, I2 = 60%). The effectiveness rate was higher (RR: 1.29, 95 %CI 1.15-1.44, p-value <0.00001, I2 = 71%). In subgroup analysis, mild and moderate AD patients with topical CHM were more effective than placebo (SMD: -0.28, 95 %CI -0.56 to -0.01, p-value = 0.04, I2 = 5%; -0.34, 95%CI -0.64 to -0.03, p-value = 0.03, I2 = 0%, separately). Topical CHM has 1.25 times more effective than the topical glucocorticoid (95 %CI 1.09-1.43, p-value = 0.001, I2 = 64%). Core CHMs, such as Phellodendron chinense C.K. Schneid., Sophora flavescens Ait., Cnidium monnieri (L.) Cusson, and Dictamnus dasycarpus Turcz., had effects on the pathways on immune and metabolism systems different from WM. CONCLUSION Our results exploit the potential role of CHM on treating AD, especially for mild and moderate AD.
Collapse
Affiliation(s)
- Meng-Chun Wang
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Yu-Ting Chou
- Fengze Chinese Medicine Clinic, Taoyuan, Taiwan.
| | - Ming-Chen Kao
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Qian-Ying Lin
- Traditional Chinese Medicine Pharmacy, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan.
| | - Sing-Ya Chang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsing-Yu Chen
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
7
|
Choy CT, Siu PLK, Zhou J, Wong CH, Lee YW, Chan HW, Tsui JCC, Lo CJY, Loo SKF, Tsui SKW. Improvements in Gut Microbiome Composition Predict the Clinical Efficacy of a Novel Synbiotics Formula in Children with Mild to Moderate Atopic Dermatitis. Microorganisms 2023; 11:2175. [PMID: 37764019 PMCID: PMC10536305 DOI: 10.3390/microorganisms11092175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a significant association with various type-2 inflammation-related comorbidities. Ongoing research suggests the crucial involvement of gut microbiome, especially in childhood onset AD, and hence, probiotics have emerged as a potential non-steroid-based therapeutics option to complement existing AD management plans. In order to delineate the impact of probiotics in the gut microbiome of pediatric AD patients from southern China, targeted 16S rRNA sequencing and thorough bioinformatic analysis were performed to analyze the gut microbiome profiles of 24 AD children after taking an orally administered novel synbiotics formula with triple prebiotics for 8 weeks. A notable improvement in Eczema Area and Severity Index (EASI) (p = 0.008) was observed after taking an 8-week course of probiotics, with no adverse effects observed. The relative abundances of key microbial drivers including Bacteroides fragilis and Lactobacillus acidophilus were significantly increased at week 8. We also found that the positive responsiveness towards an 8-week course of probiotics was associated with improvements in the gut microbiome profile with a higher relative abundance of probiotic species. Over-represented functional abundance pathways related to vitamin B synthesis and peptidoglycan recycling may imply the underlying mechanism. In summary, our study suggests how the gut microbial landscape shifts upon probiotic supplementation in AD children, and provides preliminary evidence to support targeted probiotic supplementation for the management of childhood AD.
Collapse
Affiliation(s)
- Chi Tung Choy
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Pui Ling Kella Siu
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Junwei Zhou
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Chi Ho Wong
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Yuk Wai Lee
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Ho Wang Chan
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | | | - Claudia Jun Yi Lo
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Steven King Fan Loo
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
- Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Dermatology Centre, CUHK Medical Centre, The Chinese University of Hong Kong, Hong Kong
| | - Stephen Kwok Wing Tsui
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Centre for Microbial Genomics and Proteomics, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
8
|
Nahm DH. Regulatory T Cell-Targeted Immunomodulatory Therapy for Long-Term Clinical Improvement of Atopic Dermatitis: Hypotheses and Perspectives. Life (Basel) 2023; 13:1674. [PMID: 37629531 PMCID: PMC10455293 DOI: 10.3390/life13081674] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
Atopic dermatitis (AD) is a chronically relapsing inflammatory skin disorder characterized by itching and eczematous lesions. It is often associated with a personal or familial history of allergic diseases. Allergic inflammation induced by immunoglobulin E and T-helper type 2 (Th2) cell responses to common environmental agents has been suggested to play an essential role in AD pathogenesis. The standard therapies for AD, including topical or systemic agents, focus on controlling skin inflammation. Recently developed monoclonal antibody to interleukin-4 receptor alpha or Janus kinase inhibitors can provide significant clinical improvements in patients with AD by inhibiting Th2 cell-mediated skin inflammation. However, the clinical efficacy of the Th2 cell-targeted therapy is transient and incomplete in patients with AD. Patients with AD are seeking a permanent cure. Therefore, the development of novel immunomodulatory strategies that can improve a long-term clinical outcome and provide a long-term treatment-free clinical remission of AD (disease-modifying therapy) is needed. Regulatory T (Treg) cells play a critical role in the maintenance of immune tolerance and suppress the development of autoimmune and allergic diseases. This review provides three working hypotheses and perspectives for the treatment of AD by Treg cell activation. (1) A decreased number or function of Treg cells is a critical event that causes the activation of Th2 cells, leading to the development and maintenance of AD. (2) Activation of Treg cells is an effective therapeutic approach for AD. (3) Many different immunomodulatory strategies activating Treg cells can provide a long-term clinical improvement of AD by induction of immune tolerance. The Treg cell-targeted immunomodulatory therapies for AD include allergen immunotherapy, microbiota, vitamin D, polyvalent human immunoglobulin G, monoclonal antibodies to the surface antigens of T cell or antigen-presenting cell, and adoptive transfer of autologous Treg cells or genetically engineered Treg cells expanded in vitro.
Collapse
Affiliation(s)
- Dong-Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| |
Collapse
|
9
|
Rotter G, Teut M, Schleicher R, Dell'Oro M, Ortiz M, Binting S, Tissen-Diabaté T, Roll S, Michalsen A, Staab D, Wolfarth B, Brinkhaus B. Hypnotherapy, Intermittent Fasting, and Exercise Group Programs in Atopic Dermatitis: A Randomized Controlled Explorative Clinical Trial During the COVID-19 Pandemic. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:99-110. [PMID: 36450119 PMCID: PMC9942184 DOI: 10.1089/jicm.2022.0699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Patients with atopic dermatitis (AD) frequently use healthy lifestyle behaviors, although their benefits are unclear. This study's aim was to investigate the effectiveness of hypnotherapy, fasting with diet adjustments, and exercise in AD patients. Methods: In a four-armed randomized controlled monocenter open explorative clinical trial, adult patients with mild-to-moderate severe AD underwent, over 16 weeks, a five-session hypnotherapy group program (HTP), a five-session intermittent fasting with diet adjustment group program (IFDP), a five-session exercise group program (EP), or no study intervention (control) as add-on to topical corticosteroid use if required. Endpoints included subjectively perceived itching on a visual analogue scale (VAS, 0-100 mm); disease severity by SCORing Atopic Dermatitis (SCORAD); and adverse events (AEs). Endpoints were analyzed descriptively in the Full Analysis Set (FAS). Due to the coronavirus disease 2019 (COVID-19) pandemic, relevant changes to the study protocol included online in addition to "in-presence" group interventions, closing the study arm EP and premature trial termination before randomization of 120 intended patients. Results: During the COVID-19 pandemic, study recruitment was poor. The FAS included 20 patients (17 female) with 35.0 ± 12.1 (mean ± standard deviation [SD]) years of age. At baseline, mean ± SD for HTP (n = 6), IFDP (n = 4), EP (n = 1), and control (n = 9) were VAS itching 63.2 ± 18.0, 65.0 ± 13.9, 43.0 mm, 62.1 ± 17.3; SCORAD 43.0 ± 13.6, 47.0 ± 21.0, 60.3, 39.1 ± 15.6. After 16 weeks, endpoints were VAS itching 26.0 ± 16.4, 31.7 ± 9.9, 23.0 mm, 39.3 ± 27.0; SCORAD 24.1 ± 12.2, 29.1 ± 19.1, 49.1, 25.5 ± 14.4. No serious AEs related to the interventions were observed. Conclusion: Despite very small groups, study results indicated potential beneficial changes to baseline in perceived itching intensity, disease severity, and disease-specific quality of life for HTP and IFDP. Therefore, further clinical trials should be performed investigating the effectiveness and safety of all interventions. Clinical Trial Registration: January 31, 2020 German Clinical Trials Register (DRKS): DRKS00020557, Universal Trial Number (UTN): U1111-1247-1512.
Collapse
Affiliation(s)
- Gabriele Rotter
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Address correspondence to: Gabriele Rotter, MD, MSc, Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Michael Teut
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Romy Schleicher
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Melanie Dell'Oro
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Miriam Ortiz
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvia Binting
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tatjana Tissen-Diabaté
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Roll
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Michalsen
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal and Integrative Medicine, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Doris Staab
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benno Brinkhaus
- Department of Epidemiology and Health Economics, Institute of Social Medicine, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
10
|
Tkachenko E, Okhovat JP, Manjaly P, Huang KP, Senna MM, Mostaghimi A. Complementary and alternative medicine for alopecia areata: A systematic review. J Am Acad Dermatol 2023; 88:131-143. [PMID: 31870916 DOI: 10.1016/j.jaad.2019.12.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/22/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite high use of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear. OBJECTIVE To identify all CAM therapies studied for treatment of AA. Outcomes of interest included disease course and psychologic well-being. METHODS PubMed and Embase were searched to identify English articles containing original data investigating CAM in individuals with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. RESULTS Of 1015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective noncontrolled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low-quality evidence for improvement of psychologic and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated. LIMITATIONS Inconsistent or poorly reported study methodology and nonstandardized outcomes limit the conclusions that can be made from these studies. CONCLUSIONS This work serves to inform physician treatment of patients with AA seeking CAM while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA.
Collapse
Affiliation(s)
- Elizabeth Tkachenko
- University of Massachusetts Medical School, Worcester, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jean-Phillip Okhovat
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Kathie P Huang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maryanne M Senna
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
11
|
Al-Atif HM, AL-Ghamdi HS, Alzubaidi WA, Alnaem NM, Qahtani SH. The Prevalence of Complementary and Alternative Medications Use Among Dermatology Patients in Aseer Region, Saudi Arabia. Clin Cosmet Investig Dermatol 2022; 15:2607-2615. [PMID: 36510606 PMCID: PMC9738093 DOI: 10.2147/ccid.s381199] [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: 07/10/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
Purpose The utilization rate of complementary and alternative medication (CAM) is on the rise, especially for the general population. Despite the lack of scientific support, CAM has been used for decades and is more often used among chronic patients. This research examines the prevalence of CAM use in dermatology patients in the area of Aseer, Saudi Arabia. Materials and Methods This research was done using a descriptive hospital-based cross-sectional survey among adults who attended the dermatological clinics at the major hospitals in the Aseer area of Southern Saudi Arabia. The dermatology outpatients were approached individually and were asked to fill out a survey about their usage of CAM therapies in the preceding year. The questionnaire included questions on patients' socio-demographic data and clinical data on their dermatological condition, including duration and the effect on their daily life. The occurrence and pattern of CAM use and the type of CAM utilized were also examined. Results 353 dermatological patients filled out the study questionnaire. Patients varied in age from 18 to above 60 years, with an average of 26.1 ± 12.9 years. 203 (57.5%) patients were females. 120 (34%) of the study patients reported using folk medicine with doctor medication for their dermatological disorder, 84 (23.8%) used folk medicine and stopped using medications prescribed by a doctor, while 149 (42.2%) never used folk medicine. The most used CAM was olive oil (22%), followed by sidr (21%), honey (19%), cactus (15%), henna (14%), and garlic (13%). Conclusion More than half of the participants in this study used CAM, with nearly 1 out of 5 patients not using the medications prescribed by their physicians. Females with long-lasting diseases were the main users who reported using a variety of CAMs. Satisfactory results were experienced by nearly half of the patients.
Collapse
Affiliation(s)
- Hend M Al-Atif
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha City, Kingdom of Saudi Arabia,Correspondence: Hend M Al-Atif, Tel +966556464612, Email
| | - Hasan S AL-Ghamdi
- Internal Medicine Department, Division of Dermatology, Faculty of medicine, Albaha University, Albaha City, Kingdom of Saudi Arabia
| | | | | | | |
Collapse
|
12
|
Complementary and alternative medicine use among adults with eczema: A population-based study. JAAD Int 2022; 8:154-156. [PMID: 35942061 PMCID: PMC9356148 DOI: 10.1016/j.jdin.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
13
|
Akbaş A, Emeksiz ZŞ, Yorulmaz A, Hayran Y, Kılınç F, Yakut HI, Toyran M, Demir Kİ. Complementary and Alternative Treatment Methods Practiced by Parents in Pediatric Cases Diagnosed with Atopic Dermatitis. J DERMATOL TREAT 2022; 33:3014-3021. [PMID: 35775854 DOI: 10.1080/09546634.2022.2097159] [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: 10/17/2022]
Abstract
INTRODUCTION Atopic Dermatitis (AD) is a chronic, recurrent and inflammatory skin disease experienced mostly in childhood. Chronicity of the disease, relapses, constant need of regular skin care causes seeking for alternative treatments. AIM The aim of this study is to evaluate the complementary and alternative treatments (CAT) used by parents' caregivers in pediatric patients diagnosed with AD, and the association between CAT use and patient characteristics. MATERIALS AND METHODS A questionnaire questioning the sociocultural and demographic characteristics of the family, the clinical findings of the patients, their treatments and CAT applications was recorded. RESULTS 83 patients were included in the study. 68.7% of the patients used at least 1 type of CAT. Vitamins and oils were the most commonly used CATs (48.8% and 47%, respectively) and 73.3% of the patients using CAT continued normal AD treatment while using CAT. The biggest factor affecting CAT choice was the advice of the immediate circle (75%), and 40.6% of the patients stated that they benefited from the complementary therapy. CONCLUSION CATs are widely used in AD. Physicians should know the socio-cultural structure of the region they are in, the CATs used and their side effects, and inform the families.
Collapse
Affiliation(s)
- Ayşe Akbaş
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | - Zeynep Şengül Emeksiz
- Ankara City Hospital, Pediatric Allergy and Immunology Clinic specialist doctor Ankara, Turkey
| | - Ahu Yorulmaz
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | - Yıldız Hayran
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | - Fadime Kılınç
- Associate professor, Ankara City Hospital, Dermatology, Ankara, Turkey
| | | | - Müge Toyran
- Professor, Ankara City Hospital, Pediatric Allergy and Immunology Clinic Ankara, Turkey
| | - Kezban İpek Demir
- Ankara City Hospital, Pediatric Allergy and Immunology Clinic specialist doctor Ankara, Turkey
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Mick A, Tizek L, Schielein M, Zink A. Can crowdsourced data help to optimize atopic dermatitis treatment? Comparing web search data and environmental data in Germany. J Eur Acad Dermatol Venereol 2021; 36:557-565. [PMID: 34921466 DOI: 10.1111/jdv.17875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common chronic skin diseases worldwide, showing various manifestations and having a severe impact on quality of life. As previous studies demonstrated, internet search analysis can help identify public interest in diseases and possible influencing factors on search behavior. OBJECTIVE To identify AD-related topics of interest in Germany using internet search volume. METHODS Google Ads Keyword Planner was used to identify AD-related search terms including their search volume in Germany on a national level as well as in 16 selected cities from January 2016 to December 2019. Identified keywords were qualitatively analyzed, and temporal trends as well as the influence of seasonal and environmental factors on search volume were assessed. RESULTS Overall, 1222 AD-related search terms with a search volume of 8 842 360 searches were identified. An increase from 2016 to 2019 and seasonal peaks from January to April of each year were observed. Nationwide, the search volume correlated with mean monthly temperature and sun duration. With increasing temperature and sun duration, a significant decrease in search queries was observed. The most populated cities showed the lowest number of searches per 100 000 inhabitants (Berlin, Hamburg, and Munich). In the eight categories formed (comorbidities, general, influential factors, localization, stage of life, symptoms/severity, therapy/information, and questions on AD), the highest proportion of search queries were assigned to the category "therapy/information" in most cities. In this category, a focus on the topics of "alternative medicine" and "home remedies" could be observed. CONCLUSION The overall high and increasing search volume indicates a high interest in AD-related topics, especially regarding treatment and disease education. Information provided by internet search volume analyses can optimize AD therapy and patient-centered care by providing insight into patient needs and predicting potential climatic trigger factors.
Collapse
Affiliation(s)
- A Mick
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Berardesca E, Cameli N. Vitamin E supplementation in inflammatory skin diseases. Dermatol Ther 2021; 34:e15160. [PMID: 34655146 DOI: 10.1111/dth.15160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
Vitamin E is a powerful lipophilic antioxidant that protects membranes from lipid peroxidation, and consequently, oxidative damage. Oxidative stress plays a role in the development of neurodegenerative diseases. Vitamin E supplementation is recommended in patients with vitamin E deficiency due to fat malabsorption. The addition of vitamin E to the diet slows Alzheimer's disease progression and protects older patients against respiratory infections. Recent studies also point to the involvement of oxidative stress in the pathology of immune-mediated skin diseases, such as atopic dermatitis and psoriasis. We reviewed the available clinical trials that investigated the role of vitamin E supplementation in preventing and treating atopic dermatitis and psoriasis. Data from these studies point to a positive role of vitamin E supplementation in these diseases. Still, due to limitations in study design, further evidence is needed to reach a definite conclusion.
Collapse
Affiliation(s)
- Enzo Berardesca
- Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Norma Cameli
- San Gallicano Dermatological Institute, Rome, Italy
| |
Collapse
|
17
|
Abstract
Background Atopic dermatitis (AD) is associated with considerable financial cost. However, the full burden of out-of-pocket (OOP) expenses is not well understood. Objective We sought to characterize the OOP health care expenses associated with AD management. Methods A 25-question voluntary online survey was administered to National Eczema Association members worldwide (n = 113,502). Inclusion criteria (US residents age ≥18 years who either self-reported had AD or were primary caregivers of individuals with AD) were met by 77.3% (1118/1447) of respondents. Results Respondents reported OOP expenses in 3 categories: (1) health care providers and prescriptions, including health care provider visit deductibles (68.7% [686]), prescription co-pays (64.3% [635]), and prescriptions not covered by insurance (48.6% [468]); (2) nonprescription health care products, including moisturizers (94.3% [934]), hygiene products (85.0% [824], allergy medications (75.1% [715]), itch relievers (68.25% [647]), dietary supplements (52.2% [491]), and sleep aids (37.0% [336]); and (3) complementary approaches, including cleaning products (74.7% [732]), clothing/bedding (44.8% [430]), alternative medications (19.0% [180]), and adjunctive therapies (15.9% [150]). The median annual AD OOP expense was US $600 (range, US $0–$200,000), with 41.9% (364) reporting expenditures US $1000 or greater. Conclusions Out-of-pocket expenses place a significant financial burden on individuals with AD. Additional studies are needed to better understand associations and impact of OOP costs.
Collapse
|
18
|
Potential Acupoint Prescriptions and Outcome Reporting for Acupuncture in Atopic Eczema: A Scoping Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9994824. [PMID: 34257697 PMCID: PMC8257338 DOI: 10.1155/2021/9994824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/17/2021] [Indexed: 12/03/2022]
Abstract
Background Acupuncture is considered a complementary therapy for atopic eczema. The aim of this scoping review is to identify, examine, and summarize the potential acupoint prescriptions and outcome reporting regarding the clinical trials of acupuncture for eczema. Methods We searched different databases from inception to September 30, 2020. The data were screened and extracted to identify the potential acupuncture prescription and examine the variation in outcome reporting, outcome measurement instruments (OMIs), and measurement time points in clinical trials of acupuncture. Results A total of 116 clinical studies were included. The acupoint combination of LI11 and SP10 was used frequently. The core acupoint association networks were acupoints LI11, SP10, ST36, SP6, and LI4. For clinical trials of acupuncture, a total of 6 outcome distinct domains were identified in the 32 outcome measurements. The most frequently reported outcome was the eczema area, which was reported 97 times (83.6%, 97/116). Immune system outcomes were assessed in 15 outcome measurements, which totally reported 37 times. Adverse events were reported 51 times. TCM syndrome, which could reflect the characteristics of TCM, was reported 4 times. 29 outcomes (90.6%, 29/32) were provided definitions or OMIs. Among these outcomes, the outcome measurement times ranged from 0 to 34. Conclusions This scoping review provides potential knowledge that should be considered as priority in future research of acupuncture for eczema.
Collapse
|
19
|
Li H, Sun X, He J, Tan C, Dai T. Efficacy and safety of Chinese herbal medicine Jianpi formulas for atopic dermatitis: Evidence from 11 randomized controlled trials. J Cosmet Dermatol 2021; 21:1065-1074. [PMID: 33877745 DOI: 10.1111/jocd.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Jianpi formulas have been widely used to treat atopic dermatitis (AD) by traditional Chinese medicine (TCM) practitioners, but the efficacy and safety need further evaluation. A meta-analysis of randomized controlled trials was performed to assess the efficacy and tolerability of Jianpi formulas for AD. METHODS We searched the following databases up to October 2020: PubMed, Embase, China National Knowledge Infrastructure database (CNKI), and Wanfang database. All randomized controlled trials (RCTs) evaluated Jianpi formulas add-on effect for AD were included for meta-analysis. The primary outcome was minor remission. Secondary outcomes include complete remission, marked remission, and decrease of SCORAD. RESULTS Totally eleven studies were included. Nine studies were included in qualitative analysis and seven were included in quantitative analysis. The common herbs were poria, glycyrrhiza uralensis, rhizoma atractylodis, atractylodes macrocephala, and semen coicis. The Jianpi formulas add-on therapy showed consistent higher effectiveness rate in complete remission (RR1.528, 95%CI 1.176-1.984. p<0.01; Q=2.31, I2 =0%), marked remission (RR 1.388, 95% CI 1.234-1.562. p<0.01; Q=3.682, I2 =0%), and minor remission (RR 1.170, 95% CI 1.105-1.239, p<0.01; Q=14.355, I2=44.27%). The decrease of the scoring atopic dermatitis (SCORAD) in Jianpi formulas was significantly higher than in control group (SMD=0.671, 95% CI 0.018 to 0.937). Jianpi formulas were generally well tolerated, with no significantly increased risk of adverse events (AE). CONCLUSIONS The combinations of Jianpi formulas showed moderate positive add-one effects in AD patients. Further well-designed clinical trials are needed to evaluate long-term effect of this therapy.
Collapse
Affiliation(s)
- Hongmin Li
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaoyin Sun
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jingwei He
- Children's Hospital of Fudan University, Shanghai, China
| | - Cheng Tan
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ting Dai
- Children's Hospital of Fudan University, Shanghai, China
| |
Collapse
|
20
|
Sacko A, Bourrat E, Bourdon O, Prot-Labarthe S. [Dermocorticoides and sun exposure: A misunderstanding?]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 79:589-596. [PMID: 33515590 DOI: 10.1016/j.pharma.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/26/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Fear of dermocorticoids (DCs) or corticophobia is based on an overestimation of the risks of actual side effects and on unfounded beliefs such as DCs-induced photosensitivity among community pharmacists. The objective of this study was to assess the community pharmacy teams' fear of dermocorticoids in atopic dermatitis (DA) in sunny weather and its impact on drug use advice. MATERIAL ET METHODS A questionnaire as a real case (a summer prescription for atopic dermatitis for an 18-month-old child) was posted on Facebook via groups of pharmacists, technicians and students. Data collected concerned the health professional, his or her reluctance to DCs, advice associated with dispensation, detailed concerns about the DC and sun association, and sources of information. RESULTS In total, 126 participants responded (48.4% pharmacists, 40.5% technicians, 10.3% students): 12% were reluctant to DCs, 36% were reluctant to DCs and considered them photosensitizing, and 51% were not reluctant but considered them photosensitizing. The impact on the patient advice was: a suggestion to stop DC during sun exposure (28%), to stop or limit DC (dose, duration) (43%). Concerns about the association DC/sun were mainly due to UV rays (46%). Sources cited were: monographs (54%), Internet (6%), training courses (13%). CONCLUSION The false belief of DC/sun incompatibility in DA is strong among pharmacists and impacts on patients' advice. The role of the official team in dispensing dermocorticoids is essential: training and information for professionals helps to fight false information.
Collapse
Affiliation(s)
- A Sacko
- Pharmacie clinique, faculté de pharmacie de Paris, université Paris-Descartes, Sorbonne Paris Cité, Paris, France
| | - E Bourrat
- Dermatologie, hôpital Robert-Debré, AP-HP, Paris, France
| | - O Bourdon
- Pharmacie clinique, faculté de pharmacie de Paris, université Paris-Descartes, Sorbonne Paris Cité, Paris, France; Département de pharmacie, hôpital Robert-Debré, AP-HP, Paris, France; Laboratoire éducations et pratiques de santé, université Paris XIII, Bobigny, France
| | - S Prot-Labarthe
- Département de pharmacie, hôpital Robert-Debré, AP-HP, Paris, France; Inserm U 1123, ECEVE, Paris, France.
| |
Collapse
|
21
|
Abstract
Atopic dermatitis (AD) is a multifactorial disease that may have a psychosomatic component. In this study, the authors aimed to measure the effect of hypnosis on AD in a clinical setting. Patients with AD who never had systemic treatment were offered hypnosis sessions. Twenty-seven patients with AD and a mean age of 34.5 years participated in a mean of six hypnosis sessions (range 2 to 16). AD severity can be assessed with the Eczema Area and Severity Index (EASI). EASI score was calculated during the first and last hypnosis sessions for 21 patients. Eczema improved or resolved in 26 of the 27 patients. Mean EASI score for the 21 patients evaluated was 12 at the first session and 2.8 at the last session. Hypnosis may be useful in AD and may overcome the need for systemic treatments for some patients.
Collapse
Affiliation(s)
- Léa Delaitre
- Department of Dermatology, Le Mans Hospital , France
| | - Jean Denis
- Department of Dermatology, Le Mans Hospital , France
| | | |
Collapse
|
22
|
Siriyong T, Phungtammasan S, Jansorn S, Chonsongkram N, Chanwanitsakul S, Subhadhirasakul S, Voravuthikunchai SP. Traditional Thai herbal medicine as an alternative treatment for refractory chronic eczema. Explore (NY) 2020; 16:242-249. [DOI: 10.1016/j.explore.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/03/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022]
|
23
|
Chee A, Branca L, Jeker F, Vogt DR, Schwegler S, Navarini A, Itin P, Mueller SM. When life is an itch: What harms, helps, and heals from the patients' perspective? Differences and similarities among skin diseases. Dermatol Ther 2020; 33:e13606. [PMID: 32418352 DOI: 10.1111/dth.13606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/31/2022]
Abstract
Itch is the commonest skin-related symptom, associated with a high psychosocial and economic burden. While the main focus of itch research lies on a few chronic skin diseases, only little is known about the perception of itch, itch-aggravating/-relieving factors and treatment preferences in patients with acute and chronic itch of various etiology. In this cross-sectional study, we assessed these aspects in 126 patients (mean age 61.7 ± 18.4 years, 67 females, median itch duration 3.9 years) using a 78-item questionnaire. The diseases were categorized into 11 diagnostic groups for descriptive analysis; the three most frequent groups ("atopic dermatitis," "nonatopic eczema," "inflammatory dermatoses") were statistically compared. Itch was most often perceived as localized 42.9%, burning (40.5%), and worrying (39.7%) with worsening in the evening (49.2%), due to warmth (42.1%) and sweating (26.2%). While itch perception, itch-aggravating factors and treatment preferences differed broadly among patients, the itch-relieving personal strategies were more uniform ("scratching by hand 70.6%, applying topicals 57.9%). Also, 69.8% of patients suffered from itch-related sleep disturbance, consequently affecting their relatives in 30.0%. Subgroup comparisons revealed significant differences regarding itch-aggravating factors (P = .0012) and itch duration (P = .0082). Patients rated the antipruritic effectiveness of phototherapy, "complementary and alternative medicine" and "other tablets" as high, but oral antihistamines, "cortisone tablets" and any topical as only moderately efficacious. The preferred administration of an ideal itch treatment was "creams/ointments" (51.6%) or "tablets" (35.7%), only few patients preferred "injections" or "patches." Consideration of such differences and similarities in itch characteristics and treatment preferences could help to better tailor treatment in itch patients.
Collapse
Affiliation(s)
- Alvyn Chee
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Lorenzo Branca
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Florence Jeker
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trial Unit, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Simon Schwegler
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
24
|
Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, Staubach P. Diagnosis and treatment of xerosis cutis - a position paper. J Dtsch Dermatol Ges 2020; 17 Suppl 7:3-33. [PMID: 31738016 DOI: 10.1111/ddg.13906] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND RATIONALE Xerosis cutis (also referred to as xeroderma, dry skin, asteatosis) affects more than 10 million individuals in Germany. It is among the most common dermatological diagnoses and a cardinal symptom of many dermatological, internal and neurological diseases. Even though it has been established that basic skin care plays a significant role in the management of patients with xerosis cutis, there are as yet no evidence-based algorithms for diagnosis and treatment. OBJECTIVE The present position paper provides physicians across all specialties with a practical, symptom-based approach to the prevention, diagnosis and treatment of xerosis cutis. METHODS Within a structured decision-making process, a panel of experienced dermatologists first defined questions relevant to everyday clinical practice, which were then addressed by a systematic review of the literature. Based on the evidence available as well as expert consensus, diagnostic and treatment algorithms were subsequently developed and agreed upon. RESULTS Xerosis cutis is generally diagnosed on clinical grounds. Possible trigger factors must be avoided, and comorbidities should be adequately and specifically treated. Suitable skin care products should be chosen with a view to improving skin hydration and restoring its barrier function. They should therefore contain both rehydrating and lipid-replenishing components. The "drier" the skin appears, the greater the lipid content should be (preferably using water-in-oil formulations). The choice of ingredients is based on a patient's individual symptoms, such as scaling (e.g., urea), fissures/rhagades (e.g., urea or dexpanthenol), erythema (e.g., licochalcone A) and pruritus (e.g., polidocanol). Other factors to be considered include the site affected and patient age. Ingredients or rather combinations thereof for which there is good clinical evidence should be preferentially used. The best evidence by far is available for urea, whose efficacy in the treatment of xerosis is further enhanced by combining it with other natural moisturizing components and ceramides. The "xerosimeter" is a tool developed in an effort to facilitate patient management and for training purposes. It not only includes practical tools for diagnosis and follow-up but also a classification of ingredients and a structured treatment algorithm. CONCLUSION The structured symptom- and evidence-based approach proposed herein contains a road map for diagnosis and treatment of xerosis cutis. It aims to raise awareness in terms of prevention and early treatment of this condition and may thus improve quality of life and prevent potential sequelae.
Collapse
Affiliation(s)
- Matthias Augustin
- Hamburg-Eppendorf University Medical Center, Institute for Healthcare Research in Dermatology and Nursing (IVDP), Martinistr. 52, 20246, Hamburg, Germany
| | - Dagmar Wilsmann-Theis
- Department of Dermatology and Allergology, University Medical Center, Friedrich Wilhelm University, Sigmund Freud Str. 25, 53105, Bonn, Germany
| | - Andreas Körber
- Office-based Dermatologist, Rüttenscheider Str. 143, 45130, Essen, Germany
| | - Martina Kerscher
- University of Hamburg, Division of Cosmetic Sciences, Papendamm 21, 20146, Hamburg, Germany
| | - Götz Itschert
- Office-based Dermatologist, Am Rathaus 2a, 25421, Pinneberg, Germany
| | - Michaela Dippel
- MD medscript & consult, Am Kuhtriftberg 21, 67098, Bad Dürkheim, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| |
Collapse
|
25
|
Hosono S, Fujita K, Nimura A, Akita K. Release of cervical muscular tension improved severe pruritus in moderate-to-severe atopic dermatitis: A case series. JAAD Case Rep 2020; 6:510-513. [PMID: 32490112 PMCID: PMC7256226 DOI: 10.1016/j.jdcr.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Key Words
- AD, atopic dermatitis
- AEC, absolute eosinophil counts
- DLQI, Dermatology Life Quality Index
- EASI, eczema area severity index
- LDH, lactate dehydrogenase
- OMT, osteopathic manipulative treatment
- ROM, range of motion
- TARC, serum thymus and activation-regulated chemokine
- VAS, visual analog scale
- atopic dermatitis
- cervical muscular tension
- complementary and alternative therapy
- pruritus
- sIGA, static Investigator's Global Assessment
- stressor
Collapse
Affiliation(s)
- Shusaku Hosono
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Hosono Clinic, Tokyo, Japan
| | - Koji Fujita
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
26
|
New Herbal Biomedicines for the Topical Treatment of Dermatological Disorders. Biomedicines 2020; 8:biomedicines8020027. [PMID: 32046246 PMCID: PMC7168306 DOI: 10.3390/biomedicines8020027] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/17/2022] Open
Abstract
Herbal extracts and isolated plant compounds play an increasing role in the treatment of skin disorders and wounds. Several new herbal drugs, medicinal products and cosmetic products for the treatment of various skin conditions have been developed in recent years. In this nonsystematic review, we focus on herbal drugs that were tested in controlled clinical studies or in scientifically sound preclinical studies. The herbal biomedicines are intended to treat atopic dermatitis (St. John's wort, licorice, tormentil, bitter substances, evening primrose), psoriasis (araroba tree, lace flower, barberry bark, indigo, turmeric, olibanum, St. John's wort), actinic keratosis (birch bark, petty spurge), herpes simplex (lemon balm, sage and rhubarb), rosacea (green tea, licorice, tormentil) and acne vulgaris (tea tree oil, green tea, hop), or to improve photo protection (green tea, Dyer's weed, cocoa tree, carotinoids, licorice), aesthetic dermatology (licorice, pine bark, gotu kola) and wound healing (birch bark, onion).
Collapse
|
27
|
Sharma S, Naura AS. Potential of phytochemicals as immune-regulatory compounds in atopic diseases: A review. Biochem Pharmacol 2020; 173:113790. [PMID: 31911090 DOI: 10.1016/j.bcp.2019.113790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022]
Abstract
Atopic diseases (atopic dermatitis, asthma and allergic rhinitis) affects a huge number of people around the world and their incidence rate is on rise. Atopic dermatitis (AD) is more prevalent in paediatric population which sensitizes an individual to develop allergic rhinitis and asthma later in life. The complex pathogenesis of these allergic diseases though involves numerous cellular signalling pathways but redox imbalance has been reported to be critical for induction/perpetuation of inflammatory process under such conditions. The realm of complementary and alternative medicine has gained greater attention because of the reported anti-oxidant/anti-inflammatory properties. Several case studies of treating atopic diseases with homeopathic remedies have provided positive results. Likewise, pre-clinical studies suggest that various natural compounds suppress allergic response via exhibiting their anti-oxidant potential. Despite the reported beneficial effects of phytochemicals in experimental model system, the clinical success has not been documented so far. It appears that poor absorption and bioavailability of natural compounds may be one of the reasons for realizing their full potential. The current paper throws light on impact of phytochemicals in the redox linked cellular and signalling pathways that may be critical in manifestation of atopic diseases. Further, an effort has been made to identify the gaps in the area so that future strategies could be evolved to exploit the medicinal value of various phytochemicals for an improved efficiency.
Collapse
Affiliation(s)
- Sukriti Sharma
- Department of Biochemistry, Panjab University, Chandigarh 160014, India
| | - Amarjit S Naura
- Department of Biochemistry, Panjab University, Chandigarh 160014, India.
| |
Collapse
|
28
|
Dhossche J, Corn J, Simpson EL, Funk T. A survey in uncharted territory: A collaborative study to explore the approach to atopic dermatitis patient management in allopathy and naturopathy. Pediatr Dermatol 2020; 37:109-114. [PMID: 31743495 DOI: 10.1111/pde.14036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) patients frequently use both conventional and complementary medicines for treatment. Allopathic and naturopathic providers may be unaware of each other's approach to AD diagnosis, skin care, and treatment, affecting patient and provider communication, patient safety, and potential for collaborative studies. OBJECTIVE To identify core commonalities and differences in allopathic and naturopathic approach to AD. METHODS Thirty allopathic and 21 naturopathic providers completed an 11-question free-text comment survey, covering patient education and evaluation, skin care, and treatment of AD. Qualitative content analysis detected key ideas and concepts, and word cloud analysis provided a quantitative visual representation of recurrent words in each group's responses. RESULTS All respondents indicated using similar physical features to diagnose AD. In both allopathic and naturopathic fields, the majority of providers did not perform routine testing for AD diagnosis. Skin care with moisturization and "soak-and-seal" bathing practices were routine in both fields. Naturopathic providers heavily emphasized the role of food and diet in AD pathogenesis, education, and management, while allopathic providers indicated little to no role for food and diet in AD. For treatment, allopathic providers favored topical steroids, phototherapy, and immunomodulators, whereas naturopathic providers recommended botanicals, supplements, and other complementary and alternative methods. CONCLUSIONS Providers should be aware of the differences between allopathic and naturopathic providers and their approach to AD management, particularly concerning the role of food and diet. There may be opportunities to harmonize skin care regimens for patients given similar approach in both fields, and to collaborate further on studies of diet in AD and treatments not yet effectively tested.
Collapse
Affiliation(s)
- Julie Dhossche
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Josh Corn
- National University of Natural Medicine, Portland, OR, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Tracy Funk
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
29
|
Assessment of the Effectiveness of Vitamin Supplement in Treating Eczema: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6956034. [PMID: 31781276 PMCID: PMC6875217 DOI: 10.1155/2019/6956034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022]
Abstract
Background The morbidity of eczema has increased in the recent years, and the methods to prevent or ameliorate its effects are becoming more important. To this end, this research was conducted to determine the effectiveness of vitamin supplements in eczema therapy. Method Embase, PubMed, and Cochrane Central Register of Clinical Trials were searched. Only randomized controlled trials were included, and we included all quantified eligible data where the SCORing Atopic Dermatitis (SCORAD) Index or Eczema Area and Severity Index (EASI) scores were applied to assess the severity of eczema. Results Ten studies fulfilled the inclusion criteria, and eight of them were included for quantitative analysis (total: 456 patients). Compared to the controls, the SCORAD index or EASI decreased in the vitamin supplement group (mean difference -5.96, 95% CI: -7.69 to -4.23 for vitamin D3; mean difference -5.72, 95% CI: -11.41 to -0.03 for vitamin E; and mean difference -3.19, 95% CI: -4.27 to -2.10 for vitamin B12). Conclusion This study suggests that vitamin supplements could be important therapeutics to help manage eczema patients.
Collapse
|
30
|
Lansang P, Lam JM, Marcoux D, Prajapati VH, Spring S, Lara-Corrales I. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section III: Treatment Options for Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:19S-31S. [PMID: 31692376 DOI: 10.1177/1203475419882647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Because atopic dermatitis (AD) is a chronic, relapsing disease, treatment requires the use of both active therapy to control flares and preventative maintenance therapy to promote integrity of the skin barrier. In this third of four sections, important clinical considerations for the treatment of pediatric AD are reviewed. Emerging therapies in development for pediatric AD are introduced.
Collapse
Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Paediatrics, Sainte-Justine University Hospital Center, University of Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
| | - Irene Lara-Corrales
- Division of Paediatric Medicine, Section of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| |
Collapse
|
31
|
Preliminary Comparison of the Efficacy and Safety of Needle-Embedding Therapy with Acupuncture for Atopic Dermatitis Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6937942. [PMID: 31178916 PMCID: PMC6507099 DOI: 10.1155/2019/6937942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/09/2019] [Indexed: 12/03/2022]
Abstract
Objectives Among Traditional Korean Medicine approaches, needle-embedding therapy is used in various fields and consistently studied; however, there have been no clinical studies of the treatment of adult atopic dermatitis (AD) with needle-embedding therapy. Thus, there is a need to investigate the effects of needle-embedding therapy for treatment of AD. This study was performed to identify possible effects of needle-embedding therapy at Quchi acupoint (LI11) on AD and to compare these effects with those of acupuncture therapy. Methods A total of 14 participants were enrolled in this study. Participants received acupuncture or needle-embedding treatments for 4 weeks and then were followed for an additional 2 weeks because of safety assessment. The participants were divided into 2 groups: the acupuncture group, receiving treatment at Quchi acupoint (LI11) 3 times per week, and the needle-embedding group, receiving treatment at Quchi acupoint (LI11) once per week. The groups were compared on the basis of the SCORing Atopic Dermatitis (SCORAD) index, Transepidermal Water Loss (TEWL), skin hydration, and Dermatology Life Quality Index (DLQI) at baseline and 1 week after treatment was completed (5th week). Results The SCORAD index, TEWL, Skin hydration, and DLQI at 1 week after treatment were significantly improved in both groups (p<0.05). However, there were no significant differences between the acupuncture and needle-embedding groups in any of the main evaluation indices (p>0.05). The study participants received a total of 84 acupuncture treatments or 28 needle-embedding treatments. No adverse events occurred during the study period. Conclusions Based on changes in the SCORAD index, TEWL, skin hydration, and DLQI value, we found that both needle-embedding and acupuncture treatments at the Quchi acupoint (LI11) were effective in decreasing the symptoms of AD and exhibited similar therapeutic effects, which suggests that needle-embedding treatment may be more clinically convenient than acupuncture, with longer effects and fewer treatments.
Collapse
|
32
|
Abstract
Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease in which management with topical anti-inflammatory agents during exacerbations remains the mainstay of treatment. With no cure in sight, a significant proportion of patients elect to incorporate complementary and alternative medicine (CAM) as an adjunct to conventional treatment. Many clinicians find it difficult to provide recommendations as the field covers an extensive number of very disparate therapies, with limited quality evidence to indicate efficacy. Since publication of the last review on this topic in the Journal that compiled and analyzed randomized controlled trials (RCTs) on CAMs in 2015, several new studies have surfaced. This update aims to aggregate and review these new data. A literature search was conducted in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Global Resource for EczemA Trials (GREAT) databases for RCTs on complementary and alternative therapies in AD from March 2015 through May 2018, resulting in 15 studies being included in this review. The preliminary results for many treatments such as vitamin E, East Indian Sandalwood Oil (EISO), melatonin, L-histidine, and Manuka honey show positive clinical effects, but there is currently not enough evidence to recommend their use in AD therapy. Future investigative efforts should focus on reproducing some of these studies with a larger sample size whose clinical characteristics and demographics are more reflective of the general AD population, and standardizing the process to produce reliable data.
Collapse
|
33
|
Holm J, Clausen ML, Agner T, Thomsen S. Use of Complementary and Alternative Therapies in Outpatients with Atopic Dermatitis from a Dermatological University Department. Dermatology 2019; 235:189-195. [DOI: 10.1159/000496274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Treatment of atopic dermatitis (AD) may be challenging, therefore some patients seek complementary and alternative medications (CAM). We determined prevalence and predictors for CAM use in a hospital cohort of AD patients. Material and Methods: Between January 1, 2012, and December 31, 2017, AD patients referred to the dermatological outpatient clinic at Bispebjerg Hospital were included in the study. Information on CAM use, demographics and disease characteristics were obtained by questionnaire, and associations were determined by χ2 and t test separately for children (< 16 years) and adults (≥16 years). Results: In total 441 filled in the questionnaire on AD, and 433 patients responded to the questions about CAM use: 198 children and 235 adults. A total of 137 (31.6%) had used one or more CAM. CAM use in children was significantly associated with prior use of ≥2 conventional treatments (p = 0.047) and topical calcineurin inhibitors (p = 0.021), a higher number of affected eczema sites (p < 0.001) including more frequent affection of the face and extremities, a higher SCORAD score (p = 0.045), and low mean overall self-rated health (p = 0.003). CAM use in adults was significantly associated with lower age of onset of AD (p = 0.004), comorbid allergic rhinoconjunctivitis (p = 0.039), frequent use of moisturizing cream (p = 0.024), facial and neck eczema (p = 0.005) and high educational level (p = 0.043). Conclusion: CAM use is frequent in both children and adult AD patients. CAM users are characterized by long disease duration, a significant disease burden and by having a longer education. The high prevalence of CAM may indicate that patients’ expectations regarding treatment of AD are not redeemed in the conventional health care system.
Collapse
|
34
|
Solman L, Lloyd‐Lavery A, Grindlay DJC, Rogers NK, Thomas KS, Harman KE. What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention. Clin Exp Dermatol 2019; 44:363-369. [DOI: 10.1111/ced.13885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- L. Solman
- Department of Paediatric Dermatology Great Ormond Street Hospital for Children London UK
| | - A. Lloyd‐Lavery
- Churchill Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - D. J. C. Grindlay
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
| | - N. K. Rogers
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
| | - K. S. Thomas
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
| | - K. E. Harman
- Centre of Evidence Based Dermatology University of Nottingham King's Meadow Campus Lenton Lane Nottingham UK
| |
Collapse
|
35
|
Yang EJ, Beck KM, Sekhon S, Bhutani T, Koo J. The impact of pediatric atopic dermatitis on families: A review. Pediatr Dermatol 2019; 36:66-71. [PMID: 30556595 DOI: 10.1111/pde.13727] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is an extremely common childhood disease, with considerable impact on the quality of life of affected children and their families. While pruritus is the hallmark symptom of this disease, AD has been well-documented to impact patients beyond physical symptoms, resulting in behavior problems, mood disorders, and sleep disturbance. OBJECTIVE This literature review outlines how atopic dermatitis impacts the quality of life of families of children affected by AD. METHODS A total of 3436 articles were identified via an online search of the MEDLINE health literature database and were screened for relevance to quality of life impacts on families with children affected by AD. RESULTS Caring for children affected by AD can be an extremely time-consuming task that can impair personal relationships, decrease psychosocial functioning, and cause sleep loss among family members of affected patients. Additionally, AD may result in work absence or decreased work productivity for caregivers. Special diets, irritant and allergen avoidance strategies, and alternative therapies are commonly used by patients to manage their disease and require large amounts of family involvement. CONCLUSIONS Atopic dermatitis can greatly decrease quality of life of families of affected children in various domains, including sleep, finances, and relationships. Early intervention and psychotherapy may be needed in some patients to address these quality of life impairments.
Collapse
Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California San Francisco, San Francisco, California.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Sahil Sekhon
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - John Koo
- Department of Dermatology, University of California San Francisco, San Francisco, California
| |
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
Chow S, Seow CS, Dizon MV, Godse K, Foong H, Chan V, Khang TH, Xiang L, Hidayat S, Listiawan MY, Triwahyudi D, Gondokaryono SP, Sutedja E, Diana IA, Suwarsa O, Dharmadji HP, Siswati AS, Danarti R, Soebaryo R, Budianti WK. A clinician's reference guide for the management of atopic dermatitis in Asians. Asia Pac Allergy 2018; 8:e41. [PMID: 30402408 PMCID: PMC6209602 DOI: 10.5415/apallergy.2018.8.e41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/24/2018] [Indexed: 01/08/2023] Open
Abstract
Background Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD. Objective The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians. Methods Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017. Results The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included. Conclusion The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.
Collapse
Affiliation(s)
| | | | | | - Kiran Godse
- DY Patil School of Medicine, Nerul, Navi Mumbai, India
| | - Henry Foong
- Foong Skin Specialist Clinic, Ipoh, Malaysia
| | - Vicheth Chan
- Cadau Skin and Laser Clinic, Pnomh Penh, Cambodia
| | | | | | - Syarief Hidayat
- League of ASEAN Dermatologic Societies, Kuala Lumpur, Malaysia
| | | | | | | | | | | | - Oki Suwarsa
- Univerity of Padjadjaran, Bandung, Indonesia
| | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Augustin M, Wilsmann-Theis D, Körber A, Kerscher M, Itschert G, Dippel M, Staubach P. Positionspapier: Diagnostik und Therapie der Xerosis cutis. J Dtsch Dermatol Ges 2018; 16 Suppl 4:3-35. [DOI: 10.1111/ddg.13580] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Matthias Augustin
- Universitätsklinikum Hamburg-Eppendorf; Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Martinistr. 52 20246 Hamburg
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie der Rheinischen-Friedrich-Wilhelms Universität Bonn; Sigmund-Freud-Str. 25 53105 Bonn
| | | | - Martina Kerscher
- Universität Hamburg; Fachbereich Kosmetikwissenschaft; Papendamm 21 20146 Hamburg
| | | | - Michaela Dippel
- MD medscript & consult; Am Kuhtriftberg 21 67098 Bad Dürkheim
| | - Petra Staubach
- Hautklinik und Poliklinik der Universitätsmedizin; Johannes Gutenberg-Universität; Langenbeckstr. 1 55131 Mainz
| |
Collapse
|
40
|
Chung BY, Park SY, Jung MJ, Kim HO, Park CW. Effect of Evening Primrose Oil on Korean Patients With Mild Atopic Dermatitis: A Randomized, Double-Blinded, Placebo-Controlled Clinical Study. Ann Dermatol 2018; 30:409-416. [PMID: 30065580 PMCID: PMC6029968 DOI: 10.5021/ad.2018.30.4.409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/29/2017] [Accepted: 01/30/2018] [Indexed: 11/08/2022] Open
Abstract
Background Atopic dermatitis (AD) is related to a deficiency of delta-6-desaturase, an enzyme responsible for converting linoleic acid to gamma-linolenic acid (GLA). Evening primrose oil (EPO) as a source of GLA has been of interest in the management of AD. Objective The aim of this randomized, double-blinded, placebo-controlled clinical study is to evaluate the efficacy and safety of EPO in Korean patients with AD. Methods Fifty mild AD patients with an Eczema Area Severity Index (EASI) score of 10 or less were enrolled and randomly divided into two groups. The first group received an oval unmarked capsule containing 450 mg of EPO (40 mg of GLA) per capsule, while placebo capsules identical in appearance and containing 450 mg of soybean oil were given to the other group. Treatment continued for a period of four months. EASI scores, transepidermal water loss (TEWL), and skin hydration were evaluated in all the AD patients at the baseline, and in months 1, 2, 3, and 4 of the study. Results At the end of month 4, the patients of the EPO group showed a significant improvement in the EASI score (p=0.040), whereas the patients of the placebo group did not. There was a significant difference in the EASI score between the EPO and placebo groups (p=0.010). Although not statistically significant, the TEWL and skin hydration also slightly improved in the EPO patients group. Conclusion We suggest that EPO is a safe and effective medicine for Korean patients with mild AD.
Collapse
Affiliation(s)
- Bo Young Chung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sook Young Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min Je Jung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
41
|
Affiliation(s)
- Jeannette Jakus
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY.
| | - Daniel M Siegel
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY
| |
Collapse
|
42
|
Birch S, Lee MS, Alraek T, Kim TH. Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: A Bibliometric Analysis. J Altern Complement Med 2018; 24:752-769. [PMID: 29912569 DOI: 10.1089/acm.2018.0092] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION As positive evidence emerges for the use of an intervention to treat a health problem, the intervention gradually becomes incorporated into treatment guidelines (TGs) or clinical practice guidelines (CPGs) that are related to that health problem. To assess whether this general hypothesis can apply to acupuncture, 96 health problems were identified for which positive conclusions in systematic reviews and meta-analyses regarding the effectiveness of acupuncture have been made and then searched for TGs or CPGs that have recommended the use of acupuncture. METHODS Through August 31, 2017, searches were performed in relevant medical databases and Google using "treatment guideline," "clinical practice guideline," and the names of the 96 medical conditions as search terms. A "snow-balling" search approach was adopted. All positive recommendations were added into the registry. RESULTS A total of 1311 publications were found that recommended using acupuncture published between 1991 and 2017. The number per year reached 50 in 2005 and 100 in 2009. In addition, 2189 positive recommendations were found for the use of acupuncture. Of these, 1486 were related to 107 pain indications and 703 were related to 97 nonpain indications. These recommendations were made by a wide range of groups, such as government health institutions, national guideline, and medical specialty groups. The recommendations came from around the world but were especially abundant in North America, Europe, and Australasia. DISCUSSION AND CONCLUSION Considerably more recommendations were found for the use of acupuncture than are known within the acupuncture or medical communities. A trend by year was also found; a rise in the number of positive statements about acupuncture was typically followed by a rise in the number of recommendations of acupuncture. Thus, the recommendations followed the emergent evidence for acupuncture. Better implementation plans need to be developed for the CPG/TG recommendations about acupuncture to be more effective/efficient.
Collapse
Affiliation(s)
- Stephen Birch
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway
| | - Myeong Soo Lee
- 2 Clinical Medicine Division, Korea Institute of Oriental Medicine , Daejeon, Republic of South Korea
| | - Terje Alraek
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway .,3 Department of Community Medicine, Faculty of Medicine, National Research Centre in Complementary and Alternative Medicine, UiT The Arctic University of Norway , Tromso, Norway
| | - Tae-Hun Kim
- 4 Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University , Seoul, Republic of Korea
| |
Collapse
|
43
|
de María Díaz Granados L, Quijano MA, Ramírez PA, Aguirre N, Sanclemente G. Quality assessment of atopic dermatitis clinical practice guidelines in ≤ 18 years. Arch Dermatol Res 2017; 310:29-37. [PMID: 29127480 DOI: 10.1007/s00403-017-1791-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/13/2017] [Accepted: 11/01/2017] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects the patients' quality of life greatly often from a very young age. Its worldwide incidence in children and adults varies, but it is usually among the first ten causes of dermatological consultation worldwide. There is a wide variety of treatment options for this condition including topical and systemic regimes. The decision to choose a treatment option in dermatological diseases is greatly influenced by the personal experience of each specialist, which increases variability in the selection of available therapies. Clinical practice guidelines (CPGs) not only offer recommendations supported on the available scientific evidence, but also are intended to assist in making appropriate decisions in clinical scenarios. To standardize the way in which CPGs should be developed, an instrument called AGREE II (Appraisal of Guidelines for Research and Evaluation) is used. In this study, ten clinical practice guidelines in ≤ 18 years were evaluated. Six domains (scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence) were assessed for each guideline, by three reviewers. Most of the domains obtained high scores except in the applicability domain. It is suggested that future atopic dermatitis CPGs should emphasize in the facilitating factors and barriers that may influence the application of guideline recommendations.
Collapse
Affiliation(s)
- Luz de María Díaz Granados
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - María Adelaida Quijano
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - Paola Andrea Ramírez
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - Natalia Aguirre
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - Gloria Sanclemente
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia. .,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia. .,IPS Universitaria, Universidad de Antioquia, Cra. 51c #62-42, Medellín, Colombia.
| |
Collapse
|
44
|
Lim NR, Lohman ME, Lio PA. The Role of Elimination Diets in Atopic Dermatitis-A Comprehensive Review. Pediatr Dermatol 2017; 34:516-527. [PMID: 28884902 DOI: 10.1111/pde.13244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Diet is a common concern for individuals with atopic dermatitis (AD) and their families. Studies regarding the effect of dietary interventions on AD exist, but many are limited by small size and poor design. Conflicting results present a challenge to clinicians seeking to counsel patients. The aim of the current review is to examine the published literature and generate helpful conclusions for clinicians faced with dietary questions in AD. METHODS A PubMed search was performed focusing on dietary interventions for AD in children and adults through July 2016. The search was limited to the English language and included studies that evaluated one or more forms of dietary modification for the treatment of AD. Studies of supplementation, such as with vitamins, minerals, or probiotics, were not included, nor were studies on prevention of the development of AD. A total of 43 articles met the inclusion criteria and were included in the final analysis. RESULTS Trials varied in type, duration, and the AD patient populations studied. Overall, there is some level I evidence to support specific exclusion diets in preselected patients but insufficient evidence for strict elimination diets (diets that are typically limited to six to eight foods). Data supporting other interventions are mixed and based on small, poorly designed studies. CONCLUSIONS A comprehensive literature review reveals some promising results and several areas in need of further study. More evidence is needed to form a strong foundation for recommendations regarding the utility and role of elimination diets in AD management, but current evidence suggests that strict diet management is not effective in the treatment AD in the vast majority of patients.
Collapse
Affiliation(s)
- Neil R Lim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary E Lohman
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Peter A Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
45
|
Czarnowicki T, Krueger JG, Guttman-Yassky E. Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. J Allergy Clin Immunol 2017; 139:1723-1734. [PMID: 28583445 DOI: 10.1016/j.jaci.2017.04.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/07/2017] [Accepted: 04/13/2017] [Indexed: 12/16/2022]
Abstract
Skin barrier abnormalities have been suggested to play an essential role in initiation of early atopic dermatitis (AD). Antigen penetration through a compromised barrier likely leads to increased innate immune responses, antigen-presenting cell stimulation, and priming of overt cutaneous disease. In a TH2-promoting environment, T-cell/B-cell interactions occurring in regional lymph nodes lead to excessive IgE switch. Concurrent redistribution of memory T cells into the circulation not only leads to exacerbation of AD through T-cell skin infiltration but also spreads beyond the skin to initiate the atopic march, which includes food allergy, asthma, and allergic rhinitis. Possible primary interventions to prevent AD are focusing on improving skin barrier integrity, including supplementing barrier function with moisturizers. As for secondary prophylaxis in children with established AD, this can be stratified into prevention of disease exacerbations by using proactive approaches (with either topical corticosteroids or topical calcineurin inhibitors) in mild AD cases or the prevention of other atopic disorders that will probably mandate systemic immunosuppression in severe AD cases.
Collapse
Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - James G Krueger
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
| |
Collapse
|
46
|
Yonekura S, Okamoto Y, Sakurai D, Sakurai T, Iinuma T, Yamamoto H, Hanazawa T, Horiguchi S, Kurono Y, Honda K, Majima Y, Masuyama K, Takeda N, Fujieda S, Okano M, Ogino S, Okubo K. Complementary and alternative medicine for allergic rhinitis in Japan. Allergol Int 2017; 66:425-431. [PMID: 27884625 DOI: 10.1016/j.alit.2016.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/04/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is extensively used in patients with allergic diseases worldwide. The purpose of this study was to investigate the actual situation of CAM practice in the treatment of allergic rhinitis. METHODS We distributed questionnaires to otolaryngologists at 114 facilities in Japan. The subjects who participated in this study included children <16 years of age and adults ≥16 years of age diagnosed with allergic rhinitis by otolaryngologists. The survey was performed in the period from September 2007 to August 2009. Furthermore, we performed the same investigation out of the hospital setting, such as during general health examinations. All questionnaires were returned to Chiba University and analyzed. RESULTS The proportions of patients who had ever experimented with CAM in the hospital survey were 7.1% (225/3170) and 19.2% (1416/7363) of children and adults, respectively. Approximately 36.2% of the adult patients thought that the treatments were effective. The main reasons for CAM use were safety, convenience and low price. However, the group who spent more than $1000 on CAM felt more dissatisfaction and anxiety related to treatment at the hospital. The situation of CAM practice was not consistent and was instead influenced by the backgrounds of the subjects. CONCLUSIONS Many patients who receive CAM report feeling that the effects of treatment provided by hospitals are insufficient and have concerns about the side effects of such treatments. Information regarding standard treatments, as described in the guidelines, should become widely known and diffused, and strong communication with patients should be considered.
Collapse
|
47
|
Abstract
The practice of pediatrics from an integrative framework is based on physician-patient relationship, informed by evidence, and approaches the health of children and their families from a broad perspective. This article reviews the basic principles of integrative pediatrics and summarizes data and integrative approaches to common pediatric conditions seen in the primary care setting.
Collapse
Affiliation(s)
- David K Becker
- Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero Street, 4th Floor, Box 1726, San Francisco, CA 94143-1726, USA.
| |
Collapse
|
48
|
Abstract
Atopic dermatitis (AD) is increasingly recognized as a complex, inflammatory skin disease involving interplay of multiple elements. This article notes key advances in understanding of immune dysregulation, skin barrier dysfunction, environmental, genetic, and microbial influences orchestrating disease pathogenesis, and the relevance of therapeutic interventions in each area. Accumulating evidence and the discovery of new T-cell subsets has matured AD as a multiple-cytokine-axes-driven disorder, evolved from the widely held belief of it being a biphasic Th1/Th2 disease. These new insights have led to active trials testing multiple, targeted therapeutics with better efficacy and safety-profiles.
Collapse
Affiliation(s)
- Kunal Malik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA; Laboratory of Investigative Dermatology, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA; SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Kerry D Heitmiller
- University of Maryland School of Medicine, 655 West Baltimore South, Baltimore, MD 21201, USA
| | - Tali Czarnowicki
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA; Laboratory of Investigative Dermatology, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA.
| |
Collapse
|
49
|
Abstract
Itch, or pruritus, is a hallmark feature of atopic dermatitis (AD). The impact of AD-related pruritus can range from mildly distressing or distracting to completely disabling. Traditionally, management of itch in AD patients has focused on restoring the altered skin barrier with topical emollients and/or reducing inflammation. A growing emphasis has been placed on directly targeting the neural transmission pathways that mediate itch signaling. Off-label use of neuromodulatory agents has helped reduce this aggravating symptom in atopic patients. This article reviews the current literature on the use of neuromodulatory agents and nonpharmacologic alternative therapies used to treat AD-related pruritus.
Collapse
Affiliation(s)
- Sarina B Elmariah
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
50
|
Bodeker G, Ryan TJ, Volk A, Harris J, Burford G. Integrative Skin Care: Dermatology and Traditional and Complementary Medicine. J Altern Complement Med 2017; 23:479-486. [PMID: 28410445 DOI: 10.1089/acm.2016.0405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Skin problems and diseases are extremely common globally and, due to their visibility, often result in severe distress and stigma for sufferers. Traditional (i.e., indigenous or local) and complementary health systems are widely used and incorporate many treatment modalities suitable for skin care, and a body of evidence for their efficacy and safety has built up over many decades. These approaches are often used as part of a broader "integrative medicine" (IM) approach that may also include, for example, nutrition and mind-body approaches. This article presents an overview of current knowledge about traditional and complementary medicine (T&CM) and IM principles and practices for skin health; reviews published epidemiologic studies, clinical trials, and wider literature; and discusses the challenges of conducting research into T&CM and IM. It also highlights the need for an innovative research agenda-one which is congruent with the principles of IM, as well as taking policy and public health dimensions into consideration.
Collapse
Affiliation(s)
- Gerard Bodeker
- 1 Green Templeton College, University of Oxford , Oxford, United Kingdom
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
- 3 Department of Epidemiology, Columbia University , New York, N.Y
| | - Terence J Ryan
- 1 Green Templeton College, University of Oxford , Oxford, United Kingdom
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
- 4 Faculty of Health and Life Sciences, Oxford Brookes University , Oxford, United Kingdom
- 5 Centre for Biocultural Diversity, University of Kent, Canterbury, United Kingdom
| | - Adva Volk
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
| | - Jahnavi Harris
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
| | - Gemma Burford
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
- 5 Centre for Biocultural Diversity, University of Kent, Canterbury, United Kingdom
| |
Collapse
|