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Yin L, Ungar B, Guttman-Yassky E, Cohen DE, Karagounis TK. Beyond Avoidance: Advanced Therapies for Contact Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00550-6. [PMID: 38821440 DOI: 10.1016/j.jaip.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/05/2024] [Accepted: 05/19/2024] [Indexed: 06/02/2024]
Abstract
Contact dermatitis (CD) is a common and burdensome condition divided into irritant contact dermatitis and allergic contact dermatitis. Treatment relies on accurate diagnosis and identification of the trigger, because definitive treatment is irritant or allergen avoidance. However, avoidance is not always possible, such as when the patient is reacting to a necessary medical device, when the trigger is integral to the patient's occupation, and when avoidance is practically untenable. In these cases, treatment is particularly challenging, especially because the literature on treatments in this clinical scenario is limited. In addition, CD has a complex pathophysiology that varies according to the trigger type, leading to variable treatment efficacy. This article reviews the current literature on treatments for CD with a focus on treatments when trigger avoidance is not feasible.
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Affiliation(s)
- Lu Yin
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Benjamin Ungar
- Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine, Mount Sinai Medical Center and Health System, New York, NY
| | - Emma Guttman-Yassky
- Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine, Mount Sinai Medical Center and Health System, New York, NY
| | - David E Cohen
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY
| | - Theodora K Karagounis
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY.
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Sadrolvaezin A, Pezhman A, Zare I, Nasab SZ, Chamani S, Naghizadeh A, Mostafavi E. Systemic allergic contact dermatitis to palladium, platinum, and titanium: mechanisms, clinical manifestations, prevalence, and therapeutic approaches. MedComm (Beijing) 2023; 4:e386. [PMID: 37873514 PMCID: PMC10590457 DOI: 10.1002/mco2.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Abstract
Contact dermatitis (CD) is an inflammatory skin disease of eczema that is elicited by chemicals or metal ions that have toxic effects without eliciting a T-cell response (contact elicitation) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). The clinical condition is characterized by localized skin rash, pruritus, redness, swelling, and lesions, which are mainly detected by patch tests and lymphocyte stimulation. Heavy metals such as palladium (Pd), platinum (Pt), and titanium (Ti) are ubiquitous in our environment. These heavy metals have shown CD effects as allergic agents. Immunological responses result from the interaction of cytokines and T cells. Occupational metal CD accounts for most cases of work-related cutaneous disorders. In this systematic review, the allergic effects of heavy metals, including Pd, Pt, and Ti, and the mechanisms, clinical manifestations, prevalence, and therapeutic approaches are discussed in detail. Furthermore, the therapeutic approaches introduced to treat CD, including corticosteroids, topical calcineurin inhibitors, systemic immunosuppressive agents, phototherapy, and antihistamines, can be effective in the treatment of these diseases in the future. Ultimately, the insights identified could lead to improved therapeutic and diagnostic pathways.
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Affiliation(s)
- Ali Sadrolvaezin
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Arezou Pezhman
- School of MedicineZahedan Azad University of Medical SciencesZahedanIran
| | - Iman Zare
- Research and Development DepartmentSina Medical Biochemistry Technologies Co. Ltd.ShirazIran
| | - Shima Zahed Nasab
- Department of Life Science EngineeringFaculty of New Sciences and TechnologiesUniversity of TehranTehranIran
| | - Sajad Chamani
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ali Naghizadeh
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ebrahim Mostafavi
- Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCaliforniaUSA
- Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. S1-Leitlinie Kontaktekzem. J Dtsch Dermatol Ges 2022; 20:711-734. [PMID: 35578429 DOI: 10.1111/ddg.14734_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster
| | - Vera Mahler
- Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Langen
| | | | | | | | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Johannes Geier
- Zentrale des IVDK, Universitätsmedizin Göttingen, Göttingen
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. German S1 guideline: Contact dermatitis. J Dtsch Dermatol Ges 2022; 20:712-734. [DOI: 10.1111/ddg.14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Heinrich Dickel
- Department of Dermatology Venereology and Allergology St. Josef Hospital University Medical Center of the Ruhr University Bochum Bochum Germany
| | - Andrea Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - Randolf Brehler
- Department of Dermatology University Hospital Münster Münster Germany
| | - Vera Mahler
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Hans F. Merk
- Department of Dermatology RWTH Aachen University Aachen Germany
| | - Irena Neustädter
- Department of Pediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | | | - Thomas Werfel
- Department of Dermatology Allergology and Venereology Hannover Medical School Hannover Germany
| | - Margitta Worm
- Department of Dermatology Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Johannes Geier
- Center of IVDK University Medical Center Göttingen Göttingen Germany
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Guenther L, Lynde C, Poulin Y. Off-Label Use of Topical Calcineurin Inhibitors in Dermatologic Disorders. J Cutan Med Surg 2020; 23:27S-34S. [PMID: 31476936 DOI: 10.1177/1203475419857668] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Off-label prescribing is a common practice in dermatology, particularly when uncommon dermatologic diseases have limited or no approved treatment options. Topical calcineurin inhibitors are approved for the treatment of eczema, and their anti-inflammatory, immunomodulatory, and steroid-sparing effects make them an attractive therapeutic option for a wide variety of other dermatologic diseases. This review summarizes and qualifies the available evidence supporting the clinical effectiveness of tacrolimus ointment and pimecrolimus cream in non-eczema indications. There is high-quality evidence supporting the effectiveness of topical calcineurin inhibitors in multiple dermatological disorders including vitiligo; psoriasis of the face, folds, and genitals; seborrheic dermatitis; chronic hand dermatitis; contact dermatitis; oral lichen planus; lichen sclerosus; morphea; and cutaneous lupus erythematosus. Lower-quality evidence suggests they may be considered as an option in many other cutaneous disorders.
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Affiliation(s)
| | - Charles Lynde
- 2 Lynde Dermatology, Probity Medical Research, Markham, ON, and Department of Medicine, University of Toronto, ON, Canada
| | - Yves Poulin
- 3 Laval University and Centre dermatologique du Québec métropolitain and Centre de Recherche Dermatologique du Québec métropolitain, Canada
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Abstract
Pimecrolimus is a topical calcineurin inhibitor currently approved for second-line use in the management of mild-to-moderate atopic dermatitis in patients age 2 years and older. Given the safety profile and nonsteroidal mechanism of pimecrolimus, there has been significant interest in its use in the treatment of a variety of dermatological conditions. This article reviews research that has been published on the off-label uses of topical pimecrolimus, with a focus on published RCTs. Convincing evidence exists supporting pimecrolimus' efficacy in oral lichen planus and seborrheic dermatitis. For other conditions studied to date, pimecrolimus may prove to be a useful treatment alternative when conventional agents fail. Adverse events seen with its off-label use were typically application site reactions, the most common being a transient burning sensation. In summary, pimecrolimus appears to be an effective agent in the treatment of multiple dermatological conditions and may be worth considering as a pharmacologic alternative in several conditions when first-line treatment fails, or for areas that are more susceptible to the adverse effects of topical corticosteroids.
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Affiliation(s)
- Matthew Ladda
- 1 Faculty of Medicine, University of Toronto, ON, Canada
| | - Vijay Sandhu
- 1 Faculty of Medicine, University of Toronto, ON, Canada
| | - Arvin Ighani
- 1 Faculty of Medicine, University of Toronto, ON, Canada
| | - Jensen Yeung
- 2 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,3 Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,4 Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Canada.,5 Probity Medical Research, Waterloo, Canada
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Poveda-Montoyo I, Álvarez-Chinchilla PJ, Silvestre JF. Allergic Contact Dermatitis: Therapeutic Management. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Lee KH, Ho JKK, Lam KM, Wu WY. An Unfamiliar “Common” Skin Disease: Poison Ivy Allergic Contact Dermatitis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case of phytodermatitis caused by a poisonous plant known as poison ivy. It is one of the leading causes of allergic contact dermatitis and it causes significant morbidity in the United States. Prevention of the disease is by identification and avoidance of the plant. Barrier protection minimises the chance of contact and prompt rinsing with soap water limits antigen exposure after skin contact. General approach to treatment of allergic contact dermatitis can be applied but special precaution should be taken on the duration of systemic steroid therapy. Too short a course of oral steroid may result in a more severe recurrent flare. High potency topical steroids may limit the development of skin lesions. (Hong Kong j.emerg.med. 2011; 18:335-338)
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Affiliation(s)
- KH Lee
- Cheung Sha Wan Dermatological Clinic, Social Hygiene Service, Department of Health, Cheung Sha Wan Government Offices, Sham Shui Po, Kowloon, Hong Kong
| | - JKK Ho
- Cheung Sha Wan Dermatological Clinic, Social Hygiene Service, Department of Health, Cheung Sha Wan Government Offices, Sham Shui Po, Kowloon, Hong Kong
| | - KM Lam
- Cheung Sha Wan Dermatological Clinic, Social Hygiene Service, Department of Health, Cheung Sha Wan Government Offices, Sham Shui Po, Kowloon, Hong Kong
| | - WY Wu
- Cheung Sha Wan Dermatological Clinic, Social Hygiene Service, Department of Health, Cheung Sha Wan Government Offices, Sham Shui Po, Kowloon, Hong Kong
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Therapeutic effect of Castellani's paint in patients with an itchy ear canal. The Journal of Laryngology & Otology 2017; 130:934-938. [PMID: 27774921 DOI: 10.1017/s0022215116008744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the effects of Castellani's paint on symptomatic relief and skin flora in patients with an itchy external ear canal. METHODS Subjective pruritus scores, and erythema and desquamation scores, were noted in 61 patients with an itchy external ear canal. External ear canal skin swabs were taken for bacterial and fungal cultures. Patients were then randomly divided into three groups: either Castellani's paint (group one) or steroid ear drops (group two) were instilled, or non-impacted cerumen was removed (group three). Patients were re-assessed at one month after the initial visit. RESULTS After treatment, subjective pruritus scores were significantly lower in all groups, erythema scores were significantly decreased in group one, and desquamation scores were significantly reduced in groups one and two, when compared with pre-treatment scores. Reproduction density of bacteria including normal flora was decreased in group one. However, the types of bacteria that constitute the normal flora of the external ear canal were unchanged. CONCLUSION Castellani's paint can be administered safely, effectively and easily, without affecting the type of external ear canal skin bacteria, in patients with an itchy external ear canal.
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Fonacier L, Bernstein DI, Pacheco K, Holness DL, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Contact dermatitis: a practice parameter-update 2015. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:S1-39. [PMID: 25965350 DOI: 10.1016/j.jaip.2015.02.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 01/08/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.
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Tuzuner A, Akdagli S, Sen T, Demirci S, Tarimci N, Caylan R. An objective analysis of sebum, pH and moisture levels of the external ear canal skin. Am J Otolaryngol 2015; 36:424-8. [PMID: 25749543 DOI: 10.1016/j.amjoto.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 01/26/2015] [Accepted: 02/01/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine sebum, pH and moisture levels of external ear canal skin, and compare the patients who complain of ear itching and the normal population for these parameters. And evaluate the improvement subjectively in the ones given dexamethasone sodium phosphate (DSP) cream or placebo-water in oil emulsion type cream, and to determine the changes in sebum, pH and moisture levels after the treatment. METHODS 32 females with the complaint of isolated external ear canal itching and 42 healthy women were included in this randomized prospective controlled study. The sebum, pH and moisture levels of ear skin of the patients and the controls were determined from baseline and following treatment. Patients used DSP in their right and the placebo in their left ears for 15 days. Subjective analysis of itching level was measured at baseline, and on 15th and 30th days using visual analog scale (VAS). RESULTS There was no statistically significant difference between pretreatment and post-treatment pH and sebum levels of the study group and the control group. However, pretreatment and post-treatment moisture levels of the study group were significantly higher (p<0.001). CONCLUSION The study found an association of increased moisture levels of the external ear canal skin and isolated ear itching.
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Affiliation(s)
- Arzu Tuzuner
- Ministry of Health, Ankara Training and Research Hospital, Department of Otorhinolaryngology- Head and Neck Surgery, Ankara, Turkey
| | - Seden Akdagli
- Ministry of Health, Ankara Training and Research Hospital, Department of Otorhinolaryngology- Head and Neck Surgery, Ankara, Turkey.
| | - Tangul Sen
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Sule Demirci
- Ministry of Health, Ankara Training and Research Hospital, Department of Otorhinolaryngology- Head and Neck Surgery, Ankara, Turkey
| | - Nilufer Tarimci
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Refik Caylan
- Ministry of Health, Ankara Training and Research Hospital, Department of Otorhinolaryngology- Head and Neck Surgery, Ankara, Turkey
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Grunwald MH, Ben Amitai D, Amichai B. Macrolactam Immunomodulators (Tacrolimus and Pimecrolimus): New Horizons in the Topical Treatment of Inflammatory Skin Diseases. J Dermatol 2014; 31:592-602. [PMID: 15492431 DOI: 10.1111/j.1346-8138.2004.tb00564.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2003] [Accepted: 03/30/2004] [Indexed: 11/29/2022]
Abstract
Tacrolimus and pimecrolimus are new macrolactam immunomodulators which were developed for the treatment of inflammatory skin diseases, mainly atopic dermatitis. In this article, we review the pharmacologic properties of the drugs, their side effects, and their clinical uses.
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Affiliation(s)
- Marcelo H Grunwald
- Department of Dermatology, Soroka Medical Center, Ben Gurion University, Beer-Sheva, Israel
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Brasch J, Becker D, Aberer W, Bircher A, Kränke B, Jung K, Przybilla B, Biedermann T, Werfel T, John SM, Elsner P, Diepgen T, Trautmann A, Merk HF, Fuchs T, Schnuch A. Guideline contact dermatitis: S1-Guidelines of the German Contact Allergy Group (DKG) of the German Dermatology Society (DDG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. ALLERGO JOURNAL INTERNATIONAL 2014; 23:126-138. [PMID: 26146602 PMCID: PMC4484750 DOI: 10.1007/s40629-014-0013-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Jochen Brasch
- />Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstraße 7, 24105 Kiel, Germany
| | - Detlef Becker
- />Department of Dermatology, University of Mainz, Mainz, Germany
| | - Werner Aberer
- />Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Andreas Bircher
- />Allergy Unit, Dermatology Clinic, University Hospital, Basel, Switzerland
| | - Birger Kränke
- />Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Bernhard Przybilla
- />Clinic and Policlinic for Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tilo Biedermann
- />Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Thomas Werfel
- />Department of Dermatology, Allergology und Venerology, Hannover Medical School, Hannover, Germany
| | - Swen Malte John
- />Department of Dermatology, Environmental Medicine und Theory of Health, University Osnabrück, Osnabrück, Germany
| | - Peter Elsner
- />Department of Dermatology, University Hospital Jena, Jena, Austria
| | - Thomas Diepgen
- />Department of Clinical Social Medicine, University Hospital, Jena, Austria
| | - Axel Trautmann
- />Clinic and Policlinic for Dermatology, Venerology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Hans F. Merk
- />Clinic for Dermatology, University Hospital Aachen, Aachen, Germany
| | - Thomas Fuchs
- />Clinic for Dermatology, Venerology und Allergology, Medical University Göttingen, Göttingen, Germany
| | - Axel Schnuch
- />Information Network of Departments of Dermatology, University Medicine of Göttingen, Göttingen, Germany
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Beriat GK, Akmansu SH, Doğan C, Taştan E, Topal F, Sabuncuoğlu B. Is pimecrolimus cream (1%) an appropriate therapeutic agent for the treatment of external ear atopic dermatitis? Med Sci Monit 2012; 18:BR135-43. [PMID: 22460087 PMCID: PMC3560827 DOI: 10.12659/msm.882615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In recent years, pimecrolimus 1% cream has been demonstrated to reduce symptoms of atopic dermatitis in patients when applied topically. Material/Methods In our study we compared the therapeutic effects of local 1% pimecrolimus to 1% hydrocortisone, and to a control group in a mouse model with atopic dermatitis in the external ear canals. Atopic dermatitis was created by application of Dinitrochlorobenzene in the external ear canals of mice. The development of atopic dermatitis was detected by clinical observation score and determination of total serum IgE levels. Pimecrolimus and hydrocortisone cream were topically applied to the external ear canal skin once a day for 14 days. Results There was no significant difference between the hydrocortisone and the pimecrolimus therapy groups, while there was a statistically significant difference between these 2 groups and the control group (p<0.05) Assessment of the clinical observation scoring carried out on the 14th day of therapy revealed that there was no difference between the hydrocortisone and pimecrolimus groups. Biopsies were taken on the 14th day following treatment. Tissue samples were histologically evaluated; contact dermatitis was observed microscopically in the control group, but in the therapy groups only minimal evidence of contact dermatitis was found. Conclusions The results of our study reveal that the therapeutic efficacy of 1% pimecrolimus was equivalent to 1% hydrocortisone treatment in the artificially developed atopic dermatitis model in external ear canals of mice. These results clearly demonstrate that 1% pimecrolimus cream can be an effective alternative therapeutic agent in cases where steroid treatment proves to be insufficient or in cases where treatment must be discontinued due to its adverse effects.
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Affiliation(s)
- Güçlü Kaan Beriat
- Department of Otorhinolaryngology, Ufuk University Medical School, and ENT Department, Ankara Training and Research Hospital, Ankara, Turkey
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New treatment strategy and assessment questionnaire for external auditory canal pruritis: topical pimecrolimus therapy and Modified Itch Severity Scale. The Journal of Laryngology & Otology 2009; 124:147-51. [DOI: 10.1017/s0022215109991459] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:We aimed to compare the efficacy of topical pimecrolimus versus hydrocortisone in treating external auditory canal pruritis, using the Modified Itch Severity Scale as an assessment tool.Methods:We included in the study 40 patients with isolated itching of the external auditory canal who had not received any benefit from previous topical and systemic treatments. Topical 1 per cent pimecrolimus or topical hydrocortisone was applied to each patient's external auditory canal for three months. A Modified Itch Severity Scale was developed and used to assess treatment response.Results:Compared with itching scores on initial assessment, the scores of patients receiving topical pimecrolimus had decreased by 52.3 per cent by the third week of treatment and by 77.6 per cent by the third month, whereas the scores of patients receiving topical hydrocortisone had decreased by 34.4 per cent by the third week and by 64.2 per cent by the third month.Conclusions:Topical pimecrolimus appears to be as effective as topical hydrocortisone in relieving external auditory canal pruritis. We used a novel scoring system, the Modified Itch Severity Scale, to evaluate external auditory canal pruritus; this is the first self-reporting questionnaire for the quantification of external auditory canal pruritus severity. Further studies are needed to validate this scoring system.
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Day I, Lin AN. Use of pimecrolimus cream in disorders other than atopic dermatitis. J Cutan Med Surg 2008; 12:17-26. [PMID: 18258153 DOI: 10.2310/7750.2008.07026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pimecrolimus is indicated for treatment of atopic dermatitis and has been evaluated in many other disorders. OBJECTIVE To review the efficacy of pimecrolimus in treatment of disorders other than atopic dermatitis. METHODS We performed a PubMed search of the English-language literature using the key word "pimecrolimus." We reviewed articles reporting the use of pimecrolimus in disorders other than atopic dermatitis and classified them by the type of study used to evaluate efficacy. RESULTS Randomized, double-blind studies have shown that pimecrolimus is superior to vehicle in treatment of seborrheic dermatitis, hand dermatitis, and asteatotic eczema but have yielded conflicting results regarding intertriginous psoriasis and vitiligo. Open-label studies involving four or more patients have shown favorable results in many disorders, including contact dermatitis, rosacea, lichen sclerosus, and oral and genital lichen planus. Case reports have shown that topical pimecrolimus may be useful in cutaneous graft-versus-host disease, lichen striatus, cutaneous lichen planus, and many other disorders. CONCLUSIONS Topical pimecrolimus appears to be an effective treatment for many disorders other than atopic dermatitis, especially seborrheic dermatitis, hand dermatitis, and asteatoic eczema. It may be effective in many other disorders, but its role in these disorders remains to be clarified by additional studies.
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Affiliation(s)
- Isaiah Day
- Division of Dermatology and Cutaneous Sciences, University of Alberta, Edmonton, AB, Canada
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Brasch J, Becker D, Aberer W, Bircher A, Kränke B, Denzer-Fürst S, Schnuch A. Contact Dermatitis. J Dtsch Dermatol Ges 2007; 5:943-51. [PMID: 17910679 DOI: 10.1111/j.1610-0387.2007.06523.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jochen Brasch
- Department of Dermatology, Venereology and Allergy, University of Schleswig-Hostein, Campus Kiel, Germany.
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Bhardwaj SS, Jaimes JP, Liu A, Warshaw EM. A Double-Blind Randomized Placebo-Controlled Pilot Study Comparing Topical Immunomodulating Agents and Corticosteroids for Treatment of Experimentally Induced Nickel Contact Dermatitis. Dermatitis 2007; 18:26-31. [PMID: 17303041 DOI: 10.2310/6620.2007.06031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although topical glucocorticoids are effective for most inflammatory skin disorders, their use is limited by local and systemic side effects. Tacrolimus and pimecrolimus are immunomodulators that provide clinicians with steroid-sparing options in the long-term topical treatment of allergic contact dermatitis. OBJECTIVE To obtain pilot data regarding the relative efficacies of pimecrolimus 1% cream, tacrolimus 0.1% ointment, clobetasol propionate 0.05% ointment, and triamcinolone acetonide 0.1% ointment, as compared to control preparations (Vanicream and petrolatum), for treatment of experimentally induced nickel contact dermatitis. METHODS Twenty-one volunteers with positive patch test reactions to nickel sulfate 5% at six sites (three on each arm) applied each study medication to one nickel site, respectively, twice daily for 14 days. Study medications were prepared in identical syringes, and the site of application was randomly assigned by a computer-generated randomization schedule. Assessments were performed at 3, 7, 10, and 14 days after randomization. RESULTS Most reactions were coded as resolved or as almost resolved by day 14 regardless of treatment. Although most pairwise comparisons were not statistically significant, a clear trend was observed for sites treated with active drug to do better than control sites. CONCLUSION Possible explanations for these results include contamination by neighboring medication sites, timing of assessments, and lack of repeated nickel applications.
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Abstract
OBJECTIVES/HYPOTHESIS To understand the role and efficacy of topical pimecrolimus in the treatment of refractory pruritus of the external auditory canals (EACs). STUDY DESIGN Retrospective chart review. METHODS Thirty-six patients with pruritic EACs who had failed conventional therapy with topical and systemic medications were treated with topical pimecrolimus 1% for a period of 3 months. Baseline and follow-up evaluation of the degree of pruritus among other variables was performed. A control group of 19 patients was instructed on aural toilet alone and was not treated with topical pimecrolimus 1%. RESULTS Of the 36 patients who were treated with topical pimecrolimus for their pruritic EACs, 34 patients had resolution of their symptoms. There was evidence of return of cerumen production in 86% of patients. In the control group, 16% of patients had improvement of their symptoms with aural toilet. This difference was statistically significant (chi, P < .0001). CONCLUSIONS Topical pimecrolimus appears to be more efficacious than aural toilet in the treatment of pruritic ears for chronic use without side effects.
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Affiliation(s)
- Hamid R Djalilian
- University of Illinois at Chicago and Academic Dermatology and Skin Cancer Institute, Chicago, Illinois, USA.
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Beltrani VS, Bernstein I, Cohen DE, Fonacier L. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol 2006. [DOI: 10.1016/s1081-1206(10)60811-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
The pathophysiology of ACD follows an intricate design and results in the characteristic, delayed inflammatory response. Although the astute physician may correctly diagnose ACD from its initial, classic history and presentation, alternative diagnoses should be considered and excluded. Patch testing performed with a relevant panel of contact allergens is the ultimate confirmatory test of ACD. Correctly identifying the inciting allergen permits appropriate personal avoidance. Corticosteroids remain the principal treatment options.
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Affiliation(s)
- Barry J Mark
- Division of Allergy and Immunology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Abstract
Within the last decade, healthcare providers have had a larger selection of effective novel topical immunomodulatory agents to treat many dermatologic conditions. Novel mechanisms of action of newer topical agents have facilitated differentiation from well-established topical agents such as corticosteroids and 5-fluorouracil. Further, because of a growing understanding of the immune mechanisms within the skin, the opportunity has arisen to use the body's immune system to effectively treat many dermatologic conditions, such as condyloma acuminata, actinic keratosis, basal cell carcinoma, and atopic dermatitis, while maintaining a favorable safety profile. Imiquimod 5% cream, an immune response modifier, is safe and effective in the treatment of condyloma acuminata, actinic keratosis, and primary superficial basal cell carcinoma (sBCC). Pimecrolimus cream 1% and tacrolimus ointment (0.1% and 0.03%) are safe and effective in the treatment of atopic dermatitis. This review highlights newer data on approved and investigational indications for these topical immunomodulatory agents.
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Affiliation(s)
- Robert Skinner
- Department of Medicine, Division of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
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Abstract
Pimecrolimus (SDZ ASM 981, Elidel ) is an ascomycin macrolactam derivative and a cell-selective inhibitor of inflammatory cytokines specifically developed to treat inflammatory skin diseases. Pimecrolimus combines high anti-inflammatory activity in the skin with a low potential to impair systemic immune reactions. Multi-centre studies have proved the efficacy and safety of pimecrolimus cream in patients with atopic dermatitis (AD) and confirmed that it is suitable for short-term treatment and long-term management of AD in adults, children and infants as young as 3 months. Topical application in humans is not associated with the atrophogenic side effects observed with corticosteroids. Pimecrolimus blood levels remained consistently low after repeated topical application and no clinically relevant drug-related systemic adverse events have been reported among the 8000 patients treated in clinical trials so far. Short-term, Phase I/II and Phase II trials of pimecrolimus administered orally in psoriasis and AD have shown that this drug is highly effective in a dose-dependent manner in patients with these diseases and has high safety profile. This finding is confirmed by pharmacogenomic blood analysis. Available data thus indicates that pimecrolimus, in both the cream and oral formulations, may represent a new option for the treatment of inflammatory skin diseases.
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Affiliation(s)
- Klaus Wolff
- Department of Dermatology, University of Vienna, Vienna General Hospital, Vienna, Austria.
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Kamei C, Hossen MA. Commentary 1. Exp Dermatol 2005. [DOI: 10.1111/j.0906-6705.2005.00321g.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sauder DN. Mechanism of Action and Emerging Role of Immune Response Modifier Therapy in Dermatologic Conditions. J Cutan Med Surg 2005; 8 Suppl 3:3-12. [PMID: 15647861 DOI: 10.1007/s10227-004-0803-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Immune response modifiers (IRMs) are agents that target the body's immune system (i.e., cytokines, receptors, and inflammatory cells) to combat disease. Topical IRM therapies, which encompass both proinflammatory and immunosuppressive therapeutics, have been used to successfully treat a number of dermatologic conditions. Proinflammatory treatments include Toll-like receptor agonists (e.g., imiquimod 5% cream) and interferon (e.g., interferon-alpha) therapies, which have been used in the treatment of external genital warts, basal cell carcinoma, and other dermatologic diseases. Immunosuppressive therapies include topical and intralesional corticosteroids, anti-tumor necrosis factor agents (e.g., infliximab and etanercept), and anti-CD4+ T-cell agents, including calcineurin inhibitors and mycophenolate. These agents have been used to treat a number of conditions, including atopic and seborrheic dermatitis and psoriasis. This article reviews the mechanism of action of IRMs and the application of IRMs in several dermatologic diseases.
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Affiliation(s)
- Daniel N Sauder
- Department of Dermatology, Johns Hopkins University, John Hopkins Outpatient Center, Baltimore, Maryland 21205-0900, USA.
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