1
|
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: 0] [Impact Index Per Article: 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
|
2
|
Kim H, Park SY, Lee G. Potential Therapeutic Applications of Bee Venom on Skin Disease and Its Mechanisms: A Literature Review. Toxins (Basel) 2019; 11:toxins11070374. [PMID: 31252651 PMCID: PMC6669657 DOI: 10.3390/toxins11070374] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 01/03/2023] Open
Abstract
Skin is larger than any other organ in humans. Like other organs, various bacterial, viral, and inflammatory diseases, as well as cancer, affect the skin. Skin diseases like acne, atopic dermatitis, and psoriasis often reduce the quality of life seriously. Therefore, effective treatment of skin disorders is important despite them not being life-threatening. Conventional medicines for skin diseases include corticosteroids and antimicrobial drugs, which are effective in treating many inflammatory and infectious skin diseases; however, there are growing concerns about the side effects of these therapies, especially during long-term use in relapsing or intractable diseases. Hence, many researchers are trying to develop alternative treatments, especially from natural sources, to resolve these limitations. Bee venom (BV) is an attractive candidate because many experimental and clinical reports show that BV exhibits anti-inflammatory, anti-apoptotic, anti-fibrotic, antibacterial, antiviral, antifungal, and anticancer effects. Here, we review the therapeutic applications of BV in skin diseases, including acne, alopecia, atopic dermatitis, melanoma, morphea, photoaging, psoriasis, wounds, wrinkles, and vitiligo. Moreover, we explore the therapeutic mechanisms of BV in the treatment of skin diseases and killing effects of BV on skin disease-causing pathogens, including bacteria, fungi and viruses.
Collapse
Affiliation(s)
- Haejoong Kim
- College of Korean Medicine, Dongshin University, Naju-si, Jeollanam-do 58245, Korea
| | - Soo-Yeon Park
- Department of Ophthalmology, Otolaryngology & Dermatology, College of Korean Medicine, Dongshin University, Naju-si, Jeollanam-do 58245, Korea.
| | - Gihyun Lee
- College of Korean Medicine, Dongshin University, Naju-si, Jeollanam-do 58245, Korea.
| |
Collapse
|
3
|
Wang V, Keefer M, Ong PY. Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis. Ann Allergy Asthma Immunol 2018; 122:314-317. [PMID: 30529713 DOI: 10.1016/j.anai.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Systemic antibiotics are commonly used in hospitalized patients with severe atopic dermatitis (AD) exacerbation. However, the antibiotic prescribing patterns are unclear. OBJECTIVE To compare the prescribing patterns of antibiotics for children who were hospitalized for AD exacerbation and infectious complications. METHODS Electronic medical records were reviewed for patients younger than 18 years who were hospitalized for AD exacerbation or infectious complications based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes from 2003 to 2018. The following information was obtained: history, physical examination findings, physician discharge summary, antibiotic treatments, serum tests, and wound cultures. The t test was used to compare clinical and laboratory features. RESULTS A total of 174 patients with AD were included. Seventy patients had AD exacerbation and 104 had infectious complications, including cellulitis, abscesses, invasive infections, and eczema herpeticum. The differences between these 2 groups of patients were further verified by length of stay, serum total IgE level, and inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). A total of 56 of 70 patients (80%) with AD exacerbation were treated with a systemic antibiotic. Clindamycin and vancomycin together accounted for 88% of antibiotics on admission for both groups, whereas clindamycin and sulfamethoxazole-trimethoprim were prescribed at similar rates for both groups at discharge. Wound culture results showed that the methicillin-resistant Staphylococcus aureus (MRSA) rate was significantly lower in children with AD exacerbation (22%) vs infectious complications (39%). CONCLUSION Children were treated with a high frequency of anti-MRSA antibiotics for inpatient AD exacerbation and infectious complications. However, the rate of MRSA was significantly lower in children with AD exacerbation. Thus, empiric antibiotic choice for infectious complications may not be appropriate for AD exacerbation.
Collapse
Affiliation(s)
- Vivian Wang
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Matthew Keefer
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Peck Y Ong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California.
| |
Collapse
|
4
|
Dare JB, Arogundade B, Awoniyi OO, Adegoke AA, Adekomi DA. Dexamethasone as endocrine disruptor; type I and type II (anti) oestrogenic actions on the ovary and uterus of adult Wistar rats ( Rattus Novergicus). JBRA Assist Reprod 2018; 22:307-313. [PMID: 30175909 PMCID: PMC6210616 DOI: 10.5935/1518-0557.20180061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Dexamethasone is a widely used glucocorticoid, which has been prescribed
increasingly in recent years. The effects of Dexamethasone on the ovary and
uterus was investigated in present study. Methods Twenty (20) adult female Wistar rats, weighing 130-170 g were assigned to
four (4) groups of five (5) animals each. The rats in the control group
received saline, while the rats in the experimental group was subjected to
oral treatment of dexamethasone of 12 mg/kg, 10 mg/kg, and 7 mg/kg doses
daily for a period of 10 days, respectively. The rats were slaughtered after
24 hours of the last administration, and the uterus and ovaries were
harvested following abdominal incision. Histological and biochemical
investigations were carried out and the results were analyzed using ANOVA
with the Graph-Pad prism software package 6. Results There was a significant decrease in the activities of the carbohydrate
metabolic enzymes of the uterus in the dexamethasone-treated groups compared
to the control group (p<0.05). Vacuolation, atrophy,
thick epithelium, enlarged cells, inactive interstitial glands and
follicular cyst, characterized the histological observation in the
dexamethasone-treated groups in a dose-dependent manner. Conclusion This present study revealed that high-dose dexamethasone causes multiple
changes in the histological features of the ovary and uterus, exerting type
I and type II anti-oestrogenic effects on the female reproductive
compartment.
Collapse
Affiliation(s)
- Joseph Babatunde Dare
- Anatomy Department, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Babajide Arogundade
- Anatomy Department, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Olakunle Oladipupo Awoniyi
- Anatomy Department, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Adebiyi Aderinola Adegoke
- Anatomy Department, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Damilare Adedayo Adekomi
- Anatomy Department, Faculty of Basic Medical Sciences, College of Health Sciences, Osun State University, Osogbo, Nigeria
| |
Collapse
|
5
|
Abstract
Tacrolimus ointment is the first of a new class of non-steroidal topical immunomodulators indicated for the treatment of atopic dermatitis. Topical tacrolimushas been subject to an extensive clinical development program involving more than 16,000 patients. A clinical trial program, including vehicle-controlled studies, short- and long-term comparative studies and long-term safety studies, has investigated tacrolimus 0.1%and 0.03%ointment for the treatment of atopic dermatitis in adults and children aged 24 months and older. Tacrolimusmonotherapy is rapidly effective, resulting in clinical improvements within three days of starting therapy, and produces a progressive increase in efficacy that is sustained during long-term treatment. Tacrolimus treats the signs and symptoms of atopic dermatitis, reduces the incidence of flares, and offers the potential for long-term disease control. No major safety concerns have been reported to date. Tacrolimusointment is generally well tolerated, the primary adverse events being mild to moderate and transient application-site reactions: skin burning, pruritus and erythema. Tacrolimus oint-ment is a significant advance in dermatology and provides physicians with an alternative to conventional topical corticosteroid therapy.
Collapse
Affiliation(s)
- A Kapp
- a Dept. of Dermatology and Allergology , Hannover Medical University , Hannover , Germany
| | - B R Allen
- b Dept. of Dermatology , University Hospital, Queen's Medical Centre , Nottingham , UK
| | - S Reitamo
- c Dept. of Dermatology , Hospital for Skin and Allergic Diseases, University of Helsinki , Helsinki , Finland
| |
Collapse
|
6
|
Siddique MI, Katas H, Amin MCIM, Ng SF, Zulfakar MH, Buang F, Jamil A. Minimization of Local and Systemic Adverse Effects of Topical Glucocorticoids by Nanoencapsulation: In Vivo Safety of Hydrocortisone–Hydroxytyrosol Loaded Chitosan Nanoparticles. J Pharm Sci 2015; 104:4276-4286. [DOI: 10.1002/jps.24666] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/05/2015] [Accepted: 09/09/2015] [Indexed: 12/20/2022]
|
7
|
Choopani R, Mehrbani M, Fekri A, Mehrabani M. Treatment of Atopic Dermatitis From the Perspective of Traditional Persian Medicine: Presentation of a Novel Therapeutic Approach. J Evid Based Complementary Altern Med 2015; 22:5-11. [PMID: 26260045 DOI: 10.1177/2156587215598610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/10/2015] [Indexed: 11/15/2022] Open
Abstract
There is a strong current trend for using complementary and alternative medications to treat atopic dermatitis. Atopic dermatitis is a common, chronic, pruritic, and inflammatory skin disease. It can have a profound, negative effect on patients' quality of life. Mild cases of atopic dermatitis can be controlled by the application of moisturizers and topical corticosteroids. However, in severe cases, application of immunosuppressive medication is unavoidable but it can have adverse effects. In traditional Persian medicine, diseases similar to resistant atopic dermatitis are treated with whey in combination with decoction of field dodder. Both whey and field dodder have anti-inflammatory properties. Consumption of whey can also aid skin repair, mitigate pruritus, and help combat the high level of stress experienced by patients. Therefore, it is hypothesized that consumption of traditional medicinal treatment of whey with decoction of field dodder can be applied as a complementary treatment for atopic dermatitis.
Collapse
Affiliation(s)
- Rasool Choopani
- Department of Traditional Medicine, School of Traditional Medicine, Traditional Medicine and Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrzad Mehrbani
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Fekri
- Department of Dermatology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Mehrabani
- Herbal and Traditional Medicines Research Center, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
8
|
Abstract
Background: Chronic allergic skin disorders are the inflammatory and proliferative conditions in which both genetic and environmental factors play important roles. Chronic idiopathic urticaria (CIU) and atopic dermatitis (AD) are among the most common chronic allergic skin disorders. These can be provoked by various food and aeroallergens. Skin prick tests (SPTs) represent the cheapest and most effective method to diagnose type I hypersensitivity. Positive skin tests with a history suggestive of clinical sensitivity strongly incriminate the allergen as a contributor to the disease process. Aims and Objectives: To determine the incidence of positive SPT in patients with chronic allergic skin disorders and to identify the various allergens implicated in positive SPT. Methods: Fifty patients of chronic allergic disorders were recruited in this study. They were evaluated by SPT with both food and aeroallergens. Results: In our study, SPT positivity in patients of CIU was 63.41% and in AD was 77.78%. Out of the 41 patients of CIU, the most common allergen groups showing SPT positivity were dust and pollen, each comprising 26.83% patients. SPT reaction was positive with food items (21.6%), insects (17.07%), fungus (12.20%), and Dermatophagoides farinae, that is, house dust mite (HDM) (7.32%). The allergen which showed maximum positivity was grain dust wheat (19.51%). Among nine patients of AD, maximum SPT positivity was seen with Dermatophagoides farinae, pollen Amaranthus spinosus, grain dust wheat, and cotton mill dust; each comprising 22.22% of patients. Conclusion: Our study showed that a significant number of patients of CIU and AD showed sensitivity to dust, pollen, insects, Dermatophagoides farinae, and fungi on SPT. Thus, it is an important tool in the diagnosis of CIU and AD.
Collapse
Affiliation(s)
- Pooja Bains
- Department of Dermatology and Venereology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Alka Dogra
- Department of Dermatology and Venereology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
9
|
Kim SO, Ah YM, Yu YM, Choi KH, Shin WG, Lee JY. Effects of probiotics for the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy Asthma Immunol 2014; 113:217-26. [PMID: 24954372 DOI: 10.1016/j.anai.2014.05.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/22/2014] [Accepted: 05/27/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND The effects of probiotics on the treatment of atopic dermatitis (AD) are inconclusive. OBJECTIVE To determine the clinical effect of probiotics in the management of AD overall and in different age groups. METHODS A comprehensive search of databases through December 2013 was performed. For this meta-analysis, randomized controlled trials measuring the treatment effects of probiotics or synbiotics in patients diagnosed with AD were included. The primary outcome was a difference in Scoring of Atopic Dermatitis (SCORAD) values between the treatment and placebo groups overall and in different age populations. RESULTS Twenty-five randomized controlled trials (n = 1,599) were available for this meta-analysis. Significant differences in SCORAD values favoring probiotics over the control were observed overall (mean -4.51, 95% confidence interval -6.78 to -2.24), in children 1 to 18 years old (-5.74, 95% confidence interval -7.27 to -4.20), and in adults (-8.26, 95% confidence interval -13.28 to -3.25). However, the effectiveness of probiotics in infants (<1 year old) with AD was not proved. The effect of synbiotic use was not significantly different from that of probiotic use. Treatment with a mixture of different bacterial species or of Lactobacillus species showed greater benefit than did treatment with Bifidobacterium species alone. CONCLUSION The overall result of this meta-analysis suggests that probiotics could be an option for the treatment of AD, especially for moderate to severe AD in children and adults. However, no evidence was found supporting the beneficial role of probiotics in infants.
Collapse
Affiliation(s)
- Soo-Ok Kim
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Young-Mi Ah
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Gyeonggi-do, South Korea
| | - Yun Mi Yu
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Kyung Hee Choi
- College of Pharmacy, Suncheon University, Suncheon, Joellanam-do, South Korea
| | - Wan-Gyoon Shin
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Gyeonggi-do, South Korea.
| |
Collapse
|
10
|
Differential regulation of bladder cancer growth by various glucocorticoids: corticosterone and prednisone inhibit cell invasion without promoting cell proliferation or reducing cisplatin cytotoxicity. Cancer Chemother Pharmacol 2014; 74:249-55. [PMID: 24880571 DOI: 10.1007/s00280-014-2496-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A synthetic glucocorticoid, dexamethasone, was recently shown to inhibit bladder cancer cell invasion and metastasis through the glucocorticoid receptor (GR) pathway but increased cell proliferation via inhibiting apoptosis particularly induced by cisplatin. Therefore, comedication with dexamethasone in bladder cancer patients may lead to unfavorable outcomes such as chemoresistance. We here look for any glucocorticoids with inhibitory effects on tumor cell invasion yet inhibitory or at least no stimulatory effects on cell viability. METHODS The effects of 10 glucocorticoids on cell viability were first assessed in three bladder cancer lines. Selected compounds were further assessed for their ability in cell viability and apoptosis, with or without cisplatin, as well as in cell invasion. RESULTS Most of the compounds (hydrocortisone, betamethasone, flumethasone, triamcinolone, budesonide, fluticasone propionate, and fludrocortisone acetate) increased GR-positive cell growth, which was similar to or even stronger than the effect of dexamethasone. Nonetheless, two glucocorticoids (corticosterone, prednisone) showed only marginal effects on cell growth of all the lines tested. They did not significantly reduce the effects of cisplatin on cell proliferation or cisplatin-induced apoptosis. Conversely, corticosterone, prednisone, and dexamethasone similarly inhibited cell invasion and expression of related genes, including MMP-9, VEGF, and IL-6, in GR-positive lines. CONCLUSION Corticosterone and prednisone are suggested to have the potential of being harmless, in contrast to dexamethasone, without promoting cell proliferation or inhibiting cytotoxic activity of cisplatin, yet beneficial to bladder cancer patients via suppressing tumor invasion. Our results are thus useful in improving chemotherapy regimens, including optimal glucocorticoids, for urothelial carcinoma.
Collapse
|
11
|
Park SB, Im M, Lee Y, Lee JH, Lim J, Park YH, Seo YJ. Effect of emollients containing vegetable-derived lactobacillus in the treatment of atopic dermatitis symptoms: split-body clinical trial. Ann Dermatol 2014; 26:150-5. [PMID: 24882967 PMCID: PMC4037665 DOI: 10.5021/ad.2014.26.2.150] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/05/2013] [Accepted: 02/28/2013] [Indexed: 11/18/2022] Open
Abstract
Background Atopic dermatitis (AD) patients suffer from xerosis. Proper skin care, including the use of emollients, may help improve xerosis and minimize disease exacerbation. Lactobacillus sakei probio 65, isolated from the Korean vegetable-based product kimchi, can decrease interleukin 4 and immunoglobulin E levels and inhibit Staphylococcus aureus. Moreover, it has reportedly shown positive dermatological effects in both animal and clinical studies. Objective To compare the effects of an emollient that contains Lactobacillus (treated) with a normal emollient (control) on AD. Methods This double-blind, randomized, split-body clinical trial involved 28 patients with AD. The patients applied the Lactobacillus-containing emollient on one side of their body and the control emollient on the other side twice daily for 4 weeks. Trans-epidermal water loss (TEWL) and skin capacitance were evaluated and investigator global assessment and the visual analogue scale (VAS) were administered on weeks 0, 1, 2, and 4. Results The treated sides had significantly lower TEWL and VAS values and significantly higher skin capacitance values over time than the control sides. Conclusion Topical application of Lactobacillus-containing emollients may improve the skin permeability of patients with AD.
Collapse
Affiliation(s)
- Seung Bae Park
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Myung Im
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeung Hoon Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeongheui Lim
- Department of Applied Microbiology and Biotechnology, Yeungnam University, Gyeongsan, Korea
| | - Yong-Ha Park
- Department of Applied Microbiology and Biotechnology, Yeungnam University, Gyeongsan, Korea
| | - Young Joon Seo
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| |
Collapse
|
12
|
Prucha H, Schnopp C, Akdis C, Lauener R, Wollenberg A, Ring J, Traidl-Hoffmann C. Pimecrolimus, a topical calcineurin inhibitor used in the treatment of atopic eczema. Expert Opin Drug Metab Toxicol 2013; 9:1507-16. [DOI: 10.1517/17425255.2013.819343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
Tao Y, Gao L, Wu X, Wang H, Yang G, Zhan F, Shi J. Down-regulation of 11β-hydroxysteroid dehydrogenase type 2 by bortezomib sensitizes Jurkat leukemia T cells against glucocorticoid-induced apoptosis. PLoS One 2013; 8:e67067. [PMID: 23826195 PMCID: PMC3691151 DOI: 10.1371/journal.pone.0067067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/13/2013] [Indexed: 02/06/2023] Open
Abstract
11β-hydroxysteroid dehydrogenases type 2 (11β-HSD2), a key regulator for pre-receptor metabolism of glucocorticoids (GCs) by converting active GC, cortisol, to inactive cortisone, has been shown to be present in a variety of tumors. But its expression and roles have rarely been discussed in hematological malignancies. Proteasome inhibitor bortezomib has been shown to not only possess antitumor effects but also potentiate the activity of other chemotherapeutics. In this study, we demonstrated that 11β-HSD2 was highly expressed in two GC-resistant T-cell leukemic cell lines Jurkat and Molt4. In contrast, no 11β-HSD2 expression was found in two GC-sensitive non-hodgkin lymphoma cell lines Daudi and Raji as well as normal peripheral blood T cells. Inhibition of 11β-HSD2 by 11β-HSD inhibitor 18β-glycyrrhetinic acid or 11β-HSD2 shRNA significantly increased cortisol-induced apoptosis in Jurkat cells. Additionally, pretreatment of Jurkat cells with low-dose bortezomib resulted in increased cellular sensitivity to GC as shown by elevated induction of apoptosis, more cells arrested at G1 stage and up-regulation of GC-induced leucine zipper which is an important mediator of GC action. Furthermore, we clarified that bortezomib could dose-dependently inhibit 11β-HSD2 messenger RNA and protein levels as well as activity (cortisol-cortisone conversion) through p38 mitogen-activated protein kinase signaling pathway. Therefore, we suggest 11β-HSD2 is, at least partially if not all, responsible for impaired GC suppression in Jurkat cells and also indicate a novel mechanism by which proteasome inhibitor bortezomib may influence GC action.
Collapse
Affiliation(s)
- Yi Tao
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Lu Gao
- Department of Physiology, Second Military Medical University, Shanghai, People’s Republic of China
| | - Xiaosong Wu
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Hongmei Wang
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Guang Yang
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Fenghuang Zhan
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Jumei Shi
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- * E-mail:
| |
Collapse
|
14
|
Proshutinskaya DV, Butareva MM, Inoyatova LA. New potential of the treatment of atopic dermatitis in children and adults. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Goal. To study the efficacy and safety of local administration of Tacrolimus in the form of 0.03% and 0.1% ointment for patients with moderate to severe atopic dermatitis. Materials and methods. The study involved 32 patients suffering from atopic dermatitis and aged 2—64. The first group comprised 17 children aged 2—15 (7 girls and 10 boys). The second group comprised 15 patients (8 female and 7 male) aged 18—64. All of the patients suffered from moderate to severe atopic dermatitis. Patients from both treatment groups received external therapy in the form of 0.03% of ointment for children and 0.1% of ointment for adults. The daily ointment amount was calculated as FTU (Finger Tip Units) for separate body parts. To ensure objective assessment of the severity of clinical manifestations of atopic dermatitis and treatment efficacy, SCORAD (Severity Scoring of Atopic Dermatitis) score was used for all of the patients. Results. The treatment resulted in a statistically significant reduction in the medial SCORAD index from 67.2 (54.8; 70.4) points to 14.0 (3.5; 22.1) points (р < 0.0001), Group 1, and from 52 (43.5; 75.5) points to 11.7 (0.0; 26.2) points (р < 0.0001), Group 2. Clinical recovery was achieved in 30% of children and 40% of adults. Conclusion. Protopic ointment for the treatment of patients with moderate to severe atopic dermatitis proved to be highly efficient, which was confirmed by a positive therapeutic effect on the course of the disease. There were no adverse effects characteristic of topical corticosteroids, which widens horizons in terms of treating patients with this type of dermatosis.
Collapse
|
15
|
Kelso JM, Greenhawt MJ, Li JT, Nicklas RA, Bernstein DI, Blessing-Moore J, Cox L, Khan D, Lang DM, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. Adverse reactions to vaccines practice parameter 2012 update. J Allergy Clin Immunol 2012; 130:25-43. [PMID: 22608573 DOI: 10.1016/j.jaci.2012.04.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/30/2012] [Accepted: 04/03/2012] [Indexed: 11/24/2022]
Affiliation(s)
- John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Frankel HC, Qureshi AA. Comparative effectiveness of topical calcineurin inhibitors in adult patients with atopic dermatitis. Am J Clin Dermatol 2012; 13:113-23. [PMID: 22263704 DOI: 10.2165/11597780-000000000-00000] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by extreme pruritis and lichenified papules and plaques that may begin in or persist into adulthood. Topical corticosteroids are first-line prescription therapy for AD; they are efficacious and have a well established safety profile. The topical calcineurin inhibitors tacrolimus and pimecrolimus were approved by the US FDA in 2000 and 2001, respectively, as second-line topical therapy for AD. This review evaluates the available studies on the comparative effectiveness, safety, cost, and impact on quality of life of topical corticosteroids and topical calcineurin inhibitors for the treatment of adult AD. Tacrolimus was found to be as effective as class III-V topical corticosteroids for AD of the trunk and extremities, and more effective than low-potency class VI or VII corticosteroids for AD of the face or neck. Pimecrolimus was less effective than both tacrolimus and low-potency topical corticosteroids for moderate to severe AD. The short-term safety studies found that, compared with topical corticosteroid-treated adults, patients treated with topical calcineurin inhibitors had an increased frequency of application-site reactions, an equivalent infection risk, and a decreased risk of skin atrophy. The long-term safety of topical calcineurin inhibitors remains under investigation. Currently published studies that evaluated the comparative cost and quality-of-life effects compared tacrolimus with less potent topical corticosteroids despite the availability of equivalent potency corticosteroids. Further cost and quality-of-life studies are needed that compare topical calcineurin inhibitors with stronger classes of topical corticosteroids over longer time periods. The available clinical trials data do not suggest an efficacy advantage for topical calcineurin inhibitors over topical corticosteroids in adults with AD of the trunk and extremities, and there is not yet adequate evidence to support topical calcineurin inhibitors as first-line therapy for adult AD.
Collapse
Affiliation(s)
- Hillary C Frankel
- Department of Dermatology, Brigham and Womens Hospital and Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
17
|
Motswaledi MH. An overview of topical treatment for atopic eczema. S Afr Fam Pract (2004) 2011. [DOI: 10.1080/20786204.2011.10874092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
18
|
Choi W, Lim SG, Yoon KC. Effect of Treatment With Excision of Papillae and Supratarsal Triamcinolone Injection on Refractory Vernal Keratoconjunctivitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.4.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Won Choi
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Seong-Gyu Lim
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| |
Collapse
|
19
|
Kang MJ, Eum JY, Jeong MS, Choi SE, Park SH, Cho HI, Cho CS, Seo SJ, Lee MW, Choi YW. Facilitated skin permeation of oregonin by elastic liposomal formulations and suppression of atopic dermatitis in NC/Nga mice. Biol Pharm Bull 2010; 33:100-6. [PMID: 20045944 DOI: 10.1248/bpb.33.100] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
To develop an external preparation of oregonin (ORG) for the treatment of atopic dermatitis (AD), conventional creams (CC) and elastic liposomes (EL) containing ORG have been formulated and examined for their in vitro skin permeation properties and in vivo therapeutic efficacy assessments. EL, consisting of soybean phosphatidylcholine and Tween 80 (85 : 15 w/w %), were of flexible nanocarriers: they were about 130 nm in size and had a 4-fold greater deformability index than conventional liposomes. In a skin permeation study using a Franz diffusion cell mounted with depilated mouse skin, liposomal systems were superior to cream, revealing greater flux values. Both CC and EL were diversified with the addition of Trans-activating transcriptional activator (Tat) peptide, a sort of cell penetrating peptide, and subjected to in vivo efficacy evaluations in NC/Nga mice with AD-like lesions. On clinical observation for skin severity, rapid and profound improvement was observed in the treatment group with Tat-added liposomes (EL/T), showing a significant difference (p<0.05) versus Tat-added cream. The results indicated that EL/T treatment is effective for normalizing the immune-related responses and alleviating AD, evaluated as changes in the levels of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), interleukin (IL)-4, immunoglobulin E (IgE), and eosinophils in skin or blood.
Collapse
Affiliation(s)
- Myung Joo Kang
- Division of Pharmaceutical Sciences, College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Luger TA, Lahfa M, Fölster-Holst R, Gulliver WP, Allen R, Molloy S, Barbier N, Paul C, Bos JD. Long‐term safety and tolerability of pimecrolimus cream 1% and topical corticosteroids in adults with moderate to severe atopic dermatitis. J DERMATOL TREAT 2009; 15:169-78. [PMID: 15204150 DOI: 10.1080/09546630410033781] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This randomized, double-blind, multi-centre study compared the long-term safety and tolerability of pimecrolimus cream 1% and topical corticosteroids (TCS) in 658 adults with moderate-severe atopic dermatitis (AD). METHODS Patients applied either pimecrolimus or TCS (i.e. 0.1% triamcinolone acetonide cream and/or 1% hydrocortisone acetate cream) twice daily to all affected areas until complete clearance or for up to 1 year. The study was approved by the institutional review board or ethics committee at each centre. RESULTS A majority of patients treated with either pimecrolimus or TCS used the drug on a continuous basis over 1 year. In patients who had >30% of the body surface involved by AD, the incidence rate of all skin infections was significantly lower in the pimecrolimus group than in the TCS group (95% CI of the treatment difference: -25.3% to -3.4%). The most frequent application site reaction was burning (25.9% of patients on pimecrolimus and 10.9% on TCS), which was transient and mild-moderate in most cases. Three TCS-treated patients reported skin striae. There were no treatment-related serious or clinically significant systemic adverse events. Efficacy was better in patients on continuous TCS therapy, although patients completing the study were similarly well-controlled in both groups. About 42% of the pimecrolimus-treated patients were maintained for 1 year without TCS. CONCLUSION Pimecrolimus demonstrated a favourable safety profile when used to treat adult patients with moderate-severe AD for up to 1 year. A significant proportion of patients could be maintained without TCS for a year.
Collapse
Affiliation(s)
- T A Luger
- Universitätsklinikum Münster, Hautklinik, Muenster Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Won CH, Seo PG, Park YM, Yang JM, Lee KH, Sung KJ, Park CW, Kim DW, Chang HS, Won YH, Kim KH. A multicenter trial of the efficacy and safety of 0.03% tacrolimus ointment for atopic dermatitis in Korea. J DERMATOL TREAT 2009; 15:30-4. [PMID: 14754647 DOI: 10.1080/09546630310020812] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Atopic dermatitis is a chronically relapsing, common inflammatory skin disease, which significantly affects quality of life negatively in many respects. Topical steroids are the mainstay of atopic dermatitis treatment but they carry the risk of local side effects. A topical formulation of tacrolimus, a macrolide calcineurin inhibitor, has recently been developed. OBJECTIVE To evaluate the efficacy and safety of 0.03% tacrolimus ointment for the treatment of moderate to severe atopic dermatitis in Korea. METHODS An open, non-comparative, multi-center study with 4 weeks' follow-up was performed. A total of 180 patients (aged 2-57 years old) were enrolled. Tacrolimus ointment (0.03%) was applied to all involved areas twice daily. Efficacy was evaluated by an investigator's global assessment, the eczema area and severity index score, and by the patient's assessment of pruritus and clinical response at baseline, and after weeks 1, 2 and 4. Dermatology life quality index (DLQI), children's DLQI (CDLQI) and toddler's DLQI were assessed at baseline and at week 4. The safety assessment included monitoring all adverse events and clinical laboratory values. RESULTS All efficacy parameters were improved. The mean EASI (eczema area and severity index) score was 19.7 at baseline and reduced to 8.0 at the end of the study. Moderate improvement was observed by the investigator's global assessment after 4 weeks' treatment. A marked decrease of pruritus was observed, and mild or moderate improvement was observed by patients' global assessments after the treatment period. Significant benefits in terms of quality of life in adults and children with atopic dermatitis were obtained. The most common adverse events associated with tacrolimus treatment were transient skin burning sensation (45.3%) and pruritus (41.6%) at the site of application. CONCLUSION 0.03% tacrolimus ointment should be considered effective and safe in both Korean children and adults with moderate to severe atopic dermatitis.
Collapse
Affiliation(s)
- C H Won
- Department of Dermatology, Seoul National University Hospital, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Kim ST, Lee KM, Park HJ, Jin SE, Ahn WS, Kim CK. Topical delivery of interleukin-13 antisense oligonucleotides with cationic elastic liposome for the treatment of atopic dermatitis. J Gene Med 2009; 11:26-37. [PMID: 19006098 DOI: 10.1002/jgm.1268] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Interleukin (IL)-13, overproduced in the skin of atopic dermatitis (AD), has been shown to play an essential role in the pathogenesis of the disease. Thus, inhibition of IL-13 production should provide a key step to alleviate disease conditions of the atopic skin. In the present study, IL-13 antisense oligonucleotide (ASO) was designed and formulated with cationic elastic liposome (cEL) to improve transdermal delivery. METHODS ASOs were generated against murine IL-13 mRNA (+4 to + 23) and complexed with cEL. Physicochemical properties of IL-13 ASO/cEL complex were examined by DNA retardation and DNase I protection assay. An in vitro inhibition study was performed in T-helper 2 (Th2) cells and cytotoxicity was tested by the XTT assay. The in vivo effect of IL-13 ASO/cEL complex was tested in a murine model of AD. RESULTS In vitro, the IL-13 ASO/cEL complex showed dose- and ratio-dependent inhibition of IL-13 secretion in Th2 cells. At the IL-13 ASO/cEL ratio of 6, maximum inhibition of IL-13 secretion was observed. When applied to the ovalbumin-sensitized murine model of AD, topically administered IL-13 ASO/cEL complex dramatically suppressed IL-13 production (by up to 70% of the control) in the affected skin region. In addition, the levels of IL-4 and IL-5 were also significantly reduced. Moreover, IL-13 ASO/cEL-treated AD mice showed reduced infiltration of inflammatory cells into the epidermal and dermal areas, with concomitant reduction of skin thickness. CONCLUSIONS These data suggests that IL-13 ASO/cEL complex can provide a potential therapeutic tool for the treatment of AD and also be applied to other immune diseases associated with the production of Il-13.
Collapse
Affiliation(s)
- Sung Tae Kim
- Laboratory of Excellency for Drug and Gene Delivery, College of Pharmacy, Seoul National University, Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
23
|
Eedy D. What's new in atopic dermatitis? Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.2001.04373.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]
|
24
|
van Laarhoven AIM, Kraaimaat FW, Wilder-Smith OH, van de Kerkhof PCM, Cats H, van Riel PLCM, Evers AWM. Generalized and symptom-specific sensitization of chronic itch and pain. J Eur Acad Dermatol Venereol 2008; 21:1187-92. [PMID: 17894703 DOI: 10.1111/j.1468-3083.2007.02215.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Physicians are frequently confronted with patients reporting severe itch and pain. Particularly in patients suffering from persistent itch and pain, central and peripheral sensitization processes are assumed to be involved in the long-term maintenance and aggravation of the symptoms. The present study explores generalized and symptom-specific sensitization processes in patients suffering from persistent itch and pain. Specifically, it examines whether patients with chronic itch and pain are more sensitive to somatosensory stimuli (generalized sensitization) and simultaneously perceive somatosensory stimuli as a symptom of their main physical complaint, e.g. pain in chronic pain patients (symptom-specific sensitization). METHODS Thresholds for different mechanical and electrical sensory stimuli of Quantitative Sensory Testing were determined in 15 female patients suffering from chronic itch associated with atopic dermatitis, 15 female chronic pain patients diagnosed with fibromyalgia, and 19 female healthy controls. Intensities of itch and pain sensations were rated on a visual analogue scale. RESULTS As expected, the patient groups had significantly lower tolerance thresholds for the somatosensory stimuli applied than the healthy controls, supporting generalized sensitization. Moreover, patients with chronic itch consistently reported more itch, while patients with chronic pain partly reported more pain in response to analogous somatosensory stimuli than the healthy controls and the other patient group, indicating symptom-specific sensitization. CONCLUSION The present study provides preliminary support that both generalized and symptom-specific sensitization processes play a role in the regulation and processing of somatosensory stimulation of patients with chronic itch and pain.
Collapse
Affiliation(s)
- A I M van Laarhoven
- Department of Medical Psychology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
25
|
Meurer M, Lübbe J, Kapp A, Schneider D. The Role of Pimecrolimus Cream 1% (Elidel®) in Managing Adult Atopic Eczema. Dermatology 2007; 215 Suppl 1:18-26. [DOI: 10.1159/000102117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
26
|
Abstract
OBJECTIVE Atopic dermatitis (AD) is a common, chronic, inflammatory skin disease that can significantly reduce the quality of life of not only patients but also entire families. This review will focus on the currently available non-pharmacologic and pharmacologic treatments for the control and management of AD. RESEARCH DESIGN AND METHODS A review of English-language articles from January 1953 to May 2006 was performed within the MEDLINE database. Search terms included, but were not limited to, atopic dermatitis, topical corticosteroids, and topical calcineurin inhibitors. Studies evaluating the diagnosis, physical and psychological burden, and underlying pathophysiology of AD were included. Particular focus was placed on literature presenting key safety and efficacy data from clinical trials involving AD treatment. RESULTS Although good skin care and trigger avoidance are fundamental to AD management, most patients also require pharmacologic intervention. Topical therapies comprise the foundation of AD treatment. In particular, topical corticosteroids have been a mainstay in AD treatment for several decades and the newer topical calcineurin inhibitors have become a valuable addition to the therapeutic armamentarium. TCIs are a safe and effective AD treatment; they limit the number of disease flares, extend the time between flares, and provide a steroid-sparing option that may be of particular benefit in the pediatric population. The use of more potent therapies, such as systemic (oral/injected) agents or phototherapy, is typically limited to the treatment of severe, refractory disease. Additionally, owing to the increased risk for bacterial, viral, and fungal infections in patients with AD, topical or systemic antimicrobials are an important component of treatment. LIMITATIONS Case reports and small-scale studies were typically not included in this analysis and owing to the limited number of trials evaluating TCSs, consensus statements and comprehensive review articles were used to obtain information pertaining to the use of this treatment in AD. CONCLUSIONS AD is a common, chronic disease requiring a long-term management strategy that incorporates preventive measures and a multipronged treatment approach.
Collapse
Affiliation(s)
- M L Levy
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030 USA.
| |
Collapse
|
27
|
Affiliation(s)
- K Landow
- University of Southern California School of Medicine, Los Angeles, California, USA
| |
Collapse
|
28
|
Grüber C, Wendt M, Sulser C, Lau S, Kulig M, Wahn U, Werfel T, Niggemann B. Randomized, placebo-controlled trial of Lactobacillus rhamnosus GG as treatment of atopic dermatitis in infancy. Allergy 2007; 62:1270-6. [PMID: 17919141 DOI: 10.1111/j.1398-9995.2007.01543.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some studies have suggested that supplementation of food with lactobacilli may prevent or improve atopic dermatitis in children. This study was designed to investigate the therapeutic effect of Lactobacillus rhamnosus GG (LGG) as a food supplement in infants suffering from atopic dermatitis. METHODS Infants aged 3-12 months suffering from mild-to-moderate atopic dermatitis (severity scoring of atopic dermatitis or SCORAD index of 15-40) without current antiinflammatory treatment were randomized to receive LGG (5 x 10(9) colony forming units b.i.d.) or placebo as a food supplement for 12 weeks. Severity scoring of atopic dermatitis index and use of hydrocortisone 1% ointment as rescue medication (2 points per application) were recorded at 4, 8, and 12 weeks of treatment and combined as symptom load (SL). RESULTS Fifty-four infants (LGG group, mean +/- SD SCORAD index 24.6 +/- 8.8) and 48 infants (placebo group, SCORAD index 23.6 +/- 7.8) were randomized and completed the treatment period (intention-to-treat analysis). Symptom load generally improved over time at 4 weeks (LGG vs placebo, 23.8 +/- 12.4 vs 20.6 +/- 9.9), 8 weeks (22.5 +/- 14.6 vs 17.9 +/- 13.1), and 12 weeks (19.6 +/- 15.4 vs 15.1 +/- 12.1), without statistically significant group differences. When stratified for age, eczema severity or use of rescue medication, no statistically significant group differences, in improvement, were found. No significant group differences were found for the use of rescue medication (0.8 +/- 45.0 g vs 3.5 +/- 29.8 g), increase in mean logarithmic total serum IgE (0.17 +/- 0.30 kU/l vs 0.26 +/- 0.45 kU/l), and newly developed allergic sensitization against hen's egg or cow's milk (18.8%vs 10.0%). CONCLUSION This placebo-controlled trial showed no therapeutic effect of LGG against mild-to-moderate atopic dermatitis in infancy.
Collapse
Affiliation(s)
- C Grüber
- Department of Pediatric Pneumology and Immunology, Universitätsmedizin Berlin, Charité, Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Harris JM, Williams HC, White C, Moffat S, Mills P, Newman Taylor AJ, Cullinan P. Early allergen exposure and atopic eczema. Br J Dermatol 2007; 156:698-704. [PMID: 17263823 DOI: 10.1111/j.1365-2133.2006.07710.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent-reported, doctor-diagnosed eczema by age 2 years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen. OBJECTIVES To extend the exposure-response analysis of allergen exposure and eczema outcomes measured up to age 8 years, and to investigate the role of other genetic and environmental determinants. METHODS A total of 593 children (92 x 4% of those eligible) born to all newly pregnant women attending one of three general practitioner surgeries in Ashford, Kent, were followed from birth to age 8 years. Concentrations of house dust mite and cat allergen were measured in dust samples collected from the home at 8 weeks after birth. The risk of subsequent eczema as defined by the U.K. diagnostic criteria was determined according to different levels (quintiles) of allergen exposure at birth. RESULTS By age 8 years, 150 (25 x 3%) children had met the diagnostic criteria for eczema at least once. Visible flexural dermatitis was recorded at least once for 129 (28 x 0%). As in other studies, parental allergic history was positively associated with most eczema outcomes, as were higher maternal education and less crowded homes. No clear linear associations between early exposure to house dust mite or cat allergen were found, regardless of the definition of eczema used. The risk of eczema appeared to increase for the three lowest quintiles of house dust mite allergen exposure (odds ratio, OR 1 x 37 for third quintile compared with first), and then to fall for the two highest quintiles (OR 0 x 66 and 0 x 71) even after controlling for confounding factors. CONCLUSIONS The lack of any clear exposure-disease relationship between allergens in early life and subsequent eczema argues against allergen exposure being a major factor causing eczema. If the lower levels of eczema at higher levels of house dust mite are confirmed, then interventions aimed at reducing house dust mite in early infancy could paradoxically increase the risk of subsequent eczema.
Collapse
Affiliation(s)
- J M Harris
- Occupational and Environmental Medicine, Imperial College School of Medicine, 1B Manresa Road, London SW3 6LR, UK.
| | | | | | | | | | | | | |
Collapse
|
30
|
Abramovits W, Perlmutter A. Steroids versus other immune modulators in the management of allergic dermatoses. Curr Opin Allergy Clin Immunol 2007; 6:345-54. [PMID: 16954788 DOI: 10.1097/01.all.0000244795.41357.6e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The classic role of topical and systemic corticosteroids for allergic dermatoses is discussed, with special attention to the impact on the current clinical treatment paradigm by newer systemic and topical therapies. These products are reviewed and recommendations presented on how to effectively assimilate them into clinical practice. RECENT FINDINGS Current knowledge about the etiopathogenesis of atopic dermatitis has resulted in drug development focused on agents with less toxicity than current topical and systemic corticosteroids. Some agents with ceramide/cholesterol/acid combinations demonstrate efficacy in restoring the dysfunctional skin barrier of atopic patients. Concerns resulting from the recent Federal Drug Administration announcement regarding a theoretical risk of cancer associated with topical calcineurin inhibitors are also addressed. Novel therapeutic entities are presented. SUMMARY Patients seeking relief from atopic dermatitis have historically had few really effective and safe therapeutic options. Topical calcineurin inhibitors represent an exciting new therapy for atopic dermatitis without the side-effect profile associated with topical corticosteroids. Nonsteroidal formulations incorporating glycyrrhetinic acid/telmesteine/Vitis vinifera extract and palmitoylethanolamide as 'active' ingredients recently entered the market, stressing antipruritic, antiinflammatory, and skin barrier repair. This confabulates against previously designed topical therapy paradigms. These new products may be used as monotherapy or alternatives to steroid agents.
Collapse
|
31
|
Keil T, Witt CM, Roll S, Vance W, Weber K, Wegscheider K, Willich SN. Homoeopathic versus conventional treatment of children with eczema: a comparative cohort study. Complement Ther Med 2006; 16:15-21. [PMID: 18346624 DOI: 10.1016/j.ctim.2006.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 10/26/2006] [Accepted: 10/31/2006] [Indexed: 09/30/2022] Open
Abstract
OBJECTIVES To assess, over a period of 12 months, whether homoeopathic treatment could influence eczema signs/symptoms and quality of life (QoL) compared with conventional treatment. DESIGN Prospective multi-centre cohort study. SETTING Children with eczema aged 1-16 years were recruited from primary care practices. INTERVENTIONS Conventional versus homoeopathic treatment. OUTCOME MEASURES Patients (or parents) assessed eczema symptoms by numerical rating scales as well as disease-specific Atopie Lebensqualitaets-Fragebogen (ALF) and general quality of life (KINDL, KITA) at 0, 6 and 12 months. RESULTS A total of 118 children were included: 54 from homoeopathic (mean age+/-S.D. was 5.1+/-3.3 years; 56% boys) and 64 from conventional practices (6.2+/-3.8 years; 61% boys). Eczema symptoms (assessed by patients or their parents) improved from 0 to 12 months for both treatment options, but did not differ between the two groups: 3.5-2.5 versus 3.4-2.1; p=0.447 (adjusted). Disease-related quality of life improved in both groups similarly. In the subgroup of children aged 8-16 years the general quality of life showed a better trend for conventional treatment compared with homoeopathic treatment (p=0.030). CONCLUSIONS This observational study is the first long-term prospective investigation to compare homoeopathic and conventional treatment of eczema in children. Over a period of 12 months, both therapy groups improved similarly regarding perception of eczema symptoms (assessed by patients or parents) and disease-related quality of life.
Collapse
Affiliation(s)
- T Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center Berlin, D-10098 Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
32
|
Lübbe J, Friedlander SF, Cribier B, Morren MA, García-Díez A, Gelmetti C, Hofmann H, Houwing RH, Kownacki S, Langley RGB, Virtanen M, Wolff K, Wisseh S, McGeown C, Abrams B, Schneider D. Safety, efficacy, and dosage of 1% pimecrolimus cream for the treatment of atopic dermatitis in daily practice. Am J Clin Dermatol 2006; 7:121-31. [PMID: 16605292 DOI: 10.2165/00128071-200607020-00005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Although several controlled clinical trials have demonstrated the efficacy and good tolerability of 1% pimecrolimus cream for the treatment of atopic dermatitis, the results of these trials may not apply to real-life usage. The objective of this study was to evaluate the safety and efficacy of a pimecrolimus-based regimen in daily practice. METHODS This was a 6-month, open-label, multicenter study in 947 patients aged >or=3 months with atopic dermatitis of all severities. The investigators incorporated 1% pimecrolimus cream into patients' standard treatment protocols on the basis of their clinical diagnosis. Use of topical corticosteroids was allowed at the discretion of the physician. Safety and tolerability were evaluated by monitoring adverse events. Efficacy was evaluated by recording changes in the Investigators' Global Assessment scores and pruritus scores at each visit. RESULTS No clinically unexpected adverse events were reported. The discontinuation rate for adverse events was 2.3%. The disease improvement rate was 53.7% at week 1 and 66.9% at week 24. The pimecrolimus-based regimen was particularly effective for the treatment of lesions involving the face (improvement rate: 61.9% at week 1 and 76.7% at week 24). The greatest therapeutic response was experienced by pediatric patients with mild or moderate disease. Nonetheless, 64% and 65% of infants and children, respectively, with severe/very severe facial disease at baseline were clear/almost clear of signs of atopic dermatitis on their face at week 24. In patients aged <18 years, most of the improvement occurred within the first week of treatment, while in adults a progressive improvement was observed over the entire study period. Worsening of disease by the end of the study occurred in 9.5% of patients and was most frequent in adults (12.6%). The discontinuation rate for unsatisfactory therapeutic effect was 4.8%. The mean number of treatment days was 135.6 (SD 53.2). The mean drug consumption (non-US centers only) was 4.2 g per treatment day. Drug consumption decreased over time as disease improved. In total, 47% of patients who completed the study never used topical corticosteroids over 6 months. CONCLUSION In daily practice, incorporation of 1% pimecrolimus cream into patients' standard treatment regimen is well tolerated and improves atopic dermatitis in approximately two-thirds of patients. Disease improvement is particularly evident on the face. The greatest therapeutic response is experienced by pediatric patients with mild or moderate disease. In these patients, most of the improvement is observed within 1 week from the start of treatment.
Collapse
Affiliation(s)
- Jann Lübbe
- Clinique et Policlinique de Dermatologie et Vénéréologie, Hôpital Cantonal Universitaire, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Stuetz A, Baumann K, Grassberger M, Wolff K, Meingassner JG. Discovery of Topical Calcineurin Inhibitors and Pharmacological Profile of Pimecrolimus. Int Arch Allergy Immunol 2006; 141:199-212. [PMID: 16926539 DOI: 10.1159/000095289] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Using a newly developed model of allergic contact dermatitis in pigs, calcineurin inhibitors of the tacrolimus and ascomycin type were shown to have a highly anti-inflammatory action after topical application. These findings provided the first pharmacological evidence of the efficacy of this novel class of topical agents in the treatment of inflammatory skin diseases, and, thus, their potential to become the first alternative to corticosteroids in more than 40 years. As a result of a large research program into ascomycins, pimecrolimus (Elidel(R), SDZ ASM 981) was selected for development due to its favorable pharmacology and safety profile, alongside tacrolimus (Protopic(R), FK 506). In vitro, pimecrolimus inhibits the transcription and release of pro-inflammatory cytokines in T cells. Similar to the corticosteroids, betamethasone-17-valerate and dexamethasone, pimecrolimus is effective at nanomolar concentrations. Targeting mainly T cells, pimecrolimus has, however, a more specific mode of action. Moreover, in contrast to corticosteroids, pimecrolimus has no effect on Langerhans' cells, the professional antigen- presenting dendritic cells of the skin that are crucial for local immunosurveillance. When applied topically, pimecrolimus exerts a high and selective anti-inflammatory activity in the skin, shows minimal percutaneous absorption, and has a low potential to affect systemic immunoreactions. Pimecrolimus cream 1% has proven to be well tolerated, safe, and highly effective in clinical studies in patients with atopic dermatitis.
Collapse
Affiliation(s)
- Anton Stuetz
- Novartis Institutes for BioMedical Research Vienna, Vienna, Austria.
| | | | | | | | | |
Collapse
|
34
|
Yoshioka T, Hikita I, Asakawa M, Hirasawa T, Deguchi M, Matsutani T, Oku H, Horikawa T, Arimura A. Spontaneous scratching behaviour in DS-Nh mice as a possible model for pruritus in atopic dermatitis. Immunology 2006; 118:293-301. [PMID: 16827890 PMCID: PMC1782295 DOI: 10.1111/j.1365-2567.2006.02365.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Itching is one of the major clinical symptoms in atopic dermatitis (AD) and complicates the management of this pathological condition. An animal model of AD-like pruritus would contribute to a better understanding of AD and could lead to the development of safe and effective antipruritic agents. DS non-hair (DS-Nh) mice raised under conventional conditions spontaneously develop pruritus, which is associated with a dermatitis similar to human AD. There is a significant positive correlation between disease severity and the period of scratching behaviour in DS-Nh mice. In the present study, we found that levels of histamine and nerve growth factor (NGF) in serum and/or skin tissue were higher in DS-Nh mice with AD-like dermatitis than in age-matched mice without dermatitis. The histopathological data indicated that nerve fibres extend into and mast cells infiltrate the surrounding area of the skin lesion. NGF production by XB-2 cells, which was derived from mouse keratinocytes, was enhanced by histamine via the H1 receptor. We also found that prolonged treatment with an H1-antagonist was effective against pruritus through depression of the production of NGF, which is thought to be generated by keratinocytes. We conclude that DS-Nh mice can serve as a suitable model for gaining a better understanding of pruritus in AD, and that prolonged treatment with an H1-antagonist may be beneficial in patients with AD-associated pruritus.
Collapse
Affiliation(s)
- T Yoshioka
- Shionogi Discovery Research Laboratories, Shionogi & Co., Ltd, Osaka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Draelos Z, Nayak A, Pariser D, Shupack JL, Chon K, Abrams B, Paul CF. Pharmacokinetics of topical calcineurin inhibitors in adult atopic dermatitis: a randomized, investigator-blind comparison. J Am Acad Dermatol 2006; 53:602-9. [PMID: 16198779 DOI: 10.1016/j.jaad.2005.06.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 06/15/2005] [Accepted: 06/15/2005] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We sought to compare pharmacokinetics of pimecrolimus cream 1% and tacrolimus ointment 0.1% in adults with extensive, moderate to severe atopic dermatitis. Secondary end points included efficacy and safety. METHODS Patients received twice-daily treatment for 13 days. Blood concentrations of pimecrolimus and tacrolimus were measured at days 1, 5, and 13. Treatment success was defined as an Investigators' Global Assessment score of 0 (clear) or 1 (almost clear). RESULTS Tacrolimus was detectable in 36% of blood samples and pimecrolimus was detectable in 12%. In patients with measurable blood drug concentrations, systemic exposure to tacrolimus (mean area under the curve(0-10h) < 9.7 ng.h/mL; n = 7) was higher than to pimecrolimus (mean area under the curve(0-10h) < 2.5 ng.h/mL; n = 2). Whole-body treatment success (day 13) was achieved in 1 of 18 (5.6%) and 2 of 19 (10.5%) patients treated with pimecrolimus and tacrolimus, respectively, and face/neck treatment success in 5 of 18 (27.8%) and 5 of 19 (26.3%) patients, respectively. Patients included in the study were adult patients with severe atopic dermatitis. The results and conclusions drawn from this study population may not be applicable for the majority of patients with atopic dermatitis who have mild to moderate disease. CONCLUSION Pimecrolimus appears to be associated with lower systemic drug exposure than tacrolimus.
Collapse
Affiliation(s)
- Zoe Draelos
- Dermatology Consulting Services, High Point, North Carolina, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Hossen MA, Inoue T, Shinmei Y, Minami K, Fujii Y, Kamei C. Caffeic Acid Inhibits Compound 48/80-Induced Allergic Symptoms in Mice. Biol Pharm Bull 2006; 29:64-6. [PMID: 16394511 DOI: 10.1248/bpb.29.64] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effect of caffeic acid on scratching behavior and vascular permeability changes induced by compound 48/80 in ICR mice were investigated. An oral dose of 500 mg/kg of caffeic acid significantly inhibited scratching behavior and vascular permeability induced by compound 48/80. The inhibitory effects of daily administration of lower doses of caffeic acid, 100 and 200 mg/kg, were also investigated; and it was found that 200 mg/kg significantly inhibited compound 48/80-induced scratching behavior after the second week of consecutive administration. The effect of 200 mg/kg of caffeic acid on scratching behavior was observed up to the third week of the treatment. The decrease in histamine content induced by compound 48/80 was significantly antagonized by 200 mg/kg. The findings suggest that caffeic acid may be effective for treating itch and edema in allergic dermatitis.
Collapse
Affiliation(s)
- Maria Alejandra Hossen
- Department of Medicinal Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | | | | | | | | |
Collapse
|
37
|
Staab D, Pariser D, Gottlieb AB, Kaufmann R, Eichenfield LF, Langley RG, Scott G, Ebelin ME, Barilla D, Schmidli H, Burtin P. Low systemic absorption and good tolerability of pimecrolimus, administered as 1% cream (Elidel) in infants with atopic dermatitis--a multicenter, 3-week, open-label study. Pediatr Dermatol 2005; 22:465-71. [PMID: 16191004 DOI: 10.1111/j.1525-1470.2005.00128.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pimecrolimus cream 1%, a nonsteroid inhibitor of inflammatory cytokines, offers an alternative to corticosteroids in the treatment of atopic dermatitis. Here we evaluate pimecrolimus blood concentrations and tolerability to pimecrolimus cream 1% in 22 infants below 2 years of age with atopic dermatitis (10-92% body surface area affected at baseline). Efficacy was assessed as a secondary objective. Pimecrolimus cream 1% was applied twice daily for 3 weeks. Blood concentrations were low, typically (96% of total 100 concentrations measured) below 2 ng/mL, the majority (71%) remaining below 0.5 ng/mL. The highest concentration observed was 2.26 ng/mL. At steady state, there was no indication of accumulation. Pimecrolimus was well tolerated locally and systemically, with no serious adverse events recorded. Most adverse events recorded (35 in 17/22 patients) were typical of the young pediatric population studied, of mild to moderate severity, and not considered to be study-medication related, with the exception of four local adverse effects limited to the site of cream application. No clinically relevant change was observed in physical examination, vital signs, or laboratory safety parameters. A rapid onset of therapeutic effect was observed within the first four days of treatment. Pimecrolimus cream 1% is well tolerated in infants 3 to 23 months of age treated for 3 weeks, and results in minimal systemic exposure.
Collapse
Affiliation(s)
- Doris Staab
- Department for Pediatric Pneumology and Immunology, Charité Campus Virchow, Berlin, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hossen MA, Fujii Y, Ogawa M, Takubo M, Tsumuro T, Kamei C. Effect of loratadine on mouse models of atopic dermatitis associated pruritus. Int Immunopharmacol 2005; 5:1331-6. [PMID: 15914337 DOI: 10.1016/j.intimp.2005.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 01/07/2005] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
To confirm the effectiveness of loratadine for relieving pruritus in atopic dermatitis, we examined the effect of this drug using animal models of atopic dermatitis associated pruritus in ICR and hairless mice. As for the results, in ICR mice, single oral administration of loratadine at a dose of 5 or 10 mg/kg significantly inhibited the dorsal scratching behavior induced by histamine or an antigen, and the effect of loratadine was more potent than that of fexofenadine and chlorpheniramine. In hairless mice, oral administration of loratadine at a dose of 10 mg/kg for 6 days significantly inhibited the facial scratching behavior induced by the feeding of a low magnesium diet. Furthermore, oral administration of loratadine at a dose of 10 mg/kg for 7 days also significantly inhibited the histamine-induced scratching behavior in the same animals. These results indicate that loratadine may be effective in preventing pruritus associated with atopic dermatitis.
Collapse
Affiliation(s)
- Maria Alejandra Hossen
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Okayama University, Tsushima-naka 1-1-1, Okayama 700-8530, Japan
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Successful management of atopic dermatitis requires a multipronged approach that includes skin barrier function care, use of topical or systemic agents, and identification and elimination of precipitating or exacerbating factors. Because the origin of atopic dermatitis is multifactorial and trigger factors differ among patients, treatment plans must be specific to the individual patient. This article offers an example of a permutational, or flexible, treatment paradigm. The approach utilizes 4 topical regimens--high-potency topical corticosteroids, lowest effective potency topical corticosteroids, topical calcineurin inhibitors (TCIs), or topical corticosteroid/TCI combinations--as initial therapy in a variety of induction protocols, as determined by the severity of a patient's condition and history. The paradigm permits treatment to progress from a chosen induction therapy to maintenance therapy. During the patient's induction therapy, as soon as an acceptable level of clearance is achieved, therapy should be adjusted to a maintenance regimen, such as monotherapy with either a TCI or a lowest effective potency topical corticosteroid (the latter used intermittently) or an alternation of the two agents. If there is no clearance or positive response with the initial induction protocol, the clinician should move to one of the alternative regimens.
Collapse
|
40
|
Pampura AN. Prevalence of atopic diseases and the use of topical corticosteroids. Is there any connection? Med Hypotheses 2005; 64:575-8. [PMID: 15617870 DOI: 10.1016/j.mehy.2003.12.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2003] [Accepted: 12/29/2003] [Indexed: 11/18/2022]
Abstract
The prevalence of atopic diseases (atopic dermatitis, bronchial asthma, allergic rhinitis) has considerably increased for the last 40 years. This tendency has coincided with the beginning of the epoch of the use of the topical corticosteroids, which have a potent immunomodulation action. This fact itself as well as a number of research results has allowed to formulate the following hypothesis: the use of topical corticosteroids in children of early age contributes to the increase of prevalence of atopic diseases in the developed countries. The offered hypothesis can explain lower prevalence of atopic diseases in rural areas and in children from families with the anthroposophic life style. In other side this hypothesis also capable to give explanation of increased level of atopic diseases among people with high socioeconomic level and in children from 1 child families. It is of a note that corticosteroids use in developing countries is limited due to economic reasons and active use of complementary medicine. If the proposed hypothesis is correct, a revision of the therapeutic approaches is necessary concerning the attitude towards application of topical corticosteroids in children suffering from various forms of eczema. The direct proof of this hypothesis can be found during prospective studies.
Collapse
Affiliation(s)
- Alexander N Pampura
- Department of Allergology and Clinical Immunology, Moscow Institute of Pediatrics and Child Surgery of the Ministry of Public Health, Taldomskaya Street 2, 125412 Moscow, Russian Federation.
| |
Collapse
|
41
|
Abstract
Tacrolimus ointment (Protopic) is a topically applied macrolide lactone immunomodulator effective in the treatment of atopic dermatitis. Its mechanism of action primarily involves calcineurin inhibition, which interrupts cytokine gene expression and leads to the downregulation of T-cell activity. Tacrolimus ointment (0.03% and 0.1% for adults and 0.03% for children) is an effective treatment for atopic dermatitis of the trunk and limbs, as well as sensitive skin areas such as the face. Its efficacy is similar to or greater than that of hydrocortisone acetate 1%, hydrocortisone butyrate 0.1% and betamethsone valerate 0.12% ointments and pimecrolimus 1% cream. Systemic absorption of tacrolimus from the ointment is minimal, and adverse events, which are mostly associated with the application site and include skin burning and pruritus, tend to resolve early in treatment. Unlike topical corticosteroids, tacrolimus ointment is not associated with skin atrophy, and it is a well tolerated treatment for adults or children with atopic dermatitis, particularly when long-term treatment is indicated or the face or skin-fold regions are involved.
Collapse
Affiliation(s)
- Dene Simpson
- Adis International Limited, Auckland, New Zealand.
| | | |
Collapse
|
42
|
Leung DYM, Nicklas RA, Li JT, Bernstein IL, Blessing-Moore J, Boguniewicz M, Chapman JA, Khan DA, Lang D, Lee RE, Portnoy JM, Schuller DE, Spector SL, Tilles SA. Disease management of atopic dermatitis: an updated practice parameter. Joint Task Force on Practice Parameters. Ann Allergy Asthma Immunol 2004; 93:S1-21. [PMID: 15478395 DOI: 10.1016/s1081-1206(10)61385-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
MESH Headings
- Adjuvants, Immunologic/therapeutic use
- Administration, Cutaneous
- Administration, Oral
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Algorithms
- Anti-Allergic Agents/administration & dosage
- Anti-Allergic Agents/therapeutic use
- Anti-Bacterial Agents/therapeutic use
- Anti-Inflammatory Agents/administration & dosage
- Anti-Inflammatory Agents/therapeutic use
- Calcineurin Inhibitors
- Case Management
- Child
- Child, Preschool
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/therapy
- Dermatitis, Irritant/complications
- Dermatitis, Irritant/therapy
- Emollients/administration & dosage
- Emollients/therapeutic use
- Food Hypersensitivity/complications
- Food Hypersensitivity/diet therapy
- Humans
- Infant
- Phototherapy
- Skin Diseases, Infectious/drug therapy
- Skin Diseases, Infectious/etiology
Collapse
Affiliation(s)
- Donald Y M Leung
- Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver, Colorado, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
The primary role of practice parameter/guidelines and other boundaries developed for the field of medicine is to improve the quality of patient care. Practice parameters/guidelines are also important for education, interaction with managed care and third-party payers, establishing appropriate variables for outcome assessment, reducing inappropriate variation in clinical practice, and resolving medical-legal issues. National specialty organizations, the American Medical Association, and government agencies have been actively involved in developing and promoting practice parameters. These documents provide a framework within which pediatricians can provide the best quality of care for their patients.
Collapse
Affiliation(s)
- Richard A Nicklas
- Division of Pulmonary and Allergy, George Washington University Medical Center, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA.
| |
Collapse
|
44
|
Olivry T, Mueller RS. Evidence-based veterinary dermatology: a systematic review of the pharmacotherapy of canine atopic dermatitis. Vet Dermatol 2003; 14:121-46. [PMID: 12791047 DOI: 10.1046/j.1365-3164.2003.00335.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The efficacy of pharmacological interventions used to treat canine atopic dermatitis, excluding fatty acid supplementation and allergen-specific immunotherapy, was evaluated based on the systematic review of prospective clinical trials published between 1980 and 2002. Studies were compared with regard to design characteristics (randomization generation and concealment, masking, intention-to-treat analyses and quality of enrolment of study subjects), benefit (improvement in skin lesions or pruritus scores) and harm (type, severity and frequency of adverse drug events) of the various interventions. Meta-analysis of pooled results was not possible because of heterogeneity of the drugs evaluated. Forty trials enrolling 1607 dogs were identified. There is good evidence for recommending the use of oral glucocorticoids and cyclosporin for the treatment of canine atopic dermatitis, and fair evidence for using topical triamcinolone spray, topical tacrolimus lotion, oral pentoxifylline or oral misoprostol. Insufficient evidence is available for or against recommending the prescription of oral first- and second-generation type-1 histamine receptor antagonists, tricyclic antidepressants, cyproheptadine, aspirin, Chinese herbal therapy, an homeopathic complex remedy, ascorbic acid, AHR-13268, papaverine, immune-modulating antibiotics or tranilast and topical pramoxine or capsaicin. Finally, there is fair evidence against recommending the use of oral arofylline, leukotriene synthesis inhibitors and cysteinyl leukotriene receptor antagonists.
Collapse
Affiliation(s)
- T Olivry
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, 4700 Hillsborough Street, Raleigh, NC 27606, USA.
| | | |
Collapse
|
45
|
Charman C, Williams H. The use of corticosteroids and corticosteroid phobia in atopic dermatitis. Clin Dermatol 2003; 21:193-200. [PMID: 12781437 DOI: 10.1016/s0738-081x(02)00368-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Carolyn Charman
- Department of Dermatology, Queen's Medical Centre, Nottingham, United Kingdom.
| | | |
Collapse
|
46
|
Eichenfield LF, Beck L. Elidel (pimecrolimus) cream 1%: a nonsteroidal topical agent for the treatment of atopic dermatitis. J Allergy Clin Immunol 2003; 111:1153-68. [PMID: 12743593 DOI: 10.1067/mai.2003.1492] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Elidel is a steroid-free cream containing a 1% strength of the topical immunomodulator pimecrolimus. Elidel was specifically developed as a treatment for atopic dermatitis (AD) and is approved for use in children as young as 2 years of age. The production of inflammatory cytokines by activated T cells in skin is thought to play an important role in the pathogenesis of AD. Elidel potently suppresses cytokine production by dermal T cells without significantly impairing systemic immune responses. Elidel does not cause steroid-associated local effects, such as dermal atrophy, striae, or telangiectasia. In randomized controlled clinical studies, twice-daily application of Elidel was shown to significantly improve the signs and symptoms of AD in infants, children, and adults. The clinical effect of Elidel on pruritus, the most troublesome symptom of AD, can be observed within 1 week of therapy and is maintained for the duration of treatment. Elidel is well tolerated; the risk of application-site reactions, such as itching or burning, is comparable with that of the vehicle. Adverse effects were generally mild in patients receiving Elidel and occurred at rates comparable with those in patients receiving vehicle treatment. In a 1-year study, Elidel significantly reduced the incidence of flares when used at the first signs and symptoms of acute AD. As a result, overall corticosteroid use to treat flares was significantly lower in patients using Elidel for early intervention.
Collapse
Affiliation(s)
- Lawrence F Eichenfield
- Department of Pediatric and Adolescent Dermatology, Children's Hospital, San Diego, CA 92123, USA
| | | |
Collapse
|
47
|
Affiliation(s)
- Rosanna Marsella
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32610-0126, USA.
| | | |
Collapse
|
48
|
Affiliation(s)
- Nina H Cheigh
- University of Illinois College of Pharmacy, Chicago 60612, USA.
| |
Collapse
|
49
|
Schiffner R, Schiffner-Rohe J, Landthaler M, Stolz W. Treatment of atopic dermatitis and impact on quality of life: a review with emphasis on topical non-corticosteroids. PHARMACOECONOMICS 2003; 21:159-179. [PMID: 12558467 DOI: 10.2165/00019053-200321030-00002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Atopic dermatitis (AD) is a chronic skin disease with increasing prevalence and rising costs. Stigmatisation and pruritus are only some aspects of potential quality-of-life (QOL) impairments. AD is not curable and repeated treatments are often necessary. At present, treatment with topically-applied corticosteroids is state-of-the-art for mild to moderate flare-ups. However, many patients are worried about the use of corticosteroids due to the widespread fear of adverse effects. In this review the present literature is analysed concerning impact on quality of life for topically-applicable alternatives to the state-of-the-art treatment. For comparison reasons, data from other treatment modalities are additionally given. Characteristics of studies were analysed using 'general' (year and mode of publication, type and aim of study, number of patients, and clinical measurement) and 'QOL specific' criteria (type and number of QOL measurements including relevance for study aim and age group, validation in used language, sensitivity to change, and improvement at end of study). QOL data are published only in the minority of studies evaluating treatment efficacy and do not cover the variety of possible therapies. Data are available for tacrolimus, pimecrolimus, UVA/UVB combination and UVB narrowband (topical non-corticosteroidal treatments), as well as for topical corticosteroids, cyclosporin, and inpatient treatment. All studies provided a marked improvement in quality of life after therapy. One study assessed quality of life after a treatment-free follow-up period obtaining a clear increase in impact on quality of life. Since studies used different QOL measurements and vary in inclusion criteria, treatment schedules and presentation of results, a comparison of QOL improvement is not recommended. A single randomised study compared topically applied non-corticosteroidal treatment (UVA/UVB combination) with another treatment modality (cyclosporin) and found no difference in QOL improvement. At present, there is a clear lack of controlled randomised studies evaluating different active treatment modalities and their impact on quality of life. Consensus meetings are desirable to formulate guidelines for the selection and correct use of QOL measurements. Patients' fear of side effects (e.g. concerning corticosteroids) should be integrated in QOL questionnaires for evaluation of possible compliance problems and real costs. Since relapse after treatment is frequent in AD, QOL measurements should also be performed after a treatment-free follow-up period. At present, we can not answer the question 'which treatment best improves quality of life in AD?'.
Collapse
Affiliation(s)
- Roman Schiffner
- Department of Dermatology, University of Regensburg, Regensburg, Germany.
| | | | | | | |
Collapse
|
50
|
Abstract
This review begins with a brief survey of the neurophysiology and neuroanatomy of pruritus, and goes on to describe the etiology of the major allergic and nonallergic pruritic disorders. The etiology of pruritus often suggests the appropriate treatment. For example, urticaria, which is primarily mediated by histamine, is amenable to treatment with H1 antihistamines. Second-generation, nonsedating antihistamines appear to be more effective than sedating antihistamines, perhaps because of better compliance. Other systemic pharmacologic options may be useful in nonhistamine-mediated disorders, for example, immunomodulators for inflammation-induced pruritus or opiate antagonists for atopic dermatitis. Nonpharmacologic measures, such as proper skin care, and physical modalities, such as phototherapy or acupuncture, may also be helpful.
Collapse
Affiliation(s)
- Ernest N Charlesworth
- Department of Allergy and Dermatology, Shannon Clinic, San Angelo, Texas 76903, USA.
| | | |
Collapse
|