1
|
Hernandez TD, Aleman SJ, Bao-Loc-Trung M, Forte MV, Brandt W, Armstrong C, Howard J, Mosieri CN, Ahmadzadeh S, Varrassi G, Shekoohi S, Kaye AD. Advancing Treatment in Atopic Dermatitis: A Comprehensive Review of Clinical Efficacy, Safety, and Comparative Insights Into Corticosteroids, Calcineurin Inhibitors, and Phosphodiesterase-4 Inhibitors as Topical Therapies. Cureus 2024; 16:e55393. [PMID: 38562326 PMCID: PMC10982833 DOI: 10.7759/cureus.55393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Atopic dermatitis (AD) is a pervasive and multifaceted dermatological disorder causing daily distress to afflicted individuals worldwide. This comprehensive review synthesizes the historical and contemporary advancements in therapeutic strategies, offering a critical analysis of their efficacy, safety profiles, and adaptability. The enduring role of topical corticosteroids in managing AD is examined, acknowledging their potent anti-inflammatory properties alongside their potential adverse side effects, particularly in extended usage. The article explores the utilization of topical calcineurin inhibitors like tacrolimus and pimecrolimus, highlighting their novel anti-inflammatory pathways while also scrutinizing concerns over potential malignancies that relegate them to second-line therapy. The present investigation features the emergence of crisaborole, a phosphodiesterase four inhibitor. Its innovative mode of action, benign safety profile, and applicability to mild and moderate AD are thoroughly evaluated. The review also includes challenges, particularly cost considerations, which constrain accessibility and necessitate nuanced implementation in therapeutic regimens. This study underscores the need for persistent investigation, teamwork, and innovations in managing AD. In this regard, AD requires a united approach between clinicians, researchers, affected individuals, and policymakers to refine patient-focused treatment and develop precise, economical strategies to address this chronic and frequently life-altering health condition.
Collapse
Affiliation(s)
- Tyler D Hernandez
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Sarah J Aleman
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Maria Bao-Loc-Trung
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Michael V Forte
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - William Brandt
- School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Catherine Armstrong
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Jeffrey Howard
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Chizoba N Mosieri
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | | | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA
| |
Collapse
|
2
|
Delvin T, Bygum A, Lund LC, Andersen JH, Hallas J. Application of the waiting time distribution in a nationwide screening of real-world dermatology drug utilization for aberrant use patterns. Pharmacoepidemiol Drug Saf 2024; 33:e5720. [PMID: 37885413 DOI: 10.1002/pds.5720] [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: 04/25/2023] [Revised: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Inappropriate use of medicines may have critical consequences from individual, public health, and economic perspectives. Discovering wrongful medicine use may require intentional surveillance or screening. OBJECTIVES The objectives of this study were to: (i) apply and evaluate the waiting time distribution (WTD) method as a screening tool for identifying aberrant drug use and (ii) evaluate the nationwide use of Dermatology drugs in Denmark for signals of aberrant drug use. METHOD Dermatology drug use data from the Danish nationwide healthcare registries from 2018 to 2020 were used to produce WTDs that were analyzed for drug use patterns. The method provides estimates of the prevalence and incidence and enables estimation of mean treatment duration, drug relapse, and unexpected drug prescribing. RESULTS The study included 2 027 889 individual drug users and analyzed 6 141 449 prescriptions. The analysis included approximately 100 dermatology drugs and drug categories and produced 56 WTD drug curves. The WTD patterns and epidemiological estimates confirmed that most drugs are used as intended and revealed few unexpected patterns for further investigation. Three unexpected findings were identified concerning (i) short-term use that would entail suboptimal clinical efficiency for minoxidil, (ii) sub-optimal use of topical tacrolimus, and (iii) potential undesirable increase in short-course doxycycline treatments. CONCLUSION In Denmark, dermatology drugs are predominantly used as expected, with few unexpected use patterns identified. Targeted specific follow-up on the identified signals is necessary for conclusions about inappropriate use. The findings suggest that the WTD method is applicable for screening for aberrant drug use.
Collapse
Affiliation(s)
- Thomas Delvin
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- LEO Pharma, R&D Medical Sciences, Ballerup, Denmark
| | - Anette Bygum
- Clinical Institute, University of Southern Denmark, Odense C, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense C, Denmark
| | - Lars Christian Lund
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jacob Harbo Andersen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| |
Collapse
|
3
|
Nakamura S, Ozono M, Yanagi K, Kogure K. Development of an Effective Psoriasis Treatment by Combining Tacrolimus-Encapsulated Liposomes and Iontophoresis. Biol Pharm Bull 2024; 47:196-203. [PMID: 38246645 DOI: 10.1248/bpb.b23-00667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Psoriasis is a chronic T-cell-mediated autoimmune skin disease. Tacrolimus (FK506) is commonly used treatment for psoriasis. However, since the molecular weight of FK506 is more than 500 Da, its skin penetration is limited, so that there is a need to improve the penetrability of FK506 to allow for more effective treatment. To this end, we employed iontophoresis (ItP), which is a physical, intradermal drug delivery technology that relies on the use of weak electric current. Previous findings suggest that activation of cell signaling by the weak electric current applied during ItP may affect the expression of inflammatory cytokines, leading to aggravation of psoriasis. In this study, we analyzed the effect of ItP on the expression of various inflammatory cytokines in the skin, and subsequently examined the therapeutic effect of ItP using negatively-charged liposomes encapsulating FK506 (FK-Lipo) in a rat psoriasis model induced by imiquimod. We found that ItP (0.34 mA/cm2, 1 h) did not affect mRNA levels of inflammatory cytokines or epidermis thickness, indicating that ItP is a safe technology for psoriasis treatment. ItP of FK-Lipo suppressed the expression of inflammatory cytokines induced by imiquimod treatment to a greater extent than skin treated with FK506 ointment for 1 h. Furthermore, epidermis thickening was significantly suppressed only by ItP of FK-Lipo. Taken together, results of this study demonstrate the successful development of an efficient treatment for psoriasis by combining FK-Lipo and ItP, without disease aggravation associated with the weak electric current.
Collapse
Affiliation(s)
- Seiko Nakamura
- Department of Pharmaceutical Health Chemistry, Graduate School of Pharmaceutical Sciences, Tokushima University
| | - Mizune Ozono
- Department of Pharmaceutical Health Chemistry, Graduate School of Biomedical Sciences, Tokushima University
| | - Karen Yanagi
- Department of Pharmaceutical Health Chemistry, Faculty of Pharmaceutical Sciences, Tokushima University
| | - Kentaro Kogure
- Department of Pharmaceutical Health Chemistry, Graduate School of Biomedical Sciences, Tokushima University
| |
Collapse
|
4
|
Alzahrani M, Kamal YF, Akram MA. Tacrolimus Ointment in Periorbital Atopic Dermatitis. Cureus 2024; 16:e53055. [PMID: 38410340 PMCID: PMC10896248 DOI: 10.7759/cureus.53055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Periorbital atopic dermatitis (AD) is a common sign in ophthalmological practice and usually has a persistent and relapsing course. Treatment with topical corticosteroids has various side effects associated with their usage. Tacrolimus topical ointment has unique immunomodulatory properties that decrease skin inflammation and pruritus in AD. In this case series, we present a prospective case series of five patients (three males and two females) who received topical application of tacrolimus ointment 0.1-0.03% in the periorbital area twice daily for one to four weeks. The pre- and post-treatment images of all patients were recorded to compare the effects of the treatment. The cases were selected from patients attending the outpatient clinics of East Jeddah Hospital, Saudi Arabia. All patients were suffering from AD. Patients underwent a clinical assessment by tactile inspection (location, size, color, and surface condition) in the first week, secondweek, third month, and first year. We may conclude from this study that tacrolimus showed promising outcomes and is safe and effective for the treatment of flares or resistant periorbital AD in both adults and children.
Collapse
Affiliation(s)
| | - Yumna F Kamal
- Medicine and Surgery, King Abdulaziz University, Jeddah, SAU
| | | |
Collapse
|
5
|
Zhao S, Hwang A, Miller C, Lio P. Safety of topical medications in the management of paediatric atopic dermatitis: An updated systematic review. Br J Clin Pharmacol 2023; 89:2039-2065. [PMID: 37075252 DOI: 10.1111/bcp.15751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 04/21/2023] Open
Abstract
AIM New topical agents have been developed for the treatment of atopic dermatitis (AD) in recent years. This systematic review is intended to synthesize the clinical trial literature and concisely report the updated safety and adverse effects of topical medications used to treat atopic dermatitis in children. METHODS A systematic search of Cochrane Library, Embase, PubMed and ClinicalTrials.gov from inception to March 2022 was conducted for trials of topical medications used to treat AD in patients <18 years (PROSPERO #CRD42022315355). Included records were limited to English-language publications and studies of ≥3 weeks duration. Phase 1 studies and those that lacked separate paediatric safety reporting were excluded. RESULTS A total of 5005 records were screened; 75 records met inclusion criteria with 15 845 paediatric patients treated with tacrolimus, 12 851 treated with pimecrolimus, 3539 with topical corticosteroid (TCS), 700 with crisaborole and 202 with delgocitinib. Safety data was well reported in tacrolimus trials with the most frequently reported adverse events being burning sensation, pruritus and cutaneous infections. Two longitudinal cohort studies were included, one for tacrolimus and one for pimecrolimus, which found no significant increased risk of malignancy with topical calcineurin inhibitor (TCI) use in children. Skin atrophy was identified as an adverse event in TCS trials, which other medications did not. Systemic adverse events for the medications were largely common childhood ailments. CONCLUSION Data discussed here support the use of steroid-sparing medications (tacrolimus, pimecrolimus, crisaborole, delgocitinib) as safe options with minimal adverse events for managing paediatric AD, although a larger number of TCI studies reported burning and pruritus compared to TCS studies. TCS was the only medication class associated with reports of skin atrophy in this review. The tolerability of these adverse events should be considered when treating young children. This review was limited to English-language publications and the variable safety reporting of trial investigators. Many newer medications were not included due to pooled adult and paediatric safety data that did not meet inclusion criteria.
Collapse
Affiliation(s)
- Sharon Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Austin Hwang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Corinne Miller
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Peter Lio
- Departments of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
6
|
Moreno A, Renert-Yuval Y, Guttman-Yassky E. Shedding light on key pharmacological knowledge and strategies for pediatric atopic dermatitis. Expert Rev Clin Pharmacol 2023; 16:119-131. [PMID: 36705936 PMCID: PMC9947941 DOI: 10.1080/17512433.2023.2173172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Atopic dermatitis (AD) is an inflammatory disease affecting over 20% of the pediatric population, with 85% of cases presenting before the age of five. Recently, therapeutic options in pediatric patients have evolved rapidly, following extensive development in adult treatments. AREAS COVERED This review will encompass relevant molecular drivers, along with an overlook on treatment modalities in pediatric AD, as well as a summary of pipeline treatments in clinical trials for pediatric patients from PubMed, Google Scholar, and Clinicaltrials.gov up to July 2022. Topical corticosteroids are the mainstay for AD flares in adults and children. Topical approved agents in pediatric AD are calcineurin inhibitors, crisaborolecrisaborole, and ruxolitinib. Dupilumab is the only FDA approved biologic for patients with AD from six months of age. A Janus kinase inhibitor, upadacitinib, is a systemic treatment approved for pediatric AD patients (age >12 years). Systemic immunosuppressants used in pediatric AD include methotrexate, azathioprine, cyclosporinecyclosporine, and mycophenolate mofetil. EXPERT OPINION Data regarding disease prevention are conflicting, however, an abundance of research has transpired regarding amelioration of symptoms and induction of disease clearance by targeting numerous pathological mechanisms. Understanding the pediatric AD phenotype will further advance the field and the development of improved therapeutics.
Collapse
Affiliation(s)
- Ariana Moreno
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
7
|
Devasenapathy N, Chu A, Wong M, Srivastava A, Ceccacci R, Lin C, MacDonald M, Wen A, Steen J, Levine M, Pyne L, Schneider L, Chu DK. Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:13-25. [PMID: 36370744 DOI: 10.1016/s2352-4642(22)00283-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Atopic dermatitis is a prevalent condition in children and can be effectively managed with medications such as topical calcineurin inhibitors (pimecrolimus or tacrolimus). A key unresolved safety concern is whether use of topical calcineurin inhibitors is associated with cancer. We systematically reviewed the risk of cancer in patients with atopic dermatitis exposed to topical calcineurin inhibitors. METHODS As part of the 2022 American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters atopic dermatitis guidelines, we searched MEDLINE, Embase, the Latin American and Caribbean Health Sciences Literature database, the Índice Bibliográfico Espanhol de Ciências da Saúde database, the Global Resource of Eczema Trials database, WHO's International Clinical Trials Registry Platform, the US Food and Drug Administration database, the European Medicines Agency database, company registers, and relevant citations from inception to June 6, 2022. We included randomised controlled trials and comparative and non-comparative non-randomised studies in any language addressing cancer risk in patients with atopic dermatitis using topical calcineurin inhibitors. We excluded split-body studies and studies with less than 3 weeks of follow-up. Paired reviewers independently screened records, extracted data, and assessed risk of bias in duplicate. We used Bayesian models to estimate the probability for cancer due to topical calcineurin inhibitor exposure and the GRADE approach to determine the certainty of the evidence. Patients, advocacy groups, and care providers set a priori thresholds of important effects. This study is registered with Open Science Framework, https://osf.io/v4bfc. FINDINGS We identified and analysed 110 unique studies (52 randomised controlled trials and 69 non-randomised studies [11 were non-randomised study extensions of randomised controlled trials]) including 3·4 million patients followed up for a mean of 11 months (range 0·7-120). The absolute risk of any cancer with topical calcineurin inhibitor exposure was not different from controls (absolute risk 4·70 per 1000 with topical calcineurin inhibitors vs 4·56 per 1000 without; odds ratio 1·03 [95% credible interval 0·94-1·11]; moderate certainty). For all age groups and using data from observational studies and randomised controlled trials, the use of pimecrolimus (OR 1·05 [95% credible interval 0·94-1·15]) or tacrolimus (0·99 [0·89-1·09]) is likely to have had little to no association with cancer compared with no topical calcineurin inhibitor exposure. For pimecrolimus versus tacrolimus, the finding was similar (0·95 [95% credible interval 0·83-1·07]). Findings were similar in infants, children, and adults, and robust to trial sequential, subgroup, and sensitivity analyses. INTERPRETATION Among individuals with atopic dermatitis, moderate-certainty evidence shows that topical calcineurin inhibitors do not increase the risk of cancer. These findings support the safe use of topical calcineurin inhibitors in the optimal treatment of patients with atopic dermatitis. FUNDING American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma and Immunology via the Joint Task Force on Practice Parameters.
Collapse
Affiliation(s)
| | - Alexandro Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Melanie Wong
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Renata Ceccacci
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Clement Lin
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Aaron Wen
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeremy Steen
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mitchell Levine
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lonnie Pyne
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | | | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
8
|
Lee J, Kim T, Cheon SJ, Kim J, Kim HS, Kim BS, Kim MB, Ko HC. Prescription Patterns of Topical Medications in Patients with Atopic Dermatitis: An Investigative Review Using Big Data from the National Health Insurance Corporation. Ann Dermatol 2023; 35:124-131. [PMID: 37041706 PMCID: PMC10112370 DOI: 10.5021/ad.22.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Topical medications play a crucial role in the treatment of atopic dermatitis (AD). Topical corticosteroids (TCSs) remain the main treatment of choice and topical antibiotics have also been used. However, with the new topical calcineurin inhibitors (TCIs), the prescription patterns of topical agents have changed over time. OBJECTIVE To characterize the prescription patterns of topical medications in Korean patients with AD. METHODS We investigated topical medications prescribed to Korean patients with AD using the National Health Insurance Sharing System (NHISS) database over a 14-year period (2002~2015). Additionally, the potency of prescribed TCSs was compared with AD and psoriasis patients. RESULTS The annual prescription of TCSs showed a slightly decreasing trend without significant change. In particular, in terms of steroid class, prescription of moderate-to-low potency TCSs were increased and the use of high potency TCSs were decreased. TCSs were the most commonly prescribed topical medications for AD. Tertiary hospitals had a higher prescription rate for TCIs than secondary or primary hospitals (16.2%, 3.1%, and 1.9%, respectively). Additionally, dermatologists prescribed TCIs more frequently than pediatricians and internists (4.3%, 1.2%, and 0.6%, respectively). Among TCSs, Class 5 was prescribed the most (40.6%) followed by Class 7, 6, 4, 3, 1, and 2. When we compared the potency of TCSs prescribed for AD with psoriasis patients, moderate-to-low-potency TCSs were more commonly prescribed in AD. CONCLUSION Prescription patterns of topical medications had changed from 2002 to 2015 and differed according to the type of institution and specialty of the physician.
Collapse
Affiliation(s)
- Jungsoo Lee
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Taeyeong Kim
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang-Jin Cheon
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jinmi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Dermatology, College of Medicine, Pusan National University, Busan, Korea
| |
Collapse
|
9
|
Zhao Z, Gao XH, Li W, Wang H, Liang Y, Tang J, Yao X, Zhao H, Luger T. Experts' Consensus on the Use of Pimecrolimus in Atopic Dermatitis in China: A TCS-Sparing Practical Approach. Dermatol Ther (Heidelb) 2022; 12:933-947. [PMID: 35313362 PMCID: PMC9021341 DOI: 10.1007/s13555-022-00696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease with rising prevalence. Topical corticosteroids (TCS) are recommended as first-line therapy for patients with AD in China; however, corticophobia is a widespread concern, which can manifest as noncompliance: in a previous Chinese study, almost all parents whose children had AD were very concerned about the side effects of TCS and, as a result, nearly half did not use it in the event of recurrence. We propose a TCS-sparing treatment algorithm for the management of infants, children, adolescents, and adults with mild-to-moderate AD, to guide clinical practice in China. Methods A panel of eight experts in AD from China and one expert from Germany formed to develop a practical algorithm for the management of mild-to-moderate AD, focusing on pimecrolimus. Results Irrespective of body location, all patients with mild AD (including acute flares) and infants with moderate AD should apply the topical calcineurin inhibitor (TCI) pimecrolimus twice daily to the affected area until symptoms disappear. For children, adolescents, and adults with moderate AD, pimecrolimus should be applied twice daily to sensitive skin areas, and a TCI (either pimecrolimus or tacrolimus) should be applied twice daily to other body locations. Short-term administration of TCS, followed by TCI twice daily, is recommended for most patients with moderate AD experiencing acute flares, regardless of lesion site. Emollients should be used regularly. Conclusions The algorithm presented intends to simplify treatment of AD in China and guide clinical decision-making.
Collapse
Affiliation(s)
- Zuotao Zhao
- Department of Dermatology and Venereology National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital, China Medical University, 77 Puhe Rd, Shenbei, Shenyang, Liaoning, China
| | - Wei Li
- Department of Dermatology, Huashan Hospital, Fudan University, 796 Jiangsu Rd, Changning District, Shanghai, China
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd, Liang Lu Kou, Yuzhong District, Chongqing, China
| | - Yunsheng Liang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Nanfang Ave, Baiyun, Guangzhou, Guangdong, China
| | - Jianping Tang
- Department of Dermatology, Hunan Children's Hospital, 86 Ziyuan Rd, Yuhua District, Changsha, Hunan, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng, Beijing, China
| | - Hua Zhao
- Department of Dermatology and Venereology, Chinese PLA General Hospital, 4th Ring Road, Beijing, China
| | - Thomas Luger
- Department of Dermatology, University of Münster, Von-Esmarch-Straße 58, 48149, Münster, Germany.
| |
Collapse
|
10
|
Kader HA, Azeem M, Jwayed SA, Al-Shehhi A, Tabassum A, Ayoub MA, Hetta HF, Waheed Y, Iratni R, Al-Dhaheri A, Muhammad K. Current Insights into Immunology and Novel Therapeutics of Atopic Dermatitis. Cells 2021; 10:cells10061392. [PMID: 34200009 PMCID: PMC8226506 DOI: 10.3390/cells10061392] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Atopic dermatitis (AD) is one of the most prevalent inflammatory disease among non-fatal skin diseases, affecting up to one fifth of the population in developed countries. AD is characterized by recurrent pruritic and localized eczema with seasonal fluctuations. AD initializes the phenomenon of atopic march, during which infant AD patients are predisposed to progressive secondary allergies such as allergic rhinitis, asthma, and food allergies. The pathophysiology of AD is complex; onset of the disease is caused by several factors, including strong genetic predisposition, disrupted epidermal barrier, and immune dysregulation. AD was initially characterized by defects in the innate immune system and a vigorous skewed adaptive Th2 response to environmental agents; there are compelling evidences that the disorder involves multiple immune pathways. Symptomatic palliative treatment is the only strategy to manage the disease and restore skin integrity. Researchers are trying to more precisely define the contribution of different AD genotypes and elucidate the role of various immune axes. In this review, we have summarized the current knowledge about the roles of innate and adaptive immune responsive cells in AD. In addition, current and novel treatment strategies for the management of AD are comprehensively described, including some ongoing clinical trials and promising therapeutic agents. This information will provide an asset towards identifying personalized targets for better therapeutic outcomes.
Collapse
Affiliation(s)
- Hidaya A. Kader
- Department of Biology, College of Science, UAE University, Al Ain 15551, United Arab Emirates; (H.A.K.); (S.A.J.); (A.A.-S.); (M.A.A.); (R.I.)
| | - Muhammad Azeem
- Department of Pathology, University of Würzburg, 97080 Würzburg, Germany;
| | - Suhib A. Jwayed
- Department of Biology, College of Science, UAE University, Al Ain 15551, United Arab Emirates; (H.A.K.); (S.A.J.); (A.A.-S.); (M.A.A.); (R.I.)
| | - Aaesha Al-Shehhi
- Department of Biology, College of Science, UAE University, Al Ain 15551, United Arab Emirates; (H.A.K.); (S.A.J.); (A.A.-S.); (M.A.A.); (R.I.)
| | - Attia Tabassum
- Department of Dermatology, Mayo Hospital, Lahore 54000, Pakistan;
| | - Mohammed Akli Ayoub
- Department of Biology, College of Science, UAE University, Al Ain 15551, United Arab Emirates; (H.A.K.); (S.A.J.); (A.A.-S.); (M.A.A.); (R.I.)
| | - Helal F. Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Yasir Waheed
- Foundation University Medical College, Foundation University Islamabad, Islamabad 44000, Pakistan;
| | - Rabah Iratni
- Department of Biology, College of Science, UAE University, Al Ain 15551, United Arab Emirates; (H.A.K.); (S.A.J.); (A.A.-S.); (M.A.A.); (R.I.)
| | - Ahmed Al-Dhaheri
- Department of Dermatology, Tawam Hospital, Al Ain 15551, United Arab Emirates;
| | - Khalid Muhammad
- Department of Biology, College of Science, UAE University, Al Ain 15551, United Arab Emirates; (H.A.K.); (S.A.J.); (A.A.-S.); (M.A.A.); (R.I.)
- Correspondence:
| |
Collapse
|
11
|
Shams G, Rad AN, Safdarian M, Rezaie A, Bavarsad N, Abbaspour M. Self-microemulsification-assisted incorporation of tacrolimus into hydrophilic nanofibers for facilitated treatment of 2,4-dinitrochlorobenzene induced atopic dermatitis like lesions. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
12
|
Leung AK, Lam JM, Leong KF, Leung AA, Wong AH, Hon KL. Nummular Eczema: An Updated Review. ACTA ACUST UNITED AC 2021; 14:146-155. [DOI: 10.2174/1872213x14666200810152246] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022]
Abstract
Background:
Nummular eczema may mimic diseases that present with annular configuration
and the differential diagnosis is broad.
Objective:
This article aimed to provide an update on the evaluation, diagnosis, and treatment of
nummular eczema.
Methods:
A PubMed search was performed in using the key terms “nummular eczema”, “discoid
eczema”, OR “nummular dermatitis”. The search strategy included meta-analyses, randomized controlled
trials, clinical trials, observational studies, and reviews. The search was restricted to English
literature. The information retrieved from the above search was used in the compilation of the present
article. Patents were searched using the key terms “nummular eczema”, “discoid eczema”, OR
“nummular dermatitis” in www.google.com/patents and www.freepatentsonline.com.
Results:
Nummular eczema is characterized by sharply defined, oval or coin-shaped, erythematous,
eczematous plaques. Typically, the size of the lesion varies from 1 to 10cm in diameter. The
lesions are usually multiple and symmetrically distributed. Sites of predilection include the lower
limbs followed by the upper limbs. The lesions are usually intensely pruritic. The diagnosis is mainly
clinical based on the characteristic round to oval erythematous plaques in a patient with diffusely
dry skin. Nummular eczema should be distinguished from other annular lesions. Dermoscopy
can reveal additional features that can be valuable for correct diagnosis. Biopsy or laboratory tests
are generally not necessary. However, a potassium hydroxide wet-mount examination of skin scrapings
should be performed if tinea corporis is suspected. Because contact allergy is common with
nummular eczema, patch testing should be considered in patients with chronic, recalcitrant nummular
eczema. Avoidance of precipitating factors, optimal skin care, and high or ultra-high potency
topical corticosteroids are the mainstay of therapy. Recent patents related to the management of
nummular eczema are also discussed.
Conclusion:
With proper treatment, nummular eczema can be cleared over a few weeks, although
the course can be chronic and characterized by relapses and remissions. Moisturizing of the skin
and avoidance of identifiable exacerbating factors, such as hot water baths and harsh soaps may reduce
the frequency of recurrence. Diseases that present with annular lesions may mimic nummular
eczema and the differential diagnosis is broad. As such, physicians must be familiar with this condition
so that an accurate diagnosis can be made, and appropriate treatment initiated.
Collapse
Affiliation(s)
- Alexander K.C. Leung
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Joseph M. Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Amy A.M. Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H.C. Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam L. Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Kowloon Bay, Kowloon, Hong Kong
| |
Collapse
|
13
|
Dong Y, Yang Q, Guo B, Zhu J, Sun X. The effects of tacrolimus plus phototherapy in the treatment of vitiligo: a meta-analysis. Arch Dermatol Res 2020; 313:461-471. [PMID: 32785837 DOI: 10.1007/s00403-020-02121-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
The objective of this meta-analysis was performed to compare the effects of tacrolimus plus phototherapy in the treatment of patients with vitiligo. Relevant studies were identified by searching PubMed, Embase, and Web of Science databases. The main outcomes of interest included excellent response (≥ 75% repigmentation), good response (50-75% repigmentation), moderate response (25%-50% repigmentation), and poor response (< 25% repigmentation). Risk ratio (RR) with 95% confidence intervals (95% CIs) was used to calculate the data. Eleven studies were included in this study. Compared with phototherapy alone, combination treatment of tacrolimus and phototherapy significantly improved excellent response rate (RR = 1.40, 95% CI 1.16, 1.69; P < 0.001) and reduced the poor response rate (RR = 0.37, 95% CI 0.22, 0.61; P = 0.001). However, the good response rate (RR = 1.00, 95% CI 0.59, 1.69, P = 1.000) and moderate response rate (RR = 0.91, 95% CI 0.60, 1.38; P = 0.653) were not significantly different between the two treatments. Subgroup analysis suggested that combination treatment had a higher excellent response rate than phototherapy alone for lesions located in the face and proximal limbs. Both NB-UVB and EL, when added to tacrolimus, resulted in a significantly higher excellent response rate than they were used alone. Meta-regression analysis showed that age was a predictive factor that influenced the effect of combination treatment on an excellent response, in which children had a high excellent response to the treatment. Other demographic and clinical variables, including gender, disease duration, family history, and type of vitiligo, did not have any impact on the treatment effect. Combination treatment with tacrolimus and phototherapy was more effective than phototherapy monotherapy for patients with vitiligo, especially in the lesions located in the face and proximal limbs. More large-scale, well-performed trials are needed to verify our findings.
Collapse
Affiliation(s)
- Yujie Dong
- Department of Emergency, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Qi Yang
- Department of Obstetrics and Gynecology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Baofeng Guo
- Department of Plastic and Reconstruction Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Jiajing Zhu
- Radiology Department, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Xiaojie Sun
- Department of Plastic and Reconstruction Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, China.
| |
Collapse
|
14
|
Fiorillo L, Marcoux D, Ramien M. Contemporary Role of Topical Calcineurin Inhibitors: A Pediatric Dermatology Perspective. J Cutan Med Surg 2020; 23:11S-18S. [PMID: 31476940 DOI: 10.1177/1203475419857975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis (AD) is the most common pediatric chronic inflammatory skin disease in North America, often involving complex treatment regimens and impairing the quality of life of affected children and their families. Two topical calcineurin inhibitors (TCIs) have been available for the treatment of AD in pediatric patients for more than 15 years, and they continue to represent an important steroid-sparing option for the management of AD. Despite the large body of evidence and extensive clinical experience with these agents, there remain concerns among parents and clinicians regarding the long-term safety of this class of therapy, particularly with respect to the boxed warning about the potential risk of lymphoma and malignancy associated with TCIs. Concerns about burning or stinging with initial applications are also common. This review examines the literature on the clinical effectiveness of TCIs, with a focus on the pivotal research that supports the efficacy of these agents, and the reassuring body of evidence supporting their long-term safety in pediatric patients. Practical recommendations for maximizing the utility of TCIs in pediatric patients, including discussion points to address with parents, are offered.
Collapse
Affiliation(s)
- Loretta Fiorillo
- 1 Department of Medicine, University of Alberta, Edmonton, Canada
| | - Danielle Marcoux
- 2 Department of Pediatrics, Division of Dermatology, University of Montreal and Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Michele Ramien
- 3 Department of Pediatrics, University of Calgary, AB, Canada
| |
Collapse
|
15
|
Hanna S, Zip C, Shear NH. What Is the Risk of Harm Associated With Topical Calcineurin Inhibitors? J Cutan Med Surg 2020; 23:19S-26S. [PMID: 31476938 DOI: 10.1177/1203475419857688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The topical calcineurin inhibitors (TCIs), tacrolimus (Protopic) and pimecrolimus (Elidel), were approved in the early 2000s and were widely used as a nonsteroid treatment for atopic dermatitis (AD) in adult and pediatric populations. In 2005, the addition of a boxed warning was mandated for TCIs based on a potential risk of malignancy, and there was subsequently a substantial decline in their use. Since then, evidence has mounted to support the safety of this class of medications and suggests that the increased risk of malignancy remains theoretical. This review aims to dispel some of the common myths surrounding the safety of TCIs by evaluating the key evidence regarding their safety and tolerability in adult and pediatric populations. Four major themes are addressed in a practical question-and-answer format: the risk of harm associated with TCIs including common and serious adverse events; warnings and precautions for their use including the risk of systemic absorption, immunosuppression, and malignancy; the comparative safety of TCIs; and suggestions for counselling patients about the risk of harm with TCIs. Based on the available evidence, international professional dermatological organizations and regulatory authorities have concluded that the benefits of TCIs outweigh their potential risks when used in the appropriate patient populations for the recommended duration of time.
Collapse
Affiliation(s)
- Sam Hanna
- 1 Dermatology on Bloor, Toronto, ON, Canada
| | - Catherine Zip
- 2 Department of Medicine, Section of Dermatology, University of Calgary, AB, Canada
| | - Neil H Shear
- 3 Clinical Pharmacology & Toxicology, Dermatology, Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| |
Collapse
|
16
|
Abstract
GENERAL PURPOSE The purpose of this learning activity is to provide information about the diagnosis and management of atopic dermatitis (AD). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After completing this continuing education activity, you should be able to:1. Recall the diagnostic process of AD.2. Identify nonpharmacologic therapies for skin care in patients with AD.3. Explain the pharmacologic management of AD. ABSTRACT Atopic dermatitis is a chronic, relapsing, intensely pruritic inflammatory skin disease that affects both children and adults. This article provides an overview of the epidemiology, clinical features, pathophysiology, complications, and specific investigations of atopic dermatitis. The current and novel therapies for the treatment of atopic dermatitis will be discussed.
Collapse
|
17
|
Jain S, Addan R, Kushwah V, Harde H, Mahajan RR. Comparative assessment of efficacy and safety potential of multifarious lipid based Tacrolimus loaded nanoformulations. Int J Pharm 2019; 562:96-104. [DOI: 10.1016/j.ijpharm.2019.03.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
|
18
|
Pancreatic Enzyme Supplementation in Patients with Atopic Dermatitis and Food Allergies: An Open-Label Pilot Study. Paediatr Drugs 2019; 21:41-45. [PMID: 30556101 DOI: 10.1007/s40272-018-0321-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects both patients and their families. Current therapies often alleviate symptoms but do not prevent or eradicate the disease. OBJECTIVES Our objective was to determine whether pancreatic enzyme supplementation is an effective and safe treatment in refractory pediatric AD associated with food allergies. METHODS We conducted an open-label pilot study using a case-control design. Patients with severe AD and known food allergies refractory to conventional therapies and exclusion diets were recruited and treated for 6 weeks with oral supplementation of pancreatic enzymes. The primary endpoint was the severity of AD, using the Scoring Atopic Dermatitis (SCORAD) index. Secondary measures included markers of intestinal permeability (urinary sucrose and lactulose/mannitol excretion). RESULTS A total of 11 patients met all eligibility criteria and completed the trial. Significant improvement in AD was observed after 6 weeks of pancreatic enzyme supplementation (SCORAD index 52.3 ± 5.5 vs. 34.6 ± 7.6; p = 0.0008). Beneficial effect was observed in 9 of 11 patients, without adverse events. Fractional urinary sucrose excretion improved to a level comparable to that of age-matched controls (p < 0.05). However, urinary lactulose:mannitol ratios remained abnormally high compared with those of controls (p = 0.01). CONCLUSIONS Pancreatic enzyme supplementation was associated with improved AD and gastroduodenal permeability. Additional randomized placebo-controlled studies are required before this treatment can be recommended in this clinical setting.
Collapse
|
19
|
Reda AM, Elgendi A, Ebraheem AI, Aldraibi MS, Qari MS, Abdulghani MMR, Luger T. A practical algorithm for topical treatment of atopic dermatitis in the Middle East emphasizing the importance of sensitive skin areas. J DERMATOL TREAT 2018; 30:366-373. [PMID: 30222017 DOI: 10.1080/09546634.2018.1524823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background There is a need for safe, effective treatment for atopic dermatitis (AD) in the Middle East. Objective To propose a practical algorithm for the treatment of AD throughout the Middle East. Methods An international panel of six experts from the Middle East and one from Europe developed the algorithm. The practical treatment guide was based on a review of published guidelines on AD, an evaluation of relevant literature published up to August 2016 and local treatment practices. Results Patients with an acute mild-to-moderate disease flare on sensitive body areas should apply the topical calcineurin inhibitor (TCI), pimecrolimus 1% cream twice daily until clearance. For other body locations, a TCI, either pimecrolimus 1% cream, tacrolimus 0.03% ointment in children or 0.1% ointment in adults, should be applied twice daily until clearance. Emollients should be used as needed. Patients experiencing acute severe disease flares should apply a topical corticosteroid (TCS) according to their label for a few days to reduce inflammation. After clinical improvement, pimecrolimus for sensitive skin areas or TCIs for other body locations should be used until there is a complete resolution of lesions. Conclusions These recommendations are expected to optimize AD management in patients across the Middle East.
Collapse
Affiliation(s)
- Ashraf M Reda
- a Mediclinic Welcare Hospital , Dubai , United Arab Emirates
| | | | | | - Mohammed S Aldraibi
- d Department of Dermatology, King Fahad Armed Forces Hospital , Jeddah , Saudi Arabia
| | | | | | - Thomas Luger
- f Dermatology Clinic , University of Münster , Münster , Germany
| |
Collapse
|
20
|
Abstract
Psoriasis is one of the most common chronic skin diseases, affecting 1%-3% of the general population. It can have a significant negative impact on a patient's quality of life, and in approximately 30% of patients first symptoms can be traced back to childhood. We have performed a comprehensive literature search using the MEDLINE database in order to ascertain the efficacy and adverse reactions of topical treatments in pediatric psoriasis. A total of 13 relevant articles were identified on the following topical agents: corticosteroids, calcineurin inhibitors, vitamin D analogs, and dithranol. Corticosteroids achieved clearance in 72.7% of patients. Calcitriol lead to a 57.2%-100% mean improvement in severity, and calcipotriol to 52%-64%. Combination of calcipotriol and corticosteroids achieved an improvement in mean severity ranging between 32.1% and 80%. Treatment with tacrolimus lead to an >50% improvement. Finally, short contact dithranol lead to a variable response in clearance between different studies, ranging between 3.7% and 81%. No serious adverse reactions were documented, the most common local reaction being irritation. Pediatric psoriasis is a common and challenging condition with no easy and definitive solution. Topical agents are safe, easy to use, readily available and cheap. However, they need to be applied repeatedly, may cause skin irritation, and can be messy. Based on the results presented above, we recommend utilizing all the available topical options before escalating to systemic treatments.
Collapse
Affiliation(s)
- Georgios Kravvas
- Department of Dermatology, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Karolina Gholam
- Department of Paediatric Dermatology, Great Ormond Street Hospital, London, UK
| |
Collapse
|
21
|
Papier A, Strowd LC. Atopic dermatitis: a review of topical nonsteroid therapy. Drugs Context 2018; 7:212521. [PMID: 29632548 PMCID: PMC5886549 DOI: 10.7573/dic.212521] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 12/11/2022] Open
Abstract
Background Atopic dermatitis is a chronic inflammatory skin condition that affects up to 20% of children and 3% of adults globally. Although topical corticosteroids are considered to be the first-line agents, they can be associated with cutaneous and systemic adverse effects. Since the early 2000s, two new classes of nonsteroid topical therapies, topical calcineurin inhibitors and phosphodiesterase 4 (PDE4) inhibitors, have been introduced and provide a safe treatment alternative. Method We performed a search and review of clinical trials that examined the safety and efficacy of topical calcineurin inhibitors and PDE4 inhibitors. The search was conducted using the PubMed database as well as preselected keywords and filters. This review focuses on the safety and efficacy of each therapy. Results Sixty-nine clinical trials identified in this study have demonstrated the efficacy and safety of topical calcineurin and a single novel PDE4 inhibitor in the treatment of atopic dermatitis. Topical calcineurin inhibitors have been shown to be effective in both achieving lesion clearance as well as reducing relapse when used long-term and proactively. Similarly, in clinical trials the PDE4 inhibitor showed success in lesion clearance and symptom management. All three therapies (pimecrolimus, tacrolimus, crisaborole) are associated with low systemic absorption. No clinical trials to date have shown an increased risk of systemic adverse events or malignancy such as lymphoma. The most commonly reported treatment-related adverse event across all three therapies was application-site discomfort, pain or pruritus. It is important to note that long-term studies are not yet available for the novel PDE4 inhibitor. Discussion Topical calcineurin inhibitors provide a safe and effective alternative to topical corticosteroid use in the treatment of atopic dermatitis. Although the US Food and Drug Administration (FDA) black box warning for topical calcineurin inhibitors remains, studies have not shown an increased risk of malignancy. These warnings have caused a decline in use in favor of topical steroids. A novel PDE4 inhibitor has shown efficacy and safety in studies up to one year. Further long-term safety data is needed.
Collapse
Affiliation(s)
- Ariana Papier
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lindsay C Strowd
- Department of Dermatology, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, NC, USA
| |
Collapse
|
22
|
Phosphodiesterase 4 inhibitors. J Am Acad Dermatol 2018; 78:S43-S52. [DOI: 10.1016/j.jaad.2017.11.056] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
|
23
|
Hussain Z, Thu HE, Shuid AN, Kesharwani P, Khan S, Hussain F. Phytotherapeutic potential of natural herbal medicines for the treatment of mild-to-severe atopic dermatitis: A review of human clinical studies. Biomed Pharmacother 2017; 93:596-608. [DOI: 10.1016/j.biopha.2017.06.087] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 02/07/2023] Open
|
24
|
Huang A, Cho C, Leung DYM, Brar K. Atopic Dermatitis: Early Treatment in Children. CURRENT TREATMENT OPTIONS IN ALLERGY 2017; 4:355-369. [PMID: 29868331 DOI: 10.1007/s40521-017-0140-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Therapeutic regimens for the treatment and long-term management of AD traditionally had a two-fold objective of decreasing skin inflammation and repairing the defective skin barrier. Essential treatments for AD in children should include topical moisturizers for skin hydration and prevention of flares, topical anti-inflammatory medications (e.g. corticosteroids, calcineurin inhibitors, PDE4 inhibitor), allergen/irritant avoidance, and treatment of skin infections. Treatment regimens should be severity-based, and implemented in a stepwise approach tailored to the individual patient. This stepwise approach includes initial use of emollients, gentle skin care, and escalating to more potent anti-inflammatory treatments as the disease severity increases. Currently available systemic medications should be reserved for the presence of recalcitrance to topical therapies due to associated toxicities. We believe that early treatment of AD is not only essential in treating the skin disease, but also in preventing the development of additional atopic diseases, such as food allergy, asthma and allergic rhinitis. The defective skin barrier of AD permits a route of entry for food and environmental allergens, and upon exposure, keratinocytes secrete TSLP, which activates the TH2 pathway. This TH2 differentiation sets off the atopic march and the subsequent diseases that are seen. This review highlights treatment options and strategies in pediatric AD therapy with an emphasis on early therapy. Supporting evidence on the efficacy and safety of each intervention will be discussed.
Collapse
Affiliation(s)
- Amy Huang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
| | - Christine Cho
- Department of Pediatrics, National Jewish Health, Denver, CO
| | | | - Kanwaljit Brar
- Department of Pediatrics, National Jewish Health, Denver, CO
| |
Collapse
|
25
|
Udkoff J, Waldman A, Ahluwalia J, Borok J, Eichenfield LF. Current and emerging topical therapies for atopic dermatitis. Clin Dermatol 2017; 35:375-382. [DOI: 10.1016/j.clindermatol.2017.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
26
|
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
|
27
|
Drug nanocarrier, the future of atopic diseases: Advanced drug delivery systems and smart management of disease. Colloids Surf B Biointerfaces 2016; 147:475-491. [DOI: 10.1016/j.colsurfb.2016.08.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/14/2022]
|
28
|
Jain A, Doppalapudi S, Domb AJ, Khan W. Tacrolimus and curcumin co-loaded liposphere gel: Synergistic combination towards management of psoriasis. J Control Release 2016; 243:132-145. [PMID: 27725194 DOI: 10.1016/j.jconrel.2016.10.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/29/2016] [Accepted: 10/06/2016] [Indexed: 01/01/2023]
Abstract
Psoriasis is an autoimmune skin disorder characterized by hyper proliferation and poor differentiation of keratinocytes. It significantly affects patient's quality of life. This study reports the anti-psoriatic efficacy of tacrolimus and curcumin loaded liposphere gel formulation. Poor solubility, poor skin penetration and erratic absorption are some problems associated with the topical delivery of these drugs. To overcome these problems, lipospheres containing combination of tacrolimus and curcumin was prepared with a particle size of nearly 50nm and incorporated into a gel for topical application. Liposphere gel showed slow release of both the drugs and shear thinning behaviour that is desirable property of topical formulation. Further, dermal distribution study using dye loaded formulation suggested penetration of dye into skin layers. The therapeutic efficacy of tacrolimus and curcumin loaded liposphere gel was assessed on imiquimod induced psoriatic plaque model, and the level of expression of psoriatic biochemical markers was evaluated using enzyme-linked immunosorbent assay. Results indicated improvement in the phenotypic and histopathological features of psoriatic skin treated with tacrolimus and curcumin loaded liposphere gel. There was reduction in the level of TNF-α, IL-17 and IL-22 compared to imiquimod group. These results corroborate the premise that liposphere gel containing combination of tacrolimus and curcumin can be an effective strategy for the treatment of psoriasis.
Collapse
Affiliation(s)
- Anjali Jain
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Sindhu Doppalapudi
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India
| | - Abraham J Domb
- School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, and Jerusalem College of Engineering (JCE), Jerusalem 91120, Israel.
| | - Wahid Khan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500037, India.
| |
Collapse
|
29
|
Tan J, Langley R. Safety and Efficacy of Tacrolimus Ointment 0.1% (Protopic™) in Atopic Dermatitis: A Canadian Open-Label Multicenter Study. J Cutan Med Surg 2016. [DOI: 10.1177/120347540400800402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Most previously published trials of topical tacrolimus in atopic dermatitis were of relatively short duration and comprised a limited population with moderate-to-severe disease. Objective: The goal of the study was to evaluate the safety and efficacy over a 6-month period of tacrolimus 0.1% ointment in children and adults with a broader severity spectrum of atopic dermatitis. Methods: An open-label multicenter trial in patients 2 years and older was used. Primary safety and tolerability assessments included skin infection and application site adverse events. Efficacy parameters were body surface area involvement, pruritus score, and overall reponse. Results: There were 240 patients recruited at 23 study sites. Significant improvement from baseline was noted for all efficacy endpoints in both pediatric and adult patients. Skin infections occurred in 26% of patients. Burning sensation with product application, reported by 38% of patients, was transient and of mild-to-moderate severity in the majority. Conclusion: Tacrolimus 0.1% ointment was safe, well tolerated, and efficacious in treatment of atopic dermatitis in children and adults over six months.
Collapse
Affiliation(s)
- Jerry Tan
- Department of Medicine, University of Western Ontario, Windsor, Ontario, Canada
| | - Richard Langley
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
30
|
Choi WJ, Konkit M, Kim Y, Kim MK, Kim W. Oral administration of Lactococcus chungangensis inhibits 2,4-dinitrochlorobenzene-induced atopic-like dermatitis in NC/Nga mice. J Dairy Sci 2016; 99:6889-6901. [DOI: 10.3168/jds.2016-11301] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/05/2016] [Indexed: 12/31/2022]
|
31
|
Siegfried EC, Jaworski JC, Kaiser JD, Hebert AA. Systematic review of published trials: long-term safety of topical corticosteroids and topical calcineurin inhibitors in pediatric patients with atopic dermatitis. BMC Pediatr 2016; 16:75. [PMID: 27267134 PMCID: PMC4895880 DOI: 10.1186/s12887-016-0607-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 05/13/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Many clinicians have concerns about the safety of atopic dermatitis (AD) treatments, particularly in children requiring long-term daily maintenance therapy. Topical corticosteroids (TCS) have been widely used for >5 decades. Long-term TCS monotherapy has been associated with adverse cutaneous effects including atrophy, rebound flares, and increased percutaneous absorption with potential for adverse systemic effects. Topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, available for 1-2 decades, are not associated with atrophy or increased percutaneous absorption after prolonged use and have much lower potential for systemic effects. However, since 2006 TCIs have carried a controversial Boxed Warning based on a theoretical risk of malignancy (eg, skin and lymphoma) that has limited TCI use for standard-of-care maintenance therapy. METHODS A comparative systematic search of PubMed was done for long-term (≥12 week) clinical trials of TCS or TCI treatment in patients <12 years with AD. Citations were reviewed for inclusion based on MeSH terms, abstracts, and relevant article text. Studies were excluded if they did not encompass subjects <12 years, or were <12 weeks' duration, retrospective, meta-analyses, or limited to anecdotal case reports. RESULTS Of 27 trials meeting criteria, 21 included 5825 pediatric patients treated with TCIs, and 6 included 1999 patients treated with TCS. TCS studies were limited to low- to mid-potency products, and all but one study lacked a vehicle control. Eight TCI studies were vehicle-controlled, and safety data were well reported, with ≤5 % of patients reporting discontinuation due to adverse effects (DAEs). Cutaneous and systemic adverse events (AEs) were similar in TCI and vehicle groups, with no reports of lymphoma. Safety data in TCS trials were less well reported. DAE incidence was addressed in just 2 trials, and systemic and cutaneous AEs were mostly unreported. CONCLUSIONS Data supporting long-term use of TCIs are robust, documenting safety and efficacy, while data supporting long-term TCS use are limited to low- to mid-potency products. Our review identifies a lack of information on the safety of commonly prescribed, long-term monotherapy with mid- to high-potency TCS in pediatric AD, and supports standard-of-care maintenance therapy with TCIs and intermittent use of low- to mid-potency TCS for flares.
Collapse
Affiliation(s)
- Elaine C Siegfried
- Saint Louis University, Cardinal Glennon Children's Hospital, 1465 South Grand Avenue, St Louis, MO, 63104, USA.
| | - Jennifer C Jaworski
- Prescott Medical Communications Group, 205 North Michigan Avenue, Suite 3400, Chicago, IL, 60601, USA
| | - Jennifer D Kaiser
- Prescott Medical Communications Group, 205 North Michigan Avenue, Suite 3400, Chicago, IL, 60601, USA
| | - Adelaide A Hebert
- University of Texas-Houston Medical School, 6655 Travis, Suite 980, Houston, TX, 77030, USA
| |
Collapse
|
32
|
Jung H, Chung H, Chang SE, Kang DH, Oh ES. FK506 regulates pigmentation by maturing the melanosome and facilitating their transfer to keratinocytes. Pigment Cell Melanoma Res 2016; 29:199-209. [DOI: 10.1111/pcmr.12443] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Hyejung Jung
- Department of Life Sciences; The Research Center for Cellular Homeostasis; Ewha Womans University; Seoul Korea
| | - Heesung Chung
- Department of Life Sciences; The Research Center for Cellular Homeostasis; Ewha Womans University; Seoul Korea
| | - Sung Eun Chang
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Duk-Hee Kang
- Division of Nephrology; Department of Internal Medicine; Ewha Medical Research Center; Ewha Womans University School of Medicine; Seoul Korea
| | - Eok-Soo Oh
- Department of Life Sciences; The Research Center for Cellular Homeostasis; Ewha Womans University; Seoul Korea
| |
Collapse
|
33
|
Herbal Medicines Prevent the Development of Atopic Dermatitis by Multiple Mechanisms. Chin J Integr Med 2016; 25:151-160. [PMID: 26740223 DOI: 10.1007/s11655-015-2438-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 12/22/2022]
Abstract
Atopic dermatitis (AD) is among the most common skin disorders in humans. Although a variety of regimens are available for the treatment of AD, preventive approaches are limited. Recent studies have demonstrated that certain naturally-occurring herbal medicines are effective in preventing the development of AD via divergent mechanisms, such as inhibiting cytokine and chemokine expression, IgE production, inflammatory cell infiltration, histamine release, and/or enhancement of epidermal permeability barrier function. Yet, they exhibit few adverse effects. Since herbal medicines are widely available, inexpensive and generally safe, they could represent an ideal approach for preventing the development of AD, in both highly developed and developing countries.
Collapse
|
34
|
Thomas W, Werner A, Frank A, Matthias A, Tilo B, Thomas D, Regina FH, Uwe G, Annice H, Julia K, Alexander K, Alexander N, Katja N, Hagen O, Bernhard P, Martin R, Martin S, Peter SG, Jochen S, Thomas S, Doris S, Margitta W. Leitlinie Neurodermitis [atopisches Ekzem; atopische Dermatitis]. J Dtsch Dermatol Ges 2015; 14:e1-75. [DOI: 10.1111/ddg.12884] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
| | - Aberer Werner
- Österreichische Gesellschaft für Dermatologie und Venerologie
| | - Ahrens Frank
- Gesellschaft für Pädiatrische Allergologie und Umweltmedizin e.V
| | - Augustin Matthias
- Arbeitsgemeinschaft Gesundheitsökonomie und Evidenzbasierte Medizin der Deutschen Dermatologischen Gesellschaft
| | | | - Diepgen Thomas
- Arbeitsgemeinschaft Berufs- und Umweltdermatologie der Deutschen Dermatologischen Gesellschaft
| | - Fölster-Holst Regina
- Arbeitsgemeinschaft Pädiatrische Dermatologie der Deutschen Dermatologischen Gesellschaft
| | | | | | | | - Kapp Alexander
- Deutsche Gesellschaft für Allergologie und Klinische Immunologie
| | - Nast Alexander
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (Moderation)
| | - Nemat Katja
- Berufsverband der Kinder- und Jugendärzte e.V
| | - Ott Hagen
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V
| | - Przybilla Bernhard
- Arbeitsgemeinschaft Allergologie der Deutschen Dermatologischen Gesellschaft
| | | | | | | | | | | | - Staab Doris
- Arbeitsgemeinschaft Neurodermitisschulung e.V
| | | |
Collapse
|
35
|
Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol 2014; 71:1218-33. [PMID: 25264237 DOI: 10.1016/j.jaad.2014.08.038] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/06/2014] [Accepted: 08/22/2014] [Indexed: 01/27/2023]
Abstract
Atopic dermatitis is a common, chronic inflammatory dermatosis that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this final section, treatments for flare prevention and adjunctive and complementary therapies and approaches are reviewed. Suggestions on use are given based on available evidence.
Collapse
|
36
|
Grunwald MH, Ben Amitai D, Amichai B. Macrolactam Immunomodulators (Tacrolimus and Pimecrolimus): New Horizons in the Topical Treatment of Inflammatory Skin Diseases. J Dermatol 2014; 31:592-602. [PMID: 15492431 DOI: 10.1111/j.1346-8138.2004.tb00564.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2003] [Accepted: 03/30/2004] [Indexed: 11/29/2022]
Abstract
Tacrolimus and pimecrolimus are new macrolactam immunomodulators which were developed for the treatment of inflammatory skin diseases, mainly atopic dermatitis. In this article, we review the pharmacologic properties of the drugs, their side effects, and their clinical uses.
Collapse
Affiliation(s)
- Marcelo H Grunwald
- Department of Dermatology, Soroka Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | | | | |
Collapse
|
37
|
Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol 2014; 71:116-32. [PMID: 24813302 DOI: 10.1016/j.jaad.2014.03.023] [Citation(s) in RCA: 782] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 12/22/2022]
Abstract
Atopic dermatitis is a common and chronic, pruritic inflammatory skin condition that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this second of 4 sections, treatment of atopic dermatitis with nonpharmacologic interventions and pharmacologic topical therapies are reviewed. Where possible, suggestions on dosing and monitoring are given based on available evidence.
Collapse
|
38
|
Park SJ, Lee HA, Kim JW, Lee BS, Kim EJ. Platycodon grandiflorus alleviates DNCB-induced atopy-like dermatitis in NC/Nga mice. Indian J Pharmacol 2013; 44:469-74. [PMID: 23087507 PMCID: PMC3469949 DOI: 10.4103/0253-7613.99306] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/22/2012] [Accepted: 04/30/2012] [Indexed: 11/21/2022] Open
Abstract
Objective: To investigate the therapeutic effect of crude extract from Platycodon grandiflorum (PG) roots on atopic dermatitis (AD)-like skin lesions in NC/Nga mice. Materials and Methods: To develop atopic dermatitis-like lesions, 200 μl of 0.3% 1-chloro-2, 4-dinitro benzene (DNCB) in acetone/olive oil (3:1) was applied 3 times a week for 2 weeks on the shaved skin of their backs. PG extract was dissolved in saline and orally administrated at concentrations of 300 and 500 mg/kg every day for 2 weeks. The therapeutic effect of PG on AD-like skin lesions was assessed by measuring skin severity scores and epithermal thickness, serum total immunoglobulin (Ig) E, histopathological findings for inflammatory cells including mast cells, macrophage and T cells, and mRNA expression of various cytokines related to the inflammatory and allergic response. The significance of inter-group differences was analyzed using the ANOVA test. Data were considered to be significant when P < 0.05 or P < 0.01. Results: Oral treatment of PG suppressed AD-like skin lesions according to the assessment of skin severity and epithermal thickness in the DNCB-treated NC/Nga mice. This alleviation was further correlated with a reduction of elevated serum total IgE or cytokine mRNA in the PG-treated group compared with vehicle-treated positive group. In addition, infiltrated inflammatory cells decreased on the skin lesions compared with vehicle-treated group. Conclusion: These results suggest that PG may have a potential therapeutic effect for AD via the inhibition of both inflammatory and allergic reaction.
Collapse
Affiliation(s)
- Sang-Joon Park
- College of Veterinary Medicine, Kyungpook National University, Buk-gu, Daegu, Korea
| | | | | | | | | |
Collapse
|
39
|
Li Y, Xiao Y, Wang H, Li H, Luo X. Low-concentration topical tacrolimus for the treatment of anogenital lichen sclerosus in childhood: maintenance treatment to reduce recurrence. J Pediatr Adolesc Gynecol 2013; 26:239-42. [PMID: 24049806 DOI: 10.1016/j.jpag.2012.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lichen sclerosus (LS) is a chronic inflammatory skin disorder that is commonly found in the anogenital area, especially in females. Ultra-potent topical corticosteroids are first line for the treatment of LS, but their atrophic side effects and the recurrence of the disease restrict their use. An equally effective, safer, tolerant therapeutic option is required, especially in the treatment and preventing relapse of children. METHODS Fourteen prepubertal girls (range of age: 4 to 11 years) with anogenital lichen sclerosus were treated with 0.03% tacrolimus ointment twice daily for 16 weeks, then 9 of the 14 patients adhered to 2 times weekly for further 6 months (a total of 10 months). The therapeutic effects were evaluated according to 3 grades: complete response (O75% improvement, partial response (30%-75% improvement),or no response (!30% improvement). RESULTS Clinical improvement occurred in all patients (100%). Complete response of symptoms and signs was achieved in 5 (36%), 9 (64%) and 11 (79%) patients at week 8, week 16, and month 10 respectively. During the follow-up period of 1 year, 4 patients (4/5, 80%) who treated with tacrolimus ointment for 16 weeks had a recurrence of symptoms, while only 2 of 9 (22%) patients who insisted on maintenance therapy developed recurrence of disease. No severe side effects were observed. CONCLUSIONS Low-concentration topical tacrolimus appears to be an effective and safe treatment for children with anogenital lichen sclerosus. Maintenance therapy (2 times a week for 6 months) can reduce the relapse of the disease.
Collapse
Affiliation(s)
- Yongmei Li
- Department of Dermatology, Children’s Hospital of Chongqing Medical University, and Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | | | | | | | | |
Collapse
|
40
|
Schneider L, Tilles S, Lio P, Boguniewicz M, Beck L, LeBovidge J, Novak N, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 2013; 131:295-9.e1-27. [PMID: 23374261 DOI: 10.1016/j.jaci.2012.12.672] [Citation(s) in RCA: 269] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Atopic dermatitis: a practice parameter update 2012." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available online at http://www.jcaai.org.
Collapse
|
41
|
Siegfried EC, Jaworski JC, Hebert AA. Topical calcineurin inhibitors and lymphoma risk: evidence update with implications for daily practice. Am J Clin Dermatol 2013; 14:163-78. [PMID: 23703374 PMCID: PMC3669499 DOI: 10.1007/s40257-013-0020-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Topical calcineurin inhibitors (TCIs), commercially available since 2000–2001, are the first and only topical medications approved for chronic treatment of atopic dermatitis (AD) in pediatric patients and remain a welcomed alternative to topical corticosteroids. In January 2006, the US Food and Drug Administration (FDA) issued a boxed warning requirement based on a theoretical risk of malignancy (including lymphoma) with TCI use. However, in the years since, analyses of epidemiologic and clinical data have failed to demonstrate a causal relationship between TCI use and malignancy or lymphoma risk, especially for pimecrolimus cream. In fact, the observed number of malignancies and lymphomas observed both in post-marketing surveillance and reported to the FDA using its adverse events reporting system is much lower among TCI-exposed patients than the expected number for the general population. Furthermore, among children enrolled in post-marketing pediatric registry studies for both tacrolimus and pimecrolimus followed for up to 5.5 years [10,724 patient-years (PY)] or 6.5 years (16,219 PY), respectively, the observed number of malignancies and lymphomas is very low and similar to the number expected for a sample of similar size in the general population. In addition to reporting these comparative malignancy and lymphoma data, this article provides a historical overview of the boxed warning requirement and critically evaluates the preclinical, clinical, and epidemiological evidence that has thus far failed to substantiate a relationship between TCI use and malignancy. The authors also provide practical clinical advice for optimizing AD management and patient care in the context of the boxed warning.
Collapse
Affiliation(s)
- Elaine C Siegfried
- Saint Louis University and Cardinal Glennon Children's Hospital, 1465 S Grand Ave., St. Louis, MO 63104, USA.
| | | | | |
Collapse
|
42
|
Chung BY, Kim HO, Kim JH, Cho SI, Lee CH, Park CW. The proactive treatment of atopic dermatitis with tacrolimus ointment in Korean patients: a comparative study between once-weekly and thrice-weekly applications. Br J Dermatol 2013; 168:908-10. [PMID: 23110605 DOI: 10.1111/bjd.12115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Targeting tacrolimus to deeper layers of skin with improved safety for treatment of atopic dermatitis-Part II: in vivo assessment of dermatopharmacokinetics, biodistribution and efficacy. Int J Pharm 2012; 434:70-9. [PMID: 22609427 DOI: 10.1016/j.ijpharm.2012.04.051] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/12/2012] [Accepted: 04/21/2012] [Indexed: 01/22/2023]
Abstract
The objective of present investigation was to study in vivo behavior of tacrolimus-loaded lipid-nanoparticles (T-LN) to understand its targeting potential for treatment of atopic-dermatitis-(AD). T-LN have shown significantly improved drug penetration to deeper epidermal and dermal skin-layers than commercial ointment-Protopic(®) and effectively reached target dendritic-immune-cells, responsible for immunopathogenesis of AD. Due to enhanced penetrability of T-LN, it became necessary to evaluate the toxicity of the nanocarrier and the drug at non-target tissues. This paper evaluates dermatopharmacokinetics (DPK), biodistribution, efficacy and safety of T-LN in comparison to Protopic(®) as reference. In vivo DPK in guinea pigs showed 3.02-fold higher bioavailability while γ-scintigraphy in albino-rats demonstrated 1.5-fold rapid penetration of radioactivity in skin for T-LN. Biodistribution in albino-rats revealed restricted localization at the target-skin-area with no general spreading to other body organs suggesting targeting potential of T-LN. In vivo efficacy studies in BALB/c mice showed highly efficient suppression of inflammatory AD-like skin-lesions with T-LN than reference and placebo. Dermal toxicity-studies revealed keratosis and collagenous mass-infiltration with repeated application of reference however interestingly, T-LN treated group showed no evident toxicity demonstrating significantly improved safety. Thus T-LN offered improved penetration to the target site without any toxic-effects and would represent an efficient and commercially viable alternative for AD treatment.
Collapse
|
44
|
Man W, Man M, Hupe M, Martin-Ezquerra G, Feingold KR, Elias PM, Man MQ. Topical herbal extract (Huangdang mixture) exhibits both preventive and therapeutic effects in murine acute irritant contact dermatitis. Int J Dermatol 2012; 50:1421-1427. [PMID: 22004502 DOI: 10.1111/j.1365-4632.2011.04970.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Contact dermatitises, including allergic contact dermatitis and irritant contact dermatitis, are among the most common skin disorders in humans. Chinese herbal medicines (CHM) have been used in treating contact dermatitises for centuries. Systemic administration of CHM, including ingredients in huangdang mixture containing Chinese angelica, radix Paeonlae rubra, cat nut, and phelloden dron, rhizoma alismatis, rhizoma smilacis glabrae, and rhizome of swordlike, improves allergic contact dermatitis induced by l-fluoro-2,4-dinitrobenzene. Whether topical applications of these herbal extracts display preventive and/or therapeutic effects on contact dermatitis, thereby avoiding the potential side effects of systemic CHM, remains largely unknown. AIMS To determine whether this topical CHM extract exerts preventive and/or therapeutic effects, we assessed its efficacy in both allergic contact dermatitis and irritant contact dermatitis murine models. MATERIALS AND METHODS Allergic contact dermatitis and irritant contact dermatitis murine models were established by topical oxazolone and a phorbol ester (12-O-tetradecanoylphorbol-13-acetate; TPA), respectively. Ear thickness was assessed in both dermatitis models. RESULTS Our results demonstrate that this topical CHM extract exhibits both therapeutic and preventive effects in acute irritant contact dermatitis but no demonstrable efficacy in murine allergic contact dermatitis. CONCLUSION These results suggest that this topical CHM extract could provide an alternative regimen for the prevention and treatment of irritant contact dermatitis.
Collapse
Affiliation(s)
- Wenyan Man
- Dermatology Service, Veterans Affairs Medical Center, and Department of Dermatology, University of California, San Francisco, CA 94121, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
Mandelin JM, Rubins A, Remitz A, Cirule K, Dickinson J, Ho V, Mäkelä MJ, Rubins S, Reitamo S, Undre N. Long-term efficacy and tolerability of tacrolimus 0.03% ointment in infants:* a two-year open-label study. Int J Dermatol 2011; 51:104-10. [PMID: 21923693 DOI: 10.1111/j.1365-4632.2011.05015.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tacrolimus ointment is effective for treatment of moderate to severe atopic dermatitis (AD) in children aged ≥2 years (Br J Dermatol, 2004; 150: 554). Here, efficacy and tolerability of tacrolimus 0.03% ointment were evaluated in 50 infants aged <2 years at start of treatment. METHODS Infants with AD previously enrolled in a tacrolimus ointment pharmacokinetics trial were eligible for a 24-month open-label phase II study. Tacrolimus 0.03% ointment was applied to affected areas until clearance. In cases of exacerbation or clinical worsening, patients restarted treatment. RESULTS Mean ± SD Eczema Area and Severity Index (EASI) score improved, from 11.2 ± 10.5 baseline to 2.6 ± 4.1 at endpoint (24 months); mean affected body surface area decreased from 25.2 ± 21.1% to 5.1 ± 9.0%, with improvement on all items of the Physicians' Assessment of Individual Signs. The Physicians' Global Evaluation of Clinical Response showed a result of "cleared"/"excellent" for 63.3% of patients; 85.7% of parents/guardians assessed symptoms as "much better." Treatment was well tolerated, with common, nonserious respiratory infections and gastroenteritis the most frequently reported adverse events. The most common application-site events were infections and pruritus. Over 98% of blood samples showed tacrolimus concentrations <1.0 ng/ml; >40% showed concentrations below the lower limit of quantification (0.0250 ng/ml). CONCLUSIONS Over a period of two years, tacrolimus 0.03% ointment was associated with substantial clinical improvement of AD in infants aged <2 years. Treatment tolerability was similar to that seen in older children.
Collapse
|
46
|
Kalavala M, Dohil MA. Calcineurin inhibitors in pediatric atopic dermatitis: a review of current evidence. Am J Clin Dermatol 2011; 12:15-24. [PMID: 21067248 DOI: 10.2165/11319300-000000000-00000] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic inflammatory dermatosis with a prevalence of 7-21% in school-aged children. Childhood AD has a profound impact on the social, personal, emotional, and financial perspectives of families. For the last half-century, topical corticosteroids of different potencies have been the mainstay of topical therapy. In recent years, two topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, have become available for the treatment of AD. Both tacrolimus and pimecrolimus have been extensively evaluated in the management of pediatric AD. Trials comparing them with placebo, topical corticosteroids, and each other have shown them to be effective and safe for continuous short-term use, and for noncontinuous use for up to 4 years. Long-term safety of TCIs is not known as they have been in clinical use for less than a decade.
Collapse
|
47
|
Healy E, Bentley A, Fidler C, Chambers C. Cost-effectiveness of tacrolimus ointment in adults and children with moderate and severe atopic dermatitis: twice-weekly maintenance treatment vs. standard twice-daily reactive treatment of exacerbations from a third party payer (U.K. National Health Ser. Br J Dermatol 2011; 164:387-95. [DOI: 10.1111/j.1365-2133.2010.10141.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
Bakulev AL, Bakulev AL. Tacrolimus: 10 years of successful clinical application. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tacrolimus (FK506) is the first drug from the new class of drugs - calcineurin inhibitors. It has a great potential and can change
the current approaches to treatment of different dermatoses. Topical forms of Tacrolimus are activated due to the effect on T-lymphocyte
signal transduction, and they also inhibit gene transcription. As a result, the T-cell response to antigens is alleviated.
Percutaneous absorption of Tacrolimus in affection foci is higher than in healthy skin. Due to this a smaller amount of the drug
is absorbed by the skin as long as the skin is healed. Systemic absorption of Tacrolimus is low in the course of treatment. The
maximum clinical experience has been gained in the field of applying Tacrolimus for treatment of atopic dermatitis. In a number of
clinical studies, 0.03-0.3% Tacrolimus ointment efficiently reduced the severity of symptoms and course of atopic dermatitis in
adults and children. Moreover, topical treatment with Tacrolimus did not involve any substantial toxic effects. The patients most often
complained of local irritations in the area where the ointment was applied, which were transient by nature and did not demand
the drug withdrawal. Today Tacrolimus is a valuable and safer alternative to glucocorticosteroids for treatment of atopic dermatitis.
It can also be used for treating other dermatoses, which demands additional all-round examination.
Collapse
|
49
|
Atkins D, Malka-Rais J. Food allergy: transfused and transplanted. Curr Allergy Asthma Rep 2010; 10:250-7. [PMID: 20425005 DOI: 10.1007/s11882-010-0110-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The inadvertent transfer of food allergy from an allergic donor to an unsuspecting recipient by transfusion or organ donation is a relatively rare but intriguing event with potentially catastrophic consequences. Additionally, the development of food allergy in the recipient of a transplant from a donor who was not food allergic poses questions about why this occurs, why it is observed more frequently in some situations than others, and the mechanisms that may be involved. In this review, the transfer of food allergy by transfusion, bone marrow transplantation, and the transplantation of different solid organs is explored, and potential mechanisms in addition to the importance of careful monitoring are discussed.
Collapse
Affiliation(s)
- Dan Atkins
- National Jewish Health, Denver, CO 80206, USA.
| | | |
Collapse
|
50
|
Pople PV, Singh KK. Targeting tacrolimus to deeper layers of skin with improved safety for treatment of atopic dermatitis. Int J Pharm 2010; 398:165-78. [DOI: 10.1016/j.ijpharm.2010.07.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
|