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Anheyer M, Cramer H, Ostermann T, Anheyer D. Herbal Medicine in Children and Adults With Atopic Dermatitis: A Systematic Review and Meta-Analysis. Dermatitis 2024. [PMID: 38963342 DOI: 10.1089/derm.2024.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Herbal medicine is widely used for dermatological diseases, particularly atopic dermatitis. This study aims to systematically review existing literature on the efficacy of both topical and systemic herbal interventions for atopic dermatitis across various age groups. Conducting a comprehensive search on MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (Central) until April 12, 2023, only randomized controlled trials (RCTs) were included. The review is reported following the PRISMA guidelines and was conducted in accordance to Cochrane recommendations. Two authors independently extracted details, including demographics, medication, control/placebo groups, outcomes, adverse events, and results, with quality assessment using the Cochrane risk of bias tool 2.0. A meta-analysis, utilizing the random-effects model, was conducted, and publication bias was assessed through funnel plot inspection. The quality of evidence adhered to GRADE working group recommendations. The primary focus was evaluating atopic dermatitis or pruritus severity. The review encompassed 51 RCTs (3763 participants). Of these, 31 RCTs explored 19 distinct herbs and five complex remedies, whereas 20 RCTs (1088 participants) specifically investigated evening primrose oil (EPO). Herbs such as sunflower, licorice, figs, coconut, EPO, indigo naturalis, licorice, mauve, St. John's wort, and a combination of aloe vera and olive oil were found to have evidence of efficacy in the local treatment of atopic dermatitis. A meta-analysis on systemic used EPO, involving 13 RCTs, found no significant difference in atopic dermatitis severity compared with placebo (SMD: 0.14; 95% CI [-0.45; 0.73], 13 RCTs). In conclusion, this review provides a nuanced perspective on herbal substance efficacy for atopic dermatitis. While the EPO meta-analysis failed to show a discernible benefit beyond placebo, individual herbal preparations showed promising results in RCTs included in this review. Nevertheless, larger, methodologically rigorous studies are essential to establish evidence for herbal remedies in atopic dermatitis treatment.
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Affiliation(s)
- Melanie Anheyer
- From the Department for Pediatric and Adolescent Medicine, Elisabeth Hospital Essen, Essen, Germany
- Professorship of integrative pediatrics, Faculty of Health, University Witten/Herdecke, Witten/Herdecke, Germany
| | - Holger Cramer
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Chair of Research Methodology and Statistics in Psychology, University Witten/Herdecke, Witten/Herdecke, Germany
| | - Dennis Anheyer
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
- Department of Psychology and Psychotherapy, Chair of Research Methodology and Statistics in Psychology, University Witten/Herdecke, Witten/Herdecke, Germany
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Braren-von Stülpnagel C, Augustin M, Sommer R, Westphal L. Psychosocial Burden in People with Atopic Dermatitis: Effects of a Substance-Free Basic Skincare in a Randomized Health Care Study. Skin Pharmacol Physiol 2024; 36:296-301. [PMID: 38325354 DOI: 10.1159/000536671] [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] [Received: 08/17/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Atopic dermatitis (AD) is a physical, emotional, and social burden for patients. Most suffer from itching, pain, and dry skin as well as sleep disturbances, experienced stigmatization, anxiety, or depression. Therefore, it is important to consider the psychosocial well-being and also stigmatization in the treatment of people with AD. The aims of this study were to compare clinical and psychosocial parameters between patients with a different severity of AD and to analyse the effect of an omega-6-fatty-acid-skin therapy. METHODS Adult patients with clinically confirmed AD were asked about quality of life, stigmatization, and well-being after dermatological diagnosis. A second examination took place after 2-5 weeks. Meanwhile, after randomization, half of the patients used an omega-6-fatty-acid-skin therapy. RESULTS Seventy-nine patients were included in the study. The use of omega-6-fatty-acid-skin therapy resulted in a significant reduction in the severity of xerosis cutis compared to patients using another basic therapy. In addition, the health-related quality of life of all patients improved significantly in both groups (F = 7.56; p = 0.008), and no significant difference was found between the groups over time in the patient-reported outcomes. CONCLUSION Basic therapy for AD leads to relevant improvements in clinical status as well as quality of life. Patients using omega-6-fatty-acid-skin therapy experience greater improvement in xerosis cutis compared to free-choice basic therapy.
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Affiliation(s)
- Catharina Braren-von Stülpnagel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lukas Westphal
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Heratizadeh A, Mempel M, von Kiedrowski R, Hagl S, Mosch T, Fritz B, Werfel T. Checklist identification of candidates for systemic therapy in adult patients with atopic dermatitis in Germany: A multicentre study. J Eur Acad Dermatol Venereol 2024; 38:157-166. [PMID: 37611262 DOI: 10.1111/jdv.19465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The German S2k guideline is the first to include a checklist that captures atopic dermatitis (AD) signs and symptoms as well as the lack of treatment response to identify patients eligible for systemic therapy. OBJECTIVES Identifying candidates for a start/switch of systemic therapy in adult AD patients in Germany by applying the S2k guideline's checklist. METHODS In this German multicentre, cross-sectional, non-interventional study (German Clinical Trials Register number: DRKS00023296), adult patients with mild to severe AD were enrolled at dermatological outpatient clinics and offices between April and October 2021. Demographics, clinical characteristics and quality of life were collected using questionnaires during one single visit. Eligibility for a start/switch of systemic AD therapy was evaluated according to the criteria of the German S2k guideline's checklist. RESULTS Atopic dermatitis patients (575) were included in the analysis. One hundred and sixty-four patients (28.5%) received systemic (SYS) AD therapy and 411 patients (71.5%) did not (TOP). Of the TOP therapy patients, 38.7% were eligible to start systemic AD therapy, and about half of those (49.1%), were scheduled to start systemic AD therapy. The most frequent reason deciding against a systemic therapy was the patient's wish. Although 29.3% of SYS patients were eligible for a switch according to the criteria of the German S2k guideline's checklist, the majority (81.3%) did not switch AD therapy. CONCLUSIONS This is the first study on the implementation of the German S2k guideline's checklist in everyday care of AD patients in Germany. More than one-third of the TOP patients were identified as eligible for systemic treatment. By applying the guideline's checklist criteria, another one-third of SYS patients may have benefited from a change of current systemic therapy. The use of the German S2k guideline's checklist in routine care represents an important tool to ensure effective patient care and identify inadequately treated patients.
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Affiliation(s)
- A Heratizadeh
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - M Mempel
- Hautarztpraxis Elmshorn, Elmshorn, Germany
| | - R von Kiedrowski
- Company for Medical Study & Service Selters GmbH (CMS), Selters, Germany
| | - S Hagl
- formerly AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - T Mosch
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - B Fritz
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
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4
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Mick A, Tizek L, Schielein M, Zink A. Can crowdsourced data help to optimize atopic dermatitis treatment? Comparing web search data and environmental data in Germany. J Eur Acad Dermatol Venereol 2021; 36:557-565. [PMID: 34921466 DOI: 10.1111/jdv.17875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most common chronic skin diseases worldwide, showing various manifestations and having a severe impact on quality of life. As previous studies demonstrated, internet search analysis can help identify public interest in diseases and possible influencing factors on search behavior. OBJECTIVE To identify AD-related topics of interest in Germany using internet search volume. METHODS Google Ads Keyword Planner was used to identify AD-related search terms including their search volume in Germany on a national level as well as in 16 selected cities from January 2016 to December 2019. Identified keywords were qualitatively analyzed, and temporal trends as well as the influence of seasonal and environmental factors on search volume were assessed. RESULTS Overall, 1222 AD-related search terms with a search volume of 8 842 360 searches were identified. An increase from 2016 to 2019 and seasonal peaks from January to April of each year were observed. Nationwide, the search volume correlated with mean monthly temperature and sun duration. With increasing temperature and sun duration, a significant decrease in search queries was observed. The most populated cities showed the lowest number of searches per 100 000 inhabitants (Berlin, Hamburg, and Munich). In the eight categories formed (comorbidities, general, influential factors, localization, stage of life, symptoms/severity, therapy/information, and questions on AD), the highest proportion of search queries were assigned to the category "therapy/information" in most cities. In this category, a focus on the topics of "alternative medicine" and "home remedies" could be observed. CONCLUSION The overall high and increasing search volume indicates a high interest in AD-related topics, especially regarding treatment and disease education. Information provided by internet search volume analyses can optimize AD therapy and patient-centered care by providing insight into patient needs and predicting potential climatic trigger factors.
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Affiliation(s)
- A Mick
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - L Tizek
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - M Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Division of Dermatology and Venereology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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5
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Abstract
Seit dem ersten Bericht über die Allergenimmuntherapie (AIT) durch Noon et al. vor 110 Jahren wurden zahlreiche klinische und grundlagenwissenschaftliche Studien durchgeführt, um die Effekte der einzigen kurativen Behandlung von Allergien zu untersuchen. Bei der atopischen Dermatitis (AD) findet sie jedoch nur selten Anwendung, obwohl es Evidenz dafür gibt, dass Aeroallergene zu Exazerbationen der Erkrankung beitragen können. Dieser Übersichtsbeitrag umfasst die aktuelle Studienlage, Metaanalysen und Leitlinienempfehlungen zur AIT bei AD-Patienten. Es zeigt sich eine große Heterogenität hinsichtlich Studiendesigns, Patientenkohorten, Allergenen, Applikationsformen und Endpunkten, wodurch die Vergleichbarkeit der Studien erschwert wird. Mehrere Untersuchungen zeigen eine positive Wirkung der AIT auf den Schweregrad der AD, was darauf hindeutet, dass zumindest eine Untergruppe von Patienten von der Behandlung profitieren kann. Weitere Entwicklungen auf dem Gebiet der AIT könnten dazu beitragen, dass die Therapie einen breiteren Einsatz bei AD-Patienten findet.
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Barrier defect in atopic dermatitis - possibilities and limits of basic skin therapy. Allergol Select 2021; 5:287-292. [PMID: 34532637 PMCID: PMC8439110 DOI: 10.5414/alx02268e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
The increased permeability of the skin barrier towards environmental factors such as allergens is considered a key factor in the pathogenesis of atopic dermatitis (AD). Strengthening the skin barrier through basic skin therapy represents the basis of any therapy for AD. It is well known that genetic factors as well as the skin inflammation itself contribute to the weakening of the barrier; here, recent studies have led to a deeper understanding of the complex structures of the epidermis. The possibility of counteracting the disease preventively by the use of basic skin therapy from birth on has been studied intensively in recent years. This article summarizes recent findings on the effects of basic skin therapy as a primary and secondary preventive measure.
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Zietze HA, Cabral C, Theobald K, Ihle P, Pittrow D, Kienitz C, Augustin M. [Epidemiology and treatment of adult patients with atopic dermatitis : Analysis of longitudinal data of the statutory health insurance scheme]. Hautarzt 2021; 72:963-974. [PMID: 34379145 DOI: 10.1007/s00105-021-04859-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal was to report incidence, prevalence, and treatment patterns in adult atopic dermatitis (AD) patients in the German statutory health insurance system. PATIENT AND METHODS Anonymized claims data were evaluated at patient level for 3.3 million persons insured by six different statutory health insurance companies (SHI). Patients for whom the ICD-10 diagnosis code L20 (AD) was applied at least twice were analyzed and data on prescription patterns for AD were reported for the years 2011-2015. RESULTS AD prevalence in adults was 1.6-1.9% in 2012-2015. Annual incidence was 0.28%. In Q3/Q4 2015, 44.2% of the adult population with AD diagnosis by a dermatologist received prescriptions for AD medications: 1.6% low-potency topical glucocorticoids (without previous prescription of systemic drugs), 46.9% moderate or high-potency topical glucocorticoids or topical calcineurin inhibitors, 23.9% current systemic therapy (systemic glucocorticoids, ciclosporin, methotrexate, azathioprine, mycophenolate mofetil) and 27.6% systemic therapy in the past. CONCLUSIONS The AD prevalence estimate was in the range of previous reports (1.35-4%) that used different methodologies. Based on treatment proxy, it appeared that almost more than half of AD patients treated with prescription ready-to-use drugs had a severe form of AD which required treatment with systemic drugs.
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Affiliation(s)
- Henny Anna Zietze
- Evidence based medicine/Health Economics and Outcomes Research, Sanofi-Aventis Deutschland GmbH, Potsdamer Str. 8, 10785, Berlin, Deutschland.
| | | | - Karlheinz Theobald
- Evidence based medicine/Health Economics and Outcomes Research, Sanofi-Aventis Deutschland GmbH, Potsdamer Str. 8, 10785, Berlin, Deutschland
| | - Peter Ihle
- PMV Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland
| | - Carsten Kienitz
- Evidence based medicine/Health Economics and Outcomes Research, Sanofi-Aventis Deutschland GmbH, Potsdamer Str. 8, 10785, Berlin, Deutschland
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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8
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Siegels D, Heratizadeh A, Abraham S, Binnmyr J, Brockow K, Irvine AD, Halken S, Mortz CG, Flohr C, Schmid‐Grendelmeier P, Poel L, Muraro A, Weidinger S, Werfel T, Schmitt J. Systemic treatments in the management of atopic dermatitis: A systematic review and meta-analysis. Allergy 2021; 76:1053-1076. [PMID: 33074565 DOI: 10.1111/all.14631] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND As an evidence resource for the currently planned European Academy of Allergy and Clinical Immunology (EAACI) clinical practice guideline "systemic treatment of atopic dermatitis (AD)," we critically appraised evidence on systemic treatments for moderate-to-severe AD. METHODS We systematically identified randomized controlled trials (RCTs) investigating the safety and efficacy of systemic treatments for AD up to February 2020. Primary efficacy outcomes were clinical signs, AD symptoms and health-related quality of life. Primary safety outcomes included cumulative incidence rates for (serious) adverse events. Trial quality was assessed applying the Cochrane Risk of Bias Tool 2.0. Meta-analyses were conducted where appropriate. RESULTS 50 RCTs totalling 6681 patients were included. Trial evidence was identified for apremilast, azathioprine (AZA), baricitinib, ciclosporin A (CSA), corticosteroids, dupilumab, interferon-gamma, intravenous immunoglobulins (IVIG), mepolizumab, methotrexate (MTX), omalizumab, upadacitinib and ustekinumab. Meta-analyses were indicated for the efficacy of baricitinib [EASI75 RD 0.16, 95% CI (0.10;0.23)] and dupilumab [EASI75, RD 0.37, 95% CI (0.32;0.42)] indicating short-term (ie 16-week treatment) superiority over placebo. Furthermore, efficacy analyses of AZA and CSA indicated short-term superiority over placebo; however, nonvalidated scores were used and can therefore not be compared to EASI. CONCLUSION The most robust, replicated high-quality trial evidence is present for the efficacy and safety of dupilumab for up to 1 year in adults. Robust trial evidence was further revealed for AZA, baricitinib and CSA. Methodological restrictions led to limited evidence-based conclusions for all other systemic treatments. Head-to-head trials with novel systemic treatments are required to clarify the future role of conventional therapies.
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Affiliation(s)
- Doreen Siegels
- Center for Evidence‐Based Healthcare University Hospital Dresden Dresden Germany
| | - Annice Heratizadeh
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - Susanne Abraham
- Center for Evidence‐Based Healthcare University Hospital Dresden Dresden Germany
- Department of Dermatology Medical Faculty Carl Gustav Carus University Allergy Center TU DresdenDresden Germany
| | - Jonas Binnmyr
- The Swedish Asthma‐ and Allergy Association Stockholm Sweden
- The Swedish Asthma‐ and Allergy Research Foundation Stockholm Sweden
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein School of Medicine Technical University of Munich Munich Germany
| | - Alan D. Irvine
- Department of Clinical Medicine Trinity College Dublin Ireland
- Dermatology, Children’s Health Ireland National Children’s Research Centre Dublin Ireland
| | - Susanne Halken
- Hans Christian Andersen Children’s Hospital Odense University Hospital Odense Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Center Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - Carsten Flohr
- Unit for Population‐Based Dermatology Research St John's Institute of Dermatology Guy’s & St Thomas' NHS Foundation Trust and King’s College London London UK
| | - Peter Schmid‐Grendelmeier
- Allergy Unit Department of Dermatology University Hospital of Zurich Zurich
- Christine‐Kuehne Center for Allergy Research and Education CK_CARE Davos Switzerland
| | - Lauri‐Ann Poel
- Department of Paediatric Allergy Guy's and St Thomas' NHS Foundation Trust UK
| | - Antonella Muraro
- Department of Woman and Child Health Food Allergy Referral Centre Padua University Hospital Padua Italy
| | - Stephan Weidinger
- Department of Dermatology and Allergy University Hospital Schleswig‐Holstein Kiel Germany
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - Jochen Schmitt
- Center for Evidence‐Based Healthcare University Hospital Dresden Dresden Germany
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9
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Abstract
Vaccinations are among the most successful prophylactic measures in medicine. As they are applied to healthy subjects, regulatory steps before licensing of any vaccination are strictly based on clinically controlled studies as well as on registry data in the further course. The probability and relevance of adverse reactions to vaccinations have to be weighed against any harm through the respective natural infection as well as the vaccination-induced protection against infections. Intolerance reactions to vaccinations are far more suspected than proven and altogether rare. Among these, specific dermatoses like psoriasis, atopic dermatitis and lichen planus are found as well as allergic reactions and a number of more nonspecific skin symptoms. Apart from provocation or exacerbation of an underlying dermatological disease, various intolerance reactions may be encountered which are classically allergologic or anaphylactoid. People with chronic dermatoses, especially those on immunosuppressive and immunomodulatory therapy, should have all recommended standard vaccinations. Vaccinations should not be administered during acute skin manifestations and relevant comedication-especially if immunomodulatory or immunosuppressive-has be taken into account in the decision to vaccinate and to define the time point of any vaccination. Inactivated vaccines may be administered even during ongoing immunosuppressive therapy, but may result in decreased immunological reactions and protection to infection. Live vaccines should be avoided.
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Affiliation(s)
- M Sticherling
- Psoriasiszentrum, Deutsches Zentrum Immuntherapie, Hautklinik Universitätsklinikum Erlangen, Ulmenweg 18, 91045, Erlangen, Deutschland.
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10
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Schielein MC, Tizek L, Seifert F, Biedermann T, Zink A. Versorgung von chronisch entzündlichen Hauterkrankungen. Hautarzt 2019; 70:875-882. [DOI: 10.1007/s00105-019-04481-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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11
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Blaess M, Deigner HP. Derailed Ceramide Metabolism in Atopic Dermatitis (AD): A Causal Starting Point for a Personalized (Basic) Therapy. Int J Mol Sci 2019; 20:E3967. [PMID: 31443157 PMCID: PMC6720956 DOI: 10.3390/ijms20163967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/10/2023] Open
Abstract
Active rebuilding, stabilizing, and maintaining the lipid barrier of the skin is an encouraging disease management and care concept for dry skin, atopic dermatitis (eczema, neurodermatitis), and psoriasis. For decades, corticosteroids have been the mainstay of topical therapy for atopic dermatitis; however, innovations within the scope of basic therapy are rare. In (extremely) dry, irritated, or inflammatory skin, as well as in lesions, an altered (sphingo)lipid profile is present. Recovery of a balanced (sphingo)lipid profile is a promising target for topical and personalized treatment and prophylaxis. New approaches for adults and small children are still lacking. With an ingenious combination of commonly used active ingredients, it is possible to restore and reinforce the dermal lipid barrier and maintain refractivity. Lysosomes and ceramide de novo synthesis play a key role in attenuation of the dermal lipid barrier. Linoleic acid in combination with amitriptyline in topical medication offers the possibility to relieve patients affected by dry and itchy skin, mild to moderate atopic dermatitis lesions, and eczemas without the commonly occurring serious adverse effects of topical corticosteroids or systemic antibody administration.
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Affiliation(s)
- Markus Blaess
- Institute of Precision Medicine, Medical and Life Sciences Faculty, Furtwangen University, Jakob-Kienzle-Strasse 17, 78054 Villingen-Schwenningen, Germany
| | - Hans-Peter Deigner
- Institute of Precision Medicine, Medical and Life Sciences Faculty, Furtwangen University, Jakob-Kienzle-Strasse 17, 78054 Villingen-Schwenningen, Germany.
- EXIM Department, Fraunhofer Institute IZI Leipzig, Schillingallee 68, 18057 Rostock, Germany.
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12
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Abstract
In severe cases of atopic dermatitis (AD) systemic treatment is indicated. So far, cyclosporine and systemic glucocorticosteroids represented the only systemic treatment options approved for the indications of AD in Germany; however, from clinical practice there is increasing evidence for beneficial therapeutic effects in AD by other immunosuppressive or immunomodulatory substances, such as mycophenolate, methotrexate, alitretinoin and ustekinumab. Beyond this, ongoing research activities focus on a better understanding of genetic and immunological aspects of this chronic inflammatory skin disease. Regarding treatment with mycophenolate, genetic polymorphisms in AD patients could be identified that might predict responsiveness to this medication. Moreover, several new substances specifically targeting inflammation in AD are currently being studied and the first promising treatment effects on skin condition and pruritic symptoms of AD could be observed. As an exceptional result of this development in September 2017 in Europe and therefore in Germany the first biologic as first-line treatment was approved for the indication of moderate to severe AD in adults. Dupilumab is a human monoclonal IgG4 antibody that blocks a subunit of the interleukin (IL)-4 and IL-13 receptors, thus inhibiting the proinflammatory effects of these cytokines. Furthermore, the cytokine IL-13 itself, the IL-31 receptor, which is of particular relevance for pruritus in AD, the histamine-4-receptor and Janus kinases represent further promising targets currently being investigated in clinical trials for the treatment of AD.
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13
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Wahl J, Apfelbacher C. [Quality of patient information leaflets on atopic eczema : An analysis using the DISCERN instrument]. Hautarzt 2018; 69:825-831. [PMID: 30112575 DOI: 10.1007/s00105-018-4247-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND As in other chronic diseases, providing medical information plays a key role in the therapy of atopic eczema. It is already known that information leaflets often do not meet the criteria of evidence-based patient information (EBPI). OBJECTIVE Therefore, the aim of this study was to examine the quality of information leaflets on atopic eczema. MATERIAL AND METHODS A total of 35 leaflets were included in the study. They were collected from self-aid groups, from the internet, from general practitioners, from pediatricians and dermatologists as well as from pharmacies in Regensburg. The quality of information provided was assessed using the DISCERN instrument. RESULTS Almost all of the 35 patient information leaflets assessed had shortcomings, scoring only mid- or low-point in the analysis. None of the leaflets was of excellent quality. Only three leaflets were estimated to contain good quality information. CONCLUSION Most of the leaflets did not meet the criteria of evidence-based patient information. In conclusion, there may be a lack of quality information about atopic eczema. Improving the existing material and comparing the EBPI standards with the information needs of atopic eczema patients should be topics of future research.
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Affiliation(s)
- J Wahl
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Dr.-Gessler-Str. 17, Regensburg, Deutschland.
| | - C Apfelbacher
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Dr.-Gessler-Str. 17, Regensburg, Deutschland
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14
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Melhorn S. [Dithranol]. Hautarzt 2017; 68:421-423. [PMID: 28401270 DOI: 10.1007/s00105-017-3977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Melhorn
- Deutscher Arzneimittel-Codex/Neues Rezeptur-Formularium, Avoxa - Mediengruppe Deutscher Apotheker GmbH, Carl-Mannich-Str. 26, 65760, Eschborn, Deutschland.
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15
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Affiliation(s)
- S Melhorn
- Deutscher Arzneimittel-Codex/Neues Rezeptur-Formularium, Avoxa-Mediengruppe Deutscher Apotheker GmbH, Carl-Mannich-Str. 26, 65760, Eschborn, Deutschland.
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16
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Affiliation(s)
- S Melhorn
- Avoxa - Mediengruppe Deutscher Apotheker GmbH, Carl-Mannich-Str. 26, 65760, Eschborn, Deutschland.
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