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Feldman SR, Thyssen JP, Boeri M, Gerber R, Neary MP, Cha A, Hauber B, Cappelleri JC, Xenakis J, Leach C, Zeichner J. Adult, adolescent, and caregiver preferences for attributes of topical treatments for mild-to-moderate atopic dermatitis: a discrete-choice experiment. J DERMATOL TREAT 2024; 35:2304020. [PMID: 38221777 DOI: 10.1080/09546634.2024.2304020] [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: 10/19/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
Purpose: Topical treatments for mild-to-moderate (MM) atopic dermatitis (AD) include emollients, corticosteroids, calcineurin inhibitors, a Janus kinase inhibitor, and a phosphodiesterase 4 inhibitor, which differ in multiple ways. This study aimed to quantify the conditional relative importance (CRI) of attributes of topical treatments for MM AD among adult and adolescent patients and caregivers of children with MM AD.Materials and methods: A discrete-choice experiment (DCE) survey was administered to US adults and adolescents with MM AD and caregivers of children with MM AD. Each choice task comprised 2 hypothetical topical treatments characterized by efficacy, adverse events, vehicle, and application frequency. Data were analyzed using a random-parameters logit model to calculate the CRI of each attribute.Results and conclusions: 300 adults, 331 adolescents, and 330 caregivers completed the DCE. Avoiding changes in skin color (CRI 29.0) and time until itch improves (26.6) were most important to adults, followed by time until clear/almost clear skin (17.8). Application frequency (3.0) did not have a statistically significant impact on adults' choices. Adolescents were less concerned about changes in skin color than adults or caregivers; caregivers were less concerned about time until clear/almost clear skin than patients. Physicians should consider age-relevant aspects of preferences in treatment discussions with patients and caregivers.
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Affiliation(s)
- Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jacob P Thyssen
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marco Boeri
- RTI Health Solutions, Belfast, UK
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | | | | | - Amy Cha
- Pfizer Inc, New York, NY, USA
| | | | | | | | | | - Joshua Zeichner
- Department of Dermatology, Mount Sinai Hospital, New York, NY, USA
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Go N, Arsène S, Faddeenkov I, Galland T, Martis B S, Lefaudeux D, Wang Y, Etheve L, Jacob E, Monteiro C, Bosley J, Sansone C, Pasquali C, Lehr L, Kulesza A. A quantitative systems pharmacology workflow toward optimal design and biomarker stratification of atopic dermatitis clinical trials. J Allergy Clin Immunol 2024; 153:1330-1343. [PMID: 38369029 DOI: 10.1016/j.jaci.2023.12.031] [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: 05/23/2023] [Revised: 11/03/2023] [Accepted: 12/22/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The development of atopic dermatitis (AD) drugs is challenged by many disease phenotypes and trial design options, which are hard to explore experimentally. OBJECTIVE We aimed to optimize AD trial design using simulations. METHODS We constructed a quantitative systems pharmacology model of AD and standard of care (SoC) treatments and generated a phenotypically diverse virtual population whose parameter distribution was derived from known relationships between AD biomarkers and disease severity and calibrated using disease severity evolution under SoC regimens. RESULTS We applied this workflow to the immunomodulator OM-85, currently being investigated for its potential use in AD, and calibrated the investigational treatment model with the efficacy profile of an existing trial (thereby enriching it with plausible marker levels and dynamics). We assessed the sensitivity of trial outcomes to trial protocol and found that for this particular example the choice of end point is more important than the choice of dosing regimen and patient selection by model-based responder enrichment could increase the expected effect size. A global sensitivity analysis revealed that only a limited subset of baseline biomarkers is needed to predict the drug response of the full virtual population. CONCLUSIONS This AD quantitative systems pharmacology workflow built around knowledge of marker-severity relationships as well as SoC efficacy can be tailored to specific development cases to optimize several trial protocol parameters and biomarker stratification and therefore has promise to become a powerful model-informed AD drug development and personalized medicine tool.
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de Oliveira CSF, Tavaria FK. Therapeutic textiles: A promising approach for human skin dysbiosis? Exp Dermatol 2024; 33:e15081. [PMID: 38628046 DOI: 10.1111/exd.15081] [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: 10/09/2023] [Revised: 03/12/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
The close interaction between skin and clothing has become an attractive cornerstone for the development of therapeutic textiles able to alleviate skin disorders, namely those correlated to microbiota dysregulation. Skin microbiota imbalance is known in several skin diseases, including atopic dermatitis (AD), psoriasis, seborrheic dermatitis, rosacea, acne and hidradenitis suppurative (HS). Such microbiota dysregulation is usually correlated with inflammation, discomfort and pruritus. Although conventional treatments, that is, the administration of steroids and antibiotics, have shown some efficacy in treating and alleviating these symptoms, there are still disadvantages that need to be overcome. These include their long-term usage with side effects negatively impacting resident microbiota members, antibiotic resistance and the elevated rate of recurrence. Remarkably, therapeutic textiles as a non-pharmacological measure have emerged as a promising strategy to treat, alleviate the symptoms and control the severity of many skin diseases. This systematic review showcases for the first time the effects of therapeutic textiles on patients with skin dysbiosis, focusing on efficacy, safety, adverse effects and antimicrobial, antioxidant and anti-inflammatory properties. The main inclusion criteria were clinical trials performed in patients with skin dysbiosis who received treatment involving the use of therapeutic textiles. Although there are promising outcomes regarding clinical parameters, safety and adverse effects, there is still a lack of information about the impact of therapeutic textiles on the skin microbiota of such patients. Intensive investigation and corroboration with clinical trials are needed to strengthen, define and drive the real benefit and the ideal biomedical application of therapeutic textiles.
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Affiliation(s)
- Cláudia Suellen Ferro de Oliveira
- CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
| | - Freni Kekhasharú Tavaria
- CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
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Shehab N, Hossain J, Yousef E. Variation of asthma characteristics with atopic march, gastroesophageal reflux, and ENT pathologies. J Asthma 2023; 60:1661-1667. [PMID: 36755382 DOI: 10.1080/02770903.2023.2174030] [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: 10/26/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Asthma is a significant cause of morbidity and mortality in the pediatric population. Atopic dermatitis (AD) is often the first step in the atopic march leading to the development of asthma, allergic rhinitis, and food allergies in the future. OBJECTIVE This study aimed to evaluate the severity differences between asthmatic children with and without atopic march in addition to characteristics of asthmatic patients with GER and ear-nose-and-throat (ENT) pathologies. METHODS A total of 616 pediatric asthmatic patients were enrolled. The study subjects were divided into two groups. Group A included asthmatic children with a history of AD. Group B had asthmatic children without a history of AD. Multiple factors were studied, including sex, race/ethnicity, family history of atopy, asthma severity, allergic rhinitis, food allergies, smoke exposure, ear-nose-and-throat (ENT) pathologies, gastroesophageal reflux (GER), frequency of systemic steroid use, and hospital admission rates. RESULTS Our results revealed that patients with atopic march are at risk of developing a higher severity of asthma, resulting in increased morbidity. In contrast, asthmatic patients without atopic march had a milder asthma severity, less need for steroids, and fewer hospital admissions. A higher prevalence of ENT pathologies and/or GER existed among asthmatic children without atopic march. CONCLUSION Our findings suggest that patients with atopic march should be expected to exhibit a more severe phenotype of asthma with increased asthma morbidity. Asthmatic patients without atopic march had a milder asthma phenotype, less need for steroids, and fewer hospital admissions. A higher prevalence of ENT pathologies and/or GER existed among asthmatic children without atopic march.
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Affiliation(s)
- Norane Shehab
- Department of Pediatrics, UF Health Jacksonville, Jacksonville, FL, USA
| | - Jobayer Hossain
- Department of Applied Economics and Statistics, Nemours Children's Health Delaware, Wilmington, DE, USA
| | - Ejaz Yousef
- Department of Pediatric Allergy and Immunology, Nemours Children's Health Jacksonville, Jacksonville, FL, USA
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Burlou-Nagy C, Bănică F, Negrean RA, Jurca T, Vicaș LG, Marian E, Bácskay I, Kiss R, Fehér P, Vicaș SI, Miere (Groza) F, Memete AR, Pallag A. Determination of the Bioactive Compounds from Echinacea purpurea (L.) Moench Leaves Extracts in Correlation with the Antimicrobial Activity and the In Vitro Wound Healing Potential. Molecules 2023; 28:5711. [PMID: 37570681 PMCID: PMC10420800 DOI: 10.3390/molecules28155711] [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: 06/08/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed at the relationship between antioxidant capacity, antimicrobial activity, and in vitro evaluation of the wound healing effect of the extract obtained from Echinaceae purpureae folium (EPF). This study's objective was to assess the bioactive components (total phenol and flavonoid content) and antioxidant activity of EPF extracts using the DPPH test method. The antioxidant capacity and the quantities of the compounds with antioxidant capacity were evaluated by spectrophotometric methods. Antimicrobial activity has been investigated against various pathogenic microorganisms. The minimum inhibitory concentration was determined by the microdilution method. Additionally, our work used a scratch test to examine the in vitro wound healing effects of EPF extract on NHDF cells. Statistical analysis was used to quantify the rate of migration and proliferation of fibroblast cells within the wound. Microscope pictures of fibroblast cells exposed to various EPF extract dosages were processed to estimate the width of the wound, area of the wound, and cell density inside the wound. The study proved that there was a relationship between the antioxidant, antimicrobial, and wound healing ability of EPF extracts.
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Affiliation(s)
- Cristina Burlou-Nagy
- Doctoral School of Biomedical Sciences, University of Oradea, Universitatii Street, 1, 410087 Oradea, Romania;
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 Nicolae Jiga Street, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Florin Bănică
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 Nicolae Jiga Street, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Rodica Anamaria Negrean
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410068 Oradea, Romania; (R.A.N.); (F.M.)
| | - Tünde Jurca
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 Nicolae Jiga Street, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Laura Grațiela Vicaș
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 Nicolae Jiga Street, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Eleonora Marian
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 Nicolae Jiga Street, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei krt. 98, H-4032 Debrecen, Hungary; (I.B.); (P.F.)
| | - Rita Kiss
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, H-4032 Debrecen, Hungary;
| | - Pálma Fehér
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei krt. 98, H-4032 Debrecen, Hungary; (I.B.); (P.F.)
| | - Simona Ioana Vicaș
- Department of Food Engineering, Faculty of Environmental Protection, University of Oradea, No. 26 General Magheru Avenue, 410087 Oradea, Romania; (S.I.V.); (A.R.M.)
| | - Florina Miere (Groza)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410068 Oradea, Romania; (R.A.N.); (F.M.)
| | - Adriana Ramona Memete
- Department of Food Engineering, Faculty of Environmental Protection, University of Oradea, No. 26 General Magheru Avenue, 410087 Oradea, Romania; (S.I.V.); (A.R.M.)
| | - Annamaria Pallag
- Doctoral School of Biomedical Sciences, University of Oradea, Universitatii Street, 1, 410087 Oradea, Romania;
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 Nicolae Jiga Street, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
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Lugović-Mihić L, Meštrović-Štefekov J, Potočnjak I, Cindrić T, Ilić I, Lovrić I, Skalicki L, Bešlić I, Pondeljak N. Atopic Dermatitis: Disease Features, Therapeutic Options, and a Multidisciplinary Approach. Life (Basel) 2023; 13:1419. [PMID: 37374201 DOI: 10.3390/life13061419] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The latest findings regarding AD pathogenesis point to an impaired function of the epidermal barrier, changed immune response, colonization of the skin by microorganisms, and certain psychological factors among other causes/triggers. The inflammatory response of AD patients is mainly associated with the activation of T cells (Th2 cells predominate), dendritic cells, macrophages, keratinocytes, mast cells, and eosinophils. Therapy usually involves medical evaluations and adequate management including treatment of concomitant diseases (e.g., allergies and infections), patient education and nursing care, psychological support, and nutritional consultations, which are organized through specific programs and structured educational groups. Systemic AD therapy includes conventional systemic treatment (cyclosporine, methotrexate, azathioprine) and new, specific drugs, interleukin inhibitors (e.g., dupilumab) and JAK inhibitors (baricitinib, abrocitinib, upadacitinib, etc.). Since many AD patients are affected by various psychological factors and comorbidities, they should be assessed and managed through a multidisciplinary approach, involving different professions (psychologists, ear-nose-throat specialists, pulmonologists, allergologists, immunologists, nutritionists, pediatricians, gastroenterologists, psychiatrists (when necessary), and others). A multidisciplinary approach provides better coping strategies and improves control over the disease, patient adherence to therapy, and quality of life. It also has a positive influence on family quality of life while at the same time making more efficient use of dermatology healthcare resources, reducing the economic burden on both patients and society.
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Affiliation(s)
- Liborija Lugović-Mihić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Jelena Meštrović-Štefekov
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Tea Cindrić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Ivana Ilić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivan Lovrić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Lucija Skalicki
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Iva Bešlić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nives Pondeljak
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, General Hospital Sisak, 44000 Sisak, Croatia
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Hobi S, Cafarchia C, Romano V, Barrs VR. Malassezia: Zoonotic Implications, Parallels and Differences in Colonization and Disease in Humans and Animals. J Fungi (Basel) 2022; 8:jof8070708. [PMID: 35887463 PMCID: PMC9324274 DOI: 10.3390/jof8070708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/13/2022] Open
Abstract
Malassezia spp. are commensals of the skin, oral/sinonasal cavity, lower respiratory and gastrointestinal tract. Eighteen species have been recovered from humans, other mammals and birds. They can also be isolated from diverse environments, suggesting an evolutionary trajectory of adaption from an ecological niche in plants and soil to the mucocutaneous ecosystem of warm-blooded vertebrates. In humans, dogs and cats, Malassezia-associated dermatological conditions share some commonalities. Otomycosis is common in companion animals but is rare in humans. Systemic infections, which are increasingly reported in humans, have yet to be recognized in animals. Malassezia species have also been identified as pathogenetic contributors to some chronic human diseases. While Malassezia species are host-adapted, some species are zoophilic and can cause fungemia, with outbreaks in neonatal intensive care wards associated with temporary colonization of healthcare worker’s hands from contact with their pets. Although standardization is lacking, susceptibility testing is usually performed using a modified broth microdilution method. Antifungal susceptibility can vary depending on Malassezia species, body location, infection type, disease duration, presence of co-morbidities and immunosuppression. Antifungal resistance mechanisms include biofilm formation, mutations or overexpression of ERG11, overexpression of efflux pumps and gene rearrangements or overexpression in chromosome 4.
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Affiliation(s)
- Stefan Hobi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University, Tat Chee Avenue, Kowloon, Hong Kong, China
- Correspondence: (S.H.); (V.R.B.)
| | - Claudia Cafarchia
- Department of Veterinary Medicine, University of Bari, Str. prov. per Casamassima Km 3, Valenzano, (Bari), 70010, Italy; (C.C.); (V.R.)
| | - Valentina Romano
- Department of Veterinary Medicine, University of Bari, Str. prov. per Casamassima Km 3, Valenzano, (Bari), 70010, Italy; (C.C.); (V.R.)
| | - Vanessa R. Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University, Tat Chee Avenue, Kowloon, Hong Kong, China
- Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, China
- Correspondence: (S.H.); (V.R.B.)
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Burlou-Nagy C, Bănică F, Jurca T, Vicaș LG, Marian E, Muresan ME, Bácskay I, Kiss R, Fehér P, Pallag A. Echinacea purpurea (L.) Moench: Biological and Pharmacological Properties. A Review. PLANTS (BASEL, SWITZERLAND) 2022; 11:plants11091244. [PMID: 35567246 PMCID: PMC9102300 DOI: 10.3390/plants11091244] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 05/25/2023]
Abstract
Echinacea purpurea (L.) Moench (EP)is a perennial herbaceous flowering plant, commonly known as purple coneflower and it belongs to the Asteraceae family. The Echinacea genus is originally from North America, in the United States, and its species are widely distributed throughout. There are nine different species of Echinacea, but only three of them are used as medicinal plants with wide therapeutic uses: Echinacea purpurea (L.) Moench, Echinacea pallida (Nutt.) Nutt. and Echinacea angustifolia DC. Several significant groups of bioactive compounds with pharmacological activities have been isolated from Echinacea species. Numerous beneficial effects have been demonstrated about these compounds. The immunomodulatory effect was initially demonstrated, but over time other effects have also been highlighted. The present review gives a comprehensive summary of the chemical constituents, bioactive compounds, biological effects and therapeutical uses of purple coneflower. Research shows that such a well-known and recognized species needs to be further studied to obtain efficient products with a guarantee of the safety.
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Affiliation(s)
- Cristina Burlou-Nagy
- Doctoral School of Pharmaceutical Sciences, University of Oradea, 410087 Oradea, Romania;
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Florin Bănică
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Tünde Jurca
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Laura Grațiela Vicaș
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Eleonora Marian
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
| | - Mariana Eugenia Muresan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania;
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (I.B.); (P.F.)
| | - Rita Kiss
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Pálma Fehér
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary; (I.B.); (P.F.)
| | - Annamaria Pallag
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (F.B.); (T.J.); (L.G.V.); (E.M.)
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Kim S, Ly BK, Ha JH, Carson KA, Hawkins S, Kang S, Chien AL. A consistent skin care regimen leads to objective and subjective improvements in dry human skin: investigator-blinded randomized clinical trial. J DERMATOL TREAT 2022; 33:300-305. [PMID: 32239984 PMCID: PMC7529700 DOI: 10.1080/09546634.2020.1751037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dry, itchy skin can lower quality of life (QoL) and aggravate skin diseases. Moisturizing skin care products can have beneficial effects on dry skin. However, the role of a daily skin care routine is understudied. OBJECTIVE To understand how daily skin care with a mild cleanser and moisturizer impacts skin health and patients' QoL, in dry skin population. METHODS A randomized, investigator-blinded study of 52 participants with moderate to severe dry skin. The treatment group (n = 39) used mild cleanser and moisturizer twice daily for two weeks whereas the control group (n = 13) used mild cleanser without moisturizer. Total Clinical Score (TCS; erythema, scale and fissures), Visual Dryness Score (VDS) and subjective itch-related quality of life (ItchyQoL) were collected. RESULTS The treatment group showed significantly more improvement in TCS and VDS compared to the control group after two weeks. Among the three components of the ItchyQoL (symptoms, functioning, and emotions), symptom showed significantly greater improvement in the treatment compared to the control group. Over 80% of participants in the treatment group agreed that the regimen led to decrease in dryness/pruritus and improved skin texture. CONCLUSIONS A consistent skin care regimen should be an integral component of management of dry skin.
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Affiliation(s)
- Sooyoung Kim
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Baochau K. Ly
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Judy H. Ha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathryn A. Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna L. Chien
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
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Zhang F, Shi W, Liu H, Yu Y, Wang C, Wang Z, Sun L. Lack of association between CARD11 and atopic dermatitis in Chinese population. Indian J Dermatol 2022; 67:293-295. [PMID: 36386092 PMCID: PMC9644773 DOI: 10.4103/ijd.ijd_405_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Risk factors for current wheeze among school children (6–7 and 13–14 years old) in Khuzestan, Iran. PUBLIC HEALTH IN PRACTICE 2021; 2:100172. [PMID: 36101606 PMCID: PMC9461578 DOI: 10.1016/j.puhip.2021.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives In recent years, there has been a clear trend of increasing allergic diseases especially in children, and developing countries are no exception. Thepresentstudy sought to determine the risk factors associated with wheezing among school children aged 6–7 and 13–14 years living in Khuzestan Province, Iran. Study design Cross-sectional. Methods Data for this cross-sectional study is the history of wheeze in the last 12 months. The participants included 6-7- and 13-14-year-old girls and boys studying in urban schools in Khuzestan Province in 2019. We collected the data using the multi stage sampling technique as suggested in the International Study of Asthma and Allergies in Childhood (ISAAC). The research reviewed the literature and consulted experts to collect the risk factors for demographic and clinical information, environmental exposure and lifestyle. Results Eight thousand questionnaires were handed out to both age groups, of which 7344 were completed. Two hundred ninety-nine (4.1 %) of the participants had current wheeze. Three-point four percent (124 individuals) in the 6–7 year age group and 4.8 % in the 13–14-year-old age group had current wheezing. The results of the logistic regression model suggest that the most significant risk factors associated with the chance of developing current wheeze in the both age groups are: being male (OR: 1.46, 95 % CI: 1.12–1.88), being from employed mother families (OR: 1.50, 95 %, CI:1.05–2.08), property ownership (OR:1.36, 95 %, CI:1.04–1.79) bugs in the property (OR: 1.29, 95 %, CI:0.99–1.70) mold in the property (OR: 1.75, 95 %, CI:1.12–2.76), pet(s) in the student's bedroom (OR: 1.75, 95 %, CI: 0.97–3.14), a family history of asthma and allergic diseases (OR: 2.20, 95 %, CI: 1.69–2.87), tobacco smoke exposures in the property (OR: 1.43, 95 %, CI:1.04–1.96), having allergic rhinitis (OR: 7.86, 95 % CI: 5.89–10.50) and eczema (OR: 3.85, 95 % CI: 2.10–7.08). Conclusions Families are suggested to adopt strategies to reduce exposure to outdoor air pollutants and contain indoor allergens. More studies are necessary to further explore the effects of modifying and changing these risk factors. 3.4 % in the 6–7 year age group and 4.8 % in the 13–14 year age group had current wheezing. In both age groups, current wheeze is more common in boys than girls. Mold in the home, pet in the bedroom and tobacco smoke exposures are the most important risk factors for current wheeze.
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Ervin C, Crawford R, Evans E, Feldman SR, Zeichner J, Zielinski M, Cappelleri JC, DiBonaventura M, Takiya L, Myers DE. Patient and Caregiver Preferences on Treatment Attributes for Atopic Dermatitis. J DERMATOL TREAT 2021; 33:2225-2233. [PMID: 34264145 DOI: 10.1080/09546634.2021.1940810] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The expanding number of potential treatment options for atopic dermatitis (AD) highlights the need to better understand the treatment preferences of individuals with AD. OBJECTIVE This study identified attributes that most greatly influenced treatment preferences of adults/adolescents/caregivers of children with mild/moderate/severe AD. METHODS Adults (≥18 years), adolescents (12-17 years), and caregivers of children (2-11 years) with mild, moderate, or severe AD in the United States (US) and United Kingdom (UK) participated in semistructured interviews. Thematic analysis was used to identify and generate themes across the interview results describing the treatment attributes of greatest importance to participants. RESULTS Qualitative interviews were conducted with 35 adults, 35 caregivers, and 33 adolescent participants across both countries (n = 103; US =51; UK =52) and all severity groups (mild =43; moderate =47; severe =13). The most important treatment attributes included efficacy (96.1%; speed and duration of symptom relief), mode of administration (66.0%; route of administration, frequency, and convenience), and side effects (55.3%, short-term, long-term, and general). CONCLUSION Efficacy, mode of administration, and side effects were the most important attributes that influenced AD treatment preferences for patients and caregivers across different countries, ages, and disease severity. These results may assist patients/caregivers/clinicians in shared decision-making discussions to improve treatment adherence and outcomes.
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Affiliation(s)
- Claire Ervin
- RTI Health Solutions, Research Triangle Park, NC, United States
| | | | - Emily Evans
- RTI Health Solutions, Research Triangle Park, NC, United States
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13
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Guidelines for Diagnosis and Treatment of Atopic Dermatitis in China (2020)#. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2021. [DOI: 10.1097/jd9.0000000000000143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Guglielmo A, Sechi A, Patrizi A, Gurioli C, Neri I. Head and neck dermatitis, a subtype of atopic dermatitis induced by Malassezia spp: Clinical aspects and treatment outcomes in adolescent and adult patients. Pediatr Dermatol 2021; 38:109-114. [PMID: 33155738 DOI: 10.1111/pde.14437] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Head and neck dermatitis (HND) is a clinical variant of atopic dermatitis (AD), presenting in adolescence or adulthood and characterized by involvement of the head, neck, and superior part of the trunk. The role of Malassezia spp has been advocated in the pathogenesis of HND, and antifungal agents represent the treatment of choice. METHODS A retrospective single-center study was performed to define the clinical features and treatment response of HND among adolescent and adult patients. RESULTS Thirty-one patients were identified, 17 with "adolescent-onset" and 14 with "adult-onset" HND. Adolescent-onset HND positively correlated with a past history of AD and presented with exclusive head and neck involvement (P < .05). Adult-onset HND was associated with concomitant widespread atopic eczema, involving the flexural areas of the upper and lower limbs, trunk, nipples, or hands (P < .05). A positive response to itraconazole in combination with topical treatments was observed in both groups. CONCLUSIONS This study delineates two HND clinical phenotypes: adolescent vs adult onset. Different characteristics were observed in terms of relationship to AD and eczema localization. A history of AD in childhood and presentation with exclusive involvement of head and neck regions was observed predominantly in the adolescent-onset form, while adult-onset HND often occurred in association with diffuse dermatitis and a past history of AD was less frequent than in the adolescent group. The study is limited by the single-center retrospective nature, which may lead to diagnostic and selection biases, and the small cohort of patients.
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Affiliation(s)
- Alba Guglielmo
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Andrea Sechi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlotta Gurioli
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Xu MN, Li L, Pan W, Dai SQ, Wang Q, Wang ML, Zeng K, Huang XW, Eyerich K. Transferability of suggested molecular classifiers for psoriasis and eczema to the Chinese population. J Eur Acad Dermatol Venereol 2020; 35:e189-e192. [PMID: 32869356 DOI: 10.1111/jdv.16898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- M-N Xu
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - L Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - W Pan
- Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - S-Q Dai
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Q Wang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - M-L Wang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - K Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - X-W Huang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - K Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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Sun C, Zhang J, Huang C, Liu W, Zhang Y, Li B, Zhao Z, Deng Q, Zhang X, Qian H, Zou Z, Yang X, Sun Y, Sundell J. High prevalence of eczema among preschool children related to home renovation in China: A multi-city-based cross-sectional study. INDOOR AIR 2019; 29:748-760. [PMID: 31295372 DOI: 10.1111/ina.12586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 06/09/2023]
Abstract
We surveyed 40 010 three- to six-year-old children in seven Chinese cities (Beijing, Taiyuan, Urumqi, Shanghai, Nanjing, Changsha, and Chongqing) during 2010-2012 so as to investigate possible links between home renovation and childhood eczema. Their parents responded to questions on home renovation and childhood eczema. Multivariate and two-level (city-child) logistic regression analyses yielding odds ratios with 95% confidence intervals were performed. Sensitivity analyses stratifying data for region, climate, and income level were also performed. The prevalences of childhood eczema in children with different floor and wall covering materials were significantly different and were significantly higher with home renovation during early lifetime. Exposure to synthetic materials significantly increased the risk of childhood eczema by 20%-25%. The risks (AOR, 95% CI) of current eczema among children in families with solid wood flooring and oil paint wall covering were 1.25 (1.04-1.49) and 1.35 (1.14-1.60), respectively. Home renovation during pregnancy was related to children's lifetime and current eczema.
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Affiliation(s)
- Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Jialing Zhang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Qihong Deng
- School of Public Health, Central South University, Changsha, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Zhijun Zou
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xu Yang
- College of Life Sciences, Central China Normal University, Wuhan, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
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Cowdell F. Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK. BMJ Open 2019; 9:e025220. [PMID: 31350238 PMCID: PMC6661925 DOI: 10.1136/bmjopen-2018-025220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 05/24/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To explore how atopic eczema specific mindlines are developed by primary care practitioners. DESIGN Ethnographic study. SETTING One large, urban general practice in central England. PARTICIPANTS In observation, all practitioners and support staff in the practice and in interviews a diverse group of practitioners (n=16). RESULTS Observation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Three themes were identified: beliefs about eczema, eczema knowledge and approaches to self-management. Eczema mindlines are set against a backdrop of it being a low priority and not managed as a long-term condition. Practitioners believed that eczema is simple to manage with little change in treatments available and prescribing limited by local formularies. Practice is largely based on tacit knowledge and experience. Self-management is expected but not often explicitly facilitated. Clinical decisions are made from knowledge accumulated over time. Societal and technological developments have altered the way in which practitioner mindlines are developed; in eczema, for most, they are relatively static. CONCLUSIONS The outstanding challenge is to find novel, profession and context-specific, simple, pragmatic strategies to revise or modify practitioner mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information thus potentially improve quality of eczema care.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
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Jeong MK, Kim YE, Kim A, Jung J, Son MJ. The herbal drug, Bu-Zhong-Yi-Qi-Tang, for the treatment of atopic dermatitis: Protocol for a systematic review. Medicine (Baltimore) 2019; 98:e13938. [PMID: 30608425 PMCID: PMC6344144 DOI: 10.1097/md.0000000000013938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Bu-Zhong-Yi-Qi-Tang (BZYQT) is an herbal drug that is widely used to treat various diseases, including gastrointestinal diseases, allergic rhinitis, and atopic dermatitis (AD) in East Asian countries. BZYQT has been shown to have anti-allergic, anti-inflammatory, and immunoregulatory properties in experimental studies, and there is substantial clinical evidence of its effect on AD. This review will systematically assess the evidence of BZYQT for the treatment of AD. METHODS/DESIGN Eleven databases will be searched from their inception without language restriction. Randomized controlled trials that examined BZYQT or modified BZYQT for AD will be included. The selection of the studies, data abstraction, and validations will be performed independently by 2 researchers. The methodological qualities of the randomized controlled trials will be assessed using the Cochrane Collaboration tool for assessing the risk of bias. ETHICS AND DISSEMINATION This systematic review will be published in a peer-reviewed journal and will also be disseminated electronically or in print. It will be useful to inform and guide healthcare practitioners. TRIAL REGISTER NUMBER CRD42018105173.
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Affiliation(s)
| | - Young-Eun Kim
- Future Medicine Division, Korea Institute of Oriental Medicine, Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Anna Kim
- Future Medicine Division, Korea Institute of Oriental Medicine, Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea
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Höfer D. A Real-Life Based Evaluation of the Effectiveness of Antibacterial Fabrics in Treating Atopic Dermatitis. Dermatol Res Pract 2018; 2018:7043438. [PMID: 30581460 PMCID: PMC6276436 DOI: 10.1155/2018/7043438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Antibacterial clothes are classified as a complementary treatment in line with antisepsis, although meta-studies are unable to find significant improvements of eczemas. METHODS The antibacterial effectiveness of conventional AD clothes was compared across each other by (i) standard suspension tests for the appraisal of antibacterial products and (ii) a real-life setup of affected AD skin using S. aureus colonised artificial skin, to assess if functional clothes are effective under practical wear conditions. Additionally, the interaction of the fibre types with a moisturising cream was evaluated during a real wearing situation and after domestic laundry. RESULTS In the real-life setup simulating dry skin microenvironment, all samples failed to reduce S. aureus. Silver and zinc-fabrics showed a slight activity only under unrealistic moist conditions. When using standard suspension tests, samples differed considerably in their antibacterial effectiveness, where silver and zinc endowed fibres outperformed AEGIS endowed silk fabrics. Garments absorbed the cream dependent on the particular fibre types. Furthermore, domestic laundry was unable to completely remove the cream. CONCLUSION Considerable differences in the antibacterial effectiveness of conventional AD clothes were revealed. Under practical (dry) wear conditions, garments were unable to modify skin colonization with S. aureus, although effectiveness can be triggered by wetting the garments. Remnants of moisturising cream remain on the fibres after laundry.
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Affiliation(s)
- Dirk Höfer
- Hohenstein Institute for Textile Innovation, Schlosssteige 1, 74357 Bönnigheim, Germany
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20
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Curry ZA, Johnson MC, Unrue EL, Feldman SR. Caregiver willingness to treat atopic dermatitis is not much improved by anchoring. J DERMATOL TREAT 2018; 30:471-474. [PMID: 30277424 DOI: 10.1080/09546634.2018.1530442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Caregivers are often apprehensive about treating their child's atopic dermatitis with a topical corticosteroid. Typical concerns include anxiety regarding side effects and the perceived burden of treatment. The perception of burden may be modifiable through anchoring. Objective: To evaluate caregivers willingness to treat their child's atopic dermatitis with a topical corticosteroid once-daily if initially anchored to the idea of a four-times-daily treatment regimen. Methods: A prospective survey study was performed in 100 caregivers of children with atopic dermatitis. Scores were treated as ordinal data and evaluated using the Mann-Whitney U test and chi-squared test. Results: Of the 100 recruited participants, 97 were eligible and returned completed surveys. Subjects anchored to a four-times-daily treatment regimen were more willing to treat their child's atopic dermatitis once-daily (mean, 8.7) than those not anchored (mean, 7.9), however the difference between these groups was not statistically significant (p = .173). Conclusion: Caregivers reported being generally quite willing to apply topical corticosteroids once-daily. Anchoring was associated with a slightly higher score, though it was not statistically significant. For most patients with atopic dermatitis, anchoring may not be helpful, but for patients whose main barrier is perceived burdensomeness of treatment, anchoring may be of some benefit.
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Affiliation(s)
- Zachary A Curry
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Matthew C Johnson
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Emily L Unrue
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Steven R Feldman
- a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine , Winston-Salem , NC , USA.,b Department of Public Health Sciences, Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Pathology, Wake Forest School of Medicine , Winston-Salem , NC , USA
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Pigatto PD, Diani M. Beneficial Effects of Antioxidant Furfuryl Palmitate in Non-pharmacologic Treatments (Prescription Emollient Devices, PEDs) for Atopic Dermatitis and Related Skin Disorders. Dermatol Ther (Heidelb) 2018; 8:339-347. [PMID: 29790104 PMCID: PMC6109026 DOI: 10.1007/s13555-018-0239-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a common chronic inflammatory skin disease; it requires long-term treatments focused on symptomatic relief. Current first-line treatments include moisturizers and topical corticosteroids. Recently, topical antioxidants have been added to moisturizer formulations to alleviate mild-to-moderate AD. The aim of this review was to evaluate the efficacy and tolerability of furfuryl palmitate, a new antioxidant molecule, and furfuryl derivatives. Methods A PubMed/Google Scholar search was conducted using the term “furfuryl palmitate” (and its derivatives, including AR-GG27®) combined with “skin,” “atopic dermatitis,” and “atopic eczema.” Existing trials including adult and pediatric patients with AD and related skin disorders were evaluated. The treatment indication(s), number of subjects, treatment protocols, results, and side effects were recorded. Results Effective treatments with furfuryl palmitate and furfuryl derivatives have been reported for the following conditions: atopic, seborrheic, irritative, and allergic contact dermatitis, eczema, xerosis, and cutaneous inflammatory pathologies. All the products tested showed a good tolerability profile. Conclusion Studies performed up to now showed that furfuryl derivatives can efficaciously contrast signs and symptoms of mild-to-moderate AD, erythema, and widespread diffuse cutaneous pathologies in both adult and pediatric patients, representing a real alternative to steroids and a valid aid in the treatment of skin disorders, with no side effects and without requiring precautions in use. Funding Relife S.r.l. - Menarini Group. Plain Language Summary Plain language summary available for this article.
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Affiliation(s)
- Paolo Daniele Pigatto
- Dipartimento di Scienze biomediche, chirurgiche e odontoiatriche, Clinica Dermatologica, Università degli Studi di Milano, Milan, Italy.
| | - Marco Diani
- Dipartimento di Scienze biomediche, chirurgiche e odontoiatriche, Clinica Dermatologica, Università degli Studi di Milano, Milan, Italy
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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.
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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
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Oláh A, Szabó-Papp J, Soeberdt M, Knie U, Dähnhardt-Pfeiffer S, Abels C, Bíró T. Echinacea purpurea-derived alkylamides exhibit potent anti-inflammatory effects and alleviate clinical symptoms of atopic eczema. J Dermatol Sci 2017; 88:67-77. [PMID: 28610718 DOI: 10.1016/j.jdermsci.2017.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Atopic eczema (AE) is a chronic inflammatory and pruritic skin disease. There is still an unmet need for topical anti-inflammatory and anti-pruritic substances exhibiting an excellent safety profile. The endocannabinoid system is known to regulate various aspects of cutaneous barrier and immune functions, thus targeting it may be a valid approach for alleviating the symptoms of AE. OBJECTIVE To assess the putative efficacy of Echinacea purpurea-derived alkylamides (Ec. extract) activating cannabinoid (CB)-2 receptors in exerting anti-inflammatory effects and alleviating symptoms of AE. METHODS In vitro anti-inflammatory efficiency was investigated by monitoring the effects of Ec. extract on poly-(I:C)-induced pro-inflammatory cytokine expression (Q-PCR) and release (ELISA) of HaCaT keratinocytes. Irritancy and sensitization potential (assessed by Human Repeat Insult Patch Test; Clinical trial 1); clinical efficiency in alleviating symptoms of AE (Clinical trial 2) as well as effects on human skin structure and lipid content (Clinical trial 3 followed by transmission electron microscopy and HPTLC) were investigated in randomized double blind clinical trials. RESULTS Ec. extract significantly reduced mRNA expression as well as release of poly-(I:C)-induced pro-inflammatory cytokines (IL-6 and IL-8) in keratinocytes. Thus, not surprisingly, the well-tolerated (Clinical trial 1) Ec. extract-based cream reduced local SCORAD statistically significantly, not only compared to baseline, but also compared to the comparator (Clinical trial 2). Of great importance, besides the in vitro anti-inflammatory effects, administration of the Ec. extract-based cream also resulted in significantly higher levels of overall epidermal lipids, ceramide EOS (ω-esterified fatty acid+sphingosine sphingoid base), and cholesterol at Day 15 compared to baseline as well as significantly greater numbers of intercellular lipid lamellae in the intercellular space (Clinical trial 3). CONCLUSION The investigated Ec. extract shows great potential in alleviating cutaneous symptoms of AE, and by exerting remarkable anti-inflammatory actions and restoring the epidermal lipid barrier, it will be very likely a well-tolerated, powerful novel ingredient for the adjuvant therapy of AE.
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Affiliation(s)
- Attila Oláh
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Szabó-Papp
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Michael Soeberdt
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Sudbrackstrasse 56, 33611 Bielefeld, Germany
| | - Ulrich Knie
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Sudbrackstrasse 56, 33611 Bielefeld, Germany
| | | | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Sudbrackstrasse 56, 33611 Bielefeld, Germany
| | - Tamás Bíró
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Meng SS, Gao R, Yan BD, Ren J, Wu F, Chen P, Zhang J, Wang LF, Xiao YM, Liu J. Maternal allergic disease history affects childhood allergy development through impairment of neonatal regulatory T-cells. Respir Res 2016; 17:114. [PMID: 27646403 PMCID: PMC5028930 DOI: 10.1186/s12931-016-0430-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Maternal allergic disease history and impaired regulatory T-cells (Tregs) are critical risk factors for allergy development in children. However, the mechanisms that underlie these risk factors remain poorly defined. Therefore, the aim of this study was to assess whether maternal allergies affect the Tregs of offspring and lead to allergy development in childhood. METHODS A total of 332 mothers of healthy newborns (234 from no allergic mothers, 98 from allergic mothers) were recruited to this study. Detailed questionnaires were administered yearly to determine the allergy status of the mothers and the newborns from birth to 3 years of age. Cord blood samples obtained at the time of birth were analysed for Treg counts, as well Treg activity, based on their response to Toll-like receptor (TLR) stimuli such as lipid A (LPA) and peptidoglycans (PPG). Surface markers, associated genes, suppressive capacity, and cytokine levels of Tregs were also measured. Possible correlations between Treg activity and maternal or neonate allergies were assessed. In addition, environmental microbial content and other known risk factors for allergies were measured. RESULTS Cord blood mononuclear cells (CBMCs) from offspring with allergic mothers showed fewer CD4(+)CD25(+)FOXP3(+) T cells, lower expression levels of associated genes, and reduced cytokine production of interleukin (IL)-10 and interferon-γ (P < 0.05), especially via the PPG-TLR2 pathway. Suppression of effector T cells by Tregs from children of mothers with allergies was impaired, especially IL-13 production by Type 2 T helper (Th2) cells (P = 0.026). Children who developed allergies in the first 3 years of life had lower numbers of CD4(+)CD25(+)FOXP3(+) T cells and reduced FOXP3 expression and IL-10 production as newborns (P < 0.05). Maternal allergic background was identified as a risk factor for allergy development in the children (Odds ratio (OR) = 2.46, 95 % CI = 1.05-5.79); while declining Treg numbers, IL-10 production, and FOXP3 expression in neonates (PPG and LPA stimulated) were identified as independent risk factors for allergic diseases in offspring at 3 years of age after adjusting for maternal allergic history and environmental factors (P < 0.05). CONCLUSION Maternal allergy correlated with impaired Tregs in neonates, and this could enhance the susceptibility of offspring to allergic diseases in early childhood due to an imbalance of Th1 and Th2 cells.
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Affiliation(s)
- Shan-shan Meng
- Department of Respiratory Medicine, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, China
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Rong Gao
- Department of Respiratory Medicine, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, China
| | - Bing-di Yan
- Department of Respiratory Medicine, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, China
| | - Jin Ren
- Department of Respiratory Medicine, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, China
| | - Fei Wu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Peng Chen
- Department of Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Jie Zhang
- Department of Respiratory Medicine, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, China
| | - Li-fang Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Yuan-ming Xiao
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Jing Liu
- Department of Respiratory Medicine, The Second Hospital of Jilin University, No.218, Ziqiang Street, Nanguan District, Changchun, China
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Gu SX, Zhang AL, Coyle ME, Chen D, Xue CC. Chinese herbal medicine for atopic eczema: an overview of clinical evidence. J DERMATOL TREAT 2016; 28:246-250. [DOI: 10.1080/09546634.2016.1214673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Safety and Activity of UR-1505 in Atopic Dermatitis: A Randomized, Double-blind Phase II Exploratory Trial. Clin Ther 2015; 37:1955-65. [PMID: 26163200 DOI: 10.1016/j.clinthera.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/15/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE UR-1505 is a new small molecule with immune modulator properties intended for the topical treatment of inflammatory skin diseases that has shown anti-inflammatory effects in models of skin inflammation. We compared the activity of UR-1505 ointment against its vehicle in the treatment of atopic dermatitis. Secondary objectives included exploring dose response, safety, and local tolerability of UR-1505. METHODS Patients with AD lesions on 2 symmetrical topographic areas (arms, leg, or trunk) were included in this unicenter randomized, double-blind, within-patient, controlled Phase II exploratory trial and received simultaneously 2 different treatments (0.5%, 1%, or 2% UR-1505 and vehicle or 0.1% tacrolimus ointment) once daily during 28 days. The primary efficacy end point was the change from baseline in the Investigator Global Assessment score at Day 28. Secondary end points were percentage of area clearance, local Eczema Area Severity Index (local EASI), and local tolerability. A linear mixed model was used, fitting treatment, body side, and group (treatment at the contralateral side) as fixed factors and the patient as a random effect. FINDINGS Twenty-eight patients were randomized and 25 patients were included in the per protocol analysis, with 50 evaluable lesions (n = 13 for vehicle, n = 8 for UR-1505 0.5%, n = 9 for 1% UR-1505, n=8 for 2% UR-1505, and n=12 for tacrolimus). The mean Investigator Global Assessment score change from baseline at Day 28 was -1.7 for vehicle, -1.0, -1.2, and -1.5 for 0.5%, 1%, and 2% UR-1505, respectively, and -2.6% for tacrolimus (P = 0.002). No serious nor causal adverse reactions were reported in this study, but patients reported numerous local symptoms after product applications, especially itching, tingling, tightness, and heat/burning sensations at frequencies that were similar for vehicle, 1% UR-1505, and 2% UR-1505; more frequent with 0.5% UR-1505; and lowest for tacrolimus. IMPLICATIONS This study found that UR-1505 may not be a suitable option for the treatment of atopic dermatitis due to its lack of clinically relevant effect compared with its vehicle and 0.1% tacrolimus ointment.
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Lin RJ, Qiu LH, Guan RZ, Hu SJ, Liu YY, Wang GJ. Protective effect of probiotics in the treatment of infantile eczema. Exp Ther Med 2015; 9:1593-1596. [PMID: 26136864 DOI: 10.3892/etm.2015.2299] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/18/2014] [Indexed: 02/04/2023] Open
Abstract
The aim of the present study was to provide evidence for the application of probiotics in the prevention and treatment of infantile eczema by exploring changes in the intestinal Bifidobacteria levels and the Scoring Atopic Dermatitis (SCORAD) index prior and subsequent to treatment with probiotics in infants with eczema. A total of 40 infants with eczema were randomly divided into treatment and control groups. Prior and subsequent to the treatment, the SCORAD index was evaluated and the content of Bifidobacterium bifidum in the stool of each infant in the two groups was quantified using 16S rRNA/DNA quantitative polymerase chain reaction analysis. After four weeks of treatment with B. bifidum triple viable capsules, the levels of B. bifidum increased sharply (P<0.05) and the SCORAD index was notably reduced (P<0.05) as compared with the values prior to treatment. By contrast, neither the content of B. bifidum nor the SCORAD index changed significantly in the control group after four weeks (P>0.05). Following treatment, the levels of B. bifidum in the stools of the treatment group were significantly higher than those in the stools of the control group (P<0.05), and the SCORAD index was significantly lower than that of the control group (P<0.05). In conclusion, probiotic supplementation has a positive effect on the prevention and treatment of infantile eczema.
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Affiliation(s)
- Rong-Jun Lin
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266071, P.R. China
| | - Li-Hua Qiu
- Department of Pediatrics, The Maternal-Child Healthcare Center of Qingdao, Qingdao, Shandong 266035, P.R. China
| | - Ren-Zheng Guan
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266071, P.R. China
| | - Su-Juan Hu
- Department of Pediatrics, The Maternal-Child Healthcare Center of Qingdao, Qingdao, Shandong 266035, P.R. China
| | - Ying-Ying Liu
- Department of Pediatrics, The Maternal-Child Healthcare Center of Qingdao, Qingdao, Shandong 266035, P.R. China
| | - Guang-Jun Wang
- Department of Pediatrics, Shandong Traffic hospital, Jinan, Shandong 250031, P.R. China
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Hua TC, Hwang CY, Chen YJ, Chu SY, Chen CC, Lee DD, Chang YT, Wang WJ, Liu HN. The natural course of early-onset atopic dermatitis in Taiwan: a population-based cohort study. Br J Dermatol 2015; 170:130-5. [PMID: 23980909 DOI: 10.1111/bjd.12603] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) often manifests in early childhood and has variable disease course among individual patients. Previous studies regarding the natural course of AD have usually been of small sample size and were not based on nationwide populations. OBJECTIVES We aimed to find out the disease duration and remission rate of children with early-onset AD (onset in the first 2 years of life) in Taiwan, and to determine whether the presence of allergic rhinitis (AR) or asthma affects the disease course. METHODS The patients with early-onset AD in a nationally representative cohort were selected using the National Health Insurance Research Database of Taiwan and were followed from birth to 10 years of age. Kaplan-Meier survival analysis was carried out to analyse the disease duration and remission of AD. Between-group analysis using the log-rank test was carried out to analyse the influence of risk factors on the disease course. RESULTS Of the 1404 children with early-onset AD, 19.4% had disease duration < 1 year and 48.7% had disease duration < 4 years. During the follow-up, 69.8% of the patients went into remission. Sex, onset age, presence of AR, presence of asthma and presence of respiratory atopy (either AR or asthma) did not show statistically significant influence on disease course. CONCLUSIONS Children in Taiwan with early-onset AD had disease of variable natural course, and the median disease duration was 4.2 years. About 70% of the patients went into remission eventually. The presence of AR or asthma did not affect the disease course of AD.
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Affiliation(s)
- T-C Hua
- Department of Dermatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 11217, Taiwan; Department of Dermatology, National Yang-Ming University, No. 155, Sec.2, Linong Street, Taipei 112, Taiwan
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Akcay A, Tamay Z, Ergin A, Guler N. Prevalence and risk factors of atopic eczema in Turkish adolescents. Pediatr Dermatol 2014; 31:319-25. [PMID: 24475933 DOI: 10.1111/pde.12244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atopic eczema (AE) is the most common childhood inflammatory skin condition. The aim of this study was to evaluate the prevalence of AE and its relation to various risk factors. In a cross-sectional study, 9,991 children ages 13 to 14 years in 61 primary schools in 32 districts of Istanbul were evaluated. The prevalence of AE and associated symptoms was assessed using the International Study of Asthma and Allergies in Childhood protocol. The relationship between risk factors and AE was evaluated using multivariate logistic regression analysis. Ten thousand nine hundred eighty-four questionnaires were distributed to 13- and 14-year-old children in 61 schools in 32 districts of Istanbul, 9,991 of which were suitable for analysis, for an overall response rate of 91.7%. There were 4,746 boys (47.9%) and 5,166 girls (52.1%) (M/F ratio 0.920). The rates of itchy rash ever, 12-month itchy rash, and doctor-diagnosed AE ever were 18.2%, 12.0%, and 2.8%, respectively. The difference between rates for itchy rash ever, 12-month itchy rash and doctor-diagnosed AE was high (12.8-31.3, 5.8-24.8, and 0-17.2, respectively) between the districts of Istanbul. Female sex, AE family history, watching television more than 5 hours a day, region of the district, and tonsillectomy history were found to be significantly associated with doctor-diagnosed AE at p < 0.05 in multivariate analysis. This study found a low prevalence of doctor-diagnosed AE and related symptoms in Istanbul. Several risk factors were found to be associated with doctor-diagnosed AE.
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Affiliation(s)
- Ahmet Akcay
- Division of Pediatric Allergy, Department of Pediatrics, Liv Hospital, Istanbul, Turkey
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Akcay A, Tamay Z, Ones U, Guler N. What do child daycare center teachers know about atopic dermatitis? Pediatr Dermatol 2014; 31:54-8. [PMID: 23937285 DOI: 10.1111/pde.12139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atopic dermatitis (AD) is the most common childhood inflammatory skin disorder. The purpose of this study was to elucidate the knowledge level of daycare center teachers about AD and related factors. Study subjects were 297 teachers (287 female, 10 male) from 20 randomly selected daycare centers in Istanbul. The knowledge level of teachers was assessed using a questionnaire with 21 questions about AD. The teachers were asked nine additional questions about demographic and other characteristics of the child care centers and about themselves. The mean age of the teachers was 26.4 ± 8.1 years (range 20-53 yrs). The mean score for the 21 questions was 71.4 ± 12.1 (68%) from a maximum of 105 points. The response rate of teachers rate for each question ranged from 54% to 90%. The completely true response rate for each question ranged from 3.0% to 66.7%. The knowledge level of the teachers was related to the number of children in the daycare center, but not to sex, age, education level, family history of atopy, teacher's monthly salary, location, or whether the daycare center was public or private. Although teachers in daycare centers have some knowledge about AD, widespread educational programs for teachers about AD may help to improve the understanding of the disease and the quality of life of affected children in daycare centers.
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Affiliation(s)
- Ahmet Akcay
- Division of Pediatric Allergy, Department of Pediatrics, Liv Hospital, Istanbul, Turkey
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Lopes C, Silva D, Delgado L, Correia O, Moreira A. Functional textiles for atopic dermatitis: a systematic review and meta-analysis. Pediatr Allergy Immunol 2013; 24:603-13. [PMID: 23980847 DOI: 10.1111/pai.12111] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 12/21/2022]
Abstract
Atopic dermatitis (AD) is a relapsing inflammatory skin disease with a considerable social and economic burden. Functional textiles may have antimicrobial and antipruritic properties and have been used as complementary treatment in AD. We aimed to assess their effectiveness and safety in this setting. We carried out a systematic review of three large biomedical databases. GRADE approach was used to rate the levels of evidence and grade of recommendation. Meta-analyses of comparable studies were carried out. Thirteen studies (eight randomized controlled trials and five observational studies) met the eligibility criteria. Interventions were limited to silk (six studies), silver-coated cotton (five studies), borage oil, and ethylene vinyl alcohol (EVOH) fiber (one study each). Silver textiles were associated with improvement in SCORAD (2 of 4), fewer symptoms, a lower need for rescue medication (1 of 2), no difference in quality of life, decreased Staphyloccosus aureus colonization (2 of 3), and improvement of trans-epidermal water loss (1 of 2), with no safety concerns. Silk textile use was associated with improvement in SCORAD and symptoms (2 of 4), with no differences in quality of life or need for rescue medication. With borage oil use only skin erythema showed improvement, and with EVOH fiber, an improvement in eczema severity was reported. Recommendation for the use of functional textiles in AD treatment is weak, supported by low quality of evidence regarding effectiveness in AD symptoms and severity, with no evidence of hazardous consequences with their use. More studies with better methodology and longer follow-up are needed.
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Affiliation(s)
- Cristina Lopes
- Immunology Department, Faculty of Medicine, University of Porto, Porto, Portugal.
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Kypriotou M, Boéchat C, Huber M, Hohl D. Spontaneous atopic dermatitis-like symptoms in a/a ma ft/ma ft/J flaky tail mice appear early after birth. PLoS One 2013; 8:e67869. [PMID: 23844115 PMCID: PMC3700905 DOI: 10.1371/journal.pone.0067869] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/21/2013] [Indexed: 01/27/2023] Open
Abstract
Loss-of-function mutations in human profilaggrin gene have been identified as the cause of ichthyosis vulgaris (IV), and as a major predisposition factor for atopic dermatitis (AD). Similarly, flaky tail (a/a ma ft/ma ft/J) mice were described as a model for IV, and shown to be predisposed to eczema. The aim of this study was to correlate the flaky tail mouse phenotype with human IV and AD, in order to dissect early molecular events leading to atopic dermatitis in mice and men, suffering from filaggrin deficiency. Thus, 5-days old flaky tail pups were analyzed histologically, expression of cytokines was measured in skin and signaling pathways were investigated by protein analysis. Human biopsies of IV and AD patients were analyzed histologically and by real time PCR assays. Our data show acanthosis and hyperproliferation in flaky tail epidermis, associated with increased IL1β and thymic stromal lymphopoietin (TSLP) expression, and Th2-polarization. Consequently, NFκB and Stat pathways were activated, and IL6 mRNA levels were increased. Further, quantitative analysis of late epidermal differentiation markers revealed increased Small proline-rich protein 2A (Sprr2a) synthesis. Th2-polarization and Sprr2a increase may result from high TSLP expression, as shown after analysis of 5-days old K14-TSLP tg mouse skin biopsies. Our findings in the flaky tail mouse correlate with data obtained from patient biopsies of AD, but not IV. We propose that proinflammatory cytokines are responsible for acanthosis in flaky tail epidermis, and together with the Th2-derived cytokines lead to morphological changes. Accordingly, the a/a ma ft/ma ft/J mouse model can be used as an appropriate model to study early AD onset associated with profilaggrin deficiency.
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Affiliation(s)
- Magdalini Kypriotou
- Laboratory of Cutaneous Biology, Service of Dermatology and Venereology, Beaumont Hospital CHUV, Lausanne, Switzerland
| | - Cloé Boéchat
- Laboratory of Cutaneous Biology, Service of Dermatology and Venereology, Beaumont Hospital CHUV, Lausanne, Switzerland
| | - Marcel Huber
- Laboratory of Cutaneous Biology, Service of Dermatology and Venereology, Beaumont Hospital CHUV, Lausanne, Switzerland
| | - Daniel Hohl
- Laboratory of Cutaneous Biology, Service of Dermatology and Venereology, Beaumont Hospital CHUV, Lausanne, Switzerland
- * E-mail:
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Moncrieff G, Cork M, Lawton S, Kokiet S, Daly C, Clark C. Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol 2013; 38:231-8; quiz 238. [DOI: 10.1111/ced.12104] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - S. Lawton
- Dermatology Department; Queen's Medical Centre; Nottingham University Hospitals NHS Trust; Nottingham; UK
| | - S. Kokiet
- Bedford House Medical Centre; Ashton-under-Lyne; Greater Manchester; UK
| | - C. Daly
- Mid Norfolk Clinical Commissioning Group; North Elmham; Norfolk; UK
| | - C. Clark
- Christine Clark Ltd; Rossendale; Lancashire; UK
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Futamura M, Thomas KS, Grindlay DJC, Doney EJ, Torley D, Williams HC. Mapping systematic reviews on atopic eczema--an essential resource for dermatology professionals and researchers. PLoS One 2013; 8:e58484. [PMID: 23505516 PMCID: PMC3594299 DOI: 10.1371/journal.pone.0058484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/05/2013] [Indexed: 01/31/2023] Open
Abstract
Background Many research studies have been published on atopic eczema and these are often summarised in systematic reviews (SRs). Identifying SRs can be time-consuming for health professionals, and researchers. In order to facilitate the identification of important research, we have compiled an on-line resource that includes all relevant eczema reviews published since 2000. Methods SRs were searched for in MEDLINE (Ovid), EMBASE (Ovid), PubMed, the Cochrane Database of Systematic Reviews, DARE and NHS Evidence. Selected SRs were assessed against the pre-defined eligibility criteria and relevant articles were grouped by treatment category for the included interventions. All identified systematic reviews are included in the Global Resource of EczemA Trials (GREAT) database (www.greatdatabase.org.uk) and key clinical messages are summarised here. Results A total of 128 SRs reviews were identified, including three clinical guidelines. Of these, 46 (36%) were found in the Cochrane Library. No single database contained all of the SRs found. The number of SRs published per year has increased substantially over the last thirteen years, and reviews were published in a variety of clinical journals. Of the 128 SRs, 1 (1%) was on mechanism, 37 (29%) were on epidemiology, 40 (31%) were on eczema prevention, 29 (23%) were on topical treatments, 31 (24%) were on systemic treatments, and 24 (19%) were on other treatments. All SRs included searches of MEDLINE in their search methods. One hundred six SRs (83%) searched more than one electronic database. There were no language restrictions reported in the search methods of 52 of the SRs (41%). Conclusions This mapping of atopic eczema reviews is a valuable resource. It will help healthcare practitioners, guideline writers, information specialists, and researchers to quickly identify relevant up-to-date evidence in the field for improving patient care.
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Affiliation(s)
- Masaki Futamura
- Centre of Evidence Based Dermatology, University of Nottingham, King's Meadow Campus, Nottingham, United Kingdom.
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Rubel D, Thirumoorthy T, Soebaryo RW, Weng SCK, Gabriel TM, Villafuerte LL, Chu CY, Dhar S, Parikh D, Wong LC, Lo KK. Consensus guidelines for the management of atopic dermatitis: an Asia-Pacific perspective. J Dermatol 2013; 40:160-71. [PMID: 23289827 DOI: 10.1111/1346-8138.12065] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/14/2012] [Indexed: 12/15/2022]
Abstract
Atopic dermatitis (AD) is a relatively common disease in patients in the Asia-Pacific region. It presents a particular clinical challenge and requires careful clinical management. The chronic nature of AD characterized by flares, exacerbations and periods of quiescence requires a multipronged approach aimed at reducing itch, inflammation and the appearance of secondary lesions. In addition, varying levels of maintenance therapy may be required to avoid exacerbations. Survey data from the region indicate that there is significant variation across the Asia-Pacific with regard to current treatment practices. The management of AD may also be influenced by differing health-care systems, variable climate, access to medical care and cultural diversity. The current consensus guidelines have been developed to provide up-to-date and concise evidence- and experience-based recommendations directed towards general practitioners and general dermatologists in the Asia-Pacific region on the management of pediatric and adult AD.
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Affiliation(s)
- Diana Rubel
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia.
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Evaluation of Food Allergy in Patients with Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:22-8. [DOI: 10.1016/j.jaip.2012.11.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 11/22/2022]
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