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Sowlati M, Morariu SH, Orzan O, Veraldi S, Dodiuk-Gad RP, Orasan RI, Gainaru C. Efficacy and Tolerability of a Novel Topical Treatment Containing Pea Protein and Xyloglucan in the Management of Atopic Dermatitis in Children: A Prospective, Multicenter Clinical Study. Dermatol Ther (Heidelb) 2023; 13:2669-2679. [PMID: 37740857 PMCID: PMC10613178 DOI: 10.1007/s13555-023-01035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic disease that occurs mainly in children. Topical corticosteroids are the main treatment for mild to moderate AD, although they can induce side effects. The efficacy and tolerability of xyloglucan and pea protein (XG-PP) was compared with hydrocortisone in pediatric patients with AD as a steroid-sparing solution. METHODS A prospective, multicenter, comparative study enrolled 42 patients (age 0.5-12 years) with mild-to-moderate AD, assigned 1:1 to XG-PP or hydrocortisone ointment. Treatments were applied twice daily for 14 consecutive days and assessed at baseline, day 8, and day 15. Efficacy endpoints were AD Severity Index (ADSI) score, Scoring Atopic Dermatitis (SCORAD) index, and Patient-Oriented Eczema Measure (POEM). Tolerability was assessed by the occurrence of adverse events (AEs). RESULTS Both treatments significantly improved ADSI mean score from baseline to day 15; in the XG-PP arm, ADSI score decreased from 10.55 to 4.15 (p = 0.00001), and in the hydrocortisone arm, from 10.65 to 4.30 (p = 0.0001). In the XG-PP arm, the mean SCORAD score decreased from 65.86 to 30.26 (p = 0.00001) and in the hydrocortisone arm from 68.84 to 31.19 (p = 0.0001) at day 15. An overall decrease from moderate to mild AD for both arms (p = 0.0001) was observed with POEM. For all the three indexes evaluated, no statistical significant differences between the study arms evolution from baseline to day 8 or to day 15 were found. No AEs were reported. CONCLUSION XG-PP provided a comparable efficacy to hydrocortisone ointment in managing AD, thus representing a safe and effective steroid-sparing alternative in pediatric patients with AD. TRIAL REGISTRATION Retrospectively registered on 24 November 2021 in the ISRCTN registry: 11118799.
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Affiliation(s)
- Mehdi Sowlati
- County Emergency Clinica Hospital "Sf. Apostol Andrei", Tomis Boulevard 145, 900591, Constanţa, Romania.
| | | | - Olguta Orzan
- Elias University Emergency Hospital, Bucharest, Romania
| | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roni P Dodiuk-Gad
- Dermatology and Venereology Department, Emek Medical Center, Afula, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Remus I Orasan
- Medical Office of Dermatology Prof. Dr. Orasan Remus Ioan, Cluj, Romania
| | - Cristian Gainaru
- Family Medicine Dispensary Dr. Cristian Gainaru, Dambovita, Romania
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2
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Horimukai K, Kinoshita M, Shamoto Y, Inoue T, Tanida H. Food Allergens and Essential Oils in Moisturizers Marketed for Children in Japan. Cureus 2023; 15:e34918. [PMID: 36938271 PMCID: PMC10016742 DOI: 10.7759/cureus.34918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Personal skincare leave-on products increase the risk of food allergies. Parents must be imparted with an elevated degree of cognizance regarding the allergenic nature of pediatric skincare products. Material and methods We aimed to examine the data inferred from the promotional material on labeling these products about their proclivity to elicit skin sensitization. This study investigated the relationship between food allergens and essential oil ingredients and highlighted marketing terms, product prices, and ratings of moisturizers for children that are sold on Amazon, Japan. We searched and recorded the product labels and website marketing terms, price (per gram or milliliter), the number of reviews, and allergens and investigated the relationship between the percentage of food allergens in those products and marketing terms, price, and the number of Amazon reviews. Results Among the 164 pediatric skincare products we included, 144 (87.8%) that were manufactured in Japan were the most common; 7 (4.3%), 15 (9.1%), 23 (14.0%), 24 (14.6%), and 54 (32.9%) contained the eight regulated food allergens, grain, nut, fruit, and essential oils, respectively. Marketing terms emphasizing "natural/organic" were more likely to contain grain allergens and essential oils and were more expensive with and without "organic" labeling, respectively, whereas those labeled with marketing terms emphasizing "hypoallergenic" were less likely to contain fruit allergens or essential oils. Products with fewer Amazon reviews were more likely to use the marketing term "natural/organic" and had a higher grain allergen content. Conclusion In Japan, 4.3% of children's skincare products sold on Amazon contain eight food allergens that should obligatorily be labeled when included in food products. In addition, more than 10% of these children's skin care products contain ingredients derived from nuts, while more than 30% contain fruit extracts or essential oils.
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Affiliation(s)
- Kenta Horimukai
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, JPN
| | - Misako Kinoshita
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, JPN
| | | | - Takeshi Inoue
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, JPN
| | - Hisashi Tanida
- Department of Pediatrics, Holy Spirit Hospital, Nagoya, JPN
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Araviiskaia E, Pincelli C, Sparavigna A, Luger T. The Role of a Novel Generation of Emollients, 'Emollients Plus', in Atopic Dermatitis. Clin Cosmet Investig Dermatol 2022; 15:2705-2719. [PMID: 36545500 PMCID: PMC9763050 DOI: 10.2147/ccid.s389697] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
Emollients are the mainstay maintenance treatment for atopic dermatitis (AD). A novel generation of emollients, 'emollients plus', containing active, non-medicated substances, has softened the distinction between emollients and topical drugs. A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Whilst the inclusion of five components of an ideal emollient has been proposed, no such consensus exists for emollients plus and they can vary markedly in their composition and modes of action for AD treatment. This could have a profound effect on their clinical efficacy. The efficacy of emollients plus in restoring and maintaining skin barrier function has been demonstrated on multiple levels, with evidence reported for their effects on the physical and biochemical, microbial, immunological, and neurosensory barriers. When selecting an appropriate AD treatment approach, the safety profiles of the available topical therapies must be carefully considered. There are several proposed treatment approaches for AD, including preventive, proactive, intermittent, and synergistic approaches. Emollients plus may be effective not only as maintenance therapy for AD, but also when used synergistically with anti-inflammatory pharmacological therapies.
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Affiliation(s)
- Elena Araviiskaia
- Department of Dermatology and Venereal Diseases, First Pavlov State Medical University of St Petersburg, St Petersburg, Russia
| | - Carlo Pincelli
- DermoLab, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Adele Sparavigna
- Derming Clinical Research and Bioengineering Institute, Milan, Italy
| | - Thomas Luger
- Department of Dermatology, University of Munster, Munster, Germany,Correspondence: Thomas Luger, Dermatology Clinic, University of Münster, Von-Esmarch-Straẞe 58, Münster, 48149, Germany, Email
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4
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Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, Bieber T, Brough HA, Calzavara Pinton P, Christen-Zäch S, Deleuran M, Dittmann M, Dressler C, Fink-Wagner AH, Fosse N, Gáspár K, Gerbens L, Gieler U, Girolomoni G, Gregoriou S, Mortz CG, Nast A, Nygaard U, Redding M, Rehbinder EM, Ring J, Rossi M, Serra-Baldrich E, Simon D, Szalai ZZ, Szepietowski JC, Torrelo A, Werfel T, Flohr C. European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. J Eur Acad Dermatol Venereol 2022; 36:1904-1926. [PMID: 36056736 DOI: 10.1111/jdv.18429] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022]
Abstract
The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for paediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.
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Affiliation(s)
- A Wollenberg
- Department of Dermatology and Allergy, LMU Munich, Munich, Germany.,Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Brussels, Belgium
| | - M Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B Arents
- European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Brussels, Belgium
| | - N Aszodi
- Department of Dermatology and Allergy, LMU Munich, Munich, Germany
| | - G Avila Valle
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S Barbarot
- Department of Dermatology, CHU Nantes, UMR 1280 PhAN, INRAE, Nantes Université, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - H A Brough
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, and Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | | | - M Deleuran
- Aarhus University Hospital, Aarhus, Denmark
| | - M Dittmann
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - C Dressler
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A H Fink-Wagner
- Global Allergy and Airways diseases Patient Platform GAAPP, Vienna, Austria
| | - N Fosse
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - K Gáspár
- Department of Dermatology of the University of Debrecen, Debrecen, Hungary
| | - L Gerbens
- Department of Dermatology, Amsterdam UMC (University Medical Centers), Amsterdam, The Netherlands
| | - U Gieler
- Department Dermatology, University of Giessen, Giessen, Germany
| | - G Girolomoni
- Dermatology and Venereology Section, Department of Medicine, University of Verona, Verona, Italy
| | - S Gregoriou
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Mortz
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - U Nygaard
- Department of Dermato-Venerology, Aarhus University Hospital, Aarhus, Denmark
| | - M Redding
- Eczema Outreach Support (UK), Linlithgow, UK
| | - E M Rehbinder
- Dermatology Department, Oslo University Hospital, Oslo, Norway
| | - J Ring
- Department Dermatology Allergology Biederstein, Technical University Munich, Munich, Germany
| | - M Rossi
- Dermatology Unit, Spedali Civili Hospital Brescia, Brescia, Italy
| | | | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Z Z Szalai
- Pediatric Dermatology Unit, Heim Pál National Children's Institute Budapest, Budapest, Hungary
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - A Torrelo
- Hospital Infantil Niño Jesús, Madrid, Spain
| | - T Werfel
- Hannover Medical School, Hanover, Germany
| | - C Flohr
- St John's Institute of Dermatology, King's College London, London, UK.,Guy's & St Thomas' NHS Foundation Trust, London, UK
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Zhao Z, Gao XH, Li W, Wang H, Liang Y, Tang J, Yao X, Zhao H, Luger T. Experts' Consensus on the Use of Pimecrolimus in Atopic Dermatitis in China: A TCS-Sparing Practical Approach. Dermatol Ther (Heidelb) 2022; 12:933-947. [PMID: 35313362 PMCID: PMC9021341 DOI: 10.1007/s13555-022-00696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease with rising prevalence. Topical corticosteroids (TCS) are recommended as first-line therapy for patients with AD in China; however, corticophobia is a widespread concern, which can manifest as noncompliance: in a previous Chinese study, almost all parents whose children had AD were very concerned about the side effects of TCS and, as a result, nearly half did not use it in the event of recurrence. We propose a TCS-sparing treatment algorithm for the management of infants, children, adolescents, and adults with mild-to-moderate AD, to guide clinical practice in China. Methods A panel of eight experts in AD from China and one expert from Germany formed to develop a practical algorithm for the management of mild-to-moderate AD, focusing on pimecrolimus. Results Irrespective of body location, all patients with mild AD (including acute flares) and infants with moderate AD should apply the topical calcineurin inhibitor (TCI) pimecrolimus twice daily to the affected area until symptoms disappear. For children, adolescents, and adults with moderate AD, pimecrolimus should be applied twice daily to sensitive skin areas, and a TCI (either pimecrolimus or tacrolimus) should be applied twice daily to other body locations. Short-term administration of TCS, followed by TCI twice daily, is recommended for most patients with moderate AD experiencing acute flares, regardless of lesion site. Emollients should be used regularly. Conclusions The algorithm presented intends to simplify treatment of AD in China and guide clinical decision-making.
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Affiliation(s)
- Zuotao Zhao
- Department of Dermatology and Venereology National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, 8 Xishiku St, Xicheng District, Beijing, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital, China Medical University, 77 Puhe Rd, Shenbei, Shenyang, Liaoning, China
| | - Wei Li
- Department of Dermatology, Huashan Hospital, Fudan University, 796 Jiangsu Rd, Changning District, Shanghai, China
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd, Liang Lu Kou, Yuzhong District, Chongqing, China
| | - Yunsheng Liang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Nanfang Ave, Baiyun, Guangzhou, Guangdong, China
| | - Jianping Tang
- Department of Dermatology, Hunan Children's Hospital, 86 Ziyuan Rd, Yuhua District, Changsha, Hunan, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 9 Dongdan 3rd Alley, Dong Dan, Dongcheng, Beijing, China
| | - Hua Zhao
- Department of Dermatology and Venereology, Chinese PLA General Hospital, 4th Ring Road, Beijing, China
| | - Thomas Luger
- Department of Dermatology, University of Münster, Von-Esmarch-Straße 58, 48149, Münster, Germany.
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Luu NN, Soldatova L, Friedman O. The Role of Complementary and Alternative Medicine in Facial Plastic Surgery. Facial Plast Surg 2021; 38:88-93. [PMID: 34749403 DOI: 10.1055/s-0041-1736582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Complementary and alternative medicine (CAM) has become increasingly popular among facial plastic surgery patients. Over the last few decades, there has been a surge in the use of CAM. Despite the increasing prevalence of CAM, patients may feel uncomfortable discussing these therapies with their physicians, and physicians feel under-equipped to engage in meaningful discussions regarding these nontraditional therapies. This article reviews recent literature on the use of CAM for skin treatment in an attempt to provide additional resource. To date, the evidence to support statistically significant symptom improvement with use of non-traditional therapies remains limited. While preliminary data supports essential oil therapy in some cases, the results of the studies investigating other CAM therapies (traditional Chinese medicine, Ayurveda, and homeopathy) have been mixed and inconclusive.
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Affiliation(s)
- Neil N Luu
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine at the University of Southern California, Los Angeles, California
| | - Liuba Soldatova
- Hospital of the University of Pennsylvania, Department of Otorhinolaryngology - Head and Neck Surgery, Philadelphia, Pennsylvania
| | - Oren Friedman
- Hospital of the University of Pennsylvania, Department of Otorhinolaryngology - Head and Neck Surgery, Philadelphia, Pennsylvania
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7
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Hebert AA, Rippke F, Weber TM, Nicol NH. Efficacy of Nonprescription Moisturizers for Atopic Dermatitis: An Updated Review of Clinical Evidence. Am J Clin Dermatol 2020; 21:641-655. [PMID: 32524381 PMCID: PMC7473959 DOI: 10.1007/s40257-020-00529-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Twice-daily moisturization is recommended by international guidelines as the bedrock of the management of atopic dermatitis (AD). Moisturizers should be selected based on proven clinical effectiveness in improving the skin barrier and improving the symptoms of AD. We searched the PubMed database for clinical trials assessing daily moisturization for the treatment of AD published between 2006 and 2019. Studies had to assess the efficacy of commercially available moisturizers using objective measures of corneometry, transepidermal water loss, or incidence of flare as endpoints, and treatments had to be currently available to patients. Clinical studies showed that moisturization (typically twice daily) significantly improved the skin barrier in adults and children with AD. Longer-term flare studies showed that daily moisturization reduced the incidence of flares and extended the time between flares. Proactive moisturization of infants at high risk of developing AD may reduce its manifestation. Therapeutic moisturizers for AD are specifically formulated with ingredients that target symptoms of AD, such as itch, inflammation, or compromised skin barrier. The US FDA requires that any moisturizer available in the USA and claiming to treat AD must contain colloidal oatmeal. Healthcare providers can maximize compliance and outcomes by educating patients on the benefits of liberally applying a therapeutic moisturizer twice daily to support the skin barrier and help reduce the incidence of flares. Specific recommendations should be for clinically tested moisturizers evaluated using objective, validated skin assessments.
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Affiliation(s)
- Adelaide A Hebert
- Department of Dermatology, University of Texas McGovern Medical School, 6655 Travis, Suite 980, Houston, TX, 77030, USA.
| | - Frank Rippke
- Research and Development, Beiersdorf, Hamburg, Germany
| | - Teresa M Weber
- Research and Development, Beiersdorf Inc., Wilton, CT, USA
| | - Noreen Heer Nicol
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Nowicki RJ, Trzeciak M, Kaczmarski M, Wilkowska A, Czarnecka-Operacz M, Kowalewski C, Rudnicka L, Kulus M, Mastalerz-Migas A, Peregud-Pogorzelski J, Sokołowska-Wojdyło M, Śpiewak R, Adamski Z, Czuwara J, Kapińska-Mrowiecka M, Kaszuba A, Krasowska D, Krêcisz B, Narbutt J, Majewski S, Reich A, Samochocki Z, Szepietowski J, Woźniak K. Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part I. Prophylaxis, topical treatment and phototherapy. Postepy Dermatol Alergol 2020; 37:1-10. [PMID: 32467676 PMCID: PMC7247067 DOI: 10.5114/ada.2020.93423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/01/2019] [Indexed: 12/17/2022] Open
Abstract
Atopic dermatitis is a chronic and recurrent inflammatory dermatosis with concomitant intensive pruritus, and is diagnosed both in children and adults. Atopic dermatitis-patients are predisposed to have bacterial, viral and fungal skin infections; they also suffer from an increased risk of developing food allergies (especially, at an infantile age), allergic rhinitis, or bronchial asthma (a so-called atopic march). Currently, an increasing atopic dermatitis incidence constitutes a serious medical problem that regards not only dermatology and allergology, but also paediatrics, and family medicine. The basis for atopic dermatitis treatment and prophylaxis is restoration of epidermal barrier functions by means of tailored emollients. Atopic dermatitis therapies should effectively eliminate clinical symptoms of the disease, prevent exacerbations as well as complications, and improve patients' quality of life.
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Affiliation(s)
- Roman J. Nowicki
- Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Kaczmarski
- Department of Paediatrics, Paediatric Gastroenterology and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Aleksandra Wilkowska
- Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - Cezary Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Paediatric Pneumonology and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Radosław Śpiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Andrzej Kaszuba
- Department of Dermatology, Paediatric and Oncological Dermatology, Medical University of Lodz, Lodz, Poland
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University, Lublin, Poland
| | - Beata Krêcisz
- Department of Dermatology, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Joanna Narbutt
- Department of Dermatology, Paediatric and Oncological Dermatology, Medical University of Lodz, Lodz, Poland
| | - Sławomir Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | | | - Jacek Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Katarzyna Woźniak
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
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9
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Darrigade AS. Traitements topiques et photothérapie dans la dermatite atopique. Ann Dermatol Venereol 2019; 146:12S85-12S95. [DOI: 10.1016/s0151-9638(20)30018-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, Gieler U, Girolomoni G, Lau S, Muraro A, Czarnecka-Operacz M, Schäfer T, Schmid-Grendelmeier P, Simon D, Szalai Z, Szepietowski JC, Taïeb A, Torrelo A, Werfel T, Ring J. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 2018; 32:657-682. [PMID: 29676534 DOI: 10.1111/jdv.14891] [Citation(s) in RCA: 514] [Impact Index Per Article: 85.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti-inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long-term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long-term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti-inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.
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Affiliation(s)
- A Wollenberg
- Department Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Klinik Thalkirchner Straße, Munich, Germany
| | - S Barbarot
- Department of Dermatology, Centre Hospitalier Universitaire CHU Nantes, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University Bonn, Bonn, Germany
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M Deleuran
- Department Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Fink-Wagner
- European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Global Allergy and Asthma Patient Platform (GAAPP), Konstanz, Germany
| | - U Gieler
- Department of Dermatology, University of Gießen and Marburg GmbH, Gießen, Germany.,Department of Psychosomatics and Psychotherapy, University of Gießen and Marburg GmbH, Gießen, Germany
| | - G Girolomoni
- Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
| | - S Lau
- Pediatric Pneumology and Immunology, Universitätsmedizin Berlin, Berlin, Germany
| | - A Muraro
- Centro di Specializzazione Regionale per lo Studio e la Cura delle Allergie e delle Intolleranze Alimentari presso l'Azienda Ospedaliera, Università di Padova, Padova, Italy
| | | | - T Schäfer
- Dermatological Practice, Immenstadt, Germany
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University of Zurich, Zurich, Switzerland.,Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - D Simon
- Department Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Z Szalai
- Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Taïeb
- Department of Dermatology and Pediatric Dermatology, Hôpital St André, Bordeaux, France
| | - A Torrelo
- Department of Dermatology, Hospital Niño Jesus, Madrid, Spain
| | - T Werfel
- Department Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - J Ring
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland.,Department Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
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Siegfried EC, Jaworski JC, Mina-Osorio P. A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns. Dermatol Ther (Heidelb) 2018; 8:349-377. [PMID: 29858763 PMCID: PMC6109028 DOI: 10.1007/s13555-018-0243-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns. METHODS Searches of Embase (2005-2016) and abstracts from selected meetings (2014-2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity. RESULTS Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids. CONCLUSION This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease. FUNDING Regeneron Pharmaceuticals Inc.
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Affiliation(s)
- Elaine C Siegfried
- Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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Rossi AB, Bacquey A, Nocera T, Thouvenin MD. Efficacy and Tolerability of a Medical Device Repairing Emollient Cream Associated with a Topical Corticosteroid in Adults with Atopic Dermatitis: An Open-label, Intra-individual Randomized Controlled Study. Dermatol Ther (Heidelb) 2018; 8:217-228. [PMID: 29511936 PMCID: PMC6002316 DOI: 10.1007/s13555-018-0228-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction Medical device repairing emollient creams (MDRECs) are designed to repair and protect the skin barrier. In this study, we examined the added clinical benefit and tolerability of a MDREC when used in association with a moderately potent topical corticosteroid (TCS) for adults with atopic dermatitis (AD). Methods This was an intra-individual randomized controlled trial in adults with moderate to severe AD (EudraCT no. 2014-002,194-10). Symmetrical lesions on each arm of the subjects were randomized to treatment for 10 days with twice-daily TCS (desonide) cream alone or with combined TCS + MDREC. Subjects were then included in a following 2-week maintenance phase if the AD on at least one test area had sufficiently improved so that the treatment was no longer needed. During the maintenance phase, treatment with the TCS cream was stopped, but twice-daily application of the MDREC was continued on the same test area previously assigned to receive it. The primary outcome measure was the change in local Scoring Atopic Dermatitis (SCORAD) index between day 1 and 3 based on investigators’ assessment. Secondary measures of lesion severity included changes in the local patient-oriented SCORAD index, pruritus intensity according to subjects’ assessments, and global assessments by subjects and investigators. Results The study included 54 subjects. The change in investigator-observed local SCORAD index between day 1 and 3 was − 14.4% with TCS alone and − 24.5% for TCS + MDREC (p = 0.0005). Between baseline and the end of the treatment phase, all secondary measures of lesion severity decreased more with the combined TCS + MDREC treatment than with the TCS cream alone. The MDREC also reduced the relapse of AD lesions during the maintenance phase. Tolerability was very good, and the product was well accepted by subjects. Conclusion These results support using the MDREC in association with TCS during AD flares and as a maintenance therapy after treatment with TCS has stopped. Funding Laboratoires Dermatologiques Ducray, Pierre Fabre.
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Affiliation(s)
- Ana Beatris Rossi
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.,Department of Dermatology, University Hospital Toulouse, 24, chemin de Pouvourville TSA, 31059, Toulouse CEDEX 9, France
| | - Adeline Bacquey
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France
| | - Thérèse Nocera
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.,Department of Dermatology, University Hospital Toulouse, 24, chemin de Pouvourville TSA, 31059, Toulouse CEDEX 9, France
| | - Marie-Dominique Thouvenin
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.
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Vaughn AR, Clark AK, Sivamani RK, Shi VY. Natural Oils for Skin-Barrier Repair: Ancient Compounds Now Backed by Modern Science. Am J Clin Dermatol 2018; 19:103-117. [PMID: 28707186 DOI: 10.1007/s40257-017-0301-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Natural plant oils are commonly used as topical therapy worldwide. They are usually easily accessible and are relatively inexpensive options for skin care. Many natural oils possess specific compounds with antimicrobial, antioxidant, anti-inflammatory, and anti-itch properties, making them attractive alternative and complementary treatments for xerotic and inflammatory dermatoses associated with skin-barrier disruption. Unique characteristics of various oils are important when considering their use for topical skin care. Differing ratios of essential fatty acids are major determinants of the barrier repair benefits of natural oils. Oils with a higher linoleic acid to oleic acid ratio have better barrier repair potential, whereas oils with higher amounts of irritating oleic acid may be detrimental to skin-barrier function. Various extraction methods for oils exist, including cold pressing to make unrefined oils, heat and chemical distillation to make essential oils, and the addition of various chemicals to simulate a specific scent to make fragranced oils. The method of oil processing and refinement is an important component of selecting oil for skin care, and cold pressing is the preferred method of oil extraction as the heat- and chemical-free process preserves beneficial lipids and limits irritating byproducts. This review summarizes evidence on utility of natural plant-based oils in dermatology, particularly in repairing the natural skin-barrier function, with the focus on natural oils, including Olea europaea (olive oil), Helianthus annus (sunflower seed oil), Cocos nucifera (coconut oil), Simmondsia chinesis (jojoba oil), Avena sativa (oat oil), and Argania spinosa (argan oil).
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Stettler H, Kurka P, Kandzora J, Pavel V, Breuer M, Macura-Biegun A. A new topical panthenol-containing emollient for maintenance treatment of childhood atopic dermatitis: results from a multicenter prospective study. J DERMATOL TREAT 2017; 28:774-779. [DOI: 10.1080/09546634.2017.1328938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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