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Saeki H, Ohya Y, Furuta J, Arakawa H, Ichiyama S, Katsunuma T, Katoh N, Tanaka A, Tsunemi Y, Nakahara T, Nagao M, Narita M, Hide M, Fujisawa T, Futamura M, Masuda K, Matsubara T, Murota H, Yamamoto-Hanada K. English Version of Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. J Dermatol 2022; 49:e315-e375. [PMID: 35996152 DOI: 10.1111/1346-8138.16527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
This is the English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. In Japan, from the perspective of evidence-based medicine, the current strategies for the treatment of AD consist of three primary measures: (i) use of topical corticosteroids, tacrolimus ointment, and delgocitinib ointment as the main treatment of the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling, and advice about daily life. In the present revised guidelines, descriptions of three new drugs, namely, dupilumab, delgocitinib, and baricitinib, have been added. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Junichi Furuta
- Medical Informatics and Management, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hirokazu Arakawa
- Kitakanto Allergy Research Institute, Kibounoie Hospital, Midori, Japan
| | - Susumu Ichiyama
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Toshio Katsunuma
- Department of Pediatrics, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Masami Narita
- Department of Pediatrics, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Dermatology, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Masaki Futamura
- Division of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Koji Masuda
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Tomoyo Matsubara
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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De A, Sharma N, Dhar S, Godse K, Krupa Shankar DS, Zawar V, Girdhar M, Shah B. Use of bleach baths for atopic dermatitis: An Indian perspective. Indian J Dermatol 2022; 67:273-278. [PMID: 36386066 PMCID: PMC9644761 DOI: 10.4103/ijd.ijd_536_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder affecting 15–20% of children and 1–10% of adults. Staphylococcus aureus (S. aureus) infection is the most frequent complication of AD and is involved in the worsening of the disease. Systemic and topical antibiotics are used in the treatment for AD but there are concerns over increasing resistance. Bleach (sodium hypochlorite, NaOCl) baths are an inexpensive, widely accessible, alternative antibiotic treatment that may not worsen antibiotic resistance. Bleach baths are used as adjunctive treatment in AD patients to treat superinfections, although their mechanism of action is not well understood. Balancing safety concerns with efficacious treatment should be important especially for AD where the majority of patients are in pediatrics age groups. Studies available in PubMed databases were included in this review. Most suggested bleach bath improves clinical symptoms of AD and restores surface microbiome by eradicating bacteria, most notably S. aureus. Some studies have noted that this antimicrobial effect has reduced the need for topical corticosteroids. In addition, bleach seems to have strong anti-inflammatory and antipruritic effects. Overall, bleach baths seem to be safe on human skin, without disrupting the epidermal barrier function. The review concluded, although there are some advantages of use of bleach baths, more studies to investigate long-term efficacy and safety of bleach baths are required before fixing its role in the treatment of AD especially in the context of the Indian scenario.
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Abstract
: The role of Staphylococcus aureus (SA) in the pathogenesis and management in atopic dermatitis is rapidly evolving. The modern understanding of SA in atopic dermatitis now includes an expanded array of virulence factors, the interplay of clonal and temporal shifts in SA populations, and host factors such as filaggrin and natural moisturizing factor. New, emerging therapies that focus on long-term, targeted elimination of SA colonization are currently under investigation (Br J Dermatol 2017;17(1)63-71). Herein, we discuss and review the latest staphylococcal and microbiome-modifying therapies including topical antibiotics, topical natural oil fatty acids, anti-SA vaccines, microbial transplantation, vitamin D supplementation, dupilumab and proposed future investigative directions.
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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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Spada F, Barnes TM, Greive KA. Emollient formulations containing antiseptics reduce effectively the level of Staphylococcus aureus on skin. Clin Cosmet Investig Dermatol 2019; 12:639-645. [PMID: 31564945 PMCID: PMC6735249 DOI: 10.2147/ccid.s215023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/23/2019] [Indexed: 11/23/2022]
Abstract
Background Increased skin colonization by Staphylococcus aureus is associated with atopic eczema (AE) severity. Reduction of S. aureus levels on the skin results in an improvement in the clinical condition. Methods The antimicrobial activity of topical products including a bath oil, cream, and wash combining antiseptics and emollients (A+E) was compared to products containing emollients only. The preference of patients with AE for A+E cream or emollient only cream to relieve symptoms of itching, erythema, and inflammation when applied three times daily for 10 days is evaluated. Repeat insult patch testing of the products is also conducted. Results A significant reduction in microbial counts was found following use of A+E bath oil (4.09±0.32 vs 6.20±0.24 log10 cfu/mL S. aureus, P<0.001), A+E cream (5.50±0.63 vs 5.94±0.72 log10 cfu/foot S. aureus, P=0.002), and A+E wash (2.71±0.48 vs 3.57±0.31 log10 cfu/mL Escherichia coli, P<0.001) compared to the emollient only products. The A+E cream was preferred to the emollient only cream (P=0.004) by patients with AE. All three tested formulations were found to be non-irritating and non-sensitizing to the skin. Conclusion The bath oil, cream, and wash containing antiseptics and emollients decrease the level of bacteria on the skin, including S. aureus, compared to emollient only products. Patients with AE preferred the A+E cream compared to the emollient only cream to relieve symptoms of itching, erythema, and inflammation. The choice of formulation allows clinicians and patients to choose a suitable product for the short-term treatment of eczema flare-ups caused by bacterial infections. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://www.youtube.com/watch?v=GqOXD7kHiSA
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Affiliation(s)
- Fabrizio Spada
- Research & Development, Ego Pharmaceuticals, Braeside, Victoria, Australia
| | - Tanya M Barnes
- Research & Development, Ego Pharmaceuticals, Braeside, Victoria, Australia
| | - Kerryn A Greive
- Research & Development, Ego Pharmaceuticals, Braeside, Victoria, Australia
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Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci 2019; 49:963-984. [PMID: 31408293 PMCID: PMC7018348 DOI: 10.3906/sag-1810-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder of childhood. Underlying factors that contribute to AD are impaired epithelial barrier, alterations in the lipid composition of the skin, immunological imbalance including increased Th2/Th1 ratio, proinflammatory cytokines, decreased T regulatory cells, genetic mutations, and epigenetic alterations. Atopic dermatitis is a multifactorial disease with a particularly complicated pathophysiology. Discoveries to date may be considered the tip of the iceberg, and the increasing number of studies in this field indicate that there are many points to be elucidated in AD pathophysiology. In this review, we aimed to illustrate the current understanding of the underlying pathogenic mechanisms in AD, to evaluate available treatment options with a focus on recently discovered therapeutic agents, and to determine the personal, familial, and economic burdens of the disease, which are frequently neglected issues in AD. Currently available therapies only provide transient solutions and cannot fully cure the disease. However, advances in the understanding of the pathogenic mechanisms of the disease have led to the production of new treatment options, while ongoing drug trials also have had promising results.
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Affiliation(s)
- Pınar Gür Çetinkaya
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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The Role of Immune Defects and Colonization of Staphylococcus aureus in the Pathogenesis of Atopic Dermatitis. Anal Cell Pathol (Amst) 2018; 2018:1956403. [PMID: 29854575 PMCID: PMC5954962 DOI: 10.1155/2018/1956403] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 02/19/2018] [Indexed: 12/28/2022] Open
Abstract
Atopic dermatitis (AD) is a condition with a complex and not fully understood etiology. In patients with AD, acute skin lesions are colonized by a greater number of Staphylococcus aureus (S. aureus) bacteria than chronic lesions, clinically unchanged atopic skin, or the skin of healthy people. Mechanisms promoting skin colonization by S. aureus include complex interactions among several factors. Apart from increased adhesion of S. aureus in atopic skin, defects of the innate immune response resulting in the lack of restriction of the growth of microorganisms also contribute to susceptibility to colonization by and infection with S. aureus. A deficiency in the endogenous antimicrobial peptides may be partly responsible for the susceptibility to colonization by and skin infection with S. aureus in patients with AD. Majority of isolated S. aureus stains are able to produce exotoxins, which act as superantigens. Moreover, anti-S. aureus-specific IgE was identified and measured in patients with AD, revealing that its level corresponds to the severity of the disease. This review of the literature attempts to identify factors that are involved in the pathogenesis of AD-related S. aureus skin colonization. In the light of presented mechanisms, a reduction of colonization may become both causative and symptomatic treatment in AD.
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Błażewicz I, Jaśkiewicz M, Bauer M, Piechowicz L, Nowicki RJ, Kamysz W, Barańska-Rybak W. Decolonization of Staphylococcus aureus in patients with atopic dermatitis: a reason for increasing resistance to antibiotics? Postepy Dermatol Alergol 2017; 34:553-560. [PMID: 29422820 PMCID: PMC5799759 DOI: 10.5114/ada.2017.72461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/19/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Exacerbation of atopic dermatitis can be associated with bacterial infection. The skin of patients is colonized with Staphylococcus aureus in 90% of cases. An attempt has been made to demonstrate that eradication significantly reduces the severity of the disease. Studies indicate the efficacy of topical antibiotics, topical corticosteroids and calcineurin inhibitors. Due to increasing resistance to drugs and the defective antimicrobial peptide profile, decolonization is virtually impossible. AIM To determine the prevalence of S. aureus colonization among patients with atopic dermatitis and to assess antimicrobial susceptibility of isolated strains to antibiotics, especially fusidic acid and mupirocin. MATERIAL AND METHODS One hundred patients with atopic dermatitis and 50 healthy subjects were microbiologically assessed for the carriage of S. aureus. Antimicrobial susceptibility tests were performed using the broth-microdilution method for antibiotics: ampicillin, ciprofloxacin, daptomycin, erythromycin, fusidic acid, linezolid, lincomycin, mupirocin, tetracycline and vancomycin. RESULTS Staphylococcus aureus strains were isolated from the majority of our patients, either from the skin (71%) or the anterior nares (67%). In the present study, 10% of isolations represented methicillin-resistant S. aureus (MRSA). Antibiotics exhibited diverse activities against clinical isolates of S. aureus. Among those tested, the highest rates of resistance were shown for ampicillin - 58.5%, lincomycin - 37.5% and erythromycin - 31.0%. Enhanced resistance levels were expressed to mupirocin (17.5%) and fusidic acid (15.5%). CONCLUSIONS According to the increasing rate of resistance and quick recolonization after discontinuation of the treatment, chronic use of topical antibiotics is not recommended and should be limited to exacerbation of atopic dermatitis with clinical signs of bacterial infection.
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Affiliation(s)
- Izabela Błażewicz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Jaśkiewicz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Marta Bauer
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Lidia Piechowicz
- Department of Medical Microbiology, Medical University of Gdansk, Gdansk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Kamysz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
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In Vitro Synergism between Azithromycin or Terbinafine and Topical Antimicrobial Agents against Pythium insidiosum. Antimicrob Agents Chemother 2016; 60:5023-5. [PMID: 27216049 DOI: 10.1128/aac.00154-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/15/2016] [Indexed: 11/20/2022] Open
Abstract
We describe here in vitro activity for the combination of azithromycin or terbinafine and benzalkonium, cetrimide, cetylpyridinium, mupirocin, triclosan, or potassium permanganate. With the exception of potassium permanganate, the remaining antimicrobial drugs were active and had an MIC90 between 2 and 32 μg∕ml. The greatest synergism was observed for the combination of terbinafine and cetrimide (71.4%). In vivo experimental evaluations will clarify the potential of these drugs for the topical treatment of lesions caused by Pythium insidiosum.
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Atopic dermatitis: current treatment guidelines. Statement of the experts of the Dermatological Section, Polish Society of Allergology, and the Allergology Section, Polish Society of Dermatology. Postepy Dermatol Alergol 2015; 32:239-49. [PMID: 26366146 PMCID: PMC4565838 DOI: 10.5114/pdia.2015.53319] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 12/16/2022] Open
Abstract
Atopic dermatitis (AD) is a condition frequently encountered in medical practices across the country. More than 60% of children with AD are at risk to develop allergic rhinitis or asthma (the atopic march). Patients with AD have a unique predisposition to colonization or infection by Staphylococcus aureus. Treatments for AD need to rapidly control symptoms of the disease, improve quality of life and prevent exacerbations. Given the chronic and relapsing nature of the disease, therapies need to encourage good compliance and be well tolerated.
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Lee M, Van Bever H. The role of antiseptic agents in atopic dermatitis. Asia Pac Allergy 2014; 4:230-40. [PMID: 25379483 PMCID: PMC4215429 DOI: 10.5415/apallergy.2014.4.4.230] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/12/2014] [Indexed: 11/04/2022] Open
Abstract
The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.
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Affiliation(s)
- Melissa Lee
- Department of Paediatrics, University Children's Medical Institute, Yong Loo Lin School of Medicine, Singapore 119077, Singapore
| | - Hugo Van Bever
- Department of Paediatrics, University Children's Medical Institute, Yong Loo Lin School of Medicine, Singapore 119077, Singapore
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Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory disorder of skin with significant comorbidities. AD care often requires a combination of treatment approaches, including emollients, topical steroids, systemic immunosuppressants and/or phototherapy. PURPOSE Our purpose was to review recent randomized controlled trials (RCT) and systematic reviews of AD treatments. METHODS A MEDLINE search was performed focusing on RCTs of AD treatments, with a sample size ≥ 15, and systematic reviews published from 2011 to 2013, limited to the English language. A total of 53 manuscripts met the inclusion/exclusion criteria, including 44 RCTs and nine systematic reviews. RESULTS Investigator-initiated RCTs support the use of the systemic agents cyclosporine, methotrexate, azathioprine and mycophenolate mofetil. In one RCT, petrolatum was found to be as effective as creams containing ceramides or glycyrrhetinic acid. Additional therapeutic approaches supported by RCTs include balneotherapy, oral and/or topical probiotics, nutritional interventions, vitamin D with or without vitamin E supplementation, as well as several new topical and complementary medicines. CONCLUSIONS Advances have been made with respect to AD treatment in the past few years through the use of well designed RCTs and comparative efficacy studies. However, more well designed RCTs and investigator-initiated studies are needed in order to improve the care of AD patients.
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Affiliation(s)
- Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University, Suite 1400, 680 Lake Shore Drive, Chicago, IL, 60611, USA,
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Misery L, Ansolabehere X, Grandfils N, Georgescu V, Taieb C. Nine-year follow-up of children with atopic dermatitis by general practitioners. Dermatology 2014; 228:344-9. [PMID: 24662194 DOI: 10.1159/000358296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
The frequency of associated comorbidity and the cost of treatments in patients with atopic dermatitis (AD) followed up in primary care settings are poorly known. We carried out a retrospective cohort study on a longitudinal electronic medical records database of patients consulting a panel of general practitioners in France. All subjects with AD diagnosed during the first year of life were selected and matched with infants without the disease according to sex (1,163 vs. 1,163). Subjects were followed up for 9 years. Associated diseases, drug consumptions and available medical costs were detailed. Comparisons between subjects and controls were carried out. Subjects with AD had more comorbidities than others, especially in respiratory and ophthalmic system organs. The number of prescribed treatments in the field of skin diseases as well as overall medical costs (general practitioner consultations and prescribed drugs) were higher among atopic subjects, but differences were attenuated with age.
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Affiliation(s)
- Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
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Kulthanan K, Maneeprasopchoke P, Varothai S, Nuchkull P. The pH of antiseptic cleansers. Asia Pac Allergy 2014; 4:32-6. [PMID: 24527408 PMCID: PMC3921871 DOI: 10.5415/apallergy.2014.4.1.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/05/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Daily bathing with antiseptic cleansers are proposed by some physicians as an adjunctive management of atopic dermatitis (AD). As atopic skin is sensitive, selection of cleansing products becomes a topic of concern. OBJECTIVE Our purpose is to evaluate the pH of various antiseptic body cleansers to give an overview for recommendation to patients with AD. METHODS Commonly bar and liquid cleansers consisted of antiseptic agents were measured for pH using pH meter and pH-indicator strips. For comparison, mild cleansers and general body cleansers were also measured. RESULTS All cleansing bars had pH 9.8-11.3 except syndet bar that had neutral pH. For liquid cleansers, three cleansing agents had pH close to pH of normal skin, one of antiseptic cleansers, one of mild cleansers and another one of general cleansers. The rest of antiseptic cleansers had pH 8.9-9.6 while mild cleansers had pH 6.9-7.5. Syndet liquid had pH 7 and general liquid cleansers had pH 9.6. CONCLUSION The pH of cleanser depends on composition of that cleanser. Adding antiseptic agents are not the only factor determining variation of pH. Moreover, benefit of antiseptic properties should be considered especially in cases of infected skin lesions in the selection of proper cleansers for patients with AD.
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Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pitchaya Maneeprasopchoke
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supenya Varothai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyavadee Nuchkull
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Barnes TM, Greive KA. Use of bleach baths for the treatment of infected atopic eczema. Australas J Dermatol 2013; 54:251-8. [PMID: 23330843 DOI: 10.1111/ajd.12015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
Abstract
Atopic eczema is one of the most common skin disorders in young children and also affects adults. Staphylococcus aureus infection is the most frequent complication of atopic eczema and is involved in the worsening of the disease. Antibiotic therapy against S. aureus has been an important component of treatment for atopic eczema but there are concerns about antibiotic overuse and increasing bacterial resistance. This has led some clinicians to recommend the use of homemade remedies such as bleach baths as an adjunctive treatment for patients with infected atopic eczema, despite the fact that there have been few published studies in this area. Balancing safety concerns with efficacious treatment is of particular importance in the paediatric population. This review discusses the historical use of bleach in medicine as well as its recent use for atopic eczema. Further, the chemistry and safety of bleach as well as alternative therapies are examined.
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16
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Tom WL. Atopic dermatitis: recent findings and insights. Pediatr Ann 2012; 41:e1-5. [PMID: 22224486 DOI: 10.3928/00904481-20111209-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Wynnis L Tom
- Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA, USA.
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17
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Jensen JM, Ahrens K, Meingassner J, Scherer A, Bräutigam M, Stütz A, Schwarz T, Fölster-Holst R, Harder J, Gläser R, Proksch E. Differential suppression of epidermal antimicrobial protein expression in atopic dermatitis and in EFAD mice by pimecrolimus compared to corticosteroids. Exp Dermatol 2011; 20:783-8. [PMID: 21707760 DOI: 10.1111/j.1600-0625.2011.01322.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
It has been suggested that the increased rate of bacterial infection in atopic dermatitis (AD) may be caused by reduced antimicrobial protein (AMP) expression. We were interested whether common treatments in AD affect antimicrobial defense. We investigated the effects of topically applied corticosteroids betamethasone valerate (BV) and triamacinolone acetonide (TA) and those of the calcineurin inhibitor pimecrolimus for 3 weeks on AMP expression in AD. BV and TA treatment in AD led to a significant reduction in AMP expression; protein expression of human beta-defensins (hBD)-2 and hBD-3, psoriasin, RNase 7 and cathelicidin LL-37 was below the level in skin of healthy controls. After pimecrolimus treatment, AMP expression was also reduced but less compared to BV and TA; the expression levels of hBD-2, psoriasin and RNase 7 still remained above the control levels. In essential fatty acid-deficient (EFAD) mice, a model of chronic skin barrier disease with inflammation, expression of the mouse beta-defensins mBD-1, mBD-3 and mBD-14 (orthologues for hBD-1, hBD-2 and hBD-3, respectively), was reduced by both treatments, again more pronounced by BV compared to pimecrolimus. In summary, we found that treatment for AD with corticosteroids in human skin and EFAD mice caused a strong reduction in AMPs; reduction was less with pimecrolimus. This result may explain the clinical observation that prolonged treatment with topical corticosteroids sometimes leads to bacterial infection.
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Guttman-Yassky E, Nograles KE, Krueger JG. Contrasting pathogenesis of atopic dermatitis and psoriasis—Part II: Immune cell subsets and therapeutic concepts. J Allergy Clin Immunol 2011; 127:1420-32. [DOI: 10.1016/j.jaci.2011.01.054] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 01/19/2023]
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19
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Long-term management of atopic dermatitis: evidence from recent clinical trials. ACTA ACUST UNITED AC 2011. [DOI: 10.4155/cli.10.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Choi JY, Lee JA, Lee JB, Yun SJ, Lee SC. Anti-Inflammatory Activity ofHouttuynia cordataagainst Lipoteichoic Acid-Induced Inflammation in Human Dermal Fibroblasts. Chonnam Med J 2010. [DOI: 10.4068/cmj.2010.46.3.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jee Young Choi
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Ae Lee
- Department of Dermatology, Chonnam National University Hospital, Research Institute of Clinical Medicine, Gwangju, Korea
| | - Jee Bum Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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