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Bhatt M, Lal K, Silverberg NB. Special Considerations in Atopic Dermatitis in Young Children. Dermatol Clin 2024; 42:611-617. [PMID: 39278714 DOI: 10.1016/j.det.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Atopic dermatitis (AD) begins in early childhood in the majority of children. Addressing AD in small children includes recognition of the early presentations of disease in all skin types, triggers, comorbidities, and therapeutics. These include risk of medication absorption, more xerosis, infections, and creating management plans that are acceptable to parents/caregivers, while offering safety. Vaccination efficacy, safety on systemic agents, growth and development, tactile sensory development, and teething-related facial eruptions of early childhood are additional concerns. Prevention of long-term comorbidities is the highest goal. Using age-based considerations helps support excellence in care and improved patient-parent experience.
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Affiliation(s)
- Mudra Bhatt
- Government Medical College, Bhavnagar, India
| | - Karan Lal
- Affiliated Dermatology, Scottsdale, AZ, USA; Department of Dermatology, Northwell Health, 101 Saint Andrews Lane Floor 1, Glen Cove, NY 11542, USA
| | - Nanette B Silverberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, New York, NY 10028, USA.
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Elizalde-Jiménez IG, Ruiz-Hernández FG, Carmona-Cruz SA, Pastrana-Arellano E, Aquino-Andrade A, Romo-González C, Arias-de la Garza E, Álvarez-Villalobos NA, García-Romero MT. Global Antimicrobial Susceptibility Patterns of Staphylococcus aureus in Atopic Dermatitis: A Systematic Review and Meta-Analysis. JAMA Dermatol 2024:2823597. [PMID: 39320869 PMCID: PMC11425196 DOI: 10.1001/jamadermatol.2024.3360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Importance Individuals with atopic dermatitis are frequently colonized and infected with Staphylococcus aureus. Empirical antibiotic therapy for individuals with atopic dermatitis is common, but data about the antimicrobial susceptibility profiles of S aureus strains isolated from these individuals are scarce for those living in particular geographic areas. Objective To determine the antimicrobial susceptibility of S aureus from individuals with atopic dermatitis and analyze differences according to the income level of the country of origin and the data collection period. Data Sources A meta-analysis of the literature was performed from the inception of the included databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane) to June 20, 2023, using predetermined Medical Subject Headings. Study Selection Studies were included if they reported antibiotic susceptibility profiles of 1 or more S aureus cutaneous isolates from individuals with atopic dermatitis. Articles written in English, Spanish, French, or German were included. Data Extraction and Synthesis Working in pairs, 6 of the authors conducted the data extraction. The guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed. Main Outcomes and Measures The outcome of interest was antimicrobial susceptibility. Results A total of 61 studies reported 4091 S aureus isolates from individuals with atopic dermatitis. For 4 of the 11 commonly used antibiotics (36.4%), antimicrobial susceptibility was 85% or less, including for methicillin (binomial proportion, 0.85 [95% CI, 0.76-0.91]), erythromycin (binomial proportion, 0.73 [95% CI, 0.61-0.83]), fusidic acid (binomial proportion, 0.80 [95% CI, 0.62-0.91]), and clindamycin (binomial proportion, 0.79 [95% CI, 0.65-0.89]). Most studies (46; 75.4%) were conducted in high-income countries. Antimicrobial susceptibility to erythromycin, methicillin, and trimethoprim and sulfamethoxazole was significantly lower in lower middle-income countries and upper middle-income countries. Regarding the temporal trends, 33 studies (54.1%) reported data collected from 1998 to 2010. Antimicrobial susceptibility patterns have not changed over time. Conclusions and Relevance In this systematic review and meta-analysis, antimicrobial susceptibility of S aureus to β-lactams, erythromycin, clindamycin, and fusidic acid may be suboptimal for empirical use in individuals with atopic dermatitis. Significant differences in antimicrobial susceptibility patterns were found in high-income countries and in lower middle-income countries and upper middle-income countries for some antibiotics.
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Affiliation(s)
| | - Fernando Gerardo Ruiz-Hernández
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Monterrey, México
| | - Silvia Angélica Carmona-Cruz
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
- Now with Dermatology, Hospital MAC, Mexico City, Mexico
| | - Elena Pastrana-Arellano
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
- Now with Hospital Adolfo López Mateos ISSSTE, Mexico City, Mexico
| | | | - Carolina Romo-González
- Experimental Bacteriology Laboratory, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Neri Alejandro Álvarez-Villalobos
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Monterrey, México
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Maria Teresa García-Romero
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
- Editorial Fellow, JAMA Dermatology
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Sheikh HM, Jha RK. Triggered Skin Sensitivity: Understanding Contact Dermatitis. Cureus 2024; 16:e59486. [PMID: 38826956 PMCID: PMC11142925 DOI: 10.7759/cureus.59486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Dermatitis, the incendiary reaction of the skin to various components, can manifest in various types, including atopic dermatitis, contact dermatitis, nummular eczema, seborrhoea, and stasis dermatitis. Atopic dermatitis is the most common skin disease in children and has a growing prevalence in recent years. It is characterized by extreme tingling, eczemous skin injuries, dryness of the skin, and a family history of atopic illnesses. Contact dermatitis (CD) is a common, irritating skin disorder caused by allergens and aggravating elements in the environment. It is the most common cause of work-related dermatitis and plays a substantial role in hand and face dermatitis. A complete restorative history is essential for establishing CD and identifying the allergies that cause it. Fix testing, skin tests for fast contact reactions, serum allergen-specific IgE testing, subjective and quantitative evaluation of allergens inside probable items patients were exposed to, and challenge testing are among the other diagnostic techniques. To avoid a breakdown and the continuation of the skin illness, early and suitable therapy is critical. Allergic dermatitis to contact (ACD) develops during the normal, delayed incendiary reaction and has a perplexing etiology. Accurate identification of the allergen that is causing the reaction allows for adequate individual avoidance. The major treatment alternatives continue to be corticosteroids. Nickel-contact dermatitis is an allergic reaction that affects both children and adults. Adverse contact dermatitis (ACD) is a frequent skin reaction to a common allergen that can affect both children and adults. Less than 10% of all diagnostic procedures in pediatric patients involve checking for ACD symptoms. To answer the clinical question, a thorough history is gathered based on appearance, age group, and dermatitis type. According to pediatricians in the US, metals, perfumes, topical antimicrobials, excessive chemicals, and fabric softeners are the most typical allergens.
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Affiliation(s)
- Haris M Sheikh
- College of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan K Jha
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Sun JG, Nie P, Herdewijn P, Li XJ. Exploring the synthetic approaches and clinical prowess of established macrocyclic pharmaceuticals. Eur J Med Chem 2024; 264:116051. [PMID: 38104377 DOI: 10.1016/j.ejmech.2023.116051] [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: 10/06/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
Macrocyclic compounds, characterized by cyclic structures, often originate from either modified forms of unicyclic canonical molecules or natural products. Within the field of medicinal chemistry, there has been a growing fascination with drug-like macrocycles in recent years, primarily due to compelling evidence indicating that macrocyclization can significantly influence both the biological and physiochemical properties, as well as the selectivity, when compared to their acyclic counterparts. The approval of contemporary pharmaceutical agents like Lorlatinib underscore the notable clinical relevance of drug-like macrocycles. Nonetheless, the synthesis of these drug-like macrocycles poses substantial challenges, primarily stemming from the complexity of ring-closing reactions, which are inherently dependent on the size and geometry of the bridging linker, impacting overall yields. Nevertheless, macrocycles offer a promising avenue for expanding the synthetic toolkit in medicinal chemistry, enabling the creation of bioactive compounds. To shed light on the subject, we delve into the clinical prowess of established macrocyclic drugs, spanning various therapeutic areas, including oncology, and infectious diseases. Case studies of clinically approved macrocyclic agents illustrate their profound impact on patient care and disease management. As we embark on this journey through the world of macrocyclic pharmaceuticals, we aim to provide a comprehensive overview of their synthesis and clinical applications, shedding light on the pivotal role they play in modern medicine.
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Affiliation(s)
- Jian-Gang Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Peng Nie
- Medicinal Chemistry, Rega Institute of Medical Research, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Piet Herdewijn
- Medicinal Chemistry, Rega Institute of Medical Research, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Xiao-Jing Li
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
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Sandhu A, Singh P. Oral Prescription Management. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:131-138. [PMID: 38724790 DOI: 10.1007/978-3-031-54513-9_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
The treatment of atopic dermatitis (AD) with oral treatments has been limited in the past due to the increased risk of adverse effects associated with oral agents. However, in recent years, a shift toward the minimization of adverse effects has been explored. Although existing treatment options like oral corticosteroids and Immunosuppressive therapies have been utilized for acute flare-ups of AD, their long-term use is limited by adverse effects and the need for lab monitoring. New systemic treatment options such as Janus kinase (JAK) inhibitors are emerging as a promising therapy, due to their quick onset and antipruritic features. However, the black box warning associated with this medication class requires careful selection of appropriate candidates and patient education despite early favorable safety profiles seen in AD trials. Discussion of other oral agents, like antibiotics and antihistamines, and their role in AD management are also clarified.
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Affiliation(s)
- Aman Sandhu
- Drexel University College of Medicine, Philadelphia, PA, USA.
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Adamson AS. The Economic Impact of Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:91-104. [PMID: 38724787 DOI: 10.1007/978-3-031-54513-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disorder that affects over 30 million people in the United States. Given the large and growing prevalence of AD, the associated economic burden is significant. It has been estimated that AD costs over $5 billion dollars annually. These costs include both direct and indirect costs. Direct costs include prescription medicines, visits to health-care providers, hospitalizations, and transportation. Indirect costs include missed days or lost productivity at work or school, career modification, and reduced quality of life. Understanding and measuring these costs can be accomplished through rigorous economic evaluation, which is the organized process of considering inputs and outcomes of various activities. Economic evaluation has been used to contextualize the burden of AD in society. It has also been used to inform patients, providers, and other stakeholders on how to deliver the most evidence-based, efficient way possible. Understanding the economic impact of atopic dermatitis is an important aspect of delivering high-quality care.
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Affiliation(s)
- Adewole S Adamson
- University of North Carolina Hospitals, Department of Dermatology, Chapel Hill, NC, USA
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Chang QX, Lyu JL, Wu PY, Wen KC, Chang CC, Chiang HM. Coffea arabica Extract Attenuates Atopic Dermatitis-like Skin Lesions by Regulating NLRP3 Inflammasome Expression and Skin Barrier Functions. Int J Mol Sci 2023; 24:12367. [PMID: 37569742 PMCID: PMC10418848 DOI: 10.3390/ijms241512367] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Atopic dermatitis (AD) is a common skin disease worldwide. The major causes of AD are skin barrier defects, immune dysfunction, and oxidative stress. In this study, we investigated the anti-oxidation and anti-inflammation effects of Coffea arabica extract (CAE) and its regulation of the skin barrier and immune functions in AD. In vitro experiments revealed that CAE decreased the reactive oxygen species levels and inhibited the translocation of nuclear factor-κB (NF-κB), further reducing the secretion of interleukin (IL)-1β and IL-6 induced by interferon-γ (IFN-γ)/tumor necrosis factor-α (TNF-α). Moreover, CAE decreased IFN-γ/TNF-α-induced NLR family pyrin domain-containing 3 (NLRP3), caspase-1, high-mobility group box 1 (HMGB1), and receptor for advanced glycation end products (RAGE) expression levels. It also restored the protein levels of skin barrier function-related markers including filaggrin and claudin-1. In vivo experiments revealed that CAE not only reduced the redness of the backs of mice caused by 2,4-dinitrochlorobenzene (DNCB) but also reduced the levels of pro-inflammatory factors in their skin. CAE also reduced transepidermal water loss (TEWL) and immune cell infiltration in DNCB-treated mice. Overall, CAE exerted anti-oxidation and anti-inflammation effects and ameliorated skin barrier dysfunction, suggesting its potential as an active ingredient for AD treatment.
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Affiliation(s)
- Qiao-Xin Chang
- Department of Cosmeceutics, China Medical University, Taichung 406, Taiwan; (Q.-X.C.); (J.-L.L.); (K.-C.W.); (C.-C.C.)
| | - Jia-Ling Lyu
- Department of Cosmeceutics, China Medical University, Taichung 406, Taiwan; (Q.-X.C.); (J.-L.L.); (K.-C.W.); (C.-C.C.)
- Ph.D. Program for Biotechnology Industry, China Medical University, Taichung 406, Taiwan
| | - Po-Yuan Wu
- Department of Dermatology, China Medical University Hospital, Taichung 404, Taiwan;
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Kuo-Ching Wen
- Department of Cosmeceutics, China Medical University, Taichung 406, Taiwan; (Q.-X.C.); (J.-L.L.); (K.-C.W.); (C.-C.C.)
| | - Chang-Cheng Chang
- Department of Cosmeceutics, China Medical University, Taichung 406, Taiwan; (Q.-X.C.); (J.-L.L.); (K.-C.W.); (C.-C.C.)
- School of Medicine, China Medical University, Taichung 404, Taiwan
| | - Hsiu-Mei Chiang
- Department of Cosmeceutics, China Medical University, Taichung 406, Taiwan; (Q.-X.C.); (J.-L.L.); (K.-C.W.); (C.-C.C.)
- Ph.D. Program for Biotechnology Industry, China Medical University, Taichung 406, Taiwan
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Coavoy-Sánchez SA, Cerqueira ARA, Teixeira SA, Santagada V, Andreozzi G, Corvino A, Scognamiglio A, Sparaco R, Caliendo G, Severino B, Costa SKP, Spolidorio LC, Muscará MN. Beneficial Effects of Two Hydrogen Sulfide (H 2S)-Releasing Derivatives of Dexamethasone with Antioxidant Activity on Atopic Dermatitis in Mice. Pharmaceutics 2023; 15:1907. [PMID: 37514093 PMCID: PMC10383635 DOI: 10.3390/pharmaceutics15071907] [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: 05/26/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Hydrogen sulfide (H2S) is particularly produced in the skin, where it participates in the regulation of inflammation, pruritus, cytoprotection, scarring, and angiogenesis. In this study, we compared the effects of dexamethasone (Dex) with two H2S-releasing Dex derivatives in a murine model of atopic dermatitis (AD) induced by topical application of 2,4-dinitrochlorobenzene (DNCB). After sensitization with DNCB, the animals were topically treated for five consecutive days with either the H2S-releasing compounds 4-hydroxy-thiobenzamide (TBZ) and 5-(p-hydroxyphenyl)-1,2-dithione-3-thione (ADT-OH), Dex, or the derivatives Dex-TBZ or Dex-ADT. Topical treatment with equimolar doses of either Dex, Dex-TBZ, or Dex-ADT resulted in similar reductions in dermatitis score, scratching behavior, edema, eosinophilia, splenomegaly, and histological changes. In contrast with Dex, the H2S-releasing derivatives prevented IL-4 elevation and oxidative modification of skin proteins. On an equimolar dose basis, Dex-TBZ, but not Dex-ADT, promoted the elevation of endogenous H2S production and GPx activity. Neither Dex-TBZ nor Dex-ADT decreased GR activity or caused hyperglycemia, as observed with Dex treatment. We conclude that the presence of H2S-releasing moieties in the Dex structure does not interfere with the anti-inflammatory effects of this corticosteroid and adds beneficial therapeutical actions to the parent compound.
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Affiliation(s)
- Silvia Abigail Coavoy-Sánchez
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, SP, Brazil
| | | | - Simone Aparecida Teixeira
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, SP, Brazil
| | - Vincenzo Santagada
- Department of Pharmacy, School of Medicine, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy
| | - Giorgia Andreozzi
- Department of Pharmacy, School of Medicine, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy
| | - Angela Corvino
- Department of Pharmacy, School of Medicine, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy
| | - Antonia Scognamiglio
- Department of Pharmacy, School of Medicine, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy
| | - Rosa Sparaco
- Department of Pharmacy, School of Medicine, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy
| | - Giuseppe Caliendo
- Department of Pharmacy, School of Medicine, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy
| | - Beatrice Severino
- Department of Pharmacy, School of Medicine, Università degli Studi di Napoli "Federico II", 80131 Naples, Italy
| | - Soraia Katia Pereira Costa
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, SP, Brazil
| | - Luis Carlos Spolidorio
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara 14801-903, SP, Brazil
| | - Marcelo Nicolás Muscará
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, SP, Brazil
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Bondarev AD, Attwood MM, Jonsson J, Chubarev VN, Tarasov VV, Liu W, Schiöth HB. Recent developments of phosphodiesterase inhibitors: Clinical trials, emerging indications and novel molecules. Front Pharmacol 2022; 13:1057083. [PMID: 36506513 PMCID: PMC9731127 DOI: 10.3389/fphar.2022.1057083] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
The phosphodiesterase (PDE) enzymes, key regulator of the cyclic nucleotide signal transduction system, are long-established as attractive therapeutic targets. During investigation of trends within clinical trials, we have identified a particularly high number of clinical trials involving PDE inhibitors, prompting us to further evaluate the current status of this class of therapeutic agents. In total, we have identified 87 agents with PDE-inhibiting capacity, of which 85 interact with PDE enzymes as primary target. We provide an overview of the clinical drug development with focus on the current clinical uses, novel molecules and indications, highlighting relevant clinical studies. We found that the bulk of current clinical uses for this class of therapeutic agents are chronic obstructive pulmonary disease (COPD), vascular and cardiovascular disorders and inflammatory skin conditions. In COPD, particularly, PDE inhibitors are characterised by the compliance-limiting adverse reactions. We discuss efforts directed to appropriately adjusting the dose regimens and conducting structure-activity relationship studies to determine the effect of structural features on safety profile. The ongoing development predominantly concentrates on central nervous system diseases, such as schizophrenia, Alzheimer's disease, Parkinson's disease and fragile X syndrome; notable advancements are being also made in mycobacterial infections, HIV and Duchenne muscular dystrophy. Our analysis predicts the diversification of PDE inhibitors' will continue to grow thanks to the molecules in preclinical development and the ongoing research involving drugs in clinical development.
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Affiliation(s)
- Andrey D. Bondarev
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Misty M. Attwood
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Jörgen Jonsson
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | | | | | - Wen Liu
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden
| | - Helgi B. Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, Uppsala, Sweden,*Correspondence: Helgi B. Schiöth,
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Ewig CL, Wong KS, Chan PH, Leung TF, Cheung YT. Chronic Medication Use and Factors Associated With Polypharmacy Among Outpatient Pediatric Patients. J Pediatr Pharmacol Ther 2022; 27:537-544. [PMID: 36042954 PMCID: PMC9400180 DOI: 10.5863/1551-6776-27.6.537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 01/23/2022] [Indexed: 02/05/2024]
Abstract
OBJECTIVE This study aimed to determine the prevalence and predictors of chronic polypharmacy among pediatric patients in an outpatient setting. METHODS We conducted a review of medications dispensed to patients from an outpatient pediatric facility during a 12-month period. Patients who received chronic medications (≥30 days' supply), which contained at least 1 active pharmaceutical ingredient were included in the study. Descriptive analysis was used to determine prevalence of polypharmacy while predictive factors for polypharmacy were evaluated using logistic regression. RESULTS Our study included 3920 patients (median age, 9.9 years; IQR, 9.4) and 16,401 medications. The median number of chronic medications used among our study cohort was 2.0 (IQR, 1) with polypharmacy identified in 309 (7.9%) patients. Predictors for polypharmacy were age and the use of certain therapeutic class of medications. Patients 12 to <19 years old (OR, 6.95; 95% CI, 4.1-10.1) were more likely to require ≥5 concurrent medications compared with patients younger than 2 years of age. Use of calcium supplements (OR, 21.2; 95% CI, 11.3-39.6), Vitamin D analogues (OR, 14.3; 95% CI, 8.0-25.8), and systemic glucocorticoids (OR, 18.8; 95% CI, 10.7-33.2) were also highly associated with polypharmacy. CONCLUSIONS Adolescents and children with chronic medical conditions who require prolonged systemic glucocorticoids, calcium, and Vitamin D supplements are at higher risk of incurring long-term polypharmacy. This subgroup of pediatric patients may be more vulnerable to the occurrence of negative outcomes resulting from the use of multiple chronic medications.
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Affiliation(s)
- Celeste L.Y. Ewig
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida (CE)
| | - Kai Sang Wong
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong (KSW, PHC, YTC)
| | - Pak Hei Chan
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong (KSW, PHC, YTC)
| | - Ting Fan Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong (TFL)
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong (KSW, PHC, YTC)
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11
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Armstrong J, Rosinski NK, Fial A, Ansah S, Haglund K. Emollients to Prevent Eczema in High-Risk Infants: Integrative Review. MCN Am J Matern Child Nurs 2022; 47:122-129. [PMID: 35081552 DOI: 10.1097/nmc.0000000000000809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS Searches were conducted in September 2021 in PubMed, CINAHL, Cochrane Library, and Web of Science using key word search terms dermatitis, atopic, emollients, petrolatum, and infant, newborn. Inclusion criteria were articles written in English published between 2010 and 2021 that tested emollients in high-risk infants and measured the development of AD. RESULTS Eight primary research articles were included. Six studies were limited by small sample sizes, short-term application of emollients, and short-term follow-up. These studies generated inconclusive results. Two large randomized controlled trials (RCTs) with a combined sample of 3,791 infants found no evidence that early, regular use of emollients prevents AD among high-risk infants. CLINICAL IMPLICATIONS Findings from two high-quality RCTs indicate that clinicians should not recommend use of emollients to prevent AD. Clinicians may provide evidence-based recommendations for infant skin care, including bathe with water or a combination of water and liquid cleanser formulated for infants, and avoid soaps. Products applied to skin should be free of scent and contact allergens. Petroleum jelly or mineral oil is appropriate to moisturize infants' skin as needed.
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Chaturvedi S, Khan S, Bhunia RK, Kaur K, Tiwari S. Metabolic engineering in food crops to enhance ascorbic acid production: crop biofortification perspectives for human health. PHYSIOLOGY AND MOLECULAR BIOLOGY OF PLANTS : AN INTERNATIONAL JOURNAL OF FUNCTIONAL PLANT BIOLOGY 2022; 28:871-884. [PMID: 35464783 PMCID: PMC9016690 DOI: 10.1007/s12298-022-01172-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
Ascorbic acid (AsA) also known as vitamin C is considered as an essential micronutrient in the diet of humans. The human body is unable to synthesize AsA, thus solely dependent on exogenous sources to accomplish the nutritional requirement. AsA plays a crucial role in different physiological aspects of human health like bone formation, iron absorption, maintenance and development of connective tissues, conversion of cholesterol to bile acid and production of serotonin. It carries antioxidant properties and is involved in curing various clinical disorders such as scurvy, viral infection, neurodegenerative diseases, cardiovascular diseases, anemia, and diabetes. It also plays a significant role in COVID-19 prevention and recovery by improving the oxygen index and enhancing the production of natural killer cells and T-lymphocytes. In plants, AsA plays important role in floral induction, seed germination, senescence, ROS regulation and photosynthesis. AsA is an essential counterpart of the antioxidant system and helps to defend the plants against abiotic and biotic stresses. Surprisingly, the deficiencies of AsA are spreading in both developed and developing countries. The amount of AsA in the major food crops such as wheat, rice, maize, and other raw natural plant foods is inadequate to fulfill its dietary requirements. Hence, the biofortification of AsA in staple crops would be feasible and cost-effective means of delivering AsA to populations that may have limited access to diverse diets and other interventions. In this review, we endeavor to provide information on the role of AsA in plants and human health, and also perused various biotechnological and agronomical approaches for elevating AsA content in food crops.
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Affiliation(s)
- Siddhant Chaturvedi
- Plant Tissue Culture and Genetic Engineering Lab, National Agri-
Food Biotechnology Institute (NABI), Department of Biotechnology, Ministry of Science and Technology (Government of India), Sector-81, Knowledge City, S.A.S. Nagar, Mohali, Punjab, 140306 India
- Department of Biotechnology, Panjab University, Chandigarh, 160014 India
| | - Shahirina Khan
- Plant Tissue Culture and Genetic Engineering Lab, National Agri-
Food Biotechnology Institute (NABI), Department of Biotechnology, Ministry of Science and Technology (Government of India), Sector-81, Knowledge City, S.A.S. Nagar, Mohali, Punjab, 140306 India
- Department of Botany, Central University of Punjab, Bathinda, Punjab, 151001 India
| | - Rupam Kumar Bhunia
- Plant Tissue Culture and Genetic Engineering Lab, National Agri-
Food Biotechnology Institute (NABI), Department of Biotechnology, Ministry of Science and Technology (Government of India), Sector-81, Knowledge City, S.A.S. Nagar, Mohali, Punjab, 140306 India
| | - Karambir Kaur
- Plant Tissue Culture and Genetic Engineering Lab, National Agri-
Food Biotechnology Institute (NABI), Department of Biotechnology, Ministry of Science and Technology (Government of India), Sector-81, Knowledge City, S.A.S. Nagar, Mohali, Punjab, 140306 India
| | - Siddharth Tiwari
- Plant Tissue Culture and Genetic Engineering Lab, National Agri-
Food Biotechnology Institute (NABI), Department of Biotechnology, Ministry of Science and Technology (Government of India), Sector-81, Knowledge City, S.A.S. Nagar, Mohali, Punjab, 140306 India
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Singh AM, Anvari S, Hauk P, Lio P, Nanda A, Sidbury R, Schneider L. Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps-A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:697-706. [PMID: 35101439 DOI: 10.1016/j.jaip.2021.12.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/20/2022]
Abstract
Allergists are often asked to evaluate children with atopic dermatitis (AD) for allergen triggers to disease. Testing, particularly for food triggers, often leads to elimination diets in an effort to improve AD control. However, the dual exposure hypothesis suggests that oral tolerance to food antigens is promoted through high-dose oral exposure, where sensitization occurs through lower dose cutaneous exposure. This suggests that strict elimination diets may pose some risks in children with AD. In addition, emerging evidence suggests an important role of skin inflammation in further allergic disease and the importance of dietary exposure to maintain oral tolerance. This work group report reviews current guidelines-based management for children with moderate-to-severe AD, the evidence for current recommendations for the evaluation and management of these children, provides a nuanced examination of these studies, and addresses current knowledge gaps in the care of these children.
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Affiliation(s)
- Anne Marie Singh
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Departments of Dermatology and Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Health, American Family Children's Hospital, Madison, Wisconsin.
| | - Sara Anvari
- Department of Pediatrics, Division of Immunology, Allergy, and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Pia Hauk
- Department of Pediatrics, Section of Allergy/Immunology, University of Colorado School of Medicine, Colorado Children's Hospital, Aurora, Colorado
| | - Peter Lio
- Medical Dermatology Associates of Chicago and Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas and Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Sidbury
- Department of Pediatrics, Division of Dermatology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Lynda Schneider
- Boston Children's Hospital, Department of Pediatrics, Division of Immunology, Harvard Medical School, Boston, Massachusetts
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New Strategies for Improving Budesonide Skin Retention. Pharmaceutics 2021; 14:pharmaceutics14010030. [PMID: 35056927 PMCID: PMC8781796 DOI: 10.3390/pharmaceutics14010030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
The aim of this work was to evaluate the ex vivo effect of the combination of two strategies, complexation with cyclodextrin, and poloxamer hydrogels, for improving water solubility in the dermal absorption of budesonide. Two hydrogels containing 20% poloxamer 407, alone or in combination with poloxamer 403, were prepared. Each formulation was loaded with 0.05% budesonide, using either pure budesonide or its inclusion complex with hydroxypropyl-β-cyclodextrin, and applied in finite dose conditions on porcine skin. The obtained results showed that for all formulations, budesonide accumulated preferentially in the epidermis compared to the dermis. The quantity of budesonide recovered in the receptor compartment was, in all cases, lower than the LOQ of the analytical method, suggesting the absence of possible systemic absorption. The use of a binary poloxamer mixture reduced skin retention, in line with the lower release from the vehicle. When the hydrogels were formulated with the inclusion complex, an increase in budesonide skin retention was observed with both hydrogels. Poloxamer hydrogel proved to be a suitable vehicle for cutaneous administration of budesonide.
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Torales J, Malvido K, Santos-Muñoz A, Gonzalez-Urbieta I, Barrios I, Almirón-Santacruz J, García O, Castaldelli-Maia JM, Ventriglio A, O'Higgins M. Atopic dermatitis in psychodermatology: a concise review for dermatologists. Ital J Dermatol Venerol 2021; 157:301-305. [PMID: 34761667 DOI: 10.23736/s2784-8671.21.07139-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atopic Dermatitis (AD) is a chronic disease of the skin with significant pruritus and phases of exacerbation and remission. The hallmarks of AD are changes in the epithelial barrier and chronic inflammation. This condition is associated with an increased risk of developing mental disorders such as depression, anxiety, and suicidal ideation. It has been proposed that psychological stress may impact on immunological factors with an up-regulation of mediating neuropeptides at the level of central nervous system and secondary involvement of endocrine glands, peripheral nervous system, and immune resident skin cells. This article provides a concise review for dermatologists on the psychodermatology of AD, in order to highlight the putative common pathways between the dermatologic and mental health issues in this illness.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Karina Malvido
- Center for Continuing Medical Education and Clinical Research Norberto Quirno, Buenos Aires, Argentina
| | | | - Israel Gonzalez-Urbieta
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - José Almirón-Santacruz
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João M Castaldelli-Maia
- Department of Neuroscience, Fundação do ABC, Santo André, Brazil.,Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay -
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Management of Pediatric Atopic Dermatitis by Primary Care Providers: A Systematic Review. Acad Pediatr 2021; 21:1318-1327. [PMID: 34280477 DOI: 10.1016/j.acap.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/14/2021] [Accepted: 07/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary care providers (PCPs), including pediatricians and general practitioners, are often the first to see children with eczema/atopic dermatitis (AD). Little is known about management of pediatric AD by PCPs and adherence to national guidelines. OBJECTIVE To review existing literature examining management components of pediatric AD (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], antihistamines, bathing, emollients, and diet) by PCPs. DATA SOURCES PubMed/Medline and Embase. STUDY ELIGIBILITY CRITERIA English-language articles dated 2015 to 2020 reporting outcomes addressing management of pediatric AD by PCPs. STUDY APPRAISAL AND SYNTHESIS METHODS Two authors independently screened titles/abstracts, reviewed full-text articles, extracted relevant data, and evaluated study quality. Disagreements were resolved by a third author. RESULTS Twenty articles were included. Surveys and national database analyses were the most common methodologies (n = 7 each). PCPs commonly prescribed TCS but had a preference for low-potency agents, overprescribed nonsedating antihistamines, and avoided TCIs. PCPs commonly recommended emollients, although this was not universal. Data characterizing nonmedication management were limited. LIMITATIONS Most studies did not examine individual patient encounters, but rather relied on providers reporting their general behaviors. Provider behavior may vary based on country of practice. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Knowledge and management gaps exist among PCPs in treating pediatric AD in key areas including knowledge of TCS safety profiles and prescribing of TCIs. The current literature is largely limited to small studies that evaluate prescribing behaviors with limited data characterizing nonmedication management, highlighting the need for future research in this area.
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17
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Croce EA, Levy ML, Adamson AS, Matsui EC. Reframing racial and ethnic disparities in atopic dermatitis in Black and Latinx populations. J Allergy Clin Immunol 2021; 148:1104-1111. [PMID: 34600773 DOI: 10.1016/j.jaci.2021.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023]
Abstract
Black people in the United States experience greater atopic dermatitis (AD) prevalence, severity, and persistence when compared with White people. Although very little published literature describes AD in the Latinx population, additional differences in severity, persistence, and age of onset exist in contrast to White people. Thus far, genetic polymorphisms associated with increased risk and/or severity of AD are less common among Black people, so should confer reduced, rather than the observed increased, AD risk among Black people. Little is known regarding genetic risk factors in Latinx people. In contrast, there is consistent evidence that socioeconomic, environmental, and health care factors influence AD prevalence, severity, and/or persistence, and these same risk factors are more common among racial and ethnic minority populations as a result of racism. Researchers too often pursue genetic explanations for racial and ethnic AD disparities when the evidence points to the importance of contextual, rather than genetic, causes of these disparities. Reframing the prevailing view that innate differences among racial and ethnic groups are responsible for these disparities by emphasizing the role of racism and its downstream effects on contextual factors will be a critical first step toward shrinking these disparities.
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Affiliation(s)
- Emily A Croce
- The University of Texas at Austin, School of Nursing, Austin, Tex; Dell Children's Medical Group, Austin, Tex
| | - Moise L Levy
- Dell Children's Medical Group, Austin, Tex; The University of Texas at Austin Dell Medical School, Austin, Tex
| | | | - Elizabeth C Matsui
- Dell Children's Medical Group, Austin, Tex; The University of Texas at Austin Dell Medical School, Austin, Tex.
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18
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Yang T, Huang X, Xu J, Situ M, Xiao Q, Kural KC, Kang Y. Explore the Underlying Mechanism Between Atopic Dermatitis and Major Depressive Disorder. Front Genet 2021; 12:640951. [PMID: 34122503 PMCID: PMC8194260 DOI: 10.3389/fgene.2021.640951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
Adult patients with atopic dermatitis (AD) present relatively higher rates of major depressive disorder (MDD). However, the underlying mechanism is largely unknown. Here, we first conducted a systematic literature-based data mining to identify entities linking AD and MDD, including proteins, cells, functional classes, and small molecules. Then we conducted an AD-RNA expression data-based mega-analysis to test the expression variance of the genes that were regulators of MDD. After that, a Fisher Exact test-based pathway enrichment analysis (PEA) was performed to explore the AD-driven MDD-genetic regulators’ functionality. We identified 22 AD-driven entities that were up-stream MDD regulators, including 11 genes, seven small molecules, three functional classes, and one cell. AD could exert a promoting effect on the development of MDD. Four of the 11 genes demonstrated significant expression changes in AD patients in favor of the development of MDD. PEA results showed that AD mainly drives cytokine/chemokine regulation and neuroinflammatory response-related pathways to influence the pathological development of MDD. Our results supported the promotion role of AD in the pathological development of MDD, including the regulation of multiple genetic regulators of MDD involved in cytokine/chemokine regulation and inflammatory response.
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Affiliation(s)
- Tao Yang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuehua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiajun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingjing Situ
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingqing Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Kamil Can Kural
- School of Systems Biology, George Mason University, Fairfax, VA, United States
| | - Yan Kang
- Human Biochemical Genetics Section, National Institutes of Health, Bethesda, MD, United States
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19
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Salloum S, Hatcher V. Rickets and gross motor delay in a child with atopic dermatitis. Oxf Med Case Reports 2021; 2021:omaa143. [PMID: 33614053 PMCID: PMC7885143 DOI: 10.1093/omcr/omaa143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/21/2020] [Accepted: 12/12/2020] [Indexed: 11/15/2022] Open
Abstract
We report a case of a 14-month-old boy with atopic dermatitis (AD) who presented to our hospital with hypocalcemic tetany and gross motor delay. Further laboratory and imaging confirmed the diagnosis of vitamin D deficiency and rickets. He was breastfeeding and on a restricted diet due to presumed multiple food allergies. He received calcium and vitamin D supplementation which corrected his hypocalcemia. The patient developed Staphylococcus aureus bacteremia and superficial septic thrombophlebitis for which he was treated with antibiotics and anticoagulation. An elimination diet should be avoided in AD patients as true food-induced AD is rare and management should focus on optimal skincare. AD patients have a higher rate of S. aureus skin colonization, which increases their risk for infectious complications. This case also highlights the importance of maintaining a high index of suspicion for rickets in children with isolated gross motor delay, especially in those with risk factors.
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Affiliation(s)
- Shafee Salloum
- Department of Pediatric Hospital Medicine, Dayton Children's Hospital, Dayton, OH, USA
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20
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Chong JH. Atopic dermatitis in children: when topical steroid treatment "does not work". BMJ 2021; 372:n297. [PMID: 33602868 DOI: 10.1136/bmj.n297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jin Ho Chong
- Raffles Children's Centre, Raffles Hospital, Singapore
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21
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Effects of variations in access to care for children with atopic dermatitis. BMC DERMATOLOGY 2020; 20:24. [PMID: 33341118 PMCID: PMC7749983 DOI: 10.1186/s12895-020-00114-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Background An estimated 50% of children in the US are Medicaid-insured. Some of these patients have poor health literacy and limited access to medications and specialty care. These factors affect treatment utilization for pediatric patients with atopic dermatitis (AD), the most common inflammatory skin disease in children. This study assesses and compares treatment patterns and healthcare resource utilization (HCRU) between large cohorts of Medicaid and commercially insured children with AD. Methods Pediatric patients with AD were identified from 2 large US healthcare claims databases (2011–2016). Included patients had continuous health plan eligibility for ≥6 months before and ≥12 months after the first AD diagnosis (index date). Patients with an autoimmune disease diagnosis within 6 months of the index date were excluded. Treatment patterns and all-cause and AD-related HCRU during the observation period were compared between commercially and Medicaid-insured children. Results A minority of children were evaluated by a dermatology or allergy/immunology specialist. Several significant differences were observed between commercially and Medicaid-insured children with AD. Disparities detected for Medicaid-insured children included: comparatively fewer received specialist care, emergency department and urgent care center utilization was higher, a greater proportion had asthma and non-atopic morbidities, high- potency topical corticosteroids and calcineurin inhibitors were less often prescribed, and prescriptions for antihistamines were more than three times higher, despite similar rates of comorbid asthma and allergies among antihistamine users. Treatment patterns also varied substantially across physician specialties. Conclusions Results suggest barriers in accessing specialty care for all children with AD and significant differences in management between commercially and Medicaid-insured children. These disparities in treatment and access to specialty care may contribute to poor AD control, especially in Medicaid-insured patients. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12895-020-00114-x.
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22
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Chapman TJ, Morris MC, Xu L, Pichichero ME. Nasopharyngeal colonization with pathobionts is associated with susceptibility to respiratory illnesses in young children. PLoS One 2020; 15:e0243942. [PMID: 33306743 PMCID: PMC7732056 DOI: 10.1371/journal.pone.0243942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
Some children are more susceptible to viral and bacterial respiratory infections in the first few years of life than others. However, the factors contributing to this susceptibility are incompletely understood. In a retrospective analysis of clinical samples collected from a prospectively-enrolled cohort of 358 children we sought associations between physician-attended illness visits and bacterial colonization in the first five years of life. A subset of children was identified by unsupervised clustering analysis as infection and allergy prone (IAP). Several respiratory infection- and allergy-mediated illnesses co-occurred at higher rates in IAP children, while the rates of other illnesses were not significantly different between the groups. Analyses of nasopharyngeal (NP) pathobionts and microbiota commensals showed that early age of first colonization with pathobionts Streptococcus pneumonia, non-typeable Haemophilus influenzae, and Moraxella catarrhalis was associated with IAP children, and particularly Moraxella abundance was negatively associated with NP microbiome diversity. We conclude that mucosal pathobiont exposures in early life can influence susceptibility to respiratory illnesses in children.
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Affiliation(s)
- Timothy J. Chapman
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States of America
| | - Matthew C. Morris
- Center for Clinical Systems Biology, Rochester General Hospital Medical Office Building, Rochester, NY, United States of America
| | - Lei Xu
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States of America
| | - Michael E. Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, United States of America
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23
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Ngo HTT, Hwang E, Kang H, Park B, Seo SA, Yi TH. Anti-inflammatory Effects of Achillea millefolium on Atopic Dermatitis-Like Skin Lesions in NC/Nga Mice. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:1121-1140. [PMID: 32668966 DOI: 10.1142/s0192415x2050055x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Achillea millefolium L. (AM) is an aromatic herb with a variety of pharmacological properties, such as anti-inflammatory and anti-allergic activities. However, AM's effects on atopic dermatitis (AD) have not been investigated. This study evaluates the anti-AD activity of 50% ethanol-extracted AM in murine macrophage Raw 264.7 cells, in tumor necrosis factor-alpha/interferon-gamma (TNF-[Formula: see text]/IFN-[Formula: see text])-stimulated human immortal keratinocyte HaCaT cells in vitro, and in Biostir-AD-treated NC/Nga mice in vivo. The results showed that AM significantly downregulated expression of pro-inflammatory cytokines, such as INOS, COX-2, and interleukin (IL)-6 in lipopolysaccharide (LPS)-treated Raw 264.7 cells. The mRNA expressions of INOS, COX-2, and IL-6 decreased by 76.1%, 69.3%, and 31.8%, respectively. Overexpression of chemokines, such as activation-regulated chemokine and macrophage-derived chemokine, regulated on activation of normal T-cell expressed and secreted, and IL-8 was inhibited by 70.01%, 52.91%, 73.53%, and 18.93%, respectively, in TNF-[Formula: see text]/IFN-[Formula: see text]-stimulated HaCaT cells by downregulating the mitogen-activated protein kinase, I[Formula: see text]B[Formula: see text], and the signal transducer and activator of transcription 1 signaling pathways. AD-like symptoms, such as elevated serum immunoglobin E levels, epidermal thickening, high dermatitis severity score, transepidermal water loss, and reduced skin hydration, were relieved by the dietary administration of AM in Biostir-AD-treated NC/Nga mice. In addition, filaggrin expression increased significantly in AM-treated groups. These results suggest that AM could be a useful candidate for AD treatment.
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Affiliation(s)
- Hien T T Ngo
- Graduate School of Biotechnology, Kyung Hee University, Gyeonggi-do 17104, Republic of Korea
| | - Eunson Hwang
- Graduate School of Biotechnology, Kyung Hee University, Gyeonggi-do 17104, Republic of Korea
| | - Hyungoo Kang
- Graduate School of Biotechnology, Kyung Hee University, Gyeonggi-do 17104, Republic of Korea
| | - Bom Park
- Graduate School of Biotechnology, Kyung Hee University, Gyeonggi-do 17104, Republic of Korea
| | - Seul A Seo
- Graduate School of Biotechnology, Kyung Hee University, Gyeonggi-do 17104, Republic of Korea
| | - Tae-Hoo Yi
- Graduate School of Biotechnology, Kyung Hee University, Gyeonggi-do 17104, Republic of Korea
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24
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The Effect of Atopy in the Prevalence of Contact Sensitization: The Experience of a Greek Referral Center. Dermatol Res Pract 2020; 2020:3946084. [PMID: 33133180 PMCID: PMC7568788 DOI: 10.1155/2020/3946084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
Contact dermatitis is a well-known skin condition, which is related to stimuli and environmental exposure to chemicals, affecting all ages as well as both genders. In the present work, we attempt to investigate the patterns of contact sensitization, with respect to the personal history of atopy (AT), in Greece in a large number of allergens, using patch testing. The retrospective analysis included clinical routine data of 1978 patients collected from 2014 to 2016 in the Laboratory of Patch Testing, National Referral Centre of Occupational Dermatoses. Sensitization, in all cases, was tested with 28 allergens of the European baseline series as adjusted to our local circumstances and clinical experience. A total population of 1978 patients was evaluated, with a male-to-female ratio of 0.45 (1359 females/619 males). From our patient cohort, 693 (35%) patients were evaluated with a history of atopy, while 1285 (65%) were nonatopic. The five most prevalent allergens in the total population without AT were nickel sulphate 5% (15.47%), fragrance mix (I) 8% (9.10%), balsam of Peru (6.47%), cobalt chloride 1% (4.70%), and thiomersal 0.1% (4.10%). Respectively, in the total population with AT, the five most prevalent allergens were nickel sulphate 5% (10.36%), fragrance mix (I) 8% (5.11%), balsam of Peru (3.29%), thiomersal 0.1% (3.03%), and cobalt chloride 1% (2.78%). Contact dermatitis surveillance is of great importance towards the clinical and systematic understanding of the disease. Further studies should be directed towards that end, in order to facilitate more effective health policies.
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25
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Fu X, Hong C. Osthole attenuates mouse atopic dermatitis by inhibiting thymic stromal lymphopoietin production from keratinocytes. Exp Dermatol 2020; 28:561-567. [PMID: 30825337 DOI: 10.1111/exd.13910] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/07/2019] [Accepted: 02/21/2019] [Indexed: 12/21/2022]
Abstract
Atopic dermatitis is one of the most common skin diseases. Dysregulation of immune system and chronic inflammation were believed to be associated with atopic dermatitis. Osthole was reported to play important roles in antitumor and anti-inflammation. However, whether osthole has effects on atopic dermatitis remains unclear. In this present study, we explored the biological role of osthole in atopic dermatitis and the molecular mechanism. Atopic dermatitis was induced by 2,4-dinitrochlorobenzene. Pathological damage of ear was detected by H&E staining. IgE level in serum or thymic stromal lymphopoietin (TSLP) level in supernatant was detected by ELISA. Interleukin (IL)-4 expression and IL-13 expression in CD4+ T cells were detected using flow cytometry. The expression levels of mRNA or protein levels were detected by RT-PCR or Western blot. Osthole attenuated atopic dermatitis development in mouse model. Osthole inhibits Th2 cell response, but have on influence on Th1 or Th17 cell response in the skin. In mouse model, osthole treatment significantly inhibited atopic dermatitis via directly inhibiting TLSP expression levels in keratinocytes. Osthole treatment alleviates atopic dermatitis through directly down-regulating TSLP production from keratinocytes. Osthole may serve as a potential choice for atopic dermatitis treatment in clinic.
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Affiliation(s)
- Xiangping Fu
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Chaohui Hong
- Quanzhou Medical College People's Hospital Affiliated, Quanzhou, Fujian, China
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26
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Croce EA, Rew L. Sociocultural Influences on Disparities in United States Children with Atopic Dermatitis: A Narrative Review of the Literature. Compr Child Adolesc Nurs 2020:1-16. [PMID: 32809868 DOI: 10.1080/24694193.2020.1799113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Approximately 13% of United States (US) children have atopic dermatitis (AD), also known as eczema. AD is a chronic skin condition associated with significant burdens on quality of life and both individual and overall health-care system costs. The pathogenesis of AD is considered to be multifactorial, with biologic factors such as family history and genetics often reported as influencing risk. Some lesser discussed determinants of AD prevalence and severity are sociocultural, such as race/ethnicity, neighborhood, housing type, income level, and family structure. While several factors appear to contribute to disparities in childhood AD, black or African American race/ethnicity most significantly predicts AD prevalence, severity, disease control, access to care, and family impact. There is a shortage of research related to disparities in AD, an important topic considering the large percentage of families that are affected by the disease. This article is a narrative literature review of sociocultural influences on AD disparities in US children. The purpose of this review is to increase awareness of these important risk factors and to suggest related, future areas of research that may positively impact overall outcomes in children with AD. Much work remains to be done in order to ensure equitable care and outcomes among all children with AD.
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Affiliation(s)
- Emily A Croce
- Pediatric and Adolescent Dermatology, Dell Children's Medical Group, Austin, Texas, USA
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Lynn Rew
- Denton & Louise Cooley and Family Centennial Professor of Nursing, The University of Texas at Austin School of Nursing, Austin, Texas, USA
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Utine CA, Li G, Asbell P, Pflugfelder S, Akpek E. Ocular surface disease associated with dupilumab treatment for atopic diseases. Ocul Surf 2020; 19:151-156. [PMID: 32439390 DOI: 10.1016/j.jtos.2020.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022]
Abstract
Dupilumab is the first US FDA approved biologic for treatment of atopic dermatitis. It is a human monoclonal antibody which blocks the shared receptor component, the interleukin (IL)-4α subunit, of IL-4 and IL-13 signaling pathways. Occurrence of "conjunctivitis", mostly in atopic dermatitis trials, has been the main side effect reported thus far. The etiology of "conjunctivitis" associated with dupilumab treatment is unclear and might be similar to atopic keratoconjunctivitis. There is evidence in the published literature that unlike the Th2-like profile in vernal keratoconjunctivitis, Th1-mediated inflammation is predominant in atopic keratoconjunctivitis. Blocking the Th2 pathway with dupilumab therapy might result in a shift towards Th1, causing the ocular findings associated with dupilumab. In addition, blockage of IL-13 might have implications with regards to mucin production and ocular surface health. This review highlights the clinical manifestations, reviews treatment options and offers explanations for pathogenesis of this ocular surface diseases associated with dupilumab treatment.
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Affiliation(s)
- Canan Asli Utine
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey; Izmir Biomedicine and Genome Center, Izmir, Turkey
| | - Gavin Li
- The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Penny Asbell
- The Hamilton Eye Institute, The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Esen Akpek
- The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Enhancement of Chemokine mRNA Expression by Toll-Like Receptor 2 Stimulation in Human Peripheral Blood Mononuclear Cells of Patients with Atopic Dermatitis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1497175. [PMID: 32280674 PMCID: PMC7115052 DOI: 10.1155/2020/1497175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/09/2020] [Indexed: 11/18/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease which is often associated with Staphylococcus aureus (S. aureus) colonization. S. aureus ingredients are potential ligands to activate the Toll-like receptor 2 (TLR2) and drive inflammatory cytokine or chemokine production. However, the role of TLR2-mediated chemokine expression in AD development has not been systematically investigated. In this study, we sought to determine the mode of TLR2-mediated chemokine expression in AD patients. Human peripheral blood mononuclear cells (PBMCs) were isolated from AD patients and healthy controls. Upon incubation with TLR2 ligands Pam3CSK4 and PGN, mRNA expression of chemokines, including CCL1, CCL5, CCL8, CCL13, CCL17, CCL18, CCL22, and CCL27, were determined by quantitative real-time polymerase chain reaction (qRT-PCR) analysis. The results showed that basal mRNA expression of CCL17 in PBMCs from AD patients was upregulated compared with healthy controls, while those of CCL8 and CCL13 were downregulated. When stimulated with TLR2 ligands, the mRNA expression of CCL5, CCL8, CCL13, CCL18, and CCL22 in PBMCs from AD patients was significantly higher than those from healthy controls. The different basal chemokine mRNA expression profiles indicate the different immune status in patients with AD compared with healthy controls. Excessive chemokine mRNA expression induced by TLR2 activation is associated with the development of AD.
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Abstract
Atopic dermatitis (AD) is the most common inflammatory skin condition in pediatric patients. AD has long been associated with comorbidities including food allergies, asthma, and allergic rhinitis, but recent literature has expanded this list to include attention-deficit/hyperactivity disorder and depression. AD has tremendous impact on quality of life for both affected children and their families. Improved understanding of AD pathogenesis, particularly regarding skin barrier dysfunction, the role of the cutaneous microbiome, and immune dysregulation, has spawned exciting new therapeutic directions. Although good skin care and appropriate use of topical corticosteroids remain first-line treatment, more precisely targeted treatments hold great promise. A recently approved topical phosphodiesterase inhibitor, crisaborole, and a subcutaneously administered interleukin-4/interleukin-13 blocker, dupilumab, are the first of what will likely be many new treatment options for patients with AD. [Pediatr Ann. 2020;49(3):e140-e146.].
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30
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Conceptual Model to Illustrate the Symptom Experience and Humanistic Burden Associated With Atopic Dermatitis in Adults and Adolescents. Dermatitis 2020; 30:247-254. [PMID: 31261226 PMCID: PMC6641086 DOI: 10.1097/der.0000000000000486] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental digital content is available in the text. Atopic dermatitis (AD) is a pruritic or painful dermatologic disease characterized by xerosis and eczema lesions. The symptoms/signs of AD can significantly impact patients' health-related quality of life (HRQoL). This study aimed to qualitatively explore the adult and adolescent experience of AD. A targeted literature review and qualitative concept elicitation interviews with clinicians (n = 5), adult AD patients (n = 28), and adolescent AD patients (n = 20) were conducted to elicit AD signs/symptoms and HRQoL impacts experienced. Verbatim transcripts were analyzed using thematic analysis. Twenty-nine symptoms/signs of AD were reported, including pruritus, pain, erythema, and xerosis. Atopic dermatitis symptoms/signs were reported to substantially impact HRQoL. Scratching was reported to influence the experience of symptoms and HRQoL impacts. Four proximal impacts (including discomfort and sleep disturbance) were reported. Ten domains of distal impact were reported, including impacts on psychological and social functioning and activities of daily living. A conceptual model was developed to summarize these findings. This study highlights the range of symptoms and HRQoL impacts experienced by adults and adolescents with AD. To our knowledge, this study was first to explore the lived experience of AD in both adult and adolescent patients, providing valuable insight into the relatively unexplored adolescent experience of AD.
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Park J, Youn DH, Kang J, Ahn KS, Kwak HJ, Um JY. Taeumjowi-tang, a Traditional Korean Sasang Remedy, Improves Obesity-Atopic Dermatitis Comorbidity by Regulating Hypoxia-Inducible Factor 1 Alpha. Front Pharmacol 2019; 10:1458. [PMID: 31920651 PMCID: PMC6933016 DOI: 10.3389/fphar.2019.01458] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022] Open
Abstract
Atopic dermatitis (AD) is an inflammatory disease of the skin, resulting from an immune dysfunction, that often occurs as a comorbidity of obesity. This investigation evaluated the capacity of Taeumjowi-tang (TJT), a Korean herbal formulation from the Sasang medical tradition to influence prognostic features of AD and obesity in a mouse model. Here, obesity and AD were induced by a high-fat diet (HFD) and 1-fluoro-2,4-dinitrobenzene (DNFB). Following an 8-week HFD regimen and 4 weeks of DNFB administration, the comorbid (CO) group manifested increased body weight and AD-like lesions, as compared to normal control (NC) mice, while TJT administration diminished these symptoms of obesity and AD. Specifically, TJT treatment reduced epidermal thickness and eosinophil/mast cell infiltration, along with reduction in immunoglobulin E, interleukin (IL)-4, IL-6, and tumor necrosis factor-alpha (TNF-α). It was additionally demonstrated that TJT suppresses HFD/DNFB-associated increase of the inflammation-related nuclear factor-kappa beta (NF-κB) and mitogen activated protein kinase. Moreover, significantly increased levels of hypoxia inducible factor-1 alpha (HIF-1α) protein was observed in CO group versus controls, an increase significantly down-regulated by TJT-treatment. These outcomes suggest that TJT may prove useful in clinical management of obesity-AD comorbidity treatment, an effect that may be due to regulation of HIF-1α expression.
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Affiliation(s)
- Jinbong Park
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Comorbidity Research Institute, Kyung Hee University, Seoul, South Korea
| | - Dong-Hyun Youn
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Comorbidity Research Institute, Kyung Hee University, Seoul, South Korea
| | - JongWook Kang
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Kwang Seok Ahn
- Comorbidity Research Institute, Kyung Hee University, Seoul, South Korea
| | - Hyun Jeong Kwak
- Department of Life Science, College of Natural Sciences, Kyonggi University, Suwon, South Korea
| | - Jae-Young Um
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Comorbidity Research Institute, Kyung Hee University, Seoul, South Korea
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32
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Pashirzad M, Shafiee M, Avan A, Ryzhikov M, Fiuji H, Bahreyni A, Khazaei M, Soleimanpour S, Hassanian SM. Therapeutic potency of crocin in the treatment of inflammatory diseases: Current status and perspective. J Cell Physiol 2019; 234:14601-14611. [PMID: 30673132 DOI: 10.1002/jcp.28177] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/10/2019] [Indexed: 01/24/2023]
Abstract
Crocin is the major component of saffron, which is used in phytomedicine for the treatment of several diseases including diabetes, fatty liver, depression, menstruation disorders, and, of special interest in this review, inflammatory diseases. Promising selective anti-inflammatory properties of this pharmacological active component have been observed in several studies. Saffron has been shown to exert anti-inflammatory properties against several inflammatory diseases and can be used as a novel therapeutic agent for the treatment of inflammatory diseases either alone or in combination with other standard anti-inflammatory agents. This review summarizes the protective role of saffron and its pharmacologically active constituents in the pathogenesis of inflammatory diseases including digestive diseases, dermatitis, asthma, atherosclerosis, and neurodegenerative diseases for a better understanding and hence a better management of these diseases.
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Affiliation(s)
- Mehran Pashirzad
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Shafiee
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Modern Sciences and Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mikhail Ryzhikov
- Division of Pulmonary and Critical Care Medicine, Washington University, School of Medicine, Saint Louis, Missouri
| | - Hamid Fiuji
- Department of Biochemistry, Payame-Noor University, Mashhad, Iran
| | - Amirhossein Bahreyni
- Department of Clinical Biochemistry and Immunogenetic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Majid Khazaei
- Department of Medical Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Soleimanpour
- Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Celiksoy MH, Topal E, Hazıroglu Okmen Z, Alataş C, Demirtaş MS. Characteristics of persistent diaper dermatitis in children with food allergy. Pediatr Dermatol 2019; 36:602-606. [PMID: 30488541 DOI: 10.1111/pde.13733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Diaper dermatitis is often caused by irritant contact occurring beneath the diaper of an infant, and it is aggravated by factors such as dampness, friction, urea, and feces. Food-allergic patients are known to exhibit various skin lesions ranging from urticaria to eczema. This study aims to determine the relationship between persistent diaper dermatitis and food allergy. METHODS A retrospective chart review was conducted of pediatric patients with a diagnosis of persistent diaper dermatitis between August 2015 and November 2017. RESULTS The study included 157 patients diagnosed with persistent diaper dermatitis (67 male, 72 female; median age: 13 months). Diaper dermatitis was more common and included the whole perineum in children who had multiple food allergies (P = 0.001). In children with multiple food allergies, the course of diaper dermatitis was more severe, and the condition did not respond to topical treatment (P = 0.025). A longer elimination diet was required for patients with Type I reactions and persistent diaper dermatitis (P = 0.018). In patients with Type II and mixed reactions, diaper dermatitis was more diffuse and covered the whole perineum (P = 0.025). In patients with Type II and mixed reactions, diaper dermatitis was more severe and did not respond to topical treatment (P = 0.025). CONCLUSIONS Persistent diaper dermatitis lasting longer than a month may be associated with food allergy. The diaper rash may also be the only indicator of the food allergy. Elimination of the responsible food may allow these patients to recover from persistent diaper dermatitis.
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Affiliation(s)
- Mehmet Halil Celiksoy
- Department of Pediatric Allergy and Immunology, Gaziosmanpasa Taksim Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy and Immunology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Zeynep Hazıroglu Okmen
- Department of Pediatrics, Gaziosmanpasa Taksim Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Cem Alataş
- Department of Pediatrics, Medical Faculty, Inonu University, Malatya, Turkey
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34
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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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35
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Skin lesions difficult to diagnose or treat for pediatricians. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.596265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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van Halewijn KF, Bohnen AM, van den Berg PJ, Pasmans SGMA, Bindels PJE, Elshout G. Different potencies of topical corticosteroids for a better treatment strategy in children with atopic dermatitis (the Rotterdam Eczema study): protocol for an observational cohort study with an embedded randomised open-label controlled trial. BMJ Open 2019; 9:e027239. [PMID: 31221882 PMCID: PMC6588953 DOI: 10.1136/bmjopen-2018-027239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Topical corticosteroids (TCS) of different potencies are the main treatment to control atopic dermatitis (AD). The Dutch guideline on AD for general practitioners (GPs) recommends a stepwise approach in which treatment steps are tailored to the severity of the disease, starting with the lowest possible potency of TCS. However, it remains unclear whether the recommended stepwise approach is most efficient. This randomised open-label controlled trial aims to determine whether a potent TCS is more effective than a low-potency TCS in the initial treatment of children with a moderate flare-up of AD in primary care. In the observational cohort, the overall aim is to determine the frequency, burden and determinants of flare-ups of AD during follow-up. METHODS AND ANALYSIS The study is an observational cohort study with an embedded pragmatic randomised controlled, open-label trial. Eligible are patients diagnosed with AD (aged 12 weeks to 18 years) who visited the GP for AD or received repeated prescriptions for AD in the previous 12 months; follow-up of the cohort is 1 year. Children are enrolled in the trial if they have a flare-up of AD during follow-up in the cohort. Eligible children are randomised to the intervention group (with a potent TCS once daily) or to the GP guideline group (with a low potency TCS once daily). Primary outcome is the difference in average subjective disease severity over 24 weeks follow-up in the trial, measured with the patient-oriented eczema measure. As secondary outcome, the Eczema Area and Severity Index is measured. ETHICS AND DISSEMINATION This study tests the hypothesis that immediate treatment with a potent TCS during a flare-up of AD leads to faster and more efficacious results as compared with starting with a TCS with low potency with less overall use of TCS. The study protocol is approved by the Medical Ethics Committee (MEC) of the Erasmus Medical Center Rotterdam, the Netherlands (MEC-2017-328). The results of the study will be published in international peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER NTR: 6679; Pre-results.
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Affiliation(s)
| | - Arthur M Bohnen
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Patrick J E Bindels
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gijs Elshout
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
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Liu L, Luo Y, Zhou M, Lu Y, Xing M, Ru Y, Sun X, Chen X, Li S, Hong S, Wang S, Li F, Li B, Li X. Tripterygium agents for the treatment of atopic eczema: A Bayesian analysis of randomized controlled trials. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 59:152914. [PMID: 30991183 DOI: 10.1016/j.phymed.2019.152914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/24/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Atopic eczema is a common and recrudescent skin disorder. Tripterygium agents (TA), extracted from Tripterygium wilfordii hook F, a traditional Chinese medicine, have been used as a supplemental therapy for treating eczema empirically in recent years. PURPOSE To investigate the efficacy and safety of TA for treating atopic eczema. STUDY DESIGN Systematic review and Bayesian analysis. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Chinese Scientific Journals Database, the Wan Fang Database, and Chinese Biomedicine databases were systematically searched from their respective inception dates to October 2, 2018. Randomized controlled trials (RCTs) related to TA used alone or in combination with other drugs were included. Meta-analysis was conducted by RevMan 5.3 software, and Bayesian analysis was performed in Stata 15.0 and R (V.3.4.0) package gemtc software. The Cochrane risk-of-bias tool and Jadad score were applied to assess the quality of all trials. RESULTS Thirteen trials involving 1385 patients were analyzed. Meta-analysis showed that, when treating atopic eczema patients, TA combined with other drugs were strongly synergistic (p < 0.00001). Among all combinations, the efficacy of TA combined with Diyin tablet (DYP) and topical glucocorticoids (TG) (RR: 0.06, 95%CI [0.01, 0.53]), as well as with compound glycyrrhizin (CG) (RR: 0.36, 95%CI [0.14,0.94]) was superior. Among the different combined medications, the best curative effect was achieved with TA combined with DYP and TG (98.2%), followed by TA combined with CG (85.3%), with TG (51.0%), or with Fuyang granule (FG) (49.9%). Reproductive system dysfunction was the main adverse events in patients treated with TA (RR: 6.23, 95%CI [1.12, 34.62]). Immunoglobulin E (IgE) levels were significantly decreased, after treatment with TA (p = 0.04). Subgroup analysis indicated no statistically significant difference in eczema-related cytokines (p = 0.44). Recurrence rates of using TA and other drugs were similar (p = 0.40). CONCLUSION TA appear to be effective in some therapies when treating patients with atopic eczema, but with apparent side effects. It cannot be concluded that TA can be generally used for eczema in the clinic, because of the small sample size. Further multi-center studies with large samples, and high-quality RCTs should be conducted to clarify the efficacy and safety of TA for treating eczema.
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Affiliation(s)
- Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Mi Zhou
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yi Lu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Meng Xing
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Xiaoying Sun
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xi Chen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Su Li
- Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Seokgyeong Hong
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Shoumei Wang
- Department of Pathology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Fulun Li
- Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China; Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai 201203, China.
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38
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Traisaeng S, Herr DR, Kao HJ, Chuang TH, Huang CM. A Derivative of Butyric Acid, the Fermentation Metabolite of Staphylococcus epidermidis, Inhibits the Growth of a Staphylococcus aureus Strain Isolated from Atopic Dermatitis Patients. Toxins (Basel) 2019; 11:toxins11060311. [PMID: 31159213 PMCID: PMC6628397 DOI: 10.3390/toxins11060311] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 12/20/2022] Open
Abstract
The microbiome is a rich source of metabolites for the development of novel drugs. Butyric acid, for example, is a short-chain fatty acid fermentation metabolite of the skin probiotic bacterium Staphylococcus epidermidis (S. epidermidis). Glycerol fermentation of S. epidermidis resulted in the production of butyric acid and effectively hindered the growth of a Staphylococcus aureus (S. aureus) strain isolated from skin lesions of patients with atopic dermatitis (AD) in vitro and in vivo. This approach, however, is unlikely to be therapeutically useful since butyric acid is malodorous and requires a high concentration in the mM range for growth suppression of AD S. aureus. A derivative of butyric acid, BA–NH–NH–BA, was synthesized by conjugation of two butyric acids to both ends of an –NH–O–NH– linker. BA–NH–NH–BA significantly lowered the concentration of butyric acid required to inhibit the growth of AD S. aureus. Like butyric acid, BA–NH–NH–BA functioned as a histone deacetylase (HDAC) inhibitor by inducing the acetylation of Histone H3 lysine 9 (AcH3K9) in human keratinocytes. Furthermore, BA–NH–NH–BA ameliorated AD S. aureus-induced production of pro-inflammatory interleukin (IL)-6 and remarkably reduced the colonization of AD S. aureus in mouse skin. These results describe a novel derivative of a skin microbiome fermentation metabolite that exhibits anti-inflammatory and S. aureus bactericidal activity.
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Affiliation(s)
- Supitchaya Traisaeng
- Department of Life Sciences, National Central University, Taoyuan 32001, Taiwan.
| | - Deron Raymond Herr
- Department of Pharmacology, National University of Singapore, Singapore 117600, Singapore.
| | - Hsin-Jou Kao
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan 32001, Taiwan.
| | - Tsung-Hsien Chuang
- Immunology Research Center, National Health Research Institutes, Zhunan, Miaoli 35053, Taiwan.
| | - Chun-Ming Huang
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan 32001, Taiwan.
- Department of Dermatology, University of California, San Diego 3525 John Hopkins Court, Rm276, San Diego, CA 92121, USA.
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Kim HY, Rho SH, Lim JH, Park HJ, Jeong HJ. Protective effect of linoleic acid against inflammatory reactions by mast cell via caspase-1 cascade pathways. J Food Biochem 2019; 43:e12932. [PMID: 31368553 DOI: 10.1111/jfbc.12932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022]
Abstract
Blockade of caspase-1 was reported to be a new target for allergic inflammation treatment. Here, we present the effect of linoleic acid (LA), a constituent of Allium hookeri (AH), to alleviate mast cell-mediated allergic inflammation. Pretreatment of LA and AH significantly reduced caspase-1 activation without displaying host cell cytotoxicity in activated human mast cells. IC50 value of LA on caspase-1 activity is 0.014 μM. LA and AH pretreatment effectively regulated increased levels of interleukin (IL)-1β, IL-6, IL-8, thymic stromal lymphopoietin, and tumor necrosis factor on activated human mast cells. Moreover, LA and AH were effective against activations of nuclear factor-κB and mitogen-activated protein kinases in human mast cells. In summary, LA and AH alleviate allergic inflammatory reactions via blocking caspase-1 cascade signaling pathway. These results provide evidence for the anti-allergic inflammatory properties of LA and AH and corroborate its potential use for the treatment and prevention of allergic diseases. PRACTICAL APPLICATIONS: Allium hookeri (AH) is used as traditional food to treat various diseases and contains an essential fatty acid, linoleic acid (LA). LA and AH alleviate mast cell-mediated allergic inflammatory reactions via inhibiting inflammatory mediators. These results provide evidence for the anti-allergic inflammatory properties of LA and AH and corroborate its potential use for the treatment and prevention of allergic diseases.
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Affiliation(s)
- Hee-Yun Kim
- Department of Pharmacology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Ho Rho
- School of Life Science and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Jin-Ho Lim
- Division of Food and Pharmaceutical Engineering, Hoseo University, Asan, Republic of Korea
| | - Hyun Jin Park
- School of Life Science and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Hyun-Ja Jeong
- Division of Food and Pharmaceutical Engineering, Hoseo University, Asan, Republic of Korea
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40
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Qi Y, Kong J, He J. Genetic relationship between IL-10 gene polymorphisms and the risk of clinical atopic dermatitis. BMC MEDICAL GENETICS 2019; 20:83. [PMID: 31101031 PMCID: PMC6525399 DOI: 10.1186/s12881-019-0817-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/30/2019] [Indexed: 01/02/2023]
Abstract
Background We retrieved different reports containing different genetic effects of − 1082 A/G, − 819 T/C, and − 592 A/C polymorphisms within the IL-10 (interleukin-10) gene on the susceptibility to clinical atopic dermatitis. Methods Herein, we conducted a meta-analysis to comprehensively assess such a genetic relationship after collecting the available published evidence. STATA 12.0 software was used for the statistical analysis under the allelic, homozygotic, heterozygotic, dominant, recessive and carrier genetic models. Results By retrieving and screening database literature, a total of 16 eligible case-control studies were finally selected. For the IL-10 -1082 A/G polymorphism, we did not detect a significant difference between atopic dermatitis cases and population-based controls in the overall meta-analysis under the genetic models of allele G vs. A (P = 0.540), GG vs. AA (P = 0.853), AG vs AA (P = 0.265), AG + GG vs AA (P = 0.221), GG vs AA+AG (P = 0.540) and carrier G vs. A (P = 0.643). Moreover, a statistically non-significant association was observed in the most subgroup meta-analyses by the factors of ethnicity, country and Hardy-Weinberg equilibrium. Likewise, the negative results were detected for the synthetic analysis of IL-10 -819 T/C and − 592 C/A polymorphisms. Conclusion The current evidence does not support a strong genetic relationship between IL-10 -1082 A/G, − 819 T/C and − 592 A/C polymorphisms and the susceptibility to atopic dermatitis. Electronic supplementary material The online version of this article (10.1186/s12881-019-0817-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuqing Qi
- Department of Dermatology and Venereology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, People's Republic of China
| | - Jie Kong
- Department of Dermatology and Venereology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, People's Republic of China
| | - Jinyan He
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Tianjin Medical University, No. 22 Qixiangtai Road, Tianjin, 300070, People's Republic of China.
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Moradkhani S, Jafarzadeh A, Bazargan-Harandi N, Baneshi MR, Mohammadi MM. Association of reduced count of interleukin-13-producing cells in breast milk with atopic dermatitis in infancy. Indian J Med Res 2019; 148:317-322. [PMID: 30425222 PMCID: PMC6251272 DOI: 10.4103/ijmr.ijmr_1682_16] [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] [Indexed: 12/31/2022] Open
Abstract
Background & objectives Atopic dermatitis (AD) is one of the most common pathologic conditions of skin in children. The effect of breastfeeding on the risk of AD remains controversial. The aim of this study was to determine the counts of cytokine-producing cells in the mothers' breast milk of infants with and without AD to assess association, if any. Methods Breast milk samples (10 ml) were obtained from mothers of 25 infants with AD and of 26 healthy infants as a control group. The number of cytokine-producing cells including interferon-gamma (IFN-γ), tumour necrosis factor-alpha (TNF-α), interleukin-13 (IL-13) and IL-4 in the milk samples was determined using an enzyme-linked immunospot assay technique. Results The mean of IL-13-producing cells in milk was significantly lower in mothers of AD-affected infants in comparison with mothers of normal infants (324.91±255.45 vs. 538.93±465.39, P<0.05). There were no significant differences between mothers of infants with and without AD regarding milk count of IFN-γ-, TNF-α- and IL-4-producing cells. Interpretation & conclusions Our results showed lower number of IL-13-producing cells in milk of mothers of infants with AD. Therefore, lower count of IL-13-producing cells in mothers' milk may confer a susceptibility to AD. Further studies with a large number of samples need to be done to confirm our findings.
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Affiliation(s)
- Sepideh Moradkhani
- Department of Immunology; Cardiovascular Research Center, Institute of Basic and Clinical Physiology, Kerman, Iran
| | - Abdollah Jafarzadeh
- Department of Microbiology & Immunology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Mohammad Reza Baneshi
- Modeling in Health Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Mahdi Mohammadi
- Department of Immunology; Physiology Research Center, Institute of Basic and Clinical Physiology, Kerman, Iran
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Davallow Ghajar L, Wood Heickman LK, Conaway M, Rogol AD. Low Risk of Adrenal Insufficiency After Use of Low- to Moderate-Potency Topical Corticosteroids for Children With Atopic Dermatitis. Clin Pediatr (Phila) 2019; 58:406-412. [PMID: 30694073 DOI: 10.1177/0009922818825154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to assess the risk of adrenal insufficiency (AI) with short-term use of low- to moderate-potency topical corticosteroids (TCS) for treatment of atopic dermatitis. Our systematic literature search revealed 9 studies (n = 371) that evaluated AI using adrenocorticotropic hormone stimulation testing, with measures of serum cortisol levels at baseline and following at least 2 weeks of TCS application. Biochemical AI was defined by a stimulated cortisol level of ≤18.0 µg/dL (~500 nmol/L). The overall proportion of AI with low-to-moderate TCS use was 2.7% (95% confidence interval = 1.47% to 4.89%). None of the children showed any clinical evidence of AI or adrenal crisis. Short-term use of low- to moderate-potency TCS for the treatment of atopic dermatitis is associated with a low risk of adrenal suppression. General practitioners do not need to test these patients for adrenal suppression in the absence of concerning signs and symptoms of AI.
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Affiliation(s)
| | | | - Mark Conaway
- 1 University of Virginia, Charlottesville, VA, USA
| | - Alan D Rogol
- 1 University of Virginia, Charlottesville, VA, USA
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43
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Witte M, Krause L, Zillikens D, Shimanovich I. Black tea dressings - a rapidly effective treatment for facial dermatitis. J DERMATOL TREAT 2019; 30:785-789. [PMID: 30668184 DOI: 10.1080/09546634.2019.1573306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Facial dermatitis is a common dermatologic condition. It is usually treated with either topical corticosteroids or calcineurin inhibitors. However, the use of these drugs is limited by side effects, including skin atrophy, local immunosuppression and possible oncogenicity. Objective: The aim of the study was to evaluate the use of wet dressings with black tea for treating facial dermatitis. Methods: We performed a prospective, open, uncontrolled before-after study enrolling 22 patients with atopic or contact facial dermatitis who were treated with black tea dressings and an emollient cream over 6 days. Disease severity was assessed using the (1) Facial Eczema Area and Severity Index, (2) Visual analog scale for pruritus, (3) Investigator`s Global Assessment score, and (4) Patient's Self-Assessment score. The study was registered at www.ClinicalTrials.gov as NCT02941432. Results: A dramatic and highly significant reduction of all four disease activity scores occurred within the first 3 days of treatment and the patients continued to improve between days 3 and 6. No side effects were observed. Conclusion: Black tea dressings represent an effective treatment option for facial dermatitis. Its advantages include lack of side effects, low cost, and easy availability.
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Affiliation(s)
- Mareike Witte
- Department of Dermatology, University of Lübeck , Lübeck , Germany
| | - Laura Krause
- Department of Dermatology, University of Lübeck , Lübeck , Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck , Lübeck , Germany
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Glines KR, Stiff KM, Freeze M, Cline A, Strowd LC, Feldman SR. An update on the topical and oral therapy options for treating pediatric atopic dermatitis. Expert Opin Pharmacother 2019; 20:621-629. [PMID: 30601075 DOI: 10.1080/14656566.2018.1561868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Atopic dermatitis (AD) is one of the most common childhood skin disorders. Multiple mechanisms contribute to the pathology of AD and treatment approaches are directed at these processes. AREAS COVERED The purpose of this review is to discuss the chemical treatment options for pediatric atopic dermatitis, including immunomodulators and small molecule inhibitors. A systematic literature search was conducted, and publications were reviewed for applicable treatment guidelines. EXPERT OPINION Topical therapy is first-line for pediatric atopic dermatitis. Providers should work closely with patients and caregivers to promote the success of topical treatments. In disease refractory to topical treatments, systemic agents may be considered. Clinical trials are ongoing for the use of biologics in the treatment of pediatric AD. When choosing the most appropriate treatment, physicians should consider the drug efficacy, potential adverse effects, patient adherence, and quality of life for both patients and caregivers. Additional studies are required to determine the safest and most effective doses for systemic therapy in childhood AD.
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Affiliation(s)
- Katelyn R Glines
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Katherine M Stiff
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Megan Freeze
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Abigail Cline
- a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Lindsay C Strowd
- 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 Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,c Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA
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45
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Cheong JYV, Hie SL, Koh EW, de Souza NNA, Koh MJA. Impact of pharmacists' counseling on caregiver's knowledge in the management of pediatric atopic dermatitis. Pediatr Dermatol 2019; 36:105-109. [PMID: 30408232 DOI: 10.1111/pde.13708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common skin condition in childhood. AD management can be complex, and caregivers may have inadequate information on the disease, aggravating factors, and management. Comprehensive therapeutic education has been closely associated with increased compliance and is recommended for all patients. There are, as yet, no studies on the impact of a pharmacist-led eczema counseling service. OBJECTIVES The primary objective was to assess the impact of a pharmacist-led eczema counseling service on improving caregivers' knowledge. The secondary objective was to evaluate caregivers' satisfaction of the service and their confidence in handling the patient's condition after counseling. METHODS This was a prospective, questionnaire-based observational study. After obtaining informed consent, caregivers were required to complete questionnaire A, containing items on demographics and knowledge assessment. Caregivers then underwent a counseling session by a dermatology-trained pharmacist. After counseling, caregivers were required to complete questionnaire B containing items on satisfaction and confidence level. A follow-up phone call was conducted after initial counseling session, during which knowledge-based questionnaire C would be completed. RESULTS Data from 32 participants were included in the analysis. There was a significant improvement in caregivers' knowledge score after receiving counseling, with mean precounseling score of 8.38 ± 3.92 and mean postcounseling score of 13.88 ± 3.65 (P < 0.001). Majority was satisfied with the service and was confident in handling their child's condition. CONCLUSION Pharmacist-led eczema counseling has a positive impact on caregiver's knowledge and can lead to improved compliance. The service was well received, although more time could be spent during the counseling.
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Affiliation(s)
| | - Szu Liang Hie
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore
| | - En Wei Koh
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore
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Brown J, Weitz NW, Liang A, Stockwell MS, Friedman S. Does an Eczema Action Plan Improve Atopic Dermatitis? A Single-Site Randomized Controlled Trial. Clin Pediatr (Phila) 2018; 57:1624-1629. [PMID: 30141340 DOI: 10.1177/0009922818795906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The multitude of treatment options for atopic dermatitis (AD) makes management frustrating for providers and patients. Eczema action plans (EAPs) have been proposed to improve parental and provider management. We developed a single-site randomized controlled trial to evaluate the impact of an EAP on quality of life (QOL), provider knowledge, and comfort with AD management. Providers were randomized into an EAP-use group and a traditional care group. All patients completed validated AD QOL surveys, and those with AD were verbally administered the survey 1 month later. Providers' perceptions on managing AD were compared in the EAP and usual use groups. Parents in the EAP group demonstrated a significantly increased understanding of AD treatment, and providers in the EAP group had a significantly increased understanding and management of AD. The EAP is a feasible tool that can be integrated into a busy clinic practice with a positive impact on physicians and patients.
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Affiliation(s)
- Julia Brown
- 1 Mount Sinai Health System, New York, NY, USA
| | - Nicole W Weitz
- 2 UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Amy Liang
- 3 Columbia University Medical Center, New York, NY, USA
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47
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Clinical-pathological and immunological biomarkers in dogs with atopic dermatitis. Vet Immunol Immunopathol 2018; 205:58-64. [DOI: 10.1016/j.vetimm.2018.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022]
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48
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Li H, Zuo J, Tang W. Phosphodiesterase-4 Inhibitors for the Treatment of Inflammatory Diseases. Front Pharmacol 2018; 9:1048. [PMID: 30386231 PMCID: PMC6199465 DOI: 10.3389/fphar.2018.01048] [Citation(s) in RCA: 310] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/30/2018] [Indexed: 12/25/2022] Open
Abstract
Phosphodiesterase-4 (PDE4), mainly present in immune cells, epithelial cells, and brain cells, manifests as an intracellular non-receptor enzyme that modulates inflammation and epithelial integrity. Inhibition of PDE4 is predicted to have diverse effects via the elevation of the level of cyclic adenosine monophosphate (cAMP) and the subsequent regulation of a wide array of genes and proteins. It has been identified that PDE4 is a promising therapeutic target for the treatment of diverse pulmonary, dermatological, and severe neurological diseases. Over the past decades, numerous PDE4 inhibitors have been designed and synthesized, among which roflumilast, apremilast, and crisaborole were approved for the treatment of inflammatory airway diseases, psoriatic arthritis, and atopic dermatitis, respectively. It is regrettable that the dramatic efficacies of a drug are often accompanied by adverse effects, such as nausea, emesis, and gastrointestinal reactions. However, substantial advances have been made to mitigate the adverse effects and obtain better benefit-to-risk ratio. This review highlights the dialectical role of PDE4 in drug discovery and the disquisitive details of certain PDE4 inhibitors to provide an overview of the topics that still need to be addressed in the future.
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Affiliation(s)
- Heng Li
- Laboratory of Anti-inflammation, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China.,School of Pharmacy, University of Chinese Academy of Sciences, Beijing, China
| | - Jianping Zuo
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing, China.,Laboratory of Immunopharmacology, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Wei Tang
- Laboratory of Anti-inflammation, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China.,School of Pharmacy, University of Chinese Academy of Sciences, Beijing, China.,Open Studio for Druggability Research of Marine Natural Products, Pilot National Laboratory for Marine Science and Technology, Qingdao, China
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49
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Yang EJ, Sekhon S, Sanchez IM, Beck KM, Bhutani T. Recent Developments in Atopic Dermatitis. Pediatrics 2018; 142:peds.2018-1102. [PMID: 30266868 DOI: 10.1542/peds.2018-1102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/24/2022] Open
Abstract
Atopic dermatitis (AD) is a bothersome and common skin disease affecting ∼10.7% of children in the United States. This skin condition significantly decreases quality of life in not only patients, but in their families as well. Pediatricians are often the first physicians to diagnose and manage these patients and thus are relied on by families to answer questions about this disease. AD is complex, multifactorial, and has historically had limited therapeutic options, but the landscape of this disease is now rapidly changing. Pathways contributing to the pathogenesis of this disease are continually being discovered, and new therapies for AD are being developed at an unprecedented rate. With this article, we will review the current guidelines regarding the management of AD, outline updates in the current understanding of its pathophysiology, and highlight novel developments available for the treatment of this burdensome disease.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California, San Francisco, San Francisco, California; .,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and
| | - Sahil Sekhon
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Isabelle M Sanchez
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Kristen M Beck
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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50
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Skin Deep: Simplifying Practice Guidelines for Children With Atopic Dermatitis. J Pediatr Health Care 2018; 32:507-514. [PMID: 30177012 DOI: 10.1016/j.pedhc.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
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