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Lazar M, Zhang AD, Vashi NA. Topical Treatments in Atopic Dermatitis: An Expansive Review. J Clin Med 2024; 13:2185. [PMID: 38673458 PMCID: PMC11050343 DOI: 10.3390/jcm13082185] [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: 03/19/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Atopic dermatitis (AD) is a common inflammatory skin condition found worldwide. It impacts patient quality of life (QoL) and is thought to arise as an inflammatory response to epidermal barrier dysfunction and hypersensitivity. AD can lead to large out-of-pocket costs and increased healthcare expenses over a lifetime. An analysis of all randomized control trials conducted since 1990 on topical therapies for AD were reviewed, including 207 trials in the final analysis. It was found that an average of 226 patients were enrolled over 2.43 arms. Common topical treatments included corticosteroids, calcineurin inhibitors, JAK inhibitors, and phosphodiesterase inhibitors. The most utilized tools to identify treatment efficacy were the EASI, IGA, SCORAD, and PGA. There was a paucity of data on trials that evaluated efficacy, QoL, and cost of treatment simultaneously. This review highlights the need for comprehensive trials that evaluate multiple aspects of treatment, including financial cost and QoL impact, to ensure each patient has the best treatment modality for the management of their AD.
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Affiliation(s)
| | | | - Neelam A. Vashi
- Department of Dermatology, Boston University School of Medicine, 609 Albany St., J502, Boston, MA 02118, USA
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2
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Lapeere H, Speeckaert R, Baeck M, Dezfoulian B, Lambert J, Roquet-Gravy PP, Stockman A, White J, Castelijns F, Gutermuth J. Belgian atopic dermatitis guidelines. Acta Clin Belg 2024; 79:62-74. [PMID: 37997950 DOI: 10.1080/17843286.2023.2285576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/13/2023] [Indexed: 11/25/2023]
Abstract
Atopic dermatitis (AD) is one of the most common, bothersome and difficult to treat skin disorders. Recent introduction of new systemic treatments has revolutionized the management of AD. The goal of this guideline is to provide evidence-based recommendations for the management of patients suffering from atopic dermatitis that easily can be implemented in clinical practice. These recommendations were developed by 11 Belgian AD experts. Comments of all experts on the proposed statements were gathered, followed by an online voting session. The most relevant strategies for the management and treatment of AD in the context of the Belgian health care landscape are discussed. General measures, patient education and adequate topical treatment remain the cornerstones of AD management. For moderate to severe AD, the introduction of biologics and JAK inhibitors show unprecedented efficacy, although currently access is limited to a subgroup of patients meeting the reimbursement criteria.
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Affiliation(s)
- Hilde Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | | | - Marie Baeck
- Department of Dermatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bita Dezfoulian
- Department of Dermatology, Liège University Hospital, Liège, Belgium
| | - Julien Lambert
- Department of Dermatology, University Hospital Antwerp (UZA), Edegem, Belgium
| | | | - Annelies Stockman
- Department of Dermatology, AZ Delta campus Rembert Torhout, Torhout, Belgium
| | - Jonathan White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jan Gutermuth
- Vrije Universiteit Brussel (VUB), Department of Dermatology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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3
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Werfel T, Heratizadeh A, Aberer W, Augustin M, Biedermann T, Bauer A, Fölster-Holst R, Kahle J, Kinberger M, Nemat K, Neustädter I, Peters E, von Kiedrowski R, Schmid-Grendelmeier P, Schmitt J, Schwennesen T, Simon D, Spindler T, Traidl-Hoffmann C, Werner RN, Wollenberg A, Worm M, Ott H. S3 Guideline Atopic dermatitis: Part 1 - General aspects, topical and non-drug therapies, special patient groups. J Dtsch Dermatol Ges 2024; 22:137-153. [PMID: 38171719 DOI: 10.1111/ddg.15230] [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: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 01/05/2024]
Abstract
This S3 guideline was created based on the European S3 guideline, with special consideration of the medical conditions in the German-speaking region and incorporating additions from the previous German-language version. The interdisciplinary guideline commission consisted of representatives from the German Dermatological Society, the Professional Association of German Dermatologists, the Austrian Society of Dermatology and Venereology, the Swiss Society of Dermatology and Venereology, the German Society for Allergology and Clinical Immunology, the German Society for Pediatric and Adolescent Medicine, the Professional Association of Pediatricians and Adolescent Medicine, the Society for Pediatric Allergology and Environmental Medicine, the German Society for Pediatric Rehabilitation and Prevention, the German Society for Psychosomatic Medicine and Medical Psychotherapy, the German Network for Health Services Research, the German Eczema Association and the German Allergy and Asthma Association. This first part of the guideline focuses on the definition and diagnostic aspects of atopic dermatitis (AD), addressing topical therapy as well as non-pharmacological treatment approaches such as UV therapy, psychoeducational therapy, dietary interventions for AD, allergen immunotherapy for AD, and complementary medicine. This part of the guideline also covers specific aspects of AD in children and adolescents, during pregnancy and lactation, and in the context of family planning. Additionally, it addresses occupational aspects of AD and highlights the perspective of the patients. The second part of the guideline, published separately, addresses the systemic therapy of AD.
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Affiliation(s)
- Thomas Werfel
- Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
| | - Annice Heratizadeh
- Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
| | - Werner Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Matthias Augustin
- Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergology, University Medical Center, Technical University of Munich, Munich, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Julia Kahle
- German Allergy and Asthma Association (DAAB), Mönchengladbach, Germany
| | - Maria Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Nemat
- Office for Pediatric Pneumology and Allergology, Pediatric Center Dresden-Friedrichstadt (Kid), Dresden, Germany
| | - Irena Neustädter
- Hospital Hallerwiese, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Eva Peters
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Gießen, Gießen, Germany
| | | | | | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Medical Faculty Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - Dagmar Simon
- Department of Dermatology, Inselspital Bern, Bern, Switzerland
| | - Thomas Spindler
- Specialized Clinic for Pediatric Pneumology and Allergology, Wangen, Germany
| | | | - Ricardo Niklas Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Wollenberg
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
- Department of Dermatology and Allergy, Ludwig Maximilian University Munich, Munich, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hagen Ott
- Department of Pediatric Dermatology and Allergology, Children's and Adolescents' Hospital Auf der Bult, Hannover, Germany
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4
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Werfel T, Heratizadeh A, Aberer W, Augustin M, Biedermann T, Bauer A, Fölster-Holst R, Kahle J, Kinberger M, Nemat K, Neustädter I, Peters E, von Kiedrowski R, Schmid-Grendelmeier P, Schmitt J, Schwennesen T, Simon D, Spindler T, Traidl-Hoffmann C, Werner RN, Wollenberg A, Worm M, Ott H. S3-Leitlinie Atopische Dermatitis: Teil 1- Allgemeine Aspekte, topische und nichtmedikamentöse Therapien, besondere Patientengruppen: S3 guideline Atopic dermatitis: Part 1- General aspects, topical and non-drug therapies, special patient groups. J Dtsch Dermatol Ges 2024; 22:137-155. [PMID: 38212907 DOI: 10.1111/ddg.15230_g] [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: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungDiese S3‐Leitlinie wurde auf der Basis der europäischen S3‐Leitlinie unter besonderer Berücksichtigung der medizinischen Gegebenheiten im deutschsprachigen Raum und mit Ergänzungen der deutschsprachigen Vorgängerversion erstellt. Die interdisziplinäre Leitlinienkommission bestand aus Vertretern der Deutschen Dermatologischen Gesellschaft, dem Berufsverband der Deutschen Dermatologen, der Österreichischen Gesellschaft für Dermatologie und Venerologie, der Schweizerischen Gesellschaft für Dermatologie und Venerologie, der Deutschen Gesellschaft für Allergologie und Klinische Immunologie, der Deutschen Gesellschaft für Kinder‐ und Jugendmedizin, dem Berufsverband der Kinder‐ und Jugendärzte, der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin, der Deutschen Gesellschaft für Pädiatrische Rehabilitation und Prävention, der Deutschen Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie, dem Deutschen Netzwerk Versorgungsforschung, dem Deutschen Neurodermitis Bund und dem Deutschen Allergie‐ und Asthmabund. Dieser erste Teil der Leitlinie geht auf die Definition und die diagnostischen Aspekte der atopischen Dermatitis (AD) ein, behandelt die topische Therapie sowie die nichtmedikamentösen Therapieverfahren wie die UV‐Therapie, die psychoedukative Therapie, diätische Interventionen bei AD, die Allergen‐spezifische Immuntherapie bei AD und die Komplementärmedizin. Auch behandelt dieser Teil der Leitlinie die besonderen Aspekte der AD bei Kindern und Jugendlichen, in der Schwangerschaft und in der Stillzeit sowie bei Kinderwunsch. Außerdem wird auf berufsbezogene Aspekte der AD eingegangen und die Perspektive der Patienten hervorgehoben. Der zweite, separat publizierte Teil der Leitlinie adressiert die systemische Therapie der AD.
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Affiliation(s)
- Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Deutschland
| | - Annice Heratizadeh
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Deutschland
| | - Werner Aberer
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Matthias Augustin
- Kompetenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Deutschland
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Deutschland
| | - Regina Fölster-Holst
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
| | - Julia Kahle
- Deutscher Allergie- und Asthmabund (DAAB) e. V., Mönchengladbach, Deutschland
| | - Maria Kinberger
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Katja Nemat
- Praxis für Kinderpneumologie und Allergologie, Kinderzentrum Dresden-Friedrichstadt (Kid), Dresden, Deutschland
| | - Irena Neustädter
- Klinik Hallerwiese, Cnopfsche Kinderklinik, Nürnberg, Deutschland
| | - Eva Peters
- Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen (UKGM), Gießen, Deutschland
| | | | | | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Gustav Carus, Technische Universität Dresden, Deutschland
| | | | - Dagmar Simon
- Universitätsklinik für Dermatologie, Inselspital Bern, Bern, Schweiz
| | - Thomas Spindler
- Fachklinik für Pädiatrische Pneumologie und Allergologie, Wangen, Deutschland
| | | | - Ricardo Niklas Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Andreas Wollenberg
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwigs-Maximilians-Universität, München, Deutschland
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Hagen Ott
- Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Deutschland
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5
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Emmett ER, Allen M, Crownshaw S, Ridd MJ. How and what adverse events are reported and captured in randomized control trials of emollients in the treatment of eczema? Clin Exp Dermatol 2023; 48:889-894. [PMID: 37075240 PMCID: PMC10359396 DOI: 10.1093/ced/llad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Emollients are universally recommended for atopic dermatitis/eczema ('eczema'), to improve the skin barrier and reduce symptoms. However, our knowledge of the frequency and nature of adverse effects associated with their use is limited. OBJECTIVES We sought to determine how well adverse events are reported in randomized controlled trials (RCTs) of emollients for eczema. METHODS MEDLINE was searched from inception (1946) to May 2022. Inclusion criteria were RCTs of moisturizers or emollients used as a leave-on treatment (as the intervention or control) in adults or children with eczema. Exclusion criteria were non-RCTs; patients with other diagnoses included; use of emollient as bath additives, soap substitutes or as preventative; and not published in English. References of eligible papers were reviewed for any additional, relevant research. Data were extracted into an Excel spreadsheet and analysed descriptively. An assessment of study quality was carried out using the Joanna Briggs Institute tool for RCTs. RESULTS From 369 potential papers, 35 papers (reporting on 34 studies) were included. Most research was conducted in research centres or hospitals (unclear in 34%). In total, 89% reported collecting data on adverse events related to emollient treatment use but the methods used were poorly reported (40% unclear). Four papers used patient questionnaires/diaries. However, it was unclear how and what was collected as only two studies showed the questionnaires used. CONCLUSIONS Reporting of adverse events related to emollient use in trials of patients with eczema is poor and inconsistent. Agreement should be reached on how and what adverse events should be collected, to standardize reporting across studies.
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Affiliation(s)
| | - Megan Allen
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Bristol Medical School, University of Bristol, Bristol, UK
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6
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Hebert AA. Real-World Evidence of an Emollient Device for Atopic and Contact Dermatitis in Pediatric to Adult Patients - Data from a Post-Marketing Surveillance. Clin Cosmet Investig Dermatol 2022; 15:1797-1803. [PMID: 36101562 PMCID: PMC9464441 DOI: 10.2147/ccid.s364934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022]
Abstract
Purpose Atopic and contact dermatitis have been attributed to skin barrier abnormalities, immune system dysfunction and inflammation leading to pruritus. As these factors may involve oxidative stress, emollient devices containing antioxidants furfuryl palmitate and tocopherol may help reduce itching and inflammation. In this study, a post-marketing questionnaire was carried out of 40 users of a novel emollient device containing furfuryl palmitate and tocopherol (Relizema™ cream), who purchased it from a pharmacy or health-care professional to ascertain the emollient device's action on itching, flushing and moisturizing. Patients and Methods The post-marketing questionnaire, administered by trained pharmacy and health-care staff, collected data on age; diagnosis; number of times per day and for how many days the emollient device was applied; whether the product helped alleviate itching and flushing, and in what time frame if so; and how their skin felt after using the emollient. Results Most patients had atopic dermatitis (n = 25) or irritant contact dermatitis (n = 10); most were aged ≥19 years (n = 20) or between 3 and 12 years (n = 12). Most used the emollient device twice a day (n = 26) or more (n = 11) with 27 using it for ≤30 days. Patients predominantly reported that the emollient device "significantly improved" itching (n = 34) and flushing (n = 31) with a response being noted within 1 day (n = 17) or 1 week (n = 22). All users felt the product "protected and moisturized" their skin, the product texture was "pleasant" to "excellent" and the "non-fragrance" smell was "acceptable" to "excellent". Conclusion Use of a novel emollient device containing ingredients aimed at managing atopic or contact dermatitis, including furfuryl palmitate and tocopherol, led to rapid improvements in itching and flushing. The emollient device was acceptable to the users.
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7
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Wollenberg A, Kinberger M, Arents B, Aszodi N, Avila Valle G, Barbarot S, Bieber T, Brough HA, Calzavara Pinton P, Christen-Zäch S, Deleuran M, Dittmann M, Dressler C, Fink-Wagner AH, Fosse N, Gáspár K, Gerbens L, Gieler U, Girolomoni G, Gregoriou S, Mortz CG, Nast A, Nygaard U, Redding M, Rehbinder EM, Ring J, Rossi M, Serra-Baldrich E, Simon D, Szalai ZZ, Szepietowski JC, Torrelo A, Werfel T, Flohr C. European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations. J Eur Acad Dermatol Venereol 2022; 36:1904-1926. [PMID: 36056736 DOI: 10.1111/jdv.18429] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022]
Abstract
The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for paediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.
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Affiliation(s)
- A Wollenberg
- Department of Dermatology and Allergy, LMU Munich, Munich, Germany.,Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Brussels, Belgium
| | - M Kinberger
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - B Arents
- European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Brussels, Belgium
| | - N Aszodi
- Department of Dermatology and Allergy, LMU Munich, Munich, Germany
| | - G Avila Valle
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S Barbarot
- Department of Dermatology, CHU Nantes, UMR 1280 PhAN, INRAE, Nantes Université, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - H A Brough
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, and Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | | | - M Deleuran
- Aarhus University Hospital, Aarhus, Denmark
| | - M Dittmann
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - C Dressler
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A H Fink-Wagner
- Global Allergy and Airways diseases Patient Platform GAAPP, Vienna, Austria
| | - N Fosse
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - K Gáspár
- Department of Dermatology of the University of Debrecen, Debrecen, Hungary
| | - L Gerbens
- Department of Dermatology, Amsterdam UMC (University Medical Centers), Amsterdam, The Netherlands
| | - U Gieler
- Department Dermatology, University of Giessen, Giessen, Germany
| | - G Girolomoni
- Dermatology and Venereology Section, Department of Medicine, University of Verona, Verona, Italy
| | - S Gregoriou
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Mortz
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - U Nygaard
- Department of Dermato-Venerology, Aarhus University Hospital, Aarhus, Denmark
| | - M Redding
- Eczema Outreach Support (UK), Linlithgow, UK
| | - E M Rehbinder
- Dermatology Department, Oslo University Hospital, Oslo, Norway
| | - J Ring
- Department Dermatology Allergology Biederstein, Technical University Munich, Munich, Germany
| | - M Rossi
- Dermatology Unit, Spedali Civili Hospital Brescia, Brescia, Italy
| | | | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Z Z Szalai
- Pediatric Dermatology Unit, Heim Pál National Children's Institute Budapest, Budapest, Hungary
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - A Torrelo
- Hospital Infantil Niño Jesús, Madrid, Spain
| | - T Werfel
- Hannover Medical School, Hanover, Germany
| | - C Flohr
- St John's Institute of Dermatology, King's College London, London, UK.,Guy's & St Thomas' NHS Foundation Trust, London, UK
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8
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New and Upcoming Topical Treatments for Atopic Dermatitis: A Review of the Literature. J Clin Med 2022; 11:jcm11174974. [PMID: 36078904 PMCID: PMC9456375 DOI: 10.3390/jcm11174974] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory dermatosis with periods of exacerbation and remissions. AD is characterized by intense, persistent pruritus and heterogeneity in clinical symptomatology and severity. Therapeutic goals include the amelioration of cutaneous eruptions, diminishing relapses and eventually the disease burden. To date, topical corticosteroids (TCS) and calcineurin inhibitors (TCI) have yet been deemed the mainstay of topical treatments in AD management. Nevertheless, despite their indisputable efficiency, TCS and TCI are not indicated for continuous long-term use given their safety profile. While research in AD has concentrated predominantly on systemic therapies, more than 30 novel topical compounds are under development. The existing data appear encouraging, with some regimens that are already FDA-approved (ruxolitinib was the most recent in September 2021) and several pharmaceutical pipeline products for mild-to-moderate AD that are in an advanced stage of development, such as tapinarof, difamilast and roflumilast. Larger, long-term studies are still required to evaluate the efficacy and safety of these novel compounds in the long run and weigh their advantages over present treatments. In this review, we aim to provide an overview of the latest knowledge about AD topical treatments, echoing upcoming research trends.
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Saeki H, Ohya Y, Furuta J, Arakawa H, Ichiyama S, Katsunuma T, Katoh N, Tanaka A, Tsunemi Y, Nakahara T, Nagao M, Narita M, Hide M, Fujisawa T, Futamura M, Masuda K, Matsubara T, Murota H, Yamamoto-Hanada K. English Version of Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. J Dermatol 2022; 49:e315-e375. [PMID: 35996152 DOI: 10.1111/1346-8138.16527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/03/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
This is the English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. In Japan, from the perspective of evidence-based medicine, the current strategies for the treatment of AD consist of three primary measures: (i) use of topical corticosteroids, tacrolimus ointment, and delgocitinib ointment as the main treatment of the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling, and advice about daily life. In the present revised guidelines, descriptions of three new drugs, namely, dupilumab, delgocitinib, and baricitinib, have been added. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Junichi Furuta
- Medical Informatics and Management, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hirokazu Arakawa
- Kitakanto Allergy Research Institute, Kibounoie Hospital, Midori, Japan
| | - Susumu Ichiyama
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Toshio Katsunuma
- Department of Pediatrics, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Masami Narita
- Department of Pediatrics, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Dermatology, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Masaki Futamura
- Division of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Koji Masuda
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Tomoyo Matsubara
- Department of Pediatrics, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Saeki H, Tsunemi Y, Arai S, Ichiyama S, Katoh N, Kikuchi K, Kubo A, Terui T, Nakahara T, Futamura M, Murota H, Igarashi A. English version of guidelines for the management of asteatosis 2021 in Japan. J Dermatol 2021; 49:e77-e90. [PMID: 34970776 DOI: 10.1111/1346-8138.16293] [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: 11/30/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
This is the English version of guidelines for the management of asteatosis 2021 in Japan. Asteatosis is a synonym of xerosis found in a wide range of diseases that induce dry skin through impaired functions of either water retention of the stratum corneum or skin covering with acid mantle. Patients with asteatosis may be accompanied by pruritus. Moisturizers are the first-line treatment for asteatosis and their adequate use must be recommended. The main purpose of the present guidelines is to define skin symptoms requiring treatment with moisturizers for medical use in patients with asteatosis. If the deterioration of marked scaling or scratch marks is predicted, therapeutic intervention with moisturizers for medical use should be considered even in the absence of pruritus. Regarding six important points requiring decision-making in clinical practice (clinical questions), we evaluated the balance between the benefits and harm of medical interventions in reference to previous reports of clinical research, and presented the recommendation grades and evidence levels to optimize the patient outcome by medical interventions.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Satoru Arai
- Department of Dermatology, St. Luke's International Hospital, Tokyo, Japan
| | - Susumu Ichiyama
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Norito Katoh
- Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | | | - Akiharu Kubo
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Futamura
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Allergy, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Légaré S, Chagnon M, Palijan A, Kojok K, Bissonnette R. Sensitivity of clinician-assessed efficacy outcome measurement instruments in trials of topical therapies for atopic dermatitis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2021; 36:196-212. [PMID: 34661930 DOI: 10.1111/jdv.17743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
The rising prevalence of atopic dermatitis (AD) in developing countries and its substantial socioeconomic impact have furthered research over the last two decades giving way to advances in its aetiopathogenesis and treatment. Topical therapies targeting newly identified AD signalling pathways are being developed. Numerous clinician-assessed disease severity outcome measurement instruments (OMIs) are available to evaluate the efficacy of investigational treatments in proof-of-concept (POC) trials for AD. However, little is known about the comparative sensitivity of these efficacy OMIs. We performed a systematic review and meta-analysis to compare the sensitivity of different OMIs in controlled trials of topical therapies for AD published between January 1, 2000 and April 7, 2020. Treatment effect size of OMIs reported at Week 4 was calculated with 95% Confidence Interval (CI). The sensitivity of OMIs was compared by pooling the standardized difference between means (Cohen's d and Cohen's h) for any two OMI-parameter combinations that were reported in ≥3 studies identified in our systematic review. Assessed parameters were difference between active and vehicle at Week 4 and change from baseline [CFB] and percentage change from baseline [%CFB] at Week 4. We identified a total of 15 studies with 3313 subjects examining 14 different OMIs were included in this quantitative meta-analysis. Continuous OMIs had a significantly higher treatment effect size vs. dichotomous OMIs (P = 0.006). Comparisons of Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), body surface area (BSA) and SCORing Atopic Dermatitis (SCORAD) for available parameters were performed and generally had a similar sensitivity, with BSA showing smaller overall effect size estimates. In conclusion, continuous OMIs used in topical clinical trials for AD had significantly higher treatment effect sizes when compared to dichotomous OMIs. Continuous OMIs could provide more power for POC trials with a small sample size in atopic dermatitis with topical therapies.
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Affiliation(s)
- S Légaré
- Innovaderm Research, Inc., Montreal, QC, Canada
| | - M Chagnon
- Department of Mathematics and Statistics, Université de Montréal, Montreal, QC, Canada
| | - A Palijan
- Innovaderm Research, Inc., Montreal, QC, Canada
| | - K Kojok
- Innovaderm Research, Inc., Montreal, QC, Canada
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12
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Kritsanaviparkporn C, Sangaphunchai P, Treesirichod A. Efficacy of moisturizers in paediatric atopic dermatitis: A systematic review and meta-analysis of randomised controlled trials. Indian J Dermatol Venereol Leprol 2021; 88:22-31. [PMID: 34623061 DOI: 10.25259/ijdvl_1384_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Topical moisturizer is recommended for atopic dermatitis. AIMS The aim of the study was to investigate the knowledge gap regarding the efficacy of moisturizer in young patients. METHODS A systematic review and meta-analysis were conducted on randomised controlled trials comparing participant's ≤15 years with atopic dermatitis, receiving either topical moisturizer or no moisturizer treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. RESULTS Six trials were included (intervention n= 436; control n= 312). Moisturizer use extended time to flare by 13.52 days (95% confidence interval 0.05-26.99, I2 88%). Greater reduction in risk of relapse was observed during the first month of latency (pooled risk ratio 0.47, 95% confidence interval 0.31-0.72, I2 28%) compared to the second and third months (pooled risk ratio 0.65, 95% confidence interval 0.47-0.91, I2 35% and pooled risk ratio 0.63, 95% confidence interval 0.47-0.83, I2 33%, respectively).Treated patients were 2.68 times more likely to experience a three-six months remission (95% confidence interval1.18-6.09, I2 56%). Moisturizer minimally improved disease severity and quality of life. LIMITATIONS There is a dire need to conduct randomised controlled trialswith more robust and standardised designs. CONCLUSION Moisturizer benefits young patients with atopic dermatitis. However, more research is needed to better estimate its efficacy.
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Affiliation(s)
- Chawan Kritsanaviparkporn
- Department of Paediatrics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
| | - Phoomphut Sangaphunchai
- Department of Paediatrics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
| | - Arucha Treesirichod
- Department of Paediatrics, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhonnayok, Thailand
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13
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Oakley R, Arents BWM, Lawton S, Danby S, Surber C. Topical corticosteroid vehicle composition and implications for clinical practice. Clin Exp Dermatol 2020; 46:259-269. [PMID: 33108015 DOI: 10.1111/ced.14473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
This narrative review highlights the therapeutic significance of topical corticosteroid (TCS) vehicles and provides subsequent guidance to improve clinical and research outcomes. A greater understanding of the relationship between the topical vehicle, corticosteroid and skin is needed to ensure safer, more effective treatment for patients. Topical vehicles are not inert and can affect TCS bioavailability, due to the ability of their composition to positively or negatively influence skin status and change the physiochemical characteristics of an inherent corticosteroid. However, this principle is not commonly understood, and has contributed to inconsistencies in potency classification systems. This review provides an insight into the research methods and standardization needed to determine TCS product bioavailability. It identifies formulation components responsible for vehicle composition that underpin the quality, stability, compounding and functionalities of vehicle ingredients. This helps to contextualize how topical vehicles can be responsible for clinically significant effects, and how their composition gives products unique properties. In turn, this facilitates a more in-depth understanding of which resources offer information to inform the best selection of TCS products and why products should be prescribed by brand or manufacturer. This review will better equip clinicians and formulary teams to appraise products. It will also inform prescribing of Specials and why products should not be manipulated. The recommendations, accompanied by patient perspectives on using TCS products, assist clinical decision-making. They also identify the need for research into concomitant application of TCS products with other topical therapies.
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Affiliation(s)
- R Oakley
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - B W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, Netherlands
| | - S Lawton
- Rotherham NHS Foundation Trust, Rotherham, UK
| | - S Danby
- Sheffield Dermatology Research, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, UK
| | - C Surber
- Institute of Hospital Pharmacy, Department of Dermatology and Department of Pharmacy, University of Basel, Basel, Switzerland
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14
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Singh M, Bhargava S, Pawar M, Jatana G, Maheswari A, Bothra A. Jogger's facial dermatoses: An emerging entity in COVID-19 pandemic. Dermatol Ther 2020; 33:e14293. [PMID: 32909646 DOI: 10.1111/dth.14293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mehak Singh
- Department of Dermatology, JK Medical College and LN Hospital, Bhopal, Madhya Pradesh, India
| | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Manoj Pawar
- Department of Dermatology, MVP's Dr. V.P Medical College and Hospital and Research Center, Nashik, Maharashtra, India
| | | | | | - Atul Bothra
- Department of Dermatology, Gauhati Medical College and Hospital, Guwahati, Assam, India
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15
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Baykal Selcuk L, Ipek Ö, Aksu D, Yayli S, Bahadir S. Evaluation of factors that may affect disease development and severity in childhood atopic dermatitis. Ital J Dermatol Venerol 2020; 156:440-445. [PMID: 32057217 DOI: 10.23736/s2784-8671.20.06469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Atopic dermatitis is a chronic, relapsing, inflammatory disease. Data concerning the role of perinatal conditions in the development of the disease are few and inconsistent. The purpose of this study was to investigate the effects of skin care on the severity of the disease, also to evaluate the relations of perinatal conditions with disease development and severity. METHODS Seventy-five patients with atopic dermatitis aged 2-10 years, their parents and 65 healthy age-compatible volunteers and their parents were included in the study. The Scoring Atopic Dermatitis (SCORAD) score was used to assess the severity of the disease. RESULTS Emollient use (regular/irregular) was higher in patients with severe disease compared to those with mild and moderate disease, but no significant difference was determined in regular use rates (P=0.029, and P=0.504, respectively). Topical corticosteroid use and sleep disturbance rates in the previous three months in the subjects regularly using emollients were low (P=0.032, and P=0.005, respectively). The incidence of severe disease was higher in the patients born in the winter (P=0.033). Severe disease rates were significantly high in the subjects in the patient group with advanced maternal age, a history of cesarean delivery and incubator use (P=0.017, P=0.046, and P=0.025, respectively). CONCLUSIONS Low topical corticosteroid requirement and sleep disturbance rates in the subjects regularly using moisturizers emphasize the importance of emollient use in treatment. The association of cesarean delivery, history of incubator, and birth in winter with severe disease suggests that disease severity is related to less exposure to environmental allergens in the hygiene hypothesis.
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Affiliation(s)
- Leyla Baykal Selcuk
- Department of Dermatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey -
| | - Özlem Ipek
- Department of Dermatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Deniz Aksu
- Department of Dermatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Savaş Yayli
- Department of Dermatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sevgi Bahadir
- Department of Dermatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Nowicki RJ, Trzeciak M, Kaczmarski M, Wilkowska A, Czarnecka-Operacz M, Kowalewski C, Rudnicka L, Kulus M, Mastalerz-Migas A, Peregud-Pogorzelski J, Sokołowska-Wojdyło M, Śpiewak R, Adamski Z, Czuwara J, Kapińska-Mrowiecka M, Kaszuba A, Krasowska D, Krêcisz B, Narbutt J, Majewski S, Reich A, Samochocki Z, Szepietowski J, Woźniak K. Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part I. Prophylaxis, topical treatment and phototherapy. Postepy Dermatol Alergol 2020; 37:1-10. [PMID: 32467676 PMCID: PMC7247067 DOI: 10.5114/ada.2020.93423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/01/2019] [Indexed: 12/17/2022] Open
Abstract
Atopic dermatitis is a chronic and recurrent inflammatory dermatosis with concomitant intensive pruritus, and is diagnosed both in children and adults. Atopic dermatitis-patients are predisposed to have bacterial, viral and fungal skin infections; they also suffer from an increased risk of developing food allergies (especially, at an infantile age), allergic rhinitis, or bronchial asthma (a so-called atopic march). Currently, an increasing atopic dermatitis incidence constitutes a serious medical problem that regards not only dermatology and allergology, but also paediatrics, and family medicine. The basis for atopic dermatitis treatment and prophylaxis is restoration of epidermal barrier functions by means of tailored emollients. Atopic dermatitis therapies should effectively eliminate clinical symptoms of the disease, prevent exacerbations as well as complications, and improve patients' quality of life.
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Affiliation(s)
- Roman J. Nowicki
- Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Kaczmarski
- Department of Paediatrics, Paediatric Gastroenterology and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Aleksandra Wilkowska
- Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - Cezary Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Paediatric Pneumonology and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Radosław Śpiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Andrzej Kaszuba
- Department of Dermatology, Paediatric and Oncological Dermatology, Medical University of Lodz, Lodz, Poland
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University, Lublin, Poland
| | - Beata Krêcisz
- Department of Dermatology, Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Joanna Narbutt
- Department of Dermatology, Paediatric and Oncological Dermatology, Medical University of Lodz, Lodz, Poland
| | - Sławomir Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | | | - Jacek Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
| | - Katarzyna Woźniak
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
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17
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El Hachem M, Di Mauro G, Rotunno R, Giancristoforo S, De Ranieri C, Carlevaris CM, Verga MC, Dello Iacono I. Pruritus in pediatric patients with atopic dermatitis: a multidisciplinary approach - summary document from an Italian expert group. Ital J Pediatr 2020; 46:11. [PMID: 32000823 PMCID: PMC6993480 DOI: 10.1186/s13052-020-0777-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 01/21/2020] [Indexed: 12/25/2022] Open
Abstract
Given the inadequate overall awareness of the main disease features and treatment modalities of pruritus in pediatric patients with atopic dermatitis, a multidisciplinary Italian expert group met with the major aim of increasing knowledge of the condition for improved diagnosis and better management among specialists involved in disease management. Herein, the overall features of the condition are reviewed, along with its etiopathogenesis and symptoms. Likewise, management options are summarized, emphasizing the need for a multidisciplinary approach, minimally composed of a management team that includes a pediatrician, dermatologist, psychologist, play assistant, and dedicated nurse. In addition to more traditional therapies such as emollients as highlighted by European guidelines, therapeutic patient education in a group or individually is highly encouraged as it helps patients and their parents to better understand the disease and provide practical guidance for dressing and bandaging. It can also aid in outlining coping strategies for itching and sleep disturbance. The utility of distraction techniques should also be stressed as such educational interventions involving the child and their parents can substantially improve the overall quality of life. All approaches should be tailored according to patient age and clinical features and requires individualized strategy to ensure good adherence by both children and their parents. Thus, a holistic approach embracing systemic, topical and psychological interventions is advocated in order to provide patients and their caregivers the best possible care.
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Affiliation(s)
- May El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, Italy
| | | | - Roberta Rotunno
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, Italy.
| | - Simona Giancristoforo
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, Italy
| | - Cristiana De Ranieri
- Unit of Clinical Psychology, Ospedale Pediatrico Bambino Gesù (IRCCS), Rome, Italy
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18
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Giacomelli L, Moglia A, Losa G, Quaglino P. Clinical use of Capilen, a liposomal cream based on fresh plant extracts enriched with omega fatty acids. Drugs Context 2020; 9:dic-2019-10-1. [PMID: 32158486 PMCID: PMC7048133 DOI: 10.7573/dic.2019-10-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 01/30/2023] Open
Abstract
The skin is the largest organ in the human body; beyond its regulatory and sensory roles, it is meant to protect and act like a barrier against foreign matter. Products intended to restore the skin health should reintegrate the structure of the stratum corneum in which the corneocytes are surrounded by the intercellular lipid lamellae that maintain both corneum integrity and skin permeability barrier. Capilen is a specific liposomal formulation based on a technology through which highly concentrated fresh plant extracts are conveyed into a jelly-like liposomal vehicle and combined with plant-derived omega-3, -6, -7, and -9 fatty acids, phospholipids, and precursors of ceramides. Its components have been widely investigated and produced clinical benefits in atopic dermatitis, bedsores, scars, inflammatory lesions of the skin, and generally whenever signs of xerosis cutis were present. Liposomes contribute to restore the surface lipid layer of the skin and to deliver substances in the activity site. This liposomal cream was proven to limit and delay the occurrence of radiodermatitis in breast cancer patients, and as an add-on provided complete healing of bedsore lesions in geriatric subjects.
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Affiliation(s)
- Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | | | | | - Pietro Quaglino
- Department of Medical Sciences, University Clinic of Dermatology, Turin, Italy
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19
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Youssef R, Hafez V, Elkholy Y, Mourad A. Glycerol 85% efficacy on atopic skin and its microbiome: a randomized controlled trial with clinical and bacteriological evaluation. J DERMATOL TREAT 2020; 32:730-736. [PMID: 31869257 DOI: 10.1080/09546634.2019.1708246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Treating atopic dermatitis (AD) is still a challenge. The staphylococcal skin load is known to aggravate AD. Narrow band ultraviolet B (NB-UVB) and glycerol in low concentration (20-40%) are established therapies for AD. NB-UVB has proven antimicrobial actions, while high concentration glycerol (85-100%) showed similar effects in vitro but has not been clinically tested.Objective: To evaluate the efficacy and tolerability of concentrated glycerol 85% compared to NB-UVB in patients with AD, as assessed by clinical improvement and reduction of staphylococcal colonization of the skin.Methods: 30 patients with mild to moderate AD were randomized into either NB-UVB or glycerol 85% group. Patients were treated for one month and followed for an additional month. Swabs were taken from the skin and nose to be cultured on mannitol-salt agar for Staphylococci and quantified to determine Colony Forming Units.Results: Both groups showed statistically insignificant microbial changes and statistically significant clinical improvement after treatment. The results were comparable between both groups.Conclusions: Concentrated glycerol 85% is a cheap effective readily accessible alternative for phototherapy in patients with mild-moderate AD who cannot access the facility. Reduction of staphylococcal skin load seems to be involved, but its role is minimal.
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Affiliation(s)
- Randa Youssef
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Vanessa Hafez
- Dermatology Department, Cairo University, Cairo, Egypt
| | - Yasmine Elkholy
- Medical Microbiology and Immunology Department, Cairo University, Cairo, Egypt
| | - Ahmed Mourad
- Dermatology Department, Cairo University, Cairo, Egypt
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Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, Shimojo N, Tanaka A, Nakahara T, Nagao M, Hide M, Fujita Y, Fujisawa T, Futamura M, Masuda K, Murota H, Yamamoto-Hanada K. Clinical practice guidelines for the management of atopic dermatitis 2018. J Dermatol 2019; 46:1053-1101. [PMID: 31599013 DOI: 10.1111/1346-8138.15090] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.
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Affiliation(s)
- Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masanori Ikeda
- Department of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmacuetical Sciences, Okayama, Japan
| | - Tamotsu Ebihara
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Katayama
- Department of Dermatology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Graduate School of Medicine, Nihon Medical School, Tokyo, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of medicine, Chiba University, Chiba, Japan
| | - Akio Tanaka
- Department of Dermatology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Takeshi Nakahara
- Division of Skin Surface Sensing, Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mizuho Nagao
- Division of, Clinical Research, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Michihiro Hide
- Department of Dermatology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yuji Fujita
- Department of Pediatrics, Graduate School of medicine, Chiba University, Chiba, Japan
| | - Takao Fujisawa
- Division of, Allergy, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Masaki Futamura
- Division of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Koji Masuda
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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21
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Wang S, Wang L, Li P, Shu H, Shen C, Wu Y, Luo Z, Miao L, Wang H, Jiao L, Tian J, Peng X, Zhao M, Liu Y, Nie X, He L, Ma L. The improvement of infantile atopic dermatitis during the maintenance period: A multicenter, randomized, parallel controlled clinical study of emollients in Prinsepia utilis Royle. Dermatol Ther 2019; 33:e13153. [PMID: 31705602 DOI: 10.1111/dth.13153] [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] [Received: 10/08/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
In order to investigate the effect of daily emollient treatment on infantile atopic dermatitis (AD) during the maintenance period, a total of 309 children younger than 2 years with moderate AD (155 and 154 in the treatment and control groups, respectively) were enrolled in this multicenter, randomized, parallel controlled clinical trial. Subjects were topically treated with desonide cream and emollients in Prinsepia utilis Royle for 2-4 weeks before entering the maintenance period and then differentially treated with either emollients for treatment or none for control. The cumulative maintenance rate, time to flare and improvement of eczema area and severity index (EASI) and infant's dermatitis quality of life index (IDQOL) were evaluated. Results showed that the cumulative maintenance rate of the treatment group (60.5%, 95% CI 50.0-69.4%) was significantly higher than that of the control group (23.5%, 95% CI 15.2-33.0%) (p < .001). The median time to flare in the treatment group was 90 days (interquartile range, IQR 28-90), which was significantly longer than that in the control group (28 days [IQR 18-67]) (p < .001). At Week 4 in the maintenance period, the EASI and IDQOL scores of the treatment group were lower than those of the control group. In conclusion, the application of emollients during the maintenance period of infantile AD can significantly reduce the risk of AD flares, prolong the time to flare and improve the clinical symptoms.
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Affiliation(s)
- Shan Wang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Liuhui Wang
- Department of Dermatology, Children's Hospital of Fudan University, Shanghai, China
| | - Ping Li
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, China
| | - Hong Shu
- Department of Dermatology, Kunming Children's Hospital, Kunming, China
| | - Chunping Shen
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yao Wu
- Department of Dermatology, Children's Hospital of Fudan University, Shanghai, China
| | - Zhen Luo
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, China
| | - Limin Miao
- Department of Dermatology, Kunming Children's Hospital, Kunming, China
| | - Hongbing Wang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lei Jiao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jing Tian
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Mutong Zhao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Liu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaolu Nie
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Li He
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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22
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Vaillant L, Georgescou G, Rivollier C, Delarue A. Combined effects of glycerol and petrolatum in an emollient cream: A randomized, double‐blind, crossover study in healthy volunteers with dry skin. J Cosmet Dermatol 2019; 19:1399-1403. [DOI: 10.1111/jocd.13163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Loïc Vaillant
- CHRU Dermatology Department University of Tours INSERM U 1253 iBrain Tours France
| | - Gabriela Georgescou
- CHRU Dermatology Department University of Tours INSERM U 1253 iBrain Tours France
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23
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Bhanot A, Huntley A, Ridd MJ. Adverse Events from Emollient Use in Eczema: A Restricted Review of Published Data. Dermatol Ther (Heidelb) 2019; 9:193-208. [PMID: 30771093 PMCID: PMC6522630 DOI: 10.1007/s13555-019-0284-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Indexed: 01/15/2023] Open
Abstract
Atopic dermatitis/eczema is a chronic inflammatory skin condition, and emollients are the first-line treatment. Despite their widespread use, there is uncertainty about the frequency and type of adverse events associated with different emollients. We conducted a restricted review of published data on adverse events associated with emollient use in eczema. Medline (Ovid) was searched from inception (1946) to June 2018. All types of studies, with the exception of reviews, were included. Eligibility was assessed using a two-stage screening process against inclusion and exclusion criteria. References of all included papers were screened for any additional eligible papers. Data were subsequently extracted from all eligible publications. A limited body of data were found in the published data: 24 papers reported on adverse events with 29 different emollients (3 containing urea, 5 containing ceramide, 4 containing glycerol, 4 were herbal and 13 contained "other" ingredients). Interpretation of the results and comparison of the emollients were difficult due to poor reporting and missing data. Many publications contained no data at all on adverse events, and no study reported serious treatment-related adverse events for any emollient. The proportion of participants in the studies experiencing treatment-related adverse events varied between 2 and 59%. The most common adverse events were skin related and often mild. The range of participants experiencing non-treatment-related adverse events varied between 4 and 43%. From this restricted review, clinicians and patients can be reassured that the emollients studied appear to be generally safe to use. Better studies and reporting of adverse events associated with emollients in common use are needed.
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Affiliation(s)
- Alisha Bhanot
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Alyson Huntley
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK.
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24
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Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, Gieler U, Girolomoni G, Lau S, Muraro A, Czarnecka-Operacz M, Schäfer T, Schmid-Grendelmeier P, Simon D, Szalai Z, Szepietowski JC, Taïeb A, Torrelo A, Werfel T, Ring J. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 2018; 32:657-682. [PMID: 29676534 DOI: 10.1111/jdv.14891] [Citation(s) in RCA: 513] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This first part of the guideline covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy, whereas the second part covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions. Management of AE must consider the individual clinical variability of the disease; highly standardized treatment rules are not recommended. Basic therapy is focused on treatment of disturbed barrier function by hydrating and lubricating topical treatment, besides further avoidance of specific and unspecific provocation factors. Topical anti-inflammatory treatment based on glucocorticosteroids and calcineurin inhibitors is used for flare management and for proactive therapy for long-term control. Topical corticosteroids remain the mainstay of therapy, whereas tacrolimus and pimecrolimus are preferred in sensitive skin areas and for long-term use. Topical phosphodiesterase inhibitors may be a treatment alternative when available. Adjuvant therapy includes UV irradiation, preferably with UVB 311 nm or UVA1. Pruritus is targeted with the majority of the recommended therapies, but some patients may need additional antipruritic therapy. Antimicrobial therapy, systemic anti-inflammatory treatment, immunotherapy, complementary medicine and educational intervention will be addressed in part II of the guideline.
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Affiliation(s)
- A Wollenberg
- Department Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany.,Klinik Thalkirchner Straße, Munich, Germany
| | - S Barbarot
- Department of Dermatology, Centre Hospitalier Universitaire CHU Nantes, Nantes, France
| | - T Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University Bonn, Bonn, Germany
| | - S Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M Deleuran
- Department Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Fink-Wagner
- European Federation of Allergy and Airways Diseases Patients' Associations (EFA), Global Allergy and Asthma Patient Platform (GAAPP), Konstanz, Germany
| | - U Gieler
- Department of Dermatology, University of Gießen and Marburg GmbH, Gießen, Germany.,Department of Psychosomatics and Psychotherapy, University of Gießen and Marburg GmbH, Gießen, Germany
| | - G Girolomoni
- Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
| | - S Lau
- Pediatric Pneumology and Immunology, Universitätsmedizin Berlin, Berlin, Germany
| | - A Muraro
- Centro di Specializzazione Regionale per lo Studio e la Cura delle Allergie e delle Intolleranze Alimentari presso l'Azienda Ospedaliera, Università di Padova, Padova, Italy
| | | | - T Schäfer
- Dermatological Practice, Immenstadt, Germany
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University of Zurich, Zurich, Switzerland.,Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - D Simon
- Department Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Z Szalai
- Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Taïeb
- Department of Dermatology and Pediatric Dermatology, Hôpital St André, Bordeaux, France
| | - A Torrelo
- Department of Dermatology, Hospital Niño Jesus, Madrid, Spain
| | - T Werfel
- Department Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - J Ring
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland.,Department Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
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25
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Siegfried EC, Jaworski JC, Mina-Osorio P. A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns. Dermatol Ther (Heidelb) 2018; 8:349-377. [PMID: 29858763 PMCID: PMC6109028 DOI: 10.1007/s13555-018-0243-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns. METHODS Searches of Embase (2005-2016) and abstracts from selected meetings (2014-2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity. RESULTS Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids. CONCLUSION This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease. FUNDING Regeneron Pharmaceuticals Inc.
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Affiliation(s)
- Elaine C Siegfried
- Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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26
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Tiplica G, Boralevi F, Konno P, Malinauskiene L, Kaszuba A, Laurens C, Saint-Aroman M, Delarue A. The regular use of an emollient improves symptoms of atopic dermatitis in children: a randomized controlled study. J Eur Acad Dermatol Venereol 2018; 32:1180-1187. [DOI: 10.1111/jdv.14849] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/18/2018] [Indexed: 01/09/2023]
Affiliation(s)
- G.S. Tiplica
- 2nd Dermatology Clinic; Colentina Clinical Hospital; “Carol Davila” University of Medicine; Bucharest Romania
| | - F. Boralevi
- Pediatric Dermatology unit; Hôpital Pellegrin-Enfants; CHU Bordeaux; University Hospital of Bordeaux; Bordeaux France
| | - P. Konno
- East-Tallinn Central Hospital; Tallinn Estonia
| | - L. Malinauskiene
- Center of Allergy; Vilnius City Clinical Hospital Antakalnis affiliation; Vilnius Lithuania
| | - A. Kaszuba
- Specjalistyczne Gabinety Lekarskie; “DERMED”; Lodz Poland
| | - C. Laurens
- Pierre Fabre Dermatologie; Lavaur France
| | | | - A. Delarue
- Pierre Fabre Dermatologie; Lavaur France
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27
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Rossi AB, Bacquey A, Nocera T, Thouvenin MD. Efficacy and Tolerability of a Medical Device Repairing Emollient Cream Associated with a Topical Corticosteroid in Adults with Atopic Dermatitis: An Open-label, Intra-individual Randomized Controlled Study. Dermatol Ther (Heidelb) 2018; 8:217-228. [PMID: 29511936 PMCID: PMC6002316 DOI: 10.1007/s13555-018-0228-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction Medical device repairing emollient creams (MDRECs) are designed to repair and protect the skin barrier. In this study, we examined the added clinical benefit and tolerability of a MDREC when used in association with a moderately potent topical corticosteroid (TCS) for adults with atopic dermatitis (AD). Methods This was an intra-individual randomized controlled trial in adults with moderate to severe AD (EudraCT no. 2014-002,194-10). Symmetrical lesions on each arm of the subjects were randomized to treatment for 10 days with twice-daily TCS (desonide) cream alone or with combined TCS + MDREC. Subjects were then included in a following 2-week maintenance phase if the AD on at least one test area had sufficiently improved so that the treatment was no longer needed. During the maintenance phase, treatment with the TCS cream was stopped, but twice-daily application of the MDREC was continued on the same test area previously assigned to receive it. The primary outcome measure was the change in local Scoring Atopic Dermatitis (SCORAD) index between day 1 and 3 based on investigators’ assessment. Secondary measures of lesion severity included changes in the local patient-oriented SCORAD index, pruritus intensity according to subjects’ assessments, and global assessments by subjects and investigators. Results The study included 54 subjects. The change in investigator-observed local SCORAD index between day 1 and 3 was − 14.4% with TCS alone and − 24.5% for TCS + MDREC (p = 0.0005). Between baseline and the end of the treatment phase, all secondary measures of lesion severity decreased more with the combined TCS + MDREC treatment than with the TCS cream alone. The MDREC also reduced the relapse of AD lesions during the maintenance phase. Tolerability was very good, and the product was well accepted by subjects. Conclusion These results support using the MDREC in association with TCS during AD flares and as a maintenance therapy after treatment with TCS has stopped. Funding Laboratoires Dermatologiques Ducray, Pierre Fabre.
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Affiliation(s)
- Ana Beatris Rossi
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.,Department of Dermatology, University Hospital Toulouse, 24, chemin de Pouvourville TSA, 31059, Toulouse CEDEX 9, France
| | - Adeline Bacquey
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France
| | - Thérèse Nocera
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.,Department of Dermatology, University Hospital Toulouse, 24, chemin de Pouvourville TSA, 31059, Toulouse CEDEX 9, France
| | - Marie-Dominique Thouvenin
- Clinical Skin Research and Development Center, Pierre Fabre Dermo-Cosmétique, 2 Rue Viguerie, Hotel Dieu, Toulouse, France.
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28
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Maridet C, Perromat M, Miquel J, Chiaverini C, Bessis D, Lasek A, Piram M, Bursztejn AC, Abasq C, Phan A, Martin L, Bréchat B, Chong JH, Seneschal J, Taïeb A, Boralevi F. Childhood chronic prurigo: Interest in patch tests and delayed-reading skin prick tests to environmental allergens. J Allergy Clin Immunol 2018; 141:797-799.e9. [DOI: 10.1016/j.jaci.2017.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 11/26/2022]
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29
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van Zuuren EJ, Fedorowicz Z, Arents BWM. Emollients and moisturizers for eczema: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol 2017; 177:1256-1271. [PMID: 28432721 DOI: 10.1111/bjd.15602] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 01/06/2023]
Abstract
Eczema is a chronic inflammatory skin disorder with considerable impact on quality of life. Emollients or moisturizers are widely recommended, but are these effective and safe? We searched for randomized controlled trials (RCTs) in the Cochrane Skin Group Specialised Skin Register, CENTRAL in The Cochrane Library, MEDLINE, Embase, LILACS, the GREAT database and five trial registers to December 2015. We included 77 RCTs with 6603 participants. Seven studies (9%) were at low risk of bias, 34 (44%) had unclear risk and 36 (47%) were at high risk. The quality of the evidence was mainly low or moderate for the prespecified outcomes. The most important comparison, 'moisturizer vs. no moisturizer', showed improved Scoring Atopic Dermatitis values in the moisturizer group compared with no moisturizer [mean difference -2·42, 95% confidence interval (CI) -4·55 to -0·28], but did not meet the minimal important difference of 8·7. Fewer flares were seen (risk ratio 0·40, 95% CI 0·23-0·70) and the rate of flares was reduced (hazard ratio 3·74, 95% CI 1·86-7·50). The groups applying moisturizer used less topical corticosteroids over 6-8 weeks (mean difference -9·30 g, 95% CI 15·3 to -3·27). Glycyrrhetinic acid-, urea- and glycerol-containing creams worked better than their controls (vehicle, placebo or no moisturizer) according to both participants and physicians. More flares were reported with moisturizer alone than when combined with twice-weekly fluticasone propionate (risk ratio 2·17, 95% CI 1·55-3·11). Adding moisturizers to topical anti-inflammatory treatment was more effective than anti-inflammatory treatment alone and resulted in fewer flares.
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Affiliation(s)
- E J van Zuuren
- Dermatology Department, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | | | - B W M Arents
- Dutch Association for People with Atopic Dermatitis (VMCE: Vereniging voor Mensen met Constitutioneel Eczeem), Nijkerk, the Netherlands
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30
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Malissen N, Vergely L, Simon M, Roubertie A, Malinge MC, Bessis D. Long-term treatment of cutaneous manifestations of tuberous sclerosis complex with topical 1% sirolimus cream: A prospective study of 25 patients. J Am Acad Dermatol 2017; 77:464-472.e3. [PMID: 28502378 DOI: 10.1016/j.jaad.2017.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data on long-term topical sirolimus treatment of the cutaneous manifestations of tuberous sclerosis complex are rare. OBJECTIVE To evaluate the long-term benefit and tolerance of topical 1% sirolimus in tuberous sclerosis complex. METHODS In this 18-month prospective single-center study, 1% sirolimus cream was applied daily to facial angiofibromas (FAs), fibrous cephalic plaques (FCPs), shagreen patches, hypomelanotic macules, and ungual fibromas. After complete clearance (CC) of FAs, we evaluated a maintenance protocol of 3 applications weekly. RESULTS Twenty-five patients were enrolled. Fifty percent obtained CC of FAs within 9 months. Of 7 patients with CC (58%) who were following the maintenance protocol, 6 relapsed within 7 months and 1 was still responding at 1 year. Of 16 patients with FCPs, 7 (44%) remained stable at 12 months and 9 (56%) improved after 3 to 9 months of treatment. Only 1 of 5 patients treated for shagreen patches showed improvement at 12 months. Treatment was well tolerated with no serious adverse events. LIMITATIONS The small number of patients was a limitation. CONCLUSIONS Topical 1% sirolimus applied daily produced positive responses in treatment of FAs, FCPs, and facial hypomelanotic macules and was well tolerated. A 3-times-weekly maintenance protocol did not prevent FA relapses.
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Affiliation(s)
- Nausicaa Malissen
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France
| | - Laurence Vergely
- Department of Clinical Pharmacy and Oncology, Lapeyronie Hospital, Montpellier, France
| | - Marguerite Simon
- Department of Clinical Pharmacy and Oncology, Lapeyronie Hospital, Montpellier, France
| | - Agathe Roubertie
- Department of Neuropediatric and Regional Center of Competence of Tuberous Sclerosis, Gui de Chauliac Hospital, Montpellier, France
| | | | - Didier Bessis
- Department of Dermatology, Saint-Eloi Hospital and Montpellier University Hospital, Montpellier, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U1058, Montpellier, France; Regional Center of Competence for Rare Skin Disorders, Montpellier, France.
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31
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Tiplica GS, Kaszuba A, Malinauskienė L, Konno P, Boralevi F, Garrigue E, Saint-Aroman M, Delarue A. Prevention of Flares in Children with Atopic Dermatitis with Regular Use of an Emollient Containing Glycerol and Paraffin: A Randomized Controlled Study. Pediatr Dermatol 2017; 34:282-289. [PMID: 28271540 DOI: 10.1111/pde.13113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVES Emollients are part of the standard treatment for atopic dermatitis (AD), although there is limited evidence that regular use of emollients as management therapy reduces the frequency of flares and corticosteroid consumption. The objective of this study was to evaluate the benefit of emollient use in the management of mild to moderate AD in children by assessing the ability of two different emollients (particularly V0034CR) to prevent flares and to reduce the use of corticosteroids. METHODS In this randomized, open-label study, patients with a current flare were treated with a potent topical corticosteroid. After flare resolution, patients were centrally randomized to V0034CR emollient, reference emollient, or no emollient (1:1:1 ratio) for 12 weeks. New flares were medically assessed before being treated with a moderately potent corticosteroid. RESULTS A total of 335 children 2 to 6 years of age were randomized. At 12 weeks, the percentage of patients with one or more flares was statistically significantly lower with V0034CR (35.1%) than without emollient (67.6%; p < 0.001). Fewer patients treated with V0034CR required any corticosteroids or immunosuppressants (23.6%) than patients with no emollient (43.3%) at 12 weeks. The difference was significant at all time points (p = 0.002). Patients treated with emollients had a longer time to first flare, fewer flares, higher complete remission rates, less corticosteroid consumption, lower Investigator Global Assessment scores, and lower Scoring Atopic Dermatitis scores than those who were not. V0034CR was well tolerated, with no specific safety concerns. CONCLUSION Regular emollient use in children with mild to moderate AD reduces flares and corticosteroid consumption.
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Affiliation(s)
- George Sorin Tiplica
- Second Dermatology Clinic, Colentina Clinical Hospital, "Carol Davila" University of Medicine, Bucharest, Romania
| | | | - Laura Malinauskienė
- Center of Allergy, Vilnius City Clinical Hospital Antakalnis Affiliation, Vilnius, Lithuania
| | - Pille Konno
- East-Tallinn Central Hospital, Tallinn, Estonia
| | - Franck Boralevi
- Pediatric Dermatology Unit, CHU Bordeaux, University Hospital of Bordeaux, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Eric Garrigue
- Institut de Recherche Pierre Fabre, Centre de Recherche et Développement, Toulouse, France
| | - Markéta Saint-Aroman
- Institut de Recherche Pierre Fabre, Centre de Recherche et Développement, Toulouse, France
| | - Alain Delarue
- Institut de Recherche Pierre Fabre, Centre de Recherche et Développement, Toulouse, France
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Abstract
The desire for naturally derived agents is a growing trend for patients, physicians, and pharmaceutical companies. Studies indicate that complementary and alternative medicine is often used by patients and parents of children with atopic dermatitis, not necessarily with beneficial results. A half-dozen natural agents (ie, topical agents: coconut oil, colloidal oatmeal, sunflower oil, mustard oil, glycerin, and oral Chinese herbal therapy) are discussed because they have become popular for their expected activity in the therapy of atopic dermatitis. A critical review of the published literature on these agents is presented with specific focus on potential such side effects as hepatotoxicity with Chinese herbals.
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Affiliation(s)
- Nanette B Silverberg
- Icahn School of Medicine at Mt. Sinai, Mt Sinai St Luke's-Roosevelt Hospital, New York, NY.
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Torrelo A. Methylprednisolone aceponate for atopic dermatitis. Int J Dermatol 2017; 56:691-697. [PMID: 28258632 DOI: 10.1111/ijd.13485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/02/2016] [Accepted: 09/10/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The 4th generation topical corticosteroids (TCS) have demonstrated a most favorablerisk-benefit ratio. Methylprednisolone aceponate (MPA) is a non-halogenated corticosteroid with a methyl group at C6, which confers higher intrinsic activity. MPA is included in the group of potent TCS (category III/IV). METHODS A literature review is carried out of the clinical efficacy, pharmacokinetics, and adverse effects of MPA, especially for the treatment of atopic dermatitis (AD). RESULTS Several clinical studies support the use of MPA in infants and children, with minimal local or systemic adverse effects reported. The pharmacokinetic profile and the low rate of adverse effects of MPA are most suitable for the treatment of atopic dermatitis (AD), a chronic disease with frequent flaring that can involve extensive areas of the skin. CONCLUSIONS Most patients with AD can be easily brought into control with the use of only TCS. Achieving a complete healing of eczema is key in AD, and once the skin is clinically healthy, emollients can be used according to the physician and patient preferences. Physicians should be trained in the recognition of early or subtle manifestations of active eczema that are most suitably treated with topical TCS to achieve a most rapid and satisfactory control of the disease. If the whole area with eczema is not treated, active eczema will remain and treatment will be ineffective. Insufficient use of TCS will lead to inefficiency and frustration.
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Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Hospital Infantil Niño Jesús, Madrid, Spain
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Boralevi F, Meledie N'Djong AP, Yao Yoboue P, Faye O, Dieng MT, Coniquet S, Atadokpede F, Niamba PA, Delarue A, Cazeau C. Regression of cutaneous xerosis with emollient treatment in sub-Saharan African patients. Int J Dermatol 2017; 56:467-473. [PMID: 28205205 DOI: 10.1111/ijd.13454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 06/17/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022]
Abstract
Emollients have proven effective in improving cutaneous xerosis in various populations; however, no clinical data are available for African patients. The observational study "Xerafrica" was conducted by dermatologists in seven sub-Saharan countries to assess the evolution of xerosis after an 8-week treatment with an emollient. Patients were children above 3 years or adults. Secondary objectives were to assess pruritus, improvement in symptoms, quality of life, satisfaction, and tolerance. An analysis of 185 patients was made. After 8 weeks of emollient treatment, the relative reduction of the "Scaling Roughness Redness Cracks" (SRRC) score was -83.9% and -80.4% in children and adults, respectively. The effect was significantly stronger when topical steroids were co-prescribed with the emollient and in patients with co-dermatosis. To a lesser extent, the effect of emollient was also observed at week 4. Similarly, pruritus and quality of life strongly improved during follow-up. Skin lesions improved in almost all patients, with a high level of satisfaction noted by both dermatologists and patients. The "Xerafrica" study addressed, for the first time, the treatment of xerosis by emollients in an African population. In this specific context, the emollient markedly reduced xerosis as soon as 4 weeks and resolved it almost totally by 8 weeks. The study confirms, under real-life conditions, the efficacy and tolerability of an emollient in improving xerosis.
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Affiliation(s)
- Franck Boralevi
- Pediatric Dermatology Unit, Pellegrin University Hospital, Bordeaux, France
| | | | - Pauline Yao Yoboue
- Treichville University Hospital, Boulevard de Marseille, Abidjan, Ivory Coast
| | - Ousmane Faye
- Dermatology Unit, Marchoux Institute, Bamako, Mali
| | | | | | - Félix Atadokpede
- Hubert Koutoukou Maga National University Hospital, Cotonou, Benin
| | | | - Alain Delarue
- Pierre Fabre Dermatologie, Les Cauquillous, Lavaur, France
| | - Christine Cazeau
- Pierre Fabre Pharmaceuticals, 8 Campus Drive, Parsippany, NJ, USA
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van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen A, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database Syst Rev 2017; 2:CD012119. [PMID: 28166390 PMCID: PMC6464068 DOI: 10.1002/14651858.cd012119.pub2] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eczema is a chronic skin disease characterised by dry skin, intense itching, inflammatory skin lesions, and a considerable impact on quality of life. Moisturisation is an integral part of treatment, but it is unclear if moisturisers are effective. OBJECTIVES To assess the effects of moisturisers for eczema. SEARCH METHODS We searched the following databases to December 2015: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, the GREAT database. We searched five trials registers and checked references of included and excluded studies for further relevant trials. SELECTION CRITERIA Randomised controlled trials in people with eczema. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included 77 studies (6603 participants, mean age: 18.6 years, mean duration: 6.7 weeks). We assessed 36 studies as at a high risk of bias, 34 at unclear risk, and seven at low risk. Twenty-four studies assessed our primary outcome 'participant-assessed disease severity', 13 assessed 'satisfaction', and 41 assessed 'adverse events'. Secondary outcomes included investigator-assessed disease severity (addressed in 65 studies), skin barrier function (29), flare prevention (16), quality of life (10), and corticosteroid use (eight). Adverse events reporting was limited (smarting, stinging, pruritus, erythema, folliculitis).Six studies evaluated moisturiser versus no moisturiser. 'Participant-assessed disease severity' and 'satisfaction' were not assessed. Moisturiser use yielded lower SCORAD than no moisturiser (three studies, 276 participants, mean difference (MD) -2.42, 95% confidence interval (CI) -4.55 to -0.28), but the minimal important difference (MID) (8.7) was unmet. There were fewer flares with moisturisers (two studies, 87 participants, RR 0.40, 95% CI 0.23 to 0.70), time to flare was prolonged (median: 180 versus 30 days), and less topical corticosteroids were needed (two studies, 222 participants, MD -9.30 g, 95% CI -15.3 to -3.27). There was no statistically significant difference in adverse events (one study, 173 participants, risk ratio (RR) 15.34, 95% CI 0.90 to 261.64). Evidence for these outcomes was low quality.With Atopiclair (three studies), 174/232 participants experienced improvement in participant-assessed disease severity versus 27/158 allocated to vehicle (RR 4.51, 95% CI 2.19 to 9.29). Atopiclair decreased itching (four studies, 396 participants, MD -2.65, 95% CI -4.21 to -1.09) and achieved more frequent satisfaction (two studies, 248 participants, RR 2.14, 95% CI 1.58 to 2.89), fewer flares (three studies, 397 participants, RR 0.18, 95% CI 0.11 to 0.31), and lower EASI (four studies, 426 participants, MD -4.0, 95% CI -5.42 to -2.57), but MID (6.6) was unmet. The number of participants reporting adverse events was not statistically different (four studies, 430 participants, RR 1.03, 95% CI 0.79 to 1.33). Evidence for these outcomes was moderate quality.Participants reported skin improvement more frequently with urea-containing cream than placebo (one study, 129 participants, RR 1.28, 95% CI 1.06 to 1.53; low-quality evidence), with equal satisfaction between the two groups (one study, 38 participants, low-quality evidence). Urea-containing cream improved dryness (investigator-assessed) more frequently (one study, 128 participants, RR 1.40, 95% CI 1.14 to 1.71; moderate-quality evidence) with fewer flares (one study, 44 participants, RR 0.47, 95% CI 0.24 to 0.92; low-quality evidence), but more participants in this group reported adverse events (one study, 129 participants, RR 1.65, 95% CI 1.16 to 2.34; moderate-quality evidence).Three studies assessed glycerol-containing moisturiser versus vehicle or placebo. More participants in the glycerol group noticed skin improvement (one study, 134 participants, RR 1.22, 95% CI 1.01 to 1.48; moderate-quality evidence), and this group saw improved investigator-assessed SCORAD (one study, 249 participants, MD -2.20, 95% CI -3.44 to -0.96; high-quality evidence), but MID was unmet. Participant satisfaction was not addressed. The number of participants reporting adverse events was not statistically significant (two studies, 385 participants, RR 0.90, 95% CI 0.68 to 1.19; moderate-quality evidence).Four studies investigated oat-containing moisturisers versus no treatment or vehicle. No significant differences between groups were reported for participant-assessed disease severity (one study, 50 participants, RR 1.11, 95% CI 0.84 to 1.46; low-quality evidence), satisfaction (one study, 50 participants, RR 1.06, 95% CI 0.74 to 1.52; very low-quality evidence), and investigator-assessed disease severity (three studies, 272 participants, standardised mean difference (SMD) -0.23, 95% CI -0.66 to 0.21; low-quality evidence). In the oat group, there were fewer flares (one study, 43 participants, RR 0.31, 95% CI 0.12 to 0.7; low-quality evidence) and less topical corticosteroids needed (two studies, 222 participants, MD -9.30g, 95% CI 15.3 to -3.27; low-quality evidence), but more adverse events were reported (one study, 173 participants; Peto odds ratio (OR) 7.26, 95% CI 1.76 to 29.92; low-quality evidence).All moisturisers above were compared to placebo, vehicle, or no moisturiser. Participants considered moisturisers more effective in reducing eczema (five studies, 572 participants, RR 2.46, 95% CI 1.16 to 5.23; low-quality evidence) and itch (seven studies, 749 participants, SMD -1.10, 95% CI -1.83 to -0.38) than control. Participants in both treatment arms reported comparable satisfaction (three studies, 296 participants, RR 1.35, 95% CI 0.77 to 2.26; low-quality evidence). Moisturisers led to lower investigator-assessed disease severity (12 studies, 1281 participants, SMD -1.04, 95% CI -1.57 to -0.51; high-quality evidence) and fewer flares (six studies, 607 participants, RR 0.33, 95% CI 0.17 to 0.62; moderate-quality evidence), but there was no difference in adverse events (10 studies, 1275 participants, RR 1.03, 95% CI 0.82 to 1.30; moderate-quality evidence).Topical active treatment combined with moisturiser was more effective than active treatment alone in reducing investigator-assessed disease severity (three studies, 192 participants, SMD -0.87, 95% CI -1.17 to -0.57; moderate-quality evidence) and flares (one study, 105 participants, RR 0.43, 95% CI 0.20 to 0.93), and was preferred by participants (both low-quality evidence). There was no statistically significant difference in number of adverse events (one study, 125 participants, RR 0.39, 95% CI 0.13 to 1.19; very low-quality evidence). Participant-assessed disease severity was not addressed. AUTHORS' CONCLUSIONS Most moisturisers showed some beneficial effects, producing better results when used with active treatment, prolonging time to flare, and reducing the number of flares and amount of topical corticosteroids needed to achieve similar reductions in eczema severity. We did not find reliable evidence that one moisturiser is better than another.
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Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, B1-Q, Leiden, Netherlands, 2300 RC
| | | | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg og Frederiksberg, Nordre Fasanvej 57, Copenhagen, Denmark, DK-2000
| | - Adriana Lavrijsen
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, B1-Q, Leiden, Netherlands, 2300 RC
| | - Bernd WM Arents
- Dutch Association for People with Atopic Dermatitis (VMCE: Vereniging voor Mensen met Constitutioneel Eczeem), PO Box 26, Nijkerk, Netherlands, NL-3860AA
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36
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Pyun BY. Diagnosis and treatment of atopic dermatitis in children. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.9.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Bok Yang Pyun
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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37
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Blume-Peytavi U, Tan J, Tennstedt D, Boralevi F, Fabbrocini G, Torrelo A, Soares-Oliveira R, Haftek M, Rossi AB, Thouvenin MD, Mangold J, Galliano MF, Hernandez-Pigeon H, Aries MF, Rouvrais C, Bessou-Touya S, Duplan H, Castex-Rizzi N, Mengeaud V, Ferret PJ, Clouet E, Saint Aroman M, Carrasco C, Coutanceau C, Guiraud B, Boyal S, Herman A, Delga H, Biniek K, Dauskardt R. Fragility of epidermis in newborns, children and adolescents. J Eur Acad Dermatol Venereol 2016; 30 Suppl 4:3-56. [PMID: 27062556 DOI: 10.1111/jdv.13636] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/10/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022]
Abstract
Within their first days of life, newborns' skin undergoes various adaptation processes needed to accommodate the transition from the wet uterine environment to the dry atmosphere. The skin of newborns and infants is considered as a physiological fragile skin, a skin with lower resistance to aggressions. Fragile skin is divided into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. Extensive research of the past 10 years have proven evidence that at birth albeit showing a nearly perfect appearance, newborn skin is structurally and functionally immature compared to adult skin undergoing a physiological maturation process after birth at least throughout the first year of life. This article is an overview of all known data about fragility of epidermis in 'fragile populations': newborns, children and adolescents. It includes the recent pathological, pathophysiological and clinical data about fragility of epidermis in various dermatological diseases, such as atopic dermatitis, acne, rosacea, contact dermatitis, irritative dermatitis and focus on UV protection.
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Affiliation(s)
- U Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin, Berlin, Germany
| | - J Tan
- Department of Medicine, Faculty of Medicine, Schulich School of Medicine and Dentistry, Western University, Windsor campus, Windsor, ON, Canada.,Windsor Clinical Research Inc., Windsor campus, Windsor, ON, Canada
| | - D Tennstedt
- Department of Dermatology, Saint-Luc University Clinics, Brussels, Belgium
| | - F Boralevi
- Pediatric Dermatology, Pellegrin Hospital, Bordeaux, France
| | - G Fabbrocini
- Department of Dermatology, University Hospital of Naples, Naples, Italy
| | - A Torrelo
- Pediatric Dermatology, Hospital del Niño Jesús, Madrid, Spain
| | | | - M Haftek
- University Lyon 1, Lyon, France.,University Lyon 1, EA4169, "Fundamental, clinical and therapeutic aspects of the skin barrier function", Lyon, France
| | - A B Rossi
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Department of Dermatology, Toulouse University hospital, France
| | - M D Thouvenin
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - J Mangold
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - M F Galliano
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - H Hernandez-Pigeon
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - M F Aries
- Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - C Rouvrais
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - S Bessou-Touya
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Medical Department, Pierre Fabre Research and Laboratoires Dermatologiques A-Derma, Lavaur, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - H Duplan
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - N Castex-Rizzi
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - V Mengeaud
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France
| | - P J Ferret
- Pierre Fabre Dermo-Cosmétique Research & Development, Toxicology Division, Vigoulet-Auzil, France.,Pierre Fabre Dermo-Cosmétique Research & Developement Center, Toxicology division, Vigoulet, France
| | - E Clouet
- Pierre Fabre Dermo-Cosmétique Research & Development, Toxicology Division, Vigoulet-Auzil, France.,Pierre Fabre Dermo-Cosmétique Research & Developement Center, Toxicology division, Vigoulet, France
| | | | - C Carrasco
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique Research and Development Center, Pharmacology Division, Toulouse, France.,Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - C Coutanceau
- Medical Department, Pierre Fabre Research and Laboratoires Dermatologiques A-Derma, Lavaur, France
| | - B Guiraud
- Pierre Fabre Dermo-Cosmétique Research & Development, Clinical Division, Toulouse, France
| | - S Boyal
- Windsor Clinical Research Inc., Windsor campus, Windsor, ON, Canada
| | - A Herman
- Department of Dermatology, Saint-Luc University Clinics, Brussels, Belgium
| | - H Delga
- Pierre Fabre Dermo-Cosmétique, Pierre Fabre Research and Development Center, Pharmacology Division, Toulouse, France
| | - K Biniek
- Department of Materials Science and Engineering, Stanford University hospital, Stanford, CA, USA
| | - R Dauskardt
- Department of Materials Science and Engineering, Stanford University hospital, Stanford, CA, USA
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Hill MK, Kheirandish Pishkenari A, Braunberger TL, Armstrong AW, Dunnick CA. Recent trends in disease severity and quality of life instruments for patients with atopic dermatitis: A systematic review. J Am Acad Dermatol 2016; 75:906-917. [DOI: 10.1016/j.jaad.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
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Sawatzky S, Schario M, Stroux A, Lünnemann L, Zuberbier T, Blume-Peytavi U, Garcia Bartels N. Children with Dry Skin and Atopic Predisposition: Outcome Measurement with Validated Scores for Atopic Dermatitis. Skin Pharmacol Physiol 2016; 29:148-56. [PMID: 27271265 DOI: 10.1159/000444590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dry skin is a common skin condition in childhood. Few studies exist investigating the influence of daily skin care on dry skin in infants at risk of developing atopic dermatitis (AD). We aimed to assess the effect of skin care on dry skin in this special cohort using validated scores for AD and analysis of skin microtopography. METHODS 43 children were randomized to group 1 (G1) and group 2 (G2) and 22 infants to group 3 (G3). During 16 weeks, G1 and G3 applied daily a plant-based emollient and G2 a petrolatum-based emollient. The core outcome was assessed by Severity Scoring of Atopic Dermatitis (SCORAD) and Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD). The influence on the parents' life was evaluated by a questionnaire and microtopography by Visioscan® VC 98. RESULTS The SCORAD index declined significantly until week (W) 16 in all groups (p ≤ 0.041). The sleeplessness score analyzed by PO-SCORAD was highly reduced after W12 in G1 and after W16 in G2 (p ≤ 0.030). The influence on the parents' anxiety was reduced in G3 at W12 and W16 (p = 0.016). The Visioscan parameter scaliness strongly diminished at W4 (p ≤ 0.049) and W16 (p ≤ 0.013) in all groups. CONCLUSIONS This trial demonstrates improved skin conditions and sleep following daily emollient application in infants and children having dry skin and being at risk of AD. Especially parents of infants showed a reduced fear that their children might develop AD. Further studies are required to investigate the preventive effect of daily emollient therapy in this special cohort evaluating the outcome measures used in this trial.
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Affiliation(s)
- Sabine Sawatzky
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charitx00E9; - Universitx00E4;tsmedizin Berlin, Berlin, Germany
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40
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Roesner LM, Werfel T, Heratizadeh A. The adaptive immune system in atopic dermatitis and implications on therapy. Expert Rev Clin Immunol 2016; 12:787-96. [PMID: 26967382 DOI: 10.1586/1744666x.2016.1165093] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In atopic dermatitis (AD), the skin inflammation is believed to occur due to a misdirected immune reaction against harmless antigens on the one hand, and to a disturbed skin barrier on the other. In recent years, vast efforts have been made to investigate the relevance and details of the immune response to allergens. Clinically, it was demonstrated for the first time that aeroallergen exposure leads to worsening of AD symptoms. An overexpression of Th2 cytokines has been observed in acute and subacute lesions of AD. The clinical impact of the key Th2 cytokines IL-4 and IL-13 on atopic dermatitis has recently been shown in clinical studies with dupilumab, a monoclonal antibody which blocks the IL-4/IL-13 receptor. In vitro data indicate, however, that the T cell response is not solely Th2-polarized but may lead to heterogeneous cytokine production involving IFN-γ and IL-17 in an allergen-dependent manner. Classical thymus-derived Foxp3 T cells have interestingly been detected in elevated numbers in the circulation of AD patients. Therapeutic approaches with allergen specific immunotherapy aim to induce regulatory T cells of the Tr1 type. The strikingly altered microbiome of AD skin with diminished diversity of bacteria on lesional skin but increases of S. aureus colonization and the sensitization against microbial allergens and homologue self-proteins deserve special attention. For the treatment of itch symptoms, which still represent a challenge in daily practice, promising data have been published on the relevance of the H(histamine)4-receptor and on mediators such as IL-31, TSLP.
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Affiliation(s)
- Lennart M Roesner
- a Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy , Hannover Medical School , Hannover , Germany
| | - Thomas Werfel
- a Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy , Hannover Medical School , Hannover , Germany
| | - Annice Heratizadeh
- a Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy , Hannover Medical School , Hannover , Germany
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Thomas W, Werner A, Frank A, Matthias A, Tilo B, Thomas D, Regina FH, Uwe G, Annice H, Julia K, Alexander K, Alexander N, Katja N, Hagen O, Bernhard P, Martin R, Martin S, Peter SG, Jochen S, Thomas S, Doris S, Margitta W. Leitlinie Neurodermitis [atopisches Ekzem; atopische Dermatitis]. J Dtsch Dermatol Ges 2015; 14:e1-75. [DOI: 10.1111/ddg.12884] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
| | - Aberer Werner
- Österreichische Gesellschaft für Dermatologie und Venerologie
| | - Ahrens Frank
- Gesellschaft für Pädiatrische Allergologie und Umweltmedizin e.V
| | - Augustin Matthias
- Arbeitsgemeinschaft Gesundheitsökonomie und Evidenzbasierte Medizin der Deutschen Dermatologischen Gesellschaft
| | | | - Diepgen Thomas
- Arbeitsgemeinschaft Berufs- und Umweltdermatologie der Deutschen Dermatologischen Gesellschaft
| | - Fölster-Holst Regina
- Arbeitsgemeinschaft Pädiatrische Dermatologie der Deutschen Dermatologischen Gesellschaft
| | | | | | | | - Kapp Alexander
- Deutsche Gesellschaft für Allergologie und Klinische Immunologie
| | - Nast Alexander
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (Moderation)
| | - Nemat Katja
- Berufsverband der Kinder- und Jugendärzte e.V
| | - Ott Hagen
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V
| | - Przybilla Bernhard
- Arbeitsgemeinschaft Allergologie der Deutschen Dermatologischen Gesellschaft
| | | | | | | | | | | | - Staab Doris
- Arbeitsgemeinschaft Neurodermitisschulung e.V
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Kim JE, Kim HJ, Lew BL, Lee KH, Hong SP, Jang YH, Park KY, Seo SJ, Bae JM, Choi EH, Suhr KB, Lee SC, Ko HC, Park YL, Son SW, Seo YJ, Lee YW, Cho SH, Park CW, Roh JY. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment. Ann Dermatol 2015; 27:563-77. [PMID: 26512171 PMCID: PMC4622891 DOI: 10.5021/ad.2015.27.5.563] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/23/2015] [Accepted: 08/11/2015] [Indexed: 01/28/2023] Open
Abstract
Background Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. Objective We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. Methods We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. Results Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. Conclusion This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.
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Affiliation(s)
- Jung Eun Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Dermatology, Seoul Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Ho Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Phil Hong
- Department of Dermatology, Dankook University Medical College, Cheonan, Korea
| | - Yong Hyun Jang
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Min Bae
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ki Beom Suhr
- Department of Dermatology, SA Dermatology Clinic, Daejeon, Korea
| | - Seung Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Chang Ko
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Jun Seo
- Department of Dermatology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joo Young Roh
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
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Mengeaud V, Phulpin C, Bacquey A, Boralevi F, Schmitt AM, Taieb A. An innovative oat-based sterile emollient cream in the maintenance therapy of childhood atopic dermatitis. Pediatr Dermatol 2015; 32:208-15. [PMID: 25529232 DOI: 10.1111/pde.12464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Although emollients are recommended in the management of atopic dermatitis (AD), regimens for emollient maintenance therapy are awaiting validation. We conducted an international, multicenter, open-label trial to assess the effects of a 3-month maintenance treatment regimen with a sterile, preservative-free emollient cream containing oat plantlets in children (ages 6 mos-6 yrs) with moderate AD. After a 14-day run-in stabilization phase using a topical corticosteroid (TCS) treatment of medium potency, 108 children with a SCORing Atopic Dermatitis (SCORAD) index of 20 or less were included in the study. Emollient was applied twice daily for 3 months. Rescue TCS treatment was used only in cases of flare-ups. The SCORAD index, Patient-Oriented SCORAD (PO-SCORAD) index, number of flares, TCS use, and tolerance were assessed at months 1, 2, and 3 (M1, M2, M3). AD severity improved, with a highly significant decrease in the SCORAD and PO-SCORAD indexes at M2 and M3 (p < 0.001). Changes from baseline to M3 were 48.6 ± 73.6% for SCORAD and 29.6 ± 125.3% for PO-SCORAD. The number of flares and TCS use significantly decreased by M3 (both p < 0.001). Very good tolerance was recorded in 100% of children at M2 and M3. Notwithstanding the limitations inherent in open-label trials, twice daily application of the oat-based sterile emollient cream led to a significant improvement of clinical symptoms, evidenced by parallel changes in the SCORAD and PO-SCORAD indexes and fewer flare-ups. Clinical benefit and less TCS use were maintained at M3. Tolerance was very good.
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Affiliation(s)
- Valerie Mengeaud
- Pierre Fabre Applied Skin Research Centre, Pierre Fabre Dermo Cosmétique, Toulouse, France
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Schario M, Lünnemann L, Stroux A, Reisshauer A, Zuberbier T, Blume-Peytavi U, Garcia Bartels N. Children with dry skin and atopic predisposition: daily use of emollients in a participant-blinded, randomized, prospective trial. Skin Pharmacol Physiol 2014; 27:208. [PMID: 24714097 DOI: 10.1159/000360546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dry skin reflects a skin barrier defect which can lead to atopic dermatitis. Little is known about the distinct effects of emollient use in children with dry skin and atopic predisposition. OBJECTIVES We investigated the effects of daily application of pressed ice plant juice (PIPJ)-based emollients and petrolatum-based emollients. METHODS Children aged 2-6 years with dry skin and atopic predisposition were randomized into 2 groups: group 1 received emollients containing PIPJ and natural lipids, while group 2 received petrolatum-based emollients. Skin condition and biophysical properties of the skin barrier were assessed at inclusion and weeks 4, 12 and 16. RESULTS Skin condition improved significantly in all children. Comparing the groups, children treated with emollients containing PIPJ showed significantly higher stratum corneum hydration values and significantly lower transepidermal water loss values at week 16 on the forearm and forehead. A significant decrease in skin pH was noted in group 2 on the forearm and forehead; group 1 showed a stable course. CONCLUSION Early intervention with emollients in children with dry skin condition and atopic predisposition may improve their skin condition during daily emollient application. PIPJ-based formulations may be helpful to maintain skin barrier integrity.
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Affiliation(s)
- Marianne Schario
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
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