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International Journal of Molecular... Apr 2021Atopic dermatitis is a chronic, non-infectious inflammatory dermatosis. Acharacteristic feature is persistent itching of the skin. The chronic, relapsing course of the... (Review)
Review
Atopic dermatitis is a chronic, non-infectious inflammatory dermatosis. Acharacteristic feature is persistent itching of the skin. The chronic, relapsing course of the disease, economic burden, and the whole family's involvement in the treatment process immensely reduce the quality of life of patients and their families. The disease emerges as a social problem by increasing indirect costs, such as visiting a doctor, absenteeism from work and school, and avoiding social interactions. Thepathophysiology of atopic dermatitis is complex and multifactorial. It includes genetic disorders, a defect in the epidermal barrier, an altered immune response, anddisruption of the skin's microbial balance. The numerous complex changes at thegenetic level and innate and adaptive immunity provide the basis for characterizing the various phenotypes and endotypes of atopic dermatitis. Emerging therapies rely on the action of specific molecules involved in the disease's pathogenesis. It may be the starting point for the individualization of atopic dermatitis treatment. This paper will try to present some molecular mechanisms of atopic dermatitis and their clinical implications.
Topics: Animals; Dermatitis, Atopic; Epigenesis, Genetic; Humans; Immunity, Innate; Microbiota
PubMed: 33923629
DOI: 10.3390/ijms22084130 -
American Family Physician May 2020Atopic dermatitis (atopic eczema) is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime. Atopic dermatitis is... (Review)
Review
Atopic dermatitis (atopic eczema) is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime. Atopic dermatitis is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupts the epidermis causing intensely pruritic skin lesions. Repeated scratching triggers a self-perpetuating itch-scratch cycle, which can have a significant impact on the patient's quality of life. The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings. Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers. Use of topical corticosteroids is the first-line treatment for atopic dermatitis flare-ups. Pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment. Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate. Antistaphylococcal antibiotics are effective in treating secondary skin infections. Oral antihistamines are not recommended because they do not reduce pruritus. Evidence is lacking to support the use of integrative medicine in the treatment of atopic dermatitis. Newer medications approved by the U.S Food and Drug Administration, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost prohibitive for most patients.
Topics: Administration, Topical; Adrenal Cortex Hormones; Baths; Calcineurin Inhibitors; Dermatitis, Atopic; Diagnosis, Differential; Emollients; Humans; Phototherapy; Pruritus; Severity of Illness Index; Skin Diseases, Infectious
PubMed: 32412211
DOI: No ID Found -
The Journal of Allergy and Clinical... May 2023Recent research into the pathophysiology and treatment of atopic dermatitis (AD) has shown notable progress. An increasing number of aspects of the immune system are... (Review)
Review
Recent research into the pathophysiology and treatment of atopic dermatitis (AD) has shown notable progress. An increasing number of aspects of the immune system are being implicated in AD, including the epithelial barrier, T2 cytokines, and mast cells. Major advances in therapeutics were made in biologic cytokine and receptor antagonists and among Janus kinase inhibitors. We focus on these areas and address new insights into AD epidemiology, biomarkers, endotypes, prevention, and comorbidities. Going forward, we expect future mechanistic insights and therapeutic advances to broaden physicians' ability to diagnose and manage AD patients, and perhaps to find a cure for this chronic condition.
Topics: Humans; Dermatitis, Atopic; Cytokines; Immune System; Biomarkers; Mast Cells
PubMed: 36428114
DOI: 10.1016/j.jaci.2022.10.023 -
Deutsches Arzteblatt International Mar 2023Atopic dermatitis is a common, chronically recurring inflammatory skin disease. It gives rise to a high disease burden and is of major importance in social medicine. (Review)
Review
BACKGROUND
Atopic dermatitis is a common, chronically recurring inflammatory skin disease. It gives rise to a high disease burden and is of major importance in social medicine.
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed, including the current German and European guidelines.
RESULTS
Basic therapy with drug-free topical agents markedly improves the barrier function of the skin. Adults should apply at least 250 g per week. Patient-specific trigger factors such as allergens, stress, microbial pathogens, or skin irritants should be eliminated or avoided. In mild and moderately severe forms, external treatment with topical glucocorticosteroids and topical calcineurin inhibitors usually suffices; proactive therapy is given to patients with frequent recurrences or a long course of disease. Systemic anti-inflammatory treatment with biological agents such as dupilumab and tralokinumab, Janus kinase inhibitors such as baricitinib, upadacitinib, and abrocitinib, or conventional immunosuppressant drugs is indicated particularly in severe cases. The patient should be actively involved in the choice and planning of treatment; the patient's age and the cutaneous findings should be taken into account. Interdisciplinary patient education yields a sustained benefit.
CONCLUSION
A combination of baseline therapy, reactive and proactive anti-inflammatory therapy, and systemic therapy as needed is the foundation of successful interdisciplinary treatment for atopic dermatitis.
Topics: Humans; Adult; Child; Dermatitis, Atopic; Immunosuppressive Agents; Calcineurin Inhibitors; Anti-Inflammatory Agents; Treatment Outcome
PubMed: 36747484
DOI: 10.3238/arztebl.m2023.0011 -
Acta Medica Portuguesa Sep 2019With an increasing prevalence during the past decades, atopic dermatitis has become a global health issue. A literature search following a targeted approach was... (Review)
Review
With an increasing prevalence during the past decades, atopic dermatitis has become a global health issue. A literature search following a targeted approach was undertaken to perform this non-systematic review, which intends to provide an overview of the epidemiology, pathophysiology, clinical features, comorbidities, and current therapies for the treatment of atopic dermatitis. In sum, this is a heterogeneous skin disorder associated with variable morphology, distribution, and disease course. Although not completely understood, its pathogenesis is complex and seems to result from a combination of genetic and environmental factors that induce skin barrier dysfunction, cutaneous and systemic immune dysregulation, skin microbiota dysbiosis, and a strong genetic influence. Diagnosis is based on specific criteria that consider patient and family history and clinical manifestations. Overall disease severity must be determined by evaluating both objective signs and subjective symptoms. Therapeutic goals require a multistep approach, focusing on reducing pruritus and establishing disease control. Patients should be advised on basic skin care and avoidance of triggers. Topical anti-inflammatory agents should be considered in disease flares or chronic/recurrent lesions. In case of inadequate response, phototherapy, systemic immunosuppressants and, more recently, dupilumab, should be added. Nevertheless, the treatment of moderate-to-severe atopic dermatitis remains challenging and novel, efficacious, safe and targeted treatments are urgently needed. In conclusion, although the last few years have seen important improvement in the understanding of the disease, future research in atopic dermatitis will continue exploring gene-environment interactions and how it affects pathophysiology, disease severity, and treatment outcomes.
Topics: Age Factors; Comorbidity; Dermatitis, Atopic; Disease Management; Family Health; Gene-Environment Interaction; Humans; Primary Prevention; Quality of Life; Severity of Illness Index
PubMed: 31493365
DOI: 10.20344/amp.11963 -
The Journal of Allergy and Clinical... Jan 2020Atopic dermatitis (AD) is one of the most common inflammatory skin diseases affecting children and adults. The intense pruritus and rash can be debilitating,... (Review)
Review
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases affecting children and adults. The intense pruritus and rash can be debilitating, significantly impairing quality of life. Until recently, treatment was largely nonspecific and, in severe disease, sometimes ineffective and/or fraught with many side effects. Now, multiple agents targeting specific disease pathways are available or in development. Two new therapies, crisaborole and dupilumab, have become available since 2016, and dupilumab has dramatically improved outcomes for adults with severe AD. This article provides an overview of AD, including strategies for differential diagnosis and assessment of disease severity to guide treatment selection. Key clinical trials for crisaborole and dupilumab are reviewed, and other targeted treatments now in development are summarized. Two cases, representing childhood-onset and adult-onset AD, are discussed to provide clinical context for diagnosis, severity assessment, and treatment selection and outcomes.
Topics: Adult; Antibodies, Monoclonal, Humanized; Child; Dermatitis, Atopic; Eczema; Humans; Quality of Life; Severity of Illness Index; Treatment Outcome
PubMed: 31474543
DOI: 10.1016/j.jaip.2019.06.044 -
The Journal of Allergy and Clinical... May 2023Atopic dermatitis (AD) is a complex and highly heterogeneous inflammatory skin disease. Given the highly heterogeneous character of AD, it is unlikely that every patient... (Review)
Review
Atopic dermatitis (AD) is a complex and highly heterogeneous inflammatory skin disease. Given the highly heterogeneous character of AD, it is unlikely that every patient will respond equally to a particular treatment. The recent introduction of novel targeted therapies for AD has driven the need for patient stratification based on immunologic biomarkers. We have reviewed the use of different types of biomarkers as potential tools in the movement toward personalized medicine in AD, comprising different ways of endotyping patients with AD based on immunologic profiles and predictive biomarkers. The application of biomarkers will result in better characterization and stratification of patients and allow better comparison of current and new treatments. The ultimate goal will be to switch from the current generalized "one-drug-fits-all" management to more personalized "patient endotype-specific" management.
Topics: Humans; Dermatitis, Atopic; Biomarkers; Precision Medicine
PubMed: 36792449
DOI: 10.1016/j.jaci.2023.01.019 -
The Journal of Allergy and Clinical... Oct 2021Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with heterogenous presentation and often immense patient burden. Safe, targeted treatment... (Review)
Review
Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with heterogenous presentation and often immense patient burden. Safe, targeted treatment options are currently limited. This focused review of the published literature, including clinical trial results, case reports, and abstracts, as well as presentations from scientific meetings and data from industry press releases, describes the use of topical and systemic Janus kinase (JAK) inhibitors in the treatment of AD. New topical JAK inhibitors include ruxolitinib (JAK1/2) and delgocitinib (pan-JAK). Ruxolitinib cream met all primary and secondary endpoints in phase 3 clinical trials for mild-to-moderate AD with minimal treatment-emergent adverse events. Delgocitinib ointment was recently approved in Japan for pediatric and adult AD. Oral JAK inhibitors include baricitinib (JAK1/2), abrocitinib (JAK1-selective), and upadacitinib (JAK1-selective). All 3 met primary and secondary endpoints across numerous trials for moderate-to-severe AD. Treatment-emergent adverse events were mainly mild to moderate and included acne, nausea, headache, upper respiratory tract infection, and to a lesser degree, herpes infection and selected laboratory abnormalities. JAK inhibitors hold great promise as the next generation of targeted AD therapy. While their outstanding efficacy is balanced by a favorable safety profile in clinical trials, real-world data are needed to better understand long-term safety, durability, and treatment success.
Topics: Administration, Oral; Administration, Topical; Dermatitis, Atopic; Humans; Janus Kinase Inhibitors
PubMed: 34437922
DOI: 10.1016/j.jaci.2021.08.009 -
Acta Dermato-venereologica Jun 2020Atopic dermatitis is the most prevalent chronic inflammatory skin condition globally. The burden of atopic dermatitis on children and adults is extensive and there is... (Review)
Review
Atopic dermatitis is the most prevalent chronic inflammatory skin condition globally. The burden of atopic dermatitis on children and adults is extensive and there is also significant impact on the lives of patient caregivers and family members. It is important to be able to measure this impact to inform clinical decisions and to plan appropriate patient and carer support. The current impact of atopic dermatitis on children and adults can be measured using several different quality of life questionnaires: the most frequently used are the Dermatology Quality of Life (DLQI), Children's Dermatology Quality of Life and Infants Dermatology Quality of Life. The impact on partners and family can be measured using several atopic dermatitis specific questionnaires or the Family DLQI or the generic Family Reported Outcome Measure, FROM-16.
Topics: Adaptation, Psychological; Caregivers; Cost of Illness; Dermatitis, Atopic; Family Relations; Humans; Mental Health; Patient Reported Outcome Measures; Predictive Value of Tests; Prognosis; Quality of Life
PubMed: 32412644
DOI: 10.2340/00015555-3511 -
International Journal of Molecular... Apr 2020Atopic dermatitis (AD) is a common and relapsing skin disease that is characterized by skin barrier dysfunction, inflammation, and chronic pruritus. While AD was... (Review)
Review
Atopic dermatitis (AD) is a common and relapsing skin disease that is characterized by skin barrier dysfunction, inflammation, and chronic pruritus. While AD was previously thought to occur primarily in children, increasing evidence suggests that AD is more common in adults than previously assumed. Accumulating evidence from experimental, genetic, and clinical studies indicates that AD expression is a precondition for the later development of other atopic diseases, such as asthma, food allergies, and allergic rhinitis. Although the exact mechanisms of the disease pathogenesis remain unclear, it is evident that both cutaneous barrier dysfunction and immune dysregulation are critical etiologies of AD pathology. This review explores recent findings on AD and the possible underlying mechanisms involved in its pathogenesis, which is characterized by dysregulation of immunological and skin barrier integrity and function, supporting the idea that AD is a systemic disease. These findings provide further insights for therapeutic developments aiming to repair the skin barrier and decrease inflammation.
Topics: Allergens; Animals; Biomarkers; Cytokines; Dermatitis, Atopic; Disease Management; Disease Susceptibility; Homeostasis; Humans; Immunity; Immunomodulation; Lymphocyte Subsets; Signal Transduction; Skin; Toll-Like Receptors; Thymic Stromal Lymphopoietin
PubMed: 32326002
DOI: 10.3390/ijms21082867