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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 -
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 -
Advances in Experimental Medicine and... 2017The pathophysiology of atopic dermatitis is complex and multifactorial, involving elements of barrier dysfunction, alterations in cell mediated immune responses, IgE... (Review)
Review
The pathophysiology of atopic dermatitis is complex and multifactorial, involving elements of barrier dysfunction, alterations in cell mediated immune responses, IgE mediated hypersensitivity, and environmental factors. Loss of function mutations in filaggrin have been implicated in severe atopic dermatitis due to a potential increase in trans-epidermal water loss, pH alterations, and dehydration. Other genetic changes have also been identified which may alter the skin's barrier function, resulting in an atopic dermatitis phenotype. The imbalance of Th2 to Th1 cytokines observed in atopic dermatitis can create alterations in the cell mediated immune responses and can promote IgE mediated hypersensitivity, both of which appear to play a role in the development of atopic dermatitis. One must additionally take into consideration the role of the environment on the causation of atopic dermatitis and the impact of chemicals such as airborne formaldehyde, harsh detergents, fragrances, and preservatives. Use of harsh alkaline detergents in skin care products may also unfavorably alter the skin's pH causing downstream changes in enzyme activity and triggering inflammation. Environmental pollutants can trigger responses from both the innate and adaptive immune pathways. This chapter will discuss the multifaceted etiology of atopic dermatitis which will help us to elucidate potential therapeutic targets. We will also review existing treatment options and their interaction with the complex inflammatory and molecular triggers of atopic dermatitis.
Topics: Dermatitis, Atopic; Filaggrin Proteins; Food Hypersensitivity; Humans; Inflammation; Tight Junctions
PubMed: 29063428
DOI: 10.1007/978-3-319-64804-0_3 -
The New England Journal of Medicine Mar 2021
Review
Topics: Causality; Dermatitis, Atopic; Humans; Hypersensitivity, Immediate; Immunosuppressive Agents; Phototherapy; Skin
PubMed: 33761208
DOI: 10.1056/NEJMra2023911 -
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 -
Pediatric Dermatology May 2022Atopic dermatitis (AD) is a common disease with a broad spectrum of clinical manifestations. AD can manifest differently in adults than children. Core AD features are... (Review)
Review
Atopic dermatitis (AD) is a common disease with a broad spectrum of clinical manifestations. AD can manifest differently in adults than children. Core AD features are similar between children and adults overall, including lesions affecting flexural areas, presence of atopy, and xerosis. Adults have more signs of chronic disease, higher prevalence and different patterns of hand eczema, and a stronger relationship of disease activity with emotional factors, whereas children with AD have more exudative lesions, perifollicular accentuation, pityriasis alba, Dennie-Morgan folds, and seborrheic dermatitis-like presentation. These differences may be due in part to pathophysiologic differences in AD in children compared with adults. Atopic diseases commonly co-occur with AD, although most do not temporally have the "atopic march." Further research is warranted to better understand the differential roles of immune dysregulation, epidermal-barrier disruption, and dysbiosis between children and adults and determine whether such differences translate into differences in therapeutic efficacy.
Topics: Adult; Child; Dermatitis, Atopic; Eczema; Humans; Prevalence
PubMed: 35297082
DOI: 10.1111/pde.14971 -
Allergy and Asthma Proceedings Mar 2019Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. Genetic predisposition, epidermal barrier disruption, and dysregulation of the immune system... (Review)
Review
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. Genetic predisposition, epidermal barrier disruption, and dysregulation of the immune system are some of the critical components of AD. An impaired skin barrier may be the initial step in the development of the atopic march as well as AD, which leads to further skin inflammation and allergic sensitization. Type 2 cytokines as well as interleukin 17 and interleukin 22 contribute to skin barrier dysfunction and the development of AD. New insights into the pathophysiology of AD have focused on epidermal lipid profiles, neuroimmune interactions, and microbial dysbiosis. Newer therapeutic strategies focus on improving skin barrier function and targeting polarized immune pathways found in AD. Further understanding of AD pathophysiology will allow us to achieve a more precision medicine approach to the prevention and the treatment of AD.
Topics: Dermatitis, Atopic; Humans; Inflammation; Skin
PubMed: 30819278
DOI: 10.2500/aap.2019.40.4202 -
The American Journal of Managed Care Jun 2017Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory skin condition. Incidence of AD has increased 2- to 3-fold in industrialized... (Review)
Review
Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory skin condition. Incidence of AD has increased 2- to 3-fold in industrialized nations, impacting approximately 15% to 20% of children and 1% to 3% of adults worldwide. AD has a wide-ranging impact on a patient's quality of life and the burden from direct and indirect costs (approximately $37.7 billion in out-of-pocket costs) is shared by the families and caregivers of patients with AD. This article reviews the epidemiology, burden of disease, pathophysiology, and diagnostic criteria important for early diagnosis and treatment. New insights related to the genetic, immunologic, and environmental impacts of AD have created new treatment opportunities. Nonpharmacologic and pharmacologic interventions are discussed, with an emphasis on emerging treatments for AD. Healthcare providers play an important role in the management of AD to improve economic and clinical outcomes. Treatment strategies need to be individualized with a strong emphasis on patient education and self-management strategies to optimize outcomes and reduce unnecessary costs associated with the management of AD.
Topics: Cost of Illness; Dermatitis, Atopic; Health Care Costs; Humans; Risk Factors; Skin
PubMed: 28978208
DOI: No ID Found -
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... Sep 2021Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and significantly impacts patients' lives, particularly in its severe forms. AD clinical... (Review)
Review
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease and significantly impacts patients' lives, particularly in its severe forms. AD clinical presentation varies over the course of the disease, throughout different age groups, and across ethnicities. AD is characterized by a spectrum of clinical phenotypes as well as endotypes. Starting from the current description of AD pathogenesis, this review explores the rationale of approved AD therapies from emollients to biologicals and introduces novel promising drugs.
Topics: Animals; Biological Products; Dermatitis, Atopic; Emollients; Humans
PubMed: 34638722
DOI: 10.3390/ijms221910381