[Dermocorticoides and sun exposure: A misunderstanding?] / Dermocorticoïdes et exposition solaire : un malentendu ?

INTRODUCTION: Fear of dermocorticoids (DCs) or corticophobia is based on an overestimation of the risks of actual side effects and on unfounded beliefs such as DCs-induced photosensitivity among community pharmacists. The objective of this study was to assess the community pharmacy teams' fear of dermocorticoids in atopic dermatitis (DA) in sunny weather and its impact on drug use advice. MATERIAL ET METHODS: A questionnaire as a real case (a summer prescription for atopic dermatitis for an 18-month-old child) was posted on Facebook via groups of pharmacists, technicians and students. Data collected concerned the health professional, his or her reluctance to DCs, advice associated with dispensation, detailed concerns about the DC and sun association, and sources of information. RESULTS: In total, 126 participants responded (48.4% pharmacists, 40.5% technicians, 10.3% students): 12% were reluctant to DCs, 36% were reluctant to DCs and considered them photosensitizing, and 51% were not reluctant but considered them photosensitizing. The impact on the patient advice was: a suggestion to stop DC during sun exposure (28%), to stop or limit DC (dose, duration) (43%). Concerns about the association DC/sun were mainly due to UV rays (46%). Sources cited were: monographs (54%), Internet (6%), training courses (13%). CONCLUSION: The false belief of DC/sun incompatibility in DA is strong among pharmacists and impacts on patients' advice. The role of the official team in dispensing dermocorticoids is essential: training and information for professionals helps to fight false information.

Dermatite atopique : quatre cas cliniques: Atopic dermatitis: four case reports.

We present clinical cases which illustrate the difficulty of diagnosis and therapy in everyday life. The therapeutic goal may be far from that expected following clinical trials. © 2020 Elsevier Masson SAS. All rights reserved.

Dermatite atopique : trois cas cliniques Il était une fois...: Atopic dermatitis: three case reports.

Atopic dermatitis is a common condition and the clinical presentation is often classic. Yet management of the disease varies widely, not always taking into account the severity of the disease and its repercussions on the patient and his environment - personal or social. With on one side the resilience of the patient and on the other side a shortage of general practitioners or dermatologists, a lack of understanding in the professional or family environment, and clinical inertia, disease management is clearly insufficient. Like in all inflammatory dermatoses, the patient's and the physician's assessment and perception of the clinical severity or the deterioration of the quality of life often differ. These three clinical cases are real-life situations where the emphasis is on their history and not on therapeutic choices. © 2020 Elsevier Masson SAS. All rights reserved.

Les scores d'évaluation de la dermatite atopique: Outcome measures for atopic dermatitis.

Scores evaluating the severity of atopic dermatitis are less well known and less used in daily practice of dermatologists than those for psoriasis, but things are changing. Indeed, the numerous trials and therapeutic advances in the field of eczema have also imposed the use of scales to objectively assess the severity of the disease and its improvement with treatment. The scores were initially numerous and poorly validated, but there is currently a trends towards simplification and standardization, with the work in particular of the Harmonizing Outcome Measures for Eczema (HOME) group. Scores for objective clinical signs, patient-reported symptoms, quality of life, and long-term disease control are now considered to be the core outcome set. The most used scores are detailed in this article. © 2020 Elsevier Masson SAS. All rights reserved.

Fardeau de la dermatite atopique chez l'enfant et l'adolescent: Burden of atopic dermatitis in children and adolescents.

Atopic dermatitis has a very significant impact on children and adolescents. Having visible lesions, but above all almost permanent pruritus or sometimes skin pain inevitably has consequences on all aspects of daily life, including sleep, education and relationships with others, family and emotional life. It also has an impact on the whole family. Stigmatization may occur. Treatment and especially local care can be very demanding. Adherence to treatment is therefore often difficult. Quality of life can be severely impaired and atopic dermatitis can be a heavy burden. The psychological consequences can be major. Family problems related to the disease often arise. The best way out of it is probably to have very effective and well-tolerated treatments. © 2020 Elsevier Masson SAS. All rights reserved.

Physiopathologie de la dermatite atopique et des autres maladies atopiques : une approche globale est-elle possible ?: Pathophysiology of atopic dermatitis and other atopic diseases: is a global approach possible?

Atopy is defined by the propensity to develop an exaggerated type-2 inflammatory response to environmental molecules. Clinically, atopy is diagnosed when atopic disease occurs: atopic dermatitis, food allergy, atopic asthma and allergic rhinitis and conjunctivitis. Whereas the classical "atopic march" is increasingly challenged through epidemiological studies, type-2 cellular inflammation is a characteristic shared by the atopic diseases. This inflammation can be innate (non-specific: eosinophils, mast cells, dendritic cells, innate lymphoid cells [ILC]), or adaptive (antigen-specific, involving T cells). Interleukins (IL-)4, 5 and 13 are major actors of type-2 inflammation and are mainly produced by ILC and T cells. The efficacy of treatments targeting these type-2 cytokines highlight the importance of type-2 inflammation in atopic diseases. However, several patients do not respond to type-2 targeting treatments, highlighting the presence of other actors in pathophysiology of atopic diseases: alteration of epithelial barrier, IgE-mediated allergic responses, type-17 inflammation. Thus, the term "endotype" can illustrate this diversity in pathophysiology. Finally, a global approach of atopic diseases, as type-2 inflammatory diseases, is fundamental, but not sufficient. An approach by endotype is advisable, in a personalized medicine perspective. © 2020 Elsevier Masson SAS. All rights reserved.

Les traitements systémiques de la dermatite atopique: Systemic treatments of atopic dermatitis.

The treatment of atopic dermatitis is based on the use of topical steroids and emollients. When AD is resistant to a well-conducted topical treatment, phototherapy or systemic therapeutics can be used: ciclosporin, methotrexate, azathioprine or mycophenolate mofetil. However, the therapeutic landscape of AD is changing dramatically because of the approval of dupilumab (an anti-IL4/IL13 biologic therapy) and the possible future arrival of other biologicals (anti-IL13, anti-IL31…), and JAK inhibitors. © 2019 Elsevier Masson SAS. All rights reserved.

Comorbidités de la dermatite atopique: Comorbidities of atopic dermatitis.

Atopic dermatitis is associated with an increased risk of asthma (10 to 30% according to age), allergic rhinitis and conjunctivitis and food allergy. Other comorbidiies are globally lest frequent than in psoriasis. There is no increased risk of solid cancer. Smoking is a major confounding factor that has to be taken into account. Obesity and metabolic syndrome are more frequent and there is a moderately increased cardiovascular risk in severe forms of atopic dermatitis. There is a clear-cut increased risk of vitiligo and alopecia areata and a lower risk of other auto-immune diseases, including type I diabetes in children. There is a higher risk of cutaneous but not extra-cutaneous bacterial and viral infections, and increased frequency of contact dermatitis and urticaria. Severe atopic dermatitis is associated with psychiatric comorbidities, like attention disorders/hyperactivity, depression and suicidal ideas. © 2019 Elsevier Masson SAS. All rights reserved.

Traitements topiques et photothérapie dans la dermatite atopique: Topical treatments and phototherapy in atopic dermatitis.

Atopic dermatitis is a chronic disease with an alteration of the skin barrier and an abnormal immune response. The European guidelines for treatment of atopic dermatitis in children and adults recommend basic hygiene rules including daily use of emollient. Then in the first therapeutic line, for mild or acute atopic dermatitis, the prescription of local care by topical corticosteroids or topical calcineurin inhibitors is recommended. A proactive treatment is now recommended. If the atopic dermatitis is moderate or recurrent, the use of phototherapy in addition to topical treatment is recommended. Each therapeutic step can be added to improve the lesions and reduce the burden of the disease on the patient's daily life. © 2019 Elsevier Masson SAS. All rights reserved.

Histoire naturelle de la dermatite atopique: Natural History of Atopic Dermatitis.

Atopic dermatitis (AD) is a common frequent chronic inflammatory skin disease which begins frequently in infancy. The clinical expression of AD is a recurrent eczema on a dry skin. AD is a multifactorial disease characterized by two linked abnormalities: a skin barrier defect and a cellular inflammation, with type-2 main components. However, the pathophysiology of AD is not as simple as this description looks like. In this review, we will present a synthesis of current knowledge on natural history of AD and the involved factors, in order to clarify AD care. The evolution of AD is associated with many atopic comorbidities, following the "atopic march" scheme: IgE-mediated food allergy, allergic asthma and rhinitis occurring classically after AD. In fact, this is rarely the case, but the atopic march seems to be associated with AD severity. AD has also many neuropsychological complications which are essential to be detected. Other factors could influence the natural history of AD: genetic mutations on different genes (proteins of skin barrier, innate and adaptive immunity pathways), skin dysbiosis with colonization by Staphylococcus aureus, sensitization against environmental proteins. AD treatment is based on the restauration of the skin barrier using emollients and on anti-inflammatory drugs (notably topical corticosteroids) during the inflammatory flares. It is not recommended to treat the skin colonization by S. aureus, excepted in case of skin infection. The probiotics have no efficiency as curative treatment of AD, but could have an interest for the primary prevention, especially in at-risk populations. © 2019 Elsevier Masson SAS. All rights reserved.

[What's new in pediatric dermatology?] / Quoi de neuf en dermatologie pédiatrique?

In order to describe the latest news in Pediatric dermatology (pathophysiology, clinical aspects and therapy), a literature review was performed from September 2017 to September 2018. This article is not an exhaustive review but present the new data that may infuence the daily practice. The results are presented by disease that may be common or rare. Some references are available as supplements.

[What's new in dermatological treatment?] / Quoi de neuf en thérapeutique dermatologique?

The therapeutic revolution in the management of inflammatory dermatoses is under way. The therapeutic arsenal is expanding in the field of psoriasis, including biologics (TNF blockers, anti-IL12/IL23, anti-IL17, and anti-IL23 antibodies), new small molecules (tyrosine kinase inhibitor), and a new biologic for generalized pustular psoriasis (anti-IL36 receptor). New biologics will be soon available in the field of atopic dermatitis in addition to anti-IL4/IL13 antibodies. New targeted treatments of pruritus are also coming (biologics and small molecules). A first randomized placebo-controlled trial has confirmed the interest of JAK inhibitors in alopecia areata. These molecules seem to be also promising in dermatomyositis. Another therapeutic revolution will be technological with the development of new therapeutic agents: small interfering RNA. Recent clinical trials confirmed their efficacy in hereditary amyloidosis.

Physiopathologie de la dermatite atopique: Pathophysiology of atopic dermatits.

Atopic dermatitis is a multifactorial disease due to a combination of genetic and environmental factors. The pathophysiological mechanisms involved in AD are multiple: innate functional abnormality in the skin barrier partly linked to mutations of the filaggrin, a major structural protein of the skin; and genes involved in innate and adaptive immunity; Finally, the model of the hygiene theory has been clarified in recent years: environmental factors alter the diversity of skin and digestive microbiomes, and this diversity seems to play a major role in the development of atopy.

Activités immunomodulatrice, anti-inflammatoire, antiprurigineuse et tolérogénique induites par I-modulia®, un extrait issu de culture d'Aquaphilus dolomiae, dans les modèles pharmacologiques de dermatite atopique: Immunomodulatory, anti-inflammatory, anti-pruritus and tolerogenic activities induced by I-modulia®, an Aquaphilus dolomiae culture extract, in atopic dermatitis pharmacology models.

Atopic dermatitis (AD) is an inflammatory and pruritic dermatosis of multifactorial origin. Topical steroids are the first line treatment for severe AD however alternatives treatment are increasingly needed. A biological concentrate was elaborated from culture of an Avène aquatic microflora isolate namely Aquaphilus dolomiae. Numerous extracts were evaluated in relevant AD in vitro models with human keratinocytes. Among these extracts, a particular one I-modulia® was found to be remarkable in terms of pharmacological activities: innate immunity modulating by agonizing Toll like receptor (TLR)2, TLR4 and TLR5, induction of anti-microbial peptides, inhibition of cytokines characteristics of T helper (Th)1, Th2 and Th17 responses, inhibition of Protease-activated-receptor (PAR) 2 and Thymic-stromal-lymphopoeitin (TSLP) both being known to be upregulated in pruritus. Additionally, when human dendritic cells (DC) were stimulated in vitro by Staphylococcus aureus secretomes from AD children lesions, I-modulia® was capable to induce IL-10 secretion to activate regular T lymphocytes and rendered DC tolerogenic. I-modulia®, extract of biotech origin incorporated in emollient, displays anti-inflammatory, anti-pruritus activities, restores homeostasis immune and ameliorates AD in young infant.

[Atopic dermatitis of the adult: clinical presentation, complications and comorbidities]. / Dermatite atopique de l'adulte : présentation clinique, complications et comorbidités.

Atopic dermatitis (DA) is a chronic inflammatory skin disease. Its incidence and prevalence is increasing, especially in industrialized countries. The prevalence of AD in adults is estimated at 1-3 % of the general population and can present as adult-onset AD, or as infantile/childhood AD that persists, or recurs in adulthood. There are no specific diagnostic criteria for adult AD. Diagnosis may be also complicated by the fact that the clinical manifestations sometimes differ from pediatric AD. Moreover, many recent studies have identified adult AD as a systemic disease. Due to its chronicity and comorbidities, Adult AD has a major impact on quality of life and working abilities of affected patients. With the emergence of new treatments, we should see more and more adult AD in the future, a better knowledge of its characteristics is therefore required.

[Epidemiology of atopic dermatitis]. / Épidémiologie de la dermatite atopique.

Atopic dermatitis (AD) is a chronic pruriginous skin disease which usually begins during early life (before the age of 2 years). Recently, the persistence of the disease in adulthood has been clearly established at least in a subset of patients, with frequent moderate to severe forms. The exact prevalence of the disease varies according to the study design and its estimate remains difficult mainly because of the lack of consensual diagnostic tools easily usable in population studies. Finally, the disease has a major impact in terms of public health and identification of risk factors for persistence at age adult is therefore of prime importance.

Eau thermale d'Avène et dermatite atopique: Avène's thermal water and atopic dermatitis.

Atopic dermatitis (AD) is the most frequent disease treated at the Avène hydrotherapy center. Children represent a large part of the population due to the high prevalence of AD in early childhood. Avène thermal spring water (ATSW) has been known for its therapeutic effects since the middle of the 18th century. It has been greatly studied over the last decades, with a comprehensive fundamental, pharmaco-clinical and clinical approach. Cohort studies using the Scoring Atopic Dermatitis (SCORAD) clinical score and the Dermatology Life Quality Index (DLQI) or the Children's Dermatology Life Quality Index [CDLQI]) quality of life scores, allowed to confirm the clinical results obtained from the previous studies. These results were corroborated by clinical trials conducted in atopic patients outside the Avène hydrotherapy center, allowing to demonstrate the specific effect of the ATSW. Pharmacological and pharmaco-clinical studies evidenced several effects that could explain the healing effect of ATSW: effect on histamine release, anti-inflammatory effects on standardized models, immuno-modulation of some cytokines involved in DA physiopathology (interferon [INF], interleukin 2 and 4 [IL-2, IL-4]), improvement of keratinocyte differentiation, effect on the skin microbioma by promoting the development of a diversified non-pathogenic flora. In addition, an original microorganism, Aquaphilus dolomiae, never described in another medium, has very recently been identified in the ATSW. Aquaphilus dolomiae is responsible for significant pharmacological activities on inflammation, pruritus and enhancement of innate immunity. This set of works confirms the medical significance of the hydrotherapy which should be considered as a complementary care in the sometimes difficult management of AD.

La peau : un écosystème microbien: The skin: a microbial ecosystem.

Human hosts a large number of microorganisms that constitute its microbiome and the vast majority of them are very useful and even essentials. The human microbiome is a complex ecosystem where live populations of transient or resident microorganisms. The process of co-development or co-adaptation played a major role in the establishment of indigenous communities and help explain the dominance of positive interactions (commensal, symbiotic or mutualistic) in the human-microorganism relationship. The assimilation of nutrients, production of anti-inflammatory compounds, defense against pathogens, vitamin production or stimulating the immune system are some of the key benefits of the indigenous microorganisms. Understanding the skin microbiome opens new exploratory fields and represents a real challenge for both the academic knowledge and the development of new therapeutic approaches.

[Current and upcoming treatments of adult atopic dermatitis]. / L'actuel et le futur du traitement de la dermatite atopique de l'adulte.

The treatment of atopic dermatitis in adults is based on the use of topical steroids and emollients. When AD is resistant to a well-conducted topical treatment, phototherapy or systemic treatments can be used: ciclosporin, methotrexate, azathioprine or mycophenolate mofetil. The therapeutic landscape of adult AD is about to change and even be revolutionized by the imminent arrival of new treatments: topical phosphodiesterase 4 inhibitors, topical or systemic JAK inhibitors, anti-IL-4 and/or antiIL-13 biotherapies (dupilumab, tralokinumab, lebrikizumab), anti-IL-31 (nemolizumab), anti-TSLP.

[Atopic dermatitis physiopathology]. / Physiopathologie de la dermatite atopique.

Our understanding of the physiopathology of atopic dermatitis has much improved over the recent years. Epidermal barrier alterations are integrated into 2 theories called inside out and outside in. They are related to complex immune abnormalities. Understanding their mechanism makes it possible to foresee new therapeutics. Moreover, environmental biodiversity, the diversity of cutaneous microbiota and genetic predispositions in atopic dermatitis lead to a new, more comprehensive theory, « the biodiversity theory ¼, integrating epigenetics.