Use of probiotics in atopic dermatitis

SUMMARY Atopic dermatitis is a common skin disease. Its increased incidence has changed the focus of research on atopic dermatitis toward epidemiology, prevention, and treatment. Evidence suggests that intestinal microbiota plays an important role in the pathogenesis of atopic dermatitis inducing immunosuppression, but its exact mechanism is still unclear. Probiotics have been widely reported to act on the immune system. They are living microorganisms with immunomodulatory effects that stimulate Th1 cytokines and suppress the Th2 response, which are being researched for the treatment of several diseases. Probiotics most commonly used are part of the intestinal microflora like lactobacilli, bifidobacteria, and enterococci. We describe here a case of evident response to the use of probiotics in a girl with severe atopic dermatitis, with a significant change in severity scores of atopic dermatitis (BSA/SCORAD/FDLQI). Modulation of the intestinal microbiota with probiotics may offer a way to prevent or treat allergic diseases, including atopic dermatitis.

RESUMO A dermatite atópica é uma doença de pele comum. O aumento da incidência mudou o foco da pesquisa em dermatite atópica para epidemiología, prevenção e tratamento. Evidências sugerem que a microbiota intestinal desempenha um papel importante na patogênese da dermatite atópica, induzindo imunossupressão, mas o mecanismo exato ainda não está claro. Os probióticos foram amplamente divulgados para atuar no sistema imunológico. Eles são microrganismos vivos com efeitos imunomoduladores que estimulam as citocinas Th1 e suprimem a resposta Th2 que vem sendo pesquisada para o tratamento de diversas doenças. Probióticos mais comumente usados são parte da microflora intestinal como lactobacilos, bifidobactérias e enterococos. Descrevemos um caso de resposta evidente ao uso de probióticos em uma menina com dermatite atópica grave, com grande alteração nos escores de gravidade da dermatite atópica (BSA/Scorad/FDLQI). A modulação da microbiota intestinal com probióticos pode oferecer uma maneira de prevenir ou tratar doenças alérgicas, incluindo a dermatite atópica.

Skin barrier in atopic dermatitis: beyond filaggrin

Abstract: Atopic dermatitis is a chronic inflammatory skin disease with a complex pathogenesis, where changes in skin barrier and imbalance of the immune system are relevant factors. The skin forms a mechanic and immune barrier, regulating water loss from the internal to the external environment, and protecting the individual from external aggressions, such as microorganisms, ultraviolet radiation and physical trauma. Main components of the skin barrier are located in the outer layers of the epidermis (such as filaggrin), the proteins that form the tight junction (TJ) and components of the innate immune system. Recent data involving skin barrier reveal new information regarding its structure and its role in the mechanic-immunological defense; atopic dermatitis (AD) is an example of a disease related to dysfunctions associated with this complex.

Atopic dermatitis: allergic dermatitis or neuroimmune dermatitis?

Abstract: Advances in knowledge of neurocellulars relations have provided new directions in the understanding and treatment of numerous conditions, including atopic dermatitis. It is known that emotional, physical, chemical or biological stimuli can generate more accentuated responses in atopic patients than in non-atopic individuals; however, the complex network of control covered by these influences, especially by neuropeptides and neurotrophins, and their genetic relations, still keep secrets to be revealed. Itching and airway hyperresponsiveness, the main aspects of atopy, are associated with disruption of the neurosensory network activity. Increased epidermal innervation and production of neurotrophins, neuropeptides, cytokines and proteases, in addition to their relations with the sensory receptors in an epidermis with poor lipid mantle, are the aspects currently covered for understanding atopic dermatitis.

Avaliação do efeito das enterotoxinas estafilocócicas tipos A e B em células Th17, Th22 e CD38+ na dermatite atópica do adulto / Evaluation of the effect of staphylococcal enterotoxins A and B in Th17, Th22 and CD38+ cells in adult atopic dermatitis

INTRODUÇÃO: A dermatite atópica (DA) é uma doença cutânea inflamatória, acompanhada por prurido intenso e xerose cutânea. A etiopatogenia da DA é multifatorial, envolvendo fatores genéticos, ambientais e imunológicos, dentre outros. OBJETIVOS: Avaliar a influência das enterotoxinas A e B do Staphylococcus aureus (SEA e SEB) na resposta mediada por células Th17 e Th22 nos indivíduos adultos com DA. MÉTODOS: Foram selecionados 38 pacientes adultos com DA e um grupo controle com 40 indivíduos adultos, pareados por idade e gênero Os métodos utilizados foram: 1) ELISA: dosagem dos níveis séricos de IL-6, IL-17, IL-22 e IL-12p40/IL-23 e em sobrenadantes de culturas de células mononucleares do sangue periférico (PBMC) estimuladas com SEA e SEB; 2) Imuno-histoquímica: análise da expressão de IL-17 em fragmentos de pele; 3) Citometria de fluxo: a) análise das citocinas circulantes em amostras de soro: IL-2, IL-4, IL-5, IL-6, IL-10, TNF, IL-17A e IFN-y b)avaliação das células T CD4+ mono e polifuncionais secretoras de IL-17, IL-22, TNF, IFN-y, MIP-1beta, e expressão do marcador de ativação celular CD38; c) células Th22 e Tc22 estimuladas com SEA e SEB. RESULTADOS: 1) Através do ELISA, a secreção de IL-22 sérica e em PBMC induzidas por SEA e SEB foi significativamente mais elevada, quando comparada ao grupo controle; 2) houve aumento na expressão de IL-17 em amostras de pele de doentes de DA através da imuno-histoquímica; 3) Através da citometria de fluxo, foram detectados: a) níveis séricos de IL-2, 5, 6, 10, 17A e IFN-y elevados no grupo com DA em relação aos controles; houve diferença significativa nos níveis circulantes de IL-17A nos pacientes com DA moderada e grave; b) na avaliação monofuncional das células T CD4+ sob estímulo de SEA/SEB, houve redução da expressão das citocinas IFN-y, IL-17A, IL-22 ou TNF na DA, quando comparadas ao grupo controle; na análise polifuncional das células T CD4+/CD8+, ocorreu redução da resposta na DA em relação aos...

BACKGROUND: Atopic dermatitis (AD) is an inflammatory skin disease with intense itching and xerosis. AD pathogenesis is multifactorial, involving genetic, environmental, and immunological factors, among others. OBJECTIVES: To evaluate the influence of enterotoxins A and B from Staphylococcus aureus (SEA and SEB) in Th17 and Th22 cell response in adults with AD. METHODS: We evaluated 38 adult patients with AD, and a control group of 40 adults, age and gender matched. Assays: 1) ELISA: evaluation of IL-6, IL-17, IL-12p40/IL-23 and IL-22 serum levels and in supernatants of mononuclear cell cultures from peripheral blood (PBMC), stimulated with SEA/SEB; 2) Immunohistochemistry: analysis of IL-17 expression in skin specimens; 3) Flow cytometry: a) analysis of circulating cytokines in serum samples: IL-2, IL-4, IL-5, IL-6, IL-10, TNF, IL-17A and IFN-y b) evaluation of mono and polyfunctional TCD4+ cells that secrete IL-17, IL-22, TNF, IFN-y, MIP-1beta, and expression of the activation marker CD38; c) analysis of Tc22 and Th22 cells stimulated with SEA and SEB. RESULTS: 1) Secretion of IL-22 in the serum and from supernatants of cell cultures from PBMC, stimulated with SEA and SEB were higher in AD patients, when compared to the control group by ELISA; 2) there was an increase of IL-17 expression in skin samples by immunohistochemistry; 3) Flow cytometry showed: a) elevated serum levels of IL-2, 5, 6, 10, 17A and IFN-y in AD, when compared to controls; there was a significant difference in circulating levels of IL-17A in patients with moderate and severe disease; b) monofunctional evaluation of T CD4+ cells under SEA/SEB stimuli showed reduced expression of IFN-y, IL-17A, IL-22 or TNF cytokines in AD, compared to controls; the same was observed for polyfunctional CD4+/CD8+ T cells analysis, exhibiting a diminished response in AD. In atopic patients under basal conditions, there was an augmented CD38- dependent response and reduced pattern to SEA/SEB in the...

Atopic dermatitis and vitamin D: facts and controversies / Dermatite atopica e vitamina D: fatos e controversias

Patients with atopic dermatitis have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Clinically, this results in an intensely pruriginous and inflamed skin that allows the penetration of irritants and allergens and predisposes patients to colonization and infection by microorganisms. Among the various etiological factors responsible for the increased prevalence of atopic diseases over the past few decades, the role of vitamin D has been emphasized. As the pathogenesis of AD involves a complex interplay of epidermal barrier dysfunction and dysregulated immune response, and vitamin D is involved in both processes, it is reasonable to expect that vitamin D's status could be associated with atopic dermatitis' risk or severity. Such association is suggested by epidemiological and experimental data. In this review, we will discuss the evidence for and against this controversial relationship, emphasizing the possible etiopathogenic mechanisms involved.

Pacientes com dermatite atópica têm fatores de risco geneticamente determinados que afetam a função de barreira da pele e as respostas imunes, as quais interagem com fatores ambientais. Clinicamente, isso resulta em uma pele intensamente pruriginosa, inflamada, que permite a penetração de irritantes e alérgenos e predispõe os pacientes à colonização e à infecção por micro-organismos. Dentre os diversos fatores etiológicos responsáveis pelo aumento da prevalência de doenças atópicas nas últimas décadas, o papel da vitamina D tem ganhado destaque. Uma vez que a patogênese da dermatite envolve uma interação complexa da disfunção da barreira epidérmica e desregulação da resposta imune - e a vitamina D está envolvida em ambos os processos-, é razoável esperar que a vitamina D esteja associada ao risco ou à gravidade da dermatite atópica. Tal associação é sugerida por dados epidemiológicos e experimentais. Nessa revisão, serão abordadas as evidências favoráveis e contrárias a essa polêmica relação, enfatizando os possíveis mecanismos etiopatogênicos envolvidos.

Parental smoking patterns and their association with wheezing in children

OBJECTIVE: To investigate parental smoking patterns and their association with wheezing in children. METHODS: We performed a case-control study that included 105 children between 6 and 23 months of age who were divided into two groups: cases (children with 3 previous episodes of wheezing) and controls (healthy children without wheezing). The children's exposure to cigarette smoking was estimated using a questionnaire completed by the mothers and by the children's urinary cotinine levels. RESULTS: Based on both the questionnaire results and cotinine levels, exposure to cigarette smoking was higher in the households of cases in which the incidence of maternal smoking was significantly higher than that of paternal smoking. Children in this group were more affected by maternal smoking and by the total number of cigarettes smoked inside the house. Additionally, the questionnaire results indicated that the risk of wheezing was dose dependent. The presence of allergic components, such as atopic dermatitis and siblings with allergic rhinitis and asthma, greatly increased the odds ratio when wheezing was associated with cotinine levels. CONCLUSION: Children exposed to tobacco smoke have an increased risk of developing wheezing syndrome. This risk increases in association with the number of cigarettes smoked inside the house and the presence of other allergic components in the family. .

An international multicenter study on quality of life and family quality of life in children with atopic dermatitis.

Background: Atopic dermatitis (AD) has severe impact on the quality of life (QoL) of children suffering from the disease and their families. The infant's dermatitis quality of life index (IDQoL) and the dermatitis family impact questionnaire (DFI) were designed to study this impact. Aims: To compare the impact of AD on children and their families in different countries. Methods: 419 children with AD from six countries representing three continents under the age of 4 years were included into the study. English, Ukrainian, Czech, Portuguese, and Korean versions of the IDQoL and the DFI and Dutch version of the IDQoL questionnaires were used. Results: The highest scored items for the IDQoL and the DFI were rather similar. The IDQoL and the DFI results were well correlated with parental assessment of disease severity and between each other in all countries. Some differences mostly in the IDQoL assessment were found. Conclusion: Despite some reported peculiarities, parents in different counties assessed QoL and family QoL of their AD children in a similar way. The IDQoL and the DFI may be reliable initial measures for international studies. International study on the influence of the same treatment methods on the IDQoL and the DFI assessments is important.

Dermatite atópica em Pediatria / Atopic dermatitis in Pediatrics

A autora procede a uma revisão do tema Dermatite atópica em Pediatria, ressaltando sua importância e freqüência na prática de consultório, descrevendo o quadro clínico e o roteiro diagnóstico, a fisiopatologia da moléstia, as respostas imunes adaptativas, inter-relações entre infecção e dermatite atópica e, finalmente, a terapêutica, compreendendo identificação e afastamento dos fatores desencadeantes ou agravantes, hidratação da pele, controle da inflamação e do prurido e outras formas de tratamento, eventualmente indicadas. O trabalho se acompanha de extensa relação de referências bibliográficas.

Dermatitis atópica: Revisión de tema / Atopic dermatitis. review

La dermatitis atópica (DA) es la expresión de una enfermedad cutánea crónica inflamatoria que generalmente se inicia en la niñez temprana. Caracterizada por un intenso prurito, morfología y distribución típica de sus lesiones, se ha convertido en la atracción de dermatólogos pediatras, pediatras, alergistas e inmunólogos. Su prevalencia está aumentando y dos hechos son relevantes en la actualidad: el efecto adverso en la calidad de vida de los pequeños pacientes y la demostración que es la primera manifestación del síndrome atópico. Las controversias en los esquemas de tratamiento están desplazando a los grandes avances en la fisiopatología, así como el manejo de DA a través de algoritmos está desplazando el arte del tratamiento médico.

Comparison of Transepidermal Water Loss, Capacitance and pH Values in the Skin between Intrinsic and Extrinsic Atopic Dermatitis Patients

Atopic dermatitis (AD), with the prevalence rate of around 10 to 15%, is characterized by an intensely pruritic skin lesions with typical distribution and morphology. Recently, AD is divided into extrinsic type (ADe) and intrinsic type (ADi) according to the laboratory findings and associated diseases. ADe is well-known for high IgE level, positive response to food- or aero-allergens, whereas ADi has clinically similar skin lesions and distribution patterns of AD with normal serum IgE levels, negative in vitro test for environmental or food allergens and without associated atopic diseases. To instrumentally evaluate the differences of skin involvement and functions between ADi and ADe, we checked the transepidermal water loss (TEWL), capacitance and pH in both types of childhood AD and age-matched control. The proportion of ADi was around 20% in all AD patients (10/51). Our experiment suggested possible differences between ADi and ADe. Antecubital fossa is a famous involvement site of childhood type of AD, where both types of AD patients showed higher TEWL and decreased capacitance. ADe patients showed increased TEWL in all sites and lower hydration in 4 sites, whereas ADi patients showed no significant differences of TEWL and hydration in forehead, cheek, and back of leg.

Actualizaciones en dermatitis atópica / Update in atopic dermatitis

La dermatitis atópica es una enfermedad que ha mostrado un aumento en su prevalencia durante los últimos años. Su manejo, en algunas oportunidades puede constituir un desafío terapéutico. Se analizan algunos factores desencadenantes de la crisis, especialmente el rol del estafilococo aureus. En el tratamiento se revisan las medidas generales, el uso y abuso de corticoides y finalmente los nuevos medicamentos tópicos y orales

Corticosteroides y el síndrome eccema atópico y/o dermatitis / Corticosteroids and atopic eczema/dermatitis syndrome

La dermatitis atópica es una de las afecciones de la piel más frecuentes. Caracterizada por una constelación de signos y síntomas, presentan un cuadro fisiopatológico complejo en donde están involucrados numerosos mecanismos inmunológicos, enzimáticos e inespecíficos. Los corticosteroides actúan como inmunomoduladores a diferentes niveles. La elección del corticosteroide tópico adecuado debe recaer sobre aquel que ofrece las mayores ventajas para lograr una remisión rápida y sostenida de los síntomas. El uso posterior intermitente permite su administración sin generar efectos colaterales. Aún cuando existen otras alternativas inmunomoduladoras, los corticosteroides tópicos siguen siendo la medicación de primera elección en el tratamiento de la dermatitis atópica

Nuevos conceptos en dermatitis atópica / New concepts in atopic dermatitis

La dermatitis atópica es una enfermedad inflamatoria crónica de la piel, con remisiones y exacerbaciones, pruriginosa y que se relaciona con rinitis alérgica, asma o ambas. Existe una compleja interrelación de factores genéticos, ambientales, inmunológicos, farmacológicos y psicológicos que contribuyen al desarrollo y gravedad de la enfermedad. Las aberraciones inmunológicas se manifiestan como: elevación de anticuerpos IgE específicos hacia antígenos comunes, mayor liberación de mediadores proinflamatorios por basófilos y mastocitos, eosinofilia periférica y local, actividad bifásica Th1/Th2 con liberación de citocinas (IL-4, IL-5, IL-13), GM-CSF y disminución de IFN-gamma por las células Th1, aumento en la liberación de proteína básica mayor, proteína catiónica de los eosinófilos, además de la expresión de factores quimioatrayentes por los monocitos (RANTES, eotaxina, péptido intestinal vasoactivo, etc.). En 1980 Hanifin y Rajka dieron a conocer los criterios diagnósticos para dermatitis atópica mismos que se aceptaron universalmente como estándar para el diagnóstico. Leung reportó que "un conocimiento sobre las bases inmunopatológicas de la dermatitis atópica tiene implicaciones clínicas importantes para el diagnóstico y tratamiento." Debido a la complejidad de la enfermedad se dispone de múltiples opciones terapéuticas. Entre estas están la talidomida y el factor de transferencia, como tratamiento inmunomodulador con seguridad aceptable y eficacia clínica.