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1.
Harefuah ; 159(1): 43-48, 2020 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-31930808

RESUMO

INTRODUCTION: Atopic dermatitis (AD) is one of the most common inflammatory skin diseases in the western world. Multiple causes have been implicated in the pathogenesis of atopic dermatitis, however in the past years many studies have highlighted the pathogenic role played by abnormal skin barrier in patients with AD. Impaired skin barriers facilitate the penetration of environmental agents/allergens into the skin with resultant chronic inflammation and atopic march. Many components of the epidermal barrier are impaired in atopic dermatitis including intracellular proteins comprising the cornified cell envelope, inter-cellular lipids and their metabolism, inter-cellular junctions and desquamation process. Investigating skin barrier abnormalities and understanding the mechanisms for its maintenance, are crucial for improving the management of AD patients and preventing the development of atopic march. Here we review the latest developments in skin barrier dysfunction in AD with associated clinical implications.


Assuntos
Dermatite Atópica , Humanos , Inflamação , Pele
2.
Medicine (Baltimore) ; 99(1): e18530, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895788

RESUMO

The role of atopic dermatitis (AD) in the development of colorectal cancer (CRC) has been a matter of scientific debate with mixed results. We conducted a nationwide cohort study to assess the association between AD and risk of CRC. Drawing on Taiwan's National Health Insurance Research Database, 46,703 patients with AD (the AD cohort) and 186,812 sex, age, and index year-matched patients without AD (the non-AD cohort) were identified in the period between 2000 and 2008. Follow-up time was calculated from the date of entry in the cohort until the occurrence of a first CRC diagnosis, death, or the end of the observation period (December 31, 2013), whichever occurred first. Hazards ratios (HRs) and accompanying 95% confidence intervals (CIs) derived from the Fine-Gray competing risk model were used to estimate the association between AD and CRC risk. After multivariable adjustment, AD was associated with an increased risk of CRC (adjusted HR, 1.26; 95% CI, 1.14-1.40). Of note, a significant positive association between AD and CRC risk was evident in both men and women and in all age groups. In summary, this population-based cohort study revealed that AD was associated with an increased risk of CRC in an Asian population. It will be of interest for cohort studies with prediagnostic specimens to evaluate the potential relationship between AD and CRC using biomarkers for allergy status.


Assuntos
Neoplasias Colorretais/epidemiologia , Dermatite Atópica/complicações , Adulto , Neoplasias Colorretais/etiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(2): e18565, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914034

RESUMO

BACKGROUND: Atopic dermatitis (AD, atopic eczema) is a pruritic, inflammatory, chronic skin disease. Since there is limitation of conventional treatment of AD, traditional herbal medicine can be an attractive therapeutic option in patients having AD for a long time. So-Cheong-Ryong-Tang (SCRT) has been found to inhibit histamine release and degranulation of mast cells, differentiation of basophils, and proliferation of eosinophils. We designed this clinical trial to evaluate the efficacy and safety of SCRT as compared to placebo in patients with AD and respiratory disorders. METHODS/DESIGN: This study is a single-center, randomized, double-blind, placebo-controlled, and investigator-initiated clinical trial. A total of 60 patients between 7 and 65 years of age with AD and respiratory disorders who received a diagnosis of AD by Hanifin and Rajka criteria who scored 15 to 50 in a scoring atopic dermatitis (SCORAD) will be enrolled. Participants will be randomly assigned to the SCRT or placebo group in a ratio of 1:1 and they will have a visit schedule comprising 4 visits including a screening visit during 8 to 10 weeks. The participants will be administered SCRT or placebo 3 times a day for 4 weeks. The primary outcome will be measured by a change of the SCORAD index. The secondary outcomes will be measured by changes in the dose and frequency of usage of the AD ointment, dermatology life quality index scores, pruritus and sleep disorder in visual analog scale, skin moisture content, skin surface temperature, Hamilton anxiety rating scale scores, depression rating scale scores, stress/autonomic nervous function test, and attention deficit hyperactivity disorder survey scores at week 4 as compared to those at the baseline. DISCUSSION: To the best of our knowledge, SCRT has rarely been reported for dermatologic diseases. This will be the first clinical trial to assess the efficacy and safety of SCRT in patients with AD and respiratory disorders. We hope that the results of this trial will provide evidence for the use of SCRT as a new treatment for AD with respiratory disorders. TRIAL REGISTRATION: Korean National Clinical Trial Registry, Clinical Research Information Service. (KCT0004148) (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=14981<ype=&rtype=).


Assuntos
Dermatite Atópica/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Transtornos Respiratórios/tratamento farmacológico , Transtornos Respiratórios/epidemiologia , Adolescente , Adulto , Idoso , Criança , Depressão/epidemiologia , Dermatite Atópica/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/epidemiologia , Qualidade de Vida , Pele/fisiopatologia , Transtornos do Sono-Vigília/epidemiologia , Estresse Psicológico/epidemiologia , Adulto Jovem
4.
Int Arch Allergy Immunol ; 181(1): 1-10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31593946

RESUMO

In recent decades, the worldwide prevalence of allergic disease has increased considerably. The atopic march is a model aimed at explaining the apparent progression of allergic diseases from atopic dermatitis (AD) to allergic asthma (AA) and to allergic rhinitis (AR). It hypothesizes that allergic disease begins, typically in children, with the development of AD, then AA, and finally progresses to AR. This theory has been widely studied in cross-sectional and long-term longitudinal studies and it has been found that as prevalence of AD declines, prevalence of AA increases. A similar relationship is reported between AA and AR. The legitimacy of the atopic march model is, however, currently debated. Epidemiological evidence and criticism of longitudinal studies point to an overstatement of the atopic march's prevalence and incorrect mechanisms, opening a discussion for alternative models to better explain the pathophysiological and epidemiological processes that promote this progression of allergic diseases. Albeit, risk factors for the development and progression of allergic disease, particularly AD, are critical in identifying disease progression. Investigating the role of age, severity, family history, phenotype, and genetic traits may give a better indication into the progression of allergic diseases. In addition, studies following patients from infancy into adulthood and a general increase in longitudinal studies would help broaden the knowledge of allergic disease progression and the atopic march.


Assuntos
Alergia e Imunologia/tendências , Asma/epidemiologia , Dermatite Atópica/epidemiologia , Rinite Alérgica/epidemiologia , Adulto , Animais , Criança , Progressão da Doença , Medicina Baseada em Evidências , Humanos , Modelos Imunológicos , Prevalência
5.
Scand J Immunol ; 91(1): e12835, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31596502

RESUMO

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease. Molecular characterization of AD shows an underlying inflammation with tissue infiltration of T helper (TH ) 2 cells and increased IL-4 and IL-13. The multifaceted roles of IL-4 and IL-13 in allergic disease development make IL-4Rα an attractive target for treatment strategies, and a neutralizing monoclonal antibody which antagonizes the effects of both IL-4 and IL-13 by blocking the interaction site found in the IL-4 receptor subunit α (IL-4Rα) has been successfully used to treat patients with moderate-to-severe AD. To elucidate the effects of IL-4Rα blockade on the cellular level, we used flow cytometry to examine cytokine production after antigen stimulation in human T cells from patients with AD (n = 12) and healthy controls (n = 6). The cells were stimulated with and without a neutralizing monoclonal antibody against IL-4Rα. Our results indicate that blocking IL-4Rα prohibits IL-4 signalling and IL-13 signalling and thereby TH 2 differentiation followed by an upregulation of interferon-γ-producing cells.


Assuntos
Dermatite Atópica/imunologia , Dermatite Atópica/metabolismo , Subunidade alfa de Receptor de Interleucina-4/antagonistas & inibidores , Transdução de Sinais , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Células Th1/imunologia , Células Th1/metabolismo , Adulto , Biomarcadores , Citocinas/metabolismo , Feminino , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
Med Clin North Am ; 104(1): 157-176, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757234

RESUMO

Atopic dermatitis (AD) was once thought to be a benign childhood disease that remitted with increasing age. However, recent studies have transformed the understanding of AD, particularly in adult patients. AD is common in adults and can lead to substantial disability by negatively affecting sleep, mental health, and quality of life. There seem to be different genetic, immunologic, and epidemiologic risk factors for AD in adults than in children. This article examines the pathophysiology, epidemiology, heterogeneous clinical presentation, burden, diagnosis, and treatment of adult AD.


Assuntos
Dermatite Atópica , Adulto , Efeitos Psicossociais da Doença , Humanos , Fatores de Risco
7.
Medicine (Baltimore) ; 98(52): e18559, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876756

RESUMO

BACKGROUND: The systematic review protocol is aim to evaluate the efficacy and safety of acupuncture in the treatment of atopic dermatitis (AD). METHODS: We will search the database on the Cochrane Library, PubMed, Medline, Excerpta Medica Database, Chinese Biomedical Literature Database, PsychINFO, China National Knowledge Infrastructure, Wanfang data, Chinese Scientific Journal Database, including studies and published systematic review in the reference list and grey. And will use Cochrane Collaboration's tools to evaluate the risk of bias of the included randomized controlled trials. The Review Manager 5.3 will be used to synthesize collected data. RESULTS: This study will assess the safety and effectiveness based on current evidence of acupuncture for AD, especially scoring atopic dermatitis, eczema area, and severity index, patient-oriented eczema measure, and quality of life. CONCLUSION: This study will provide high-quality recently evidence for evaluating the efficacy of acupuncture for patients with AD.PROSPERO registration number: CRD42019135919.


Assuntos
Terapia por Acupuntura , Dermatite Atópica/terapia , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/métodos , Humanos , Resultado do Tratamento
9.
Int Arch Allergy Immunol ; 180(4): 291-305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31694018

RESUMO

The immune system has vital functions for homeostasis and host defense. Thus, imbalances of the immune system whether associated with allergy, hypersensitivity, or autoimmunity are of great importance, as is manifest from common diseases such as atopic diseases, urticaria, and angioedema, and drug hypersensitivity reactions. These can affect patients' quality of life and can generate high costs for health care. Epidemiological studies have provided evidence for changing patterns of allergic diseases caused by lifestyle and climate changes which have consequences for medical care. Deeper insights into the pathogenesis of allergic/immunologic diseases, combined with novel technologies, provide improved diagnostic options and treatment measures. This review will summarize novel aspects of the epidemiology, pathogenic mechanisms, as well as disease management in the fields of allergy and clinical immunology.


Assuntos
Angioedema/terapia , Dermatite Atópica/terapia , Hipersensibilidade a Drogas/terapia , Imunoterapia/métodos , Urticária/terapia , Alergia e Imunologia , Anafilaxia/patologia , Angioedema/patologia , Dermatite Atópica/patologia , Hipersensibilidade a Drogas/patologia , Exposição Ambiental/efeitos adversos , Humanos , Qualidade de Vida , Urticária/patologia
10.
Int Arch Allergy Immunol ; 180(4): 235-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31694044

RESUMO

Over the last decades, an increasing appearance of allergies and atopic disorders, such as asthma, dermatitis, and rhinitis, has been observed. The mechanisms of these disorders remain unclear, and therefore the development of novel therapies is limited. Current treatments are often symptomatic, nonspecific, or may have severe side effects. Further insights into the mechanisms of the underlying disease pathogenesis could reveal novel targets for treatment. In this review, we provide an update on recent basic and translational studies that offer novel insights and opportunities for the treatment of patients with atopic disorders.


Assuntos
Asma/etiologia , Dermatite Atópica/etiologia , Hipersensibilidade Alimentar/etiologia , Rinite Alérgica/etiologia , Alérgenos/imunologia , Asma/genética , Asma/terapia , Dermatite Atópica/genética , Dermatite Atópica/terapia , Hipersensibilidade Alimentar/genética , Hipersensibilidade Alimentar/terapia , Predisposição Genética para Doença/genética , Humanos , Rinite Alérgica/genética , Rinite Alérgica/terapia , Fatores de Risco
11.
Hautarzt ; 70(12): 942-947, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31728551

RESUMO

Coal tar therapy was used for centuries to treat skin disorders characterised by inflammation and skin barrier damage. It has been shown that the aryl hydrocarbon receptor (AhR) is the key target structure for these pharmacological effects of coal tar. Since coal tar has been used less and less because of the carcinogenicity of many ingredients of coal tar, other ligands of AhR were studied. Tapinarof is such a ligand and proved to be a promising new drug to treat psoriasis and atopic dermatitis. Since many endogenous and exogenous ligands of AhR are known, it may be that this "tar-smart" product is a first example of a new drug family with which dermatologists can treat skin disorders that are characterized by inflammation and skin barrier damage.


Assuntos
Dermatite Atópica , Eczema , Psoríase , Receptores de Hidrocarboneto Arílico , Alcatrão/farmacologia , Dermatite Atópica/tratamento farmacológico , Eczema/tratamento farmacológico , Humanos , Psoríase/tratamento farmacológico , Receptores de Hidrocarboneto Arílico/efeitos dos fármacos
12.
Hautarzt ; 70(12): 934-941, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31740978

RESUMO

Modern dermatotherapy is dominated by the development of various biologicals and small molecules. Janus kinase inhibitors (JAKi) form a novel class of small molecular synthetic compounds inhibiting the intracellular signal transduction of cytokine receptors. Cytokines are key mediators in the pathophysiology of numerous inflammatory skin diseases. Many cytokines use so-called type I and II cytokine receptors, which associate with the Janus kinases JAK1, JAK2, JAK3 or TYK2. JAKi are under clinical investigation for inflammatory skin disease, specifically in phase 3 trials for psoriasis or atopic dermatitis. Since JAKi are tested in oral as well as in topical formulations, they could become very popular in dermatotherapy. The mechanisms of JAKi, their selectivity, preliminary efficacy data, and their safety profile are discussed in this article.


Assuntos
Dermatite Atópica , Inibidores de Janus Quinases , Psoríase , Citocinas , Dermatite Atópica/tratamento farmacológico , Humanos , Inibidores de Janus Quinases/farmacologia , Inibidores de Proteínas Quinases , Psoríase/tratamento farmacológico
14.
An Bras Dermatol ; 94(5): 549-552, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777355

RESUMO

BACKGROUND: Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. OBJECTIVE: To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. METHODS: This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. RESULTS: Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. STUDY LIMITATIONS: Lack of long term follow-up and no large studies in literature to compare results. CONCLUSION: Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.


Assuntos
Doenças Mamárias/patologia , Dermatite Atópica/patologia , Eczema/patologia , Mamilos/patologia , Complicações na Gravidez/patologia , Adulto , Doenças Mamárias/sangue , Doenças Mamárias/diagnóstico , Dermatite Atópica/sangue , Dermatite Atópica/diagnóstico , Eczema/sangue , Eczema/diagnóstico , Feminino , Humanos , Imunoglobulina E/sangue , Índia , Contagem de Leucócitos , Neutrófilos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Trimestres da Gravidez , Estudos Prospectivos
15.
Nat Commun ; 10(1): 4703, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619666

RESUMO

Despite recent advances in understanding microbial diversity in skin homeostasis, the relevance of microbial dysbiosis in inflammatory disease is poorly understood. Here we perform a comparative analysis of skin microbial communities coupled to global patterns of cutaneous gene expression in patients with atopic dermatitis or psoriasis. The skin microbiota is analysed by 16S amplicon or whole genome sequencing and the skin transcriptome by microarrays, followed by integration of the data layers. We find that atopic dermatitis and psoriasis can be classified by distinct microbes, which differ from healthy volunteers microbiome composition. Atopic dermatitis is dominated by a single microbe (Staphylococcus aureus), and associated with a disease relevant host transcriptomic signature enriched for skin barrier function, tryptophan metabolism and immune activation. In contrast, psoriasis is characterized by co-occurring communities of microbes with weak associations with disease related gene expression. Our work provides a basis for biomarker discovery and targeted therapies in skin dysbiosis.


Assuntos
Dermatite Atópica/genética , Interações entre Hospedeiro e Microrganismos/genética , Microbiota/genética , Psoríase/genética , Pele/metabolismo , Pele/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Dermatite Atópica/microbiologia , Disbiose/genética , Feminino , Expressão Gênica , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/microbiologia , RNA Ribossômico 16S , Adulto Jovem
16.
Forensic Sci Int ; 305: 109968, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31622855

RESUMO

In the present study, an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was developed, validated, and applied for measuring cortisol in human hair. Baseline levels of cortisol in hair were taken from 12 control subjects, with concentrations for adult controls (n = 8) of 1.7 to 9.1 pg/mg and a median of 4.7 pg/mg and for child controls (n = 4) of 1.1 to 7.2 pg/mg and a median of 3.1 pg/mg. However, the concentrations in the hair of two children whose mother had been applying a cortisol-containing hand cream 2-3 times per week ranged from 30 to 390 pg/mg. No external contamination was observed with the children as judged from wash water concentrations. The mother had hair cortisol concentrations of 80-220 pg/mg. External contamination was observed in her proximal hair segments (0-4 cm) but not in distal ones (8-12 cm). In an experiment, cortisol cream (1%) was applied on the fingers of a subject, who then scratched the head hair once in a while. Hair was collected 1, 5, and 30 days after exposure to the cream. The cortisol level in the hair one day after exposure was 20-186 times higher than the pre-exposure level. High levels in the wash fraction agreed with external contamination. Cortisol concentrations in the hair at 5 and 30 days after exposure were 15-38 and 9-11 times higher, respectively, than the pre-exposure levels. However, no external contamination was suggested from the wash water concentrations in the hair collected 5 and 30 days after exposure. The results showed that the externally applied cortisol had, after some time, been incorporated into the hair matrix and was not removed by a pre-analysis washing. Therefore, the use of a standard decontamination procedure prior to analysis of hair may not be able to prevent the spread of cortisol from applied hand cream within a family.


Assuntos
Anti-Inflamatórios/análise , Cabelo/química , Hidrocortisona/análise , Creme para a Pele , Anti-Inflamatórios/uso terapêutico , Estudos de Casos e Controles , Pré-Escolar , Cromatografia Líquida , Dermatite Atópica/tratamento farmacológico , Família , Feminino , Dermatoses da Mão/tratamento farmacológico , Humanos , Hidrocortisona/uso terapêutico , Lactente , Masculino , Espectrometria de Massas em Tandem
17.
J Drugs Dermatol ; 18(10): 987-990, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584776

RESUMO

Introduction: Introduction: Although future atopic dermatitis (AD) clinical research is intended to improve standard-of-care treatment, how patients are currently treated is not well characterized. The purpose of this study was to determine the most frequent medications prescribed in all ages of AD. Methods: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of United States office-based ambulatory visits and records demographics, diagnoses, and treatments. This is a cross-sectional study using the NAMCS of all AD outpatient office visits from 2006 to 2015. Patient visits with an ICD-9-CM code for AD (691.8) were collected and analyzed. Frequency tables were created for age, race, providers managing AD, and treatment. Results: Patient demographics of AD visits included 51% male (95% Confidence Interval [CI]: 44-58%), 71% white (65-77%), 19% African American (14-25%), and 10% Asian (6-14%). About 31% (24-37%) of visits were to pediatricians and 27% (22-33%) to dermatologists whereas per physician, dermatologists managed more AD visits than pediatricians. Topical corticosteroids (59%; 52-66%) were the most common class of medications prescribed followed by antibiotics (11%; 6-16%) and second generation antihistamines (6%; 3-10%). The most common topical corticosteroid prescribed in AD was triamcinolone (25% of office visits; 18-31%). Hydrocortisone was the most common topical corticosteroid prescribed to children <1 year of age and children aged 8 to 18, whereas triamcinolone was more common in children 2 to 7 years and adults >18 years. Discussion: Topical corticosteroids were the most frequent prescriptions provided at office-based ambulatory visits whereas antibiotics and second-generation antihistamines were the second and third most common prescribed medications, respectively. Although pediatricians manage more AD visits than dermatologists in total visits, dermatologists manage more AD visits than pediatricians per physician. Characterizing how AD patients are currently treated may build a reference for future clinical research investigating novel standard-of-care treatment in AD. J Drugs Dermatol. 2019;18(10):987-990.


Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrão de Cuidado/estatística & dados numéricos , Administração Cutânea , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Feminino , Glucocorticoides/uso terapêutico , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Estados Unidos , Adulto Jovem
18.
J Drugs Dermatol ; 18(10): 1020-1027, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584781

RESUMO

Introduction: Atopic dermatitis (AD) is a chronic, relapsing skin disease starting typically in atopic-prone children between 3­6 months of age, with most children having developed AD by the age of 5 years. Intense itching leads to sleep disturbance, especially in younger children and toddlers. This review explores early intervention in infants and young children with AD by controlling skin barrier function and inflammation at the earliest time point using a moisturizer and a proactive treatment. Methods: A working group of experienced clinicians managing pediatric populations with AD convened for a meeting. The panel reviewed the literature surrounding early intervention in infants and young children with AD and developed and discussed clinical questions aimed at optimizing clinical outcomes. Results: Complex gene/immune system/environment interactions are involved in AD development. Epidermal barrier defects play a central role in the condition, with various studies showing impairment of skin barrier function at birth may precede clinical AD. Dynamic changes take place in the amounts of skin lipids during infancy. Studies confirm that daily use of a moisturizer from birth onwards may offer benefits in improving skin barrier function and possibly prevention of AD, especially in high-risk, atopic prone newborns. Plant-based moisturizers were shown to be safe and effective when applied in pediatric patients with AD and may provide a TCS-sparing effect while improving skin condition. Conclusion: Dry skin conditions during infancy may predict the subsequent development of AD. Consequently, emollient therapy from birth represents a feasible, safe, and effective approach for AD prevention. Therefore, parental education and the application of moisturizers are recommended as an integral part of AD prevention, treatment, and maintenance. J Drugs Dermatol. 2019;18(10):1020-1027.


Assuntos
Dermatite Atópica/tratamento farmacológico , Emolientes/administração & dosagem , Carga Global da Doença , Extratos Vegetais/administração & dosagem , Fatores Etários , Idade de Início , Pré-Escolar , Dermatite Atópica/epidemiologia , Dermatite Atópica/etiologia , Emolientes/efeitos adversos , Humanos , Incidência , Lactente , Recém-Nascido , Extratos Vegetais/efeitos adversos , Prevalência , Fatores de Risco
19.
J Drugs Dermatol ; 18(10): 1038-1045, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584783

RESUMO

Objective: The study was conducted to determine the efficacy of the botanical combination incorporated in Kamedis Eczema Therapy Cream (the test product) for children with mild to moderate atopic dermatitis. Design: The study was designed as an interventional, multi-center, double-blind, randomized, controlled study. Setting: Children subjects were a sub-population of the 108 combined population of adults and children evenly randomly divided into three treatment groups: test product, vehicle, and comparator. The vehicle used was the identical test product without the botanical combination while the comparator was a leading OTC brand in the US market. All three groups used the same Kamedis body wash followed by one of the three randomized treatment creams for the affected areas. Participants: Thirty-nine (39) children subjects with uncomplicated, stable, mild to moderate atopic dermatitis were recruited and qualified for the study, 24 female and 15 male, ages varying between 3 and 18. Measurements: Investigators assessed the severity of each subject using the Investigator Global Assessment (IGA), affected Body Surface Area (BSA) extent evaluated parameters at each of the visit days 0, 7, 14, and 28. Subjective symptoms of pruritus and insomnia were evaluated by the patient or their legal guardian. The SCORAD and EASI indexes were calculated based on the collected parameters. Results: The test product demonstrated an improvement in all evaluated and calculated clinical parameters over the vehicle at the end of the treatment duration, proving the validation that the test product is much more effective and beneficial than the vehicle. The test product reached 40% of 'clear' IGA subjects out of the enrolled subjects and 60% out of the 'clear' and 'almost clear' IGA subjects comparing to 8% and 38%, respectively, with the vehicle, presenting a clear advantage over the vehicle. The BSA improvement comparison analysis of the test product over the vehicle yielded P value of less than 0.05, which is statistically significant. The SCORAD and EASI indexes also showed an advantage of the test product versus the vehicle at week 4. Conclusion: The study results validate that the botanical combination is the key factor for the efficacy and improvement of the AD symptoms within this population of children. J Drugs Dermatol. 2019;18(10):1038-1045.


Assuntos
Dermatite Atópica/tratamento farmacológico , Extratos Vegetais/administração & dosagem , Creme para a Pele/administração & dosagem , Adolescente , Criança , Pré-Escolar , Dermatite Atópica/diagnóstico , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Extratos Vegetais/efeitos adversos , Índice de Gravidade de Doença , Creme para a Pele/efeitos adversos , Resultado do Tratamento
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