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1.
Pediatr Ann ; 49(3): e140-e146, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32155280

RESUMO

Atopic dermatitis (AD) is the most common inflammatory skin condition in pediatric patients. AD has long been associated with comorbidities including food allergies, asthma, and allergic rhinitis, but recent literature has expanded this list to include attention-deficit/hyperactivity disorder and depression. AD has tremendous impact on quality of life for both affected children and their families. Improved understanding of AD pathogenesis, particularly regarding skin barrier dysfunction, the role of the cutaneous microbiome, and immune dysregulation, has spawned exciting new therapeutic directions. Although good skin care and appropriate use of topical corticosteroids remain first-line treatment, more precisely targeted treatments hold great promise. A recently approved topical phosphodiesterase inhibitor, crisaborole, and a subcutaneously administered interleukin-4/interleukin-13 blocker, dupilumab, are the first of what will likely be many new treatment options for patients with AD. [Pediatr Ann. 2020;49(3):e140-e146.].


Assuntos
Dermatite Atópica , Inibidores de Fosfodiesterase , Anticorpos Monoclonais Humanizados/uso terapêutico , Asma/complicações , Criança , Comorbidade , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/etiologia , Hipersensibilidade Alimentar/complicações , Humanos , Inibidores de Fosfodiesterase/uso terapêutico , Qualidade de Vida , Rinite Alérgica/tratamento farmacológico
2.
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
3.
Scand J Immunol ; 91(3): e12856, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31794090

RESUMO

Atopic dermatitis (AD) is a chronic inflammatory skin disease. A hallmark of AD is dry itchy skin that results from defects in the epidermal barrier function. Aloe vera is used widely to promote general health and is administered topically to treat skin conditions such as eczema, burns and wounds. However, effects of A vera on AD were not fully elucidated. In this study, we investigated the oral administration of processed A vera gel (PAG) containing low molecular weight Aloe polysaccharides to treat ovalbumin (OVA)-induced AD in mice. Oral administration of PAG suppressed total and OVA-specific IgE production in sera and decreased the epidermal thickness of skin. Numbers of Ki-67-positive cells were reduced by PAG treatment. Expression levels of tight junction genes, including those that encode ZO-1, Claudin-1 and Claudin-8, were decreased in AD skin lesions, whereas oral administration of PAG partially restored the expression levels of tight junction genes. In addition, IL-4 and IL-17A mRNA transcript levels were reduced in skin lesions after PAG treatment. Taken together, our findings suggest that oral administration of PAG ameliorated AD, normalized tight junction gene expression and suppressed inflammatory cytokines in AD skin.


Assuntos
Aloe/química , Antialérgicos/farmacologia , Dermatite Atópica/etiologia , Exsudatos de Plantas/farmacologia , Polissacarídeos/farmacologia , Junções Íntimas/efeitos dos fármacos , Junções Íntimas/imunologia , Animais , Antialérgicos/química , Biomarcadores , Citocinas/metabolismo , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/patologia , Modelos Animais de Doenças , Progressão da Doença , Feminino , Mediadores da Inflamação/metabolismo , Queratinócitos/efeitos dos fármacos , Queratinócitos/imunologia , Queratinócitos/metabolismo , Camundongos , Ovalbumina/efeitos adversos , Exsudatos de Plantas/química , Polissacarídeos/química , Pele/efeitos dos fármacos , Pele/imunologia , Pele/metabolismo , Pele/patologia
4.
Yakugaku Zasshi ; 139(12): 1563-1567, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31787646

RESUMO

Itching, or pruritus, can be defined as an unpleasant sensation that evokes the desire to scratch. Pruritus is most commonly associated with a primary skin disorder such as atopic dermatitis (AD), psoriasis, etc., and can have a major impact on the quality of life of those patients. Itch-induced scratching can further damage the skin barrier, leading to a worsening of symptoms. For that reason, it is important to manage pruritus. Topical glucocorticoids are commonly the first-line therapy in the management of AD and psoriasis patients. We found that topical glucocorticoids induce pruritus in mice under certain conditions. Topical glucocorticoids may induce pruritus in a mouse model of allergic contact dermatitis via inhibition of prostaglandin (PG)D2 production in antigen-mediated activated mast cells in the skin. Additionally, topical glucocorticoids do not induce pruritus in healthy skin. These results indicate the importance of controlling skin inflammation to a healthy level by applying sufficient quantities of glucocorticoids to avoid glucocorticoid-induced pruritus. However, topical "steroid phobia" is common in Japan, and most patients apply inadequate amounts of topical glucocorticoids for this reason. This may cause glucocorticoid-induced pruritus in patients by prolonging the skin inflammation. We conducted a survey regarding community pharmacists' instructions on the application quantity of topical glucocorticoids and found that most community pharmacists have experienced inappropriate instructions concerning this point.


Assuntos
Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Educação de Pacientes como Assunto , Farmacêuticos , Papel Profissional , Prurido/induzido quimicamente , Administração Tópica , Animais , Dermatite Atópica/tratamento farmacológico , Modelos Animais de Doenças , Humanos , Mastócitos/imunologia , Mastócitos/metabolismo , Camundongos , Prostaglandina D2/metabolismo , Psoríase/tratamento farmacológico , Pele/citologia , Pele/imunologia
7.
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
8.
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
9.
J Immunol Res ; 2019: 1820182, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637264

RESUMO

Objectives: To investigate CD4+CD25+FoxP3+ T regulatory cells (Tregs) in the peripheral blood of patients with atopic dermatitis (AD) and its correlation with disease severity. Methods: Blood samples from 79 AD patients before and after four-week conventional treatment were collected. Cell counts of CD4+CD25+FoxP3+Tregs, CD4+CD25+FoxP3-T effector cells (Teffs), and CD4+IL-10+Tregs were analyzed by flow cytometry. Serum levels of IL-4, IL-10, IL-12, IL-13, IFN-γ, and TGF-ß were measured by ELISA. Results: The pretreatment cell count of CD4+CD25+FoxP3+Tregs positively correlated with disease severity in all patients (P < 0.0001). However, when that correlation was rechecked based on the treatment response, a much stronger correlation of that was found in those patients with remission after treatment, while no correlation of that was found in patients without remission. Both the cell count and proportions of peripheral CD4+CD25+FoxP3+Tregs and CD4+CD25+FoxP3-Teffs reduced significantly after treatment in patients with remission, but remained unchanged in patients without remission. The cell count and proportion of CD4+IL-10+Tregs did not change after treatment in both groups. In patients with remission, serum levels of IL-4 and IL-13 significantly reduced (all P < 0.05); IL-12 and IFN-γ levels increased significantly (all P < 0.05); IL-10 and TGF-ß levels remained unchanged after treatment. None of those cytokine levels changed in patients without remission. Conclusions: CD4+CD25+FoxP3+Tregs is associated with AD development and severity in some patients but not in others. AD maybe divided into CD4+CD25+FoxP3+Treg-associated subtype, which CD4+CD25+FoxP3+Treg is parallel to the activity of AD, and nonassociated subtype, which CD4+CD25+FoxP3+Treg is not related. This subgroup difference may contribute partly to the nonidentical markers that have been found in AD and should be studied further.


Assuntos
Citocinas/sangue , Dermatite Atópica/imunologia , Fatores de Transcrição Forkhead/sangue , Linfócitos T Reguladores/metabolismo , Adulto , Contagem de Células , Dermatite Atópica/tratamento farmacológico , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Masculino , Índice de Gravidade de Doença , Adulto Jovem
10.
BMC Vet Res ; 15(1): 337, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604435

RESUMO

BACKGROUND: Flea bite is considered to be the main cause of allergic dermatitis in cats. There is a need for treatments able to control clinical signs of allergic dermatitis associated with flea bite in cats. This was an open pre-treatment versus post-treatment clinical field study. All cats included in the study presented pruritus, skin lesions or other evidence compatible with flea infestation. Skin lesions were assessed (using SCORFAD) at days 0, 28, 56 and 84 whereas pruritus severity was assessed (using PVAS) at days 0, 15, 28, 56 and 84. On day 0, The fluralaner (280 mg/ml) product (Bravecto® spot-on for cats) was supplied in pipettes containing 0.4, 0.89 and 1.79 ml for cats of 1.2-2.8 kg, > 2.8-6.25 kg and > 6.25-12.5 kg body weight, respectively. The other animals living in the same household also received fluralaner. Based on cytological examination at day 0, oral amoxicillin and clavulanic acid was prescribed for 21 days if indicated. For cats presenting intense pruritus and discomfort at day 0, oral prednisolone at 0.5 mg/kg was prescribed for 3 days. RESULTS: During the study all cats, except for one (cat number 10), improved significantly. Post-treatment median SCORFAD scores at all evaluations were significantly different from the pre-treatment score on day 0 (P values < 0.002 for all three post treatment examination days) with a score reduction of 49% on day 28, 79% on day 56 and 87% on day 84. The PVAS score decreased significantly over the study period for all cats but one (cat number 10). Post-treatment median PVAS scores at all evaluations were significantly different from the pre-treatment PVAS score on day 0 (P value < 0.002 for all four post-treatment days) with a reduction of 46% on day 15, 67% on day 28, 82% on day 56 and 92% on day 84. No adverse reaction or other health issue was reported during the study. CONCLUSIONS: A single topical treatment with fluralaner results in a significant reduction of flea bite allergic dermatitis clinical signs in cats over the subsequent 12 weeks without any additional environmental treatment.


Assuntos
Doenças do Gato/tratamento farmacológico , Dermatite Atópica/veterinária , Infestações por Pulgas/veterinária , Inseticidas/administração & dosagem , Isoxazóis/administração & dosagem , Administração Tópica , Amoxicilina/uso terapêutico , Animais , Gatos , Ácido Clavulânico/uso terapêutico , Ctenocephalides , Dermatite Atópica/tratamento farmacológico , Feminino , Infestações por Pulgas/complicações , Infestações por Pulgas/tratamento farmacológico , França , Masculino , Prednisolona/uso terapêutico , Prurido/tratamento farmacológico , Prurido/veterinária , Resultado do Tratamento
11.
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
12.
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
13.
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
14.
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
15.
Hautarzt ; 70(10): 790-796, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31515578

RESUMO

The treatment of hand eczema represents a great challenge in the daily clinical practice for dermatologists. There are various forms of local, physical and systemic treatment, such as alitretinoin which is the only registered systemic treatment option for severe chronic hand eczema. In 2017 dupilumab was approved for the treatment of moderate to severe atopic dermatitis and can theoretically also be applied for atopic hand eczema. The first and most important step in treatment is to identify the underlying etiology of the hand eczema with the appropriate diagnostic measures, ranging from skin biopsy to allergy testing including occupational products. An important component of treatment is the basic treatment in the form of consistent and stage-adapted skin care. Treatment of hand eczema should follow a step by step procedure whereby the basic treatment should be maintained and, depending on the etiology and clinical type, should be supplemented by topical, systemic and physical treatment forms, also often used in parallel. Mild to moderate forms of hand eczema are usually treated with the basic treatment, emollients and topical glucocorticoids according to various guidelines. In moderate to severe forms of hand eczema UV phototherapy and systemic treatment should be implemented. This article summarizes the most important treatment modalities based on case reports and series, clinical studies, guidelines and expert recommendations.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Eczema/terapia , Emolientes/uso terapêutico , Dermatoses da Mão/tratamento farmacológico , Terapia Ultravioleta , Alitretinoína/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/prevenção & controle , Dermatite Atópica/terapia , Gerenciamento Clínico , Eczema/diagnóstico , Dermatoses da Mão/diagnóstico , Humanos , Resultado do Tratamento
16.
Pak J Pharm Sci ; 32(3 Special): 1423-1426, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31551225

RESUMO

To observe and analyze the clinical efficacy of mucopolysaccharide polysulfate (MPS) ointment combined with desonide ointment in treatment of infantile eczema. A total of 180 infants who had been treated for eczema at our hospital were enrolled. The patients were divided into control group accepting desonide ointment only and research group accepting mucopolysaccharide polysulfate ointment and desonide ointment. The therapeutic efficacies of two groups were compared. Results: By comparing the total therapeutic efficacy, results showed that the total efficacy of the research group was 96.67%, while that value of the control group was 82.22%, making the total efficacy of the research group significantly higher (p<0.05). And the improvement of the Eczema Area and Severity Index (EASI) score in the research group after drug administration was significantly better than that of the control group (p<0.05). Moreover, there was a greater decrease in the recurrence rate of the research group than that of the control group (p<0.05). Combined application of mucopolysaccharide polysulfate ointment and desonide ointment can achieve better therapeutic effect in treatment of infantile eczema.


Assuntos
Dermatite Atópica/tratamento farmacológico , Desonida/uso terapêutico , Glicosaminoglicanos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Pré-Escolar , Dermatite Atópica/patologia , Quimioterapia Combinada , Feminino , Humanos , Lactente , Masculino , Pomadas , Resultado do Tratamento
17.
Dermatitis ; 30(5): 287-293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31524756

RESUMO

Multiple etiologies contribute to sleep disturbance in atopic dermatitis (AD) patients, including learned scratching behavior and increased monoamines, cutaneous blood flow, inflammatory cell activities, and cytokines, as well as decreased melatonin, anti-inflammatory cytokines, and skin barrier function. Insomnia impairs cognitive development in children with AD, leading to behavioral problems and learning disabilities. Insomnia in adults with AD impedes work productivity. In this article, we discuss pearls on improving insomnia through both nonpharmacologic modalities, such as environmental adjustments and massage therapy, and pharmaceutical approaches including melatonin, antihistamines, tricyclic antidepressants, mirtazapine, and benzodiazepine and nonbenzodiazepine sedatives. Future investigations should further delineate the mechanistic link between insomnia and AD exacerbation and identify strategies to combat sleep-related disease burden.


Assuntos
Dermatite Atópica/complicações , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Antidepressivos Tricíclicos/uso terapêutico , Benzodiazepinas/uso terapêutico , Depressores do Sistema Nervoso Central/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Massagem , Melatonina/uso terapêutico , Mirtazapina/uso terapêutico , Antagonistas da Serotonina/uso terapêutico , Higiene do Sono
18.
Dermatitis ; 30(5): 294-299, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31524757

RESUMO

Atopic dermatitis (AD) often requires combination treatment regimens. However, little is known about treatment combinations and polypharmacy in AD. We sought to characterize patterns of outpatient prescriptions and polypharmacy among US children and adults with AD. Data from the 1993-2015 National Ambulatory Medical Care Survey were analyzed, including 128,300 pediatric and 623,935 adult outpatient visits. Among AD visits, dermatologists prescribed more topical corticosteroids (TCSs, P = 0.01) than any other clinicians, particularly multiple TCSs (P < 0.0001), topical calcineurin inhibitors (TCI, P = 0.009), combination TCIs with TCSs (P = 0.004), and systemic immunosuppressants (P = 0.003). Prescriptions for multiple TCSs increased from ages 0 to 19 years, 20 to 39 years, and peaked at 40 to 59 years (P = 0.0002). Prescriptions for prednisone peaked at ages of 40 to 59 years (P = 0.003). A subset of AD patients was prescribed oral antibiotics (7.1%), although fewer than half had a diagnosis of bacterial infection (42.1%). The proportion of patients receiving multiple prescriptions was higher in visits to primary care practitioners versus dermatologists, those with private versus public insurance, and 50 years or older versus 20 to 49 years versus 0 to 19 years. Visits with 4 or more prescriptions by dermatologists increased between 1993-2000 (10%) and 2011-2015 (29%, P = 0.0001). In conclusion, significant treatment variation exists among specialists managing AD, with increasing polypharmacy over time.


Assuntos
Corticosteroides/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Imunossupressores/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Administração Cutânea , Adolescente , Corticosteroides/administração & dosagem , Adulto , Fatores Etários , Antibacterianos/uso terapêutico , Inibidores de Calcineurina/administração & dosagem , Criança , Pré-Escolar , Dermatologia/estatística & dados numéricos , Quimioterapia Combinada , Glucocorticoides/uso terapêutico , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Seguro Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Polimedicação , Prednisona/uso terapêutico , Estados Unidos , Adulto Jovem
20.
J Cutan Med Surg ; 23(4_suppl): 5S-10S, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476937

RESUMO

Topical calcineurin inhibitors (TCIs) were approved in the early 2000s for the treatment of atopic dermatitis (AD), and despite the recent introduction of newer topical and systemic therapies for AD, TCIs such as tacrolimus ointment (0.03% and 0.1%) and pimecrolimus cream (1%), remain recommended treatment options in contemporary management guidelines. The goal of this article is to review the evidence supporting the approved indications for TCIs in adults with AD, including short-term treatment of active disease and as intermittent or maintenance treatment for the prevention of flares. Other evidence reviewed in this article includes the treatment of specific body areas (such as the face and eyelids), combination or sequential use of TCIs with topical corticosteroids, and the comparative efficacy of the 2 commercially available TCIs. This review of the evidence confirms that TCIs remain an effective treatment option for the management of adult AD.


Assuntos
Inibidores de Calcineurina/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Administração Tópica , Humanos
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