Cutaneous nerves are increased in atopic dermatitis, and itch is a prominent symptom. We studied the functional interactions between eosinophils and nerves in human and mouse skin and in culture. We demonstrated that human atopic dermatitis skin has eosinophil granule proteins present in the same region as increased nerves. Transgenic mice in which interleukin-5 (IL-5) expression is driven by a keratin-14 (K14) promoter had many eosinophils in the epidermis, and the number of nerves was also significantly increased in the epidermis. In co-cultures, eosinophils dramatically increased branching of sensory neurons isolated from the dorsal root ganglia (DRG) of mice. This effect did not occur in DRG neurons co-cultured with mast cells or with dead eosinophils. Physical contact of the eosinophils with the neurons was not required, and the effect was not blocked by an antibody to nerve growth factor. DRG neurons express eotaxin-1, ICAM-1 and VCAM-1, which may be important in the recruitment, binding, and activation of eosinophils in the region of cutaneous nerves. These data indicate a pathophysiological role for eosinophils in cutaneous nerve growth in atopic dermatitis, and suggest they may present a therapeutic target in atopic dermatitis and other eosinophilic skin conditions with neuronal symptoms such as itch.

hared decision-making (SDM) is a formal process of consensus building between health care professionals and patients to select treatment plans based on the best medical evidence and the patient's values. Shared decision-making has been reported to improve patient knowledge, satisfaction, and adherence to treatment. 1 Active collaboration between patient and the clinician is important based on the premises that patients will better adhere to treatment if they understand and agree to its use. Shared decision-making is a measure of high-quality decisionmaking and has been incorporated into reimbursement by payers and legislation of health care models. [2][3][4] Shared decision-making has been broadly applied to medical and surgical specialties since it was first defined in 1982. 5 Shared decisionmaking is particularly relevant in complex, preference-sensitive de-cision-making when there are several medically reasonable alternatives. 6 Fields such as palliative care, oncology, and cardiology have been leaders in the implementation of SDM. [7][8][9][10][11] In addition, the Centers for Medicare & Medicaid Services Innovation Center has developed payment models to encourage clinicians to use patient decision support tools aimed to improve individual understanding of medical options as well as requiring SDM for payment of procedures. 2 Dermatologists and patients co-manage complex chronic conditions with medical, economic, and quality-of-life implications. Decision tools, also known as patient decision aids (PDAs), provide detailed and balanced, evidence-based information about varying treatment options and can therefore be used before, during, or after a clinic visit. 12,13 These tools can be used by the patient before IMPORTANCE Shared decision-making (SDM) can improve the quality of care for patients. The extent to which this tool has been used and the evidence supporting its use in dermatology have not been systematically examined.OBJECTIVE To perform a scoping review of the literature regarding SDM in dermatology.

The critical role of peptide antigen-specific T cells in controlling mycobacterial infections is well documented in natural resistance and vaccine-induced immunity against Mycobacterium tuberculosis. However, many other populations of leukocytes contribute to innate and adaptive immunity against mycobacteria. Among these, non-conventional T cells recognizing lipid antigens presented by the CD1 antigen presentation system have attracted particular interest. In this chapter, we review the basic immunobiology and potential antimycobacterial properties of a subset of CD1-restricted T cells that have come to be known as Natural Killer T cells. This group of lipid reactive T cells is notable for its high level of conservation between humans and mice, thus enabling a wide range of highly informative studies in mouse models. As reviewed below, NKT cells appear to have subtle but potentially significant activities in the host response to mycobacteria. Importantly, they also provide a framework for investigations into other types of lipid antigen-specific T cells that may be more abundant in larger mammals such as humans.

Graphical abstract6″-Triazole-substituted-α-galactosyl ceramides 12a–f, 13, 14 and 15 have been synthesised. Along with azide precursor 11, their ability to activate iNKT cells and stimulate the production of IL-2 cytokines in vitro, and IFN-γ and IL-4 cytokines in vivo, has been evaluated.