Atopic Dermatitis

Bieber, Thomas

doi:10.1056/nejmra074081

Cited by 1,744 publications

(1,629 citation statements)

References 95 publications

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“…36 Microscopically, the characteristic appearance of eczema is fluid between the cells in the epidermis (spongiosis). When severe, this fluid eventually disrupts the adjacent cells in the epidermis to form small collections of fluid, which are visible to the naked eye as vesicles.…”

Section: Pathophysiologymentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Pathophysiologymentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…Skin diseases that alter the epithelium are reported to be an influential factor on S. aureus carriage. Atopic dermatitis (AD) is a pruritic skin disease characterized by barrier dysfunction of the skin and chronic inflammation [28]. Several smaller clinical studies have shown strong associations between AD and S. aureus colonisation of the skin and nose.…”

Section: El-shenawy Et Almentioning

confidence: 99%

Cross Sectional Study of Skin Carriage and Enterotoxigenicity of Staphylococcus aureus among Food Handlers

El‐Shenawy¹,

Tawfeek²,

El‐Hosseiny³

et al. 2014

OJMM

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The prevalence of enterotoxigenic Staphylococcus aureus was investigated among 200 participants working in three different food processing plants in Egypt. Using skin swabs, 75 (38%) of the 200 tested persons were positive for the presence of S. aureus. Of the S. aureus positive persons, 28 (14%) harboured S. aureus produced staphylococcal enterotoxins. The serotypes of these enterotoxins were enterotoxin A (68%), enterotoxin B (36%), enterotoxin C (46%) and enterotoxin D (18%). Some of these isolates produced more than one type of enterotoxins namely AB, AC, BC, BD, ABC and ACD. Analysis of risk factors implicated in skin carriage of S. aureus as age, gender, marital status, education, duration in employment, frequency and method of hand wash and incidence of chronic skin infection revealed insignificant association with staphylococcal skin carriage. The obtained results put forth the risk of food contracting contamination with enterotoxigenic strains of S. aureus owing to skin colonization of S. aureus among food handlers.

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“…Yani intrinsik tip, ekstrinsik tipin erken bir evresidir. Bu konuda halen yap›lmakta olan birçok çal›flma mevcuttur 8,9,10 . Atopik ekzeman›n topikal tedavisinde topikal kortikosteroidler ve topikal kalsinörin inhibitörleri (takrolimus ve pimekrolimus) kullan›l›r.…”

Section: Giriflunclassified

Efficacy of Pimecrolimus 1% Cream in Various Clinical Forms of Atopic Dermatitis

İkizler¹,

Karabacak²,

Karabudak³

et al. 2010

turkderm

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ÖzetAmaç: Atopik dermatit bilindi¤i gibi farkl› klinik tiplerde karfl›m›za ç›kar. Bu deneysel çal›flman›n temel amac›, atopik dermatitin bu tipleri aras›nda pimekrolimusun etkinli¤ini karfl›laflt›rmakt›r. Gereç ve Yöntem: Çal›flmaya 2-38 yafllar› aras›nda, 50'si erkek, 20'si kad›n, toplam 70 hasta al›nd›. Hastalar›n 22'si (%31,4) çocuktu (2-10 yafl). Hastalarda, solunum yolu allerjisi, total IgE yüksekli¤i, deri "prick" test pozitifli¤i ve tetikleyici allerjenler araflt›r›ld›. Hastalar Wüthrich s›n›flamas›na göre, "mikst", "pür intrinsik" ve "pür ekstrinsik" olarak s›n›fland›r›ld›. Hastalara 6 hafta boyunca günde iki kez %1 pimekrolimus krem tedavisi uyguland› ve hastalar SCORAD indeksi kullan›larak de¤erlendirildi. Bulgular: Sonuç olarak hastalar›n %58,6's›nda (n=41) tedavi baflar›l›, %4,3'ünde (n=3) tedavi k›smen baflar›l›, %37,1'inde (n=26) tedavi baflar›s›z bulundu. 35 hastada tam remisyon elde edildi. Tedavi öncesi ve sonras›ndaki SCORAD de¤erleri aras›ndaki fark, istatistiksel olarak anlaml› bulundu (p<0,0001). Sonuç: Çal›flmada, mikst, pür intrinsik ve pür ekstrinsik atopik dermatit tipleri aras›nda pimekrolimus etkinli¤i karfl›laflt›r›l-d›¤›nda, pür intrinsik tipte pimekrolimus daha etkili bulunmas›na ra¤men bu durum istatistiksel olarak anlaml› de¤ildi (p=0,75). Yine, pimekrolimus etkinli¤i aç›s›ndan, hafif ve orta fliddetli atopik dermatit hastalar› aras›nda, istatistiksel olarak anlaml› bir fark saptanmad›. (p=0,107) Ayr›ca, bu çal›flmada optimum tedavi süresinin eriflkinlerde yaklafl›k 6 hafta, çocuklarda ise 4 hafta oldu¤u kan›s›na var›ld›. (Türkderm 2010; 44: 83-7) Anahtar Kelimeler: Atopik dermatit, tedavi, pimekrolimus, etkinlik SummaryBackground and Design: Atopic dermatitis shows some different clinical appearances.The main aim of this experimental study is to compare the efficacy of pimecrolimus among these clinical subgoups of atopic dermatitis. Material and Method: A total of 70 patients, 50 male and 20 female, aged between 2-38 years were included in the study. Twenty-two patients (%31.4) were pediatric (2-10 years). Patients were investigated in regard to high levels of total IgE, airway allergy, positive skin prick test and triggering allergens. Patients were classified as: mixed, pure intrinsic and pure extrinsic according to Wüthrich classification. Pimecrolimus 1% cream was applied to the patients twice daily for 6 weeks and patients were evaluated with SCORAD index before and after treatment. Results: FAs a result, 58.6% of the patients (n=41) had a successful therapy with pimecrolimus while 4.3% (n=3) had partially successful. Thirty-five patients achieved full remission. The difference between the SCORADs before and after the treatment was found to be statistically significant (p<0.0001). Conclusion: In this study, efficacy of pimecrolimus was compared to mixed, pure intrinsic and pure extrinsic types of atopic dermatitis. Although pimecrolimus was more effective in the pure intrinsic type, it was not statistically significant (p=0,75). There was also an insignificant difference b...

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Atopic Dermatitis

Cited by 1,744 publications

References 95 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Cross Sectional Study of Skin Carriage and Enterotoxigenicity of Staphylococcus aureus among Food Handlers

Efficacy of Pimecrolimus 1% Cream in Various Clinical Forms of Atopic Dermatitis

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