Recent Advances in Treatment Strategies for Atopic Dermatitis

Roos, Thomas C.; Geuer, Stefan; Roos, Sabine; Brost, Harald

doi:10.2165/00003495-200464230-00003

Cited by 18 publications

(9 citation statements)

References 212 publications

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“…However, the active ingredients are identified on the packaging. The type of moisturizer or emollient should be tailored to the individual skin condition as well as the child’s needs and preferences [31, 32]. …”

Section: Discussionmentioning

confidence: 99%

Acceptability and Efficacy of an Emollient Containing Ceramide-Precursor Lipids and Moisturizing Factors for Atopic Dermatitis in Pediatric Patients

et al. 2013

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BackgroundAtopic eczema or dermatitis (AD) is associated with atopy and is characterized by reduced skin hydration and an impaired skin barrier in the epidermis. We investigated the patient acceptability and efficacy of an emollient containing ceramide-precursor lipids and moisturizing factors (LMF) in AD.MethodsConsecutive AD patients were recruited. Swabs and cultures were obtained from the right antecubital fossa and the worst-affected eczematous area, and disease severity [according to the SCORing Atopic Dermatitis (SCORAD) Index], skin hydration, and transepidermal water loss (TEWL) were measured prior to and after 2 weeks’ use of the LMF moisturizer. The general acceptability of treatment was documented as being ‘very good’, ‘good’, ‘fair’, or ‘poor’.ResultsTwenty-four AD patients [mean age 13.8 (standard deviation 5.7) years] were recruited. Two thirds of the patients reported very good or good acceptability of the LMF moisturizer, whereas one third reported fair or poor acceptability. There were no inter-group differences in the pre-use clinical parameters of age, objective SCORAD score, pruritus score, sleep disturbance score, skin hydration, TEWL, topical corticosteroid use, oral antihistamine use, or acceptability of previously used proprietary emollients. However, patients in the fair/poor acceptability group were more likely to have Staphylococcus aureus colonization and to be female (odds ratio 13, 95 % confidence interval 1.7–99.4; p = 0.021). Following use of the LMF moisturizer, the objective SCORAD score, pruritus score, and sleep disturbance score were lower in the very good/good acceptability group than in the fair/poor acceptability group. The mean objective SCORAD score improved (from 31.5 to 25.7; p = 0.039) and skin hydration improved [from 30.7 arbitrary units (a.u.) to 36.0 a.u.; p = 0.021] in the very good/good acceptability group. When the data were analyzed for the strength of the agreement of the rating of acceptability, the κ values were 0.338 (fair) for use of body wash and 0.118 (poor) for use of emollients before and after the trial.ConclusionThe LMF moisturizer was considered acceptable by two thirds of the patients with AD. It seems that patients who found the moisturizer acceptable were less likely to be female or to be colonized by S. aureus before switching to the product, and they had less severe eczema, less pruritus, and less sleep disturbance after its use than patients who did not find the product acceptable. Gender and S. aureus colonization may have influenced the patient acceptability and clinical efficacy of the LMF moisturizer. The lack of agreement with regard to the acceptability of the moisturizer implies that there is room for parent/patient education to improve compliance.

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Section: Discussionmentioning

confidence: 99%

Acceptability and Efficacy of an Emollient Containing Ceramide-Precursor Lipids and Moisturizing Factors for Atopic Dermatitis in Pediatric Patients

et al. 2013

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“…The type of moisturizer or emollient should be tailored to the individual skin condition as well as the child's needs and preferences [58,59]. The actual ingredients in most of these products are a commercial secret of individual pharmaceutical companies.…”

Section: Optimal Skin Care: Relevance Of Cera-mides and Pseudoceramidesmentioning

confidence: 99%

“…In areas rich with sebaceous glands such as the face, formulations should contain less oil than on other body areas [58]. In areas rich with sebaceous glands such as the face, formulations should contain less oil than on other body areas [58].…”

Section: Optimal Skin Care: Relevance Of Cera-mides and Pseudoceramidesmentioning

confidence: 99%

Use of Ceramides and Related Products for Childhood-Onset Eczema

Hon

Leung²

2013

Recent Patents on Inflammation & Allergy Drug Discovery

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Atopic eczema or dermatitis (AD) is a chronically relapsing dermatosis associated with pruritus, sleep disturbance and impaired quality of life. AD affects 10 to 20% of school-aged children. The prevalence has increased two to three folds over the past three decades in industrialized countries and there is evidence to suggest that this prevalence is increasing. AD is frustrating to both patients and caregivers and can impose considerable financial impact on the families. The pruritus and sleep disturbance can be intractable and the disease has important physical and psychological implications. Filaggrin (filament-aggregating protein) has an important function in epidermal differentiation and barrier function. Null mutations within the filaggrin gene cause ichthyosis vulgaris and are major risk factors for developing AD. The affected skin of atopic individuals is deficient in natural moisturizing factors (derived from deiminated filaggrin peptides filaggrin) or ceramides (a family of lipid molecules, composed of sphingosine and a fatty acid, found in high concentrations within the cell membrane of cells in the stratum corneum). Avoidance of triggering factors, optimal skin care and topical corticosteroids are the mainstay of therapy for AD. There are two important dermatologic facets to its management, namely, preventive and therapeutic measures. Preventive measures refer to the frequent and proper application of skin moisturizers. When these preventive measures fail to control the disease exacerbation, therapeutic measures such as topical/systemic corticosteroids, antibiotics and immunomodulating agents may be required to control the skin inflammation. Proper moisturizer therapy can reduce the frequency of flares and the demand of topical corticosteroids or topical calcineurin inhibitors. Regular topical application of a moisturizer is the key in the management of patients with AD. Moisturizer therapy of childhood-onset AD is significantly complicated by the diversity of disease manifestations and by a variety of complex immune abnormalities. Recent advances in the understanding of the pathophysiological process of AD leads to the production of new moisturizers and topical skin products targeted to correct reduced amount of ceramides in the skin with ceramide and pseudoceramide products. However, many cosmetic products claimed to have these ingredients have no or limited studies to document their clinical efficacy. Recent studies have shown the therapeutic efficacy of several new compounds. This review provides an update on recent patents that could develop into novel therapeutics available to the clinical armamentarium for the management of the disease.

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“…Entre os casos de concentração detectada, os níveis variaram 0,5 a 1,8 µg/mL. Não há níveis estabelecidos de imunossupressão para pimecrolimo, mas é sabido que níveis de 5 a 15 ng/mL de tacrolimo são considerados imunossupressores e são os preconizados em indivíduos transplantados [11][12][13][14][15] .…”

Section: Conhecendo O Pimecrolimounclassified

Calcineurin inhibitors in the treatment of allergic dermatitis

Castro

2006

J Pediatr (Rio J)

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Objective: To review the role of calcineurin inhibitors in the treatment of allergic dermatitis, focusing on mechanisms of action, efficacy and topical and systemic adverse effects.Sources: Articles written in English and published in MEDLINE using the following keywords: pimecrolimus, tacrolimus, calcineurin inhibitors. Original articles that presented controlled and open studies for assessing efficacy, tolerability and adverse effects were selected. Review articles and case series were also evaluated; the latter was only considered for assessing adverse effects. The official websites of the Food and Drug Administration and of manufacturers of calcineurin inhibitors were also used. Summary of the findings:The data showed that calcineurin inhibitors are efficient in the treatment of mild to severe atopic dermatitis, leading to improvement in symptoms, reduction in number of attacks and need of topical corticotherapy. Calcineurin inhibitors have good tolerability and few topical adverse effects. To date, there has been no evidence to support higher prevalence of neoplasia in patients using these drugs; however, an adequate pharmacovigilance system has been set up to assess this aspect. Conclusions:Calcineurin inhibitors, which are a new drug class in the treatment of allergic dermatitis, are efficient, well tolerated and have few adverse effects. Calcineurin inhibitors should always be used according to recommended guidelines, and patients should always be followed by the physician during and after their administration.J Pediatr (Rio J). 2006;82(5 Suppl):S166-72: Pimecrolimus, tacrolimus, calcineurin inhibitors. ResumoObjetivo: Revisar o papel dos inibidores da calcineurina no tratamento das dermatoses alérgicas, com ênfase nos mecanismos de ação, eficácia e efeitos adversos tópicos e sistêmicos.Fontes dos dados: Artigos de língua inglesa publicados na MEDLINE, considerando as palavras chave: pimecrolimus, tacrolimo, calcineurin inhibitors. Foram selecionados os artigos originais que apresentaram estudos controlados e estudos abertos para avaliação da eficácia, tolerabilidade e eventos adversos. Também foram avaliados artigos de revisão e relatos e série de casos, sendo estes últimos considerados apenas para avaliação de efeitos adversos. Foram consultados os sites oficiais da Food and Drug Administration e dos fabricantes de inibidores da calcineurina. Síntese dos dados:Os dados mostraram que inibidores de calcineurina são eficientes no tratamento da dermatite atópica leve a grave, levando a melhora dos sintomas, diminuição do número de crises e necessidade de corticoterapia tópica. Apresentam boa tolerabilidade e poucos efeitos adversos tópicos. Até o momento, não há evidências que sustentem a maior prevalência de neoplasias nos pacientes que utilizam esses medicamentos; entretanto, um adequado sistema de farmacovigilância está montado para avaliar esse aspecto.Conclusões: Os inibidores de calcineurina são uma nova classe de medicamentos para o tratamento das dermatoses alérgicas. São eficazes, tolerado...

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Recent Advances in Treatment Strategies for Atopic Dermatitis

Cited by 18 publications

References 212 publications

Acceptability and Efficacy of an Emollient Containing Ceramide-Precursor Lipids and Moisturizing Factors for Atopic Dermatitis in Pediatric Patients

Acceptability and Efficacy of an Emollient Containing Ceramide-Precursor Lipids and Moisturizing Factors for Atopic Dermatitis in Pediatric Patients

Use of Ceramides and Related Products for Childhood-Onset Eczema

Calcineurin inhibitors in the treatment of allergic dermatitis

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