Review of Systemic Treatment Options for Adult Atopic Dermatitis

2016 ◽  
Vol 21 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Melinda Gooderham ◽  
Charles W. Lynde ◽  
Kim Papp ◽  
Marc Bourcier ◽  
Lyn Guenther ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Immune Responses ◽  
Systemic Therapy ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Skin Barrier ◽  
New Approach ◽  
Systemic Treatments ◽  
Systemic Therapies

Background: Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease resulting from defects in skin barrier and aberrant immune responses. AD significantly affects the quality of life. Not all patients respond to topical therapies, and often systemic therapy is required to control the disease. Objective: To review the treatment options for adult AD patients including those options for patients who do not respond adequately or have contraindications to oral systemic therapy. Methods: A working group of clinicians with experience managing AD was convened to review the current literature on treatment options for adult AD patients. This review is based on the best available evidence from a published systematic review and an additional literature search. Results: Current treatments for AD are reviewed, including options for adult AD patients who do not respond or have contraindications to current systemic therapies. A new approach with targeted therapies is reviewed based on best available evidence. Conclusion: Many AD patients respond satisfactorily to topical or systemic treatments, but for those patients who do not respond or have contraindications, new biologic agents appear to be promising therapies.

Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section I: Pathophysiology of Atopic Dermatitis and Implications for Systemic Therapy

2018 ◽  
Vol 22 (1_suppl) ◽  
pp. 6S-9S ◽  
Author(s):  
Mark G. Kirchhof ◽  
Ian Landells ◽  
Chuck W. Lynde ◽  
Melinda J. Gooderham ◽  
Chih-ho Hong
Keyword(s):  
Atopic Dermatitis ◽  
Environmental Factors ◽  
Chronic Inflammation ◽  
Systemic Therapy ◽  
Skin Disease ◽  
Treatment Options ◽  
Adult Patients ◽  
Inflammatory Skin Disease ◽  
Consensus Document ◽  
Systemic Therapies

Atopic dermatitis (AD) is a chronic, relapsing, and remitting inflammatory skin disease whose onset typically occurs early in life. AD pathophysiology includes genetic, immune, and environmental factors contributing to chronic inflammation. A rapidly evolving understanding of the pathogenesis of AD has led to the development of several treatment options for AD in adults, including topicals, phototherapy, and systemic therapies. Here, we provide a concise summary of AD pathophysiology with a focus on implications for systemic therapy.

A Treatment Algorithm for Moderate to Severe Atopic Dermatitis in Adults

2017 ◽  
Vol 22 (1) ◽  
pp. 78-83 ◽  
Author(s):  
Charles W. Lynde ◽  
Marc Bourcier ◽  
Melinda Gooderham ◽  
Lyn Guenther ◽  
Chih-ho Hong ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Systemic Treatment ◽  
Topical Therapy ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Current Evidence ◽  
Severe Atopic Dermatitis ◽  
Routine Practice ◽  
Clinical Criteria ◽  
Systemic Treatments

Background: Atopic dermatitis (AD) is a common and chronic inflammatory skin disease. Approximately 10% of adults with AD do not respond adequately to topical therapies and require phototherapy and/or systemic therapy. Objective: To provide a patient-focused approach to the identification and management of adults with AD who require systemic treatment. Methods: A working group of clinicians experienced in managing AD was convened to review and discuss current evidence on the identification and clinical management of adults with moderate to severe AD. Results: We propose a set of simple and practical clinical criteria for selecting candidates for systemic treatment of AD based on their response to first-line topical therapy and 4 clinical measures that are easily incorporated into routine practice. We also suggest a framework for evaluating systemic treatments according to attributes that are important from both a clinician’s and a patient’s perspective. An algorithm was developed proposing a pathway for treatment of moderate to severe AD in adults. Conclusion: Adults with moderate to severe AD that does not respond adequately to topical therapies currently have few safe and effective treatment options. A clinical algorithm could help guide treatment decisions.

scholarly journals Approach to the Assessment and Management of Adult Patients With Atopic Dermatitis: A Consensus Document. Section IV: Treatment Options for the Management of Atopic Dermatitis

2018 ◽  
Vol 22 (1_suppl) ◽  
pp. 21S-29S ◽  
Author(s):  
Gurbir Dhadwal ◽  
Lorne Albrecht ◽  
Robert Gniadecki ◽  
Yves Poulin ◽  
Jensen Yeung ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Topical Therapy ◽  
Treatment Options ◽  
Skin Barrier ◽  
Skin Inflammation ◽  
Skin Barrier Function ◽  
Improve Quality ◽  
Consensus Document ◽  
Basic Care

The objectives of therapy for atopic dermatitis (AD) are to reduce skin inflammation and pruritus, restore skin barrier function, and improve quality of life (QoL). Treatments can be classified as moisturizing and basic care, topical therapy, phototherapy, and systemic therapy. In this review, we summarize the treatments for AD and recommendations for their use.

scholarly journals SKIN MICROBIOTA AND ATOPIC DERMATITIS IN CHILDREN: NEW TREATMENT OPTIONS

2019 ◽  
Vol 21 (2) ◽  
pp. 106-113
Author(s):  
Galina I. Smirnova ◽  
D. B. Munblit ◽  
A. I. Kolotilina ◽  
D. M. Levina
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Options ◽  
Skin Barrier ◽  
General Concept ◽  
Small Species ◽  
Dry Skin ◽  
Skin Microbiota ◽  
New Treatment ◽  
The Relationship

There are presented data characterizing atopic dermatitis (AD) in children as a form of allergic pathology, directly related to the condition and quality of the microbiota (intestinal and skin) of the growing organism. The microbiota of the affected skin of AD patients is characterized by a small species diversity of bacteria; the decrease in the number of actinomycetes and proteobacteria; increased colonization by various types of staphylococci (etc.). The relationship between the rate of formation of AD and the disturbance of the skin microbiota in children has been established. The concept of the preservation of high biodiversity of microbiota of a growing organism as a strategy for optimizing microecology of children by using adaptive probiotics in a healthy microenvironment is proposed. The restoration of the barrier function of the skin is determined as the most important task included in the general concept of the treatment of AD, where a significant role is assigned to new means of dermatological cosmetics and proper skin care. The possibilities of normalization the microbiota of affected areas of the skin with the help of cosmetic means for the care of dry skin are shown as a result of the restoration of the skin barrier.

scholarly journals The Implications of Pruritogens in the Pathogenesis of Atopic Dermatitis

2021 ◽  
Vol 22 (13) ◽  
pp. 7227
Author(s):  
Lai-San Wong ◽  
Yu-Ta Yen ◽  
Chih-Hung Lee
Keyword(s):  
Atopic Dermatitis ◽  
Environmental Factors ◽  
Immune Responses ◽  
Immune Cells ◽  
Inflammatory Disease ◽  
Targeted Therapies ◽  
Skin Barrier ◽  
Skin Barrier Function ◽  
Inflammatory Molecules

Atopic dermatitis (AD) is a prototypic inflammatory disease that presents with intense itching. The pathophysiology of AD is multifactorial, involving environmental factors, genetic susceptibility, skin barrier function, and immune responses. A recent understanding of pruritus transmission provides more information about the role of pruritogens in the pathogenesis of AD. There is evidence that pruritogens are not only responsible for eliciting pruritus, but also interact with immune cells and act as inflammatory mediators, which exacerbate the severity of AD. In this review, we discuss the interaction between pruritogens and inflammatory molecules and summarize the targeted therapies for AD.

scholarly journals Congenital Deficiency of Conventional Dendritic Cells Promotes the Development of Atopic Dermatitis-Like Inflammation

2021 ◽  
Vol 12 ◽  
Author(s):  
Yotaro Nishikawa ◽  
Tomohiro Fukaya ◽  
Takehito Fukui ◽  
Tomofumi Uto ◽  
Hideaki Takagi ◽  
...  
Keyword(s):  
Dendritic Cells ◽  
Atopic Dermatitis ◽  
Immune Responses ◽  
Skin Barrier ◽  
Lymphoid Cells ◽  
Congenital Deficiency ◽  
T Cell Immune Responses ◽  
Group 2 ◽  
And Function ◽  
The Impact

Atopic dermatitis (AD) is a common pruritic inflammatory skin disease characterized by impaired epidermal barrier function and dysregulation of Thelper-2 (TH2)-biased immune responses. While the lineage of conventional dendritic cells (cDCs) are implicated to play decisive roles in T-cell immune responses, their requirement for the development of AD remains elusive. Here, we describe the impact of the constitutive loss of cDCs on the progression of AD-like inflammation by using binary transgenic (Tg) mice that constitutively lacked CD11chi cDCs. Unexpectedly, the congenital deficiency of cDCs not only exacerbates the pathogenesis of AD-like inflammation but also elicits immune abnormalities with the increased composition and function of granulocytes and group 2 innate lymphoid cells (ILC2) as well as B cells possibly mediated through the breakdown of the Fms-related tyrosine kinase 3 ligand (Flt3L)-mediated homeostatic feedback loop. Furthermore, the constitutive loss of cDCs accelerates skin colonization of Staphylococcus aureus (S. aureus), that associated with disease flare. Thus, cDCs maintains immune homeostasis to prevent the occurrence of immune abnormalities to maintain the functional skin barrier for mitigating AD flare.

scholarly journals Tumor Reduction with Pazopanib in a Patient with Recurrent Lumbar Chordoma

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Maurício Fernando Silva Almeida Ribeiro ◽  
Micelange Carvalho de Sousa ◽  
Samir Abdallah Hanna ◽  
Marcos Vinicius Calfat Maldaun ◽  
Ceci Obara Kurimori ◽  
...  
Keyword(s):  
Kinase Inhibitors ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Axial Skeleton ◽  
Low Grade ◽  
Complete Excision ◽  
Systemic Treatments ◽  
Tumor Reduction ◽  
Comprehensive Genomic Profiling ◽  
Multifocal Recurrence

Introduction. Chordomas are rare malignancies of bone origin that occur in the axial skeleton, typically the skull base and lumbar/sacral regions. Although often classified as low-grade neoplasms, its locally infiltrative behavior may result in significant morbidity and mortality. Optimal surgical resection may be curative, but up to 50% of the cases relapse within 5 years, and currently there are no systemic treatments approved in this setting. A large proportion of these tumors express stem-cell factor receptor (c-KIT) and platelet-derived growth factor receptors (PDGFRs), providing a rationale for the use of tyrosine-kinase inhibitors (TKIs). Case report. A 27-year-old male presented with recurrent chordoma of the lumbar spine 4 years after initial diagnosis. Salvage therapies in the interval included repeat resections and radiation therapy. He ultimately developed multifocal recurrence not amenable to complete excision or reirradiation. A comprehensive genomic profiling assay was performed and revealed nondrugable alterations. Decision was made to proceed with systemic treatment with pazopanib 800 mg/day, resulting in tumor reduction (−23.1% reduction in size) and prolonged disease control. Conclusion. For this patient with a multiple recurrent chordoma and limited treatment options, pazopanib resulted in sustained clinical benefit following initial tumor reduction.

scholarly journals Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section III: Treatment Options for Pediatric Atopic Dermatitis

2019 ◽  
Vol 23 (5_suppl) ◽  
pp. 19S-31S
Author(s):  
Perla Lansang ◽  
Joseph M. Lam ◽  
Danielle Marcoux ◽  
Vimal H. Prajapati ◽  
Shanna Spring ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Maintenance Therapy ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Skin Barrier ◽  
Active Therapy ◽  
Disease Treatment ◽  
Consensus Document ◽  
Emerging Therapies ◽  
Clinical Considerations

Because atopic dermatitis (AD) is a chronic, relapsing disease, treatment requires the use of both active therapy to control flares and preventative maintenance therapy to promote integrity of the skin barrier. In this third of four sections, important clinical considerations for the treatment of pediatric AD are reviewed. Emerging therapies in development for pediatric AD are introduced.

scholarly journals Progress in the Systemic Treatment of Advanced Soft-Tissue Sarcomas

1998 ◽  
Vol 5 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Scott H. Okuno ◽  
John H. Edmonson
Keyword(s):  
Clinical Trials ◽  
Soft Tissue ◽  
Systemic Treatment ◽  
Soft Tissue Sarcomas ◽  
Multimodality Treatment ◽  
Clinical Situation ◽  
Controlled Clinical Trials ◽  
Systemic Treatments ◽  
Review Current ◽  
Systemic Therapies

Background: Despite the plethora of chemotherapeutic remedies for advanced soft-tissue sarcomas, little evidence has developed to indicate that these efforts have been curative. No controlled comparison has yet proven that patients receiving multidrug regimens survive longer than those receiving doxorubicin alone. Methods: The authors review current systemic treatments and then discuss some investigational efforts now in progress. Also, they seek to demonstrate how the therapies currently available can be integrated with surgery and radiation therapy to accomplish more than might be anticipated from chemotherapy alone. Results: While working to develop better systemic therapies for advanced soft-tissue sarcomas, the integrated use of our best chemotherapy regimens in combination with selected surgical and radiotherapy efforts may provide patients with the best available therapy. Some recent observations involving the use of molgramostim plus chemotherapy have been intriguing. Conclusions: Progress in the systemic treatment of advanced soft-tissue sarcomas may be gradual, but it is real. Our daily challenge is to be certain that we offer each patient the best available multimodality treatment applicable to his or her clinical situation. Molgramostim should be made available for further study with chemotherapy in controlled clinical trials.

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