Adult-Onset Atopic Dermatitis: Presentations and Progress

2020 ◽  
Vol 24 (3) ◽  
pp. 267-272
Author(s):  
Airiss R. Chan ◽  
Vijay K. Sandhu ◽  
Aaron M. Drucker ◽  
Patrick Fleming ◽  
Charles W. Lynde
Keyword(s):  
Atopic Dermatitis ◽  
Immune Dysregulation ◽  
Upper Limbs ◽  
Adult Onset ◽  
Barrier Dysfunction ◽  
Childhood Onset ◽  
Exclusion Criteria ◽  
Body Regions ◽  
Chronic Skin ◽  
Chronic Skin Disease

Atopic dermatitis (AD) is a chronic skin disease characterized by barrier dysfunction and immune dysregulation that affects approximately 20% of children and 2-5% of adults worldwide. Traditionally, AD has been considered a disease of childhood with many cases resolving before adulthood. However, in recent years, the prevalence of adult AD is increasingly recognized to be substantial, but it is uncertain whether this increase is due to increased childhood-persistent or relapsed AD, or new adult-onset AD. This highlights a need for further investigation into the adult AD population and evaluation of phenotypes in the adult-onset cohort. In this literature review, we examine five studies focused on adult-onset AD phenotype, conducted between 2013 and 2017. The most commonly reported body regions affected in adult-onset AD were the hands, eyelids, neck, and flexural surfaces of the upper limbs. These vary from childhood-onset AD findings, which are less specific to body regions other than flexural areas. These findings have implications for diagnostic accuracy and treatment of AD, including considerations for therapeutic choices and inclusion and exclusion criteria in clinical trials.

scholarly journals The Keratinocyte as a Crucial Cell in the Predisposition, Onset, Progression, Therapy and Study of the Atopic Dermatitis

2021 ◽  
Vol 22 (19) ◽  
pp. 10661
Author(s):  
Pamela Gallegos-Alcalá ◽  
Mariela Jiménez ◽  
Daniel Cervantes-García ◽  
Eva Salinas
Keyword(s):  
Atopic Dermatitis ◽  
Complex Disease ◽  
Skin Diseases ◽  
Current Knowledge ◽  
Immune Dysregulation ◽  
Chronic Inflammatory Disease ◽  
Skin Microbiota ◽  
External Agents ◽  
Chronic Skin ◽  
Inflammatory Molecules

The keratinocyte (KC) is the main functional and structural component of the epidermis, the most external layer of the skin that is highly specialized in defense against external agents, prevention of leakage of body fluids and retention of internal water within the cells. Altered epidermal barrier and aberrant KC differentiation are involved in the pathophysiology of several skin diseases, such as atopic dermatitis (AD). AD is a chronic inflammatory disease characterized by cutaneous and systemic immune dysregulation and skin microbiota dysbiosis. Nevertheless, the pathological mechanisms of this complex disease remain largely unknown. In this review, we summarize current knowledge about the participation of the KC in different aspects of the AD. We provide an overview of the genetic predisposing and environmental factors, inflammatory molecules and signaling pathways of the KC that participate in the physiopathology of the AD. We also analyze the link among the KC, the microbiota and the inflammatory response underlying acute and chronic skin AD lesions.

scholarly journals Skin Barrier Abnormalities and Immune Dysfunction in Atopic Dermatitis

2020 ◽  
Vol 21 (8) ◽  
pp. 2867 ◽  
Author(s):  
Gabsik Yang ◽  
Jin Kyung Seok ◽  
Han Chang Kang ◽  
Yong-Yeon Cho ◽  
Hye Suk Lee ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Systemic Disease ◽  
Skin Barrier ◽  
Immune Dysregulation ◽  
Food Allergies ◽  
Atopic Diseases ◽  
Barrier Dysfunction ◽  
Underlying Mechanisms ◽  
Chronic Pruritus ◽  
And Function

Atopic dermatitis (AD) is a common and relapsing skin disease that is characterized by skin barrier dysfunction, inflammation, and chronic pruritus. While AD was previously thought to occur primarily in children, increasing evidence suggests that AD is more common in adults than previously assumed. Accumulating evidence from experimental, genetic, and clinical studies indicates that AD expression is a precondition for the later development of other atopic diseases, such as asthma, food allergies, and allergic rhinitis. Although the exact mechanisms of the disease pathogenesis remain unclear, it is evident that both cutaneous barrier dysfunction and immune dysregulation are critical etiologies of AD pathology. This review explores recent findings on AD and the possible underlying mechanisms involved in its pathogenesis, which is characterized by dysregulation of immunological and skin barrier integrity and function, supporting the idea that AD is a systemic disease. These findings provide further insights for therapeutic developments aiming to repair the skin barrier and decrease inflammation.

scholarly journals The Role of Allergens in Atopic Dermatitis

2020 ◽  
Author(s):  
Suna Asilsoy ◽  
Serdar Al
Keyword(s):  
Allergic Rhinitis ◽  
Atopic Dermatitis ◽  
Allergic Diseases ◽  
Skin Lesions ◽  
Atopic Diseases ◽  
Chronic Skin ◽  
Genetic And Environmental Factors ◽  
Inhalant Allergens ◽  
Chronic Skin Disease

Atopic dermatitis (AD) is a chronic skin disease caused by genetic and environmental factors. Often it begins in early childhood. It is located at the first step of the process we refer to as atopic march. This feature is a precursor of the development of other allergic diseases such as asthma and allergic rhinitis. Especially in patients with atopy of food and inhalant allergens, the occurrence of other atopic diseases is more common. Although the role of these sensitivities in AD is controversial, it has been determined that some patients may trigger eczematous skin lesions. In this report, the role of allergens in atopic dermatitis are reviewed in the light of current literature.

scholarly journals Dressing a Demanding Body to Fit In: Clean and Decent with Ostomy or Chronic Skin Disease

2019 ◽  
Vol 7 (1) ◽  
pp. 124-135
Author(s):  
Kirsi Laitala ◽  
Ingun Grimstad Klepp
Keyword(s):  
Atopic Dermatitis ◽  
Skin Disease ◽  
Social Life ◽  
Qualitative Interviews ◽  
Economic Resources ◽  
Chronic Skin ◽  
Skin Conditions ◽  
Chronic Skin Disease ◽  
Main Strategy

This article discusses what kind of strategies people with a stoma or various chronic skin conditions, such as psoriasis or atopic dermatitis, use to find clothes that fit and enable them to fit in. Based on qualitative interviews in Norway, we study how they manage to dress with a demanding body, a poor market and limited economic resources. This includes describing how purchases take place, which clothes fit, how much clothing is needed, and which laundry practices are used. Their main strategy was to reduce the requirements for their own appearance rather than to cleanliness and body odours. If they were unable to appear appropriately dressed, as a minimum odourless and stain free, they reduced their participation in social life.

scholarly journals New Era in Atopic Dermatitis Treatment: Results of Long-Term Dupilumab Administration

2021 ◽  
Vol 20 (5) ◽  
pp. 390-395
Author(s):  
Nikolay N. Murashkin ◽  
Leonid A. Opryatin ◽  
Roman V. Epishev ◽  
Alexander I. Materikin ◽  
Eduard T. Ambarchyan ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Skin Inflammation ◽  
Efficacy And Safety ◽  
Barrier Dysfunction ◽  
Treatment Results ◽  
New Era ◽  
Short And Long Term ◽  
Chronic Skin

Atopic dermatitis (AD) is a disease characterized by chronic skin inflammation and epidermal barrier dysfunction leading to decrease in patients' quality of life. AD is widespread in general population including children. This article covers the disease pathophysiological mechanisms including those that depend on the endotype, as well as core principles of systemic therapy for children with moderate and severe AD. Features of targeted therapy of such patients with dupilumab (IL-4 and IL-13 inhibitor) are presented. The studies' results on dupilumab efficacy and safety in the short- and long-term are shown.

scholarly journals Neonatal-derived IL-17 producing dermal γδ T cells are required to prevent spontaneous atopic dermatitis

eLife ◽  
2020 ◽  
Vol 9 ◽  
Author(s):  
Nicholas A Spidale ◽  
Nidhi Malhotra ◽  
Michela Frascoli ◽  
Katelyn Sylvia ◽  
Bing Miu ◽  
...  
Keyword(s):  
T Cells ◽  
Atopic Dermatitis ◽  
Inflammatory Diseases ◽  
Γδ T Cells ◽  
Skin Barrier ◽  
Commensal Bacteria ◽  
Dermal Cell ◽  
Chronic Skin ◽  
Basal Keratinocyte ◽  
Chronic Skin Disease

Atopic Dermatitis (AD) is a T cell-mediated chronic skin disease and is associated with altered skin barrier integrity. Infants with mutations in genes involved in tissue barrier fitness are predisposed towards inflammatory diseases, but most do not develop or sustain the diseases, suggesting that there exist regulatory immune mechanisms to prevent aberrant inflammation. The absence of one single murine dermal cell type, the innate neonatal-derived IL-17 producing γδ T (Tγδ17) cells, from birth resulted in spontaneous, highly penetrant AD with many of the major hallmarks of human AD. In Tγδ17 cell-deficient mice, basal keratinocyte transcriptome was altered months in advance of AD induction. Tγδ17 cells respond to skin commensal bacteria and the fulminant disease in their absence was driven by skin commensal bacteria dysbiosis. AD in this model was characterized by highly expanded dermal αβ T clonotypes that produce the type three cytokines, IL-17 and IL-22. These results demonstrate that neonatal Tγδ17 cells are innate skin regulatory T cells that are critical for skin homeostasis, and that IL-17 has dual homeostatic and inflammatory function in the skin.

scholarly journals The Pathogenic and Therapeutic Implications of Ceramide Abnormalities in Atopic Dermatitis

Cells ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 2386
Author(s):  
Masanori Fujii
Keyword(s):  
Atopic Dermatitis ◽  
Skin Barrier ◽  
Skin Barrier Function ◽  
Permeability Barrier ◽  
Barrier Dysfunction ◽  
Therapeutic Implications ◽  
Beneficial Effects ◽  
Chronic Skin ◽  
Th1 Cytokines ◽  
Lipid Abnormalities

Ceramides play an essential role in forming a permeability barrier in the skin. Atopic dermatitis (AD) is a common chronic skin disease associated with skin barrier dysfunction and immunological abnormalities. In patients with AD, the amount and composition of ceramides in the stratum corneum are altered. This suggests that ceramide abnormalities are involved in the pathogenesis of AD. The mechanism underlying lipid abnormalities in AD has not yet been fully elucidated, but the involvement of Th2 and Th1 cytokines is implicated. Ceramide-dominant emollients have beneficial effects on skin barrier function; thus, they have been approved as an adjunctive barrier repair agent for AD. This review summarizes the current understanding of the mechanisms of ceramide abnormalities in AD. Furthermore, the potential therapeutic approaches for correcting ceramide abnormalities in AD are discussed.

scholarly journals IgE Autoreactivity in Atopic Dermatitis: Paving the Road for Autoimmune Diseases?

Antibodies ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 47
Author(s):  
Christophe Pellefigues
Keyword(s):  
Atopic Dermatitis ◽  
Autoimmune Diseases ◽  
Current Knowledge ◽  
Skin Barrier ◽  
Allergic Diseases ◽  
Specific Ige ◽  
Barrier Dysfunction ◽  
The Road ◽  
Common Skin ◽  
Chronic Skin

Atopic dermatitis (AD) is a common skin disease affecting 20% of the population beginning usually before one year of age. It is associated with the emergence of allergen-specific IgE, but also with autoreactive IgE, whose function remain elusive. This review discusses current knowledge relevant to the mechanisms, which leads to the secretion of autoreactive IgE and to the potential function of these antibodies in AD. Multiple autoantigens have been described to elicit an IgE-dependent response in this context. This IgE autoimmunity starts in infancy and is associated with disease severity. Furthermore, the overall prevalence of autoreactive IgE to multiple auto-antigens is high in AD patients. IgE-antigen complexes can promote a facilitated antigen presentation, a skewing of the adaptive response toward type 2 immunity, and a chronic skin barrier dysfunction and inflammation in patients or AD models. In AD, skin barrier defects and the atopic immune environment facilitate allergen sensitization and the development of other IgE-mediated allergic diseases in a process called the atopic march. AD is also associated epidemiologically with several autoimmune diseases showing autoreactive IgE secretion. Thus, a potential outcome of IgE autoreactivity in AD could be the development of further autoimmune diseases.

scholarly journals Comparison of Epidermal Barrier Integrity in Adults with Classic Atopic Dermatitis, Atopic Prurigo and Non-Atopic Prurigo Nodularis

Biology ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1008
Author(s):  
Regina Fölster-Holst ◽  
Rahel Reimer ◽  
Claudia Neumann ◽  
Erhardt Proksch ◽  
Elke Rodriguez ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Transepidermal Water Loss ◽  
Prurigo Nodularis ◽  
Epidermal Barrier ◽  
Molecular Biological Analysis ◽  
Chronic Skin ◽  
And Function ◽  
Clinical Pictures ◽  
Altered Lipid ◽  
Chronic Skin Disease

A deficient epidermal barrier is a key feature of atopic dermatitis (AD) and comprises altered lipid and protein content and composition of the stratum corneum resulting in disturbed water balance. Clinically, eczematous lesions on dry skin and pruritus develop. Pruritic nodules occur in prurigo nodularis (PN), another chronic skin disease, which can be associated with atopy. We aimed at comparing the three clinical pictures, classic AD, atopic prurigo (AP), and non-atopic PN, to healthy controls regarding the epidermal barrier. We determined clinical parameters and performed biophysical measurements, histology/immunohistochemistry, electron microscopy, and molecular biological analysis. We found distinctively elevated clinical scores, reduced hydration and increased transepidermal water loss, epidermal hyperplasia and inflammation reduced filaggrin and increased loricrin and involucrin expression, as well as reduced intercellular lipid lamellae in all three disease groups. These findings show a severe disruption in epidermal barrier structure and function in all three disorders so that epidermal barrier impairment is now proven not only for AD but also for PN.

scholarly journals Dermatitis Atópica en Adultos

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Luis Seas Garita ◽  
Maria Fernanda Ochoa Perez ◽  
Alison Villachica Madriz
Keyword(s):  
Quality Of Life ◽  
Atopic Dermatitis ◽  
Multifactorial Disease ◽  
Atopic Diseases ◽  
Negative Effects ◽  
Calidad De Vida ◽  
Immunological Factors ◽  
Chronic Skin ◽  
Chronic Skin Disease

Resumen La dermatitis atópica o eczema, es la enfermedad cutánea crónica en recaídas más común, que afecta tanto a niños como adultos en todo el mundo y que aparece con frecuencia en familias con otras enfermedades atópicas como el asma, la rinitis alérgica y la alergia alimentaria. Se trata de una enfermedad multifactorial que resultante de la interacción de factores ambientales, defectos en la función barrera y una serie de factores inmunológicos. Este artículo ofrece una visión actualizada de la epidemiología, diagnóstico, tratamiento, prevención y factores que ayudan a disminuir los efectos negativos de la dermatitis atópica en la calidad de vida de los pacientes. Abstract Atopic dermatitis, or eczema, is the most common chronic skin disease in relapses, affecting both children and adults worldwide and appearing frequently in families with other atopic diseases such as asthma, allergic rhinitis, and food allergy. It is a multifactorial disease that results from the interaction of environmental factors, defects in barrier function and a series of immunological factors. This article offers an updated view of the epidemiology, diagnosis, treatment, prevention and factors that help decrease the negative effects of atopic dermatitis on the quality of life of patients.

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