Pathophysiology and Management of Atopic Dermatitis: A Laconic Review

2020 ◽  
Vol 15 (4) ◽  
pp. 321-336
Author(s):  
Pravin Kumar ◽  
Dinesh Kumar Sharma ◽  
Mahendra Singh Ashawat
Keyword(s):  
Monoclonal Antibody ◽  
Atopic Dermatitis ◽  
Topical Therapy ◽  
Human Monoclonal Antibody ◽  
Life Quality ◽  
Calcineurin Inhibitors ◽  
Developed Countries ◽  
Skin Lesions ◽  
Lymphoid Cells ◽  
Immunological Factors

Conclusion: : Atopic Dermatitis (AD) is long-lasting degenerating skin disease with a characteristic phenotype and stereotypically spread skin lesions. The AD results due to a complex interface among genetic factors, host’s surroundings, pharmacological anomalies and immunological factors. In previous decades, researchers had shown marked interest due to increased prevalence in developed countries. In this review, basics along with the advances in pathogenesis and management of AD have been discussed. The immunological factors i.e. Innate Lymphoid Cells, IL-22 and Toll-like receptors have an important role in the pathogenesis. The proactive topical therapy by skincare, topical glucocorticosteroids and calcineurin inhibitors have improved effect in the management of AD. The human monoclonal antibody-based systemic drug (Duplimab) is a considerable advancement in the management of AD. Other monoclonal antibody-based drugs (Lebrikizumab, Tralokinumab, Apremilast and Nemolizumab) are in different phases of clinical trials. A better understanding of genetics and immunoregulatory cascade will lead to the development of efficacious drugs and better management therapy preventing the relapse of flares and improved life quality of AD patients.

scholarly journals Dupilumab in the treatment of moderate-to-severe atopic dermatitis: A focused review

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Eman Deif ◽  
Sheerja Bali ◽  
Asha Rajeev
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Option ◽  
Topical Therapy ◽  
Human Monoclonal Antibody ◽  
Injection Site Reaction ◽  
Life Quality ◽  
Severity Index ◽  
Skin Condition ◽  
Severe Atopic Dermatitis ◽  
Helper Cell Type

Atopic dermatitis (AD) is a chronic inflammatory skin condition causing significant decline in quality of life. Moderate-to-severe AD is refractory to first-line topical therapy, while systemic immunosuppressants can have significant adverse effects. Dupilumab is a fully human monoclonal antibody and the first food and drug administration approved biologic therapy for the treatment of adults with moderate-to-severe AD. It inhibits the actions of both interleukin (IL)-4 and IL-13, two T helper cell type 2 cytokines involved in the pathogenesis of AD. Dupilumab has been found to be an efficacious treatment option in AD with its main adverse reactions being conjunctivitis, injection site reaction, and facial redness. Dupilumab is known to improve the severity and extent of AD, as measured by the eczema area severity index and dermatology life quality index. A similar observation was made by the authors in 30 patients. Thus, dupilumab represents a valuable new treatment option for moderate-to-severe AD, however, high cost remains a major consideration.

Traditional Herbal Medicines, Newer Herbs and Other Novel Approaches Integrated in Herbal Medicine for Atopic Dermatitis-A Narrative Review

2020 ◽  
Vol 15 (3) ◽  
pp. 194-208
Author(s):  
Pravin Kumar ◽  
Dinesh Kumar Sharma ◽  
Mahendra Singh Ashawat
Keyword(s):  
Atopic Dermatitis ◽  
Herbal Medicines ◽  
Developed Countries ◽  
Skin Lesions ◽  
Scientific Data ◽  
Herbal Drugs ◽  
Biological Drugs ◽  
Alternative Treatment Option

Atopic Dermatitis (AD) is a prolonged reverting skin ailment with characteristically distributed skin lesions. In the previous decades, researchers had shown a marked interest in AD due to its increased prevalence in developed countries. Although different strategies including biological and immune modulators are available for the treatment of AD, each has certain limitations. The researchers had shown considerable interest in the management of AD with herbal medicines. The establishment of herbal drugs for AD might eliminate local as well as systemic adverse effects associated with long term use of corticosteroids and also higher cost of therapy with biological drugs. The present review discusses the traditional East Asian herbal medicines and scientific data related to newer herbal extracts or compositions for the treatment of AD. In vivo animal models and in vitro cell cultures, investigated with herbal medicines to establish a possible role in AD treatment, have also been discussed in the paper. The paper also highlights the role of certain new approaches, i.e. pharmacopuncture, a combination of allopathic and herbal medicines; and novel carriers (liposomes, cubosomes) for herbal drugs on atopic skin. In conclusion, herbal medicines can be a better and safe, complementary and alternative treatment option for AD.

Atopische Dermatitis: IL-13-Antikörper macht Hoffnung auf gut verträgliche und lang wirkende Therapieoption

2021 ◽  
pp. 1-2
Author(s):  
Sandra Philipp
Keyword(s):  
Atopic Dermatitis ◽  
Initial Period ◽  
Human Monoclonal Antibody ◽  
Life Quality ◽  
Signs And Symptoms ◽  
Phase Iii ◽  
Inadequate Response ◽  
Double Blind ◽  
Topical Corticosteroids ◽  
Phase Ii Studies

<b>Background:</b> Tralokinumab, a fully human monoclonal antibody, specifically neutralizes interleukin-13, a key cytokine driving peripheral inflammation in atopic dermatitis (AD). In phase II studies, tralokinumab combined with topical corticosteroids provided early and sustained improvements in AD signs and symptoms. <b>Objectives:</b> To evaluate the efficacy and safety of tralokinumab monotherapy in adults with moderate-to-severe AD who had an inadequate response to topical treatments. <b>Methods:</b> In two 52-week, randomized, double-blind, placebo-controlled, phase III trials, ECZTRA 1 and ECZTRA 2, adults with moderate-to-severe AD were randomized (3 : 1) to subcutaneous tralokinumab 300 mg every 2 weeks (Q2W) or placebo. Primary endpoints were Investigator’s Global Assessment (IGA) score of 0 or 1 at week 16 and ≥ 75% improvement in Eczema Area and Severity Index (EASI 75) at week 16. Patients achieving an IGA score of 0 or 1 and/or EASI 75 with tralokinumab at week 16 were rerandomized to tralokinumab Q2W or every 4 weeks or placebo, for 36 weeks. The trials were registered with ClinicalTrials.gov: NCT03131648 and NCT03160885. <b>Results:</b> At week 16, more patients who received tralokinumab vs. placebo achieved an IGA score of 0 or 1: 15·8% vs. 7·1% in ECZTRA 1 [difference 8·6%, 95% confidence interval (CI) 4·1–13·1; P = 0·002] and 22·2% vs. 10·9% in ECZTRA 2 (11·1%, 95% CI 5·8–16·4; P &#x3c; 0·001) and EASI 75: 25·0% vs. 12·7% (12·1%, 95% CI 6·5–17·7; P &#x3c; 0·001) and 33·2% vs. 11·4% (21·6%, 95% CI 15·8–27·3; P &#x3c; 0·001). Early improvements in pruritus, sleep interference, Dermatology Life Quality Index, SCORing Atopic Dermatitis and Patient-Oriented Eczema Measure were observed from the first postbaseline measurements. The majority of week 16 tralokinumab responders maintained response at week 52 with continued tralokinumab treatment without any rescue medication (including topical corticosteroids). Adverse events were reported in 76·4% and 61·5% of patients receiving tralokinumab in ECZTRA 1 and ECZTRA 2, respectively, and in 77·0% and 66·0% of patients receiving placebo in ECZTRA 1 and ECZTRA 2, respectively, in the 16-week initial period. <b>Conclusions:</b> Tralokinumab monotherapy was superior to placebo at 16 weeks of treatment and was well tolerated up to 52 weeks of treatment.

scholarly journals External therapy of allergic dermatoses in children (literature review)

2020 ◽  
pp. 41-47
Author(s):  
O.M. Mochulska ◽  
Keyword(s):  
Clinical Course ◽  
Life Quality ◽  
Allergic Inflammation ◽  
Local Therapy ◽  
Calcineurin Inhibitors ◽  
Allergic Diseases ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Topical Calcineurin Inhibitors ◽  
Allergic Skin

Allergic dermatoses have a special place in the structure of allergic diseases in children due to their weight. The most common allergic skin lesions: simple and allergic contact dermatitis, atopic dermatitis, various forms of eczema, acute and chronic allergic urticaria, Quincke's edema, multiforme exudative erythema (Stevens—Johnson syndrome), acute epidermal necrolysis (Lyell's syndrome), toxicodermias, as well as less common dermatoses, in the pathogenesis of which are leading allergic reactions. Despite a number of research research, the difficulties in the determining of the therapeutic approach of allergic dermatoses in children are still observed. According to the international program documents EAACI (European Academy of Allergy and Clinical Immunology), AAAAI (American Academy of Allergy, Asthma & Immunology), PRACТALL (Practical Allergology Consensus Report) in treatment of allergic dermatoses the leading place takes external therapy, which requires an individual approach and daily care of skin. External therapy consists of local application of emollients, topical glucocorticosteroids, topical calcineurin inhibitors, topical antihistamines, keratolytic, keratoplastic, reparants, epithelializing and anti-inflammatory medications, in the case of complicated clinical course of the disease — antibacterial, antifungal, antiviral medications, also with skin care. Purpose — to increase information on modern possibilities of external therapy of allergic dermatoses in children. External pharmacotherapy of allergic dermatoses should be etiopathogenetic and should affect on the mechanisms of allergic inflammation in the skin, elimination of itching, dryness,so finding ways to improve it will help to control the clinical course of the disease, to reduce disability, will promote to improve the life quality in patients. No conflict of interest was declared by the author. Key words: children, allergy, allergic dermatoses, external therapy, local therapy.

scholarly journals Severe аtopic dermatitis: problems in care

2012 ◽  
Vol 9 (4) ◽  
pp. 33-38
Author(s):  
E S Fedenko ◽  
O G Elisyutina ◽  
O V Shtyrbul
Keyword(s):  
Atopic Dermatitis ◽  
Topical Therapy ◽  
Calcineurin Inhibitors ◽  
Intravenous Immunoglobulins ◽  
Difficult Problem ◽  
Severe Atopic Dermatitis ◽  
Complex Treatment ◽  
Topical Calcineurin Inhibitors ◽  
Long Time ◽  
And Control

In this article problems in care of severe atopic dermatitis (AD) are considered. The main medications for AD treatment are topical corticosteroids, topical calcineurin inhibitors and emollients. In spite of adequate topical therapy the disease often gets a severe recurrent course with frequent exacerbations. In such cases treatment is considered to be a difficult problem and quite often it is necessary to use systemic preparations: corticosteroids, immunosupressors, cytostatics. They are able to reduce and control exacerbations fast and effectively, but because of side effects these preparations shouldn’t be applied for a long time. Considering increase of severe AD cases, now great attention is given to immunotherapy. In the article the retrospective analysis of data about 56 severe AD patients who underwent a course of complex treatment including plasmapheresis and intravenous immunoglobulins is presented.

Skin care in children with atopic dermatitis

2021 ◽  
Vol 16 (3) ◽  
pp. 134-140
Author(s):  
O.V. Goncharova ◽  
◽  
O.A. Komissarova ◽  
D.B. Kameldenova ◽  
L.A. Baryshnikova ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Normal Skin ◽  
Clinical Manifestations ◽  
Life Quality ◽  
Coconut Oil ◽  
Skin Lesions ◽  
Skin Care ◽  
Peloid Therapy ◽  
Unique Composition

In this article, we described specific features of baby skin and care for it (washing baby's face, bottom; cleaning ears, nose, and eyes; baby's bathing). We also assessed the efficacy of cream-balm ‘Tamba-PS’ (‘Adonis’ LLC, Russia) for the treatment of atopic dermatitis. ‘Tamba-PS’ contains only natural ingredients, including oil extract of native peloids from Lake Tambukan, plant extracts and essential oils, propolis, mumiyo, beeswax, honey, olive oil, sea buckthorn oil, coconut oil, and lecithin. We demonstrated its efficacy in infants and children aged 3 months to 3 years with both focal skin lesions and advanced lesions. Treatment improved children's quality of life, which was evaluated using the Dermatology Life Quality Index (DLQI) for children (from 22.8 ± 3.1 to 10.1 ± 2.0, р < 0.01); ‘socialization’ (according to the ‘KID-questionnaire,’ p ≤ 0.05) and the dynamics of clinical manifestations according to the SCORAD index (from 33.1 ± 2.9 to 14.2 ± 1.8 after therapy, p < 0.01). The unique composition of ‘Tamba-PS’ allows its daily use for problematic, irritated skin of children, as well as to protect normal skin from adverse effects, and as the external therapy for atopic dermatitis (the minimum course is 2 weeks (twice a day); the courses can be repeated if necessary). Key words: atopic dermatitis, Lake Tambukan mud, peloid therapy, skin care

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