Atopic dermatitis: advancement and problems in understanding the essence of the disease and its treatment

The review represents the analysis of modern data on the pathogenesis and methods of treatment of atopic dermatitis (AtD). The literature search was carried out using the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, e-library databases. AtD is one of the most common skin diseases, aff ecting about 20% of children and 5% of adults in advanced countries. The disease is multifactorial by its etiology. Among the genetic factors, the main attention is paid to the mutation of the gene encoding the synthesis of fi laggrin-protein involved in the functioning of the skin barrier. The role of cytokines regulating the synthesis of IgE — interleukins (IL) -4, -5, -12, -13, -31 is studied in the genesis of immune disorders in AtD. Steady-state stress accompanying pruritic dermatitis contributes to the development of anxiodepressive сonditions degrades quality of life, and stress-related increase of cortisol level may be essential in impairing the barrier function of the skin. Among the new approaches to the treatment of patients with AtD, the possibilities of using Selank, which represents the group of regulatory peptides and narrow-band phototherapy of the 311 nm range, are discussed.

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PSYCHOSOCIAL IMPACT OF COMMON SKIN DISORDERS – A REVIEW STUDY

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj2009072021 ◽

2021 ◽

Vol 9 (7) ◽

pp. 1452-1456

Author(s):

Manish Choudhari ◽

Nikita Jamadari ◽

Naresh Jain

Keyword(s):

Quality Of Life ◽

Atopic Dermatitis ◽

Skin Disease ◽

Skin Diseases ◽

Fungal Infections ◽

Acne Vulgaris ◽

Well Being ◽

Psychosocial Impact ◽

Common Skin

Objective - To increase awareness of the psychosocial impact of Kushtha, Visarpa, Mukhadushika, Sheetpitta, Udarda and Kotha in Ayurveda and Acne vulgaris, Urticaria, Various types of fungal infections, Atopic dermatitis, Psoriasis etc. in modern point of view. Quality Of Evidence - A literature review was based on a MEDLINE search (1966 to 2000). Selected articles from the dermatologic and psychiatric literature, as well as other relevant medical journals, were reviewed and used as the basis for discussion of how skin disease affects patients’ lives and of appropriate management. Message - Dermatologic problems hurt patients’ quality of life. skin disease can produce stress, anxiety, anger, depression, low self-esteem, embarrassment, and other psychological, personal, professional and social life problems that affect patients’ lives in ways comparable to arthritis or other disabling illnesses, as well as showing a bidirectional relationship between skin disease and psychological distress. This review focuses on the effects of five common skin diseases seen by family physicians- Acne, Urticaria, Various types of fungal infections, Atopic dermatitis and Psoriasis. Conclusion - How skin disease affects psychosocial well-being is un- derappreciated. Increased understanding of the psychiatric comorbidity associated with skin disease and a biopsy- chosocial approach to management will ultimately improve patients’ lives. Keywords: Skin disease, Psychosocial Impact, Quality of life.

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Interventions for Alleviating Cancer-Related Dyspnea: A Systematic Review

Journal of Clinical Oncology ◽

10.1200/jco.2007.15.5796 ◽

2008 ◽

Vol 26 (14) ◽

pp. 2396-2404 ◽

Cited By ~ 113

Author(s):

Irit Ben-Aharon ◽

Anat Gafter-Gvili ◽

Mical Paul ◽

Leonard Leibovici ◽

Salomon M. Stemmer

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Supplemental Oxygen ◽

Cochrane Library ◽

Analog Scale ◽

Terminally Ill Cancer Patients ◽

Randomized Controlled ◽

The Cochrane Library

Purpose Dyspnea is one of the most distressing symptoms experienced by terminally ill cancer patients. This study aimed to evaluate the role of interventions for the palliation of dyspnea. Methods We conducted a systematic review of randomized controlled trials assessing all pharmacologic and nonpharmacologic interventions for dyspnea palliation in cancer patients, and searched the Cochrane Library, MEDLINE, conference proceedings, and references. Two reviewers independently appraised the quality of trials and extracted data. Results Our search yielded 18 trials. Fourteen evaluated pharmacologic interventions: seven assessing opioids (a total of 256 patients), five assessing oxygen (137 patients), one assessing helium-enriched air, and one assessing furosemide. Four trials evaluated nonpharmacologic interventions (403 patients). The administration of subcutaneous morphine resulted in a significant reduction in dyspnea Visual Analog Scale (VAS) compared with placebo. No difference was observed in dyspnea VAS score when nebulized morphine was compared with subcutaneous morphine, although patients preferred the nebulized route. The addition of benzodiazepines to morphine was significantly more effective than morphine alone, without additional adverse effects. Oxygen was not superior to air for alleviating dyspnea, except for patients with hypoxemia. Nursing-led interventions improved breathlessness. Acupuncture was not beneficial. Conclusion Our review supports the use of opioids for dyspnea relief in cancer patients. The use of supplemental oxygen to alleviate dyspnea can be recommended only in patients with hypoxemia. Nursing-led nonpharmacologic interventions seem valuable. Only a few studies addressing this question were performed. Thus, further studies evaluating interventions for alleviating dyspnea are warranted.

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Pruritus and Atopic Dermatitis: from Etiological Features to Management

Вопросы современной педиатрии ◽

10.15690/vsp.v19i6.2151 ◽

2020 ◽

Vol 19 (6) ◽

pp. 468-476

Author(s):

Nikolay N. Murashkin ◽

Leonid A. Opryatin ◽

Roman V. Epishev ◽

Alexander I. Materikin ◽

Eduard T. Ambarchian ◽

...

Keyword(s):

Quality Of Life ◽

Atopic Dermatitis ◽

Immune System ◽

Clinical Studies ◽

Clinical Manifestations ◽

Skin Barrier ◽

Current Data ◽

Scientific Images

Pruritus is one of the main clinical manifestations of atopic dermatitis, and it significantly reduces the quality of life of patients in childhood. Scientific images on its pathophysiological basis have now undergone significant changes. The histamine exceptional role in pruritus development was confounded, as well as data on immune system involvement in its maintenance was given. This article presents current data on differential approaches to pruritus management depending on its etiopathogenetic characteristics. The role of dermocosmetics in restoration of the skin barrier as the first stage prevention of pruritus in atopic dermatitis was considered. The results of clinical studies showing efficacy of topical agents (innovative component with anti-pruritic action — STIMU-TEX) application are presented.

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Oxidative Stress in Atopic Dermatitis

Oxidative Medicine and Cellular Longevity ◽

10.1155/2016/2721469 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 53

Author(s):

Hongxiu Ji ◽

Xiao-Kang Li

Keyword(s):

Oxidative Stress ◽

Atopic Dermatitis ◽

Skin Diseases ◽

Treatment Strategies ◽

Scientific Progress ◽

Skin Barrier ◽

Skin Aging ◽

Barrier Defect ◽

Pruritic Skin

Atopic dermatitis (AD) is a chronic pruritic skin disorder affecting many people especially young children. It is a disease caused by the combination of genetic predisposition, immune dysregulation, and skin barrier defect. In recent years, emerging evidence suggests oxidative stress may play an important role in many skin diseases and skin aging, possibly including AD. In this review, we give an update on scientific progress linking oxidative stress to AD and discuss future treatment strategies for better disease control and improved quality of life for AD patients.

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Appraising the Accuracy of Ischaemia-Modified Albumin in Diagnosing Stroke: A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000514382 ◽

2021 ◽

pp. 1-6

Author(s):

Wenhua Shi ◽

Guanghua Tang ◽

Xianshi Zhou ◽

Ye Ye

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Meta Analysis ◽

Characteristic Curve ◽

Diagnostic Odds Ratio ◽

Cochrane Library ◽

Meta Regression ◽

The Cochrane Library

Introduction: Ischaemia-modified albumin (IMA) is a new, sensitive marker of ischaemic diseases that has been approved for diagnosing myocardial ischaemia. However, the accuracy of IMA in the diagnosis of stroke remains to be clarified. The study’s purpose is to assess the potential role of IMA as a diagnostic indicator in stroke. Methods: We carried out a systematic search in Medline, the Cochrane Library, Embase, Scopus, Science Direct, ISI Web of Knowledge, and the reference lists of relevant articles from the databases’ inception to September 1, 2019. Studies that appraised the diagnostic accuracy of IMA for acute stroke patients were included in our study. Two reviewers extracted data independently and assessed the quality of the retrieved studies, and disagreements were resolved through discussions with a third reviewer. Sensitivities and specificities were pooled by using bivariate diagnostic meta-analysis. We calculated I2 to test the heterogeneity and used meta-regression to identify potential sources of heterogeneity. This systematic review and meta-analysis is registered in international prospective register of systematic reviews (number CRD42020149174). Results: Six studies with 605 patients were eligible for inclusion. Our meta-analysis produced the following outcomes: the mean sensitivity of IMA in diagnosing acute stroke was 0.80 (95% confidence interval [CI], 0.69–0.88) and the specificity was 0.80 (95% CI, 0.71–0.87). The area under the receiver operating characteristic curve was 0.86 (95% CI, 0.83–0.89), and the pooled diagnostic odds ratio was 16 (95% CI, 8–33). There was obvious heterogeneity between studies (I2 = 78%, 95% CI, 53–100). Sensitivity analysis and meta-regression could account for the heterogeneity. Conclusion: IMA is a helpful marker for consideration in the early diagnosis of stroke.

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A Meta-Analysis of Adalimumab for Fistula in Crohn’s Disease

Gastroenterology Research and Practice ◽

10.1155/2017/1745692 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yin-mei Fu ◽

Ming Chen ◽

Ai-jun Liao

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Therapeutic Value ◽

The Cochrane Library

Purpose. This study aimed to evaluate the therapeutic value of adalimumab (ADA) for fistula in Crohn’s disease (CD). Methods. A computerized search of electronic databases, including PubMed, Web of Science, Embase, Google scholar, and the Cochrane Library from 2000 to October 2016, was performed. Randomized controlled trials (rcts) or nonrandomized controlled trials (n-rcts) were included in this article to evaluate the role of ADA in the management of fistula in CD. The methodological index for nonrandomized studies (MINORS evaluation tools) was used to assess the quality of every study. Result. Overall, seven studies and 379 patients comforted to the inclusion criteria of this meta-analysis. The result showed that 36% (95% CI: 0.31–0.41) of patients with complete fistula closure and 31% (95% CI: 0.031–0.61) of patients with partial response were received in CD with ADA treatment. Conclusion. We concluded that ADA is effective and safe for the treatment of fistula in CD according to current evidence.

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Skin barrier: structure and immune changes in common skin diseases

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja549 ◽

2014 ◽

Vol 11 (2) ◽

pp. 83-89

Author(s):

Marius-Anton Anton Ionescu

Keyword(s):

Atopic Dermatitis ◽

Immune System ◽

Human Skin ◽

Skin Diseases ◽

Complex Structure ◽

Skin Barrier ◽

In Vivo Studies ◽

Toll Like Receptors ◽

Physical Barrier ◽

Common Skin

Skin barrier must be seen as a complex structure with complex functions involving hydrolipidic film, stratum corneum, the intercellular cement and also immunologic barrier as innate adaptive immune system (as Toll Like Receptors - TLR), complement, dendritic cells and antigen-related responses. Skin barrier changes are seen in different skin diseases as atopic dermatitis, rosacea , contact dermatitis and others. In the first part of this article we describe skin physical barrier and its key elements roles (ceramides, filaggrin, tight junctions and claudins), the clinical consequences of barrier damages in different common skin diseases (atopic dermatitis, xeroses of different origins). Immune skin barrier is complex and in this first part of the article we focus only on innate immune system skin represented by Toll Like Receptors and their role in the synthesis of antimicrobial peptides (AMP). In the second part we present ex vivo and in vivo studies on skin physical barrier repair and improvement of AMP expression in human skin by modulating TLR2. The management of human skin barrier damages and their repair by active topicals must by a holistic approach, taking in account the complexity of physical and of immune barriers of the skin.

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AI-based localization and classification of skin disease with erythema

Scientific Reports ◽

10.1038/s41598-021-84593-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ha Min Son ◽

Wooho Jeon ◽

Jinhyun Kim ◽

Chan Yeong Heo ◽

Hye Jin Yoon ◽

...

Keyword(s):

Neural Network ◽

Skin Diseases ◽

Classification Model ◽

Screening Tests ◽

Sensitivity Score ◽

Common Skin ◽

Novel Method ◽

Improved Performance ◽

High Level

AbstractAlthough computer-aided diagnosis (CAD) is used to improve the quality of diagnosis in various medical fields such as mammography and colonography, it is not used in dermatology, where noninvasive screening tests are performed only with the naked eye, and avoidable inaccuracies may exist. This study shows that CAD may also be a viable option in dermatology by presenting a novel method to sequentially combine accurate segmentation and classification models. Given an image of the skin, we decompose the image to normalize and extract high-level features. Using a neural network-based segmentation model to create a segmented map of the image, we then cluster sections of abnormal skin and pass this information to a classification model. We classify each cluster into different common skin diseases using another neural network model. Our segmentation model achieves better performance compared to previous studies, and also achieves a near-perfect sensitivity score in unfavorable conditions. Our classification model is more accurate than a baseline model trained without segmentation, while also being able to classify multiple diseases within a single image. This improved performance may be sufficient to use CAD in the field of dermatology.

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Lumbar Roll Usage While Sitting Reduces the Forward Head Posture in Healthy Individuals: A Systematic Review with Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105171 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5171

Author(s):

Yusuke Handa ◽

Kenya Okada ◽

Hiroshi Takasaki

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grade System ◽

Cochrane Library ◽

Forward Head Posture ◽

Quality Of Evidence ◽

Head Posture ◽

Head Extension ◽

The Cochrane Library

This systematic review and meta-analysis investigated whether the use of a lumbar roll reduced forward head posture (FHP) while sitting among individuals with or without musculoskeletal disorders. EMBASE, MEDLINE, and the Cochrane Library were systematically searched from their inception to August 2020. The quality of evidence for variables used in the meta-analysis was determined using the GRADE system. Five studies satisfied the criteria for data analysis. All studies included individuals without any spinal symptoms. Data from five studies on neck angle showed a statistically significant (p = 0.02) overall effect (standardized mean difference (SMD) = 0.77), indicating a lesser neck flexion angle while sitting with a lumbar roll than without it. Data from two studies on head angle showed a statistically significant (p = 0.04) overall effect (SMD = 0.47), indicating a lesser head extension angle while sitting with a lumbar roll than without it. In each meta-analysis, the quality of evidence was very low in the GRADE system. The use of a lumbar roll while sitting reduced FHP among individuals without spinal symptoms.

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The Implications of Pruritogens in the Pathogenesis of Atopic Dermatitis

International Journal of Molecular Sciences ◽

10.3390/ijms22137227 ◽

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.

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