Atopic Dermatitis


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Conventional and Natural Approaches to Treating Atopic Dermatitis

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Atopic Dermatitis

  1. 1. NMR News: Volume 3, Issue 1, January 2010 Conventional & Natural Approaches to Treating Atopic Dermatitis Conventional & Natural Approaches to Treating Atopic Dermatitis By: Charles Spielholz, Ph.D. A topic dermatitis (also called atopic eczema) is a chronic, inflammatory skin condition. The skin is easily irritated, generally dry, and becomes itchy. Patients often scratch in an attempt to alleviate the itch. Unfortunately scratching often causes physical damage to the skin; resulting open skin wounds are then subject to infection which further complicates atopic dermatitis. Atopic dermatitis is not life threatening, but is very uncomfortable and, in some cases, can cause patients to be sensitive about their looks (1). It should be noted, however, that rare case studies relating atopic dermatitis to more serious conditions (2,3). Available evidence strongly indicates that atopic dermatitis is an inherited condition involving the immune system and allergy (4,6). Although there is no cure for atopic dermatitis, there are approaches to treat the symptoms which may alleviate the condition. One course of treatment involves agents that decrease the immune response such as antihistamines (6) and steroids (6). However, if the skin becomes broken and infected, steroids are counter-indicated and antibiotics may be needed (6). Before steroids are used or if the skin has become broken and infected, the advice of a physician should be obtained. In some cases, lotions containing coal tars (7,8) or approaches using UV light (9) have been used to treat atopic dermatitis even though 1 © Copyright 2010. All Rights Reserved.
  2. 2. NMR News: Volume 3, Issue 1, January 2010 Conventional & Natural Approaches to Treating Atopic Dermatitis there is concern among some that these agents may have unwanted side effects (7,10). In severe cases, the immunosuppressive drugs, tacrolimus and pimercrolimus, can be used topically (11). However, if the patient recognizes an attack of atopic dermatitis early in its course, and there are no complicating factors, it may be possible to alleviate the symptoms and avoid complications that would require treatment with steroids, antibiotics. One avenue of treatment of atopic dermatitis is prevention. Prevention involves identifying and avoiding the elements in a patient's environment that actually trigger an attack of atopic dermatitis (11,12). Such triggering elements can include food as well as agents that come in contact with the skin. This approach requires careful observation of the patient’s daily routines although there are also skin tests that can be performed by a health care provider. For foods that cause atopic dermatitis, there are health food products available that do not contain common allergens. Such allergens include, but are not limited to, dairy products, nuts, peanuts, certain fruits, wheat and tomatoes. Agents that come in direct contact with the skin and trigger an attack of atopic dermatitis include clothing, jewelry, soaps, laundry detergents, anti-static agents, perfumes, antiperspirants, dust, plants and insects. Avoidance of scratching is a very important way to control atopic dermatitis although the response to scratch seems to be very strong (13). Scratching is very problematic in children; relieving the dry and itchy symptoms is very helpful in preventing skin infections in children 2 © Copyright 2010. All Rights Reserved.
  3. 3. NMR News: Volume 3, Issue 1, January 2010 Conventional & Natural Approaches to Treating Atopic Dermatitis (14). Scratching not only has the potential of breaking open the skin and making it prone to infection (15), but also causes the patient to enter a scratch-itch cycle (16,17). Scratching further increases the inflammation associated with atopic dermatitis which results in further increases in itching. This causes the patient to scratch even more and to enter an ever increasing scratch-itch cycle. Other approaches to treating atopic dermatitis, especially in the early stages, involve moisturizing the dry skin (18,19) and attempting to control inflammation (20,21). Alleviating these two Figure 1: Glycerol is a non-toxic, colorless, viscous liquid and a component of many lipids (fats). It is hygroscopic making it excellent for conditions will decrease the itch and attenuate the holding water. It also makes an excellent lubricant. It is used in soaps and lotions. atopic dermatitis before it becomes serious. Moisturizers are designed to add water back to the skin and to coat the skin with an oil based material that can then hold moisture in. Products used for this purpose may contain ingredients that include glycerol (Figure 1) (22), vitamin E (Figure 2) (23), Figure 2: Vitamin E is a fat soluble vitamin and a well known antioxidant. oils from the evening primrose (Figure 3) (24) as well as other sources (25). In addition, many moisturizers may contain urea (Figure 4) (26,27) or 3 © Copyright 2010. All Rights Reserved.
  4. 4. NMR News: Volume 3, Issue 1, January 2010 Conventional & Natural Approaches to Treating Atopic Dermatitis another molecule that is hygroscopic; that is a molecule which attracts and holds water. Hyaluronic acid (Figure 5) (28,29) and ceramide (Figure 6) (30) are also used in many moisturizers. Interestingly, there is some evidence that Figure 3: The Evening Primrose, of the genus Oenothera, is a flowering plane native to the Hyaluronic acid may have anti-allergenic properties New World. It is often used as an ornamental plant. Its oil is sometimes used in skin lotions and creams. (29); however these observations require further investigation before any solid conclusions can be drawn. It must be clearly pointed out, however, that research in this area is incomplete. Well controlled clinical trials have not been completed (25). Figure 4: The chemical structure of urea. However, if the skin is not broken and the condition is known to be atopic dermatitis without any complications, then approaches of using moisturizing agents in an attempt to relieve the dry skin can used. It is sometimes useful to bath the affected skin area with warm water prior to adding Figure 5: Hyaluronic acid (also known as hyaluronan or hyaluronate) is a mucopolysaccharide. This figure shows one of the many repeating disaccharide units the moisturizer. Combined with avoiding the of hyaluronic acid. It is found in connective, epithelial and neural tissue. It increases the viscosity of biological fluids found in certain joints. The substances that cause the atopic dermatitis, hyaluronic acid in synovial fluid helps lubricate joints and keeps them moving smoothly. moisturizers may be a good way to avoid treatments 4 © Copyright 2010. All Rights Reserved.
  5. 5. NMR News: Volume 3, Issue 1, January 2010 Conventional & Natural Approaches to Treating Atopic Dermatitis with compounds that have side effects that may be problematic for some people. Some herbs appear to have anti- Figure 6a inflammatory properties and early research is currently under way on a number of such herbs (31- 33). For example, the bark of the Asian White Birch Tree, Betula playphylla (Figure 7) (33) is used Figure 6b traditionally in the treatment of skin inflammation. Figures 6a & 6b: Ceremide is a lipid (fat) molecule. Ceremide functions as a structural element of cell membranes and is also involved Extracts of the bark of this tree have been shown to in signaling for differentiation, development, cell division and even the death of cells. decrease inflammation of skin in a mouse model. There was a decrease in the scratching behavior of the mice treated with the extract. A preliminary conclusion from that work suggested that the extract may be exerting its effect by inhibiting cells of the immune system. However, at this other herbs have any bona fide positive effect on inflammation associated with atopic dermatitis. Figure 7: Betula platyphylla is a species of Birch Tree. 5 © Copyright 2010. All Rights Reserved.
  6. 6. NMR News: Volume 3, Issue 1, January 2010 Conventional & Natural Approaches to Treating Atopic Dermatitis References 1) Alberts, Bray, Lewis, Raff, Roberts, Watson. Molecular Biology of the Cell. 2nd Edition. 2) Kitamura S, Nakayama Y, Shirai Y, Hashiguchi H, Kim R. (2000) Septic arthritis of the hip associated with atopic dermatitis. A case report. J Nippon Med Sch 67:464-7. 3) Onoda K, Mizutan H, Komada T, Kanemitsu S, Shimono T, Shimpo H, Yada I. (2000) Atopic dermatitis as a risk factor for acute native valve endocarditis. J Heart Valve Dis. 9:469-71. 4) Incorvaia C, Frati F, Verna N, D'Alò S, Motolese A, Pucci S. (2008) Allergy and the skin. Clin Exp Immunol. 153 Suppl 1:27-9. 5) Werfel T. (2009) The role of leukocytes, keratinocytes, and allergen-specific IgE in the development of atopic dermatitis. J Invest Dermatol. 129:1878-91. 6) Hardman, Limbirach, Molinoff, Ruddon, Gilma. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 9th Edition. 7) Schmid MH, Korting HC. (1996) Coal tar, pine tar and sulfonated shale oil preparations: comparative activity, efficacy and safety. Dermatology 193:1-5. 8) Paghdal KV, Schwartz RA. (2009) Topical tar: back to the future. J Am Acad Dermatol. 61:294-302. 9) Gambichler T. (2009) Management of atopic dermatitis using photo(chemo)therapy. Arch Dermatol Res.301:197-203. 10) Maverakis E, Miyamura Y, Bowen MP, Correa G, Ono Y, Goodarzi H. (2009) Light, including ultraviolet. J Autoimmun. 2009 Dec 15. 11) Leung AK, Barber KA. (2003) Managing childhood atopic dermatitis. Adv Ther. 20:129-37 12) Nicol NH, Boguniewicz M. (2008) Successful strategies in atopic dermatitis management. Dermatol Nurs. 2008 Oct;Suppl:3-18 13) Evers AW, Duller P, de Jong EM, Otero ME, Verhaak CM, van der Valk PG, van de Kerkhof PC, Kraaimaat FW. (2009) Effectiveness of a multidisciplinary itch-coping training programme in adults with atopic dermatitis. Acta Derm Venereol. 89:57-63. 14) Alvarenga TM, Caldeira AP. (2009) Quality of life in pediatric patients with atopic dermatitis. J Pediatr (Rio J). 85:415-20. 15) Kiken DA, Silverberg NB. (2006) Atopic dermatitis in children, part 1: epidemiology, clinical features, and complications. Cutis. 78:241-7. 16) Kiken DA, Silverberg NB. (2006) Atopic dermatitis in children, part 2: treatment options. Cutis. 78:401-6. 17) Yosipovitch G, Papoiu AD. (2008) What causes itch in atopic dermatitis? Curr Allergy Asthma Rep. 8:306-11. 18) Chiang C, Eichenfield LF. (2009) Quantitative assessment of combination bathing and moisturizing regimens on skin hydration in atopic dermatitis. Pediatr Dermatol. 26:273-8. 6 © Copyright 2010. All Rights Reserved.
  7. 7. NMR News: Volume 3, Issue 1, January 2010 Conventional & Natural Approaches to Treating Atopic Dermatitis 19) Wirén K, Nohlgård C, Nyberg F, Holm L, Svensson M, Johannesson A, Wallberg P, Berne B, Edlund F, Lodén M. (2009) Treatment with a barrier-strengthening moisturizing cream delays relapse of atopic dermatitis: a prospective and randomized controlled clinical trial. J Eur Acad Dermatol Venereol. 23:1267-72. 20) Ikoma A. (2009) Analysis of the mechanism for the development of allergic skin inflammation and the application for its treatment: mechanisms and management of itch in atopic dermatitis. J Pharmacol Sci. 110:265-9. 21) Komine M. (2009) Analysis of the mechanism for the development of allergic skin inflammation and the application for its treatment:keratinocytes in atopic dermatitis - their pathogenic involvement. J Pharmacol Sci.110:260-4. 22) Fluhr JW, Darlenski R, Surber C. (2008) Glycerol and the skin: holistic approach to its origin and functions. Br J Dermatol. 159:23-34. 23) Thiele JJ, Ekanayake-Mudiyanselage S. (2007) Vitamin E in human skin: organ-specific physiology and considerations for its use in dermatology. Mol Aspects Med. 28:646-67. 24) Morse NL, Clough PM. (2006) A meta-analysis of randomized, placebo-controlled clinical trials of Efamol evening primrose oil in atopic eczema. Where do we go from here in light of more recent discoveries? Curr Pharm Biotechnol. 7:503-24. 25) Hoare C, Li Wan Po A, Williams H. (2000) Systematic review of treatments for atopic eczema. Health Technol Assess. 41-191. 26) Fredriksson T, Gip L. (1975) Urea creams in the treatment of dry skin and hand dermatitis. Int J Dermatol. 14:442-4. 27) Amichai B, Grunwald MH. (2009) A randomized, double-blind, placebo-controlled study to evaluate the efficacy in AD of liquid soap containing 12% ammonium lactate + 20% urea. Clin Exp Dermatol. 34:e602-4. 28) Veraldi S, De Micheli P, Schianchi R, Lunardon L. (2009) Treatment of pruritus in mild-to-moderate atopic dermatitis with a topical non-steroidal agent. J Drugs Dermatol. 8:537-9. 29) Kim Y, Lee YS, Hahn JH, Choe J, Kwon HJ, Ro JY, Jeoung D. (2008) Hyaluronic acid targets CD44 and inhibits FcepsilonRI signaling involving PKCdelta, Rac1, ROS, and MAPK to exert anti-allergic effect. Mol Immunol. 45:2537- 47. 30) Na JI, Hwang JS, Park HJ, Kim DH, Park WS, Youn SW, Huh CH, Park KC. (2009) A new moisturizer containing physiologic lipid granules alleviates atopic dermatitis. J Dermatolog Treat. 1:1-5. 31) Mainardi T, Kapoor S, Bielory L. (2009) Complementary and alternative medicine: herbs, phytochemicals and vitamins and their immunologic effects. J Allergy Clin Immunol. 123:283-94 32) Chan BC, Hon KL, Leung PC, Sam SW, Fung KP, Lee MY, Lau HY. (2008) Traditional Chinese medicine for atopic eczema: PentaHerbs formula suppresses inflammatory mediators release from mast cells. J Ethnopharmacol. 120:85-91. 33) Kim EC, Lee HS, Kim SK, Choi MS, Lee S, Han JB, An HJ, Um JY, Kim HM, Lee NY, Bae H, Min BI. (2007) The bark of Betula platyphylla var. japonica inhibits the development of atopic dermatitis-like skin lesions in NC/Nga mice. J Ethnopharmacol. 116:270-8. 7 © Copyright 2010. All Rights Reserved.