This document provides information on atopic dermatitis (AD), including its definition, epidemiology, pathogenesis, clinical features, complications, diagnosis, and differential diagnosis. AD is defined as an itchy, chronic inflammatory skin condition with a flexural distribution and early age of onset. Genetic and environmental factors contribute to skin barrier dysfunction and immune dysregulation underlying AD. Clinical features vary by age but commonly include dry skin, rashes, and skin thickening/lichenification due to scratching. Secondary infections can occur. Diagnosis is based on characteristic features and history. Differential diagnoses include other eczemas and psoriasis.
Summary of updated information about the disease of Atopic dermatitis, aetiology, immunopathogenesis, main clinical features and dianostic criteria, concepts of managemnt of Atopic dermatitis including newest treatment trends.
hanifin and rajka criteria, entymology, definition of AD, atopy, etiopathogenesis of AD, genetics in AD, filaggrin, epidermal barrier dysfunction, atopic march, hygiene hypothesis, infantile phase of AD, childhood phase of AD, adult phase of AD, pityriasis alba, denne morgan folds, dirty neck appearence, nipple dermatitis, hanifin and rajka criteria, UK refinement of hanifin and rajka criteria, millenium criteria of AD, japanese dermatological association criteria, management of AD, wet wrap therapy,
Summary of updated information about the disease of Atopic dermatitis, aetiology, immunopathogenesis, main clinical features and dianostic criteria, concepts of managemnt of Atopic dermatitis including newest treatment trends.
hanifin and rajka criteria, entymology, definition of AD, atopy, etiopathogenesis of AD, genetics in AD, filaggrin, epidermal barrier dysfunction, atopic march, hygiene hypothesis, infantile phase of AD, childhood phase of AD, adult phase of AD, pityriasis alba, denne morgan folds, dirty neck appearence, nipple dermatitis, hanifin and rajka criteria, UK refinement of hanifin and rajka criteria, millenium criteria of AD, japanese dermatological association criteria, management of AD, wet wrap therapy,
INTRODUCTION OF PSORIASIS, EPIDEMIOLOGY OF PSORIASIS, CLINICAL FEATURES OF PSORIASIS, PROGNOSIS OF PSORIASIS, HISTOPATHOLOGY OF PSORIASIS, TRIGGERING FACTORS OF PSORIASIS, PATHOGENESIS OF PSORIASIS
INTRODUCTION OF PSORIASIS, EPIDEMIOLOGY OF PSORIASIS, CLINICAL FEATURES OF PSORIASIS, PROGNOSIS OF PSORIASIS, HISTOPATHOLOGY OF PSORIASIS, TRIGGERING FACTORS OF PSORIASIS, PATHOGENESIS OF PSORIASIS
Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin (dermatitis). It results in itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thickens over time. While the condition may occur at any age
Children's skin problems span nearly two decades from birth through adolescence. Several common pediatric skin conditions will be discussed including: diaper dermatitis, atopic dermatitis, warts, and acne.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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3. INTRODUCTION
The word ‘eczema’ comes from the Greek for ‘boiling’ – a reference to
the tiny vesicles (bubbles) that are often seen in the early acute stages
of the disorder, but less often in its later chronic stages.
‘Dermatitis’ means inflammation of the skin and is therefore, strictly
speaking, a broader term than eczema
The terms eczema and dermatitis are used interchangeably, denoting a
polymorphic inflammatory reaction involving the epidermis and dermis
4. Eczema: a working classification
• Exogenous (contact) factors
– Irritant
– Allergic
– Photodermatitis
• Other types of eczema
(endogenous)
– Atopic
– Seborrhoeic
– Discoid (nummular)
– Pompholyx
– Gravitational (venous, stasis)
– Asteatotic
– Neurodermatitis
– Ptyriasis alba
5. ATOPIC DERMATITIS
The word ‘atopy’comes from the Greek (a-topos
meaning ‘without a place’)
It was introduced by Coca and Cooke in 1923 and refers
to the lack of a niche in the medical classifications
then in use for the grouping of asthma, hay fever and
eczema.
6. DEFINITION
Atopic dermatitis is a difficult condition to define
because it lacks a diagnostic test and shows variable
clinical features.
Atopic dermatitis is an (( itchy, chronic, or chronically
relapsing, inflammatory skin condition)).
The rash is characterized by itchy papules (occasionally
vesicles in infants) which become excoriated and
lichenified, and typically have a flexural distribution.
7. EPIDEMIOLOGY
Age of Onset First 2 months of life and by the first years in
60% of patients. 30% are seen for the first time by age 5, and
only 10% develop AD between 6 and 20 years of age. Rarely
AD has an adult onset.
Gender Slightly more common in males than females.
Prevalence Between 7 and 15% reported in population
studies in Scandinavia and Germany, Prevalence of AD has
been increasing since World War II.
9. The inheritance
The inheritance pattern has not
been ascertained. However, in
one series, 60% of adults with AD
had children with AD. The
prevalence in children was higher
(81%)when both parents had AD.
10. ELICITING FACTORS
• Inhalants Specific aeroallergens, especially dust mites
and pollens, have been shown to cause exacerbations
of AD.
• Microbial Agents Exotoxins of Staphylococcus aureus
may act as superantigens and stimulate activation of T
cells and macrophages.
• Autoallergens IgE antibodies directed at human
proteins, release of autoallergens from damaged tissue
trigger IgE or T cell responses, suggesting maintenance
of allergic inflammation by endogenous antigens.
• Foods Subset of infants and children have flares of AD
with eggs, milk, soybeans, fish, and wheat.
11. Exacerbating Factors
• Skin Barrier Disruption: increase transepidermal
water loss by frequent bathing and hand washing
and dehydration
• Infections: S. aureus present in severe cases; rarely
fungus (dermatophytosis, candidiasis).
• Season: AD improves in summer, flares in winter.
• Clothing: Wool is an important trigger; wool
clothing or blankets (also wool clothing of parents)
• Emotional Stress: results from or an exacerbating
factor in flares of the disease.
13. Genetics
The inheritance were recognized early, Higher
risk was associated with maternal rather than
paternal atopy.
The chromosomal regions 3q21 and 5q31 have
been linked to elevated serum IgE levels and AD.
“Loss-of-function” mutations in the gene
encoding filaggrin; underlie ichthyosis vulgaris,
accompanied by AD in half of cases.
14. Skin Barrier Dysfunction
xerosis is hallmarks of AD , which affects lesional and
nonlesional skin areas increasing transepidermal water
loss, favor the penetration of high-molecular-weight
structures such as allergens, bacteria, and viruses.
Several mechanisms have been postulated:
1) decrease in skin ceramides, serving as the major
water-retaining molecules in the extracellular space
2) alterations of the stratum corneum pH
3) overexpression of the chymotryptic enzyme (chymase)
4) defect in Filaggrin
16. 2) Increase number of Th2 ???????
The hygiene hypothesis
Low birth weight
Maternal smoking
Early infection with with respiratory syncytial
virus
Vaccination against Bordetella pertussis
Early allergen contacts.
17.
18.
19. CLINICAL FEATURES
Atopic dermatitis is an itchy, chronic, fluctuating
disease that is slightly more common in boys
than girls, with a range of clinical features.
The age of onset is between 2 and 6 months in
the majority of cases, but it may start at any age,
even before the age of 2 months in some cases.
The distribution of the eruption varies with age.
20. Infantile phase
most frequently start on the face,
but may occur anywhere. Often,
the napkin area spared
The lesions consist of erythema
and discrete or confluent
oedematous papules. The
papules are intensely itchy, and
may become exudative and
crusted as a result of rubbing.
Secondary infection and
lymphadenopathy are common.
21. Childhood phase
The lesions are
papular, lichenified
plaques, erosions,
crusts, especially on
the antecubital and
popliteal, the neck
‘atopic dirty neck’
and face; may be
generalized
22. Adult phase
There is a similar
distribution, mostly
flexural but also face
and neck, with
lichenification and
exoriations being the
most conspicuous
symptoms. May be
generalized.
23.
24. Associated Clinical Features
Pruritus
• the hallmark of AD.
• worse in the evening, by
sweating or wool clothing.
• The rubbing and scratching
exacerbate pathogenic
events >> the dermatitis.
Excoriations
• Scratching & rubbing can
produce lichenified plaques
and prurigo nodularis.
25. Xerosis
cardinal feature of AD (dry,
scaly skin in a generalized
distribution ( beyond areas
of active dermatitis).
Xerosis seen in 80–98% of
AD patients.
Impaired epidermal barrier
function decreased water
content in the stratum
corneum >>> easier entry
of irritants, promotes
pruritus and initiate an
inflammatory response.
26. Keratosis pilaris
• Excessive keratinization
leading to horny plugs
within hair follicle orifices.
• seen primarily on the lateral
aspects of the upper arms
and thighs and the cheeks
in children.
• A small rim of erythema
surrounds the involved hair
follicles.
27. Ichthyosis vulgaris
• Up to 50% of AD
patients have this
autosomal dominant
disorder
• characterized by
excessive scaling, which
spares the flexures
28. Dennie–Morgan lines
• symmetric, prominent fold
(single or double) beneath the
margin of the lower eyelid.
• originates in or near the inner
canthus and extends to one-half
to two-thirds of the lower lid .
• Periorbital edema and
lichenification or darkening
under the eyes (‘allergic shiners’)
may seen.
29. Palmoplantar hyperlinearity
• Increased prominence
of palmar and plantar
creases may be seen in
AD patients, particular
those with associated
ichthyosis vulgaris
30. Pityriasis alba
• Infants and children with
AD may have patches of
hypopigmentation with
fine scale, most commonly
on the face. Such lesions
are more noticeable in
darkly pigmented children
31. Cheilitis
• Dry, crusty, ‘chapped’ lips
or fissuring of the
commisures (angular
cheilitis) is more
common in infants and
children with AD than in
adults
32. Lichenification
• results from repeated
rubbing and scratching
• the skin becomes
thickened and leathery
with exaggerated skin
markings.
• Early dermatologists
called AD an ‘itch that
rashes’, referring to the
cutaneous changes that
result from chronic
rubbing and scratching.
33. Prurigo nodularis
• Multiple intensely
and pruritic nodules
occurring chiefly on
the extremities
(especially the
anterior surfaces of
the thighs and legs)
34. COMPLICATIONS
Secondary infection
with S. aureus
herpes simplex virus
(eczema herpeticum).
Rarely
• keratoconus
• cataracts
• Keratoconjunctivitis
• with secondary
herpetic infection and
corneal ulcers.
36. Essential
features (must
present)
Important
features
(support)
Associated
features
(helpful, less
specific)
37. Essential features (must present)
Pruritus
Eczematous changes
• Typical morphology and age-specific distribution patterns:
• Facial, neck and extensor involvement in infants and
children
• Current or prior flexural lesions in any age group
• Sparing of groin and axillary regions
Chronic or relapsing course
38. Important features (support)
Early age of onset
Personal and/or family history of atopy
(IgE reactivity)
Xerosis
39. Associated features (helpful, less specific)
Keratosis pilaris/ichthyosis vulgaris/palmar hyperlinearity
Atypical vascular responses
Perifollicular accentuation/lichenification/prurigo
Ocular/periorbital changes
Perioral/periauricular lesions
41. In order to qualify as a case of atopic dermatitis
with the UK diagnostic criteria, the child must have:
• An itchy skin
condition (or
parental
report of
scratching or
rubbing in a
child)
• Plus three or more of the
following:
1. Onset below age 2 years
2. History of skin crease
involvement
3. History of a generally dry
skin
4. Personal history of other
atopic disease
5. Visible flexural dermatitis
(or dermatitis of
cheeks/forehead and outer
limbs in children under 4
years)
42. PATHOLOGY
‘Acute’AD. Spongiosis in
the epidermis
producing intra-epidermal
vesicles with
exocytosis of
lymphocytes
‘Chronic’AD. There is
less spongiosis, with
more irregular
epidermal hyperplasia.
48. Primary Prevention
• Allergen avoidance during pregnancy, infancy, or
both. Such investigations have typically focused
on dietary allergens (particularly cow’s milk and
eggs) and dust mites.
• breastfeeding (which is thought to have
immunomodulatory effects) and the reduce
development AD but (especially in a family
history of atopy) to suggestion of a higher risk of
AD with a longer duration of breastfeeding.
49. Supportive Care
1) After the onset of AD, a reduction of trigger
factors
50. 2) Hydration
a specific Foaming detergents and soaps should be avoided.
The regular use of emollients protect against inflammation
provoked by irritants such as detergent, and increase the
benefit obtained from topical corticosteroid therapy.
Ceramide-rich emollients may lead to improvements in
childhood atopic dermatitis through barrier repair mechanism
51. Management of acute AD
1) Wet dressings and topical
glucocorticoids; topical antibiotics
(mupirocin ointment)
2) Hydroxyzine, 10–100 mg
four times daily for pruritus.
3) Oral antibiotics (dicloxacillin,
erythromycin) to eliminate S. aureus and
treat MRSA according to sensitivity as
shown by culture.
54. Emollients
Individually adapted
emollients containing
urea (4% in children;
up to 10% in adults)
should be used to
support the skin
barrier function and
allow hydration of
the skin.
55. Topical steroids
Principles of treatment with topical corticosteroids.
Use the weakest
steroid that controls
the eczema
effectively
Review their use
regularly; check for
local and systemic
side-effects
In primary care,
avoid using potent
and very potent
steroids for children
with atopic eczema
Be wary of repeat
prescriptions
56.
57. Topical calcineurin inhibitors (TCIs)
Tacrolimus and
Pimecrolimus,
are gradually
replacing
glucocorticoids
in most
patients.
potently
suppress
itching and
inflammatio
n and do not
lead to skin
atrophy.
not effective
enough to
suppress acute
flares but work
very well in minor
flares and
subacute atopic
dermatitis.
60. ANTI- HISTAMINIC
SEDATING ANTIHISTAMINES are helpful in breaking the
‘itch–scratch cycle’ in AD, given at bedtime.
useful to patients in whom itching prevents sleep or in
those scratch to producing hemorrhagic crusts at night.
NON-SEDATING ANTIHISTAMINES are occasionally helpful,
but the most benefit is usually obtained at higher doses
61. SYSTEMIC GLUCOCORTICOIDS
SHOULD BE AVOIDED EXCEPT in rare
instances in adults for only short courses.
For severe disease, prednisone, 60–80 mg daily for 2
days, then halving the dose each 2 days for the next 6
days.
Patients tend to become dependent on oral
glucocorticoid. Often, small doses (5–10 mg) make the
difference in control and can be reduced gradually to
even 2.5 mg/d, as is used for the control of asthma.
Intramuscular glucocorticoids are risky and
should be avoided.
62. ANTIMICROBIALS
• Antimicrobials are important for AD patients with
cutaneous infections.
• antibiotics can directly improve AD by reducing
bacterial products thought to exacerbate AD is
less clear.
• Antistaphylococcal therapy (e.g. cephalosporins)
can significantly improve superinfected AD and
may provide some benefit to non-infected skin.
• Ketoconazole has been used for head- or neck-based
AD, presumably to reduce Malassezia
colonization
63. PHOTOTHERAPY
Improve AD, but some patients cannot tolerate the
heat generated by the equipment.
UVB, UVA, narrowband UVB, combined UVA and
UVB, and (PUVA) have all been effective in AD.
Some patients benefit from natural sunlight.
Has a favorable side-effect profile compared
to systemic immunosuppressive agents, with
potential risks of ‘sunburn’ and, with long-term
treatment, photoaging and cutaneous
malignancies.
64. Advanced Therapies
For the unusually difficult-to-manage AD patient
CYCLOSPORINE
METHOTREXATE
AZATHIOPRINE
BIOLOGICS
65. CYCLOSPORINE
Oral cyclosporine at a dose of 1.25 mg/kg per
day is effective in reducing disease extent and
severity as well as improving pruritus, sleep and
quality of life in AD.
renal toxicity after as little as 3–6 months of
therapy limit the use of cyclosporine, but short-term
courses followed by maintenance therapy
can be prescribed
66. METHOTREXATE
MTX is the folic antagonist aminopterin
causes a temporary inhibition of keratinocyte proliferation
during the first 24 hours after a therapeutic dose, and has an
inhibtory effect on circulating and cutaneous lymphocytes
Methotrexate 2.5–25 mg per week (depending upon patient
age,weight and renal function)
67. AZATHIOPRINE
Azathioprine is an immunosuppressant drug effective in severe AD.
Side effects are high, including myelo-suppression, hepato-toxicity,
gastrointestinal disturbances, increased susceptibility for
infections, and possible development of skin cancer.
azathioprine is metabolized by the thiopurine methyl-transferase
(TPMT); a deficiency of this enzyme should be excluded before
starting azathioprine treatment.
Dosage (2–3.5 mg/kg/day if normal, 0.5–1 mg/ kg/day if low)
68. BIOLOGICS
• Anti-IgE (omalizumab), which is approved for
asthma, has been tried with variable results in
AD.
• Since these patients usually display very high
levels of IgE, neutralizing these levels would
require extremely high amounts of this biologic.
• Nevertheless, some recent case report suggested
the successful of omalizumab in selected patients
• However, effects of biologics may be serious and
need further evaluation.
70. AD IS A COMMON WELL KNOWN DISEASE
BUT NEED TO BE CARFULLY DIAGNOSED
SYSTEMIC STEROID IS NOT
INDICATED IN TEARTMENT OF
AD WHER AS EMOLLIENT ARE
THE 1ST LINE