Management of atopic dermatitis
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This document discusses the management of atopic dermatitis (AD). It covers the epidemiology, risk factors, clinical presentation, conventional therapies, and role of topical corticosteroids in treating AD. Specifically, it notes that AD is a chronic inflammatory skin disease affecting 15-30% of children and 2-10% of adults. Genetic and environmental factors like allergens and irritants play a role. Treatment focuses on eliminating triggers, moisturizing, and using topical corticosteroids in a stepwise approach depending on severity.
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Management of atopic dermatitis
- 1. Management of Atopic dermatitis Sasikarn Suesirisawad, M.D.
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- 13. Color Textbook of Pediatric Dermatology, 4th Edition. Infantile type Childhood type Adult type Face, scalp, trunk, extensor surfaces of extremities Flexural folds of ext (antecubital, popliteal fossa) neck, ankles Upper arms, back, wrists, hands, fingers, feet, toes
- 16. Mark Boguniewicz, Donald Leung.Middleton’s Allergy 7’th edition 1 893-1999
- 18. Exacerbating factor in AD
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- 26. Tan et al. Lancet 1996; 347: 15-18 p= 0.002 ** 12.6 4.2 p= 0.006
- 31. An. Bras. Dermatol. vol.82 no.1 Rio de Janeiro Jan./Feb. 2007 Breaking the cycle: how I manage difficult AD
- 32. Wet wrap Pediatrics 2008;122;812-824
- 38. The Steroid-Sparing Effect of an Emollient Therapy in Infants with Atopic Dermatitis Grimalt et al. Dermatology 2007;214: 61–7 Patient 173 infants, moderate to severe AD, SCORAD Index 20-70 Intervention Exomega lotion (containing water, petrolatum, Shea butter, Evening primrose oil, glycerin, paraffin oil, niacinamide, butylene glycol, benzoic acid, carbomer oat extracts) Compare Placebo Outcome Primary Outcome: Amounts of use of high potency (0.1% Locatop) and moderate potency topical steroids cream (Locapred) Secondary Outcome: SCORAD index
- 39. Grimalt et al. Dermatology 2007;214: 61–7 P<0.05 P=0.722 * P<0.0005 **P<0.0001
- 41. Stepwise management of patients with AD. Akdis et al. J ALLERGY CLIN IMMUNOL JULY 2006
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- 44. Pediatric patients: aware of age-appropriate indications Hengge et al. J Am Acad Dermatol 2006; 54:1-15 Brodkin et al. Cutis 1997; 60: 279-80
- 51. Tacrolimus and Pimecrolimus are structurally similar Pimecrolimus 810.48 Da C 43 H 68 CINO 11 Tacrolimus 822.05 Da C 44 H 69 NO 12 ·H 2 O HO H 3 CO CH 3 OH O CH 3 · H 2 O CH 3 H 3 CO OCH 3 N O O O O H 3 C H 3 C O OH H H CI H 3 CO CH 3 OH O CH 3 CH 3 H 3 CO OCH 3 N O O O O H 3 C H 3 C O OH H H CH 3
- 53. Topical calcineurin inhibitors complexing with macrophilin-12 and calcium-calmodulin to block dephosphorylation of NF-AT by calcineurin, preventing translocation of NF-AT to the nucleus. CaN, Calcineurin; MP-12, macrophilin-12;NF-ATc, nuclear factor of activated T cells in the cytoplasm;NF-ATn, NF-AT in the nucleus; NF-κB,nuclear factor-kappa B; TCI, topical calcineurin inhibitor. Journal of the American Academy of Dermatology V olume 53, Issue 1 Suppl (July 2005)
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- 60. Robert S.et al. Acta Derm Venereol 2010; 90: 58–64
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- 65. Paghdal KV - J Am Acad Dermatol - 01-AUG-2009; 61(2): 294-302
- 79. *=p≤0.05 ***=p≤0.02 **p≤0.005 ***p≤0.002
Editor's Notes
- worldwide
- AD14
- As a result of genetically determined epidermal-barrier dysfunction and the effect of environmental factors, nonatopic dermatitis is the first manifestation of atopic dermatitis. Subsequently, because of their genetic predisposition for IgE-mediated sensitization, patients become sensitized. This phenomenon is favored by Staphylococcus aureus enterotoxin products. Finally, scratching leads to tissue damage and the release of structural proteins, triggering an IgE response in patients with atopic dermatitis. This sensitization to self-proteins can be due to the homology of allergen-derived epitopes and human proteins in the context of molecular mimicry.
- AD25
- maternal age, maternal education, family income, family history of atopy, maternal smoking and drinking alcohol during pregnancy, maternal diet and supplements such as multivitamins or fish oils during pregnancy, duration of breast feeding and consumption of infant formula, age of introduction of solid foods or highly allergenic foods, infant history of allergy, acute bronchiolitis, number of siblings, pet raising, cockroaches and carpets at home, environmental tobacco smoke, fungi on the walls of the house, frequent use of microwave oven or magnetic oven, moving into a new house, new paintings Vasoactive intestinal peptide, substance P, nerve growth factor toward Th2
- AD8
- difference between active and placebo covers at 6 months was highly significant (p=002). severity of eczema decreased in both groups, but active group showed significantly greater improvements in severity score (difference between mean final scores 4.3 units, p=0.006)
- AD9
- AD10
- AD18
- The four test products were Cetaphil Daily Advance ultra hydrating lotion (CDA lotion; Galderma); Epidrat ultra hydrating lotion (E lotion; Quimica Farmaceutica Ltda); Physiogel lotion (P lotion; Stiefel Laboratories); and Physiogel AI cream (PAI cream; Stiefel Laboratories)
- micronized desonide AD11
- consumption of high-potency corticosteroids ( fig. 2 a) was significantly lower in the emollient group compared to the control group from D0 to D21 [8.87 8 1.37 g vs. 4.86 8 0.97 g (–45.2%), p = 0.019] and from D0 to D42 [14.7 8 2.08 g vs. 8.56 8 1.74 g (–41.8%), p = 0.025]. consumption of moderate-potency topical corticosteroids from D0 to D21 and D42 in the 2 study groups is shown in figure 2 b. From D0 to D21 and from D0 to D42, the emollient group consumed slightly less moderate- potency topical corticosteroid than the control group (4.66 8 0.65 g vs. 4.91 8 0.75 g and 7.43 8 1.13 g vs. 8.03 8 1.23 g, respectively), but this difference of consumption was not significant either at D21 (–5.1%, p = 0.8043) or D42 (–7.5%, p = 0.722).
- Prolonged duration can alter barrier function
- AD13
- AD26
- AD29
- AD21
- AD23
- AD28
- AD17