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Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion, which is frequently encountered in clinical practice. Skin barrier dysfunction leads to enhanced skin irritability to non-specific stimuli and epicutaneous sensitization. In the lesion site, a further inflammation-related reduction in skin barri...
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Context 1
... stratum corneum forms a barrier contributing to the prevention of leakage of body fluids, retention of internal water within the cell layers, and contributes to biological defense ( Fig. 1, 2). If the barrier function of the horny cell layer is dysfunctional, skin irritability to non-specific stimuli is enhanced, and allergen sensitization and inflammation are likely to occur. 4 Intercellular lipids of the stratum corneum are mainly composed of ceramide, cholesterol, and free fatty acids, and in the case of AD, the function ...
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Background:
Atopic dermatitis (AD), a chronic, recurrent inflammatory skin condition primarily affects children. Topical treatment, systemic treatment, and phototherapy are mainstays of treatment. Topical corticosteroids (TCS) are first-line therapy for AD but are associated with various adverse effects. Topical calcineurin inhibitors (TCI) can be...
Citations
... Atopic dermatitis/eczema (AD) is a skin disease commonly seen around the world, affecting approximately 10% to 20% of children in Japan [1][2][3]. Although the pathogenesis of AD has not been fully elucidated, multiple genetic and environmental factors are thought to influence the onset and progress of the disease [1,4,5]. With the recent improvements in genetic analysis technology, comprehensive genetic studies of the gut microbiota revealed that the diversity of the gut microbiota was reduced in children with AD, called as dysbiosis [6][7][8]. ...
Background: No study has examined the association between constipation and atopic dermatitis (AD) in infants and toddlers. We aimed to explore that association in toddlers using the data from a nationwide birth cohort study.
Methods: From the Japan Environment and Children’s Study, a nationwide prospective birth cohort study that began in 2011, children born in a singleton live birth were analyzed. Participants completed questionnaires containing questions related to bowel movements and AD, during 1.5 to 3 years after birth. Constipation at 1 year of age was defined as having ≤2 bowel movements per week. AD was defined based on participant’s responses to the modified ISAAC questionnaire and/or self-reported physician’s diagnosis. Outcome was defined as the cumulative number of AD cases that occurred until 3 years of age. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for development of AD were calculated by a multivariable logistic regression.
Results: From a total of 62,777 participants who met the study inclusion criteria, 14,188 children (22.6%) were affected by AD between the ages of 1.5 and 3 years. The adjusted OR of developing AD for the presence versus absence of constipation at 1 year of age was 1.18 (95% CI, 1.01–1.38).
Conclusion: Constipation at 1 year of age was associated with a slightly higher risk of AD until 3 years of age.
... Eczema or atopic dermatitis (AD) is a chronic inflammatory skin condition manifesting as intermittent flares of itchy skin. The lifetime prevalence is roughly 15%-30% in children and adolescents and 2%-10% in adults (1). The normal barrier function provided by the stratum corneum is deficient in AD, resulting in invasion of allergens or pathogens and leading to activation of lymphocytes, monocytes/macrophages, eosinophils, and dendritic cells. ...
... The normal barrier function provided by the stratum corneum is deficient in AD, resulting in invasion of allergens or pathogens and leading to activation of lymphocytes, monocytes/macrophages, eosinophils, and dendritic cells. In turn, these immune cells release pro-inflammatory cytokines that stimulate receptors on skin keratinocytes, fibroblasts, and sensory neurons, inducing inflammation and itch (1,2). In particular, type 2 inflammatory cytokines such as interleukin (IL)-4, IL-13, and IL-31 produced by Th2 cells and type 2 innate lymphoid cells are primary drivers of the inflammatory process (3). ...
Background
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intermittent itchy rash. Type 2 inflammatory cytokines such as interleukin (IL)-4, IL-13, and IL-31 are strongly implicated in AD pathogenesis. Stimulation of IL-31 cognate receptors on C-fiber nerve endings is believed to activate neurons in the dorsal root ganglion (DRG), causing itch. The IL-31 receptor is a heterodimer of OSMRβ and IL31RA subunits, and OSMRβ can also bind oncostatin M (OSM), a pro-inflammatory cytokine released by monocytes/macrophages, dendritic cells, and T lymphocytes. Further, OSM expression is enhanced in the skin lesions of AD and psoriasis vulgaris patients.
Objective
The current study aimed to examine the contributions of OSM to AD pathogenesis and symptom expression.
Methods
The expression levels of the OSM gene ( OSM ) and various cytokine receptor genes were measured in human patient skin samples, isolated human monocytes, mouse skin samples, and mouse DRG by RT-qPCR. Itching responses to various pruritogens were measured in mice by counting scratching episodes.
Results
We confirmed overexpression of OSM in skin lesions of patients with AD and psoriasis vulgaris. Monocytes isolated from the blood of healthy subjects overexpressed OSM upon stimulation with IL-4 or GM-CSF. Systemic administration of OSM suppressed IL31RA expression in the mouse DRG and IL-31-stimulated scratching behavior. In contrast, systemic administration of OSM increased the expression of IL-4- and IL-13-related receptors in the DRG.
Conclusion
These results suggest that OSM is an important cytokine in the regulation of skin monocytes, promoting the actions of IL-4 and IL-13 in the DRG and suppressing the action of IL-31. It is speculated that OSM released from monocytes in skin modulates the sensitivity of DRG neurons to type 2 inflammatory cytokines and thereby the severity of AD-associated skin itch.
... Atopic dermatitis generally occurs in preschool age and is persistent throughout childhood [27]. Approximately 60% of children have AD in the first year of life and 90% by their fifth year. ...
... The flares in AD cause a shift in the skin microbiome to S. aureus. Erosive plaque, yellowish crusts, folliculitis, and abscesses are clinical indicators of bacterial skin infection requiring antibiotics [15,27]. This bacterium produces virulence factors determining pathogenicity and resistance to antimicrobials, including toxins, enzymes, and antigens, allowing bacteria to evade the host's natural defenses [31]. ...
... It has adequate interobserver reliability and qualified interpretability. SCORAD is recommended to assess the severity of AD objectively, especially in clinical trials [26,27]. Moreover, the SCORAD index has been associated with bacterial infection in adults with AD [47]. ...
Background and Objectives: The ineffective combination of corticosteroids and antibiotics in treating some atopic dermatitis (AD) cases has been concerning. The skin barrier defects in AD ease the colonization of Staphylococcus aureus (S. aureus), which results in a rise in interleukin-31 (IL-31). Lumbricus rubellus (L. rubellus) has shown antimicrobial and antiallergic effects but has not been studied yet to decrease the growth of S. aureus and IL-31 levels in AD patients. This study aimed to analyze the effect of L. rubellus extract in reducing S. aureus colonization, the IL-31 level, and the severity of AD. Materials and Methods: A randomized controlled trial (RCT) (international registration number TCTR20231025004) was conducted on 40 AD patients attending Dermatology and Venereology Polyclinic, Mother and Child Hospital (RSIA), Aceh, Indonesia, from October 2021 to March 2022. AD patients aged 8–16 who had a Scoring Atopic Dermatitis (SCORAD) index > 25, with total IgE serum level > 100 IU/mL, and had healthy weight were randomly assigned into two groups: one received fluocinolone acetonide 0.025% and placebo (control group) and one received fluocinolone acetonide 0.025% combined with L. rubellus extract (Vermint®) (intervention group). The S. aureus colony was identified using a catalase test, coagulase test, and MSA media. The serum IL-31 levels were measured using ELISA assay, while the SCORAD index was used to assess the severity of and improvement in AD. Mean scores for measured variables were compared between the two groups using an unpaired t-test and Mann–Whitney U test. Results: A significant decline in S. aureus colonization (p = 0.001) and IL-31 (p = 0.013) in patients receiving L. rubellus extract was found in this study. Moreover, fourteen AD patients in the intervention group showed an improvement in the SCORAD index of more than 35% (p = 0.057). Conclusions: L. rubellus extract significantly decreases S. aureus colonization and the IL-31 level in AD patients, suggesting its potential as an adjuvant therapy for children with AD.
... The patients received 600 mg of DUP as a loading dose and 300 mg every 2 weeks thereafter, in addition to topical steroids or calcineurin inhibitors during DUP treatment. The topical applications and emollients were used according to the proactive therapy recommended by the Japanese AD guidelines [4]. Clinical and laboratory data were collected at baseline (before DUP treatment). ...
Dupilumab (DUP) is the first biological agent used treating atopic dermatitis (AD). Notwithstanding its high cost, the type of patient group for which the drug is effective remains unclear. In this retrospective study, we aimed to identify novel and reliable biomarkers which can be measured before DUP administration and to predict the efficacy of DUP. Serum samples from 19 patients with AD treated with DUP were analysed by metabolome analysis using gas chromatography–mass spectrometry. Total 148 metabolites were detected, and the relative values of the metabolites were compared between the patient group that achieved 75% improvement in Eczema Area and Severity Index 16 weeks after administration of DUP (high responders: HR; n = 11) and that did not (low responders: LR; n = 8). The HR and LR groups had significant differences in the relative values of the eight metabolites (lactic acid, alanine, glyceric acid, fumaric acid, nonanoic acid, ribose, sorbitol, and ornithine), with ribose emerging as the best. Furthermore, we evaluated the serum concentrations of ribose and found that ribose may be a useful metabolite biomarker for predicting the efficacy of DUP in AD.
... Additionally, these 'atopic schools' are not feasible for healthcare centres with limited resources. The European, American, Japanese and Canadian guidelines for the management of AD recommend patient education programs as an adjunct to conventional therapy in AD [15][16][17][18]. Despite these recommendations there has been no evaluation of formalized and harmonized educational interventions. ...
Background
Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects children and adults. Poor treatment adherence in AD requires interventions to promote self-management; patient education in chronic diseases is key to self-management. Many international AD management guidelines published to date include a recommendation for educating patients as part of their treatment but there are no formal recommendations on how to deliver this knowledge.
Main
We performed a scoping review to map the existing literature on patient education practices in AD and to highlight the clinical need for improved patient education in AD. The literature search was performed with the online databases MEDLINE, Embase, Grey Matters, ClinicalTrails.gov and the International Clinical Trials Registry Platform (ICTRP). The search strategy yielded 388 articles. Of the 388 articles screened, 16 studies met the eligibility criteria, and the quantitative data was summarized by narrative synthesis. The majority of studies were randomized controlled trials conducted in Europe, Asia and North America. Since 2002, there have been limited studies evaluating patient education in the treatment of AD. Frequent education methods used included group-based educational programs, educational pamphlets, individual consultations and online resources. Education was most commonly directed at caregivers and their children. Only one study compared the efficacy of different education methods. In all included studies, the heterogenous nature of outcome measures and study design limited the consistency of results. Despite the heterogeneity of studies, patient education was shown to improve quality of life (QoL), disease severity and psychological outcomes in AD patients.
Conclusion
This scoping review highlights that patient education is effective in a variety of domains relevant to AD treatment. Further comparative studies and randomized trials with longer-term follow-up are needed to provide validated and consistent patient education recommendations for AD; these may depend on age and population.
... Note that the use of antihistamines was recommended as an adjuvant therapy to anti-inflammatory topical therapy to reduce itchiness in the treatment policy proposed by the Japanese guideline at the moment (i.e. 2016-2020) 54 . This policy was later modified to lower the grading of recommendation for the use of antihistamines in the revised guideline in 2021 in response to the increased recognition of uncertainty of its efficacy on relief of itchiness 55,56 . ...
Atopic dermatitis (AD) is a skin disease that is heterogeneous both in terms of clinical manifestations and molecular profiles. It is increasingly recognized that AD is a systemic rather than a local disease and should be assessed in the context of whole-body pathophysiology. Here we show, via integrated RNA-sequencing of skin tissue and peripheral blood mononuclear cell (PBMC) samples along with clinical data from 115 AD patients and 14 matched healthy controls, that specific clinical presentations associate with matching differential molecular signatures. We establish a regression model based on transcriptome modules identified in weighted gene co-expression network analysis to extract molecular features associated with detailed clinical phenotypes of AD. The two main, qualitatively differential skin manifestations of AD, erythema and papulation are distinguished by differential immunological signatures. We further apply the regression model to a longitudinal dataset of 30 AD patients for personalized monitoring, highlighting patient heterogeneity in disease trajectories. The longitudinal features of blood tests and PBMC transcriptome modules identify three patient clusters which are aligned with clinical severity and reflect treatment history. Our approach thus serves as a framework for effective clinical investigation to gain a holistic view on the pathophysiology of complex human diseases.
... These emollients effectively reduce itching and the urge to scratch, resulting in clinical improvement. [2][3][4] In addition, skin hygiene practices hold a crucial role in AD management. Cleansers, in particular, aid in the removal of bacteria from the stratum corneum and facilitate the elimination of crusts, rendering them a recommended component in AD treatment. ...
... AD is clinically characterized by pruritus and dry skin. 1 Immune abnormalities and skin barrier dysfunction are the primary pathogenesis of AD. 1 The central focus of AD treatment is the restoration of the skin's barrier function, Current clinical management typically follows a "stepwise therapy" approach. 2 ...
Objective
To observe the effect of niacinamide‐containing body emollients combined with a cleansing gel on the clinical symptoms of mild atopic dermatitis (AD) in adults.
Methods
From July 2022 to January 2023, adults with mild AD were enrolled at Huashan Hospital Affiliated to Fudan University using single‐center, randomized and placebo‐controlled methods. They were divided into three groups: the control group, treatment group 1 (T1) receiving niacinamide‐containing body emollients alone, and treatment group 2 (T2) receiving emollients plus niacinamide‐containing cleansing gel. All patients were orally administered 10 mg of ebastine tablets daily. AD severity (SCORAD score), peak pruritus numeric rating scale (PP‐NRS), patient‐oriented measure of eczema (POEM), dermatological quality of life index (DLQI) score, transepidermal water loss (TEWL), and stratum corneum water content (SCWC) were measured by the same dermatologist at days 0, 7, 14, and 28.
Results
A total of 122 patients were enrolled, including 38 in the control group, 42 in the T1 group and 42 in the T2 group. There were no obvious adverse reactions at the end of the study and the clinical scores and stratum corneum barrier of all the groups improved significantly relative to baseline. The SCORAD, PP‐NRS, DLQI, TEWL and SCWC scores in T1 group (12.43 ± 3, 3.3 ± 0.9, 7.1 ± 2.33, 17.1 ± 9.12, 67.2 ± 21.46, seperately) and T2 group (11.17 ± 3.26, 3 ± 1.3, 6.5 ± 2.11, 16.3 ± 9.12, 69.4 ± 24.52, seperately) were significantly improved than the control group(15.1 ± 3.64, 4.3 ± 1.7, 9.5 ± 2.46, 21.2 ± 9.47, 52.7 ± 22.43, seperately) at the endpoint of the study, while compared the POEM scores, only T2 group showed the difference with control group (5.2 ± 1.4 vs. 6 ± 1.6). The epidermal barrier parameters of TEWL and SCWC in the T2 group (17.57 ± 5.24, 66.46 ± 21.38, seperately) were significantly better than that of the T1 (19.96 ± 4.45, 56.45 ± 20.48, seperately) and control group(21.89 ± 7.03, 51.56 ± 16.58, seperately) on the 14th day of follow‐up.
Conclusion
The use of niacinamide‐containing body emollients can significantly improve the clinical symptoms, quality of life, and skin barrier function in patients with mild AD. The addition of niacinamide‐containing cleansing gel can also affect the clinical efficacy at certain time points.
... Atopic dermatitis (AD), also known as atopic eczema, has been recognized as a global health issue with pruritus as the primary lesion [19,20]. For decades, AD has caused extensive burden on children and adults, whereas the extent and appearance of lesions vary with race and age [21]. ...
... At the meantime, current advances in the aforementioned pathophysiology of AD are facilitating the stratification of different AD phenotypes, which thus would potentially convert to the development of targeted-specific, personalized regimens of AD in future [29,30]. State-of-the-art literatures have indicated the feasibility of effective strategies for the improvement of AD, including detailed countermeasures and investigation of the potential causes and the exacerbating factors, correction of skin dysfunctions in AD patients, and the concomitant pharmacotherapy [19,24]. ...
Longitudinal studies have indicated the multifaceted regimens for atopic dermatitis (AD) administration, including ultraviolet phototherapy, oral JAK inhibitors, and the concomitant adjunctive therapies according to the American Academy of Dermatology published Guidelines of Care for the Management of Atopic Dermatitis. As a disease with typical characteristics of relapsing pruritus and chronic inflammation, AD has caused heavy burden on children and adults, as well as healthcare providers and family members. As a multi-factorial disease, AD has been considered primarily derived by Th2 dysfunction, with clinical and molecular heterogeneity. The current therapeutic regimens are various and largely due to the diversity in the wide spectrum of the clinical phenotypes based on epidermal barrier disruption, genetic predisposition, and dysregulation of patients’ immune system. Meanwhile there’s an urgent need for developing safer and long-term agents to efficiently control moderate to severe AD. In this book chapter, we mainly summarized the fundamental concept, clinical manifestation, pathophysiology and molecular mechanisms of AD, and in particular, the biofunction and modulation of natural killer (NK) cells for AD. Collectively, the contents in this chapter will help further understand the landscape of this disease and the rationale behind new emerging therapies.
... Importantly, self-care strategies should be considered in a shared decision-making approach. For example, although wearing occlusive clothing, especially in more severe disease, may alleviate mental burden while protecting the skin from scratching and aeroallergen contact, [36][37][38] avoiding social situations and spending time alone may negatively impact well-being by limiting real-life social interactions 39 and should not be actively encouraged. ...
Background: Atopic dermatitis (AD) has large mental health impacts for patients and caregivers, yet their preferences regarding how to relieve these impacts are poorly understood. Objective: To understand patients' and caregivers' preferences for AD-related mental health care and support. Methods: We surveyed 279 adult AD patients and 154 caregivers of children with AD across 26 countries regarding their AD-related mental health burden, preferred strategies for improving AD-related mental health, and experiences with mental health care in AD. Results: Caregivers reported significantly worse overall mental health (P = 0.01) and anxiety (P = 0.03) than adult patients when controlling for AD severity. Among adult patients, 58% selected treating the AD, 51% managing itch, 44% wearing clothing to cover up skin, 43% avoiding social situations, and 41% spending time alone, as strategies they felt would improve their own AD-related mental health. Caregivers selected managing itch and treating the AD most frequently for both their own (76% and 75%, respectively) and their children's (75% and 61%) mental health. Adult patients were less satisfied with mental health care from mental health providers versus nonmental health providers (P < 0.001). Conclusions: Effective AD management is the preferred method for improving mental health among patients as well as caregivers, who may experience the greatest mental health impacts. Self-care strategies should be considered in a shared decision-making approach.
... Further large-scale trials should be 125 performed to confirm the efficacy of Fam's Baby moisturizer in preventing AD in infants. This trial was registered with the Japan Registry of Clinical Trials (jRCT): ID:Atopic dermatitis (AD) is a chronic skin disease associated with poor quality of life.1,2 ...
Background:
The effectiveness of moisturizers in preventing infant atopic dermatitis (AD) remains unclear. We previously showed that using 2e moisturizer of commercial moisturizer (Shiseido Japan Co., Ltd., Tokyo, Japan) at least once a day significantly prevented AD in infants as compared with as-needed petroleum jelly. This trial aimed to determine the effectiveness of twice- or once-daily application of Fam's Baby moisturizer (Fam's Inc., Tokyo, Japan) in preventing AD compared with once-daily 2e moisturizer.
Methods:
This trial was a single-center, three-parallel-group, assessor-blinded, superiority, individually randomized, controlled, phase II trial that was conducted from August 25, 2020 to September 28, 2021. We randomly assigned 60 newborns with at least one parent or sibling who has AD to receive Fam's Baby moisturizer twice daily (Group A) or once daily (Group B), or 2e once daily (Group C) in a 1:1:1 ratio until they were 32 weeks old. The primary outcome was the time to AD onset.
Results:
AD was observed in 11/20 (55%), 5/20 (25%), and 10/20 (50%), infants in Groups A, B, and C, respectively. Cumulative incidence values for AD according to the Kaplan-Meier method showed that infants in Group B tended to maintain an intact skin for a longer period than those in Group C (median time, not reached [NR] vs. 212 days, log-rank test, p = 0.064). Cox regression analysis showed that the risk of AD tended to be lower in Group B (hazard ratio with group C as control, 0.36; 95% confidential intervals: 0.12-1.06). No serious adverse events occurred in any of the enrolled infants.
Conclusion:
Fam's Baby moisturizer may better prevent AD than 2e. Further large-scale trials should be performed to confirm the efficacy of Fam's Baby moisturizer in preventing AD in infants.
