International Consensus Conference on Atopic Dermatitis II (ICCAD II*): clinical update and current treatment strategies (original) (raw)

Atopic Dermatitis and Asthma: Parallels in the Evolution of Treatment

Pediatrics, 2003

Objectives. To review epidemiologic correlations between asthma and atopic dermatitis (AD), identify common features in disease pathophysiology, and review steps involved in the development of asthma therapy guidelines to assess the appropriateness of a similar process and approach for AD. Methods. A 7-member panel representing specialists in dermatology, allergy, asthma, immunology, and pediatrics from around the United States convened to review the current literature and evolving data on AD. Participants presented reviews to the panel on the epidemiology of asthma and AD, the genetic predisposition to allergic disease, the current understanding of the immunopathophysiology of AD, interrelationships between the pathologic pathways of asthma and AD, evolving treatment concepts and options in AD, and the applicability of the asthma treatment model and how it may be adapted for guideline development for AD. Commentary and criticism were recorded for use in document preparation. Result...

Clinical correlations of recent developments in the pathogenesis of atopic dermatitis

Anais Brasileiros de Dermatologia, 2008

Atopic dermatitis is a chronic inflammatory skin disease with a steadily increasing prevalence affecting 10-20 % of infants and 1-3% of adults globally. It is often the first clinical manifestation of atopic disease preceding asthma and allergic rhinitis. Probably half of the children with atopic dermatitis develop some other form of atopic disease later in life. The pathogenesis involves a complex interplay of factors including genetic predisposition due to altered immune or skin barrier function, interactions with the environment such as food and allergen exposures, and infectious triggers of inflammation. In this review, we summarize the recent advances in understanding the contribution of different factors in the pathophysiology of atopic dermatitis and how insights provide new therapeutic potential for its treatment.

Atopic Dermatitis: Clinical Aspects and Unmet Needs

Biomedicines

Atopic dermatitis is a common chronic-relapsing, inflammatory and itchy eczematous skin disorder which occurs in both children and adults. AD pathogenesis is complex and several factors are implicated. Pruritus plays a pivotal role in disease’s burden, significantly worsening atopic patient quality of life by limiting productivity and daily activities. AD diagnosis relies still on the experience of the healthcare professional and there are several unmet needs as for the diagnostic criteria, the management and the recognition of the burden of the disease. In this paper we present an indeep focus on the main clinical features of AD and the major unmet needs that should be addressed in the next research.

Correlates of outcome for atopic dermatitis

Annals of Allergy, Asthma & Immunology, 2009

Background: The worldwide incidence and prevalence of atopic dermatitis (AD) are increasing. Few good studies have addressed AD in terms of the factors affecting disease prognosis. Objective: To identify significant correlates of persistent AD because this would be clinically valuable information. Methods: Potential correlates of AD, including race, onset age, age of solid food introduction, breastfeeding, sinopulmonary infections, other atopic diseases, peripheral eosinophilia, total IgE level, and eosinophilic cationic protein levels, were investigated in 177 patients aged 5 to 18 years. Correlates were compared with AD remission vs nonremission status. Results: A total of 133 patients (75.1%) were not in remission at the age of 5 years or older and were, thus, classified as having persistent AD. Patients with histories of peanut allergy (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.30-6.55), egg allergy (OR, 2.71; 95% CI, 1.17-6.30), or dust mite allergy (OR, 4.02; 95% CI, 1.84-8.82) were significantly more likely to have persistent AD than those without these factors. There was a trend toward increased odds of persistence in those with peripheral eosinophilia (P ϭ .06) and decreased odds of persistence in those with frequent sinopulmonary infections (OR, 0.51; 95% CI, 0.25-1.03). Conclusions: Egg, peanut, and dust mite allergies are significant correlates of AD persisting beyond school age. There may also be increased odds in those with peripheral eosinophilia and decreased odds in those with frequent sinopulmonary infections. This highlights the importance of assessing these correlates in patients with AD and modifying the correlates that can be modified. Further studies on whether modification of these correlates and/or early aggressive AD management improves outcome are needed.

Atopic Dermatitis – Associated Immune Dysfunction

Romanian Journal of Pediatrics, 2016

The immune system shows a complex role to defend the body in response to "non-self" antigens, respond abnormally to antigens allergens (hypersensitivity and autoimmunity) and shows immune tolerance by lack of reactivity to its own structures (self). Aim. The aim of this study is to demonstrate that in atopic dermatitis immune deficiency influences the development of atopy, disease severity and comorbidities. Material and methods. Following medical record review, 135 cases diagnosed with AD were included in the study. Statistical analysis was performed using SPSS v20 for determining the frequency and testing the hypotheses, for p < 0.05, by t tests and One-Way ANOVA. Results. Of the 135 cases, 51.9% were male children and 48.1% female children aged 1 month to 127 months with a mean of 26.21. According to total serum IgE level, 64.4% of patients had elevated IgE levels, 35.6% normal levels. According to the SCORAD, children had mild AD in 20.7% of cases, moderate in 70.4%, and severe in 8.9%. IgA deficiency was found for 48.1% of cases, and for 51.9% normal. IgG deficiency was found in 38.5% of cases. The independent samples t tests showed statistical significant demonstrating correlations between IgE level and IgA immune deficiency, between SCORAD and IgG and IgA immune deficiency. Atopic march is influenced by elevated IgE, IgA and IgG immune deficiency, p <0.05. Conclusions. Atopy in AD can be influenced by complex factors, both internal and environmental, but this remains a controversial topic. External factors acting on a background genetically predisposed to atopy trigger the manifestation of AD.

Clinical-epidemiological Profiles and Therapeutic Approaches of Atopic Dermatitis Patients

2021

Objectives: Atopic dermatitis, also known as atopic eczema, is a chronic inflammatory skin disease. The main objective of this study is to document atopic dermatitis patients’ clinical-epidemiological profiles and therapeutic approaches. Methods: The study is a retrospective cross-sectional study conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, including records from 2016 to 2020. Results: Of the total 125 patients, 65 (52%) were males and 60 (48%) were females. Almost half (53%) of the study subjects reported a positive family history of at least one of the atopic triad diseases. 44 (35%) patients have another atopic disease, with bronchial asthma being the most common associated atopy. Multiple sites were affected in 63% of the patients, followed by the upper extremities (17.6%), lower extremities (11.2%), and finally the face (6.4%). Almost all patients (91%) received emollients and moisturizers as therapy. Topical steroids were the second most common treatment cho...

Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide

British Journal of Dermatology, 2019

Background Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians. Methods We reviewed recent cohort studies to synthesize and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD. Results Despite the variability in data collection and methods of analysis and their limitations, there are common patterns of early-childhood AD that may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitization and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants and children with AD at potentially higher risk of developing persistent AD and atopic comorbidities. We also present clinical scenarios to illustrate how these data relate to real-life situations. Conclusions Useful insights are provided for physicians and patients to inform them better about the risk of AD progression and to help guide care pathways for the paediatric population with AD. What's already known about this topic? • The complex pathophysiology of atopic dermatitis (AD) translates into a heterogeneous clinical presentation and trajectories of disease progression. • Although the consensus is that most paediatric patients with AD will eventually 'outgrow' the disease or follow the longitudinal trajectory known as the 'atopic march', a significant proportion will develop persistent AD and/or other atopic conditions. • No known factors conclusively predict the risk of progression or development of comorbidities. What does this study add? • Recent analyses of data from large cohorts of paediatric patients with AD have suggested the existence of potentially discrete clusters of patients who present with relatively common AD phenotypes. • These studies have shed some light onto the factors associated with risk of progression, which we review in this article.

Atopic Dermatitis—Beyond the Skin

Diagnostics

Atopic dermatitis is a chronic inflammatory disease that can arise during the first months of life or at maturity and have a significant negative impact on the quality of life. The main pathogenic mechanism is the breakdown of cutaneous barrier integrity, which is associated with systemic inflammatory immunologic disorders. Atopic dermatitis involves numerous immunologic, allergic, respiratory, and ophthalmologic comorbidities that develop through similar intricate pathogenic phenomena. The atopic march represents the evolution in time of various allergic diseases, of which food allergies often cause the first manifestations of atopy, even from a very young age. Chronic inflammation translated through specific markers, next to increased immunoglobulin E (IgE) serum levels and heterogenous clinical manifestations, argue for the inclusion of atopic dermatitis in the systemic disease category.