Dermatitis atopic

Atopic Dermatitis. The mechanism of itching associated with atopic dermatitis remains unknown, but histamine is almost certainly involved to some extent as histamine concentrations are increased in the skin and in the plasma of patients with this disorder (39,42). Second-generation H receptor antagonists, unlike first-generation H receptor antagonists, have not been uniformly found to be effective in relieving itching in atopic dermatitis, which may be related to the absence of a sedative effect (43). 

In the pathogenesis of many chronic inflammatory diseases (e.g., rheumatoid arthritis, glomerulonephritis, colitis ulcerosa, Morbus Crohn, atopic dermatitis, psoriasis) autoimmune processes play an important role, too. Although first of all nonsteroidal antiinflammatory agents or glucocorticoids should be applied, immunosuppressive agents may also be indicated. 

For the topical treatment of some chronic inflammatory skin diseases (like atopic dermatitis) immunosuppressive macrolides (like TRL and pimecrolimus) that permeate the inflamed epidermis are of benefit for patients. Severe side effects comparable to those after systemic application of TRL in transplanted patients (see above) have not been observed so far. For the treatment of psoriasis vulgaris these drugs are less effective. The CD2 antagonist alefacept may be a suitable alternative to allergic reactions. 

Control of severe or incapacitating allergic conditions not controlled by other methods, bronchial asthma (including status asthmaticus), contact dermatitis, atopic dermatitis, serum sickness, drug hypersensitivity reactions... 

PIH can be observed after endogenous or exogenous inflammatory conditions. Essentially any disease with cutaneous inflammation can potentially result in PIH in individuals capable of producing melanin. Several skin disorders such as acne, atopic dermatitis, allergic contact dermatitis, incontinenti pigmenti, lichen planus, lupus erythematosus, and morphea have PIH as a predominant feature. Exogenous stimuli,both... 

Novak N, Bieber T The role of dendritic cell sub-types in the pathophysiology of atopic dermatitis. J Am Acad Dermatol 2005 53 S171-S176. 

Natter S. Seiberler S, Hufnagl P, Binder BR, Hirschl AM. Ring J, Abeck D. Schmidt T, Valent P, Valenta R Isolation of cDNA clones coding for IgE autoantigens with serum IgE from atopic dermatitis patients. FASEB J 1998 12 1559-1569. 

Connective tissue disease Substance abuse Stevens-Johnson syndrome Immunocompromised Atopic dermatitis Gonococcal infection Vitamin A deficiency... 

His father and one of his brothers have psoriasis his only sister has atopic dermatitis... 

Billow JA. Acne. In Berardi RR, McDermott JH, Newton GD, et al, eds. The Handbook of Nonprescription Drugs. 14th ed. Washington, DC American Pharmaceutical Association, 2004 913-928. Cheigh NH. Atopic dermatitis. In DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York City McGraw-Hill, 2005 1785-1792. 

Atopy A genetic predisposition to develop type I hypersensitivity reactions against common environmental antigens commonly seen in patients with allergic rhinitis, asthma, and atopic dermatitis. 

Vestergaard C, Deleuran M, Gesser B, Gronhoj Larsen C. Expression of the T-helper 2-specific chemokine receptor CCR4 on CCRIO-positive lymphocytes in atopic dermatitis skin but not in psoriasis skin. Br J Dermatol 2003 149 457-463. 

Nickel RG, Casolaro V, Wahn U, et al. Atopic dermatitis is associated with a functional mutation in the promoter of the C-C chemokine RANTES. J Immunol 2000 164(3) 1612-1616. 

The word dermatitis denotes an inflammatory erythematous rash. The disorders discussed in this chapter include contact dermatitis, seborrheic dermatitis, diaper dermatitis, and atopic dermatitis. Drug-induced skin disorders have been associated with most commonly used medications and may present as maculopapular eruptions, fixed-drug eruptions, and photosensitivity reactions. 

Atopic dermatitis is an inflammatory condition with genetic, environmental, and immunologic mechanisms. Many immune cells have demonstrated abnormalities, including Langerhans cells, monocytes, macrophages, lymphocytes, mast cells, and keratinocytes. 

Patient age and hormonal status in women should be considered in the initial evaluation of patients with skin disorders. Older patients are predisposed to developing psoriasis, seborrhea, and other skin conditions. Atopic dermatitis is most likely to occur in children. Menopausal women tend to develop brown hyperpigmentation, or melasma. Pregnant women may develop hyperpigmentation of the areola and genitalia as well as melasma. 

Diagnostic criteria for atopic dermatitis include the presence of pruritus with three or more of the following (1) history of flexural dermatitis of the face in children younger than 10 years of age (2) history of asthma or allergic rhinitis in the child or a first-degree relative (3) history of generalized xerosis (dry skin) within the past year (4) visible flexural eczema (5) onset of rash before 2 years of age. 

The evidence of the safety and efficacy of pimecrolimus was derived from studies primarily in patients with mild-to-moderate atopic dermatitis tacrolimus data was derived from moderate-to-severe patients. 

The topical immunomodulators tacrolimus (Protopic) and pimecrolimus (Elidel) inhibit calcineurin, which normally initiatives T-cell activation. These agents can be used on all parts of the body for prolonged periods without producing corticosteroid-induced adverse effects. Tacrolimus ointment 0.03% and 0.1% is applied twice daily the lower strength is preferred in children with moderate to severe atopic dermatitis. The most common adverse effect is transient itching and burning at the site of application. Pimecrolimus cream 1% is applied twice daily for mild to moderate atopic dermatitis in adults and children older than age 2. 

See Chap. 99, Dermatologic Drug Reactions and Self-Treatable Skin Disorders, and Chap. 102, Atopic Dermatitis, both authored by Nina H. Cheigh, for a more detailed discussion of this topic. 

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