Atopic dermatitis, treatment

Treatment of moderate to severe atopic dermatitis Treatment of plaque psoriasis Calcipotriene Dovonex White petrolatum, propylene glycol, fatty alcohol citrate fatty acid pentaerythritol ester, beeswax... 

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. 

Atopic dermatitis has been proposed to be the cutaneous manifestation of IgE-mediated hypersensitive reaction to allergenic substances [29]. Conceptually, antagonizing IgE emerges as a logical therapeutic option. Systemic treatment with omalizumab, however, appears to be less efficacious in the skin than in the airway mucosa [23]. It is possible that small molecule Syk inhibitors may offer a more suitable mode to reach and prevent activation of sensitized dermal mast cells and dendritic cells. 

Warner JO A double-blind, randomized, placebo-controlled trial of ceti-rizine in preventing the onset of asthma in children with atopic dermatitis 18 months treatment and 18 months posttreatment follow-up. J Allergy Clin Immunol 2001 108 929-937. 

Diepgen TL Long-term treatment with cetirizine of infants with atopic dermatitis a multi-country, double-blind, randomized, placebo-controlled trial (the ETAC trial) over 18 months. Pediatr Allergy Immunol 2002 13 278-286. 

T Cells May Contribute to the Defects in Innate Immune Response in Atopic Dermatitis Most patients with atopic dermatitis are colonized with S. aureus and experience exacerbation of their skin disease after infection with this organism [2]. In patients with S. aureus infection, treatment with anti-staphylococcal substances can result in the reduction of skin disease. Binding of S. aureus to the epidermis is enhanced by atopic skin inflammation. This is supported by clinical studies demonstrating that treatment with topical corticosteroids or tacrolimus reduces S. aureus counts in atopic dermatitis. 

It has been shown that IFN-y induces Fas on keratinocytes which renders them susceptible to apoptosis induction by infiltrating FasL+ T cells. This has been interpreted as an important event in eczema, mainly in atopic dermatitis. There is further evidence that cleavage of E-cadherin and sustained desmosomal cadherin contacts between keratinocytes that are undergoing apoptosis result in spon-gioform morphology in the epidermis as a hallmark of eczematous lesions. Suppression of keratinocyte activation and apoptosis thus remains a potential target for the treatment of atopic dermatitis [2]. 

Trautmann A, Akdis M, Schmid-Grendelmeier P, Disch R, Brocket EB, Blaser K, et al Targeting keratinocyte apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. 1 Allergy Clin Immunol 2001 108 839-846. 

Hj antihistamines are clinically used in the treatment of histamine-mediated allergic conditions. Specifically, these indications may include allergic rhinitis, allergic conjunctivitis, allergic dermatological conditions (contact dermatitis), pruritus (atopic dermatitis, insect... 

Moderate to severe atopic dermatitis TacroWmus ointment, both 0.03% and 0.1% for adults, and only 0.03% for children 2 to 15 years of age, is indicated for short-term and intermittent long-term therapy in the treatment of patients with moderate to severe atopic dermatitis. 

Apply a thin layer to the affected skin areas twice daily and rub in gently and completely. Continue treatment for 1 week after clearing of signs and symptoms of atopic dermatitis. 

Infected atopic dermatitis Before commencing treatment with tacrolimus ointment, clear clinical infections at treatment sites. 

Tacrolimus is used in situations where cyclosporine has been shown to be ineffective or cannot be used because of toxicity or otherwise. It is also used in a topical preparation in the treatment of severe atopic dermatitis, severe refractory uveitis after bone marrow transplants and in vitiligo. 

Ashcroft DM, Dimmock P, Garside R, Stein K, Williams HC. Efficacy and tolerability of topical pimecrolimns and tacrolimus in the treatment of atopic dermatitis meta-analysis of randomised controlled trials. BMJ 2005 330 516-21. 

Although the antihistamines are not useful as primary agents in the treatment of asthma, a number of studies have shown that the second-generation compounds are effective as adjunctive therapies in asthmatic patients with concomitant rhinitis, urticaria, or dermatitis. Cetirizine has been used to prevent the progression from atopic dermatitis to asthma in young children. 

Pimecrolimus (SDZ ASM 981, Elidel) is another recently approved macrolide immunosuppressant that acts by inhibiting calcineurin and blocking the release of proinflammatory cytokines from T lymphocytes. The parent compound, ascomycin, was originally isolated from Streptomyces hygroscopicus var ascomyceticus. Like tacrolimus, pimecrolimus is approved for the topical treatment of moderate to severe atopic dermatitis that is refractory to other therapies. Transient local irritation is a common side effect. 

Unlabeled Uses Treatment of alopecia areata, aplastic anemia, atopic dermatitis, Behpet s disease, biliary cirrhosis, prevention of corneal transplant rejection... 

Topical doxepin in the form of cream is used in the treatment of pruritus associated with atopic dermatitis or lichen chronicus. Adverse effects include marked burning and stinging at the treatment site. 

G. Other applications Actimmune may have application in the treatment of a variety of cancers (e.g., malignant melanoma, ovarian cancer), AIDS, rheumatoid arthritis, hepatitis B, and cutaneous leishmaniasis, atopic dermatitis, and keloidal scarring. There is preliminary evidence that Actimmune may benefit patients with pulmonary fibrosis. 

Nakayama, H., Kumei, A. and Sakurai, M. (1998). Treatment of atopic dermatitis by mite elimination (environmental improvement). Japan Pediatric Dermatology 17 97-102. (In Japanese.)... 

Nowicki and Bara ska-Rybak (2007) studied the protective effect of shark liver oil. They observed a significant protection against bacterial and fungal infections by shark liver oil treatment which contains mostly squalene and alkylglycerol. Further, this treatment showed improved effects on xerosis and skin lesion-induced atopic dermatitis. This antibacterial and antifungal effect could be accounted for the high-squalene-including composition of the shark liver oil however, detailed studies are needed to be carried out for reputed activity of squalene as an anti-infectant. 

Mueller RS, Bettenay SV Evaluation of the safety of an abbreviated course of injections of allergen extracts for the treatment of dogs with atopic dermatitis. Am J Vet Res 2001 62 307-310. 

Topical doxepin hydrochloride 5% cream (Zonalon) may provide significant antipruritic activity when utilized in the treatment of pruritus associated with atopic dermatitis or lichen simplex chronicus. The precise mechanism of action is unknown but may relate to the potent Hi and H2-receptor antagonist properties of dibenzoxepin tricyclic compounds. Percutaneous absorption is variable and may result in significant drowsiness in some patients. In view of the anticholinergic effect of doxepin, topical use is contraindicated in patients with untreated narrow-angle glaucoma or a tendency to urinary retention. 

Proving effective reversed targeting, which results from the soft nature of this steroid, systemic levels or effects cannot be detected even after chronic ocular administration [57], Plasma levels of loteprednol etabonate and its primary metabolite (PJ-91) were less than the 1 ng/L detection limit in 10 healthy volunteers who received the drug in both eyes eight times daily for 2 days and four times daily for a further 41 days [57], In addition to its already approved uses, loteprednol etabonate is also being developed for the treatment of colitis, atopic dermatitis, and asthma based on promising results from animal studies [47, 48],... 

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