Epidemiology, Diagnosis, and Treatment of Atopic Dermatitis in the Developing Countries of Asia, Africa, Latin America, and the Middle East: A Review

Abstract

Atopic dermatitis (AD), the leading cause of skin-related burden of disease worldwide, is increasing in prevalence in developing countries of Asia, Africa, Latin America, and the Middle East. Although AD presents similarly across racial and ethnic groups as chronic and relapsing pruritic eczematous lesions, some features of the disease may be more or less prominent in patients with darker skin. Despite a similar presentation, consistent diagnostic criteria and consistent treatment guidelines are lacking. Because of these and other challenges, adherence to treatment guidelines is difficult or impossible. Previous studies have stated that many patients with AD receive ineffective or inappropriate care, such as oral antihistamines, oral corticosteroids, or traditional medicines, if they are treated at all; one study showed that approximately one-third of patients received medical care for their dermatologic condition; of those, almost three-quarters received inappropriate or ineffective treatment. In addition, other challenges endemic to developing countries include cost, access to care, and lack of specialists in AD. Furthermore, most of the available diagnostic criteria and treatment guidelines are based on European and North American populations and few clinical trials report the racial or ethnic makeup of the study population. Drug pharmacokinetics in varying ethnicities and adverse effects in different skin physiologies are areas yet to be explored. The objective of this review is to describe the diagnosis, treatment, and management of AD in developing countries in Asia, Africa, Latin America, and the Middle East; to discuss the differences among the countries; and to establish the unmet needs of patients with AD in them. The unmet medical need for treatment of AD in developing countries can be addressed by continuing to train medical specialists, improve Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.9918782.

Solidagenone from Solidago chilensis Meyen inhibits skin inflammation in experimental models

“…On the other hand, non-steroidal anti-inflammatory drugs, antihistamines, glucocorticoids and immunosuppressants are available for clinical practice, but they are far from effective in treating skin conditions such as psoriasis and atopic dermatitis. 3 Accordingly, the development of new anti-inflammatory agents capable of treating or preventing these conditions, especially those based on natural products, is of great therapeutic interest. 2 Among the natural compounds with anti-inflammatory activity, labdane-type diterpenoids from Physalis angulate have exhibited inhibitory effects against NO production.…”

Genetic polymorphisms in serine protease inhibitor Kazal-type 5 and risk of atopic dermatitis

“…Moreover, skin barrier dysfunctions are one of the major factors involved in AD development. [ 2 ] The gene SPINK5 is located on chromosome 5q31-32, which encodes the skin barrier protein lympho-epithelial Kazal-type-related inhibitor (also known as serine protease inhibitor Kazal-type 5). [ 21 , 22 ] SPINK5 in the epidermis is primarily expressed in the stratum granulosum, where it functions as a protease.…”

“…As of 2018, the point prevalence of adult AD in the overall/treated populations was 4.9%/3.9% in the United States, 3.5%/2.6% in Canada, 4.4%/3.5% in the EU, and 2.1%/1.5% in Japan, [ 1 ] and the prevalence of AD continues to increase in developing countries. [ 2 ] Traditionally, AD is often associated with abnormalities in the skin barrier and immune system dysfunction, accompanied by high microbial colonization and a higher susceptibility to skin infection. [ 3 , 4 ] However, the pathogenesis of AD is not fully understood.…”

Natural Xanthones and Skin Inflammatory Diseases: Multitargeting Mechanisms of Action and Potential Application

“…AD, also known as atopic eczema, is the most common chronic skin disorder affecting 3-20% of the global population (Lopez Carrera et al, 2019;Schwingen et al, 2020). AD is commonly characterized by pruritic skin lesions with concurrent allergic inflammation and augmented immunoglobulin E (IgE) and histamine levels (Higuchi et al, 2013;Zhao et al, 2017).…”