Role of Topical Calcineurin Inhibitors on Atopic Dermatitis of Children

Ricci, Giampaolo; Dondi, Arianna; Patrizi, Annalisa

doi:10.2174/092986707780831032

Cited by 6 publications

(5 citation statements)

References 73 publications

(118 reference statements)

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“…However, new therapeutic approaches to AD seem to be efficacious in combating S. aureus skin colonization. Topical calcineurin inhibitors are a possible alternative to topical corticosteroids in the treatment of mild to severe forms of AD [43]. Several studies indicate that these new medicaments seem to block S. aureus SAg-triggered T cells [44][45][46].…”

Section: Non-pharmacological Treatmentsmentioning

confidence: 99%

Staphylococcus aureus overinfection in atopic dermatitis

Ricci

Dondi

Patrizi

2015

J Pediatr Infect Dis

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The skin of patients affected by atopic dermatitis (AD) is extremely susceptible to colonization by Staphylococcus aureus, which plays an important role in AD exacerbations and is correlated with AD extent and severity. The mechanisms by which the bacterium colonizes and infects the skin of patients with AD can be summarized by three different and subsequent steps: 1) a defective skin barrier, on which 2) S. aureus is able to adhere and proliferate thanks to 3) the defective immune response of the skin. Several S. aureus strains can secrete enterotoxins, which can act as superantigens thus contributing to disease severity by inducing a polyclonal T-cell activation and the release of proinflammatory cytokines such as TNFα, IL-1β, IL-2. The production of immunoglobulin E antibodies against staphylococcal exotoxins has also been demonstrated, and the staphylococcal wall protein A has been suggested to act as a "superallergen". Therapeutical actions against S. aureus skin overinfection include both pharmacological (antimicrobial and/or anti-inflammatory therapy and the newer topical calcineurin inhibitors) and nonpharmacological treatments (silk fabric textiles), and are aimed at minimizing skin colonization in order to reduce clinical exacerbations and AD severity.

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Section: Non-pharmacological Treatmentsmentioning

confidence: 99%

Staphylococcus aureus overinfection in atopic dermatitis

Ricci

Dondi

Patrizi

2015

J Pediatr Infect Dis

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“…Sporadic case of cancer set during treatment are reported. However, several groups [38–41] have focused on the evidence of TCIs' carcinogenetic role and have agreed that data are inconclusive and further studies must be done. Furthermore recent vehicle-controlled trials indicate efficacy of proactive treatment with tacrolimus in association with corticosteroides to prevent AE flares [42] At present however tacrolimus (Protopic) and pimecrolimus (Elidel) ointment have to be considered second-line treatments for AD in children [43].…”

Section: Therapymentioning

confidence: 99%

Atopic Dermatitis and the Atopic March: What Is New?

et al. 2011

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Objective. In this paper the authors review the management of atopic dermatitis (AD) and the association between AD and allergic respiratory diseases. Data Sources. PubMed databases, researching articles in the last 15 years. Results. Studies about atopic march are cross-sectional population studies at different ages. They show that the most important predisposing factor for atopy is a decrease of the filaggrin's expression. Conclusions. The most modern theories seem to show that the most important factor which starts the atopic march is represented by an impaired epidermal barrier. It causes an increase in skin permeability to allergens that could induce sensitization even in the airways. The major predisposing factor is a primary inherited epithelial barrier defect resulting from filaggrin gene mutation, but other factors may play a role in this complex mechanism. Further studies are needed to focus on AD treatment and preventive strategies.

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“…Nevertheless, at present, tacrolimus and pimecrolimus are only considered second-line treatments for eczema. [70] It is noteworthy that a recent Cochrane review about topical pimecrolimus for eczema states that topical tacrolimus 0.1% and moderate and potent topical corticosteroids are more effective than pimecrolimus, and that its role in the treatment of eczema is still uncertain because of a lack of key comparisons with mild corticosteroids. [71] …”

Section: Treatment Guidelines and Algorithmsmentioning

confidence: 99%

Useful Tools for the Management of Atopic Dermatitis

Ricci

Dondi

Patrizi

2009

American Journal of Clinical Dermatology

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Eczema, frequently named atopic dermatitis, is the most frequent chronic skin disease of early childhood, with a high prevalence in industrialized countries and a relapsing-remitting course that is responsible for a serious burden on affected children and their families. Even though most facets of this disease are nowadays well known and numerous guidelines are available, some confusion still exists regarding certain aspects. First, several names have been proposed for the disorder. We suggest that the name and definition adopted by the World Allergy Organization should be used: 'eczema,' divided into 'atopic,' when an allergic sensitization can be demonstrated, and 'non-atopic,' in the absence of sensitization. Several diagnostic criteria have been proposed, but at present the two most reliable are the 2003 revision by the American Academy of Dermatology of the Hanifin-Rajka criteria, and those by Williams revised in 2005. To date, 20 different clinical scores have been published to assess the severity; however, only the EASI (Eczema Area and Severity Index), the SCORAD (SCORing Atopic Dermatitis), and the POEM (Patient-Oriented Eczema Measure) seem to have been adequately validated and are recommended for use in clinical practice and trials. The diagnostic tests to identify associated allergy or sensitization include skin-prick tests, determination of the specific IgE in serum using different assays, and atopy patch tests; in the case of suspected food allergy, a food challenge may be necessary to define the diagnosis. To evaluate quality of life, tools exist that allow both the child's and family's impairment to be considered. In addition, several algorithms exist to help decide therapy on a step-wise basis. However, such guidelines and algorithms represent only an aid to the physician and not an obligatory directive, since the ultimate judgment regarding any therapy must be performed by the physician and tailored to individual needs. A clear and validated definition of eczema control would permit better monitoring of the disease, similar to the situation with asthma in recent years. Finally, the review examines the role of special textiles in diminishing Staphylococcus aureus skin superinfection, of house dust-mite avoidance measures, and of educational programs for patients and their families, which may all help improve eczema.

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Role of Topical Calcineurin Inhibitors on Atopic Dermatitis of Children

Cited by 6 publications

References 73 publications

Staphylococcus aureus overinfection in atopic dermatitis

Staphylococcus aureus overinfection in atopic dermatitis

Atopic Dermatitis and the Atopic March: What Is New?

Useful Tools for the Management of Atopic Dermatitis

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