Strategies for Successful Management of Severe Atopic Dermatitis

Brar, K. S.; Nicol, Noreen Heer; Boguniewicz, Mark

doi:10.1016/j.jaip.2018.10.021

Cited by 32 publications

(35 citation statements)

References 108 publications

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“…AD is also associated with an increased risk of irritant and allergic contact dermatitis, and hand dermatitis. 2,4,5,12,18 Remarkably in children, sleep disturbances may be related with growth impairment, lower school performance, attention deficit hyperactivity disorders, and higher accident risks. 9 Potentially under-recognized AD non-allergic comorbidities include cutaneous and extra-cutaneous infections, other autoimmune-or immune-mediated diseases, neuropsychiatric conditions, and emerging comorbidities, such as obesity, cardiovascular and metabolic diseases, as well as specific cancers.…”

Section: Comorbiditiesmentioning

confidence: 99%

“…Treatment should be paired with a formal patient and caregiver treatment education program in order to achieve the best outcomes. 2,12,14,15,18,25 Microbial colonization and superinfection may cause disease exacerbation and require additional treatment. Allergen-specific immunotherapy with aeroallergens may be considered in selected cases.…”

Section: Disease Management and Therapeutic Approachesmentioning

confidence: 99%

“…Also, adequate skin care and hygiene procedures in cleansing, bathing and dressing play a relevant role in AD management and should be discussed with the patient and included in the above-mentioned educational intervention. 6,7,12,14,18 Basic therapy is also focused on treating disturbed barrier function by hydrating and lubricating topical treatment, the backbone of therapy for patients with mild-to-moderate AD, along with adequate cleansing/bathing practices. 6,12,14,18,25 When used on a daily basis, moisturizers with non-aqueous emollients, occlusive agents and humectants improve barrier function, reduce AD signs and symptoms, and the need for topical corticosteroids.…”

Section: Disease Management and Therapeutic Approachesmentioning

confidence: 99%

“…2 Although the underlying mechanisms causing these conditions are largely unknown and the absolute magnitude of the risks has not yet been well defined, AD has been considered more recently as a systemic disorder associated with increased risk of various allergic and non-allergic comorbidities, namely food allergies, respiratory disorders, cutaneous and extra-cutaneous infections, neuropsychiatric conditions, other inflammatory and autoimmune diseases, lymphoma, and cardiovascular disease, with important implications for management and treatment. 1,2,5,6,[9][10][11][12][13] Therapeutic goals require a multistep approach, focused on reducing pruritus and establishing disease control. Treatment selection is based primarily on disease severity but also on the patient's age, comorbidities, compliance, and costs.…”

Section: Introductionmentioning

confidence: 99%

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Update on Atopic Dermatitis

Torres¹,

et al. 2019

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With an increasing prevalence during the past decades, atopic dermatitis has become a global health issue. A literature search following a targeted approach was undertaken to perform this non-systematic review, which intends to provide an overview of the epidemiology, pathophysiology, clinical features, comorbidities, and current therapies for the treatment of atopic dermatitis. In sum, this is a heterogeneous skin disorder associated with variable morphology, distribution, and disease course. Although not completely understood, its pathogenesis is complex and seems to result from a combination of genetic and environmental factors that induce skin barrier dysfunction, cutaneous and systemic immune dysregulation, skin microbiota dysbiosis, and a strong genetic influence. Diagnosis is based on specific criteria that consider patient and family history and clinical manifestations. Overall disease severity must be determined by evaluating both objective signs and subjective symptoms. Therapeutic goals require a multistep approach, focusing on reducing pruritus and establishing disease control. Patients should be advised on basic skin care and avoidance of triggers. Topical anti-inflammatory agents should be considered in disease flares or chronic/recurrent lesions. In case of inadequate response, phototherapy, systemic immunosuppressants and, more recently, dupilumab, should be added. Nevertheless, the treatment of moderate-to-severe atopic dermatitis remains challenging and novel, efficacious, safe and targeted treatments are urgently needed. In conclusion, although the last few years have seen important improvement in the understanding of the disease, future research in atopic dermatitis will continue exploring gene-environment interactions and how it affects pathophysiology, disease severity, and treatment outcomes.

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Section: Comorbiditiesmentioning

confidence: 99%

Section: Disease Management and Therapeutic Approachesmentioning

confidence: 99%

Section: Disease Management and Therapeutic Approachesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Update on Atopic Dermatitis

Torres¹,

et al. 2019

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“…Skin lesions can be present in a large body‐surface area and are frequently associated to an intense and persistent pruritus, which is one of the main features of the disease. Patients with moderate‐to‐severe grade of disease have often poor results with steroidal topical therapies, and systemic treatments are associated with toxic effects . The requirement of effective and safe long‐term treatments for AD has prompted the development of novel therapeutic targets.…”

Section: Atopic Dermatitismentioning

confidence: 99%

Biologicals targeting type 2 immunity: Lessons learned from asthma, chronic urticaria and atopic dermatitis

et al. 2019

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During the last decades, progression of research has led to great achievements for treatment and therapy of several disabling disorders, particularly in the field of chronic inflammatory diseases. The increased knowledge of the molecular mechanisms operating in such diseases has represented the first step in this process, and the discovery of molecules able to interfere with the natural history of the diseases, has been the second. This review is focused on the effects of biologics on type 2 diseases such as asthma, chronic urticaria and atopic dermatitis, both biologics just approved for clinical application and also those that are currently undergoing clinical trials. We will also discuss aspects and emphasize clinical trials and recently published studies, as well as research that is currently in the progress, which will be highly relevant for basic immunologists. Likewise, we will cover aspects that are pertinent for clinical immunologists and highlight translational studies that are evaluating novel biologicals in animal models.Keywords: atopic dermatitis r bronchial asthma r chronic urticaria r precision medicine

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Where and how have written action plans for atopic eczema/dermatitis been developed and evaluated? Systematic review

Thandi

Constantinou

Vincent

et al. 2023

Skin Health and Disease

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Background Atopic eczema/dermatitis is a common inflammatory condition which affects 15%–30% of children and 2%–10% of adults. It can have a significant impact and its management can be challenging. It is important for patients, parents, and caregivers to know how to look after their skin. Objectives To identify and review written eczema action plans (WAPs) that are available internationally for use by patients, parents, and caregivers. Methods We followed Preferred Reporting Items for Systematic reviews and Meta‐analysis guidelines. We searched relevant databases (MEDLINE, Embase, COCHRANE) from inception until March 2022. We sought grey literature via Google searches and professional networks. Database search results were independently reviewed by two different reviewers. With identified WAPs, we assessed length, appearance, content, how it was developed and whether it had been evaluated. Results From 312 abstracts, supplemented by other searches, we identified 20 unique eczema WAPs. From nine countries, all were written in English with 18 were designed for children. For the majority, it was unclear whether any development work preceded their creation or the intended clinical setting for use. Nineteen had a stepwise approach, 17 advised when to seek help, 6 were visually appealing and 6 had a rationale behind treatment documented in the WAP. Only three had been evaluated in clinical trials. Conclusion Further evaluation is needed to assess the effectiveness of the WAPs that currently exist, prior to creating further WAPs. Patient and caregiver involvement is needed in any future work.

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Strategies for Successful Management of Severe Atopic Dermatitis

Cited by 32 publications

References 108 publications

Update on Atopic Dermatitis

Update on Atopic Dermatitis

Biologicals targeting type 2 immunity: Lessons learned from asthma, chronic urticaria and atopic dermatitis

Where and how have written action plans for atopic eczema/dermatitis been developed and evaluated? Systematic review

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