Atopic dermatitis (eczema)

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Belgian observational drug utilization study of pimecrolimus cream 1% in routine daily practice in atopic dermatitis.

Dermatology. 2008;217(2):156-63

Authors: De Backer M, Morren MA, Boonen H, Boyden B, Vertruyen A, Lecomte P, Paquay C, Lesaffre E, Lambert J

BACKGROUND: For reimbursement purposes of pimecrolimus cream 1%, the Belgian authorities asked to document its consumption, its topical corticosteroid-sparing effect and quality of life within the routine clinical practice. OBJECTIVES: We aimed to address the 3 queries of the Belgian authorities. METHODS: An open-label, observational, multicentre, 1-year study under drug prescription was performed. RESULTS: A total of 416 consecutive patients were enrolled in 49 centres. The mean annual amount of prescribed pimecrolimus cream 1% per patient was 120.8 g (SD = 117.0), with an estimated consumption of 104.4 g (SD = 117.6). The median annual amount prescribed was 90.0 g [interquartile range (IQR) = 45-150] and the estimated consumption 63.6 g (IQR = 32.4-132). Topical corticosteroids had been used before the study in 81.7% of the population. With pimecrolimus cream 1% during the study, 83.3% of the previous corticosteroid users stated less topical corticosteroid use than before and 36% of them did not apply topical corticosteroids at all during the study. The mean improvements compared to baseline in Parents’ Index Quality of Life-Atopic Dermatitis and Quality of Life Index-Atopic Dermatitis scores were 34.5% (SD = 84.3) and 31.2% (SD = 70.8), respectively. The median improvements were 50.0% (IQR = 12.5-85.7%) and 46.4% (IQR = 0.0-85.0%), respectively. CONCLUSIONS: In routine practice the consumption of pimecrolimus cream 1% is relatively low, with corticosteroid-sparing effect, improvement in quality of life and good tolerability.

PMID: 18525202 [PubMed - indexed for MEDLINE]

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Prognostic factor of adult patients with atopic dermatitis.

J Dermatol. 2008 Aug;35(8):477-83

Authors: Katoh N, Hirano S, Kishimoto S

The increased prevalence of atopic dermatitis (AD) in adults in recent decades suggests that dermatologists may be expected to estimate the prognosis of adult patients with AD when they visit as new patients. We therefore evaluated the change in the extent of involvement and analyzed the factors that contribute to the prognosis of adult AD. A retrospective chart review was performed for 65 adults patients (median age at first visit, 25 years) with AD who had been followed monthly for over 10 years. The median area of involvement at first visit was 19%. The area of the eruptions and peripheral eosinophil counts decreased significantly in the fifth and 10th years with standard treatment. The values of immunoglobulin (Ig)E were also reduced after 10 years. Patients with high values of serum total IgE and peripheral eosinophil count, and long duration of AD had wide areas of eruptions 10 years after the first visit. Total IgE had the highest correlation with area of involvement after 10 years. Although the prognosis of adult AD is not poor, patients with high IgE values are expected to have ongoing eczema with wide distribution after 10 years of follow up.

PMID: 18789066 [PubMed - indexed for MEDLINE]

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Possible pathogenic role of Th17 cells for atopic dermatitis.

J Invest Dermatol. 2008 Nov;128(11):2625-30

Authors: Koga C, Kabashima K, Shiraishi N, Kobayashi M, Tokura Y

The critical role of IL-17 has recently been reported in a variety of conditions. Since IL-17 deeply participates in the pathogenesis of psoriasis and keratinocyte production of certain cytokines, the involvement of T helper cell 17 (Th17) in atopic dermatitis (AD) is an issue to be elucidated. To evaluate the participation of Th17 cells in AD, we successfully detected circulating lymphocytes intracellularly positive for IL-17 by flow cytometry, and the IL-17+ cell population was found exclusively in CD3+CD4+ T cells. The percentage of Th17 cells was increased in peripheral blood of AD patients and associated with severity of AD. There was a significant correlation between the percentages of IL-17+ and IFN-gamma+ cells, although percentage of Th17 cells was not closely related to Th1/Th2 balance. Immunohistochemically, IL-17+ cells infiltrated in the papillary dermis of atopic eczema more markedly in the acute than chronic lesions. Finally, IL-17 stimulated keratinocytes to produce GM-CSF, TNF-alpha, IL-8, CXCL10, and VEGF. A marked synergistic effect between IL-17 and IL-22 was observed on IL-8 production. The number of Th17 cells is increased in the peripheral blood and acute lesional skin of AD. Th17 cells may exaggerate atopic eczema.

PMID: 18432274 [PubMed - indexed for MEDLINE]

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A role for Th17 cells in the immunopathogenesis of atopic dermatitis?

J Invest Dermatol. 2008 Nov;128(11):2569-71

Authors: Di Cesare A, Di Meglio P, Nestle FO

Atopic dermatitis (AD) is a common inflammatory skin disease. Both epidermal barrier dysfunction and immunodysregulation are suggested to influence the pathogenesis of AD. AD has been considered a paradigmatic T helper cell (Th) 2-mediated disease, with a switch to a Th1 cell environment during the chronic phase of the disease. Previously unreported findings now suggest a possible role for Th17 cells as well.

PMID: 18927538 [PubMed - indexed for MEDLINE]

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