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Atopic eczema
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Atopic eczema is diagnosed on the basis of the presence of a typical rash associated with itching. Younger children may have the typical rash on the extensor surfaces (rather than the usual flexural surfaces) and the cheeks. A history of atopy in the child or in a first-degree relative helps aid the diagnosis. The underlying mechanisms in atopic eczema have been probed extensively. The two major causative factors are considered to be a defective skin barrier function and skin inflammation. The breakdown in the skin defensive mechanisms, through a variety of mechanisms, is thought to increase the likelihood of allergen absorption and infection with microbial colonisation. Filaggrin gene defects have recently been identified as one of the underlying mechanisms increasing the risk of developing atopic eczema and asthma via altered skin barrier function (van den Oord and Sheikh, 2009). Cutaneous inflammation is triggered and maintained by a whole host of pro-inflammatory cytokines. Various inflammatory mediators are implicated and are serving as markers for research and future targeted drug development.
Dermatology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Atopic eczema typically presents as an intense, itchy, erythematous rash on the flexure surfaces, sparing the groin and axillary regions. The rash typically starts in childhood and is episodic in nature. The clinical presentation varies from mild to severe.
The Integumentary (Dermatologic) System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Several drugs are commonly used in topical or systemic preparations for dermatological conditions. Topical corticosteroids are used in the treatment of atopic eczema, all inflammatory and pruritic eruptions, and hyperplastic and infiltrative disorders. Brief courses of systemic corticosteroids are indicated for severe contact dermatitis.
Dupilumab for the treatment of atopic dermatitis: real-world data from the Czech Republic BIOREP registry
Published in Journal of Dermatological Treatment, 2022
Martina Kojanova, Milena Tanczosova, Daniela Strosova, Petra Cetkovska, Jorga Fialova, Tomas Dolezal, Alena Machovcova, Spyridon Gkalpakiotis
The most frequent reasons for discontinuation of dupilumab were ineffectiveness, side effects, and patient request or non-cooperation. In our cohort, only 16 patients (4.4%) terminated treatment. The most common reason for discontinuation of dupilumab therapy was lack of effectiveness (1.1%), followed by non-compliance (0.8%) and adverse events (0.8%). Similar reasons for discontinuation have been reported in other real-world studies. In the BioDay registry with 210 patients, a total of 8.1% had discontinued dupilumab treatment during the one-year follow-up, 3.8% because of adverse effects and 4.3% due to ineffectiveness (27); in the same registry during the two-year follow-up, out of a total of 358 patients, 9% of patients had discontinued treatment, the most frequent reason was side effects in 4% of patients, 2% discontinued treatment because of ineffectiveness, 0.5% due to a combination of both and 2% were lost to follow-up (28). In the TREatment of ATopic eczema Registry (221 patients), 6.3% had discontinued treatment, half of them were due to ineffectiveness (29). In a single-center study conducted by Wang et al. with a cohort of 77 patients, the lack of effectiveness (7.8%) and adverse events (7.8%) were the most common reasons for termination of the treatment (17). In a French multicenter study, adverse events were described as a reason for termination in 11.3% of cases, inefficiency in 3.8%, and wish of patient in 3.4% (25).
The prevention effect of probiotics against eczema in children: an update systematic review and meta-analysis
Published in Journal of Dermatological Treatment, 2022
Shuya Sun, Guizhen Chang, Litao Zhang
In conclusion, we could confirm that the prevention of eczema and atopic eczema among children represents a potential indication for probiotic use during pregnancy and early infancy, especially mothers’ intake significantly contributes to reducing the risk of eczema and atopic eczema, which may become a novel prevention strategy. What’s more, probiotics are effective on eczema prevention ≤2 year of age but perform well in further prevention against atopic eczema, more evidences are needed. As the pathogenesis of infantile eczema and atopic eczema are not fully understood yet, and no effective and detailed treatment is available at the moment. It is essential for further studies on effective methods for the prevention of these diseases, especially the appropriate time to begin oral probiotic supplement, the suitable objects and way of accepting probiotic supplement, the exact composition of probiotic supplement to achieve the longest-term benefit (33).
Human mesenchymal stem cell-derived exosomes accelerate wound healing of mice eczema
Published in Journal of Dermatological Treatment, 2022
Miao Wang, Yang Zhao, Qingyi Zhang
Our results indicated that MSC-exs can inhibit the proliferation of peripheral mononuclear cells and promote their differentiation into Treg cells, suggesting that MSC-exs can regulate Th1/Th2 immune balance, inhibit local inflammatory reaction and reduce tissue damage. The exact pathogenesis of atopic eczema remains unclear. It is generally believed that based on genetic factors, allergens invade the skin, causing abnormal immune response and inflammation. Recent studies (4,25) have shown that CD4 + CD8+ T cells infiltrating in contact dermatitis can release inflammatory mediators and cause pathological reactions such as exudative edema, Tregs dysfunction and other pathological reactions. As a result, the suppressive function to Th2 cells is weakened, which leads to the hyperfunction of Th2 cells and a series of allergic reactions. Verhagen et al. (4) found that native Tregs were not detected locally in the skin lesions of patients with atopic dermatitis, and that adaptive Tregs and their cytokines and corresponding receptors were locally expressed in large quantities, suggesting that functional defects in natural regulatory Treg cells plays an important role in atopic dermatitis.