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Arraia da Bessa 2022 Group

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ATOPIC DERMATITIS THERAPY Fix


To diagnose atopic dermatitis, your health care provider will likely talk with you about your symptoms, examine your skin and review your medical history. You may need tests to identify allergies and rule out other skin diseases.




ATOPIC DERMATITIS THERAPY



Your doctor may recommend patch testing on your skin. In this test, small amounts of different substances are applied to your skin and then covered. During visits over the next few days, the doctor looks at your skin for signs of a reaction. Patch testing can help diagnose specific types of allergies causing your dermatitis.


Treatment of atopic dermatitis may start with regular moisturizing and other self-care habits. If these don't help, your health care provider might suggest medicated creams that control itching and help repair skin. These are sometimes combined with other treatments.


Light therapy. This treatment is used for people who either don't get better with topical treatments or rapidly flare again after treatment. The simplest form of light therapy (phototherapy) involves exposing the affected area to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) alone or with drugs.


Though effective, long-term light therapy has harmful effects, including premature skin aging, changes in skin color (hyperpigmentation) and an increased risk of skin cancer. For these reasons, phototherapy is less commonly used in young children and is not given to infants. Talk with your health care provider about the pros and cons of light therapy.


Atopic dermatitis can make you feel uncomfortable and self-conscious. It can be especially stressful, frustrating or embarrassing for adolescents and young adults. It can disrupt their sleep and even lead to depression.


Atopic dermatitis is a chronic condition that causes itchy skin that gets dry and scaly. It tends to come and go and may only be in childhood or may affect you your entire life. In people with light-colored skin, atopic dermatitis looks like red rashes. People with darker skin may develop brown, purple or gray rashes.


Atopic dermatitis is most common in children, but it can occur at any age. The condition affects people assigned male at birth (AMAB) and people assigned female at birth (AFAB) in equal numbers. Black people are slightly more likely to develop the condition compared to white people. Of all the people affected by atopic dermatitis, 65% develop the condition within the first year of life, while 90% develop the condition before age 5.


The condition is quite common. Approximately 1 out of every 10 babies and young children develops symptoms of atopic dermatitis. Almost two-thirds of those affected continue to have flare-ups on into adulthood.


Atopic dermatitis (atopic eczema) is a chronic relapsing and remitting inflammatory skin disease affecting one in 10 people in their lifetime. Atopic dermatitis is caused by a complex interaction of immune dysregulation, epidermal gene mutations, and environmental factors that disrupts the epidermis causing intensely pruritic skin lesions. Repeated scratching triggers a self-perpetuating itch-scratch cycle, which can have a significant impact on the patient's quality of life. The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings. Maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers. Use of topical corticosteroids is the first-line treatment for atopic dermatitis flare-ups. Pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment. Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate. Antistaphylococcal antibiotics are effective in treating secondary skin infections. Oral antihistamines are not recommended because they do not reduce pruritus. Evidence is lacking to support the use of integrative medicine in the treatment of atopic dermatitis. Newer medications approved by the U.S Food and Drug Administration, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost prohibitive for most patients.


Atopic dermatitis (AD) is a common inflammatory skin disorder characterized by recurrent eczematous lesions and intense itch. Although it most often starts in infancy and affects children, it is also highly prevalent in adults. In this article, the main aspects of AD have been updated, with a focus on the pathogenetic and therapeutic aspects. The pathogenesis of AD is complex, and it is evident that a strong genetic predisposition, epidermal dysfunction, skin microbiome abnormalities, immune dysregulation, and the neuroimmune system are critical in AD development. Mutations in the genes associated with disrupted epidermal barrier, exaggerated pathological inflammation and inadequate antimicrobial peptides can promote enhanced Th2 inflammation and mediate pruritus. Current understanding of etiology highlights gut microbial diversity, NK cell deficiency, and different immunological phenotype with age and race. For topical anti-inflammatory treatment for mild-to-severe AD, phosphodiesterase 4 inhibitors (PDE-4), JAK inhibitors, and microbiome transplantation with Roseomonas mucosa provided more management selections. The treatment of moderate-to-severe AD has been limited to merely symptomatic and relatively nonspecific immunosuppressive approaches. In-depth understanding of the pathogenesis of AD has led to the development of innovative and targeted therapies, such as biologic agents targeting interleukin (IL)-4, IL-13 and JAK/STAT inhibitors. Other potential therapeutic agents for AD include agents targeting the T helper (Th) 22 and Th17/IL23 pathway. Antipruritic therapy and complementary probiotics therapy have also been reviewed.


Atopic eczema or dermatitis (AD) is a chronically relapsing dermatitis associated with pruritus, sleep disturbance, psychosocial symptoms, and impaired quality of life. It affects 10-20 % of school-aged children, and there is evidence to suggest that this prevalence is increasing. Filaggrin (filament-aggregating protein) has an important function in epidermal differentiation and barrier function. Null mutations within the filaggrin gene cause ichthyosis vulgaris and appear to be a major risk factor for developing AD. The affected skin of atopic individuals is deficient in filaggrin degradation products or ceramides. Avoidance of triggering factors, optimal skin care, topical corticosteroids, and calcineurin inhibitors are the mainstays of therapy for AD. Proper moisturizer therapy can reduce the frequency and intensity of flares, as well as the need for topical corticosteroids or topical calcineurin inhibitors. Recent advances in the understanding of the pathophysiological process of AD involving filaggrin and ceramides has led to the concept of barrier therapy and the production of new moisturizers and topical skin products targeted to correct reduced amounts of ceramides and natural moisturizing factors in the skin with natural moisturizing factors, ceramides, and pseudoceramide products. Emollients, both creams and ointments, improve the barrier function of the stratum corneum by providing it with water and lipids. Studies on AD and barrier repair treatment show that adequate lipid replacement therapy reduces the inflammation and restores epidermal function. We reviewed 12 randomized trials and 11 cohort studies and found some evidence that certain products had therapeutic efficacy in improving clinical and/or biophysical parameters of patients with AD. Nevertheless, study methods were often flawed and sample sizes were small. Additional research is warranted to better understand the optimal formulary compositions. Also, long-term studies would be important to evaluate whether lipid barrier replacement therapy reduces bacterial colonization or prevents progression of the atopic march.


"Results from MEASURE-AD broaden awareness of the continued burden that people living with atopic dermatitis experience every day and of the potential link between disease severity, treatment approach and overall impact on patient-reported quality of life," said Juan Francisco Silvestre, M.D., attending dermatologist, General University Hospital of Alicante in Alicante, Spain, and investigator for the MEASURE-AD study. "These real-world analyses underscore the multidimensional burden of atopic dermatitis and the need for more therapeutic options for patients."


This post-hoc analysis titled, "Real-World Burden in Patients with Atopic Dermatitis Who Are Candidates for Systemic Therapy and Currently Receiving No Systemic Therapy, No Treatment, Topical Therapy Only, or Systemic Therapy: Results from a Real-World Multicountry Study," showed greater clinical, psychosocial and economic burden among adult patients with moderate to severe atopic dermatitis not receiving systemic therapy versus those receiving systemic therapy.1 Additionally, data suggested that many patients living with atopic dermatitis may be undertreated, with only half of eligible patients receiving systemic therapy.1


For more than a decade, AbbVie has worked to uncover new solutions and improve care for people with serious skin diseases, including psoriasis, psoriatic arthritis, hidradenitis suppurativa and atopic dermatitis. With a broad clinical trial program, we continue to actively research and adapt to the evolving needs of the dermatology community and advance our pipeline to help people achieve their treatment goals and live beyond their skin disease. For more information on AbbVie in dermatology, visit -science/therapeutic-focus-areas/immunology/immunology-focus-areas/dermatology.html.


* Measures included Eczema Area and Severity Index (EASI), Worst Pruritus Numeric Rating Scale (WP-NRS), Validated Investigator Global Assessment for AD (vlGA-AD), body surface area affected (BSA), average hours slept per night and number of participants with inadequately controlled atopic dermatitis. 041b061a72


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