Abstract
Atopic dermatitis is a chronic inflammatory disease that arises from polygenic disposition, a dysfunction of the physicochemical epithelial barrier, a cutaneous dysbiosis, and a faulty neurosensory activity and shows a highly individual acuity due to epigenetic factors. An essential component of therapeutic management is the application of anti-inflammatory topical medication. Currently, topical glucocorticoids and topical calcineurin inhibitors are routinely used in reactive and proactive therapy. In recent years, the development of molecular medicine has identified several new therapeutic targets that have enabled the development of innovative therapeutic approaches. In addition to phosphodiesterase-4 inhibitors and aryl hydrocarbon receptor modulators, it is mainly Janus kinase inhibitors with different selectivity that are emerging as new effective and safe options for topical therapy. The current data suggests that in the coming months and years representatives of the above-mentioned substance classes will be approved for topical use.
Highlights
Received July 22, 2021; accepted in revised form August 6, 2021Correspondence to Prof
Based on a polygenic disposition, facilitated by the barrier damage, after exogenous triggering for example by allergens, pollutants, microbial antigens, toxins, or scratching, interleukin 25 (IL-25), IL33 as well as thymic stromal lymphopoietin (TSLP) are released as so-called “alarmins” by keratinocytes [1]
These condition the activation of dendritic cells (DC) as well as the release of IL-13 by innate lymphoid cells
Summary
In the phase of maintenance therapy with an efficient systemic therapeutic agent is it possible in most cases to omit the use of anti-inflammatory topical medication. The use of topical medication with anti-inflammatory agents is propagated in a phase-specific manner This means that the choice of vehicle system and the active drug ingredient are selected and adjusted according to the disease activity in the therapeutic area [4]. The importance of the aryl hydrocarbon receptor (AhR) has been highlighted This is a cytoplasmic receptor system that migrates to the nucleus after complexation with appropriate ligands and here induces the expression of anti-inflammatory cytokines as well as barrier proteins (for example, filaggrin) via the regulation of transcription factors. Pharmaceutical development of CBD-containing topical medications for use in AD outside of narcotic status will become feasible, and larger studies can provide objective verification of efficacy
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