Facial Atopic Dermatitis Research Articles

Facial atopic dermatitis is associated with sensitization to cow's milk, egg whites, and peanuts in children under 36 months

Atopic dermatitis (AD) in early childhood often precedes the development of food sensitization and allergy, but the role of treating AD to prevent food allergy remains poorly understood. Our objective was to assess the relationship between facial dermatitis and food sensitization to cow's milk, egg whites, and peanuts in early childhood, as aggressive treatment of facial dermatitis could serve as a potential opportunity for food sensitization prevention. By 3 years of age, food sensitization levels to cow's milk, egg whites, and peanuts were 48% greater in children with facial AD than in children with no facial involvement of their AD. Additional research is needed to determine if facial involvement of AD in infants and young children is associated with increased food allergy.

Effectiveness of tacrolimus ointment for dupilumab‐resistant facial erythema

AbstractSome patients treated with dupilumab for atopic dermatitis (AD) develop resistance on their face, despite achieving good response on other body parts. The pathomechanisms of dupilumab‐resistant facial erythema (DRFE) are unclear and its treatment is challenging. We report a case of DRFE resistant to topical corticosteroids and delgocitinib that was successfully treated with tacrolimus ointment. Tacrolimus ointment was not effective for his facial AD before dupilumab initiation but was effective for DRFE, suggesting that DRFE has a different pathomechanism from AD.

Effectiveness and safety of tacrolimus ointment combined with dupilumab for patients with atopic dermatitis in real-world clinical practice.

Atopic dermatitis (AD) is the most common inflammatory skin disease affecting people of all age groups worldwide. To our knowledge, there are currently no studies estimating the effectiveness of tacrolimus ointment and dupilumab as a combination therapy for AD. Thus, here we describe the effectiveness and safety of tacrolimus ointment in combination with dupilumab for facial rashes in patients with AD. Overall, we included 109 patients who newly received dupilumab from April 2018 to July 2020 in the Dermatology Department of Hyogo College of Medicine Hospital. Of them, 60 patients were treated with tacrolimus ointment. Specifically, of the 60 patients, 40 were treated with dupilumab in combination with tacrolimus ointment and topical steroids, whereas the remaining 20 were prescribed tacrolimus ointment alone and were further analyzed. The analysis showed that the combination does not cause serious side-effects at high frequency. The patients showed rapid improvement of facial dermatitis along with systemic dermatitis, and the rate of improvement of head/neck Eczema Area and Severity Index (EASI) score significantly correlated with the rate of improvement of overall EASI score. In addition, there was no complication of herpes simplex observed in these 20 patients. Thus, tacrolimus ointment combined with dupilumab is an effective and safe treatment option for facial AD.

The FADS mouse: A novel mouse model of atopic keratoconjunctivitis

Atopic keratoconjunctivitis (AKC) is a chronic allergic conjunctival disease. However, a mouse model of AKC to investigate the underlying mechanism of the therapeutic agents and estimate their efficacy has not been established. We recently generated mice in which Ikk2 is specifically deleted in facial skin fibroblasts and found that these mice spontaneously develop atopic dermatitis (AD)-like facial skin inflammation and scratching behaviors; thus, we named them facial AD with scratching (FADS) mice. We sought to evaluate whether the ocular lesions that FADS mice spontaneously develop are similar to those of patients with AKC and to estimate the efficacy of topical treatments with tacrolimus and betamethasone for FADS mice by using tear periostin, a novel biomarker for allergic conjunctival disease. FADS mice, in which Ikk2 is deleted in dermal fibroblasts, were generated by crossing female Ikk2Flox/Flox mice to male Nestincre; Ikk2Flox/+ mice. We conducted histologic analysis of the ocular lesions in FADS mice. Furthermore, we measured periostin in the tears collected from FADS mice untreated or treated with tacrolimus or betamethasone. The FADS mice exhibited severe blepharitis and scratch behaviors for their faces. In these mice, corneal epithelium and stroma showed hyperplasia and infiltration of eosinophils, mast cells, and TH2/TC2 cells. Periostin was significantly expressed in the lesions and tear periostin was upregulated. Betamethasone showed more suppressive effects than did tacrolimus on severe corneal lesions and increased tear periostin level. The FADS mouse is a novel mouse model of AKC and is useful to examine the therapeutic effects of anti-AKC agents.

Effects of ruxolitinib cream on pruritus and quality of life in atopic dermatitis: Results from a phase 2, randomized, dose-ranging, vehicle- and active-controlled study

Atopicdermatitis (AD), a chronic, highly pruritic skin disorder, impairs quality of life (QoL). Janus kinase inhibitors suppress inflammatory and pruritus-associated cytokine signaling in AD. To report the effects of ruxolitinib (RUX) cream on itch and QoL in AD. A total of 307 adult patients with an Investigator's Global Assessment (score of 2 or 3) and 3% to 20% affected body surface area were randomly assigned for 8weeks to receive double-blind treatment with RUX (1.5% twice daily, 1.5% once daily, 0.5% once daily, or 0.15% once daily), vehicle twice daily, or triamcinolone cream (0.1% twice daily for 4weeks then vehicle for 4weeks). Itch was measured by using the numerical rating scale, and patient QoL was assessed with Skindex-16. Improvements in itch numerical rating scale and Skindex-16 were observed with RUX cream. Overall, 42.5% of patients who applied 1.5% RUX twice daily experienced minimal clinically important difference in itch within 36hours of treatment (vehicle, 13.6%; P<.01); near-maximal improvement was observed by week 4. Itch reduction was associated with improved QoL burden (Pearson correlation, 0.67; P<.001). Significant improvements in Skindex-16 overall scores were noted at week 2. Facial AD lesions were not treated. RUX cream provides a clinically meaningful reduction in itch and QoL burden.

얼굴아토피 피부염환자 45명의 한의학적 치료효과에 대한 후향적 연구

Objective : The purpose of this study is to report the effectiveness of a Korean Medicine Treatment on 45 facial atopic dermatitis patients. Methods : Total 45 facial atopic dermatitis patients, who has visited korean medical clinic in year 2011 were analyzed by Objective SCORAD Index(OSI) and Investigator's Global Assessment(IGA). Subanalysis of OSI and IGA were done according to topical ointment user/non-user, treatment period and change in IGA distribution. Results : 1. Male and female percent was 20%:80%. 17.8% were teens, 55.6% were twenties, 13.3% were thirties, 13.3% were above age forty. 64.4% were on topical ointment treatment of corticosteroid or calcineurin inhibitor, and 35.6% were not at the initial visit. Patients with family history were 44.4% and 62.2% had atopic dermatitis past history. 2. OSI and IGA were significantly lower after 1~3, 3~6, 6~9 month of treatment. Average post-treatment score was lower in longer-treated group. 3. IGA distribution has changed from average 3.42 at the first visit to 1.76 at final visit. 91.1% of total patients reported decrease in IGA at the final visit. 4. OSI and IGA improvement rate were significantly higher in non-topical ointment user than the user. Age, treatment period, initial OSI and IGA score difference were not significantly different. Conclusion : A significant percent of 45 facial atopic dermatitis patients who were treated with Korean Medicine Treatment reported decrease in OSI and IGA. The difference increased with the treatment period. Non-topical ointment users' improvement was significantly higher than topical ointment user.

Allergic contact eczema

Allergic contact eczema due to type IV reactions are more frequent than irritative eczema in facial skin, particularly in the sensitive periorbital region. Concomitant eczema of different locations is pathognomonic and allows a distinction from seborrhoic dermatitis. Avoidance of allergen exposure is mandatory for an effective treatment; therefore allergological examinations have a very high significance. Patch tests with a wide spectrum of potential allergens have to be included in these tests. Therapeutic regimes include a restrictive use of topical steroids. Substances like calcineurin inhibitors are the first-line therapy in facial atopic dermatitis, in spite of therapeutic effects, they have not yet been approved for other forms of periorbital dermatitis.

Severe Atopic Dermatitis and Transient Hypogammaglobulinemia in Children

We sought to describe the clinical outcomes of eight pediatric patients diagnosed with atopic dermatitis (AD) and hypogammaglobulinemia through retrospective review of medical records. All patients presented with severe facial AD. The mean and median ages of diagnosis of hypogammaglobulinemia were 6.2 months and 6.5 months, respectively, with a mean immunoglobulin G (IgG) level of 156 mg/dL. Seven of the eight patients identified in our search demonstrated simultaneous improvement in AD and serum IgG levels within 2 years of initial presentation, suggesting a diagnosis of transient hypogammaglobulinemia. The remaining patient demonstrated normalization by age 6, but no IgG levels had been measured between initial presentation and age 6. The five patients who were tested for specific antibody response to tetanus and Haemophilus influenzae type b vaccination all produced protective responses. All eight patients initially presented with high serum IgE levels. On initial evaluation, three patients had leukocytosis (white blood cell count >18,000 cells/μL), and six had peripheral blood eosinophilia. Three patients outgrew their AD by age 5, and five had clinically good to excellent control of their AD at their last visit, coincident with normalization of IgG levels. Although severe AD and immunoglobulin deficiency may rarely be associated with complex immunodeficiency disorders, our observations suggest that, with careful immunologic monitoring and diligent skin care, most children who present with severe AD and hypogammaglobulinemia exhibit improvement in dermatitis and serum IgG levels within 2 years of onset without major complications.

Effective Treatment of Facial Redness Caused by Atopic Dermatitis Using Intense Pulsed Light Systems

Patients with facial atopic dermatitis (AD) experience psychological and social distress. To evaluate the safety and the efficacy of intense pulsed light (IPL) treatment in patients with facial AD. Eleven patients (9 men, 2 women; aged 14-39) with mild to moderate refractory facial AD were included in this study. In three separate sessions at 2-week intervals, the whole face was exposed to an IPL device using a 590-nm cut-off filter. Objective clinical response was examined using the Eczema Severity Score (ESS), a polarization color imaging system, and two dermatologists' evaluations. Data on quality of life were evaluated using the Dermatology Life Quality Index (DLQI). The ESS in 11 patients with facial AD was significantly lower 4 weeks after the third treatment (p=.005). Scaling (p=.003); edema, induration, and papules (p=.011); erythema (p=.009), and lichenification (p=.008) improved significantly. The erythema scale, examined using the polarization color imaging system, also decreased significantly (p=.04). No patients showed any noticeable side effects. Mean DLQI score improved significantly after the completion of therapy (from baseline to 4 weeks after the last IPL treatment; p=.005). IPL treatment could be used as an adjunct modality for the treatment of refractory facial AD with minimal side effects.

The treatment of facial atopic dermatitis in children who are intolerant of, or dependent on, topical corticosteroids: a randomized, controlled clinical trial

The treatment of facial atopic dermatitis in children who are intolerant of, or dependent on, topical corticosteroids: a randomized, controlled clinical trial

Superiority of tacrolimus 0·1% ointment compared with fluticasone 0·005% in adults with moderate to severe atopic dermatitis of the face: results from a randomized, double-blind trial

No specific data are available on tacrolimus ointment as a second-line treatment in adults with facial eczema. To compare tacrolimus 0.1% and fluticasone 0.005% ointments in adults with moderate to severe atopic dermatitis (AD) of the face in whom conventional treatment was ineffective or poorly tolerated. Patients were randomized to double-blind treatment of facial AD with twice-daily tacrolimus ointment (n = 288) or fluticasone ointment (n = 280) for 3 weeks or until clearance. After day 21, patients could continue without the study treatment, apply the same ointment once daily, or switch to the other medication twice daily, depending on lesion clearance and patient/physician satisfaction. The primary endpoint was the day-21 response [> or = 60% reduction in the modified Local Eczema and Severity Index (mLEASI) score]. Secondary endpoints included facial erythema and pruritus, global clinical response, treatment switching at day 21 and safety. RESULTS Response with tacrolimus ointment (93%) was superior to that with fluticasone (88%; P = 0.026). Improvements in mLEASI components were also greater with tacrolimus ointment. Facial erythema and pruritus improved in both groups. Global clinical response was rated 'marked improvement' or better in 88% and 79% of patients in the tacrolimus ointment and fluticasone groups, respectively. At day 21, 9% of patients switched from fluticasone to tacrolimus ointment, while 4.5% switched from tacrolimus ointment to fluticasone. Adverse events were more frequent with tacrolimus ointment as a result of the higher incidence of application-site skin burning sensation. Safety of both drugs was in line with their respective summary of product characteristics. Tacrolimus 0.1% ointment has superior efficacy to fluticasone 0.005% ointment for twice-daily treatment of adults with moderate to severe facial AD in whom conventional therapy was inadequately effective or not tolerated. Tacrolimus 0.1% ointment is a safe and effective second-line treatment for the control of moderate to severe AD of the face.

The treatment of facial atopic dermatitis in children who are intolerant of, or dependent on, topical corticosteroids: a randomized, controlled clinical trial

Atopic dermatitis (AD) is most prevalent in areas of reduced skin barrier reserve, like face and neck, especially in children. Treatment with topical corticosteroids (TCS) is limited due to heightened risk of treatment-associated side-effects, thus necessitating alternative AD therapies. The primary study objective was to determine the efficacy of pimecrolimus cream 1% in children with mild-moderate facial AD dependent on/intolerant of TCS. Secondary objectives included effects on overall Eczema Area and Severity Index (EASI), head/neck EASI, pruritus severity and time to clearance of facial AD. A multicentre, double-blind (DB) study of < or = 6 weeks, followed by a 6-week, open-label (OL) phase was conducted. Two hundred patients (aged 2-11 years) were randomized 1:1 to pimecrolimus cream 1% (n = 99) or vehicle (n = 101) twice daily until clearance of facial AD or for a maximum of 6 weeks (DB phase). Sixteen patients receiving vehicle were allowed to switch to the OL phase at day 22. Significantly more pimecrolimus-treated vs. vehicle-treated patients were cleared/almost cleared of facial AD (Investigators' Global Assessment 0/1): 74.5% vs. 51.0%, P < 0.001 (day 43) [57.1% vs. 36.0%, P = 0.004 (day 22)]. Median time to clearance was 22.0 vs. 43.0 days (pimecrolimus vs. vehicle, respectively). Statistically significant differences for pimecrolimus vs. vehicle were also seen on head/neck EASI, overall EASI, and head/neck pruritus scores. Adverse events were mainly mild-moderate, occurring with similar frequency in both treatment groups. In children with facial dermatitis intolerant of/dependent on TCS, pimecrolimus cream 1% effectively controls eczema and pruritus and is well tolerated.

Long‐term management of facial atopic eczema with pimecrolimus cream 1% in paediatric patients with mild to moderate disease

The aim of this post hoc analysis was to evaluate whether treatment of patients with atopic dermatitis (AD) with pimecrolimus cream 1% can decrease the development of flares necessitating the use of a topical corticosteroid on the face and thus reduce the need for use of topical corticosteroids in this sensitive skin area. In a controlled, double-blind, multicentre study, 140 patients, aged 2 to 17 years, with facial involvement and mild to moderate disease after treatment of the initial flare with prednicarbate 0.25% cream were randomized to an intermittent treatment with pimecrolimus cream 1% twice daily or vehicle for 24 weeks. If a flare occurred, defined as an exacerbation (unacceptable severity of itching/scratching or onset of oozing) not controlled by study medication, patients were treated with prednicarbate 0.25% cream instead. Patients in the vehicle group needed prednicarbate treatment on the face on 20.7% of the days vs. 11.7% of the study days in the pimecrolimus group (P = 0.0024). Fifty per cent of patients in the pimecrolimus group had no flare on the face during the treatment period compared with 37.5% of patients in the vehicle group (P = 0.012). The median time to first flare in pimecrolimus-treated patients was twice as long as in patients receiving vehicle (138 vs. 68 days, P = 0.01). Three adverse events (one case of skin burning) suspected to be related to use of the study medication were reported for three patients (3.9%) in the pimecrolimus group. Long-term intermittent treatment of facial AD in children and adolescents with pimecrolimus cream 1% does significantly reduce the need for topical corticosteroids.

Pimecrolimus cream 1% for the treatment of facial atopic dermatitis: Exploratory analysis of a double-blind, randomized, vehicle-controlled study in pediatric patients

Pimecrolimus cream 1% for the treatment of facial atopic dermatitis: Exploratory analysis of a double-blind, randomized, vehicle-controlled study in pediatric patients

Pimecrolimus cream 1% for mild to moderate facial atopic dermatitis in children

Pimecrolimus cream 1% for mild to moderate facial atopic dermatitis in children

A randomized controlled trial of pimecrolimus cream 1% in adolescents and adults with head and neck atopic dermatitis and intolerant of, or dependent on, topical corticosteroids

There is a need for alternative treatments for atopic dermatitis (AD) of the face and neck as long-term use of topical corticosteroids (TCS) is associated with skin atrophy and telangiectasia and some patients develop allergy, intolerance or other side-effects. This study was designed to assess the efficacy and safety of pimecrolimus cream 1% in patients with AD of the face and neck who are either dependent on, or intolerant of, TCS. A 12-week study comprising a 6-week, double-blind, randomized, vehicle-controlled phase was conducted, followed by a 6-week, open-label phase. Two hundred patients aged 12 years or over with mild to moderate head and neck AD, intolerant of, or dependent on, TCS were randomized to either pimecrolimus cream or vehicle cream. The primary efficacy criterion was the facial investigator's global assessment score at 6 weeks. Secondary efficacy criteria were head and neck Eczema Area and Severity Index (EASI), pruritus score and eyelid dermatitis. Facial skin atrophy and telangiectasia were assessed with dermatoscopy. A significantly higher percentage of patients treated with pimecrolimus was cleared or almost cleared of facial AD compared with vehicle (47% vs. 16%, respectively). A statistically significant difference was also seen on head and neck EASI and pruritus score. Significantly more pimecrolimus-treated patients than vehicle-treated patients achieved clearance of eyelid dermatitis (45% vs. 19%, respectively). Among the 77 patients with skin atrophy at baseline, treatment with pimecrolimus was associated with a reversal in skin thinning. Of the 112 patients with telangiectasia at baseline, no statistically significant difference was seen between treatment groups. Adverse events occurred with similar frequency in both groups. Pimecrolimus cream 1% is effective in patients with head and neck dermatitis intolerant of, or dependent on, TCS. Reversion of skin atrophy may occur during TCS-free intervals.

Usefulness of Anti-histamine Drugs in Treatment of Facial Atopic Dermatitis &mdash;Their Effect on the Dose-reduction Maintenance of Tacrolimus Ointments Used for Facial Lesions&mdash;

Usefulness of Anti-histamine Drugs in Treatment of Facial Atopic Dermatitis &mdash;Their Effect on the Dose-reduction Maintenance of Tacrolimus Ointments Used for Facial Lesions&mdash;

Three Cases of Facial Atopic Dermatitis Treated with Topical Pimecrolimus (Elidel)

Three Cases of Facial Atopic Dermatitis Treated with Topical Pimecrolimus (Elidel)

Tacrolimus ointment:An Open study for Effects on Severe Facial Atopic Dermatitis in Korean

Tacrolimus ointment:An Open study for Effects on Severe Facial Atopic Dermatitis in Korean

Intraocular lens subluxation in a patient with facial atopic dermatitis

A 66-year-old Japanese man presented with subluxation of a posterior chamber intraocular lens (IOL) caused by a rupture of part of Zinn’s zonule but no retinal break 2 years after phacoemulsification with IOL implantation. He had a history of atopic dermatitis since infancy. This case presents a rare ocular complication of scratching and rubbing the face and eyelids because of itching related to atopic dermatitis.