Severe Forms Of Atopic Dermatitis Research Articles

Characteristics of infectious complications in moderate and severe forms of atopic dermatitis

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.

ATOPIC DERMATITIS: CURRENT STATE OF THE PROBLEM IN UKRAINE AND THE WORLD

Introduction. Social and environmental disasters in recent years have induced an increase in morbidity, which poses a threat to the health and life of the population not only in Ukraine but also in the world. Among the most common skin diseases is atopic dermatitis (AD), a chronic recurrent disease characterized by skin inflammation, disruption of the epidermal barrier, and, as a result, a decrease in the skin's ability to retain moisture. Today general practitioners are usually the first to encounter this pathology, and they must assess self level of competence in a particular case and provide the necessary medical care or justify a referral to a dermatologist.
 The aim. To carry out an analytical review of domestic and foreign literature on the problem of atopic dermatitis (AD), methods of diagnosis and personalized approach to the treatment of this disease and to substantiate further directions of necessary scientific research to improve appropriate medical care.
 Materials and methods. A search, synthesis and analysis of world and national scientific publications on a personalized approach to the diagnosis and treatment of atopic dermatitis were conducted. A systematic approach, bibliosemantic method and method of structural and logical analysis were applied.
 Results and discussion. AD occurs with a frequency of up to 20% among children and up to 10% among adults in European countries. In Ukraine, as of 2020, the prevalence of AD among the pediatric population ranges from 9.0 to 28.5%.
 The study of the complex pathogenesis of the disease, where genetic factors, immune dysregulation and epidermal barrier disorders play a key role, has allowed scientists to identify endotypes and phenotypes of AD, which has become an important step in the development of personalized therapy for patients with AD. It was biological drugs (blockers of IL-4 and IL-13 and JK-inhibitors) that made a breakthrough in the treatment of severe AD. Another promising direction in the treatment of AD is the use of probiotics, as it is known that in patients with AD there is a decrease in the number of commensal bacterial skin flora and colonization of the skin with S. aureus.
 Conclusions. Thus, the incidence of atopic dermatitis, which is characterized by a complex etiopathogenesis, is increasing every year in the population of Ukraine and the world. The medical and social significance of AD opens up new challenges for the search for new approaches to the management of patients with AD. In recent years, biologic therapies have been actively introduced into medical practice, opening up new opportunities for personalized management of patients with severe forms of AD. As for the treatment of mild and moderate forms of AD, the issue is still relevant, given the problem of corticophobia in society. That is why at this stage, attention to the treatment and prevention approach should be more focused, and treatment methods with high efficacy and low side effect profile should be a priority. The literature review revealed that the problem remains relevant, despite the large number of studies on the etiology, pathogenesis and treatment of AD, which substantiates promising areas for the development and application of methods of modern effective personalized treatment of AD.

Chronicles of A.I. Pospelov Moscow Society of Dermatovenerologists and Cosmetologists (MSDC was founded on October 4, 1891) Bulletin of the MSDC meeting N 1152

On April 18, 2023, the 1152nd meeting of the Moscow Society of Dermatologists and Cosmetologists named after A.I. Pospelov took place. The meeting was held in a face-to-face format. There were 115 participants in total. Ac-cepted as a member of the MSDC 1 person.
 Two reports are presented in the clinical part of the meeting: clinical variations of the course of skin sarcoidosis: the mini-lecture describes 8 clinical cases of cutaneous sarcoidosis; Kaposi's sarcoma in a 24-year-old patient with positive antibodies to cytomegaly and EpsteinBarr viruses.
 Three reports were presented in the scientific part of the meeting: The possibilities of im-proving the effectiveness of onychomycosis therapy (speaker I.S. Maximov, Sechenov University); The use of botulinum toxin type A for the correction of erythematous-telangiectatic subtype of rosacea (speaker A.O. Yakovleva, State Scientific Center of Dermatovenerology and Cosmetology); A post-graduate student of the Department of Dermatovenereology of the Peoples' Friendship University of Russia Aun Rami Yusefovi made a report on targeted therapy of children with moderate and severe forms of atopic dermatitis (co-speakers ― Prof. E.A. Batkaev, Prof. V.Yu. Ujuhu).

Economic Burden of Atopic Dermatitis in Taiwan

Atopic dermatitis is a prevalent inflammatory skin disease that manifests clinically as pruritus and eczema. Severe forms of atopic dermatitis can be chronic and relapsing or associated with other dermatological complications and comorbidities, resulting in lifelong impacts across multiple aspects for patients. This study was conducted to calculate the atopic dermatitis-related economic burden in Taiwan. First, the out-of- pocket costs incurred by 200 patients with atopic dermatitis were estimated using a specifically designed questionnaire. Secondly, work impairment was converted into quantifiable costs. The costs reimbursed by the Taiwan National Health Insurance (NHI), which were estimated in our previous work, were included in the final calculation. The atopic dermatitis-related economic burden for patients in Taiwan in 2018 was estimated as (2018 New Taiwan dollars; NT$) 37.90 billion, which is 0.207% of Taiwan's gross domestic product. This substantial economic burden suggests an existing need for more effective and equitable treatment for atopic dermatitis.

ЛЕЧЕБНОЕ ПИТАНИЕ ПРИ ПИЩЕВОЙ АЛЛЕРГИИ: НЕ ВСЕ ТАК ПРОСТО

Purpose of the study. To assess the effectiveness of elimination diet therapy using therapeutic formulas in children with cow's milk protein allergy according to a 5-year follow-up. Materials and methods. A prospective, single-center, open, uncontrolled study was conducted. We observed 99 children with atopic dermatitis and allergy to cow's milk protein (CMP), the average age at the beginning of the study was 4.6 ± 0.8 months. The results of clinical observation, clinical assessment of the function of the digestive organs, and the level of the IgE to CMP were used as control methods. The selection of formulas for clinical nutrition at the stage of elimination diet therapy was carried out differentially, depending on the severity of the skin syndrome and gastrointestinal manifestations. The follow-up period was 5 years. Results. Food allergy manifested itself in 34 (34.3%) children only as a skin syndrome (atopic dermatitis), in 65 (65.7%) children as a skin syndrome in combination with gastrointestinal symptoms. In 67.7% of children, the use of therapeutic formulas based on highly hydrolyzed cow's milk protein and amino acids led to the normalization of the level of specific IgE. In mild atopic dermatitis, the average duration of the elimination period was 9.43 ± 2.7 months, in moderate atopic dermatitis, 19.3 ± 9.0 months, and in severe, 35.5 ± 14.8 months (p < 0.05). The number of patients with an exacerbation of an allergic disease with of the introduction of dairy products in mild, moderate and severe form of atopic dermatitis constituted 2 of 7, 6 of 48 (12.5%), 6 of 12 (50.0%) respectively (p < 0.05). Conclusion. In children with atopic dermatitis caused by food allergy to cow's milk proteins, the elimination diet in most cases (67.7%) leads to the normalization of the level of specific IgE, which makes it possible to start expanding the diet by introducing dairy products. The duration of the elimination period depends on the clinical manifestations of the allergic disease and the level of sensitization. When expanding the diet, patients should be provided with careful clinical and laboratory monitoring, including the determination of specific IgE to CMP. The high probability of persistent sensitization to CMP must be taken into account when prescribing elimination measures and drawing up rehabilitation programs for children with allergic diseases.

Pacient se závažnou formou atopické dermatitidy, polyvalentní alergií a extrémní elevací IgE

Je uvedena kazuistika 37letého muže, který trpěl od 22 let věku závažnou formou atopické dermatitidy. Postupně byl léčen všemi dostupnými systémovými léky: cyklosporinem A intermitentně 5,5 roku, azathioprinem 11 měsíců a methotrexátem 2,3 roku. Později u něj byly 5 let prováděny výměnné plazmaferézy s limitovaným efektem. Teprve biologická léčba dupilumabem vedla nejprve k velmi výraznému zlepšení a později k dlouhodobé kompletní remisi. Zhojení trvá již 14 měsíců. Léčba dupilumabem je dobře tolerována. Pacient je velmi spokojen, jeho kvalita života je vynikající.

Особенности иммунного статуса детей с разной тяжестью атопического дерматита

Актуальность. Атопический дерматит (АД) — наиболее распространенное атопическое заболевание среди детей, характеризующееся поражением кожи с выраженным зудом. Развитие АД связывают с генетической предрасположенностью, влиянием эпигенетических факторов, которые приводят к нарушению эпидермальной барьерной функции, иммунодисрегуляцией и IgE-опосредованной сенсибилизацией к наиболее распространенным аллергенам. Особое значение исследователи придают не только поляризации Th2-иммунного ответа, но и особенностям работы врожденного звена иммунитета. Целью исследования было изучить особенности иммунного статуса у детей с учетом тяжести течения атопического дерматита. Материалы и методы. Основную группу составили 85 детей в возрасте от 3 месяцев до 3 лет с верифицированным диагнозом АД, группу контроля — 20 детей без проявлений атопии в анамнезе. Для оценки тяжести кожных проявлений использовали шкалу SCORAD. Дети, которые принимали участие в исследовании, были разделены на группы по тяжести АД. Всем детям проводился общий клинический анализ крови. Изучение иммунного статуса у детей основной группы включало типирование лимфоцитарной популяции по CD-маркерам (C3, C4–2, CD3+, CD19–, CD4+, CD8–, CD4–, CD8+, CD3–, CD56+, CD19+, CD14, CD45), измерение уровней IgA, IgM, IgG, IgE, исследование системы комплемента (С3, С4–2), фагоцитарной активности нейтрофилов и пролиферативной активности лимфоцитов проводилось методом проточной цитометрии в ООО «Синэво». Метод иммуноферментного анализа использовался для выявления уровней интерлейкина (ИЛ)-13 (ELISA Kit, Thermo Fisher Scientific, Австрия), исследование проводилось на базе Учебного медико-лабораторного центра Запорожского государственного медицинского университета. Статистическую обработку результатов проводили с помощью официального программного пакета Statistica 13.0. Результаты. У детей с тяжелым течением АД и уровнями ИЛ-13 ниже уровней контрольной группы и групп детей с тяжелым и среднетяжелым течением наблюдалась эозинофилия периферической крови, прирост CD4+, CD8– с одновременным снижением уровней CD4–, CD8+, дисиммуноглобулинемия и низкие уровни С3 по сравнению с другими группами исследования (р < 0,05). Выводы. Полученные результаты позволяют предположить, что у детей тяжелое течение АД было связано с изменениями системы комплемента и низкими уровнями цитотоксических клеток, транзиторной гипогаммаглобулинемией, что, в свою очередь, требует более детального изучения каскадов иммунологических реакций у детей с АД.

Atopic Dermatitis and Sensitisation to Molecular Components of Alternaria, Cladosporium, Penicillium, Aspergillus, and Malassezia-Results of Allergy Explorer ALEX 2.

Progress in laboratory diagnostics of IgE-mediated allergies is being made through the use of component-resolved diagnosis. The aim of our study is to analyze the sensitization profile to allergen reagents in patients suffering from atopic dermatitis with the use of the ALEX 2–Allergy Explorer and especially to show the sensitization to molecular components of molds and yeast. The complete dermatological and allergological examination including the examination of the sensitization to allergen reagents with Allergy Explorer ALEX 2 testing was performed. The relation between the sensitization to molecular components of molds and yeast and the severity of atopic dermatitis, and the occurrence of bronchial asthma and allergic rhinitis was evaluated. Altogether, 100 atopic dermatitis patients were examined—48 men and 52 women, with an average age of 40.9 years. The sensitization to Mala s 6, Mala s 11, Sac c, Asp f 6, Cla h and Cla h 8 correlates to the severity of atopic dermatitis. The sensitization to Sac c, Alt a 6, Cla h, Cla h 8 was observed significantly more frequently in patients suffering from bronchial asthma to Mala s 6 in patients suffering from allergic rhinitis. In patients with severe form of atopic dermatitis (AD), a very high level of specific IgE was recorded to Mala s 11 (in 36%) and to Asp f 6 (in 12%).

The capacity and effectiveness elimination domestic animals allergens: myths and realities

At present, sensitization to airborne allergens in domestic animals is absolutely rightly considered one of the key risk factors for the development of allergic rhinitis and bronchial asthma, as well as largely determines the development of severe forms of atopic dermatitis and respiratory allergosis. Of particular importance is the fact that, unlike other triggers, the elimination of allergens in domestic animals is often associated with internal resistance from patients. Various aspects of this problem are associated with a large number of baseless statement that lead to inadequate prevention and therapy, as well as negatively affecting the social activity of patients and their families. The article presents the current data on the prevalence of sensitization, the properties and clinical significance of the allergens of domestic animals, outlines approaches to conducting elimination activities.

Sensitization to Molecular Components in 104 Atopic Dermatitis Patients in Relation to Subgroups of Patients Suffering from Bronchial Asthma and Allergic Rhinitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease. The progression from AD to bronchial asthma (AB) and allergic rhinitis (AR) is called atopic march. The aim of this study was to evaluate the difference in the sensitization to molecular components in patients suffering from AD in relation to subgroups of patients with AR and AB. The complete dermatological and allergological examinations were performed. Specific IgE antibodies against 112 molecular components were measured with the multiplex ImmnoCAP ISAC test. Altogether 104 atopic dermatitis patients (50 men, 54 women) at the average age 40.1 years were examined. The sensitization to molecular components was confirmed in 93.3% of patients. The sensitization to components of mites, grasses, trees, animals, moulds, and shrimps was significantly more frequent in patients with severe form of AD and the sensitization to components of grasses, trees, and moulds was significantly higher in subgroup of patients with AB. In subgroup of patients suffering from AR the higher occurrence of pollen-derived and pollen-food derived PR-10 proteins, grasses, mites, and animals was observed also. We have confirmed the significant differences in the sensitization to molecular components in patients suffering from severe form of AD, and in subgroups of patients suffering from AB and AR. These molecular components may play the important role in the consecutive development of different allergy pathologies called atopic march.

Comorbidités de la dermatite atopique

Atopic dermatitis is associated with an increased risk of asthma (10 to 30% according to age), allergic rhinitis and conjunctivitis and food allergy. Other comorbidiies are globally lest frequent than in psoriasis. There is no increased risk of solid cancer. Smoking is a major confounding factor that has to be taken into account. Obesity and metabolic syndrome are more frequent and there is a moderately increased cardiovascular risk in severe forms of atopic dermatitis. There is a clear-cut increased risk of vitiligo and alopecia areata and a lower risk of other auto-immune diseases, including type I diabetes in children. There is a higher risk of cutaneous but not extra-cutaneous bacterial and viral infections, and increased frequency of contact dermatitis and urticaria. Severe atopic dermatitis is associated with psychiatric comorbidities, like attention disorders/hyperactivity, depression and suicidal ideas. © 2019 Elsevier Masson SAS. All rights reserved.

Těžká forma atopické dermatitidy - kandidát na léčbu dupilumabem

Těžká forma atopické dermatitidy - kandidát na léčbu dupilumabem

Atopic dermatitis: new horizons of therapy

Over the past decades, the first breakthrough milestone in the treatment of severe forms of atopic dermatitis (AD) has been targeted therapy aimed at inhibiting IL-4 and IL-13. This was made possible thanks to advances in the understanding of the pathogenesis of AD, the driver of which is the Th2-type immune response, which also underlies such manifestations of atopy as bronchial asthma, allergic rhinitis, and polynosis. In the case of the Th2-type immune response, cytokines IL-4 and IL-13 are secreted, which are the main promoters of the inflammatory response in AD. Inhibition of IL-4 and IL-13 leads to the prevention of inflammation and is an effective approach to therapy. The use of therapy aimed at inhibition of cytokines allows you to effectively cope with the manifestations of severe and moderately severe blood pressure.

What's new in the treatment of atopic dermatitis?

Atopic dermatitis (AD) is a pruritic, chronic and inflammatory skin disease, with an usual onset in the pediatric age. Several drugs are used in the treatment of this skin disease. Drugs as steroid, calcineurin inhibitors, and moisturizing creams are widely used in the treatment of this disease but often patients are not satisfied with the obtained results. New drugs like dupilumab or crisaborole seem to be a promising option for moderate and severe forms of AD. This article analyzes the newest therapy available today for the treatment of AD.

Sensitization to allergens of domestic animals

At present, sensitization to airborne allergens in domestic animals is absolutely rightly considered one of the key risk factors for the development of allergic rhinitis and bronchial asthma, as well as largely determines the development of severe forms of atopic dermatitis and respiratory allergosis. Of particularimportance isthe fact that, unlike othertriggers, the elimination of allergensin domestic animals is often associated with internal resistance from patients. The article presents the current data on the prevalence of sensitization, the properties and clinical significance of the main allergens of cats and dogs, outlines approaches to conducting elimination activities.

Biological Therapeutic Treatment of Atopic Dermatitis

Atopic dermatitis is a chronic recurrent inflammatory disease caused, inter alia, by violations of the barrier function of the skin and pathological immune response in the form of an imbalance of Th1 and Th2 lymphocytes with increased production of IL-4, IL-5, IL-13, IL-31. Treatment of severe forms of atopic dermatitis is not an easy task due to the variability of the individual response to treatment, the short duration of the therapeutic effect and the frequent development of undesirable phenomena associated with the use of existing methods of systemic immunosuppressive therapy. The study of the pathogenesis of atopic dermatitis made it possible to identify the spectrum of molecular targets, providing the basis for researching alternative variants to the previously used systemic therapy methods – genetic engineering biological preparations. Contemporary data on the pathogenesis of atopic dermatitis as well as potential molecular targets for innovative biological preparations, the efficacy of which has been evaluated through clinical trials, are presented in the review.

POSSIBILITIES OF REPLACEMENT INTERFERON THERAPY TO TREAT ATOPIC DERMATITIS IN IMMUNOCOMPROMISED PATIENTS

Atopic dermatitis remains an important medico-social problem, whose significance is determined by the steady increase in morbidity, recurrent course and often low therapeutic efficacy. In recent years, the number of patients suffering from severe forms of atopic dermatitis has increased [1–3]. One of the most important causes of the complication of an allergic disease is the combination of allergies and secondary immune deficiency syndrome characterized by reversible (as a rule) disturbances of the functions and adaptation mechanisms of the immune system [4, 5].

Experience of using tacrolimus as a part of a complex therapy of atopic dermatitis

This review presents the results of international and Russian clinical studies conducted to assess the efficacy and safety of topical calcineurin inhibitors (TCIs) for the treatment of atopic dermatitis. The main mechanisms of action of TCIs are described. The authors demonstrate the advantages of Tacrolimus belonging to the TCI group. Due to the hydrophilic drug form and pharmacoeconomic index promoting compliance with treatment, it is possible to consider the new drug Tacropic (0.1% and 0.03% Tacrolimus ointments) as the optimum topical drug for the treatment of moderate to severe and severe forms of atopic dermatitis in adults and children.

The severity of atopic dermatitis and the relation to the level of total IgE, onset of atopic dermatitis and family history about atopy

ABSTRACTThe aim of this study is the evaluation, if the level of total IgE, onset of atopic dermatitis (AD) and the family history are in the significant dependence to the severity of AD. The statistical evaluation of the dependence between the severity of AD and the the level of total IgE, family history and onset of AD was performed. 296 patients were examined. The level of total IgE above 200 IU/ml is recorded in 93 % of patients suffering from severe form and the positive data about atopy in family history are recorded in 66 % of patients with severe form of AD. The significant dependence was recorded between the severity of AD and parameters such as the level of total IgE, and family history about atopy. No dependence was recorded between the severity of AD and the onset of AD.

OC08 - Care for the children with severe forms of atopic dermatitis.

Theme: Complex health care and chronic disease management.