Zusammenfassung
Die atopische Dermatitis ist eine der häufigsten chronisch entzündlichen Hauterkrankungen. Die Pathomechanismen der atopischen Dermatitis wurden in den letzten Jahren immer besser ...verstanden. Dies kann zukünftig dazu beitragen, verschiedene Endotypen zu identifizieren, die für bestimmte Therapien bevorzugt geeignet sind. Eine patientenadaptierte Therapie berücksichtigt neben dem phänotypischen Erscheinungsbild genetische und biologische Merkmale. Die aktuelle Entwicklung von Biologika und kleinmolekularen Medikamenten zur Behandlung der atopischen Dermatitis wird im vorliegenden Artikel vorgestellt. Diese Moleküle werden, wenn sie zugelassen werden, die Therapieperspektiven in der Zukunft verändern.
Dupilumab ist als erstes Biologikum bereits zur Behandlung der atopischen Dermatitis bei Jugendlichen und Erwachsenen zugelassen und hat die Behandlung von Patienten mit mittelschwerer und schwerer atopischer Dermatitis verbessert. In der vorliegenden Arbeit werden eigene Real‐Life‐Daten zur Wirksamkeit von Dupilumab bei der atopischen Dermatitis vorgestellt. Darüber hinaus werden weitere relevante Daten gezeigt, die in der praktischen Anwendung von Dupilumab eine Rolle spielen, und offene Fragen werden diskutiert.
Atopic dermatitis and allergic contact dermatitis are both common skin diseases having an immune pathogenesis. There has been considerable interest about their inter‐relationships with regard to ...altered susceptibility. Recent investigations have shed new light on this important question, and in this article, we explore whether there is evidence that atopic dermatitis affects the risk of contact sensitization and allergic contact dermatitis. The use of topical products to treat xerotic and inflamed skin in atopic dermatitis often results in a higher prevalence of sensitization to, for example, fragrances and other ingredients in emollients. Moreover, the prevalence of metal allergy seems to be increased, probably due to compromised chelation of the metals in the stratum corneum of patients with atopic dermatitis. However, conversely, the T‐helper cell 2 bias that characterizes immune responses in atopic dermatitis appears to lower the risk of contact sensitization compared to healthy controls. Based on these observations, we conclude that multiple factors affect the association between atopic dermatitis and contact sensitization, and that these need to be appreciated in the clinical management of atopic dermatitis patients.
Debido a la prevalencia de la dermatitis del pañal en la infancia, afección que cursa con irritación e inflamación cutánea de la zona del bebé que se encuentra en contacto directo con el pañal, se ...planteó buscar una solución a este problema. Para ello, tras estudiar en profundidad la patología, se procedió al desarrollo de una crema pañal capaz de prevenir, paliar y/o tratar el problema. Entre sus ingredientes, cuenta con leche de burra, componente que ha demostrado tener capacidad para mejorar el problema que se describe.
Background
Occupational irritant hand dermatitis (OIHD) causes significant functional impairment, disruption of work, and discomfort in the working population. Different preventive measures such as ...protective gloves, barrier creams and moisturisers can be used, but it is not clear how effective these are. This is an update of a Cochrane review which was previously published in 2010.
Objectives
To assess the effects of primary preventive interventions and strategies (physical and behavioural) for preventing OIHD in healthy people (who have no hand dermatitis) who work in occupations where the skin is at risk of damage due to contact with water, detergents, chemicals or other irritants, or from wearing gloves.
Search methods
We updated our searches of the following databases to January 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLlNE, and Embase. We also searched five trials registers and checked the bibliographies of included studies for further references to relevant trials. We handsearched two sets of conference proceedings.
Selection criteria
We included parallel and cross‐over randomised controlled trials (RCTs) which examined the effectiveness of barrier creams, moisturisers, gloves, or educational interventions compared to no intervention for the primary prevention of OIHD under field conditions.
Data collection and analysis
We used the standard methodological procedures expected by Cochrane. The primary outcomes were signs and symptoms of OIHD developed during the trials, and the frequency of treatment discontinuation due to adverse effects.
Main results
We included nine RCTs involving 2888 participants without occupational irritant hand dermatitis (OIHD) at baseline. Six studies, including 1533 participants, investigated the effects of barrier creams, moisturisers, or both. Three studies, including 1355 participants, assessed the effectiveness of skin protection education on the prevention of OIHD. No studies were eligible that investigated the effects of protective gloves. Among each type of intervention, there was heterogeneity concerning the criteria for assessing signs and symptoms of OIHD, the products, and the occupations. Selection bias, performance bias, and reporting bias were generally unclear across all studies. The risk of detection bias was low in five studies and high in one study. The risk of other biases was low in four studies and high in two studies.
The eligible trials involved a variety of participants, including: metal workers exposed to cutting fluids, dye and print factory workers, gut cleaners in swine slaughterhouses, cleaners and kitchen workers, nurse apprentices, hospital employees handling irritants, and hairdressing apprentices. All studies were undertaken at the respective work places. Study duration ranged from four weeks to three years. The participants' ages ranged from 16 to 67 years.
Meta‐analyses for barrier creams, moisturisers, a combination of both barrier creams and moisturisers, or skin protection education showed imprecise effects favouring the intervention. Twenty‐nine per cent of participants who applied barrier creams developed signs of OIHD, compared to 33% of the controls, so the risk may be slightly reduced with this measure (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.06; 999 participants; 4 studies; low‐quality evidence). However, this risk reduction may not be clinically important. There may be a clinically important protective effect with the use of moisturisers: in the intervention groups, 13% of participants developed symptoms of OIHD compared to 19% of the controls (RR 0.71, 95% CI 0.46 to 1.09; 507 participants; 3 studies; low‐quality evidence). Likewise, there may be a clinically important protective effect from using a combination of barrier creams and moisturisers: 8% of participants in the intervention group developed signs of OIHD, compared to 13% of the controls (RR 0.68, 95% CI 0.33 to 1.42; 474 participants; 2 studies; low‐quality evidence). We are uncertain whether skin protection education reduces the risk of developing signs of OIHD (RR 0.76, 95% CI 0.54 to 1.08; 1355 participants; 3 studies; very low‐quality evidence). Twenty‐one per cent of participants who received skin protection education developed signs of OIHD, compared to 28% of the controls.
None of the studies addressed the frequency of treatment discontinuation due to adverse effects of the products directly. However, in three studies of barrier creams, the reasons for withdrawal from the studies were unrelated to adverse effects. Likewise, in one study of moisturisers plus barrier creams, and in one study of skin protection education, reasons for dropout were unrelated to adverse effects. The remaining studies (one to two in each comparison) reported dropouts without stating how many of them may have been due to adverse reactions to the interventions. We judged the quality of this evidence as moderate, due to the indirectness of the results. The investigated interventions to prevent OIHD probably cause few or no serious adverse effects.
Authors' conclusions
Moisturisers used alone or in combination with barrier creams may result in a clinically important protective effect, either in the long‐ or short‐term, for the primary prevention of OIHD. Barrier creams alone may have slight protective effect, but this does not appear to be clinically important. The results for all of these comparisons were imprecise, and the low quality of the evidence means that our confidence in the effect estimates is limited. For skin protection education, the results varied substantially across the trials, the effect was imprecise, and the pooled risk reduction was not large enough to be clinically important. The very low quality of the evidence means that we are unsure as to whether skin protection education reduces the risk of developing OIHD. The interventions probably cause few or no serious adverse effects.
We conclude that at present there is insufficient evidence to confidently assess the effectiveness of interventions used in the primary prevention of OIHD. This does not necessarily mean that current measures are ineffective. Even though the update of this review included larger studies of reasonable quality, there is still a need for trials which apply standardised measures for the detection of OIHD in order to determine the effectiveness of the different prevention strategies.
S1‐Leitlinie Diagnostik und Therapie des Analekzems Weyandt, Gerhard; Breitkopf, Claudia; Werner, Ricardo Niklas ...
Journal der Deutschen Dermatologischen Gesellschaft,
June 2020, 2020-06-00, 20200601, Letnik:
18, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Zusammenfassung
Das Analekzem (Syn.: perianale Dermatitis, perianales Ekzem) ist eine der häufigsten proktologischen Erkrankungen und tritt als Folgeerscheinung oder Teilsymptom verschiedener ...proktologischer, dermatologischer, allergologischer oder mikrobieller Veränderungen auf. Die drei Hauptformen des Analekzems sind das irritativ‐toxische, das atopische und das kontaktallergische Analekzem. Die diagnostische Einordnung der Ätiologie ermöglicht die angemessene und erfolgreiche Behandlung von Patienten mit Analekzem. Diese umfasst die Behandlung beziehungsweise Beseitigung ätiologischer Faktoren und die nichtmedikamentöse Therapie (Meidung aggravierender Faktoren). Unterstützend kann eine topische antientzündliche und/oder spezifische symptomatische Therapie erforderlich werden. Die vorliegende Leitlinie enthält Empfehlungen zum diagnostischen und therapeutischen Management des Analekzems und richtet sich an Ärzte der Fachrichtungen Dermatologie und Proktologie sowie aller weiteren Fachrichtungen in Klinik und Praxis, die an der Behandlung von Patienten mit Analekzem beteiligt sind.
Zusammenfassung
Hintergrund
Rosazea ist eine häufige chronisch‐entzündliche Hauterkrankung, die circa 5,5 % der erwachsenen Bevölkerung betrifft. Unser Ziel war es, die Prävalenz und Epidemiologie ...von Rosazea und perioraler Dermatitis (POD) in einer ambulanten, universitären Versorgungseinrichtung zu untersuchen.
Methoden
Wir analysierten retrospektiv die medizinischen Daten von Patienten mit der bestätigten Diagnose Rosazea oder perioraler Dermatitis (POD), die sich während eines Zeitraums von drei Jahren in der Ambulanz unseres Universitätsklinikums vorstellten.
Ergebnisse
Von 1032 Patienten wurde bei 81,5 % Rosazea und bei 18,5 % POD diagnostiziert. Die Gesamtprävalenz betrug 1,4 % für Rosazea und 0,3 % für POD. 69,3 % der analysierten Patienten waren weiblich. Das Durchschnittsalter betrug 49,3 ± 17,7 (1–92) Jahre. Das Durchschnittsalter der Frauen war niedriger als das der Männer. Patienten mit POD waren jünger und überwiegend weiblich, während Patienten mit phymatöser Rosazea älter und überwiegend männlich waren. Die häufigsten Phänotypen waren Rosacea papulopustulosa (68,4 %), Rosacea erythematosa‐teleangiectatica (22,5 %) und phymatöse Rosazea (8,0 %). Bei 15,8 % der Patienten wurden Sonderformen der Rosazea diagnostiziert; am häufigsten waren okuläre Rosazea (6,9 %) und Steroid‐induzierte Rosazea (5,4 %).
Schlussfolgerungen
Die große Patientenkohorte, die in unserer Studie analysiert wurde, ermöglicht eine gute Einschätzung der Häufigkeit von Subtypen und Sonderformen der Rosazea sowie der perioralen Dermatitis in der Ambulanz einer klinisch‐universitären Einrichtung.
Atopic dermatitis Langan, Sinéad M; Irvine, Alan D; Weidinger, Stephan
The Lancet (British edition),
08/2020, Letnik:
396, Številka:
10247
Journal Article
Recenzirano
Atopic dermatitis is a common inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. The disorder affects people of all ages and ethnicities, has a substantial ...psychosocial impact on patients and relatives, and is the leading cause of the global burden from skin disease. Atopic dermatitis is associated with increased risk of multiple comorbidities, including food allergy, asthma, allergic rhinitis, and mental health disorders. The pathophysiology is complex and involves a strong genetic predisposition, epidermal dysfunction, and T-cell driven inflammation. Although type-2 mechanisms are dominant, there is increasing evidence that the disorder involves multiple immune pathways. Currently, there is no cure, but increasing numbers of innovative and targeted therapies hold promise for achieving disease control, including in patients with recalcitrant disease. We summarise and discuss advances in our understanding of the disease and their implications for prevention, management, and future research.
Moisturizer is a major component of basic daily skin care, particularly in presence of epidermal barrier alteration and reduced epidermal water content. It is an important part of a dermatologist's ...strategy to maintain skin health as well as treating various dermatoses which co-exist with skin dryness and are linked to impaired skin barrier function, such as in atopic disorders as well as other types of dermatitis. Mastering the knowledge regarding mechanism of action, application, dosage, adverse effects as well as specific clinical usage of moisturizers is a must for a dermatologist in order to support their use, particularly for evidence-based, therapeutic purposes. This review discusses the use of moisturizer both for skin health maintenance as well as a definitive or adjuvant therapy for many kinds of dermatitis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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