Naslov
New therapeutic approaches in atopic eczema

Autori
Lipozenčić, Jasna

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Journal of the European Academy of Dermatology and Venereology / Lotti, Torello ; Freedman, Derek - Firenza : München : Wiley-Blackwell, 2004

Skup
13th Congress of the European Academy of Dermatology and Venereology

Mjesto i datum
Firenca, Italija, 17.11.2004. - 21.11.2004

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Atopic dermatitis; IgE-mediated Th2 type; IgE-independent Th1 type; topical immunomodulators

Sažetak
Atopic dermatitis (AD) is a chronic relapsing inflammatory disease, it appears that immediate (Immunoglobulin E-mediated mast cell type), late (IgE-mediated Th2 type) and delayed (IgE-independent Th1 type) allergic reactions are involved. There seems to be no common antigen that activates T cells, or triggers, involved in the disease as like as many environmental factors that contribute to local immune responses in genetically disposed individuals. The first clinical observation sings are red, scaly, and oozing plaques on the forehead and face, which may spread to the neck, hands, and flexural areas. In severe cases, atopic eczema (dermatitis) can cover most of the body. Atopic eczema profoundly impairs the quality of life of the patient, families and, carriers especially during an exacerbation of the disease. Objective: to assess immunomodulatory treatment in AD. AD can be managed in many patients with topical therapies, sometimes supplemented by systemic antibiotics, but some individuals with widespread disease require more aggressive treatment. Management should embrase measures to control environmental factors such as house dust mites, certain foods, coincident skin infection, emotional distress, xerosis, allergen avoidance, bathing and skin hydration, humidification. If control of flare factors combined with aggressive topical therapy or phototherapy fail to control symptoms of AD, a number of systemic immunomodulatory agents may play a role in treatment. Systemic prednisone may be used for control of acute exacerbations in low dosages such as 2, 5 or 5 mg/day for shorter periods of time (weeks). Cyclosporine, a macrolide agent with immunosuppressive activity is efficacious in children and adults with non-controllable AD (initial dosage 5 mg/kg/day, can be tapered to about 1-2 mg/kg). Azathioprine, a purine analog, 50 mg twice daily can also have an effect on AD, but after several months of treatment. Methotrexate is a folic antagonist causes apoptosis of activated T cells, although less effective than cyclosporine, it is probably safer on a long-term basis as a steroid-sparing agent at a dosage of 2, 5 mg per day /4 times per week for moderately severe widespread AD. Mycopfhenolate mofetil has been described to be successful in the long-term management in a few studies in an oral dose of 2 g per day or 1 g bid for 4 weeks (with dose reduction after 5 weeks). Interferon γ (IFN-γ ), a substance produced by Th 1 cells and a known inhibitor of Th 2 cells, several studies were conducted to assess its effectiveness, safely in the AD treatment with recombinant IFN- γ 50 μ g/m2 daily injections for 1-2 years, or every other day for 22 months. Other immunomodulators: Intravenous Immunoglobulin (IVIG), Phosphodiesterase Inhibitors, Thalidomide and Leukotriene Inhibitor have been used in patients with AD with beneficial effects. Topical immunomodulators (TIM) such as tacrolimus hydrate (FK 506, Protopic 0.1% ointment, a novel macrolide immunosuppresant on activation of sensitized T lymphocytes (Th 1 cells) already accumulated in the dermis. Therefore, FK 506 exerts a therapeutic effect locally against the chronically incurable AD in children and adults in short-term (12 week), or long-term (2-3 years). Pimecrolimus cream 1% (Elidel, SDZASM 981), a nonsteroid selective inhibitor of inflammatory cytokines is effective on early signs and symptoms of AD reducing the incidence of flares and improving overall control of AD. Pimecrolimus cream is safe and well tolerated if applied twice daily in infants ages 3 to 23 months and adults. Early intervention with pimecrolimus cream has proven the prevention progression of AD cource and efficacy in infants, children/adolescents, and adults in short-term (6-week) and long-term (12 month ; 6 month) treatment mild to severe AD. The use of intermittent steroids every other day is efficacious while further reducing the risk of side effects. Promising emerging treatments are tacrolimus and pimecrolimus. Early treatment with TIM in infants with AD, prevents disease flares.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA