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Dermatologic Clinics

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https://www.readbyqxmd.com/read/28577808/atopic-dermatitis-a-heterogeneous-disorder
#1
EDITORIAL
Jonathan I Silverberg, Nanette B Silverberg
No abstract text is available yet for this article.
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577807/atopic-dermatitis-racial-and-ethnic-differences
#2
REVIEW
Adeline Mei-Yen Yong, Yong-Kwang Tay
Atopic dermatitis (AD) is a common, chronic inflammatory skin condition affecting up to 20% of children and 3% of adults worldwide. There is wide variation in the prevalence of AD among different countries. Although the frequency of AD is increasing in developing countries, it seems to have stabilized in developed countries, affecting approximately 1 in 5 schoolchildren. Adult-onset AD is not uncommon and is significantly higher, affecting between 11% and 13% of adults in some countries, for example, Singapore, Malaysia, and Sweden...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577806/adjunctive-management-of-itch-in-atopic-dermatitis
#3
REVIEW
Sarina B Elmariah
Itch, or pruritus, is a hallmark feature of atopic dermatitis (AD). The impact of AD-related pruritus can range from mildly distressing or distracting to completely disabling. Traditionally, management of itch in AD patients has focused on restoring the altered skin barrier with topical emollients and/or reducing inflammation. A growing emphasis has been placed on directly targeting the neural transmission pathways that mediate itch signaling. Off-label use of neuromodulatory agents has helped reduce this aggravating symptom in atopic patients...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577805/management-of-atopic-hand-dermatitis
#4
REVIEW
Anne-Sofie Halling-Overgaard, Claus Zachariae, Jacob P Thyssen
This article provides an overview of clinical aspects of hand eczema in patients with atopic dermatitis. Hand eczema can be a part of atopic dermatitis itself or a comorbidity, for example, as irritant or allergic contact dermatitis. When managing hand eczema, it is important to first categorize the subtype and identify potential culprit allergens or irritants. First-line therapy should be a combination of emollients and topical corticosteroids; possible alternatives include topical calcineurin inhibitors or coal tar...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577804/special-considerations-for-therapy-of-pediatric-atopic-dermatitis
#5
REVIEW
Nanette B Silverberg, Carola Durán-McKinster
Atopic dermatitis is the leading cause of pediatric dermatology visits in developed nations. Recurrent, itchy rashes in typical locations and a family/personal history of atopy helps to identify children with disease. Most cases (85%) are diagnosed by age 5 years. Some comorbidities are age-based and may affect disease course. Topical corticosteroids are the mainstay of therapy; corticosteroidphobia and side effects complicate use. Topical calcineurin inhibitors are alternatives to corticosteroids, especially in sensitive locations...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577803/long-term-treatment-of-atopic-dermatitis
#6
REVIEW
James C Prezzano, Lisa A Beck
Many patients with mild to moderate atopic dermatitis (AD) are managed by identifying and avoiding allergens and irritants, ensuring skin moisturization, and graded use of topical corticosteroids and/or calcineurin inhibitors. There is little consensus on the next step. Most systemic therapies are "off label" in the United States and include phototherapy, cyclosporine, mycophenolic acid precursors, azathioprine, and methotrexate. The decision to use these therapies should be based on efficacy and safety readouts from well designed, long-term trials...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577802/the-role-of-interleukins-4-and-or-13-in-the-pathophysiology-and-treatment-of-atopic-dermatitis
#7
REVIEW
Jonathan I Silverberg, Robert Kantor
Moderate to severe atopic dermatitis (AD) can be debilitating and often requires use of systemic immunosuppressant therapy to achieve adequate disease control. There are currently no US Food and Drug Administration-approved systemic agents for the long-term treatment of AD. Recent insight has identified the T helper 2 cytokines, interleukins 4 and 13, as playing a major role in the pathogenesis of AD. There are multiple novel biologic agents in development that target interleukins 4 and/or 13 for the treatment of moderate to severe AD...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577801/an-update-on-the-pathophysiology-of-atopic-dermatitis
#8
REVIEW
Kunal Malik, Kerry D Heitmiller, Tali Czarnowicki
Atopic dermatitis (AD) is increasingly recognized as a complex, inflammatory skin disease involving interplay of multiple elements. This article notes key advances in understanding of immune dysregulation, skin barrier dysfunction, environmental, genetic, and microbial influences orchestrating disease pathogenesis, and the relevance of therapeutic interventions in each area. Accumulating evidence and the discovery of new T-cell subsets has matured AD as a multiple-cytokine-axes-driven disorder, evolved from the widely held belief of it being a biphasic Th1/Th2 disease...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577800/patient-burden-of-atopic-dermatitis
#9
REVIEW
Cathryn Sibbald, Aaron M Drucker
Atopic dermatitis is associated with significant patient burden, with impacts from symptoms and visible physical manifestations of the disease. Consequences include detrimental effects on quality of life (QoL), sleep, self-esteem, interpersonal relationships, participation in leisure and sports, and attendance or performance at school or work. Patients also spend a significant amount of time on treatments and care. Worsening severity of disease appears to be associated with a higher risk of impaired QoL, and pharmacologic and educational interventions that improve disease severity appear to, for the most part, simultaneously improve QoL...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577799/adult-onset-atopic-dermatitis-fact-or-fancy
#10
REVIEW
Jon M Hanifin
Atopic dermatitis therapy can be a challenge in many cases. Persistence into adulthood often reflects the more severe cases and such patients have the added problems of hand eczema and thick nummular lesions that resist topical medications. Within this group are patients labeled as having adult-onset atopic dermatitis, a designation that is hard to define and probably represents those whose childhood eczema was simply forgotten. Management is difficult for most adult cases and should not be diverted by questionable labels...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577798/the-long-term-course-of-atopic-dermatitis
#11
REVIEW
Katrina Abuabara, David J Margolis, Sinéad M Langan
Atopic dermatitis (AD) is a chronic, relapsing condition, meaning that the intensity of symptoms usually fluctuates over time. Changes in skin physiology may be evident from birth, suggesting that AD may be a lifelong condition marked by intermittent symptoms/disease activity. Methodological considerations for studying the long-term course of AD are reviewed in detail. Improved measurement of the frequency and duration of active disease periods can help to elucidate more about the clinical course AD and the role of treatment in long-term outcomes...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577797/public-health-burden-and-epidemiology-of-atopic-dermatitis
#12
REVIEW
Jonathan I Silverberg
Atopic dermatitis (AD) is a chronic inflammatory skin disorder with significant morbidity and quality-of-life impairment. The epidemiology of AD is complex and challenging to study. The 1-year US prevalence of AD was 12.98% in children in 2007-2008 and 7.2%-10.2% in adults in 2010-2012. There is considerable statewide and countrywide variation of AD prevalence and severity. The prevalence of childhood AD dramatically increased over the past few decades but may be leveling off in developed nations. AD is associated with increased direct and indirect costs to payers and patients, thereby contributing toward a considerable public health burden...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28577796/how-to-define-atopic-dermatitis
#13
REVIEW
Thomas Bieber
Although atopic dermatitis (AD) is the most common skin disorder, there remains an ongoing debate on this denomination, its definition and the binary view based on immunoglobulin E measurement. The wide spectrum of the clinical phenotype of AD reflects the complex genetic and pathophysiologic mechanisms underlying the disease. The diagnostic criteria have to be reconsidered and adapted to different ethnic populations. There is an urgent need for biomarker discovery further supporting the clinical diagnostic criteria as well as the precision medicine approach on a global level...
July 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28317535/optimizing-vitiligo-management-past-present-and-future
#14
EDITORIAL
John E Harris
No abstract text is available yet for this article.
April 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28317534/vitiligo-pathogenesis-and-emerging-treatments
#15
REVIEW
Mehdi Rashighi, John E Harris
The pathogenesis of vitiligo involves interplay between intrinsic and extrinsic melanocyte defects, innate immune inflammation, and T-cell-mediated melanocyte destruction. The goal of treatment is to not only halt disease progression but also promote repigmentation through melanocyte regeneration, proliferation, and migration. Treatment strategies that address all aspects of disease pathogenesis and repigmentation are likely to have greatest efficacy, a strategy that may require combination therapies. Current treatments generally involve nontargeted suppression of autoimmunity, whereas emerging treatments are likely to use a more targeted approach based on in-depth understanding of disease pathogenesis, which may provide higher efficacy with a good safety profile...
April 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28317533/genetics-of-vitiligo
#16
REVIEW
Richard A Spritz, Genevieve H L Andersen
Vitiligo reflects simultaneous contributions of multiple genetic risk factors and environmental triggers. Genomewide association studies have discovered approximately 50 genetic loci contributing to vitiligo risk. At many vitiligo susceptibility loci, the relevant genes and DNA sequence variants are identified. Many encode proteins involved in immune regulation, several play roles in cellular apoptosis, and others regulate functions of melanocytes. Although many of the specific biologic mechanisms need elucidation, it is clear that vitiligo is an autoimmune disease involving a complex relationship between immune system programming and function, aspects of the melanocyte autoimmune target, and dysregulation of the immune response...
April 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28317532/the-role-of-diet-and-supplements-in-vitiligo-management
#17
REVIEW
Pearl E Grimes, Rama Nashawati
Vitiligo is an autoimmune disorder that involves the interplay between oxidative stress and the immune system. Preliminary observations suggest that the presence of gluten in the diet may play a role in vitiligo development in some patients, but to date vitiligo-specific diets have not been studied. The role of oral supplements, including vitamins, minerals, and botanicals, is increasingly being investigated as adjuncts to conventional medical treatment due to their antioxidant and immunomodulatory activity...
April 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28317531/special-considerations-in-children-with-vitiligo
#18
REVIEW
Alain Taïeb, Julien Seneschal, Juliette Mazereeuw-Hautier
Childhood vitiligo differs from adult-onset vitiligo for several features including increased incidence of the segmental variant, higher prevalence of halo nevi, and more common family history for autoimmune diseases and atopic diathesis. The major differential diagnoses are the postinflammatory hypomelanoses for nonsegmental vitiligo and nevus depigmentosus for segmental vitiligo. From a therapeutic standpoint, early awareness of the diagnosis seems to correlate with a good treatment outcome in this age group...
April 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28317530/depigmentation-therapies-for-vitiligo
#19
REVIEW
Pearl E Grimes, Rama Nashawati
The general goals of medical management of vitiligo are to repigment vitiliginous areas of skin and to stabilize the progression of depigmentation. However, for some patients with vitiligo affecting extensive body surface areas who are unresponsive to repigmentation therapies, depigmentation of the remaining normal skin may be a better choice. Candidates for depigmentation therapy should be carefully screened and patient education is essential. Permanent topical therapies used for depigmentation include monobenzyl ether of hydroquinone, 4-methoxyphenol, and 88% phenol...
April 2017: Dermatologic Clinics
https://www.readbyqxmd.com/read/28317529/repigmentation-through-melanocyte-regeneration-in-vitiligo
#20
REVIEW
Stanca A Birlea, Nathaniel B Goldstein, David A Norris
Repigmentation in vitiligo is the process that replaces, in the epidermal basal layer of vitiligo skin, the mature melanocytes that have been killed by cytotoxic T cells specific for melanocyte antigens. It consists of mobilization of melanocyte precursors in the hair follicle bulge and infundibulum to proliferate, migrate, and differentiate into mature melanocytes, moving from the hair follicle bulge to the interfollicular epidermis. The most common clinical presentation of repigmentation in vitiligo is the perifollicular pattern...
April 2017: Dermatologic Clinics
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