Advances in Diagnostic Criteria and Severity Assessment of Atopic Dermatitis / 中国医学科学院学报

Atopic dermatitis(AD),a chronic and relapsing skin disease,is characterized by dry skin and pruritus,severely affecting the quality of patients' life.Accurately grasping the diagnostic criteria and severity assessment is essential and helps to avoid misdiagnosis and missed diagnosis.Moreover,it facilities the development and adjustment of the therapeutic schedule according to the therapeutic reaction and disease control conditions.This article reviews the research advances in the diagnostic criteria and severity assessment of AD.

Dupilumabe e upadacitinibe comparados a medicamentos imunossupressores para o tratamento de dermatite atópica moderada a grave refratária a terapia tópica: revisão rápida de evidências / Dupilumab and upadacitinib compared to immunosuppressive drugs for the treatment of moderate to severe atopic dermatitis refractory to topical therapy: rapid review of evidence

Tecnologia: Dupilumabe e upadacitinibe. Comparadores: Azatioprina, metotrexato, ciclosporina, micofenolato de mofetila. Indicação: Tratamento de dermatite atópica severa em pacientes adultos. Pergunta: Dupilumabe e upadacitinibe são mais eficazes e tão seguros quanto ciclosporina ou outros agentes imunossupressores para obter os desfechos de saúde no tratamento sistêmico de dermatite atópica moderada a grave refratária à terapia atópica? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED e Cochrane Library, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Foram selecionados três estudos que atenderam aos critérios de inclusão. Conclusão: Dupilumabe, upadacitinibe, ciclosporina e azatioprina são mais eficazes que placebo nos desfechos de eficácia (reduzir sinais clínicos em escalas, reduzir sintomas em escalas) para tratamento da dermatite atópica moderada a grave refratária à terapia tópica, mas esses medicamentos não diferem entre si. Dupilumabe, upadacitinibe, ciclosporina e azatioprina são bem tolerados e seguros

Technology: Dupilumab, upadacitinibe. Comparators: Azathioprine, methotrexate, cyclosporine, mycophenolate mofetil. Indication: Treatment of severe atopic dermatitis in adult patients. Question: Are dupilumab and upadacitinib more effective and as safe as cyclosporine or other immunosuppressive agents for achieving health outcomes in the systemic treatment of moderate to severe atopic dermatitis refractory to atopic therapy? Methods: A bibliographic survey was done in the PUBMED e Cochrane Library databases, following predefined search strategies. The methodological quality of systematic reviews was evaluated using the AMSTAR-2 tool (Assessing the Methodological Quality of Systematic Reviews Version 2). Results: Three studies that met the inclusion criteria were selected. Conclusion: Dupilumab, upadacitinib, cyclosporine, and azathioprine are more effective than placebo on efficacy endpoints (reduce clinical signs on scales, reduce symptoms on scales) for treating moderate to severe atopic dermatitis refractory to topical therapy, but these drugs do not differ from each other. Dupilumab, upadacitinib, cyclosporine, and azathioprine are well tolerated and safe

Efficacy and safety of dupilumab in two adolescents with severe atopic dermatitis / Eficácia e segurança do uso de dupilumabe em dois adolescentes com dermatite atópica grave

ABSTRACT We report the cases of two adolescent siblings with severe atopic dermatitis, who, despite weighing approximately 40kg, presented a good response to dupilumab with the off-label dose for individuals aged 12 years and weighing 60kg. Both had already used cyclosporine, azathioprine, methotrexate and oral corticosteroids for long periods, plus topical treatments with no adequate disease control. Skin lesions were constant and widespread, with frequent skin infections and very poor quality of life, with numerous physical and psychosocial consequences, such as dropping out of school activities due to severe itching, appearance and bullying. They also showed delayed growth and development. In 2018, dupilumab, an immunobiological agent, was approved for treatment of moderate to severe atopic dermatitis in adults and, in 2019, extended to the 12-17-year age group. Although it had already been approved by the Brazilian Health Surveillance Agency, the 200mg presentation (indicated for the weight of patients) was not available, with no expected arrival date. Therefore, weighing the risks and benefits of the situation of both, we chose to treat them with an adult dose (loading dose of 600mg subcutaneously, and 300mg subcutaneously every 2 weeks) despite the low weight. So far, they have received eight injections, showing significant improvement of disease and quality of life. There were no major adverse effects, only worsening of allergic conjunctivitis in one of them. The patients and their family are very satisfied, and we believe that the therapy has been successful.

RESUMO Relatamos os casos de dois irmãos adolescentes com dermatite atópica grave e que, apesar de pesarem cerca de 40kg, apresentaram boa resposta ao dupilumabe com a dose off-label para indivíduos com 12 anos e peso de 60kg. Ambos já tinham usado ciclosporina, azatioprina, metotrexato e corticoide oral por longos períodos, acrescidos de tratamentos tópicos sem controle adequado da doença. As lesões cutâneas eram constantes e disseminadas, e os irmãos apresentavam infeções de pele frequentes e qualidade de vida muito ruim, com inúmeras consequências físicas e psicossociais, como o abandono da atividade escolar pelo prurido intenso, pela aparência e pelo bullying sofrido. Apresentavam também retardo de crescimento e de desenvolvimento. Em 2018, o dupilumabe, um agente imunobiológico, foi aprovado para o tratamento de dermatite atópica moderada a severa para adultos e, em 2019, ampliado para faixa etária de 12 a 17 anos. Embora já tivesse a aprovação da Agência Nacional de Vigilância Sanitária no Brasil, a apresentação de 200mg (indicada para o peso dos pacientes) não estava disponível, sem previsão de chegada. Assim, pesando os riscos e benefícios da situação de ambos, optamos por tratá-los com dose de adulto (ataque de 600mg por via subcutânea e 300mg por via subcutânea a cada 2 semanas) apesar do baixo peso. Até o momento, eles realizaram oito aplicações, apresentando importante melhora da doença e da qualidade de vida. Não houve efeitos adversos importantes - apenas a piora da conjuntivite alérgica em um deles. Os pacientes e sua família estão muito satisfeitos, e nós avaliamos que a terapia está sendo bem-sucedida.

Presente y futuro del tratamiento biológico y moléculas pequeñas en la dermatitis atópica / Present and future of biological treatment and small molecules in atopic dermatitis

La dermatitis atópica (DA) es una condición inflamatoria crónica de la piel de etiología multifactorial. Buscando mejorar la respuesta clínica minimizando los efectos adversos y ampliar el arsenal terapéutico disponible, se ha dado pie al desarrollo de nuevos fármacos con resultados prometedores en la calidad de vida. Los inmunomoduladores sistémicos clásicos son considerados el tratamiento estándar en los casos de DA moderada a severa refractaria al tratamiento con corticoides tópicos. Estos se encasillan dentro de las denominadas moléculas pequeñas, junto con los inhibidores de Janus- en un efecto pleiotrópico en las citoquinas y por ende, no selectivo. Los medicamentos biológicos poseen ventajas frente a los inmunomoduladores clásicos, principalmente su mayor especificidad gracias a la similitud con las moléculas endógenas. Dupilumab se mantiene siendo el único fármaco biológico aprobado por la FDA para el tratamiento de la DA, con una seguridad a corto plazo demostrada. Algunas moléculas nuevas, como el tralokinumab y los inhibidores JAK, presentan resultados prometedores. De este grupo, abrocitinib pareciera posicionarse como una alternativa al menos similar que dupilumab. La creciente investigación de nuevas alternativas ha creado una revolución terapéutica para que nuestros pacientes puedan acceder a una mejor calidad de vida. No obstante, es difícil lograr comprender la efectividad y seguridad de cada uno de los tratamientos disponibles, por la falta de estudios comparativos. La siguiente revisión muestra las nuevas terapias biológicas y algunas moléculas pequeñas con evidencia para su uso en DA

Atopic dermatitis (AD) is a chronic inflammatory condition of the skin with a multifactorial etiology. Seeking to improve the clinical response by minimizing adverse effects and expanding the available therapeutic arsenal, the development of new drugs has led to promising results on quality of life. Classic systemic immunomodulators are considered the standard treatment in cases of moderate to severe AD refractory to treatment with topical corticosteroids. These are classified into molecules, along with Janus kinase inhibitors (JAKs). Small molecules act on intracellular targets, with the inconveniency of producing a pleiotropic effect on cytokines and, therefore, non-selective actions. Biologics have advantages over classical immunomodulators, mainly their greater specificity thanks to the similarity between endogenous molecules. Dupilumab remains the only biologic drug approved by the FDA for the treatment of AD, with demonstrated short-term safety. Some new molecules, such as tralokinumab and JAK inhibitors, have shown promising results. Of this group, abrocitinib seems to be positioned as an alternative at least similar to dupilumab. The current investigation of new alternatives has created a therapeutic revolution so that we can offer our patients a better quality of life. However, it is difficult to understand the efficacy and safety of each of the available treatments due to the lack of comparative studies. The following review shows the new biological therapies and small molecules with evidence for their use in DA.

A randomized half-body, double blind, controlled trial on the effects of a pH-modified moisturizer vs. standard moisturizer in mild to moderate atopic dermatitis,

Abstract Background: Higher skin pH in atopic dermatitis contributes to impaired epidermal barrier. A moisturizer compatible with physiological pH could improve atopic dermatitis. Objective: To determine the effect of a physiologically compatible pH moisturizer in atopic dermatitis. Methods: A randomized half body, double blind, controlled trial involving patients with stable atopic dermatitis was performed. pH-modified moisturizer and standard moisturizer were applied to half body for 6 weeks. Results: A total of 6 (16.7%) males and 30 (83.3%) females participated. Skin pH reductions from week 0, week 2 and 6 were significant at the forearms (5.315 [0.98] to 4.85 [0.54] to 5.04 [0.78], p = 0.02) and abdomen (5.25 [1.01], 4.82 [0.64], 5.01 [0.59], p = 0.00) but not at the shins (5.01 [0.80], 4.76 [0.49], 4.85 [0.79], p = 0.09) with pH-modified moisturizer. Transepidermal water loss (TEWL) at the forearms decreased (4.60 [2.55] to 3.70 [3.10] to 3.00 [3.55], p = 0.00), abdomen (3.90 [2.90] to 2.40 [3.45] to 2.70 [2.25], p = 0.046). SCORAD improved from 14.1 ± 12.75 to 10.5 ± 13.25 to 7 ± 12.25, p = 0.00. In standard moisturizer group, pH reductions were significant at the forearms (5.29 [0.94] to 4.84 [0.55] to 5.02 [0.70], p = 0.00) and abdomen (5.25 [1.09], 4.91 [0.63], 5.12 [0.66], p = 0.00). TEWL at the forearm were (4.80 [2.95], 4.10 [2.15], 4.60 [3.40], p = 0.67), shins (3.80 [1.40], 3.50 [2.35], 4.00 [2.50], p = 0.91) and abdomen (3.70 [2.45], 4.10 [3.60], 3.40 [2.95], p = 0.80). SCORAD improved from 14.2 ± 9.1 to 10.9 ± 10.65 to 10.5 ± 11, p = 0.00. Reduction in pH was observed with both moisturizers while TEWL significantly improved with pH-modified moisturizer. pH-modified moisturizer resulted in greater pH, TEWL and SCORAD improvements however the differences were not significant from standard moisturizer. Study limitation: Skin hydration was not evaluated. Conclusion: Moisturization is beneficial for atopic dermatitis; use of physiologically compatible pH moisturizer is promising.

Dihydroartemisinin alleviates atopic dermatitis in mice by inhibiting mast cell infiltration / 南方医科大学学报

OBJECTIVE@#To observe the therapeutic effect of different doses of dihydroartemisinin (DHA) on atopic dermatitis (AD) in mice and explore the mechanism.@*METHODS@#Forty-two C57BL/6 mice were randomly divided into 7 groups (@*RESULTS@#Treatment with 25, 75, and 125 mg/kg DHA and dexamethasone all alleviated AD symptoms of mice, reduced the severity scores of skin lesions, and ameliorated pathological changes of the skin tissue. DHA at 125 mg/kg produced the most obvious therapeutic effect and significantly alleviated mast cell infiltration in the lesions as compared with the other treatment groups (@*CONCLUSIONS@#DHA is effective for the treatment of AD in mice with an optimal dose of 125 mg/kg. The therapeutic effect of DHA is achieved probably through regulation of local immunity by inhibiting mast cell infiltration in the lesions.

Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology

Abstract: BACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.

Aspectos de interés sobre dermatitis atópica, su diagnóstico y tratamiento / Interest aspects about Atopic Dermatitis, its diagnosis and treatment

RESUMEN La evolución favorable de los pacientes afectados con dermatitis atópica está muy relacionada con un diagnóstico y orientación precoz en la atención primaria, para un seguimiento más especializado en las consultas de dermatología y alergología, por ser una entidad que ofrece dificultades en su identificación. Es necesario incrementar el nivel de información en los médicos de las áreas de salud, por ser estos escenarios donde ocurre el primer contacto con el paciente. El objetivo es ofrecer una visión actualizada sobre el diagnóstico y tratamiento de la dermatitis atópica que contribuya a la formación de los médicos en la atención primaria. Se realiza una revisión bibliográfica de los últimos 5 años, principalmente en las bases de datos PubMed y Scielo sobre el tema. Se abordan aspectos de interés relacionados con las manifestaciones clínicas, criterios diagnósticos y tratamiento. Los resultados que se ofrecen en este trabajo contribuirán a la formación profesional para una mejor promoción, prevención, diagnóstico precoz y tratamiento de esta enfermedad, cuya prevalencia es mayor en la infancia.

ABSTRACT The favorable evolution of the patients affected with Atopic Dermatitis is quite related with a diagnosis and precocious orientation in the primary attention, for a more specialized follow up in the dermatology and alergology consultations, as it is an entity that offers difficulties in its identification. It is necessary to increase the level of knowledge of doctors in these medical areas as these are the scenarios where it occurs the first contact patient doctor. Offering an updated vision about Atopic Dermatitis that contributes to the continuous formation of the professionals of the health sector in the primary attention. A revision of articles in the PubMed and Scielo database is carried out principally during the last 5 years. Aspects of interest related with the clinical manifestations, diagnoses criteria and treatment are considered. The results that are offered in this work will contribute to the professional formation for a better promotion, prevention, precocious diagnosis and treatment of this illness that is more likely to be found in the childhood.

Dermatitis atópica del adulto: un desafío diagnóstico y terapéutico / Adult atopic dermatitis: a challenge diagnosis and therapy

Adult atopic dermatitis is a chronically recurring inflammatory dermatosis which presents in various forms. Some of these forms develop mostly in adults such as head and neck dermatitis and chronic hand eczema. Even though the diagnosis is clinical it frequently requires further investigations to exclude differential diagnosis. Once confirmed, it is crucial to classify its severity and exclude other comorbidities. Treatment includes general measures such as the use of emollients and soap substitutes which are applicable in all cases regardless of its severity. Other therapeutic options include topical corticosteroids, topical calcineurin inhibitors, phototherapy and immunosuppressants. Their use will depend on the degree of severity and specific characteristics of each individual. Newer biologics have proven to be a safe and effective alternative, and seem to be a promising option in cases of adult atopic dermatitis refractory to conventional treatments. (AU)

Dupilumab in the treatment of severe atopic dermatitis refractory to systemic immunosuppression: case report / Dupilumabe no tratamento da dermatite atópica grave refratária à imunossupressão sistêmica: relato de caso

ABSTRACT Case report of a patient with severe atopic dermatitis who showed a good response to dupilumab. She had already used two immunosuppressive agents, cyclosporine A and mycophenolate mofetil, for the treatment of atopic dermatitis with no proper control of the disease. She had also been taking all measures to control severe cases of the disease: bath and environmental controls, topical potent corticosteroids and emollients. She presented constant pruritus and skin lesions, frequent skin infections e poor quality of life. She also developed depression due to her disease. Recently, dupilumab, a new biological agent, was approved for the treatment of moderate/severe atopic dermatitis in many countries, including Brazil. Dupilumab is a monoclonal antibody with a common alpha chain of interleukin (IL) 4 and IL-13 receptors, two cytokines involved in the Th2 profile immune response that promote atopic inflammation. In a pioneer way in Brazil, the patient initiated the treatment with an attack dose of 600mg subcutaneous of dupilumab and 300mg subcutaneous every other week. Up to now, she has taken four applications, presenting a great improvement of the disease and her quality of life. There were no adverse effects, nor in the injection site nor of other kind. Patient and her family are very satisfied, and the medical team evaluates that the treatment is being well succeed. The case report described here subsidizes the use of dupilumab in the treatment of severe atopic dermatitis refractory to use of immunosuppressive agents.

RESUMO Relatamos o caso de uma paciente com dermatite atópica grave, que mostrou boa resposta ao dupilumabe. Ela já tinha usado dois agentes imunossupressores, a ciclosporina A e o micofenolato de mofetila, para o tratamento da dermatite atópica, sem obter o controle adequado da doença. Ela também vinha fazendo uso de todas as medidas de controle para casos graves da doença: cuidados com o banho, controle ambiental, corticosteroides potentes tópicos e emolientes. Apresentava prurido e lesões cutâneas constantes, infeções de pele frequentes e qualidade de vida ruim. Passou a apresentar depressão devido à sua doença. Recentemente, o dupilumabe, um agente biológico novo, foi aprovado para o tratamento de dermatite atópica moderada a severa em muitos países, incluindo o Brasil. Dupilumabe é um anticorpo monoclonal cujo alvo é a cadeia alfa comum aos receptores da interleucina (IL) 4 e IL-13, duas citocinas envolvidas no perfil de resposta imune Th2, que promove inflamação atópica. De modo pioneiro no Brasil, a paciente iniciou o tratamento, com dose de ataque de 600mg por via subcutânea de dupilumabe e 300mg também por via subcutânea a cada 2 semanas. Até o momento deste relato, ela realizou quatro aplicações, apresentando grande melhora da doença e da qualidade de vida. Não houve efeitos adversos, nem no local da injeção e nem de outro tipo. A paciente e sua família estão muito satisfeitas, e os médicos que a tratam avaliam que a terapia está sendo bem-sucedida. Este relato de caso subsidia o uso de dupilumabe no tratamento da dermatite atópica grave refratária ao uso de imunossupressores.

New and developing therapies for atopic dermatitis

Abstract: Atopic dermatitis is a common inflammatory skin disease. New understanding in disease pathogenesis has led to a considerable number of promising new drugs in development. New topical agents can be especially helpful for children, providing an alternative to the need for chronic topical corticosteroid use. While many patients with mild or moderate disease can be managed with topical treatments, there are unmet needs for recalcitrant and severe cases. New and developing therapies hold promise for real advances in management of this complex disease.

Vitamin D and skin diseases: A review.

Vitamin D, originally associated with rickets and osteomalacia, has recently been shown to have a role in a number of medical and dermatological diseases. It has been found that vitamin D receptors and the enzymatic machinery capable of converting circulating 25-hydroxyvitamin D [25(OH)D] to the active 1,25-hydroxyvitamin D [1,25(OH)D] is present in most cells in the body including the skin. It is well known that vitamin D analogs are effective in the treatment of psoriasis vulgaris because of their anti-proliferative and pro-differentiating effects on keratinocytes. However, new roles have been found for vitamin D in skin, such as immunomodulatory and anti-apoptotic effects thus raising a possibility of its use in conditions such as atopic dermatitis and infections. Increasing evidence now indicates that cutaneous vitamin D synthesis may help in prevention of skin malignancies and further, that cancer mortality may be reduced by oral supplementation of vitamin D. Various epidemiological studies have linked low levels of vitamin D to autoimmune diseases including vitiligo, and topical vitamin D has been used to treat vitiligo. This review focuses on a wide array of roles of vitamin D in various skin disorders with emphasis on both its well-established role as in psoriasis and the less characterized role in other disorders such as ichthyosis, tuberculosis or acne.

Há lugar para o uso de probióticos na prevenção e no tratamento da dermatite atópica pediátrica? / Can probiotics play a role in the prevention and treatment of pediatric atopic dermatiti

A dermatite atópica (DA) é a doença dermatológica crônica mais frequente na infância e traz impacto negativo na qualidade de vida do paciente e de seus familiares. Os probióticos surgem como uma nova opção terapêutica, pela sua capacidade de modulação da reposta imunológica do hospedeiro, produzindo benefícios à saúde. Realizou-se uma busca nas plataformas de dados científicos PubMed, SciELO e Cochrane, apurando estudos nos idiomas português, inglês e espanhol. Baseado nos bancos de descritores DeCS e MeSH foram utilizadas as seguintes palavras/expressões: probiotics, probiotics and atopic dermatitis, atopic dermatitis and child e suas correspondentes nas demais línguas, sendo selecionados estudos entre 1993 e 2014. Considerando o papel dos probióticos na prevenção da DA, foram encontrados sete ensaios clínicos randomizados, sendo que quatro destes apresentaram desfecho positivo e os demais foram inconclusivos. Avaliando-se as possibilidades terapêuticas dos probióticos, cinco dos sete estudos analisados evidenciaram que a imunomodulação exercida pelas cepas probióticas tem melhor resposta à DA, além de menos efeito colateral que o obtido com o uso de corticoides e imunossupressores sistêmicos. O uso de probióticos na prevenção e no tratamento da DA mostrou-se seguro e eficaz, com descrição de efeitos colaterais em apenas um estudo. É possível que a suplementação com probióticos alcance seu lugar no manejo clínico da DA, podendo ser uma alternativa mais interessante e menos onerosa se comparada à terapia conservadora utilizada atualmente.

Atopic dermatitis (AD) is the most common chronic skin disease in childhood and it causes negative effect on patients? and their families? quality of life. The probiotics arise as a new therapeutic option for their ability to modulate the host?s immune response and produce benefits on their health. The authors searched on the scientific databases PubMed, SciELO and Cochrane, assessing studies in Portuguese, English and Spanish. Based on the descriptive databases of MeSH and DeCS, the following words/ phrases were used: probiotics, probiotics and atopic dermatitis, atopic dermatitis and child and their correspondents in other languages, studies were selected between 1993 and 2014. Considering the role of probiotics in the prevention of AD, seven randomized controlledtrials were found, four of those had a positive outcome and the others were inconclusive. Evaluating probiotics? therapeutic potential, five of the seven analyzed studies showed that the immunomodulation exerted by probiotic strains has a better answer for AD, as well as minor side effects than those obtained with the use of systemic corticosteroids and immunosuppressants. The use of probiotics in the prevention and treatment of AD proved to be safe and effective, being that side effects have been reported in only one study. It is possible that supplementation with probiotics can play a role in the clinical management of AD, being a more interesting and less expensive alternative compared to conservative therapy currently used

Comparative efficacy of topical mometasone furoate 0.1% cream vs topical tacrolimus 0.03% ointment in the treatment of atopic dermatitis

To compare the efficacy of mometasone furoate and tacrolimus in the treatment of atopic dermatitis. Sixty patients of atopic dermatitis were treated with mometasone furoate 0.1% [n=30] and tacrolimus 0.03% [n=30]. Both treatments were applied twice daily for 12 weeks. Patients were followed up monthly. The disease severity assessed by SCORAD index. A 4-point scale was used to measure the level of response to treatment. Before treatment the respective mean SCORAD was 30.57 +/- 13.62 and 30.90 +/- 17.17 in group A and B and at the end of treatment decreased to 11.87 +/- 12.04 and 11.20 +/- 13.85, respectively [p>0.05]. Percent reduction of severity from baseline to final follow-up was 69.20 +/- 23.41 in group A and 74.77 +/- 23.30 in group B [p=0.360]. At final follow-up 56.7% of group A and 63.3% of group B achieved excellent response, 13.3% of group A and 16.7% of group B achieved good response. We conclude that both treatments, mometasone furoate and tacrolimus, are effective in the treatment of atopic dermatitis

Atopic dermatitis and vitamin D: facts and controversies / Dermatite atopica e vitamina D: fatos e controversias

Patients with atopic dermatitis have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Clinically, this results in an intensely pruriginous and inflamed skin that allows the penetration of irritants and allergens and predisposes patients to colonization and infection by microorganisms. Among the various etiological factors responsible for the increased prevalence of atopic diseases over the past few decades, the role of vitamin D has been emphasized. As the pathogenesis of AD involves a complex interplay of epidermal barrier dysfunction and dysregulated immune response, and vitamin D is involved in both processes, it is reasonable to expect that vitamin D's status could be associated with atopic dermatitis' risk or severity. Such association is suggested by epidemiological and experimental data. In this review, we will discuss the evidence for and against this controversial relationship, emphasizing the possible etiopathogenic mechanisms involved.

Pacientes com dermatite atópica têm fatores de risco geneticamente determinados que afetam a função de barreira da pele e as respostas imunes, as quais interagem com fatores ambientais. Clinicamente, isso resulta em uma pele intensamente pruriginosa, inflamada, que permite a penetração de irritantes e alérgenos e predispõe os pacientes à colonização e à infecção por micro-organismos. Dentre os diversos fatores etiológicos responsáveis pelo aumento da prevalência de doenças atópicas nas últimas décadas, o papel da vitamina D tem ganhado destaque. Uma vez que a patogênese da dermatite envolve uma interação complexa da disfunção da barreira epidérmica e desregulação da resposta imune - e a vitamina D está envolvida em ambos os processos-, é razoável esperar que a vitamina D esteja associada ao risco ou à gravidade da dermatite atópica. Tal associação é sugerida por dados epidemiológicos e experimentais. Nessa revisão, serão abordadas as evidências favoráveis e contrárias a essa polêmica relação, enfatizando os possíveis mecanismos etiopatogênicos envolvidos.

Bacterial skin colonization and infections in patients with atopic dermatitis / Colonização bacteriana e infecções da pele em pacientes com dermatite atópica

Atopic Dermatitis is a chronic inflammatory skin disease that affects a large number of children and adults. The disease results from an interaction between genetic predisposition, host environment, skin barrier defects, and immunological factors. A major aggravating factor associated with Atopic Dermatitis is the presence of microorganisms on the patient's skin surface. Staphylococcus aureus and Streptococcus pyogenes, for instance, can exacerbate chronic skin inflammation. As a result, antimicrobials have often been prescribed to control the acute phase of the disease. However, increased bacterial resistance to antimicrobial agents has made it difficult for dermatologists to prescribe appropriate medication. In the presence of disseminated dermatitis with secondary infection, systemic antibiotics need to be prescribed; however, treatment should be individualized, in an attempt to find the most effective antibiotic with fewer side effects. Also, the medication should be used for as short as possible in order to minimize bacterial resistance.

A dermatite atópica é uma doença inflamatória crônica da pele que afeta um grande número de crianças e adultos. A doença resulta da interação entre predisposição genética, fatores ambientais, defeitos da barreira cutânea e fatores imunológicos. Um dos grandes fatores agravantes associados à dermatite atópica é a presença de microorganismos na superfície cutânea desses pacientes. Staphylococcus aureus e Streptococcus pyogenes, por exemplo, podem exacerbar a inflamação crônica da pele. Como resultado, antimicrobianos são prescritos para controlar a fase aguda da doença. O constante crescimento da resistência bacteriana aos antimicrobianos tem tornado a escolha do mais adequado medicamento uma difícil decisão para os dermatologistas. Na presença de dermatite disseminada com infecção secundaria, antibióticos sistêmicos necessitam ser prescritos; no entanto, o tratamento deve ser individualizado, de forma a encontrar o antimicrobiano mais eficaz e com menores efeitos colaterais. Além disso, esse medicamento deve ser utilizado pelo menor tempo possível, a fim de minimizar a resistência bacteriana.