Skip to main content

Advertisement

SpringerLink
Log in

Atopic Dermatitis

Immune Indicators and Immunomodulatory Treatment

  • Review Article
  • Immunological Basis of Disease
  • Published:
Clinical Immunotherapeutics Aims and scope Submit manuscript

Summary

Atopic dermatitis is a chronic cutaneous inflammatory disease characterised by early age of onset, severe pruritus, a typical morphology and distribution of skin rash, chronic relapsing course, positive family history of atopy, and low thresholds for pruritogenic stimuli. Conventional treatment, including antihistamines, topical corticosteroids and control of superinfection, usually cannot prevent its chronic relapsing course.

Recent knowledge about the nature of the inflammatory response in lesional skin and the inherited immunological abnormalities has prompted the empirical use of a wide variety of immunomodulatory agents in the treatment of patients with atopic dermatitis. These agents include thymopentin, interferon-α, interferon-γ interleukin-2 and systemic immunosuppressants such as cyclosporin. Nearly all of these agents show transient therapeutic effects during the course of treatment; however, the disease usually relapses after discontinuation of the therapy.

Clinical trials with more patients and a prolonged treatment period, as well as more studies of the immunology of the disease, are needed to clarify the mechanisms of actions of these immunomodulatory agents and the rationale for their use in the treatment of atopic dermatitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Taylor B, Wadsworth J, Wadsworth M, et al. Changes in the reported prevalence of childhood eczema since the 1939–45 war. Lancet 1984; ii: 1255–7

    Article  Google Scholar 

  2. Hsieh KH, Tsai YT. Increasing prevalence of childhood allergic disease in Taipei, Taiwan, and the outcome. In: Miyamoto T, Okuda M, editors. Progress in allergy and clinical immunology. Vol 2. Göttingen: Hogrefe & Huber, 1992: 223–5

    Google Scholar 

  3. Besnier E. Premiere note et observations preliminaries pour servir d’introduction a l’etude des pruripos diatrhesiques. Ann Dermatol Syph 1892; 23: 634–7

    Google Scholar 

  4. Wise F, Sulzberger MB. Yearbook of dermatology and syphilology. Chicago: Yearbook Medical Publishers, 1933: 59

    Google Scholar 

  5. Van der Heijden FL, Wierenga EA, Gos JD, et al. High frequency of IL-4 producing CD4+ allergen-specific T lymphocytes in atopic dermatitis lesional skin. J Invest Dermatol 1991; 97: 389–94

    Article  PubMed  Google Scholar 

  6. Sager N, Feldman A, Schilling G, et al. House dust mite-specific T cells in the skin of subjects with atopic dermatitis: frequency and lymphokine profile in the allergen patch test. J Allergy Clin Immunol 1992; 89: 801–10

    Article  PubMed  CAS  Google Scholar 

  7. Zurawski G, deVries JE. Interleukin 13, an interleukin 4-like cytokine that acts on monocytes and B cells, but not on T cells. Immunol Today 1994; 15: 19–26

    Article  PubMed  CAS  Google Scholar 

  8. Vollenweider S, Saurat J-H, Rocken M, et al. Evidence suggesting involvement of interleukin-4 (IL-4) production in spontaneous in vitroIgE synthesis in patients with atopic dermatitis. J Allergy Clin Immunol 1991; 87: 1088–95

    Article  PubMed  CAS  Google Scholar 

  9. Bruynzeel-Koomen C, Wichen DF, Toonstra J, et al. The presence of IgE molecules on epidermal Langerhans’ cells in patients with atopic dermatitis. Arch Dermatol Res 1986; 278: 199–205

    Article  PubMed  CAS  Google Scholar 

  10. Maggi E, Parronchi P, Manetti R, et al. Reciprocal regulatory effects of IFN-gamma and IL-4 on the in vitro development of human Thl and Th2 clones. J Immunol 1992; 148: 2142–7

    PubMed  CAS  Google Scholar 

  11. Orino E, Sone S, Nii A, et al. IL-4 up-regulates IL-1 receptor antagonist gene expression and its production in human blood monocytes. J Immunol 1992; 149: 925–31

    PubMed  CAS  Google Scholar 

  12. Leiferman KM. A current perspective on the role of eosinophils in dermatologic diseases. J Am Acad Dermatol 1991; 24: 1101–5

    Article  PubMed  CAS  Google Scholar 

  13. Reinhold U, Pawelec G, Wehrmann W, et al. Immunoglobulin E and immunoglobulin G subclass distribution in vivo and relationship to in vitro generation of interferon-γ and neopterin in patients with severe atopic dermatitis. Int Arch Allergy Appl Immunol 1988; 87: 120–6

    Article  PubMed  CAS  Google Scholar 

  14. Jujo K, Renz H, Abe J, et al. Decreased γ interferon and increased interleukin-4 production promote IgE synthesis in atopic dermatitis. J Allergy Clin Immunol 1992; 90: 323–30

    Article  PubMed  CAS  Google Scholar 

  15. Van der Heijden FL, Wierenga E, Bos J, et al. High frequency of IL-4-producing CD4+ allergen-specific T lymphocytes in atopic dermatitis lesional skin. J Invest Dermatol 1991; 97: 389–94

    Article  PubMed  Google Scholar 

  16. Van Reijsen F, Bruijnzeel-Koomen C, Kalthoff F, et al. Skin-derived aeroallergen-specific T-cell clones of Th2 phenotype in patients with atopic dermatitis. J Allergy Clin Immunol 1992; 90: 184–92

    Article  PubMed  Google Scholar 

  17. Jones HE, Inouye JC, McGerity JL, et al. Atopic disease and serum immunoglobulin E. Br J Dermatol 1975; 92: 17–25

    Article  PubMed  CAS  Google Scholar 

  18. Leung DYM, Geha RS. Immunoregulatory abnormalities in atopic dermatitis. Clin Rev Allergy 1986; 4: 67–86

    PubMed  CAS  Google Scholar 

  19. Chiarelli F, Canfora G, Verrotti A, et al. Humoral and cellular immunity in children with active and quiescent atopic dermatitis. Br J Dermatol 1987; 116: 651–60

    Article  PubMed  CAS  Google Scholar 

  20. Leung DYM, Wood N, Dubey D, et al. Cellular bases of defective cell-mediated lympholysis in atopic dermatitis. J Immunol 1983; 130: 1678–82

    PubMed  CAS  Google Scholar 

  21. Leung DYM, Parkman R, Feller J, et al. Cell-mediated cytotoxicity against skin fibroblasts in atopic dermatitis. J Immunol 1982; 128: 1736–41

    PubMed  CAS  Google Scholar 

  22. Saurat J-H. Eczema in primary immune deficiencies: clues to the pathogenesis of atopic dermatitis with special reference to the Wiskott-Aldrich syndrome. Acta Derm Venereol 1985; 114: 125–8

    CAS  Google Scholar 

  23. Saarinen UM. Transfer of latent atopy by bone marrow transplantation: a case report. J Allergy Clin Immunol 1984; 74: 196–200

    Article  PubMed  CAS  Google Scholar 

  24. Agosti JM, Sprenger JD, Lum LG, et al. Transfer of allergenspecific IgE-mediated hypersensitivity with allogeneic bone marrow transplantation. N Engl J Med 1988; 319: 1623–8

    Article  PubMed  CAS  Google Scholar 

  25. Goldstein G, Scheid MP, Boyse EA, et al. A synthetic pentapeptide with biological activity characteristic of the thymic hormone thymopoietin. Science 1979; 204: 1309–10

    Article  PubMed  CAS  Google Scholar 

  26. Kang K, Cooper KD, Hanifin JM. Thymopentin pentapeptide (TP-5) improves clinical parameters and lymphocyte subpopulations in atopic dermatitis. J Am Acad Dermatol 1983; 8: 372–7

    Article  PubMed  CAS  Google Scholar 

  27. Leung DYM, Hirsch RL, Schneider L, et al. Thymopentin therapy reduces the clinical severity of atopic dermatitis. J Allergy Clin Immunol 1990; 85: 927–33

    Article  PubMed  CAS  Google Scholar 

  28. Hsieh KH, Shaio MF, Liao TN. Thymopentin treatment in severe atopic dermatitis: clinical and immunological evaluations. Arch Dis Child 1992; 67: 1095–102

    Article  PubMed  CAS  Google Scholar 

  29. Halpern N, Schwartz S. Regulation of the low affinity IgE Fc receptor (CD23) in atopic dermatitis. Int Arch Allergy Appl Immunol 1993; 100: 197–200

    Article  CAS  Google Scholar 

  30. Boguniewicz M, Jaffe HS, Izu A, et al. Recombinant gamma interferon therapy in treatment of patients with atopic dermatitis and elevated IgE levels. Am J Med 1990; 88: 365–70

    Article  PubMed  CAS  Google Scholar 

  31. Hanifin JM, Schneider LC, Leung DYM, et al. Recombinant interferon gamma therapy for atopic dermatitis. J Am Acad Dermatol 1993; 28: 189–97

    Article  PubMed  CAS  Google Scholar 

  32. Souillet G, Rousset F, De Vries JE. Alpha-interferon treatment of patients with hyper IgE syndrome. Lancet 1989; i: 1384

    Article  Google Scholar 

  33. Torrelo A, Harto A, Sendagorta E, et al. Interferon-α therapy in atopic dermatitis. Acta Derm Venereol 1992; 72: 370–2

    PubMed  CAS  Google Scholar 

  34. Gruschwitz MS, Peters KP, Heese A, et al. Effects of interferonalpha-2b on the clinical course, inflammatory skin infiltrates and peripheral blood lymphocytes in patients with severe atopic eczema. Int Arch Allergy Immunol 1993; 101: 20–30

    Article  PubMed  CAS  Google Scholar 

  35. Nielsen BW, Reimert CM, Hammer R, et al. Interferon therapy for atopic dermatitis reduces basophil histamine release, but does not reduce serum IgE or eosinophilic proteins. Allergy 1994; 49: 120–8

    Article  PubMed  CAS  Google Scholar 

  36. Hsieh KH, Chou CC, Huang SF. Interleukin 2 therapy in severe atopic dermatitis. J Clin Immunol 1991; 11: 22–8

    Article  PubMed  CAS  Google Scholar 

  37. Sowden JM, Berth-Jones J, Ross JS, et al. Double-blind, controlled, crossover study of cyclosporin in adults with severe refractory atopic dermatitis. Lancet 1991; 338: 137–40

    Article  PubMed  CAS  Google Scholar 

  38. Berth-Jones J, Finlay A, Zaki I, et al. Cyclosporin in severe childhood atopic dermatitis [abstract]. Br J Dermatol 1994; 131 Suppl. 44: 25

    Google Scholar 

  39. Munro CS, Levell NJ, Shuster S, et al. Maintenance treatment with cyclosporin in atopic eczema. Br J Dermatol 1994; 130: 376–80

    Article  PubMed  CAS  Google Scholar 

  40. Sheehan MP, Atherton DJ. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative dermatitis. Br J Dermatol 1992; 126: 179–84

    Article  PubMed  CAS  Google Scholar 

  41. Alomar A, Gimenez-Camarasa JM, Moragas JM. The use of levamisole in atopic dermatitis: a prospective study. Arch Dermatol 1978; 114: 1316–9

    Article  PubMed  CAS  Google Scholar 

  42. Hovmark A, Ekre HT. Failure of transfer factor therapy in atopic dermatitis. Acta Derm Venereol 1978; 58: 497–500

    PubMed  CAS  Google Scholar 

  43. Atherton DJ, Cababott F, Glover MT, et al. The role of psoralen chemotherapy (PUVA) in the treatment of severe atopic eczema in adolescence. Br J Dermatol 1988; 118: 791–5

    Article  PubMed  CAS  Google Scholar 

  44. Leroy BP, Lachapelle JM, Somville MM, et al. Injection of allergen-antibody complexes is an effective treatment of atopic dermatitis. Dermatologica 1991; 182: 98–106

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, National Taiwan University College of Medicine, Taipei, Taiwan

    Kue-Hsiung Hsieh

Authors
  1. Kue-Hsiung Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hsieh, KH. Atopic Dermatitis. Clin. Immunother. 3, 88–93 (1995). https://doi.org/10.1007/BF03259052

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03259052

Keywords

Search

Navigation