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Advances in the Diagnosis and Therapeutic Management of Atopic Dermatitis

Drugs volume 74, pages 757–769 (2014)Cite this article

Abstract

Atopic dermatitis is a very prevalent disease that affects children as well as adults. The disease has a severe impact on quality of life for the patients and their families. The skin in atopic dermatitis patients is a site of both a severe inflammatory reaction dominated by lymphocytes and decreased skin barrier function. The treatment of the disease is mainly aimed at reducing the inflammation in the skin and/or restoring the skin barrier function. However, most of the treatments used today singularly aim at reducing the inflammation in the skin. Depending on the severity of the disease, the anti-inflammatory treatment may be topical or systemic, but basic treatment, no matter the severity, should always be emollients. In addition, new studies have shown good effects of psychosocial interventions, such as eczema schools, for patients and their families. This review covers the latest trends in the treatment of atopic dermatitis.

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References

  1. Bieber T. Atopic dermatitis. N Engl J Med. 2008;358(14):1483–94.

    CAS  PubMed  Google Scholar 

  2. Leung DY, Bieber T. Atopic dermatitis. Lancet. 2003;361(9352):151–60.

    PubMed  Google Scholar 

  3. Ong PY, Leung DY. The infectious aspects of atopic dermatitis. Immunol Allergy Clin North Am. 2010;30(3):309–21.

    PubMed Central  PubMed  Google Scholar 

  4. Olesen AB, Ellingsen AR, Larsen FS, Larsen PO, Veien NK, Thestrup-Pedersen K. Atopic dermatitis may be linked to whether a child is first- or second-born and/or the age of the mother. Acta Dermato-Venereologica. 1996;76(6):457–60.

    CAS  PubMed  Google Scholar 

  5. Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract. 2006;60(8):984–92.

    CAS  PubMed  Google Scholar 

  6. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Dermato-Venereologica. 1980;Suppl 92:44–7.

  7. Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis? J Allergy Clin Immunol. 2004;114(1):150–8.

    PubMed  Google Scholar 

  8. Williams H, Flohr C. How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. J Allergy Clin Immunol. 2006;118(1):209–13.

    PubMed  Google Scholar 

  9. Deleuran MS, Vestergaard C. Therapy of severe atopic dermatitis in adults. Journal der Deutschen Dermatologischen Gesellschaft (J German Soc Dermatol JDDG). 2012;10(6):399–406.

    Google Scholar 

  10. Darsow U, Wollenberg A, Simon D, Taieb A, Werfel T, Oranje A, et al. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol JEADV. 2010;24(3):317–28.

    CAS  Google Scholar 

  11. Bohme M, Svensson A, Kull I, Wahlgren CF. Hanifin’s and Rajka’s minor criteria for atopic dermatitis: which do 2-year-olds exhibit? J Am Acad Dermatol. 2000;43(5 Pt 1):785–92.

    CAS  PubMed  Google Scholar 

  12. Gaitanis G, Velegraki A, Mayser P, Bassukas ID. Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol. 2013;31(4):455–63.

    PubMed  Google Scholar 

  13. Sutton RL. Summertime pityriasis of the elbow and knee. In: Sutton RLJ, editor. Disease of the skin. 2nd ed. St. Louis: CV Mosby; 1956. p. 898.

    Google Scholar 

  14. Wütrich B. Minimal variants of atopic eczema. In: Ring J, Przybilla B, Ruzicka T, editors. Handbook of atopic eczema. 2nd ed. Berlin: Springer; 2006. p. 74–83.

    Google Scholar 

  15. Parronchi P, Macchia D, Piccinni MP, Biswas P, Simonelli C, Maggi E, et al. Allergen- and bacterial antigen-specific T-cell clones established from atopic donors show a different profile of cytokine production. Proc Natl Acad Sci USA. 1991;88(10):4538–42.

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Wuthrich B, Schmid-Grendelmeier P. The atopic eczema/dermatitis syndrome. Epidemiology, natural course, and immunology of the IgE-associated (”extrinsic”) and the nonallergic (”intrinsic”) AEDS. J Invest Allergol Clin Immunol. 2003;13(1):1–5.

    CAS  Google Scholar 

  17. Hvid M, Johansen C, Deleuran B, Kemp K, Deleuran M, Vestergaard C. Regulation of caspase 14 expression in keratinocytes by inflammatory cytokines—a possible link between reduced skin barrier function and inflammation? Exp Dermatol. 2011;20(8):633–6.

    CAS  PubMed  Google Scholar 

  18. Yagi R, Nagai H, Iigo Y, Akimoto T, Arai T, Kubo M. Development of atopic dermatitis-like skin lesions in STAT6-deficient NC/Nga mice. J Immunol. 2002;168(4):2020–7.

    CAS  PubMed  Google Scholar 

  19. Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006;38(4):441–6.

    CAS  PubMed  Google Scholar 

  20. Gittler JK, Shemer A, Suarez-Farinas M, Fuentes-Duculan J, Gulewicz KJ, Wang CQ, et al. Progressive activation of T(H)2/T(H)22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis. J Allergy Clin Immunol. 2012;130(6):1344–54.

    CAS  PubMed Central  PubMed  Google Scholar 

  21. Gutowska-Owsiak D, Schaupp AL, Salimi M, Taylor S, Ogg GS. Interleukin-22 downregulates filaggrin expression and affects expression of profilaggrin processing enzymes. Br J Dermatol. 2011;165(3):492–8.

    CAS  PubMed  Google Scholar 

  22. Nograles KE, Zaba LC, Shemer A, Fuentes-Duculan J, Cardinale I, Kikuchi T, et al. IL-22-producing ”T22” T cells account for upregulated IL-22 in atopic dermatitis despite reduced IL-17-producing TH17 T cells. J Allergy Clin Immunol. 2009;123(6):1244–52, e2.

  23. Grimstad O, Sawanobori Y, Vestergaard C, Bilsborough J, Olsen UB, Gronhoj-Larsen C, et al. Anti-interleukin-31-antibodies ameliorate scratching behaviour in NC/Nga mice: a model of atopic dermatitis. Exp Dermatol. 2009;18(1):35–43.

  24. Homey B, Alenius H, Muller A, Soto H, Bowman EP, Yuan W, et al. CCL27-CCR10 interactions regulate T cell-mediated skin inflammation. Nat Med. 2002;8(2):157–65.

    CAS  PubMed  Google Scholar 

  25. Vestergaard C, Bang K, Gesser B, Yoneyama H, Matsushima K, Larsen CG. A Th2 chemokine, TARC, produced by keratinocytes may recruit CLA+ CCR4+ lymphocytes into lesional atopic dermatitis skin. J Investig Dermatol. 2000;115(4):640–6.

    CAS  PubMed  Google Scholar 

  26. Hvid M, Vestergaard C, Kemp K, Christensen GB, Deleuran B, Deleuran M. IL-25 in atopic dermatitis: a possible link between inflammation and skin barrier dysfunction? J Investig Dermatol. 2011;131(1):150–7.

    CAS  PubMed  Google Scholar 

  27. Ikeda K, Nakajima H, Suzuki K, Kagami S, Hirose K, Suto A, et al. Mast cells produce interleukin-25 upon Fc epsilon RI-mediated activation. Blood. 2003;101(9):3594–6.

    CAS  PubMed  Google Scholar 

  28. Ohno T, Morita H, Arae K, Matsumoto K, Nakae S. Interleukin-33 in allergy. Allergy. 2012;67(10):1203–14.

    CAS  PubMed  Google Scholar 

  29. Savinko T, Karisola P, Lehtimaki S, Lappetelainen AM, Haapakoski R, Wolff H, et al. ST2 regulates allergic airway inflammation and T-cell polarization in epicutaneously sensitized mice. J Investig Dermatol. 2013;133(11):2522–9.

    CAS  PubMed  Google Scholar 

  30. Yang Q, Li G, Zhu Y, Liu L, Chen E, Turnquist H, et al. IL-33 synergizes with TCR and IL-12 signaling to promote the effector function of CD8+ T cells. Eur J Immunol. 2011;41(11):3351–60.

    CAS  PubMed Central  PubMed  Google Scholar 

  31. Grewe M, Walther S, Gyufko K, Czech W, Schopf E, Krutmann J. Analysis of the cytokine pattern expressed in situ in inhalant allergen patch test reactions of atopic dermatitis patients. J Investig Dermatol. 1995;105(3):407–10.

    CAS  PubMed  Google Scholar 

  32. Fischer-Stabauer M, Boehner A, Eyerich S, Carbone T, Traidl-Hoffmann C, Schmidt-Weber CB, et al. Differential in situ expression of IL-17 in skin diseases. Eur J Dermatol EJD. 2012;22(6):781–4.

    CAS  Google Scholar 

  33. Peric M, Koglin S, Dombrowski Y, Gross K, Bradac E, Buchau A, et al. Vitamin D analogs differentially control antimicrobial peptide/”alarmin” expression in psoriasis. PloS one. 2009;4(7):e6340.

    PubMed Central  PubMed  Google Scholar 

  34. Irvine AD. Fleshing out filaggrin phenotypes. J Investig Dermatol. 2007;127(3):504–7.

    CAS  PubMed  Google Scholar 

  35. O’Regan GM, Sandilands A, McLean WH, Irvine AD. Filaggrin in atopic dermatitis. J Allergy Clin Immunol. 2008;122(4):689–93.

    PubMed  Google Scholar 

  36. Thyssen JP, Linneberg A, Ross-Hansen K, Carlsen BC, Meldgaard M, Szecsi PB, et al. Filaggrin mutations are strongly associated with contact sensitization in individuals with dermatitis. Contact Dermat. 2013;68(5):273–6.

    CAS  Google Scholar 

  37. Candi E, Schmidt R, Melino G. The cornified envelope: a model of cell death in the skin. Nat Rev Mol Cell Biol. 2005;6(4):328–40.

    CAS  PubMed  Google Scholar 

  38. McGrath JA, Uitto J. The filaggrin story: novel insights into skin-barrier function and disease. Trends Mol Med. 2008;14(1):20–7.

    CAS  PubMed  Google Scholar 

  39. Resing KA, Johnson RS, Walsh KA. Characterization of protease processing sites during conversion of rat profilaggrin to filaggrin. Biochemistry. 1993;32(38):10036–45.

    CAS  PubMed  Google Scholar 

  40. Denecker G, Ovaere P, Vandenabeele P, Declercq W. Caspase-14 reveals its secrets. J Cell Biol. 2008;180(3):451–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  41. Leyvraz C, Charles RP, Rubera I, Guitard M, Rotman S, Breiden B, et al. The epidermal barrier function is dependent on the serine protease CAP1/Prss8. J Cell Biol. 2005;170(3):487–96.

    CAS  PubMed Central  PubMed  Google Scholar 

  42. List K, Szabo R, Wertz PW, Segre J, Haudenschild CC, Kim SY, et al. Loss of proteolytically processed filaggrin caused by epidermal deletion of Matriptase/MT-SP1. J Cell Biol. 2003;163(4):901–10.

    CAS  PubMed Central  PubMed  Google Scholar 

  43. Pellerin L, Henry J, Hsu CY, Balica S, Jean-Decoster C, Mechin MC, et al. Defects of filaggrin-like proteins in both lesional and nonlesional atopic skin. J Allergy Clin Immunol. 2013;131(4):1094–102.

    CAS  PubMed  Google Scholar 

  44. Howell MD, Kim BE, Gao P, Grant AV, Boguniewicz M, Debenedetto A, et al. Cytokine modulation of atopic dermatitis filaggrin skin expression. J Allergy Clin Immunol. 2007;120(1):150–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  45. Cornelissen C, Marquardt Y, Czaja K, Wenzel J, Frank J, Luscher-Firzlaff J, et al. IL-31 regulates differentiation and filaggrin expression in human organotypic skin models. J Allergy Clin Immunol. 2012;129(2):426–33, 33, e1–8.

  46. Kim BE, Howell MD, Guttman-Yassky E, Gilleaudeau PM, Cardinale IR, Boguniewicz M, et al. TNF-alpha downregulates filaggrin and loricrin through c-Jun N-terminal kinase: role for TNF-alpha antagonists to improve skin barrier. J Investig Dermatol. 2011;131(6):1272–9.

    CAS  PubMed  Google Scholar 

  47. Gutowska-Owsiak D, Schaupp AL, Salimi M, Selvakumar TA, McPherson T, Taylor S, et al. IL-17 downregulates filaggrin and affects keratinocyte expression of genes associated with cellular adhesion. Exp Dermatol. 2012;21(2):104–10.

    CAS  PubMed  Google Scholar 

  48. Breternitz M, Kowatzki D, Langenauer M, Elsner P, Fluhr JW. Placebo-controlled, double-blind, randomized, prospective study of a glycerol-based emollient on eczematous skin in atopic dermatitis: biophysical and clinical evaluation. Skin Pharmacol Physiol. 2008;21(1):39–45.

    CAS  PubMed  Google Scholar 

  49. Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112(4):667–74.

    PubMed  Google Scholar 

  50. Boussault P, Leaute-Labreze C, Saubusse E, Maurice-Tison S, Perromat M, Roul S, et al. Oat sensitization in children with atopic dermatitis: prevalence, risks and associated factors. Allergy. 2007;62(11):1251–6.

    CAS  PubMed  Google Scholar 

  51. Lack G, Fox D, Northstone K, Golding J. Avon Longitudinal Study of P, Children Study T. Factors associated with the development of peanut allergy in childhood. N Engl J Med. 2003;348(11):977–85.

    PubMed  Google Scholar 

  52. Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, et al. Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol JEADV. 2012;26(8):1045–60.

    CAS  Google Scholar 

  53. Barnes PJ. Corticosteroids: the drugs to beat. Eur J Pharmacol. 2006;533(1–3):2–14.

    CAS  PubMed  Google Scholar 

  54. Charman C, Williams H. The use of corticosteroids and corticosteroid phobia in atopic dermatitis. Clin Dermatol. 2003;21(3):193–200.

    PubMed  Google Scholar 

  55. Berth-Jones J, Damstra RJ, Golsch S, Livden JK, Van Hooteghem O, Allegra F, et al. Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study. BMJ. 2003;326(7403):1367.

    CAS  PubMed Central  PubMed  Google Scholar 

  56. Levin E, Gupta R, Butler D, Chiang C, Koo JY. Topical steroid risk analysis: differentiating between physiologic and pathologic adrenal suppression. J Dermatol Treat. 2014;25(6):501–6.

    CAS  Google Scholar 

  57. Walsh P, Aeling JL, Huff L, Weston WL. Hypothalamus–pituitary–adrenal axis suppression by superpotent topical steroids. J Am Acad Dermatol. 1993;29(3):501–3.

    CAS  PubMed  Google Scholar 

  58. Jensen JM, Scherer A, Wanke C, Brautigam M, Bongiovanni S, Letzkus M, et al. Gene expression is differently affected by pimecrolimus and betamethasone in lesional skin of atopic dermatitis. Allergy. 2012;67(3):413–23.

    CAS  PubMed  Google Scholar 

  59. Liu J, Farmer JD Jr, Lane WS, Friedman J, Weissman I, Schreiber SL. Calcineurin is a common target of cyclophilin–cyclosporin A and FKBP-FK506 complexes. Cell. 1991;66(4):807–15.

    CAS  PubMed  Google Scholar 

  60. Meurer M, Folster-Holst R, Wozel G, Weidinger G, Junger M, Brautigam M, et al. Pimecrolimus cream in the long-term management of atopic dermatitis in adults: a six-month study. Dermatology. 2002;205(3):271–7.

    CAS  PubMed  Google Scholar 

  61. Reitamo S, Wollenberg A, Schopf E, Perrot JL, Marks R, Ruzicka T, et al. Safety and efficacy of 1 year of tacrolimus ointment monotherapy in adults with atopic dermatitis. The European Tacrolimus Ointment Study Group. Arch Dermatol. 2000;136(8):999–1006.

    CAS  PubMed  Google Scholar 

  62. Ruzicka T, Bieber T, Schopf E, Rubins A, Dobozy A, Bos JD, et al. A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group. N Engl J Med. 1997;337(12):816–21.

    CAS  PubMed  Google Scholar 

  63. Van Leent EJ, Graber M, Thurston M, Wagenaar A, Spuls PI, Bos JD. Effectiveness of the ascomycin macrolactam SDZ ASM 981 in the topical treatment of atopic dermatitis. Arch Dermatol. 1998;134(7):805–9.

    PubMed  Google Scholar 

  64. Reitamo S, Rustin M, Ruzicka T, Cambazard F, Kalimo K, Friedmann PS, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. J Allergy Clin Immunol. 2002;109(3):547–55.

    CAS  PubMed  Google Scholar 

  65. Chen SL, Yan J, Wang FS. Two topical calcineurin inhibitors for the treatment of atopic dermatitis in pediatric patients: a meta-analysis of randomized clinical trials. J Dermatol Treat. 2010;21(3):144–56.

    CAS  Google Scholar 

  66. Arellano FM, Wentworth CE, Arana A, Fernandez C, Paul CF. Risk of lymphoma following exposure to calcineurin inhibitors and topical steroids in patients with atopic dermatitis. J Investig Dermatol. 2007;127(4):808–16.

    CAS  PubMed  Google Scholar 

  67. Leyden JJ, Marples RR, Kligman AM. Staphylococcus aureus in the lesions of atopic dermatitis. Brit J Dermatol. 1974;90(5):525–30.

    CAS  Google Scholar 

  68. Birnie AJ, Bath-Hextall FJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema. Cochrane Database Syst Rev. 2008(3):CD003871.

  69. Huang JT, Abrams M, Tlougan B, Rademaker A, Paller AS. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009;123(5):e808–14.

    PubMed  Google Scholar 

  70. Abeck D, Mempel M. Staphylococcus aureus colonization in atopic dermatitis and its therapeutic implications. Brit J Dermatol. 1998;139(Suppl 53):13–6.

    Google Scholar 

  71. Niebuhr M, Mai U, Kapp A, Werfel T. Antibiotic treatment of cutaneous infections with Staphylococcus aureus in patients with atopic dermatitis: current antimicrobial resistances and susceptibilities. Exp dermatol. 2008;17(11):953–7.

    PubMed  Google Scholar 

  72. Huang JT, Rademaker A, Paller AS. Dilute bleach baths for Staphylococcus aureus colonization in atopic dermatitis to decrease disease severity. Arch Dermatol. 2011;147(2):246–7.

    PubMed  Google Scholar 

  73. Garritsen FM, Brouwer MW, Limpens J, Spuls PI. Photo(chemo)therapy in the management of atopic dermatitis: an updated systematic review with the use of GRADE and implications for practice and research. 2014;170(3):501–13.

  74. Darné S, Leech SN, Taylor AE. Narrowband ultraviolet B phototherapy in children with moderate-to-severe eczema: a comparative cohort study. Brit J Dermatol. 2014;170(1):150–6.

    Google Scholar 

  75. Clayton TH, Clark SM, Turner D, Goulden V. The treatment of severe atopic dermatitis in childhood with narrowband ultraviolet B phototherapy. Clin Exp Dermatol. 2007;32(1):28–33.

    CAS  PubMed  Google Scholar 

  76. Pavlovsky M, Baum S, Shpiro D, Pavlovsky L, Pavlotsky F. Narrow band UVB: is it effective and safe for paediatric psoriasis and atopic dermatitis? J Eur Acad Dermatol Venereol JEADV. 2011;25(6):727–9.

    CAS  Google Scholar 

  77. Schmitt J, Schakel K, Folster-Holst R, Bauer A, Oertel R, Augustin M, et al. Prednisolone vs. ciclosporin for severe adult eczema. An investigator-initiated double-blind placebo-controlled multicentre trial. Brit J Dermatol. 2010;162(3):661–8.

    CAS  Google Scholar 

  78. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess. 2000;4(37):1–191.

    CAS  PubMed  Google Scholar 

  79. Roekevisch E, Spuls PI, Kuester D, Limpens J, Schmitt J. Efficacy and safety of systemic treatments for moderate-to-severe atopic dermatitis: a systematic review. J Allergy Clin Immunol. 2014;133(2):429–38.

  80. Hijnen DJ, ten Berge O, Timmer-de Mik L, Bruijnzeel-Koomen CA, de Bruin-Weller MS. Efficacy and safety of long-term treatment with cyclosporin A for atopic dermatitis. J Eur Acad Dermatol Venereol JEADV. 2007;21(1):85–9.

    CAS  Google Scholar 

  81. Mrowietz U, Boehncke WH. Leukocyte adhesion: a suitable target for anti-inflammatory drugs. Curr Pharm Des. 2006;12(22):2825–31.

    CAS  PubMed  Google Scholar 

  82. Goujon C, Berard F, Dahel K, Guillot I, Hennino A, Nosbaum A, et al. Methotrexate for the treatment of adult atopic dermatitis. Eur J Dermatol EJD. 2006;16(2):155–8.

    CAS  Google Scholar 

  83. Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, et al. Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults. J Eur Acad Dermatol Venereol JEADV. 2010;24(1):43–9.

    CAS  Google Scholar 

  84. Weatherhead SC, Wahie S, Reynolds NJ, Meggitt SJ. An open-label, dose-ranging study of methotrexate for moderate-to-severe adult atopic eczema. Brit J Dermatol. 2007;156(2):346–51.

    CAS  Google Scholar 

  85. Schram ME, Roekevisch E, Leeflang MM, Bos JD, Schmitt J, Spuls PI. A randomized trial of methotrexate versus azathioprine for severe atopic eczema. J Allergy Clin Immunol. 2011;128(2):353–9.

    CAS  PubMed  Google Scholar 

  86. El-Khalawany MA, Hassan H, Shaaban D, Ghonaim N, Eassa B. Methotrexate versus cyclosporine in the treatment of severe atopic dermatitis in children: a multicenter experience from Egypt. Eur J Pediatr. 2013;172(3):351–6.

    CAS  PubMed  Google Scholar 

  87. Gromnica-Ihle E, Kruger K. Use of methotrexate in young patients with respect to the reproductive system. Clin Exp Rheumatol. 2010;28(5 Suppl 61):S80–4.

    CAS  PubMed  Google Scholar 

  88. Paller AS. Dermatologic uses of methotrexate in children: indications and guidelines. Pediatr Dermatol. 1985;2(3):238–43.

    CAS  PubMed  Google Scholar 

  89. Berth-Jones J, Takwale A, Tan E, Barclay G, Agarwal S, Ahmed I, et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Brit J Dermatol. 2002;147(2):324–30.

    CAS  Google Scholar 

  90. Meggitt SJ, Gray JC, Reynolds NJ. Azathioprine dosed by thiopurine methyltransferase activity for moderate-to-severe atopic eczema: a double-blind, randomised controlled trial. Lancet. 2006;367(9513):839–46.

    CAS  PubMed  Google Scholar 

  91. Murphy LA, Atherton D. A retrospective evaluation of azathioprine in severe childhood atopic eczema, using thiopurine methyltransferase levels to exclude patients at high risk of myelosuppression. Brit J Dermatol. 2002;147(2):308–15.

    CAS  Google Scholar 

  92. Ballester I, Silvestre JF, Perez-Crespo M, Lucas A. Severe adult atopic dermatitis: treatment with mycophenolate mofetil in 8 patients. Actas Dermosifiliogr. 2009;100(10):883–7.

    CAS  PubMed  Google Scholar 

  93. Murray ML, Cohen JB. Mycophenolate mofetil therapy for moderate to severe atopic dermatitis. Clin Exp Dermatol. 2007;32(1):23–7.

    CAS  PubMed  Google Scholar 

  94. Anderka MT, Lin AE, Abuelo DN, Mitchell AA, Rasmussen SA. Reviewing the evidence for mycophenolate mofetil as a new teratogen: case report and review of the literature. Am J Med Genet A. 2009;149A(6):1241–8.

    PubMed  Google Scholar 

  95. Klieger-Grossmann C, Chitayat D, Lavign S, Kao K, Garcia-Bournissen F, Quinn D, et al. Prenatal exposure to mycophenolate mofetil: an updated estimate. J Obstet Gynaecol Can. 2010;32(8):794–7.

    PubMed  Google Scholar 

  96. van Velsen SG, Haeck IM, Bruijnzeel-Koomen CA, de Bruin-Weller MS. First experience with enteric-coated mycophenolate sodium (Myfortic) in severe recalcitrant adult atopic dermatitis: an open label study. Brit J Dermatol. 2009;160(3):687–91.

    Google Scholar 

  97. Haeck IM, Knol MJ, Ten Berge O, van Velsen SG, de Bruin-Weller MS, Bruijnzeel-Koomen CA. Enteric-coated mycophenolate sodium versus cyclosporin A as long-term treatment in adult patients with severe atopic dermatitis: a randomized controlled trial. J Am Acad Dermatol. 2011;64(6):1074–84.

    CAS  PubMed  Google Scholar 

  98. Hanifin JM, Schneider LC, Leung DY, Ellis CN, Jaffe HS, Izu AE, et al. Recombinant interferon gamma therapy for atopic dermatitis. J Am Acad Dermatol. 1993;28(2 Pt 1):189–97.

    CAS  PubMed  Google Scholar 

  99. Schneider LC, Baz Z, Zarcone C, Zurakowski D. Long-term therapy with recombinant interferon-gamma (rIFN-gamma) for atopic dermatitis. Ann Allergy Asthma Immunol. 1998;80(3):263–8.

    CAS  PubMed  Google Scholar 

  100. Stevens SR, Hanifin JM, Hamilton T, Tofte SJ, Cooper KD. Long-term effectiveness and safety of recombinant human interferon gamma therapy for atopic dermatitis despite unchanged serum IgE levels. Arch Dermatol. 1998;134(7):799–804.

    CAS  PubMed  Google Scholar 

  101. Simon D, Hosli S, Kostylina G, Yawalkar N, Simon HU. Anti-CD20 (rituximab) treatment improves atopic eczema. J Allergy Clin Immunol. 2008;121(1):122–8.

    CAS  PubMed  Google Scholar 

  102. Sediva A, Kayserova J, Vernerova E, Polouckova A, Capkova S, Spisek R, et al. Anti-CD20 (rituximab) treatment for atopic eczema. J Allergy Clin Immunol. 2008;121(6):1515–6 (author reply 6–7).

  103. Oldhoff JM, Darsow U, Werfel T, Katzer K, Wulf A, Laifaoui J, et al. Anti-IL-5 recombinant humanized monoclonal antibody (mepolizumab) for the treatment of atopic dermatitis. Allergy. 2005;60(5):693–6.

    CAS  PubMed  Google Scholar 

  104. Forman SB, Garrett AB. Success of omalizumab as monotherapy in adult atopic dermatitis: case report and discussion of the high-affinity immunoglobulin E receptor, FcepsilonRI. Cutis. 2007;80(1):38–40.

    PubMed  Google Scholar 

  105. Sheinkopf LE, Rafi AW, Do LT, Katz RM, Klaustermeyer WB. Efficacy of omalizumab in the treatment of atopic dermatitis: a pilot study. Allergy Asthma Proc. 2008;29(5):530–7.

    CAS  PubMed  Google Scholar 

  106. Vigo PG, Girgis KR, Pfuetze BL, Critchlow ME, Fisher J, Hussain I. Efficacy of anti-IgE therapy in patients with atopic dermatitis. J Am Acad Dermatol. 2006;55(1):168–70.

    PubMed  Google Scholar 

  107. Heil PM, Maurer D, Klein B, Hultsch T, Stingl G. Omalizumab therapy in atopic dermatitis: depletion of IgE does not improve the clinical course - a randomized, placebo-controlled and double blind pilot study. Journal der Deutschen Dermatologischen Gesellschaft (J German Soc Dermatol JDDG). 2010;8(12):990–8.

    Google Scholar 

  108. Bieber TRM, Thaci D, Graham N, Pirozzi G, Teper A, Ren H, et al. Dupilumab monotherapy in adults with moderate-to-severe atopic dermatitis: a 12-week, Randomized, Double-Blind, Placebo-Controlled Study. J Allergy Clin Immunol. 2014;133(2 Supplement):AB404.

  109. Thaci D, Worm M, Ren H, Weinstein S, Graham N, Pirozzi G, et al. Safety and Efficacy Of Dupilumab Versus Placebo For Moderate-To-Severe Atopic Dermatitis In Patients Using Topical Corticosteroids (TCS): Greater Efficacy Observed With Concomitant Therapy Compared To TCS Alone. Journal of Allergy and Clinical Immunology. 2014;133(2, Supplement):AB192.

  110. Paul C, Lahfa M, Bachelez H, Chevret S, Dubertret L. A randomized controlled evaluator-blinded trial of intravenous immunoglobulin in adults with severe atopic dermatitis. Brit J Dermatol. 2002;147(3):518–22.

    CAS  Google Scholar 

  111. Jee SJ, Kim JH, Baek HS, Lee HB, Oh JW. Long-term efficacy of intravenous immunoglobulin therapy for moderate to severe childhood atopic dermatitis. Allergy Asthma Immunol Res. 2011;3(2):89–95.

    CAS  PubMed Central  PubMed  Google Scholar 

  112. Bemanian MH, Movahedi M, Farhoudi A, Gharagozlou M, Seraj MH, Pourpak Z, et al. High doses intravenous immunoglobulin versus oral cyclosporine in the treatment of severe atopic dermatitis. Iran J Allergy Asthma Immunol. 2005;4(3):139–43.

    PubMed  Google Scholar 

  113. Werfel T, Breuer K, Rueff F, Przybilla B, Worm M, Grewe M, et al. Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose–response study. Allergy. 2006;61(2):202–5.

    CAS  PubMed  Google Scholar 

  114. Novak N, Thaci D, Hoffmann M, Folster-Holst R, Biedermann T, Homey B, et al. Subcutaneous immunotherapy with a depigmented polymerized birch pollen extract—a new therapeutic option for patients with atopic dermatitis. Int Arch Allergy Immunol. 2011;155(3):252–6.

    PubMed  Google Scholar 

  115. Kasperkiewicz M, Schmidt E, Frambach Y, Rose C, Meier M, Nitschke M, et al. Improvement of treatment-refractory atopic dermatitis by immunoadsorption: a pilot study. J Allergy Clin Immunol. 2011;127(1):267–70, 70, e1–6.

  116. Eller E, Kjaer HF, Host A, Andersen KE, Bindslev-Jensen C. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy. 2009;64(7):1023–9.

    CAS  PubMed  Google Scholar 

  117. Sampson HA. The evaluation and management of food allergy in atopic dermatitis. Clin Dermatol. 2003;21(3):183–92.

    PubMed  Google Scholar 

  118. Foolad N, Brezinski EA, Chase EP, Armstrong AW. Effect of nutrient supplementation on atopic dermatitis in children: a systematic review of probiotics, prebiotics, formula, and fatty acids. JAMA Dermatol. 2013;149(3):350–5.

    CAS  PubMed  Google Scholar 

  119. Folster-Holst R. Probiotics in the treatment and prevention of atopic dermatitis. Ann Nutr Metab. 2010;57(Suppl):16–9.

    PubMed  Google Scholar 

  120. Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E. Oral evening primrose oil and borage oil for eczema. Cochrane Database Syst Rev. 2013;4:CD004416.

  121. Chrostowska-Plak D, Reich A, Szepietowski JC. Relationship between itch and psychological status of patients with atopic dermatitis. J Eur Acad Dermatol Venereol JEADV. 2013;27(2):e239–42.

    CAS  Google Scholar 

  122. Schut C, Weik U, Tews N, Gieler U, Deinzer R, Kupfer J. Psychophysiological effects of stress management in patients with atopic dermatitis: a randomized controlled trial. Acta Dermato-Venereol. 2013;93(1):57–61.

    Google Scholar 

  123. Schut C, Felsch A, Zick C, Hinsch KD, Gieler U, Kupfer J. Role of illness representations and coping in patients with atopic dermatitis: a cross-sectional study. J Eur Acad Dermatol Venereol JEADV. 2013 [epub ahead of print].

  124. Staab D, Diepgen TL, Fartasch M, Kupfer J, Lob-Corzilius T, Ring J, et al. Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ. 2006;332(7547):933–8.

    PubMed Central  PubMed  Google Scholar 

  125. Barbarot S, Bernier C, Deleuran M, De Raeve L, Eichenfield L, El Hachem M, et al. Therapeutic patient education in children with atopic dermatitis: position paper on objectives and recommendations. Pediatr Dermatol. 2013;30(2):199–206.

    PubMed  Google Scholar 

  126. Stalder JF, Bernier C, Ball A, De Raeve L, Gieler U, Deleuran M, et al. Therapeutic patient education in atopic dermatitis: worldwide experiences. Pediatr Dermatol. 2013;30(3):329–34.

    PubMed  Google Scholar 

  127. Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, et al. Guidelines for treatment of atopic eczema (atopic dermatitis) Part II. J Eur Acad Dermatol Venereol JEADV. 2012;26(9):1176–93.

    CAS  Google Scholar 

  128. Proudfoot LE, Powell AM, Ayis S, Barbarot S, Baselga Torres E, Deleuran M, et al. The European TREatment of severe Atopic eczema in children Taskforce (TREAT) survey. Brit J Dermatol. 2013;169(4):901–9.

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Acknowledgments

Mette Deleuran is an investigator, speaker and/or an advisor for AbbVie A/S, MSD, Pierre Fabre Dermo-cosmétique, Meda Pharma, Leo Pharma, and Regeneron. Christian Vestergaard is an investigator and/or speaker for Abbvie A/S, Leo Pharma, Novartis and Astellas. No sources of funding were used to prepare this review.

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  1. Department of Dermatology, Aarhus University Hospital, P.P. Ørumsgade 11, 8000, Aarhus C, Denmark

    Christian Vestergaard & Mette Deleuran

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  1. Christian Vestergaard
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Correspondence to Mette Deleuran.

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Vestergaard, C., Deleuran, M. Advances in the Diagnosis and Therapeutic Management of Atopic Dermatitis. Drugs 74, 757–769 (2014). https://doi.org/10.1007/s40265-014-0219-3

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Keywords

  • Atopic Dermatitis
  • Food Allergy
  • Fluticasone Propionate
  • House Dust Mite
  • Omalizumab