Causes and Treatment of Atopic Dermatitis

Dong Seok Cha, Ph.D.

Department of Oriental PharmacyCollege of Pharmacy Woosuk University

14 September 2010

- Characteristic of Atopic Dermatitis (AD)

- Causes of AD

- Treatment of AD

- Prevention of AD

• Definition• Symptom

Contents

• Avoiding allergens• Drug treatment• Phototherapy• Alternative Treatment

• Genetic factor• Environmental factor• Immune system imbalance• Dysfunction of skin barrier

Characteristic of Atopic Dermatitis

What is Atopic Dermatitis?

• Atopy or atopic syndrome= allergic hypersensitivity

• Dermatitis= inflammation of the skin • Atopic Dermatitis (AD)

- A type of eczema- Non-contagious- Often begins in childhood and may persist into adulthood.- Occurs together with other atopic diseases

Prevalence Rate of Atopic Dermatitis

1995 20050

5

10

15

20

25

30

35

AD

pre

vale

nce

rate

(%

)

AD25%

non AD75%

AD prevalence rate of elementary school student

AD13%

non AD87%

AD prevalence rate of middle school student

1~5세

6~11

세

12~18

세

19~29

세

30~39

세

40~49

세

50~59

세

60~69

세

70

세이상

0

4

8

12

16

20

AD

pre

va

len

ce

ra

te (

%)

Symptoms of Atopic Dermatitis

Atopic Dermati-

tis

Causes of Atopic Dermatitis

Dysfunction of skin

barrier

Environmental fac-

tor

Causes of Atopic Dermatitis

Immune system im-

balance

Genetic factor

Causes of AD – Genetic Factor

• Family history is very important

• The inheritance pattern is complex

• AD genetics involve several genes, each with a different func-tion

- IgE response related gene- skin barrier function related gene- skin inflammation related gene

• Genetic mutation of the epidermal barrier protein, filaggrin is one predisposing factor for atopic dermatitis

Causes of AD – Genetic Factor

Causes of AD – Environmental Factor

1995 2000 20050

5

10

15

20

25

30

35

AD

pre

vale

nce

rate

(%

)

• IndustrializationHygiene hypothesis

• Dietary lifeFood allergyTrans fat

• Residential EnvironmentAeroallergens eg. dust mites, pollens, animal dandersVOCs eg. formaldehyde, benzene

Sick building syndrome

Causes of AD - Immune System Imbalance

Th1

Th2

[Homeostatic state]

Th1

Th2

Th1

Th2

[Cell-mediated Immunity] [Allergy / Atopy]

Causes of AD - Immune System Imbalance

Causes of AD – Dysfunction of Skin Barrier

Ceramide

TEWL Skin Bar-rier Func-

tion

AllergenIrritant

Chronic Stage of

AD

Treatment of Atopic Dermatitis

Treatment of Atopic Dermatitis

• Treatment for Atopic Dermatitis has multidimensional aims- Improving the skin barrier function- Reducing the inflammation- Identifying the responsible triggers - Preventing any secondary infection

• Common treatment options for AD- Avoiding allergens

- Drug treatment- Phototherapy- Alternative therapy

Treatment of AD – Avoiding Allergens

• Discovering the triggers of allergic reactions • Learning to avoid them.

Treatment of AD – Drug Treatment

• Topical Treatment - Emollient (moisturizer) - Topical corticosteroids - Topical calcineurin inhibitors

eg. Pimecrolimus and Tacrolimus - Topical antimicrobial therapy - Coal tar

• Systemic Treatment - Antihistamines - Corticoteroids - Immunomodulators

eg. Azathioprine - Antimicrobials

Treatment of AD – Recent Drugs Being Tested for AD

• Corticosteroids, immunosuppressants have serious side ef-fects

• AD imposes tremendous social and financial costs on patientsImproved drugs are necessary

Leukotriene antagonist

Monoclonal antibodies

Leflunomide

Recombinant interferon-gamma

Treatment of AD – Phototherapy• Ultraviolet (UV) light therapy

• Works as an anti-inflammatory agent

• Various type of UV - Psoralen plus UVA (PUVA) - A combination of broadband UVB/UVA light treatment - Broadband UVA exposure - Broad-band UVB exposure - Narrowband UVB (280-320 nm) - UVA-1 (340-400 nm)

• Side effects - stinging, burning, ageing of the skin, pigmentation - risk of squamous cell carcinoma and melanoma.

Treatment of AD – Alternative Therapy

• Currently, the level of interest in alternative treatments contin-ues to increase

• Traditional herbal medicine formulation

• External application

• Combined internal and external treatment

Merit Demerit

Reducing corticosteroid usage Prescribed differently for each patient

Less side effect Unique flavor

Regulation of immune responses Herbal allergens

Synergic effect Expensive

Prevention of Atopic Dermatitis

Prevention of Atopic Dermatitis

Lifestyle

Mental healthcare

Diet

Skin care

Thank you for your attention