Pathogenesis and Management of Atopic Dermatitis

Description

Recently, a breakthrough in understanding the pathogenesis of atopic dermatitis (AD) has been made with studies successfully linking loss-of-function mutations in the genes encoding the epidermal structure protein filaggrin with the subsequent risk of developing AD. Another area of AD research apparently points us to the importance of the increased exposure to various environmental agents - in particular those deprived of microbial stimuli - which is known as the ‘hygiene hypothesis’. Other studies suggest specific mechanisms in AD whereby innate immune responses are functionally defective. Also, the sweating disturbance in AD has recently received increasing attention. Nevertheless, the most common emergent theme has been the role of adaptive immunity in providing cytokines and chemokines that sustain the recruitment, retention and activation of allergen-specific T cells, dendritic cells, eosinophils, basophils and mast cells in the involved tissues.The key message of this book is to address the questions raised by dermatologists, pediatricians, practicing physicians, basic immunologists, biologists, pharmacologists and medical students on the pathogenesis, management and therapies of AD. To this end, virtually all chapters have been authored by original investigators who have contributed significantly to the establishment of current concepts.

Informations

• Publié par: S. Karger AG
• Date de parution: 09 mai 2011
• Nombre de lectures: 0
• EAN13: 9783805596879
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Pathogenesis and Management of Atopic Dermatitis
Current Problems in Dermatology
Vol. 41
Series Editor
Peter Itin Basel
Gregor Jemec Roskilde
Pathogenesis and Management of Atopic Dermatitis


Volume Editors
Tetsuo Shiohara Tokyo
26 figures, 20 in color, and 9 tables, 2011



Basel • Freiburg • Paris • London • New York • New Delhi • Bangkok • Beijing • Tokyo • Kuala Lumpur • Singapore • Sydney
Current Problems in Dermatology ______________________ Tetsuo Shiohara Department of Dermatology Kyorin University School of Medicine 6-20-2 Shinkawa, Mitaka Tokyo 181-8611 Japan
Library of Congress Cataloging-in-Publication Data
New drugs and targets for asthma and COPD / volume editors, Trevor T. Hansel, Peter J. Barnes. p.; cm. -- (Current problems in dermatology, ISSN 1421-5721; vol. 41) Includes bibliographical references and indexes. ISBN 978-3-8055-9686-2 (hard cover: alk. paper) -- ISBN 978-3-8055-9687-9 (electronic) 1. Atopic dermatitis. I. Shiohara, Tetsuo. II. Series: Current problems in dermatology; v. 41. [DNLM: 1. Asthma-drug therapy. 2. Pulmonary Disease, Chronic RC591.N497 2010 616.2’38061-dc22
2011003457

Bibliographic Indices. This publication is listed in bibliographic services, including MEDLINE/Pubmed.
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Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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© Copyright 2011 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN 1421-5721 ISBN 978-3-8055-9686-2 e-ISBN 978-3-8055-9687-9
 
 
 
Contents
 
 
 
Preface
Shiohara, T. (Tokyo)
Atopic Dermatitis and the Hygiene Hypothesis Revisited
Flohr, C.; Yeo, L. (London)
Loss-of-Function Mutations within the Filaggrin Gene and Atopic Dermatitis
Kawasaki, H.; Kubo, A.; Sasaki, T.; Amagai, M. (Tokyo)
FcεRI-Toll-Like Receptor Interaction in Atopic Dermatitis
Novak, N.; Bieber, T. (Bonn)
The Antimicrobial Skin Barrier in Patients with Atopic Dermatitis
Schittek, B. (Tübingen)
Defective Sweating Responses in Atopic Dermatitis
Shiohara, T.; Doi, T.; Hayakawa, J. (Tokyo)
The Role of Cytokines/Chemokines in the Pathogenesis of Atopic Dermatitis
Yamanaka, K.; Mizutani, H. (Tsu)
Contribution of Interleukin 18 to the Development of Infection-Associated Atopic Dermatitis
Tsutsui, H. (Nishinomiya); Mizutani, H. (Tsu); Nakanishi, K. (Nishinomiya/Tokyo)
Innate Immunity in Atopic Dermatitis
Mrabet-Dahbi, S.; Maurer, M. (Berlin)
The Role of Regulatory T Cells in Atopic Dermatitis
Agrawal, R.; Wisniewski, J.A.; Woodfolk, J.A. (Charlottesville, Va.)
Increased Susceptibility to Cutaneous Viral Infections in Atopic Dermatitis: The Roles of Regulatory T Cells and Innate Immune Defects
Shiohara, T.; Sato, Y.; Takahashi, R.; Kurata, M.; Mizukawa, Y. (Tokyo)
Biomarkers for Itch and Disease Severity in Atopic Dermatitis
Lee, C.-H.; Yu, H.-S. (Kaohsiung)
Practical Issues on Interpretation of Scoring Atopic Dermatitis: SCOR AD Index, Objective SCOR AD , Patient-Oriented SCOR AD and Three-Item Severity Score
Oranje, A.P. (Rotterdam)
Systemic Therapy of Atopic Dermatitis in Children and Adults
Simon, D. (Bern)
Author Index
Subject Index
Preface


Atopic dermatitis (AD) is indeed a multifactorial genetic disease arising as a result of the complicated interaction of many genes with environmental factors. It has long been thought that a genetic predisposition to a defective skin barrier represents a primary event that can favor the increased penetration of allergens, thereby facilitating the occurrence of allergic inflammatory responses. A recent breakthrough in the understanding of AD pathogenesis has been made with the studies successfully linking loss-of-function mutations in the genes encoding the epidermal structure protein filaggrin with the subsequent risk of developing AD. Another area of AD research apparently points us to the importance of the increase in exposure to various environmental agents, particularly deprived of microbial stimuli, which is known as the ‘hygiene hypothesis’. Recent studies also suggest specific mechanisms whereby innate immune responses are functionally defective in AD. After a long period of neglect, sweating disturbance in AD has recently received increasing attention, because sweat is now recognized as the first element of the innate immune system. Nevertheless, the most common emergent theme has been the role of adaptive immunity in providing cytokines and chemokines that sustain the recruitment, retention and activation of allergen-specific T cells, dendritic cells, eosinophils, basophils and mast cells in the involved tissues.
However, no single text concerning the entire spectrum has been available. The key message of this book is to address the questions raised by dermatologists, pediatricians, practicing physicians, basic immunologists, biologists, pharmacologists and students studying medicine on the pathogenesis, management and therapies of AD. To this end, virtually all chapters have been authored by original investigators who have contributed significantly to the establishment of current concepts. I would like to thank the distinguished authors who made tremendous efforts to make this book very useful, and I am also very thankful to the staff of Karger AG, in particular Ms. Tanja Sebuk.
Following the succes of "New Drugs for Asthma, Allergy and COPD" Volume 31 in ‘Progress in Respiratory Research published by Karger in 2001, it has been a pleasure to prepare this related volume. We are grateful for the assistance of staff at Prous Science (Thomson Reuters) and thank Karger and Chris Bolliger for publishing it in ‘Progress in Respiratory Research’.
We hope that the reader will find this book both interesting and helpful, and that this volume will facilitate the provision of better therapy for patients with respiratory diseases.
Tetsuo Shiohara , Tokyo
Shiohara T (ed): Pathogenesis and Management of Atopic Dermatitis. Curr Probl Dermatol. Basel, Karger, 2011, vol 41, pp 1-34
______________________
Atopic Dermatitis and the Hygiene Hypothesis Revisited
Carsten Flohr • Lindsey Yeo
Department of Paediatric Dermatology, St. John s Institute of Dermatology, Guy s and St. Thomas Hospital NHS Foundation Trust and King s College London, London, UK
______________________
Abstract
Background: We published a systematic review on atopic dermatitis (AD) and the hygiene hypothesis in 2005. Since then, the body of literature has grown significantly. Objectives: We therefore repeated our systematic review to examine the evidence from population-based studies for an association between AD risk and specific infections, childhood immunizations, the use of antibiotics and environmental exposures that lead to a change in microbial burden. Methods: Medline was searched from 1966 until June 2010 to identify relevant studies. Results: We found an additional 49 papers suitable for inclusion. There is evidence to support an inverse relationship between AD and endotoxin, early day care, farm animal and dog exposure in early life. Cat exposure in the presence of skin barrier impairment is positively associated with AD. Helminth infection at least partially protects against AD. This is not the case for viral and bacterial infections, but consumption of unpasteurized farm milk seems protective. Routine childhood vaccinations have no effect on AD risk. The positive association between viral infections and AD found in some studies appears confounded by antibiotic prescription, which has been consistently associated with an increase in AD risk. Conclusions: There is convincing evidence for an inverse relationship between helminth infections and AD but no other pathogens. The protective effect seen with early day care, endotoxin, unpasteurized farm milk and animal exposure is likely to be due to a general increase in exposure to non-pathogenic microbes. This would also explain the risk increase associated with the use of