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Çocukluklarda Atopik Dermatit Tedavisinde Güncel ve Gelecek Yaklaşımlar

Yıl 2011, Cilt: 9 Sayı: 2, 39 - 43, 01.09.2011

Öz

Atopik dermatit AD immün yanıtın düzenlenmesindeki bozukluğa bağlı gelişen kronikinflamatuvar bir cilt hastalığıdır. AD çocukların yaklaşık %20’sini etkilemekte veerişkinlerin %6’sında sebat etmektedir. Tedavi prensibi akut hastalığın ortadankaldırılması, yaşam kalitesinin artırılması ve uzun dönemde istenmeyen yan etkilerinönlenmesine yöneliktir. Hafif ve orta şiddetteki olgular genellikle tetikleyici uyaranlardan kaçınma ve topikal medikasyonlarla kontrol altına alınabilmektedir. Şiddetli olgularda ise bunlara ek olarak immünosupresif tedaviler gerekmektedir. Bu ilaçlarınbirikmiş toksisitesinin fazla olması AD tedavisinde kullanımlarını sınırlandırmaktadır.Bu yüzden güvenli ve etkin alternatif tedavi seçeneklerine özellikle çocukluk çağı yaşgrubunda ihtiyaç duyulmaktadır

Kaynakça

  • 1. Rancé F, Boguniewicz M, Lau S. New visions for atopic eczema: an iPAC summary and future trends. Pediatr Allergy Immunol 2008;19:17-25.
  • 2. Schultz Larsen F, Hanifin JM. Epidemiology of atopic dermatitis. Immunol Allergy Clin North Am 2002;22:1-24.
  • 3. Rancé F. Food allergy in children suffering from atopic eczema. Pediatr Allergy Immunol 2008;19:279-84.
  • 4. Werfel T, Ballmer-Weber B, Eigenmann PA, Niggemann B, Rancé F, Turjanmaa K et al. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy 2007;62:723-8.
  • 5. Hanifin JM, Rajka G. Diagnostic feature of atopic dermatitis. Act Derm Venereol 1980;92:44-7.
  • 6. Thestrup-Pedersen K. Clinical aspects of atopic dermatitis. Clin Exp Dermatol 2000;25:535-43.
  • 7. Kristal L, Klein PA. Atopic dermatitis in infants and children. An update. Pediatr Clin North Am 2000;47:877-95.
  • 8. Schmitt J, Langan S, Williams HC; European DermatoEpidemiology Network. What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol 2007;120:1389-98.
  • 9. Morar N, Willis-Owen SA, Moffatt MF, Cookson WO. The genetics of atopic dermatitis. J Allergy Clin Immunol 2006;118:24-34.
  • 10. 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;38:441-6.
  • 11. Vasilopoulos Y, Cork MJ, Murphy R, Williams HC, Robinson DA, Duff GW et al. Genetic association between an AACC insertion in the 3'UTR of the stratum corneum chymotryptic enzyme gene and atopic dermatitis. J Invest Dermatol 2004;123:62-6.
  • 12. Weidinger S, Klopp N, Rummler L, Wagenpfeil S, Novak N, Baurecht HJ et al. Association of NOD1 polymorphisms with atopic eczema and related phenotypes. J Allergy Clin Immunol 2005;116:177-84.
  • 13. Ou LS, Goleva E, Hall C, Leung DY. T regulatory cells in atopic dermatitis and subversion of their activity by superantigens. J Allergy Clin Immunol 2004;113:756-63.
  • 14. Hauk PJ, Leung DY. Tacrolimus (FK506): new treatment approach in superantigen-associated diseases like atopic dermatitis? J Allergy Clin Immunol 2001;107:391-2.
  • 15. Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med 2002;347:1151-60.
  • 16. Nomura I, Goleva E, Howell MD, Hamid QA, Ong PY, Hall CF et al. Cytokine milieu of atopic dermatitis, as compared to psoriasis, skin prevents induction of innate immune response genes. J Immunol 2003;171:3262-9.
  • 17. Krakowski AC, Eichenfield LF, Dohil MA. Management of atopic dermatitis in the pediatric population. Pediatrics 2008;122:812-24.
  • 18. Lewis-Jones S, Mugglestone MA; Guideline Development Group. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ 2007;335:1263-4.
  • 19. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P et al; European Academy of Allergology; Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Group. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy 2006; 61: 969-87.
  • 20. Plötz SG, Ring J. What's new in atopic eczema? Expert Opin Emerg Drugs 2010;15:249-67.
  • 21. 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 Dermatolog Treat 2010;21:144-56.
  • 22. Darsow U, Wollenberg A, Simon D, Taïeb A, Werfel T, Oranje A et al; European Task Force on Atopic Dermatitis/EADV Eczema Task Force. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol 2010;24:317-28.
  • 23. Ricci G, Dondi A, Patrizi A, Masi M. Systemic therapy of atopic dermatitis in children. Drugs 2009;69:297-306.
  • 24. Shaw MG, Burkhart CN, Morrell DS. Systemic therapies for pediatric atopic dermatitis: a review for the primary care physician. Pediatr Ann 2009;38:380-7.
  • 25. Martel RM, Melwani P, Islas D, Peñate Y, Borrego L. Safety of azathioprine therapy adjusted to thiopurine methyltransferase activity in the treatment of infantile atopic dermatitis. Report on 7 cases. Actas Dermosifiliogr 2010;101:415-20.
  • 26. 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 2010;24:43-9.
  • 27. Heller M, Shin HT, Orlow SJ, Schaffer JV. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol 2007;157:127-32.
  • 28. Lamb SR, Rademaker M. Intravenous immunoglobulin therapy for the treatment of severe atopic dermatitis. Expert Opin Pharmacother 2001;2:67-74.
  • 29. Jolles S. A review of high-dose intravenous immunoglobulin treatment for atopic dermatitis. Clin Exp Dermatol 2002;27:3-7.
  • 30. Belloni B, Andres C, Ollert M, Ring J, Mempel M. Novel immunological approaches in the treatment of atopic eczema. Curr Opin Allergy Clin Immunol 2008;8:423-7.
  • 31. Chamlin SL, Kao J, Frieden IJ, Sheu MY, Fowler AJ, Fluhr JW et al. Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol 2002;47:198-208.
  • 32. Jung T, Stingl G. Atopic dermatitis: therapeutic concepts evolving from new pathophysiologic insights. J Allergy Clin Immunol 2008;122:1074-81.
  • 33. Katayama I, Minatohara K, Yokozeki H, Nishioka K. Topical vitamin D3 downregulates IgE-mediated murine biphasic cutaneous reactions. Int Arch Allergy Immunol 1996;111:71-6.
  • 34. Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol 2008;121:116-21.
  • 35. Beck LA, Saini S. Wanted: A study with omalizumab to determine the role of IgE-mediated pathways in atopic dermatitis. J Am Acad Dermatol 2006;55:540-1.
  • 36. Jacobi A, Antoni C, Manger B, Schuler G, Hertl M. Infliximab in the treatment of moderate to severe atopic dermatitis. J Am Acad Dermatol 2005;52:522-6.
  • 37. Simon D, Wittwer J, Kostylina G, Buettiker U, Simon HU, Yawalkar N. Alefacept (lymphocyte function-associated molecule 3/IgG fusion protein) treatment for atopic eczema. J Allergy Clin Immunol 2008;122:423-4.
  • 38. Takiguchi R, Tofte S, Simpson B, Harper E, Blauvelt A, Hanifin J et al. Efalizumab for severe atopic dermatitis: a pilot study in adults. J Am Acad Dermatol 2007;56:222-7.
  • 39. Simon D, Hösli S, Kostylina G, Yawalkar N, Simon HU. Anti-CD20 (rituximab) treatment improves atopic eczema. J Allergy Clin Immunol 2008;121:122-8.
  • 40. Bussmann C, Maintz L, Hart J, Allam JP, Vrtala S, Chen KW et al. Clinical improvement and immunological changes in atopic dermatitis patients undergoing subcutaneous immunotherapy with a house dust mite allergoid: a pilot study. Clin Exp Allergy 2007;37:1277-85.
  • 41. Werfel T, Breuer K, Ruéff 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;61:202-5.

Current and Future Concepts in Treatment of Childhood Atopic Dermatitis

Yıl 2011, Cilt: 9 Sayı: 2, 39 - 43, 01.09.2011

Öz

Atopic dermatitis AD is a chronic inflammatory skin disorder caused by a dysregulationof immune response to allergenic or non-allergenic stimuli. Interplay of several effector cells including migrating lymphocytes, fibrocytes, Langerhans cells, mastcells and epidermal keratinocytes enroll in the development of AD. Atopic dermatitisaffects approximately 20% of children and persists in 6% of adults. Relieving acute exacerbations, improving the quality of life and prevention of side effects in the longterm are the main steps of the management of AD. Mild to moderate cases can becontrolled with avoidance of triggering factors, skin care and topical medications. Insevere cases immune suppression is an option with cumulative toxicity and variableefficacy of drugs as a limiting factor. It is essential to develop safer and efficaciousalternatives for the treatment of AD, especially in pediatric age group

Kaynakça

  • 1. Rancé F, Boguniewicz M, Lau S. New visions for atopic eczema: an iPAC summary and future trends. Pediatr Allergy Immunol 2008;19:17-25.
  • 2. Schultz Larsen F, Hanifin JM. Epidemiology of atopic dermatitis. Immunol Allergy Clin North Am 2002;22:1-24.
  • 3. Rancé F. Food allergy in children suffering from atopic eczema. Pediatr Allergy Immunol 2008;19:279-84.
  • 4. Werfel T, Ballmer-Weber B, Eigenmann PA, Niggemann B, Rancé F, Turjanmaa K et al. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy 2007;62:723-8.
  • 5. Hanifin JM, Rajka G. Diagnostic feature of atopic dermatitis. Act Derm Venereol 1980;92:44-7.
  • 6. Thestrup-Pedersen K. Clinical aspects of atopic dermatitis. Clin Exp Dermatol 2000;25:535-43.
  • 7. Kristal L, Klein PA. Atopic dermatitis in infants and children. An update. Pediatr Clin North Am 2000;47:877-95.
  • 8. Schmitt J, Langan S, Williams HC; European DermatoEpidemiology Network. What are the best outcome measurements for atopic eczema? A systematic review. J Allergy Clin Immunol 2007;120:1389-98.
  • 9. Morar N, Willis-Owen SA, Moffatt MF, Cookson WO. The genetics of atopic dermatitis. J Allergy Clin Immunol 2006;118:24-34.
  • 10. 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;38:441-6.
  • 11. Vasilopoulos Y, Cork MJ, Murphy R, Williams HC, Robinson DA, Duff GW et al. Genetic association between an AACC insertion in the 3'UTR of the stratum corneum chymotryptic enzyme gene and atopic dermatitis. J Invest Dermatol 2004;123:62-6.
  • 12. Weidinger S, Klopp N, Rummler L, Wagenpfeil S, Novak N, Baurecht HJ et al. Association of NOD1 polymorphisms with atopic eczema and related phenotypes. J Allergy Clin Immunol 2005;116:177-84.
  • 13. Ou LS, Goleva E, Hall C, Leung DY. T regulatory cells in atopic dermatitis and subversion of their activity by superantigens. J Allergy Clin Immunol 2004;113:756-63.
  • 14. Hauk PJ, Leung DY. Tacrolimus (FK506): new treatment approach in superantigen-associated diseases like atopic dermatitis? J Allergy Clin Immunol 2001;107:391-2.
  • 15. Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med 2002;347:1151-60.
  • 16. Nomura I, Goleva E, Howell MD, Hamid QA, Ong PY, Hall CF et al. Cytokine milieu of atopic dermatitis, as compared to psoriasis, skin prevents induction of innate immune response genes. J Immunol 2003;171:3262-9.
  • 17. Krakowski AC, Eichenfield LF, Dohil MA. Management of atopic dermatitis in the pediatric population. Pediatrics 2008;122:812-24.
  • 18. Lewis-Jones S, Mugglestone MA; Guideline Development Group. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ 2007;335:1263-4.
  • 19. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P et al; European Academy of Allergology; Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Group. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy 2006; 61: 969-87.
  • 20. Plötz SG, Ring J. What's new in atopic eczema? Expert Opin Emerg Drugs 2010;15:249-67.
  • 21. 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 Dermatolog Treat 2010;21:144-56.
  • 22. Darsow U, Wollenberg A, Simon D, Taïeb A, Werfel T, Oranje A et al; European Task Force on Atopic Dermatitis/EADV Eczema Task Force. ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol 2010;24:317-28.
  • 23. Ricci G, Dondi A, Patrizi A, Masi M. Systemic therapy of atopic dermatitis in children. Drugs 2009;69:297-306.
  • 24. Shaw MG, Burkhart CN, Morrell DS. Systemic therapies for pediatric atopic dermatitis: a review for the primary care physician. Pediatr Ann 2009;38:380-7.
  • 25. Martel RM, Melwani P, Islas D, Peñate Y, Borrego L. Safety of azathioprine therapy adjusted to thiopurine methyltransferase activity in the treatment of infantile atopic dermatitis. Report on 7 cases. Actas Dermosifiliogr 2010;101:415-20.
  • 26. 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 2010;24:43-9.
  • 27. Heller M, Shin HT, Orlow SJ, Schaffer JV. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol 2007;157:127-32.
  • 28. Lamb SR, Rademaker M. Intravenous immunoglobulin therapy for the treatment of severe atopic dermatitis. Expert Opin Pharmacother 2001;2:67-74.
  • 29. Jolles S. A review of high-dose intravenous immunoglobulin treatment for atopic dermatitis. Clin Exp Dermatol 2002;27:3-7.
  • 30. Belloni B, Andres C, Ollert M, Ring J, Mempel M. Novel immunological approaches in the treatment of atopic eczema. Curr Opin Allergy Clin Immunol 2008;8:423-7.
  • 31. Chamlin SL, Kao J, Frieden IJ, Sheu MY, Fowler AJ, Fluhr JW et al. Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol 2002;47:198-208.
  • 32. Jung T, Stingl G. Atopic dermatitis: therapeutic concepts evolving from new pathophysiologic insights. J Allergy Clin Immunol 2008;122:1074-81.
  • 33. Katayama I, Minatohara K, Yokozeki H, Nishioka K. Topical vitamin D3 downregulates IgE-mediated murine biphasic cutaneous reactions. Int Arch Allergy Immunol 1996;111:71-6.
  • 34. Lee J, Seto D, Bielory L. Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis. J Allergy Clin Immunol 2008;121:116-21.
  • 35. Beck LA, Saini S. Wanted: A study with omalizumab to determine the role of IgE-mediated pathways in atopic dermatitis. J Am Acad Dermatol 2006;55:540-1.
  • 36. Jacobi A, Antoni C, Manger B, Schuler G, Hertl M. Infliximab in the treatment of moderate to severe atopic dermatitis. J Am Acad Dermatol 2005;52:522-6.
  • 37. Simon D, Wittwer J, Kostylina G, Buettiker U, Simon HU, Yawalkar N. Alefacept (lymphocyte function-associated molecule 3/IgG fusion protein) treatment for atopic eczema. J Allergy Clin Immunol 2008;122:423-4.
  • 38. Takiguchi R, Tofte S, Simpson B, Harper E, Blauvelt A, Hanifin J et al. Efalizumab for severe atopic dermatitis: a pilot study in adults. J Am Acad Dermatol 2007;56:222-7.
  • 39. Simon D, Hösli S, Kostylina G, Yawalkar N, Simon HU. Anti-CD20 (rituximab) treatment improves atopic eczema. J Allergy Clin Immunol 2008;121:122-8.
  • 40. Bussmann C, Maintz L, Hart J, Allam JP, Vrtala S, Chen KW et al. Clinical improvement and immunological changes in atopic dermatitis patients undergoing subcutaneous immunotherapy with a house dust mite allergoid: a pilot study. Clin Exp Allergy 2007;37:1277-85.
  • 41. Werfel T, Breuer K, Ruéff 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;61:202-5.
Toplam 41 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Collection
Yazarlar

Elif Karakoç Aydıner Bu kişi benim

Safa Barış Bu kişi benim

Cevdet Özdemir

Yayımlanma Tarihi 1 Eylül 2011
Yayımlandığı Sayı Yıl 2011 Cilt: 9 Sayı: 2

Kaynak Göster

APA Karakoç Aydıner, E., Barış, S., & Özdemir, C. (2011). Çocukluklarda Atopik Dermatit Tedavisinde Güncel ve Gelecek Yaklaşımlar. Güncel Pediatri, 9(2), 39-43.
AMA Karakoç Aydıner E, Barış S, Özdemir C. Çocukluklarda Atopik Dermatit Tedavisinde Güncel ve Gelecek Yaklaşımlar. Güncel Pediatri. Eylül 2011;9(2):39-43.
Chicago Karakoç Aydıner, Elif, Safa Barış, ve Cevdet Özdemir. “Çocukluklarda Atopik Dermatit Tedavisinde Güncel Ve Gelecek Yaklaşımlar”. Güncel Pediatri 9, sy. 2 (Eylül 2011): 39-43.
EndNote Karakoç Aydıner E, Barış S, Özdemir C (01 Eylül 2011) Çocukluklarda Atopik Dermatit Tedavisinde Güncel ve Gelecek Yaklaşımlar. Güncel Pediatri 9 2 39–43.
IEEE E. Karakoç Aydıner, S. Barış, ve C. Özdemir, “Çocukluklarda Atopik Dermatit Tedavisinde Güncel ve Gelecek Yaklaşımlar”, Güncel Pediatri, c. 9, sy. 2, ss. 39–43, 2011.
ISNAD Karakoç Aydıner, Elif vd. “Çocukluklarda Atopik Dermatit Tedavisinde Güncel Ve Gelecek Yaklaşımlar”. Güncel Pediatri 9/2 (Eylül 2011), 39-43.
JAMA Karakoç Aydıner E, Barış S, Özdemir C. Çocukluklarda Atopik Dermatit Tedavisinde Güncel ve Gelecek Yaklaşımlar. Güncel Pediatri. 2011;9:39–43.
MLA Karakoç Aydıner, Elif vd. “Çocukluklarda Atopik Dermatit Tedavisinde Güncel Ve Gelecek Yaklaşımlar”. Güncel Pediatri, c. 9, sy. 2, 2011, ss. 39-43.
Vancouver Karakoç Aydıner E, Barış S, Özdemir C. Çocukluklarda Atopik Dermatit Tedavisinde Güncel ve Gelecek Yaklaşımlar. Güncel Pediatri. 2011;9(2):39-43.