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14 September 2010
Causes and Treatment of Atopic Dermatitis
Dong Seok Cha, Ph.D.
Department of Oriental Pharmacy
College of Pharmacy
Woosuk University
Contents
- Characteristic of Atopic Dermatitis (AD)
• Definition
• Symptom
- Causes of AD
• Genetic factor
• Environmental factor
• Immune system imbalance
• Dysfunction of skin barrier
- Treatment of AD
• Avoiding allergens
• Drug treatment
• Phototherapy
• Alternative Treatment
- Prevention of AD
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
AD prevalence rate of
AD prevalence rate of
elementary school student
middle school student
AD
25%
13%
non AD
non AD
75%
87%
35
20
30
AD prevalence rate (%)
AD prevalence rate (%)
AD
25
20
15
10
5
0
16
12
8
4
0
1995
2005
1~5세
6~11세 12~18세 19~29세 30~39세 40~49세 50~59세 60~69세 70세 이상
Symptoms of Atopic Dermatitis
Atopic
Dermatitis
Causes of Atopic Dermatitis
Causes of Atopic Dermatitis
Causes of AD – Genetic Factor
• Family history is very important
• The inheritance pattern is complex
• AD genetics involve several genes, each with a different function
- 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
• Dietary life
Food allergy
Trans fat
35
AD prevalence rate (%)
• Industrialization
Hygiene hypothesis
30
25
20
15
10
5
0
1995
• Residential Environment
Aeroallergens
eg. dust mites, pollens, animal danders
VOCs
eg. formaldehyde, benzene
2000
2005
Sick building syndrome
Causes of AD - Immune System Imbalance
Th2
Th1
[Homeostatic state]
Th2
Th1
Th1
[Cell-mediated Immunity]
Th2
[Allergy / Atopy]
Causes of AD - Immune System Imbalance
Causes of AD – Dysfunction of Skin Barrier
TEWL
Ceramide
Skin
Barrier
Function
Allergen
Irritant
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 effects
• AD imposes tremendous social and financial costs on patients
Improved drugs are necessary
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 continues
to increase
• Traditional herbal medicine formulation
Merit
Demerit
Reducing corticosteroid usage
Prescribed differently for each patient
Less side effect
Unique flavor
Regulation of immune responses
Herbal allergens
Synergic effect
Expensive
• External application
• Combined internal and external treatment
Prevention of Atopic Dermatitis
Prevention of Atopic Dermatitis
Thank you for your attention