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Long Term Treatment Concepts and Proactive Therapy for Atopic Eczema
( Andreas Wollenberg ),( Laura Maximilane Ehmann ) 대한피부과학회 2012 Annals of Dermatology Vol.24 No.3
Atopic eczema, also known as atopic dermatitis, is a frequent, highly pruritic, chronic skin disease, which is typically running in flares. The traditional treatment mainly consists of the reactive application of topical anti-inflammatory agents such as topical corticosteroids and topical calcineurin inhibitors. The short term benefit of this approach is well known, but long term remission between flares is difficult to achieve. Therefore, innovative long-term treatment strategies targeting flare prevention and skin barrier stabilization are needed. We and others have shown that normal looking, non-lesional skin of atopic dermatitis patients is immunobiologially not normal but characterized by an invisible inflammation and barrier defect. This has led to the novel concept of proactive therapy, which is defined as long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin. This review article describes the most important long-term treatment options for atopic dermatitis, which includes emollient therapy, the novel concept of proactive treatment, the different ultraviolet light modalities and a selection of systemic immunosuppressive drugs and biologics. Current trial data, licensed indications, off-label use and relevant side effects of the different treatment modalities are summarized.
Huygen Lisa,Thys Pauline Marie,Wollenberg Andreas,Gutermuth Jan,Krohn Inge Kortekaas 대한피부과학회 2024 Annals of Dermatology Vol.36 No.2
Background: Skin barrier function assessment is commonly done by measuring transepider- mal water loss (TEWL). An important limitation of this method is the influence of intrinsic and extrinsic factors. Electrical impedance spectroscopy (EIS) is a lesser-established method for skin barrier function assessment. Some influential factors have been described, but no guidelines exist regarding the standardization of these measurements. Objective: To evaluate the effect size of daily routine activities on TEWL and EIS, as well as their correlation with age and anatomical differences. Methods: Healthy participants (n=31) were stratified into three age groups (18–29, 30–49, and ≥50 years). In a climate-controlled room, EIS and TEWL measurements were performed on the left and right volar forearm and abdomen. Results: Body cream application decreased TEWL and EIS values after 15 and 90 minutes. Skin washing decreased TEWL for 15 minutes and EIS values for at least 90 minutes. TEWL was in- creased 5 minutes after moderate to intense exercise. Coffee intake increased TEWL on the ab- domen after 60 minutes. TEWL and EIS values did not correlate with participants’ age and no anatomical differences were obser ved. No correlation was obser ved between TEWL and EIS. Conclusion: Body cream application and skin washing should be avoided at least 90 minutes prior to measurements of TEWL and EIS. Exercise and coffee intake should also be avoided prior to TEWL measurements. EIS may be a promising tool for skin barrier function assess- ment as it is less affected by daily routine activities than TEWL.
( Laura Ehmann ),( Markus Reinholz ),( Tanja Maier ),( Martin Lang ),( Andreas Wollenberg ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.4
Background: Perioral dermatitis (POD) is a common inflammatory skin disease without standard therapy. Objective: We sought to evaluate the clinical value of a soothing fluid for the treatment of POD. Methods: We included 51 patients with POD in this 8-week clinical trial. The Toleriane Fluide Efficacy in Perioral Dermatitis (TOLPOD) study had an open-label design and involved twice-daily application of Toleriane Fluide, a soothing cosmetic fluid. Clinical assessment of POD was performed with a predefined questionnaire including the POD severity index (PODSI). Control visits were made after 4 and 8 weeks of treatment. Results: The results were compared with those of a historical control group treated with a vehicle cream. Patients treated with the soothing fluid showed a continuous and significant improvement of the PODSI over time. The improvement of PODSI observed with the soothing fluid was better, but not significantly better, than that observed in the historical controls. In addition, the subjective complaints of patients such as disease burden, itching, distension of the skin, and appearance improved during treatment. Conclusion: A soothing fluid could be a clinically useful treatment option for POD. (Ann Dermatol 26(4) 462~468, 2014)