The Infectious Complications of Atopic Dermatitis - PowerPoint Presentation

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The Infectious Complications of Atopic Dermatitis

Vivian Wang, MD

Juri Boguniewicz, MD

Mark Boguniewicz, MD

Peck Y. Ong, MD

Ann Allergy Asthma Immunol. January 2021;126(1):3-12

The Infectious Complications of Atopic Dermatitis

Key Messages

Factors that contribute to the increased infections in atopic dermatitis (AD) are skin barrier defects, suppression of cutaneous innate immunity by type 2 inflammation, Staphylococcus aureus colonization, and cutaneous dysbiosis.

Skin infections in AD increase the risk of life-threatening systemic infections.

The use of antibiotics for AD exacerbation remains controversial, and further studies are needed to define which subsets of these patients can benefit from antibiotics.The goals of infection prevention in AD consist of skin barrier improvement, anti-inflammatory therapy, and minimizing the use of antibiotics.

Wang, et al. Ann Allergy Asthma Immunol. January 2021;126(1):3-12

Dysbiosis and Immune Dysregulation

of Atopic Dermatitis

Wang, et al. Ann Allergy Asthma Immunol. January 2021;126(1):3-12

Impetigo in a Child with Atopic Dermatitis

Wang, et al. Ann Allergy Asthma Immunol. January 2021;126(1):3-12

Eczema

Herpeticum

Wang, et al. Ann Allergy Asthma Immunol. January 2021;126(1):3-12

Eczema

Coxsakium

with Palm Lesions

Wang, et al. Ann Allergy Asthma Immunol. January 2021;126(1):3-12

Molluscum Contagiosum Along with the Flexural Areas of a Patient with Atopic Dermatitis

Wang, et al. Ann Allergy Asthma Immunol. January 2021;126(1):3-12

Principles of Infection Prevention and

Treatment in Atopic Dermatitis

Wang, et al. Ann Allergy Asthma Immunol. January 2021;126(1):3-12

New and Emerging Treatments for Inflammatory Itch

Stephen Erickson, MD

Aaron Ver Heul, MD, PhD

Brian S. Kim, MD, MTR, FAAD 

Ann Allergy Asthma Immunol. January 2021;126(1):13-20

New and Emerging Treatments for Inflammatory Itch

Key Messages

Chronic pruritus, defined as itch lasting longer than 6 weeks, is a major unmet need with no universally effective therapeutics.

Chronic itch underlies many primary dermatologic disorders, such as atopic dermatitis and chronic urticaria, but is also associated with a number of other allergic, hepatobiliary, neurologic, renal, and lymphoproliferative disorders; it can also present commonly in idiopathic forms.

Itch involves complex interactions between the skin, immune system, and the sensory nervous system; emerging therapeutics selectively target these interactions.Beyond histamine and IgE, type 2 immune cell–associated cytokines, including interleukins 4, 13, and 31, and the epithelial cell–derived cytokines have become prime targets for itch therapeutics.New potential anti-itch therapeutic targets include histamine receptor 4, Janus kinases, κ-opioid receptor, neurokinin 1 receptor, and phosphodiesterase 4.

Erickson, et al. Ann Allergy Asthma Immunol. January 2021;126(1):13-20

Type 2 Immunity and Chronic Pruritus

Erickson, et al. Ann Allergy Asthma Immunol. January 2021;126(1):13-20

Key Immune and Pruriceptive Signaling Pathways

in Chronic Itch

Erickson, et al. Ann Allergy Asthma Immunol. January 2021;126(1):13-20

New Treatments in Atopic Dermatitis

Neha Puar, MD

Raj Chovatiya, MD, PhD

Amy S. Paller, MD 

Ann Allergy Asthma Immunol. January 2021;126(1):21-31

New Treatments in Atopic Dermatitis

Key Messages

For decades, treatment of atopic dermatitis (AD) has been limited to topical corticosteroids, topical calcineurin inhibitors, and for those with moderate-to-severe AD, phototherapy and systemic immunosuppressants.

Despite medical need for more aggressive management, many patients are undertreated owing to concerns about the adverse effects and frequent laboratory monitoring associated with systemic immunosuppressants. Even adherence to topical regimens is threatened by caregiver phobia about the use of topical corticosteroids and calcineurin inhibitors.

Of note, the following 2 targeted therapies have recently been approved by the US Food and Drug Administration for treatment of AD: topical crisaborole 2% ointment, a phosphodiesterase 4 inhibitor, and subcutaneously injected dupilumab, a monoclonal antibody targeting the interleukin-4 receptor.Given the recent advances in our understanding of AD pathogenesis, numerous topical and systemic targeted therapies are in development and likely to alter the landscape of therapeutic options for AD.

Puar, et al. Ann Allergy Asthma Immunol. January 2021;126(1):21-31

Pathogenesis of Atopic Dermatitis: Immune System Targets

Puar, et al. Ann Allergy Asthma Immunol. January 2021;126(1):21-31

Cutaneous Itch Sensation in Atopic Dermatitis: A New Focus for Finding New Targets

Puar, et al. Ann Allergy Asthma Immunol. January 2021;126(1):21-31

A Review of Contact Dermatitis

Kanwaljit K. Brar, MD

Ann Allergy Asthma Immunol. January 2021;126(1):32-39

A Review of Contact Dermatitis

Key Messages

Nickel is the most common allergen, though many other sources of contact allergens are hidden in everyday products, such as preservatives and fragrances.

In screening for contact allergy, it is important to inquire about environmental and occupational exposures, including wet work and mechanisms of irritation, such as frequent hand washing or wiping.

The mechanisms of contact dermatitis are complex and may involve different T cell signaling pathways.Patch testing is required for diagnosis, and patch testing with patient’s personal products is recommended.Management currently focuses on allergen avoidance, topical therapies, or corticosteroids; some biologics may be indicated for treatment.

Brar. Ann Allergy Asthma Immunol. January 2021;126(1):32-39

Budesonide 0.1% in Petroleum at 72 Hours Showing the Effect and 7 Days Later Showing a Delayed Positive Test Result

Brar. Ann Allergy Asthma Immunol. January 2021;126(1):32-39

Management Approach to Contact Dermatitis

Brar. Ann Allergy Asthma Immunol. January 2021;126(1):32-39