Atopic Dermatitis: Inside Out or Outside In

1st Edition - January 14, 2022
Editors: Lawrence S Chan, Vivian Y. Shi
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 8 4 7 4 4 - 5
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 8 4 7 4 5 - 2

Atopic dermatitis (eczema) is one of the most common and most challenging skin conditions, for patients and practitioners alike. Uniquely organized by intrinsic and extrinsic etio… Read more

Atopic Dermatitis: Inside Out or Outside In

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Atopic dermatitis (eczema) is one of the most common and most challenging skin conditions, for patients and practitioners alike. Uniquely organized by intrinsic and extrinsic etiologies, Atopic Dermatitis: Inside Out or Outside In? examines a myriad of causes that start from both the inside of the body and from the external environment, offering physicians practical ways to design treatments that specifically address these causes. Drs. Lawrence S. Chan and Vivian Y. Shi, along with a team of expert contributing authors, examine the etiology of this complex disorder and provide targeted, comprehensive solutions and the most useful therapeutic plans based on pathophysiology, including evidence-based integrative management.

Cover image
Title page
Table of Contents
Any screen, Any time, Anywhere
Copyright
Contributors
Preface
Foreword
Acknowledgment
Section I: A History of Atopy
1. Historic Perspective
Abstract
Introduction
Ancient history and middle ages, through the 18th century
The 19th century
The 20th century
Historical approaches to the treatment of eczema
Summary
Further readings
References
2. Atopy Redefined
Abstract
Introduction
Clear definition of atopic dermatitis
Childhood-onset versus adult-onset subsets
Intrinsic versus extrinsic subsets
Filaggrin-defect versus filaggrin-intact subsets
Nonuniform clinical responses to immune modulatory therapeutics
Future directions
Summary
Further readings
References
3. Atopy of the Skin
Abstract
Introduction
Atopy of the skin under the microscope: histopathology
A bird's-eye view of the atopic skin surface
A bird's-eye view of the atopic physiology
A bird’s-eye view of the atopic immune deviation
Summary
Further readings
References
4. Epidemiology
Abstract
Introduction
Prevalence, distribution, and generally recognized factors
Genetics as a controlling factor
Socioeconomic burden perspectives
The factor of barriers to care
Psychosocial burden: physical health, mental health, and quality of life
Summary
Further readings
References
Section II: External Factors
5. Skin Barrier
Introduction
The compromised skin barrier in atopic dermatitis
Summary
Further reading
References
6. Skin and Gut Microbiome
Abstract
Introduction
Microbiome
Skin dysbiosis
Risk factors of skin dysbiosis
Bacterial composition
Importance of Staphylococcus aureus
Other factors
Gut dysbiosis
Establishment of the gut microbiome
Gut and the immune system
Gut dysbiosis and atopic dermatitis
Leaky gut
Summary
Further readings
References
7. Immunogens
Abstract
Introduction
Immunogens, outside in and inside out
Irritant contact dermatitis–related immunogens
ICD in patients with AD
Pathogenesis of ICD in AD
Risk factors
Diagnosis
Management
Allergic contact dermatitis–related immunogens
ACD pathogenesis
ACD in patients with AD
Identifying the need to patch test patients with AD
Patch testing patients with AD
Management of ACD in patients with AD
Immediate hypersensitivity reactions
Approach to the patient with AD and ICD or ACD
Summary
Further readings
References
8. Nutrition
Abstract
Introduction
Diet and the risk of AD development
Diet and existing AD
Micronutrients
Summary
Further readings
References
9. Oxidative Stress, Environmental Factors, and Pollutants
Abstract
Introduction
General mechanism of pollution-induced barrier dysfunction
Cigarette smoke
Particulate matter
Volatile organic compounds
Traffic-related air pollution
Solutions
Summary
Further readings
References
10. Clinical Evidence: External Factors
Abstract
Introduction
Staphylococcus aureus colonization
Skin infection
Allergic contact dermatitis
Environmental pollution
Evidence from atopic march
Summary
Further readings
References
Section III: Internal Factors
11. Keratinocytes
Abstract
Introduction
Keratinocyte: Roles in skin structure and integrity
Roles in epidermal structure
Roles in barrier proteins: Stratum corneum
Roles in barrier proteins: Epidermal tight junction
Roles in epidermal-dermal adhesion
Keratinocyte: Roles in cutaneous sensation
Keratinocyte: Role in wound healing
Keratinocyte: Roles in immune regulation
Role in innate immune responses
Role in adaptive immune responses
Keratinocyte’s barrier proteins: Impacts of IL4 and other Th2 cytokines
Th2 cytokines and keratinocyte’s physical barrier proteins
IL4 suppresses involucrin mRNA and protein production
IL4 downregulates loricrin mRNA and protein levels
Combined IL4/IL13 reduces filaggrin expression
IL4 abrogates stratum corneum cohesion
IL13 suppresses skin basement membrane proteins type IV collagen and integrin-α6
IL4/IL13/IL31 trio cytokines reduce tight junction protein claudin-1
Th2 cytokines and keratinocyte’s immune barrier proteins
IL4 and keratinocyte’s inflammatory protein production
Summary
Further readings
References
12. Microvasculature
Abstract
Introduction
Cutaneous blood vessels: Structures
Cutaneous blood vessels: Functions
Cutaneous blood vessels: Roles in atopic dermatitis
Cutaneous blood vessels in the keratin-14/IL4 transgenic mice
Cutaneous blood vessels in human patients of atopic dermatitis
Cutaneous lymphatic vessels: Structures
Cutaneous lymphatic vessels: Functions
Cutaneous lymphatic vessels: Roles in atopic dermatitis
Cutaneous lymphatic vessels in the keratin-14/IL4 transgenic mice
Summary
Further Reading
References
13. Humoral Factors
Abstract
Introduction
IgE antibodies in atopic dermatitis
Cytokines in atopic dermatitis: An overview
Cytokine effects on phenotypes of AD
Cytokines: Detail analysis
Chemokines
Summary
Further readings
References
14. Cellular Factors
Abstract
Introduction
Antigen presenting cells
Dendritic cells
Langerhans cells
B cells
T cells
Inflammatory Th2 and Th22 cells
Th1 and Th17 cells
T follicular helper cells
Regulatory T cells
Autoreactive T cells
Mast cells
Basophils
Eosinophils
ILC2
Summary
Further readings
References
15. Skin-Gut-Lung Epithelial Permeability
Abstract
Introduction
Skin permeability
Lipid alterations
Filaggrin deficiency
Tight junction defects
Proteases
Itch and scratch
Skin microbiome alteration
Gut permeability
Gut barrier defects
Food allergy
Gut microbiome alteration
Lung permeability
Lung epithelium defects
Lung epithelium junctional defects
Airway microbiome alteration
The skin-gut-lung model
A compromised barrier promotes a hyperactive immune system
“Chicken or the egg” conundrum
Summary
Further readings
References
16. Neurosensory Mechanisms
Abstract
Introduction
Prevalence of itch and pain in atopic dermatitis
Pathogenesis of itch in atopic dermatitis and neuronal sensitization
Itch mediators in the skin and neuronal sensitization
Pathogenesis of pain in atopic dermatitis and neuronal sensitization
Pain mediators in the skin and neuronal sensitization
Summary
Further readings
References
17. Epigenetics
Abstract
Introduction
Current model of atopic dermatitis
Three major types of epigenetic modifications
Epigenetic mechanisms affecting AD
Summary
Acknowledgments
Further readings
References
18. Clinical Evidence: Internal Factors
Abstract
Introduction
Skin barrier defect is not synonymous with atopic dermatitis
Not all patients with filaggrin gene mutation develop atopic dermatitis
Not all atopic dermatitis patients have an identifiable filaggrin gene mutation
Th2 immune type correlates with inside-out dysregulation in atopic dermatitis
Summary
Further readings
References
Section IV: Clinician’s Corner
19. Therapeutic Guideline Overview
Abstract
Introduction
Overview of recently published guidelines
Diagnostic and severity grading criteria for atopic dermatitis
Severity grading criteria
Nonpharmaceutic agents: moisturization, wet wrap therapy, and bleach baths
Moisturization
Wet wrap therapy
Bleach baths
Topical modalities: corticosteroids, calcineurin inhibitors, and phosphodiesterase-4 inhibitors
Topical corticosteroids
Topical calcineurin inhibitors
Topical phosphodiesterase-4 inhibitors
Phototherapy
Systemic therapies
Systemic immunomodulatory agents
Systemic steroids
Dupilumab
Emerging therapies
Antihistamines
Food allergy guidelines
Peanut allergy guidelines
Summary
Further reading
References
20. Topical Therapies
Abstract
Introduction
Bathing
Frequency of bathing
Type of bathing and duration
Cleansers, soaps, and bathing practices
Dilute bleach baths
Bath additives
Other bathing practices
Recommendations
Topical management with antiinflammatories
Topical corticosteroids
Topical calcineurin inhibitors
Other topical antiinflammatories
Recommendations
Topical antimicrobials
Recommendations for topical treatments
Summary
Further readings
References
21. Wound Care
Introduction
Atopic dermatitis pathobiology: Relationship to wound care
Wound healing biology
Biologic underpinning for wound healing impairment in atopic dermatitis
Interleukin-4
Vascular endothelial growth factors/angiogenesis
Caspases 1 and 8
Thymic stromal lymphopoietin
Role of the microbiome
Periostin and histamine
Epidermal growth factor
Chemokines
Macrophage migration inhibitory factor
Cathelicidin protein hCAP18/LL-37
Peroxisome proliferator-activated receptors
Tenascin-C
Surgical complications in atopic dermatitis
Wound care in atopic dermatitis
Summary
Further readings
References
22. Skin Barrier Repair
Abstract
Introduction
The skin barrier
Moisturizers
Moisturizer delivery systems
Ointments
Creams
Lotions
Gels
Oils
Moisturizer ingredients
Prescription emollients
Alternative and natural moisturizers
Role of proactive use of moisturizers in prevention of eczema in infants
Summary
Further readings
References
23. Emerging Targeted Treatments
Abstract
Introduction
Pathogenesis
Treatments targeting pathogenic cytokines
Treatments targeting pathogenic antibodies: Anti-IgE
Treatment targeting immune cells: Anti-CD20
Treatments targeting immune signaling: JAK-STAT/JAK-SYK
Topical JAK inhibitors
Calcineurin inhibitors
Phosphodiesterase inhibitors
Opioid agonists
Aryl hydrocarbon receptor (AhR) agonists
Anti-H4 receptor (H4R)
Dihomo-γ-linolenic acid (DGLA)
Neurokinin-1 receptor (NK1-R) antagonist
PPAR-γ
Summary
Further readings
References
24. Microbiome Modulation
Introduction
Oral probiotics
Treatment of AD with oral probiotics
Prevention of AD with oral probiotics
Recommendations
Topical microbial therapy
Lactobacillus
Roseomonas
Vitreoscilla
Bifidobacterium
Staphylococcus
Streptococcus
Endolysins
Antimicrobial-embedded clothing
Safety and Food and Drug Administration regulations
Treatments on the horizon
Summary
Further readings
References
25. Itch and Pain Treatments
Abstract
Introduction
Nonpharmacologic therapies: Moisturization and bathing practices reducing itch
Topical pharmacologic treatments
Oral immunosuppressants
Miscellaneous therapies
Drugs targeting neural sensitization
Experimental treatments
Summary
Further reading
References
26. Complementary and Alternative Approaches I
Abstract
Introduction
Topical natural oils
Sunflower seed oil
Sunflower oleodistillate
Virgin coconut oil
Borage seed oil
Menthol
Tea-tree oil
Olive oil
Combination topicals
Oral oils
Topical micronutrients
Oral micronutrients
Summary
Acknowledgments
References
Further readings
27. Complementary and Alternative Approaches II
Abstract
Introduction
Physical treatments
Tea and caffeine
Summary
Practical pearls
Further readings
References
Glossary
Bibliography
Index
Confidence is ClinicalKey

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Lawrence S Chan

Vivian Y. Shi