Transcript 슬라이드 1
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