Atopic Dermatitis

New concepts about atopic dermatitis
                  

Rev Alerg Mex 2001 Jan-Feb;48(1):15-24
[Article in Spanish]

 

Sosa Vazquez M, Orea M, Flores G.
Servicio de alergia e inmunologia clinica, Hospital Regional Lic. Adolfo Lopez Mateos, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico, DF.

 

The atopic dermatitis is a chronic inflammatory skin illness, with remissions and exacerbations, itch, and association with allergic rhinitis and asthma. There is a complex interrelationship of genetic, environmental, pharmacological and psychological factors that contribute to the development and severity of the illness: Different manifestations of immunological disorders are an increment in the number of IgE antibodies toward common antigens, an increment in the liberation of proinflammatory mediators by basophils and mast cells, peripheral and local eosinophilia, biphasic activity Th1/Th2 with the liberation of cytokines (IL-4, IL-5, IL-13), GM-CSF and the IFN-gamma caused by the cells Th1. an increment in the liberation of major basic protein, eosinophil cationic protein besides the expression of chemotactic factors by the monocytes (RANTES, eotaxin, vasoactive intestinal peptide, etc.).

In 1980, Hanifin and Rajka made public the diagnostic criteria for the atopic dermatitis and it has been universally accepted as an standard for the diagnosis. Leung reported that a knowledge about the immunopathological bases of the atopic dermatitis has important clinical implications for the diagnosis and possible treatment there are multiple choices for a treatment because of the complexity of the illness. Among these are thalidomide and transfer factor as an immunomodulator treatment with acceptable safety and clinical efficacy.

Publication Types:
Review
Review, Tutorial
PMID: 11398366 [PubMed - indexed for MEDLINE]

Transfer factors in moderate and severe atopic dermatitis

Rev Alerg Mex 1996 Sep-Oct;43(5):116-23
[Article in Spanish]

 

Navarro Cruz D, Serrano Miranda E, Orea M, Estrada Parra S, Teran Ortiz L, Gomez Vera J, Flores Sandoval G. Servicio de alergologia e inmunologia clinica, Hospital Regional Lic, Adolfo Lopez Mateos, ISSSTE.

 

We did a prospective, comparative, experimental study with 30 patients with moderate to severe atopic dermatitis from the allergy section from September 1994 to March, 1995. The test laboratory examination was performed in all patients: complete blood cell count, immunoglobulins A, G, M and E determination, lymphocyte subpopulations CD3, CD4, CD8, CD4-CD8 proportion, CD25, rosette formation for B and T lymphocytes, coproparasitoscopic examination, throat and nose cultures, nasal cytology, skin tests of cellular immunity to PPD, thrichophytin, candidine, varidasa; skin prick test to poliens, fungi, inhalants and foods.

All patients underwent to a sign and symptom grading score system as follows: the parameters were erythema, pruritus, eczema, papule valorated on a scale from 0 a 4+( O = no symptoms, + = mild, ++ = moderate, + ++= severe, ++ ++ = very severe). Initially all patients received one placebo unit every 15 days orally 3 times, then one after 30 days.

Laboratory examination was performed and then treatment with transfer factor was initiated, initially 1 unit every 15 days three times and the fourth 30 days after. 15 days after the last dose a new immunological valoration was done.

Results demonstrate a CD4 cell decrement, blood eosinophil and lgE dissemination although they're not statistically significative. There was a statistically significative improvement in the 4 clinical parameters: erythema, eczema, pruritus and populous with the use of transfer factors.

PMID: 9005003 [PubMed - indexed for MEDLINE]

 Safety and efficacy of treatment for severe atopic dermatitis with cyclosporin A and transfer factor

Rev Alerg Mex 1999 Mar-Apr;46(2):49-57 [Article in Spanish]

Cordero Miranda MA, Flores Sandoval G, Orea Solano M, Estrada Parra S, Serrano Miranda E.
Servicio de alergia e inmunologia, Hospital Regional Lic. Adolfo Lopez Mateos, ISSSTE.

BACKGROUND:

The atopic dermatitis is a chronic skin disease that appears in patients with a personal or family history of allergic asthma and rhinitis. It is associated to the specific activation of a gene group. In most instances, the response to the conventional treatment is adequate. The are cases,  though, know as refractory, where that is not the case. The study of two therapeutic alternatives, Transfer Factor (TF) and Cyclosporin A (CyA), was elaborated for this type of patients.

MATERIAL AND METHODS:

Patients with severe refractory AD were studied, being admitted to the Allergic Service to the ISSSTE Lic. Adolfo Lopez Mateos, ISSSTE, between September 1997 and june 1998. They were randomly divided in two groups. The first one was subjected to CyA, on a 4 mg/kg/day dosage, with monthly surveillance of kidney and hepatic functions and blood pressure twice a week. Group two was subjected to TF, as follows: one unit every third day for the first week, two units per week for the next three weeks and one monthly unit to complete six months. Initial and final clinical and immunologic testing was performed on both groups (eosinophils, total IgE, CD4 and CD8). RESULTS:

Six patients included group A, and 12 patients in group B. Both groups showed a significant statistic reduction in the total eosinophils count, without an statistic difference between them. None showed changes in the total IgE. CyA reduced the CD4 levels, while the TF increased the levels of CD8 cells,
both with a p < 0.05. Both groups showed clinical improvement satistically significant, but no differences with a p > 0.05 appeared between them. Tolerance to the treatments was adequate, and there was not need to suspend the treatment in any case. Only three patients showed hypertricosis and other one presented headaches, with CyA.

CONCLUSION:

Both treatments showed therapeutic benefits in the treatment of patients with severe refractory AD, with similar immunologic improvement. Both drugs present different action mechanisms, so their joint application could offer clinical benefit to the patient (synergetic action), cost reduction, and long term treatments with reduced adverse effects.

Publication Types: Clinical Trial Randomized Controlled Trial PMID: 10391070 [PubMed - indexed for MEDLINE]