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Source publication
Background:
Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management.
Objective:
We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD.
Methods:
We collected a databas...
Context in source publication
Context 1
... evidence of each statement was graded as follows: level 1, systematic re- view of randomized controlled trials (RCTs) and individual RCTs; level 2, systematic review of cohort studies and in- dividual cohort study (including low-quality RCTs); level 3, systematic review of case-control studies and individual case-control studies; level 4, case series (and poor-quality cohort and case-control studies); and level 5, expert opinion. The strength of each recommendation was classi- fied as A (level 1), B (levels 2 and 3), C (level 4), or D (level 5) (Table 1) 7 . ...
Citations
... Therapeutic moisturizers for AD offer additional anti-inflammatory, antipruritic, and antioxidant benefits, 10 while some others demonstrate the steroidsparing effect. 11 Ultraviolet radiation is known to affect skin barrier function, trigger skin inflammation and aggravate atopic dermatitis, rosacea, and acne flares. 12 These statements were reviewed, re-drafted and agreed upon after thorough discussion and refinement. ...
Background
While treatment is a definitive therapeutic component in the management of inflammatory skin conditions, adjunctive skin care comprising of appropriate cleansing, moisturization, and photoprotection are just as important. Cleansing, treatment, moisturization, and photoprotection (CTMP) constitute the four major components of holistic skincare routine for dermatological conditions. However, inadequate patient understanding of the condition, limited resources for physicians, and insufficient time for patient education during busy dermatological consultations are the main obstacles to establishing a holistic skincare routine in the real world.
Aims
This study aimed to identify key challenges in the implementation of a holistic skincare routine, and offer practical guidance to physicians to improve adoption in the management of acne, atopic dermatitis, rosacea, and sensitive skin syndrome.
Methods
An expert panel comprising of nine dermatologists from Australia, China, Hong Kong, Taiwan, India, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements to stimulate real‐world adoption of holistic skincare routine in acne, rosacea, atopic dermatitis, and sensitive skin syndrome using the Delphi approach.
Results
Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations to encourage adoption of holistic skincare routine.
Conclusion
Promoting patient education on the skin condition, training support staff in patient counseling, and offering physician training opportunities are the key strategies to encourage real‐world adoption of CTMP as a holistic skincare routine. The consensus recommendations presented here should be considered in all dermatology patients to accomplish the ultimate goals of improved treatment outcomes and patient satisfaction.
... Most of the dermatitis drugs used to treat AD are topical drugs used primarily for treating external symptoms. However, antihistamine drugs can promote itchiness in patients with AD and steroids can produce adverse effects due to their toxicities, making them unsuitable for long-term treatment and fundamental therapy for AD (Cooper, 1994;Kim et al., 2015). Consequently, safe and effective atopic treatments need to be developed. ...
Atopic dermatitis (AD) is a chronic inflammatory-allergic skin disorder that causes pruritic and eczematous skin lesions. Effect of Codium fragile extract (CFE) on AD has not been reported yet. In this study, inhibitory effects of CFE against skin severity scores, skin lesions, AD characteristics, and histological features of BALB/c mice with AD caused by 2,4-dinitrochlorobenzene (DNCB) were investigated. Results indicated that AD effects of CFE reduced body, skin, ear, spleen, thymus, and lymph node weights. Histopathological changes in skin reactions on the back and ears showed that CFE inhibited thickening of the epidermis and ear. Moreover, CFE reduced epidermal swelling and ear thickness compared with the DNCB group. These results suggest that CFE might be effective in alleviating AD with potential as a promising candidate for therapeutic and cosmetic treatment of inflammatory dermatitis. CFE may be useful in alleviating AD and could be a potential treatment for inflammatory dermatitis.
... aureus] in damaged and non-damaged skin, aggravating the inflammatory skin condition [10,11]. After the diagnosis, the first step is correctly assessing disease severity, which is crucial for selecting and monitoring treatment response [8,[12][13][14]. Different instruments are used to establish AD severity. ...
... It is important for patients and their caregivers to have a clear picture of the disease and to understand which existing therapeutic strategy is more suitable for their symptoms. Recently, numerous guidelines have been published for atopic dermatitis management in children [8,[12][13][14]. The treatment regimen for AD is complex, encompassing a variety of approaches to effectively manage the condition. ...
... Eichenfield et al. recommended up to once-daily bathing to remove serous crust and the subsequent administration of moisturizers [12]. Finally, the Korean consensus guidelines [14] specify that bathing should not exceed once per day. Emerging research suggests that the frequency of bathing may not significantly impact the severity of AD. ...
Atopic dermatitis is a chronic inflammatory skin disease. The treatment plays an important role in influencing the patients’ quality of life. The basic management consists of appropriate skin cleansing, including bathing and eventually using bathing additives. Recommendations regarding frequency and duration of bathing, water temperature and usefulness of bathing additives are widely different, often leading to confusion among patients. This review aims to give insights into the best bathing practices and the use of bathing additives in atopic dermatitis in children. Several bathing additives, including bleach baths, commercial baby cleansers, bath baby oils and bath salt, appear to be promising adjunctive therapies for atopic dermatitis due to their anti-inflammatory, anti-bacterial, anti-pruritus and skin barrier repair properties through different mechanisms of action. However, their efficacy and safety are not fully understood in some cases. The usefulness of other bath additives, such as acidic and more natural substances (green tea extracts, pine tar, sodium bicarbonate), is still under investigation. Further studies are needed to determine their optimal use to achieve clinical benefit safely.
... For example, they have been reported to exert beneficial effects in murine models of experimental systemic lupus erythematosus (SLE) [27] and inflammation-mediated autoimmune diseases [11][12][13]. AD is a chronic, relapsing, and highly pruritic inflammatory skin disease that significantly reduces the quality of life for patients [28,29]. As reported in our previous study on human ASC-EVs, systemic administration of ASC-EVs ameliorated AD-like symptoms through the regulation of inflammatory responses and the expression of inflammatory cytokines [26]. ...
Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with systemic inflammation and immune modulation. Previously, we have shown that extracellular vesicles resulting from human adipose-tissue-derived mesenchymal stem cells (ASC-EVs) attenuated AD-like symptoms by reducing the levels of multiple inflammatory cytokines. Here, we aimed to investigate the improvement of canine AD upon using canine ASC-exosomes in a Biostir-induced AD mouse model. Additionally, we conducted in vivo toxicity studies to determine whether they targeted organs and their potential toxicity. Firstly, we isolated canine ASCs (cASCs) from the adipose tissue of a canine and characterized the cASCs-EVs. Interestingly, we found that cASC-EVs improved AD-like dermatitis and markedly decreased the levels of serum IgE, ear thickness, inflammatory cytokines, and chemokines such as IL-4 and IFN-γ in a dose-dependent manner. Moreover, there was no systemic toxicity in single- or repeat-dose toxicity studies using ICR mice. In addition, we analyzed miRNA arrays from cASC-EVs using next-generation sequencing (NGS) to investigate the role of miRNAs in improving inflammatory responses. Collectively, our results suggest that cASC-EVs effectively attenuate AD by transporting anti-inflammatory miRNAs to atopic lesions alongside no toxicological findings, resulting in a promising cell-free therapeutic option for treating canine AD.
... Based on the Korean treatment guidelines for AD, all patients should use moisturizers regularly [61]. Moisturizer helps alleviate pruritus and has short-and long-term steroid-sparing effects [61]. ...
... Based on the Korean treatment guidelines for AD, all patients should use moisturizers regularly [61]. Moisturizer helps alleviate pruritus and has short-and long-term steroid-sparing effects [61]. In addition, bathing can help manage AD by providing skin hydration and removing crust and irritants. ...
... Regular bathing is recommended in Korea for managing AD patients. Generally, using a non-soap cleanser is essential for bathing with warm or lukewarm water for a short period [61]. Moreover, identifying and limiting exposure to possible triggering factors, such as animal dander, house dust mite, wool, sweat, personal hygiene products, foods, exercise, perfumes, stress, and alcohol, are recommended [61]. ...
Atopic dermatitis (AD) is a chronic inflammatory skin condition associated with a significant disease burden in Korea. AD is highly prevalent among Korean children, adolescents, and adults, and can cause physical discomfort, psychological distress, and social isolation for those affected. Despite advances in our understanding of AD, there are still many unmet needs in diagnosing and managing the disease in Korea. One of the challenges in diagnosing AD is the lack of a definitive biomarker for AD in Korea, and there is a need for more effective, safe, and cost-effective treatments for AD. Therefore, finding out the current epidemiology, burden of AD, and how AD is currently being diagnosed in Korea and reviewing management options available in Korea will help resolve the unmet needs of AD patients in Korea. Addressing these and other unmet needs in AD management and diagnosis in Korea may improve outcomes for those affected by this challenging condition.
... Studies provided insight into the potential mechanisms of cannabinoid modulation on pruritus, with neuronal modulation of peripheral itch fibers and centrallyacting cannabinoid receptors providing the most evidence [34]. Topical application of cannabinoid receptor agonists has been documented to have antipruritic and analgesic effects, additionally alleviating AD skin symptoms in some trials [20,35]. Despite the fact that preliminary studies demonstrated the efficacy of cannabinoids in AD treatment, they should not be recommended to patients due to the absence of larger-scale studies [35]. ...
... Topical application of cannabinoid receptor agonists has been documented to have antipruritic and analgesic effects, additionally alleviating AD skin symptoms in some trials [20,35]. Despite the fact that preliminary studies demonstrated the efficacy of cannabinoids in AD treatment, they should not be recommended to patients due to the absence of larger-scale studies [35]. However, up to 36.3% of patients declared using it at least once. ...
... 7-9 Consensus guidelines of Korea and the European Academy of Dermatology and Venereology endorsed short periods of bathing of 5-10 min and less than 5 min respectively. 10,11 Topical corticosteroids remain to be the first-line therapy in AD during disease flares, however, fear of steroids can critically hurdle treatment adherence, resulting in persistent disease and escalation of treatment to systemic agents. 12 Topical corticosteroid phobia is a global issue, with the prevalence ranging from 31% to 95.7% across different countries. ...
Importance
Preserving skin health is crucial for atopic dermatitis control as well as for the thriving of children. However, a well‐developed and validated tool that measures the knowledge, attitude, and practice of skin care is lacking.
Objective
To develop and validate the atopic dermatitis and infant skincare knowledge, attitude, and practice (ADISKAP 1.0) scale that measures parental health literacy on atopic dermatitis and skin care.
Methods
We conducted a review of the literature, a focus group (two dermatologists and 12 parents), and a panel discussion in order to generate the ADISKAP prototype. Two samples of parents with knowingly superior (dermatologists, n = 59) and inferior (general population, n = 395) knowledge traits participated in the validation of ADISKAP. Cronbach's alpha was reported as a measure of internal consistency, and the intraclass correlation coefficient (ICC) was calculated to assess the test‐retest validity. The known‐groups technique was used to evaluate construct validity.
Results
The ADISKAP scale contained 17 items after content and face validity validation. After removing items that displayed poor test‐retest reliability ( n = 4) and construct validity ( n = 3), 12 items were retained in the ADISKAP 1.0.
Interpretation
ADISKAP 1.0 is a reliable and valid tool for assessing parental knowledge, attitude, and practice on infantile atopic dermatitis and skin care.
... Topical medications are the mainstay of treatments for atopic dermatitis (AD), especially in patients with mild AD. In 2015, the Korean Atopic Dermatitis Association (KADA) suggested topical medications, including topical corticosteroids (TCSs) and calcineurin inhibitors (TCIs), as primary medications for the active treatment of mild AD and supplementary treatment for moderate-to-severe AD 1 . In addition, long-term treatment of AD using intermittent application of tacrolimus, one of TCIs, has been demonstrated to prevent disease flare-ups, thus emphasizing the importance of topical agents in the treatment of AD 2 . ...
... In addition, some patients are prescribed topical antibiotics for infective AD 4 . In early 2000s, when TCIs were first sold in Korea, they became a good treatment alternative for AD, owing to their relative safety and efficacy 1,5 . Thus, with the advent of TCIs, the prescription patterns of topical agents for AD patients have begun to change. ...
Background:
Topical medications play a crucial role in the treatment of atopic dermatitis (AD). Topical corticosteroids (TCSs) remain the main treatment of choice and topical antibiotics have also been used. However, with the new topical calcineurin inhibitors (TCIs), the prescription patterns of topical agents have changed over time.
Objective:
To characterize the prescription patterns of topical medications in Korean patients with AD.
Methods:
We investigated topical medications prescribed to Korean patients with AD using the National Health Insurance Sharing System (NHISS) database over a 14-year period (2002~2015). Additionally, the potency of prescribed TCSs was compared with AD and psoriasis patients.
Results:
The annual prescription of TCSs showed a slightly decreasing trend without significant change. In particular, in terms of steroid class, prescription of moderate-to-low potency TCSs were increased and the use of high potency TCSs were decreased. TCSs were the most commonly prescribed topical medications for AD. Tertiary hospitals had a higher prescription rate for TCIs than secondary or primary hospitals (16.2%, 3.1%, and 1.9%, respectively). Additionally, dermatologists prescribed TCIs more frequently than pediatricians and internists (4.3%, 1.2%, and 0.6%, respectively). Among TCSs, Class 5 was prescribed the most (40.6%) followed by Class 7, 6, 4, 3, 1, and 2. When we compared the potency of TCSs prescribed for AD with psoriasis patients, moderate-to-low-potency TCSs were more commonly prescribed in AD.
Conclusion:
Prescription patterns of topical medications had changed from 2002 to 2015 and differed according to the type of institution and specialty of the physician.
... Most (60%) childhood AD is remitted by adulthood. However, children with already persistent disease, later onset, and/or more severe disease have increased persistence [40]. Early treatment at the first signs and symptoms in infants and children is necessary for long-term treatment of AD and to prevent comorbidity [41]. ...
... In India, TCI (PIM 1% and tacrolimus 0.03%) are recommended as first-line therapies for the treatment of mild to moderate AD, with PIM 1% being preferred in children less than 2 years of age and on the face, flexures and genitalia [67]. The Korean Atopic Dermatitis Association (KADA) has recommended the use of tacrolimus (0.03%) and PIM (1%) in children older than 2 years for the management of AD, but they also mention that both of them can be safely used in children younger than 2 years, even in infants [40]. The Taiwanese Dermatological Association (TDA) and the Taiwan Academy of Pediatric Allergy, Asthma and Immunology (TAPAAI) recommend the use of TCI in children requiring long-term topical treatment, or the frequent use of mild TCS for AD in face and sensitive areas [68,69]. ...
Atopic dermatitis (AD) is a common chronic, multisystem inflammatory skin disease in pediatric patients. There has been an increase in the incidence of AD in the pediatric population of the Asia-Pacific region. Studies have shown that genetic, epigenetic, environmental and cultural factors may lead to differences in the clinical manifestation and prevalence of AD between races. Early treatment of AD is necessary to prevent the atopic march leading to comorbidities such as asthma and allergic rhinitis. Topical corticosteroids (TCS) are used as first-line therapy for the treatment of AD, but their long-term usage poses a risk to the patient's health. Pimecrolimus (1%) is a topical calcineurin inhibitor (TCI) that is indicated for the treatment of mild to moderate AD. Pimecrolimus has no apparent increase in adverse events compared to TCS, and it causes less of a burning sensation than tacrolimus. The safety and efficacy of pimecrolimus has been established through various clinical trials; yet, in many Asian countries, the use of pimecrolimus in infants is still restricted due to safety concerns. Based on the available evidence, the expert panel recommends pimecrolimus in infants between 3 months and 2 years of age in the Asian population.
... In this approach, a high-potency TCS of the same rank as the initial treatment is used intermittently as maintenance treatment after remission is achieved. PA therapy was reported to reduce the risk of both AD relapse and adverse effects of TCS treatment [10][11][12][13][14][15][16]. PA therapy also provided significantly better rash control and quality of life compared with reactive therapy (on-demand TCS use upon relapse) in pediatric patients with AD aged 3 months to 7 years [2]. ...
Topical corticosteroids are used as first-line treatment for atopic dermatitis (AD). Regarding the maintenance of remission achieved by topical corticosteroids, no previous studies have compared proactive therapy with rank-down therapy. We compared their efficacy and safety in Japanese children with moderate to severe AD. Patients who had achieved remission with a very strong topical corticosteroid were randomized to 4-week maintenance treatment with either intermittent use of the same drug (proactive therapy) or daily use of a strong topical corticosteroid for 1 week followed by daily use of a medium-potency topical corticosteroid for 3 weeks (rank-down therapy); 49 patients were randomized (proactive therapy, n = 24; rank-down therapy, n = 25). During maintenance treatment, the relapse rate was 8.33% in the proactive therapy group and 20.0% in the rank-down therapy group (p = 0.0859). The mean (±standard deviation) itching score on a numerical rating scale in the rank-down therapy group increased significantly from 2.5 ± 1.9 to 3.6 ± 2.6 (p = 0.0438). Adverse events occurred in 2 patients receiving proactive therapy and 3 patients receiving rank-down therapy. Proactive therapy appears to be as safe as rank-down therapy and may be more effective for itch in pediatric AD in remission.
