Background: Topical corticosteroids are the mainstay of treatment for patients with atopic dermatitis. However, adverse effects associated with long-term steroid use often limit its use. This interventional study compared the efficacy of a proprietary moisturiser containing licochalcone A, omega-6 fatty acids, and ceramide 3 against 1% hydrocortisone cream in treating patients with mild-to-moderate atopic dermatitis. Methods: Patients with mild-to-moderate atopic dermatitis affecting either the cubital fossa or popliteal fossa symmetrically were given twice-daily applications of the moisturiser and hydrocortisone on opposite sides of the body and monitored for a total of three weeks in a non-randomised half body, doubleblind study. Hydrocortisone was switched to aqueous cream after two weeks, whereas the application of the moisturiser continued until study completion. The assessment of SCORing Atopic Dermatitis (SCORAD) index and Dermatology Life Quality index was performed at baseline and every subsequent follow-up visit to measure patients’ response to treatment. Results: The licochalcone A (LA) moisturiser and 1% hydrocortisone (HC) cream both demonstrated significant reduction in sign and symptom scores after only 1 week of treatment (percentage of reduction in sign and symptom scores: 52.8% [LA] vs 58.5% [HC]). Further reduction in mean sign and symptom scores for both treatments was observed at week 2 (61.3% [LA] vs 56.8% [HC]) and also at week 3 when HC was switched to aqueous cream (70.5% [LA] vs 63.5% [HC→aqueous cream]) (p<0.001 vs baseline within the same treatment arm at weeks 1, 2 and 3). When comparing the mean difference in SCORAD index for both individual as well as total skin signs and symptoms between LA and HC (i.e. inter-arm comparison), there was no significant difference between the two treatments for all the assessed parameters. Patients reported improvements in itching, sleeplessness, and overall quality of life over the course of treatment. Conclusion The licochalcone A moisturiser can be considered as an effective steroid-sparing alternative to topical corticosteroids in managing mild-to-moderate atopic dermatitis.
Dermatitis, Atopic-therapy

Atopic dermatitis (AD) is a chronic, recurrent, and inflammatory skin disease. It usually occurs in children with a clinical manifestation of severe itching. In recent years the incidence of AD is slowly increasing, which severely impacts the physical and mental health of children. This article summarizes the epidemiology, influencing factors, and management of this diseases.
Dermatitis, Atopic ; epidemiology ; etiology ; therapy ; Humans ; Prognosis

Abstract Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that impacts the quality of life and exerts an economic toll on patients and their families. One of the factors contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE. The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends that these JAK-i can be considered as an option for systemic therapy in severe AE.
Dermatitis, Atopic--therapy ; Janus Kinase Inhibitors

Background: Vitamin B12 is a contributing factor in pruritus and peripheral nerve regeneration. Its role in atopic dermatitis (AD) is still unclear. This study aimed to compare vitamin B12 level between AD patients and healthy controls, determine its correlation with pruritus and AD severity, and evaluate dietary pattern with energy, macro and micronutrient intakes. Methods: This was a case control study involving adult AD patients and age-, gender-, ethnicity- and body mass index-matched healthy controls. All adult patients who fulfilled UK Working Party AD diagnostic criteria were included. Exclusion criteria include patients on systemic agents, diseases known to affect B12 level and vegan diet. AD severity was determined using SCORing Atopic Dermatitis (SCORAD) index. Serum vitamin B12 level were measured. A three-day 24-hour dietary recall was collected and analyzed. Results: A total of 42 AD patients and 42 controls were recruited. Mean SCORAD index was 39.2±16.6, and AD duration was 12.7 ± 8.1 years. Vitamin B12 was lower among AD (215.6 ± 110.2 pmol/L) versus control (295.1± 119.9 pmol/L), p<0.01 despite similar dietary B12 intake in both groups. There were no significant correlations between AD duration and severity with vitamin B12 level. Energy intake (kcal/ day) was significantly lower in AD (p=0.04). There were no significant differences in proportion of main food groups consumed and other macronutrient and micronutrient intakes. Conclusion Serum vitamin B12 level was significantly lower in AD patients despite similar dietary pattern and nutrient intake with healthy controls. There were no correlations with AD severity or disease duration. Dietary pattern of AD patients should be routinely assessed to ensure adequate nutrition.
Dermatitis, Atopic--therapy ; Vitamin B12 ; Diet Therapy ; Adult

The avoidance of incriminated foods is one of the principal therapies for atopic dermatitis (AD). Recently, interferon (IFN)-gamma therapy has been tried in AD with limited success. The necessity of diet therapy for the success of IFN-gamma therapy in AD was evaluated. A total of 524 AD patients participated in this study and 316 patients among them were entered into open food challenge tests. As the first step, an elimination diet was administered to 43 AD patients and 30 AD patients were enrolled as an untreated control group. As the second step, 45 AD patients were treated by both IFN-gamma therapy and elimination diet alone, 30 AD patients by elimination diet alone, 50 AD patients by IFN-gamma therapy, and 43 AD patients as controls. Clinical severity reduced significantly by using only the elimination diet in 58.1% patients with varying degrees of AD. Elimination diet improved the clinical results of IFN-gamma therapy in AD. In regard to the food challenge test, 77.8% of AD patients showed an adverse reaction to at least one food. Diet therapy itself had therapeutic effects on AD and an elimination diet might be essential for the success of IFN-gamma therapy in AD.
Adolescence ; Adult ; Child ; Child, Preschool ; Dermatitis, Atopic/drug therapy* ; Dermatitis, Atopic/diet therapy* ; Female ; Food Hypersensitivity/diet therapy ; Human ; Interferon Type II/therapeutic use* ; Male ; Treatment Outcome

Humans ; Child ; Myrtus ; Molluscum Contagiosum/drug therapy* ; Dermatitis, Atopic/drug therapy*

Many trials have been done on steroid-resistant atopic dermatitis. Recently, intravenous immune globulin (i.v.IG) was reported to be effective in the treatment of steroid-dependent atopic dermatitis. The aim of this study was to clarify whether i.v.IG therapy is effective in steroid-resistant atopic dermatitis. Forty-one steroid-resistant atopic dermatitis patients were tested in this study. Patients who weighed less than 30 kg were administered 500 mg/kg of i.v.IG. Patients who weighed 30 kg or more were administered 15 g of i.v.IG. Patient evaluations and laboratory tests with peripheral bloods such as eosinophil percentages and serum IgE levels were performed at days 0, 1, 7, and 21. In the present study, patients who responded to i.v.IG therapy were classified as Group A. Twelve patients who showed transient effects with lower clinical significance were classified as Group B (29.3%). Remaining 12 patients (29.3%) in Group C showed no improvement at all. Serum IgE levels and blo eosinophil percentages were markedly decreased in Group A. I.v.IG therapy may be recommended in the treatment of atopic dermatitis with extremely high serum IgE levels.
Adolescence ; Adrenal Cortex Hormones/pharmacology* ; Child ; Dermatitis, Atopic/therapy* ; Dermatitis, Atopic/immunology ; Drug Resistance ; Eosinophils/cytology ; Female ; Human ; IgE/blood ; Immunoglobulins, Intravenous/therapeutic use* ; Immunotherapy ; Male

Mycosis fungoides palmaris et plantaris (MFPP) is a rare form of mycosis fungoides that is confined to the palms and soles. The clinical manifestation of MFPP is often confused with inflammatory palmoplantar dermatoses. Mycosis fungoides is usually considered as a disease of middle age, but it is rarely developed at any age. A 10-year-old girl was referred to us with a 2-year history of recalcitrant palmoplantar dermatoses. Other clinics had treated her for more than 2 years, but all medical treatments turned out to have had no effect, despite her young age. She had not had any atopic dermatitis or allergic contact dermatitis. Histopathologic findings showed inflammatory cell infiltration and lymphocytic epidermotrophism. Monoclonal TCR-rearrangement was positive, so we diagnosed her as having MFPP. We tried to treat her with topical PUVA therapy and she improved within 3 months. Herein, we report on a case of mycosis fungoides Palmaris et plantaris in a 10-year-old girl that was treated successfully with topical PUVA.
Child ; Dermatitis, Allergic Contact ; Dermatitis, Atopic ; Humans ; Middle Aged ; Mycosis Fungoides ; Organophosphorus Compounds ; PUVA Therapy ; Skin Diseases

Dermatitis, Atopic ; diagnosis ; drug therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional

Child ; Child, Preschool ; Dermatitis, Atopic ; therapy ; Female ; Humans ; Infant ; Male ; Massage