Dissertations / Theses on the topic 'Atopic dermatitis Treatment Malaysia'

Background: Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE). Objectives: To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE. Methods: Based on a systematic literature review, we developed an evidence-based severity-score-oriented treatment algorithm for AE and compared its effectiveness to that of an individualised symptom-oriented treatment (individual therapy) in a randomised controlled trial. Sixty-three participants were randomised to algorithm (n = 32) or individual therapy (n = 31) and treated accordingly for 12 months. Study end points included difference between baseline SCORAD and mean SCORAD under treatment (primary end point), quality of life and treatment utilisation. Analysis was by intention to treat (registration: ClinicalTrials.gov:NCT00148746). Results: No statistically significant differences in clinical or subjective response were observed between groups. Treatment following the algorithm and individual treatment both effectively controlled AE. Mean SCORAD reductions were 47% (95% confidence interval, CI = 38–55; algorithm) and 42% (95% CI = 29–54; individual). Clinical response was paralleled by improved quality of life in both groups. Physicians adhered to the algorithm option in 93% of their treatment decisions. Conclusion: Treatment following an evidence-based algorithm is an effective and applicable concept for the management of AE but does not show clear advantages compared to individualised treatment in a dermatological setting
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Diverse pharmacological activities and the solid clinical performance of Chinese herbal medicines have attracted worldwide attention in terms of its modernization. Here, a hexaherbal Chinese formula (HHCF) for treating atopic dermatitis (AD) topically has been studied from chemical and biological perspectives. The HHCF comprises the rootstock of Scutellaria baicalensis Georgi (SCU), Rheum tanguticum Maxim. Ex Balf. (RHE), Sophora flavescens Aiton (SOP); the root bark of Dictamnus dasycarpus Turcz. (DIC); the bark of Phellodendron chinense C.K. Schneid. (PHE) and the fruit of Kochia scoparia (L.) Schrad. (KOC). In this thesis the chemical composition of the HHCF has been profiled and characterized using liquid-chromatography (LC) coupled with triple quadruple mass spectrometry (MS). 68 chemical compounds including alkaloids, anthraquinones, coumarins, flavonoids, naphthalene derivatives, phenylbutanone glucosides, phenolic acids, pterocarpans, stilbenes and tannins were putatively identified in the LC-MS profile of the HHCF based on mass measurement and characteristic fragment ions. The source(s) of these chemical compounds has been analyzed using the developed EXCEL template and PHE, RHE and SOP contributed the largest number of chemical compounds identified in the HHCF, while KOC seems to contribute very little. To evaluate the anti-inflammatory effects of the HHCF for treating AD/skin inflammation, the thymus and activation-regulated chemokine (CCL17), Prostaglandin E2 (PGE2), IL-8, IL-6 and hyaluronidase inhibitory effects were studies in vitro. Results showed that the HHCF inhibited hyaluronidase activity, TNF-α- plus IFN--induced CCL17 production in spontaneously immortalized human epidermal keratinocytes (HaCaT) and IL-1β-induced PGE2 in human fibroblasts with no effects on IL-8 and IL- 6. Among the chemical compounds characterized in LC-MS profile of the HHCF, multivariate regression models indicated the major contributor to the CCL17 inhibition were berberine, catechin dimers, gallic acid, galloylglucose, 4-(4'-hydroxylphenyl)-2- butanone 4'-O-β-D-glucoside, pyrogallol and resveratrol 4'-O-β-D-(6''-O-galloyl) glucoside. The effects of the HHCF against other pathogenesis-related targets need to be further study to ascertain its therapeutic efficacy against AD.

Background: Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE). Objectives: To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE. Methods: Based on a systematic literature review, we developed an evidence-based severity-score-oriented treatment algorithm for AE and compared its effectiveness to that of an individualised symptom-oriented treatment (individual therapy) in a randomised controlled trial. Sixty-three participants were randomised to algorithm (n = 32) or individual therapy (n = 31) and treated accordingly for 12 months. Study end points included difference between baseline SCORAD and mean SCORAD under treatment (primary end point), quality of life and treatment utilisation. Analysis was by intention to treat (registration: ClinicalTrials.gov:NCT00148746). Results: No statistically significant differences in clinical or subjective response were observed between groups. Treatment following the algorithm and individual treatment both effectively controlled AE. Mean SCORAD reductions were 47% (95% confidence interval, CI = 38–55; algorithm) and 42% (95% CI = 29–54; individual). Clinical response was paralleled by improved quality of life in both groups. Physicians adhered to the algorithm option in 93% of their treatment decisions. Conclusion: Treatment following an evidence-based algorithm is an effective and applicable concept for the management of AE but does not show clear advantages compared to individualised treatment in a dermatological setting.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

ABSTRACT Introduction and Rationale: Atopic Dermatitis (AD) is a common skin condition, characterized by markedly pruritic eczematous lesions, that most often presents in childhood. The majority of children diagnosed with AD will have mild disease and will first present with symptoms to a primary care provider (PCP), however approximately 85% of pediatricians only provide limited initial care followed by a referral to dermatology (Eichenfield et al., 2015). While there are specialty care based treatment guidelines for childhood AD, there are no guidelines available that specifically address primary care management of childhood AD. Purpose and Objective: The primary purpose of this DNP project is to develop an evidence-based clinical practice guideline (CPG) for pediatric PCPs. The secondary purpose is to develop a corresponding atopic dermatitis action plan (ADAP) to be used by children and parents. The objective is to equip PCPs to better manage children with AD in the primary care setting and to guide patients and parents in the importance of daily control measures and in the individualized treatment plan prescribed by the PCP. Methods: The Appraisal of Guidelines for Research & Evaluation II (AGREE II) framework and Social Cognitive Theory (SCT) serve as the theoretical frameworks for CPG and ADAP development. The American Academy of Pediatrics (AAP) process for evidence based policy setting is used as a model for key action statement development. Results: Evaluation of the CPG was completed using the AGREE II tool, a reliable and validated tool for evaluating CPGs. Five of the six domains evaluated, yielded combined scores of at least 90%, with one domain a combined score of 63%. The overall standard deviation was 0.58, indicating an overall low level of user discrepancy Additions and revisions were made based on the results of the AGREE II evaluation scores with specific emphasis on the lowest scoring domain. Conclusion: This DNP Project identified the need for a CPG specific to pediatric primary care. A CPG with accompanying ADAP was developed and evaluated using the AGREE II tool. The CPG was found to meet the recommended standards and recommended for use in pediatric primary care.

Atopic dermatitis (AD) typically develops in patients with a history of allergic ailments, and is characterised by an itchy, inflammatory skin condition with scaling, lichenification, papules, excoriations and pruritus. In AD patients a chronic relapsing inflammatory condition is seen, associated with IgE hyper production. AD flares are largely triggered by environmental factors. However, the exact etiology of AD is unclear and there is a pressing need for new treatment regimens as AD is a chronic condition and requires long term treatment. Historically Aloe has been used to treat skin conditions as well as a variety of other diseases. To further explore the pathogenesis and treatment of AD, Balb/c mice were sensitized and challenged with 2,4-dinitrochlorobenzene (DNCB) for atopic dermatitis induction. Thereafter, mice were treated with either Aloe ferox or Aloe vera applied daily on the dorsal skin for 10 consecutive days. A placebo gel was used for the control mice. Blood was collected at the end of the treatment period and serum IgE levels measured. Serum IgE levels were significantly lowered in the Aloe ferox group than in the Aloe vera group. This study demonstrated Aloe’s immunoregulatory potential for alleviating atopic dermatitis through influencing of Th2 cell activation.
Dissertation (MSc)--University of Pretoria, 2013.
gm2014
Pharmacology
unrestricted

Background: Financial constraints challenge evidence of the effectiveness of dermatological inpatient management. Objective: To evaluate the effectiveness of hospitalization in atopic dermatitis and psoriasis regarding initial and sustained benefits. Methods: Prospective study on adults with psoriasis vulgaris (n = 22) and atopic dermatitis (n = 14). At admission, discharge, and 3 months after discharge, validated outcomes of objective and subjective disease severity were assessed by trained investigators. Results: Hospitalization resulted in substantial benefit in quality of life and clinical disease severity. Looking at mean scores, the observed benefit appeared stable until 3-month follow-up. The analysis of individual patient data revealed significant changes in disease severity between discharge and 3-month follow-up with some patients relapsing, others further improving. Reasons for hospitalization and treatment performed were not related to sustained benefit. Conclusions: In psoriasis vulgaris and atopic dermatitis, hospitalization effectively improved quality of life and clinical disease severity. Further research should focus on prognostic factors for sustained improvement
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Background: Financial constraints challenge evidence of the effectiveness of dermatological inpatient management. Objective: To evaluate the effectiveness of hospitalization in atopic dermatitis and psoriasis regarding initial and sustained benefits. Methods: Prospective study on adults with psoriasis vulgaris (n = 22) and atopic dermatitis (n = 14). At admission, discharge, and 3 months after discharge, validated outcomes of objective and subjective disease severity were assessed by trained investigators. Results: Hospitalization resulted in substantial benefit in quality of life and clinical disease severity. Looking at mean scores, the observed benefit appeared stable until 3-month follow-up. The analysis of individual patient data revealed significant changes in disease severity between discharge and 3-month follow-up with some patients relapsing, others further improving. Reasons for hospitalization and treatment performed were not related to sustained benefit. Conclusions: In psoriasis vulgaris and atopic dermatitis, hospitalization effectively improved quality of life and clinical disease severity. Further research should focus on prognostic factors for sustained improvement.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Atopic dermatitis (AD), ichthyosis vulgaris (IV), and X-linked recessive ichthyosis (XLRI) are characterized by dry skin and impaired skin barrier. AD and IV are related to loss-of-function mutations in FLG (encoding filaggrin), whereas XLRI is caused by deletions or inactivating mutations in the steroid sulphatase gene (STS). Patients regularly use moisturizing creams, but little is known about the creams’ effects on the skin barrier. The present work combines objective scorings, non-invasive techniques, and molecular analyses of skin biopsies to characterize the skin in 57 patients with AD, IV, or XLRI, and in 14 healthy controls. Patients were classified according to their FLG and STS mutation status: AD with FLG+/+ (n = 14), AD with FLG+/– (n = 14), AD/IV with FLG–/– (n = 15), and XLRI with STS– (n = 14), as well as one man with a novel point mutation. Assessments were conducted at baseline and after four weeks of treatment with three different moisturizers applied to volar forearm skin. At baseline, dryness scoring and non-invasive assessments verified impaired skin barrier function in all patients. In patients with AD/IV, microarray analysis identified 300–3000 up- or downregulated mRNA transcripts involved in signalling pathways important for inflammation and barrier repair. The skin phenotype and number of altered transcripts were correlated with the FLG mutation status, with FLG–/– patients displaying the highest transepidermal water loss (TEWL) and the most altered transcript levels. In contrast, despite an equally dysfunctional skin barrier, only limited changes in mRNA transcripts occurred in XLRI patients. Treatment with moisturizers improved skin dryness similarly in all groups, but TEWL behaved differently: it decreased slightly in the AD/IV group and increased in the XLRI group, especially after urea treatment. Only minute effects on skin pH and mRNA expression were observed. In conclusion, FLG mutations elicit pro-inflammatory mechanisms probably aimed at restoring barrier competence. This does not occur in patients with XLRI, presumably because STS deficiency automatically increases the barrier thickness. Moisturizing treatment improves skin dryness in patients with AD, IV, or XLRI, but does not seem to normalize the altered epidermal gene expression profile in AD/IV patients.

M.A. (Clinical Psychology)
The purpose of this study was to determine whether a behavioural intervention could reduce scratching behaviour in atopic dermatitis. The literature dealing with the psychological aspects, and existing approaches to the treatment of atopic dermatitis and related dermatoses was reviewed. It was hypothesized that if subjects with atopic dermatitis were able to reduce their scratching behaviour they would show a corresponding reduction in size of identified lesions. In order to test these hypotheses, SUbjects with atopic dermatitis participated in a self-control programme lasting between eight and ten weeks. Of the seven subj ects that originally started the programme, four completed it. SUbjects' self-monitoring details reflected changes in scratching behaviour, and a specially designed grid was used to measure changes in lesion size. Inspection of the data showed that two SUbjects eliminated their scratching behaviour and lesions entirely; the other two showed marked reduction. The results of this study indicate that self-control procedures could be usefully applied as adjuncts to the conventional dermatological management of atopic dermatitis.

Research indicates that psychological stress plays a role in aggravating Atopic Dermatitis (AD), a genetically-based, chronic, inflammatory skin disorder. Most psychological interventions used to treat AD have employed behavioural techniques such as relaxation training and biofeedback. Some treatments have focused on reducing individuals' stress level, whereas others have focused on eliminating the scratching behaviour associated with exacerbation of the disorder. Very few studies have used a cognitive behavioural approach to treat AD. Stress Inoculation Training (SIT), a cognitive behavioural stress management program has been successful in treating a wide range of psychosomatic disorders. The purpose of this study, therefore, was to determine the effectiveness of SIT in treating seven women suffering from AD of the hands. A multiple baseline design was employed that included a baseline period of 4 weeks for two of the women and 5 weeks for the other 5 women, followed by 8 weeks of treatment, a 2-week post-intervention period, and a 3-month follow-up. Subjective measures of stress, coping, and extent of AD were repeatedly monitored using a diary technique. In addition, a self-report measure of anxiety and quality of life was administered weekly and objective ratings of skin condition were made on three occasions. The data were analyzed visually and statistically on an individual and group level to determine both they effectiveness of the intervention and the nature of the relationship between AD and aspects of the stress process. Overall, a positive treatment effect was revealed (p<.10), however on an individual basis it was apparent that SIT was effective for 4 of the women and not for 3. Positive relationships were also found between the women's skin condition and aspects of the stress and coping process. Implications for further research are discussed.

M.Tech. (Homoeopathy)
Atopic dermatitis (atopic eczema) is a chronic, relapsing, allergic inflammatory skin disease (Hauk, 2008). The prevalence of atopic dermatitis has increased significantly over the past few decades, with highest rates of 45 – 64% occurring amongst preschool children (Butler, 2009), and 40% amongst older children and adults (Manjra, 2005). This increase in prevalence is attributed to environmental factors such as microbial exposure and poor nutrition, which can all lead to atopic dermatitis (Schnopp, 2006). The quality of life of patients suffering from atopic dermatitis and their family members are significantly affected (Manjra, 2005). Atopic dermatitis is characterized by active skin lesions that are red, flaky, dry and itchy and in children commonly occurs in the flexural areas of the body (Fölster-Hols et al., 2007, Schnopp, 2006). Conventional treatment potions for atopic dermatitis are associated with adverse effects in children (Kalicharan et al., 2005). Homoeopathic remedies may offer an alternative option for this condition. This study aimed to assess the effect of a homoeopathic complex consisting of Graphites 6cH, Histaminum 9cH, Psorinum 6cH and Sulphur 6cH, on atopic dermatitis in children. All the participants of the study received the homoeopathic complex. The atopic dermatitis was evaluated using the SCORAD index (Scoring of Atopic Dermatitis) (Appendix F) and the Children’s Dermatology Life Quality Index (CDLQI) (Appendix E). Thirty four participants who met the inclusion and exclusion criteria were recruited to participate in this pre-test – post-test single group study by means of advertisements (Appendix A) placed in and around primary schools in the Gauteng area (with relevant permission given) and in the local newspaper. Participants were also recruited via word of mouth. Once participants were accepted into the study they were allocated into the treatment group which received the homoeopathic complex containing Graphites 6cH, Histaminum 9cH, Psorinum 6cH and Sulphur 6cH. The study was completed over a four week period. The percentage of the area affected, the intensity of the symptoms, the pruritus and the loss of sleep as well as the quality of life of the participants suffering from atopic dermatitis were aspects of the condition evaluated on a weekly basis. The results for the CDLQI showed improvements in the participant’s perception of itching/ pain of the affected area, as well as their quality of sleep. These improvements were shown to have occurred gradually over the study period. There were however no statistically significant changes noted in the mental and emotional quality of life of the participants.

Atopic eczema is a common condition that can interfere with social function, sleep and employment. Its persistence and accompanying pruritis may be stressful and frustrating for patients (Zug and McKay 1996 : 1243). The purpose of this randomised, double-blind, placebo-controlled study was to evaluate the efficacy of a homoeopathic complex (Arsenicum album 12CH, Graphites 12CH, Petroleum 12CH, Rhus toxicodendron 12CH, Sulphur 12CH and Urtica urens 12CH), in the treatment of atopic eczema in terms of its clinical manifestations and the impact on the quality of life of the patient. Thirty patients between the ages of eighteen and sixty years who met the Diagnostic criteria (Appendix A), were selected to participate in this study. Simple random sampling was used to divide them into two equal groups of fifteen i.e. the treatment group (Group 1) and the placebo group (Group 2). The trial lasted three months; at the initial consultation patients filled in the Clinical Evaluation Index (Appendix C), the Patients’ Perception questionnaire (Appendix D) and the General Well Being Schedule (Appendix E). Patients then received their three months supply of medication or placebo. Patients returned after three weeks and filled in the questionnaires and repeated this procedure every two weeks until the end of the trial. This amounted to six consultations per patient. Statistical evaluation of the data obtained from the questionnaires were analysed using the SPSS ver. 9 package. The Friedman test and Wilcoxon signed rank test were used to analyse the intra group comparisons. These are non parametric tests. The Mann-Whitney U-test was used for the inter group comparison. Both groups showed improvements with regards to all three questionnaires. The placebo group showed consistent improvement throughout the study. Therefore, statistically there was no difference between the two groups. The results of this study demonstrated that the use of a homoeopathic complex (Arsenicum album 12CH, Graphites 12CH, Petroleum 12CH, Rhus toxicodendron 12CH, Sulphur 12CH and Urtica urens 12CH) was no more effective than the placebo in the treatment of atopic eczema.
Dr. M. R. A. Moiloa Dr. D. Naude Dr. C. Hall

特應性皮炎(Atopic dermatitis,AD)是一種易復發、慢性炎症性皮膚病，同時還具有明顯的家族遺傳特徵，臨症狀主主要表現為皮疹及劇烈皮膚瘙癢。此病多於嬰幼兒時期發病，容易頻繁複發，甚至遷延至成年。據報導，在全球範圍內約有15-30%的兒童，2-10%的成年人正遭受不同程度的特應性皮炎困擾。關於特應性皮炎的具體發病機制尚不清楚，可能主要與遺傳易感性、免疫異常、表皮屏障功能障礙等有關。目前，臨床上針對特應性皮炎的治療方案主要是症狀管理，常用的藥物包括糖皮質激素類，抗組胺藥物和鈣調神經磷酸酶抑制劑。但是，這些藥物使用，尤其是長期使用，容易會造成耐藥性及諸多不良發應，例如皮膚萎縮，增加皮膚感染幾率等。 因此，越來越多特應性皮炎患者開始尋求中醫藥的説明。
在中醫中，特應性皮炎常備表述為四彎風、奶癬，主要由風、濕、熱等相關。常用的中藥主要分為：清熱藥、祛濕藥、祛風藥等，如黃連解毒湯、四心導赤飲、培土清心方等。許多中藥複方和單味中藥對特應性皮炎具有很好的治療效果，但是其中的絕大多數仍然缺少足夠的實驗性證據來證明其有效性，也缺乏相應的治療機制研究。
本研究選取一些具有代表性的複方和單味中藥進行提取，並以NO和肥大細胞脫顆粒為指標，對這些提取物分別進行抗炎和抗過敏篩選，最終確定對黃連解毒湯和白鮮皮具有良好的抗炎、抗過敏作用，並對其進行深入研究。
在質量控制方面，我們運用HLPC技術分別對黃連解毒湯和白鮮皮的乙醇提取物中特徵性成分進行定性、定量分析。梔子苷、小檗堿、黃芩素、漢黃芩素、黃芩苷這5種指標性成分用於黃連解毒湯醇提物的品質控制；梣酮和黃柏酮這個2中指標性成分用於白鮮皮醇提物的品質控制。
在體外抗炎、抗過敏實驗中，我們分別選取了RAW264.6和RBL-2H3細胞作為體外研究模型。黃連解毒湯提取物具有很強體外抗炎作用，能有通過抑制MAPKs和NF-κB的啟動抑制炎症性介質的釋放，包括IL-4、GM-CSF、IL-1β和MCP-1。同時還有非常明顯的抑制肥大細胞脫顆粒的作用。在DNP-BSA誘導的RBL-2H3細胞上，黃連解毒湯提取物能夠有效地抑制炎症、過敏介質的釋放(IL-4,TNF-α和MCP-1)，並且能抑制其MAPKs、Syk和Lyn的表達。而白鮮皮同樣具有強大的抗肥大細胞脫顆粒作用，且能明顯的阻滯鈣離子內流，抑制PLC1/2,Syk和Lyn激活，從而的降低IL-4,TNF-α和MCP-1的分泌。
為了進一步探索黃連解毒湯和白鮮皮，我們選取DNCB誘導的BALB/c小鼠作用體內研究模型來評價其治療效果。在口服黃連解毒湯提取物(150、300、600mg/kg/d)和白鮮皮提取物(600、1200、2400mg/kg/d)治療2周後，小鼠皮膚所表現出的皮損得到明顯改善，皮膚肥大細胞和嗜酸性粒細胞浸潤減少；同時血清和皮膚中炎症介質的也明顯減少。黃連解毒湯提取物和白鮮皮提取物最大的不同在於對血清IgE和組胺的影響。 白鮮皮提取物能有效地抑制血清IgE和組胺的升高，但是黃連解毒湯對此毫無作用。 兩者
總而言之，本研究對黃連解毒湯和白鮮皮治療特應性皮炎的機制進行初步探索，為其在臨床上的運用提供實驗性的證據。
Atopic dermatitis (AD) is a common relapsing chronic inflammatory skin disease characterized by erythema, pruritus, excoriation, edema, exodus and thickening of the skin. It usually presents during early infancy and childhood, but can persist into adulthood. It has been reported that AD affects 15%-30% of children and 2%-10% of adult worldwide and has high familial occurrence. The exact pathophysiology of AD is still unclear, therefore, the major clinical therapy of AD is through symptom management, usually involving long-term use of topical corticosteroids and calcineurin inhibitors, some alternative anti-inflammatory treatment (e.g. UV light therapy), protection of skin barrier and education. However, conventional therapy usually comes with potential adverse events and the development of drug resistance. For these reasons, patients frequently seek other alternative therapeutic options, such as Chinese herbal medicine. Some Chinese herbs and formulas (oral or topical treatment) are applied to AD patients for years in clinical practice, such as Huang-Lian-Jie-Du Extract (HLJDE黃連解毒湯), Sixindaochi Yin (四心導赤飲), Qingxinpeitu Fang (清心培土方). However, the efficacy and potential mechanism are still lacking.
The present research project aimed to screen some formula and Chinese herbs for AD treatment through evaluating their anti-inflammatory and anti-allergic effect. Then, we investigate the biological activities and underlying mechanisms of these products, with a particular focus on HLJDE and DCE (白鮮皮), using relevant in vitro and in vivo AD experimental models.
HLJDE and DCE was extracted with 80% aqueous ethanol. Nitric Oxide (NO) form RAW264.7 and RBL-2H3 cell degranulation were used as the biomarkers for evaluating the anti-inflammatory and anti-allergic effect of selected Chinese medicines. The related cytokines and chemokines such as IL-1β and IL-4, and the close protein pathways (NF-κB, MAPKs, Syk and Lyn) in both cell model were detected for investigating the underlying mechanisms of HLJDE and Cortex Dictamni. Female Balb/c mice were sensitized with 1-chloro-2,4-dinitrobenzene (DNCB) for three days. After sensitization, mice were challenged by DNCB every three days and orally administrated with HLJDE (150, 300 and 600 mg/kg/d) and Cortex Dictamni (600, 1200, 2400 mg/kg/d) every day from day 14-29. After mice were sacrificed, the ears and dorsal skin were collected for histopathological studies (H&E and toluidine blue staining). Serum and dorsal skin were also collected for cytokines (IL-4, TNF-α and TSLP) and antibody (IgE) determination.
HLJDE exerted significant anti-inflammatory and anti-allergic effects through suppressing the production of allergic and inflammatory mediators via the inactivation of the NF-κB, MAPKs, Syk and Lyn pathway. In vivo model, HLJDE was able to reduce inflammatory symptoms in AD-like mice by suppressing the production of Th2-associated cytokine (IL-4) and pro-inflammatory cytokines (TNF-α), thereby inhibiting eosinophil and mast cell infiltration. On the other hand, its inhibitory effect on skin TSLP also suppressed Th2-type responses and reduce the the production of pro-inflammatory cytokines such as TNF-α.
Cortex Dictamni has potent anti-allergic effect through inhibiting mast cell degranulation and inhibiting the activation of PLC1/2, Syk and Lyn, not suppressing some inflammatory pathways (MAPKs). In the meanwhile, Cortex Dictamni could improve the AD-like symptoms in AD-like mice by inhibiting the serum IgE and histamine level. The findings help provide scientific rationale for prescribing this herbal formula for AD treatment.
Chen, Yunlong.
Thesis Ph.D. Chinese University of Hong Kong 2016.
Includes bibliographical references (leaves ).
Abstracts also in Chinese.
Title from PDF title page (viewed on …).
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.

Relatório de Estágio do Mestrado Integrado em Ciências Farmacêuticas apresentado à Faculdade de Farmácia
A dermatite atópica é a inflamação crónica dermatológica mais prevalente, caracterizando-se por um forte prurido e lesões eczematosas em diversas partes do corpo. Esta doença afeta crianças e adultos numa proporção de 20 % em diferentes partes do mundo. A fisiopatologia da dermatite atópica envolve uma mistura de fatores tais como os de foro ambiental, genético,imunológico e disfunção ao nível da barreira da pele. A base da prevenção consiste no uso diário de hidratantes para o restauro da função de barreira epidérmica. As terapias convencionais envolvem o uso de corticosteroides tópicos (terapia de primeira linha),inibidores de calcineurina, anti-histamínicos, antibióticos, fototerapia e fármacos imunossupressores sistémicos (em casos de dermatite atópica refratária). No entanto, a aplicação tópica é um mecanismo difícil devido à barreira natural da pele que limita a penetração dos fármacos. Decorrente de tal, os investigadores procuram desenvolver alternativas para as terapias convencionais. Os sistemas inovadores de libertação de fármacos têm vindo a ganhar uma atenção crescente devido à sua capacidade de melhorar a solubilidade,a biodisponibilidade, a penetração, a atuação nas células-alvo e reduzir os efeitos secundários dos fármacos usados no tratamento da dermatite atópica. Não obstante, estudos adicionais são necessários para se compreenderem os aspetos toxicológicos e a segurança a longo prazo das nanopartículas. Esta revisão aborda o potencial tratamento da dermatite atópica recorrendo a sistemas de libertação de nanopartículas assim como as limitações de foro toxicológico inerentes às mesmas.
Atopic dermatitis (AD) is the most prevalent relapsing chronic inflammation of the skin, characterized by strong itching and eczematous lesions in different parts of the body. This disease affects both children and adults in a ratio of 20 % in different parts of the world. The pathophysiology of AD concerns a mixture of factors, such as environmental, genetic,immunological and dysfunctions of the epidermal barrier. The base of prevention is the daily use of moisturizers to aid in the repair of the epidermal barrier function. The conventional therapies involve the use of topical corticosteroids (TCSs) (first-line therapy), calcineurininhibitors (TCIs), antihistamines, antibiotics, phototherapy and systemic immunosuppressantdrugs (in severe refractory cases of AD). However, topical delivery to the skin is a difficult task to achieve due to the natural barrier of skin which limits the penetration of drugs.Therefore, researchers have sought to develop alternatives to conventional therapies.Innovative delivery systems have achieved increasing attention due to their capacity to enhance solubility, bioavailability, penetration, targeting specific types of cells and reduce the secondary effects of the drugs employed in the treatment of AD. Nonetheless, additional studies are needed to understand the toxicological aspects and long-term safety of nanoparticles (NPs).This review includes the potential treatment of AD with nanoparticle skin delivery systemsand their toxicologic concerns.

Tsang, Yin Ching.
Thesis M.Phil. Chinese University of Hong Kong 2015.
Includes bibliographical references (leaves 128-143).
Abstracts also in Chinese; appendix in Chinese.
Title from PDF title page (viewed on 04, January, 2017).
Tsang, Yin Ching.

A dermatite atópica é uma doença inflamatória crónica da pele que afeta todas as faixas etárias com maior incidência nas idades mais jovens. É caracterizada pela xerose cutânea, as lesões eczematosas, eritematosas, exsudativas e crostosas com morfologia e distribuição característica. A disfunção da barreira cutânea e do sistema imunitário são os principais fatores que apresentam maior magnitude quando associados à colonização e infeção frequente pela bactéria patogénica Staphylococcos aureus. A prevenção de manifestações clínicas é o principal foco de tratamento da doença e é nesta perspetiva que surge o interesse na utilização de pré e probióticos quer com atuação a nível tópico como a nível intestinal. Estudos preliminares são otimistas para o seu uso mas são necessários estudos adicionais para determinar o efeito completo que os pré ou probióticos têm sobre a pele, indicando que existem desafios consideráveis pela frente, mas também muitas oportunidades. Na primeira parte deste trabalho é efetuada a descrição da dermatite atópica, das suas características e complicações. Em seguida é apresentada uma revisão relativa à microbiota cutânea e a importância da manutenção de uma microbiota comensal equilibrada e funcional. Depois são apresentados os diversos tratamentos possíveis para a doença e a sua ordem de escolha e por último é explorado o possível uso de pré e probióticos na prevenção e atenuação dos sintomas atópicos com uma revisão bibliográfica a diferentes estudos clínicos e possibilidades futuras para a implementação destas novas terapêuticas na prática clínica.
Atopic dermatitis is a chronic inflammatory skin disease that affects all age groups with the highest incidence at younger ages. Is characterized by cutaneous xerosis, and eczematous, erythematous, exudative, and crusty lesions with characteristic morphology and distribution. The dysfunction of the skin barrier and the immune system are the main factors that present greater magnitude when associated to colonization and frequent infection by the pathogenic bacteria Staphylococcus aureus. The prevention of clinical manifestations is the main focus of treatment of the disease and it is in this perspective that the interest in the use of pre and probiotics appears with either topical or intestinal level performance. Preliminary studies are optimistic for its use, but further studies are needed to determine the full effect that pre or probiotics have on the skin, indicating that there are considerable challenges ahead, but also many opportunities. In the first part of this work the description of atopic dermatitis, its characteristics and complications is made. The following is a review of the cutaneous microbiota and the importance of maintaining a balanced and functional commensal microbiota. Then the different possible treatments for the disease and its order of choice are presented and finally the possible use of pre and probiotics in the prevention and attenuation of the atopic symptoms is explored with a bibliographical revision to different clinical studies and future possibilities for the implementation of these new therapies in clinical practice.