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Background: Azathioprine is frequently used in severe eczema. It is converted in the liver into active metabolites, including 6-thioguanine nucleotide (6-TGN) and methylated 6-methylmercaptopurine (6-MMP). In the past, the therapeutic potential of azathioprine may have not been fully utilized. Recent investigations on inflammatory bowel disease have led to a better understanding of azathioprine metabolism and optimizing treatment. Objective: To investigate whether measuring thiopurine metabolites in circulation can improve the effectiveness and safety of azathioprine treatment in patients with atopic dermatitis and/or chronic hand/foot eczema. Methods: Azathioprine metabolite levels were measured in eczema patients during maintenance treatment (Part I) and dose escalation (Part II). Clinical effectiveness, hepatotoxicity, and bone marrow suppression were analyzed and TPMT genotype was assessed. Results: A wide variation in metabolite levels in all dose groups was observed. In Part I (32 patients), there were no significant differences in 6-TGN levels between clinical responders and non-responders (p = .806). No hepatoxicity or myelotoxicity was observed. In Part II, all 6-TGN and 6-MMP levels increased during dose escalation. Hypermethylation was observed in 2/8 patients. Conclusion: For individual eczema patients treated with azathioprine, routinely measuring 6-TGN and 6-MMP can be helpful in optimizing azathioprine dose, improving clinical effectiveness, and preventing side effects. [ABSTRACT FROM AUTHOR]

Background:Atopic dermatitis, a chronic inflammatory disease, has a lifetime prevalence of 10–20%. Atopic dermatitis reduces quality of life, primarily due to pruritus. Interleukin-31 and its target receptor are newly discovered entities that are involved in pruritus. Purpose:To summarize the current understanding of interleukin-31 and its role in atopic dermatitis, potential therapeutic interventions and future prospects. Methods:A systematic review was designed to identify articles related to interleukin-31 and its role in pruritus. Predefined queries containing interleukin-31 and related key terms were searched with no past date restriction, through 31 August 2016, using MEDLINE, Cochrane Controlled Trials Register, ClinicalTrials.gov and the International Clinical Trials Registry Platform Search Portal database. Results:Of 151 identified articles, 61 met eligibility criteria. Interleukin-31 receptors are expressed constitutively on the surface of keratinocytes, eosinophils and small diameter neurons. Overexpression of interleukin-31, independent of mast cells and lymphocytes, induces clinical and histological features consistent with atopic dermatitis. In addition, overexpression of interleukin-31 causes reversible alopecia. Human monoclonal interleukin-31 antagonist, CIM331, decreased pruritus in phase-I and phase-II clinical trials. Conclusions:Interleukin-31 plays an important role in atopic dermatitis and alopecia. Inhibiting this pathway may provide an alternative to antihistamines for the pruritus of atopic dermatitis. [ABSTRACT FROM AUTHOR]

Background:The limited efficacy of topical tacrolimus may result from insufficient frequency of application or amount applied in eczema patients. Objective:To investigate the frequency of application and amount of use of topical tacrolimus in patients with various types of eczema. Methods:The frequency of application and the applied amount of topical tacrolimus were assessed over two weeks. Results:A total of 200 eczema patients completed this study. The average number of applications per day was 1.75 ± 0.53, despite instructions to apply the topical tacrolimus twice daily. With respect to the frequency of application, 147 (73.5%) and 122 (61.0%) of patients followed the prescription in the first and second weeks, respectively. The average amount applied per 2% of total body surface area (TBSA) was 0.54 ± 0.52 g. Only 53 (26.5%) patients applied between 80 and 120% of expected amount of topical tacrolimus. Limitations:The frequency of application was self-reported, possibly resulting in limited accuracy. Conclusion:Korean patients with eczema tend to apply topical tacrolimus less frequently and in inappropriate amounts. Clear instructions regarding both the frequency and amount of application are needed to improve the therapeutic outcome with treatment with topical tacrolimus. [ABSTRACT FROM PUBLISHER]

The aim of this study is the evaluation of the specificity and sensitivity of the skin prick tests (SPTs), specific IgE and atopy patch tests (APTs) in atopic dermatitis patients suffering from food allergy. A total of 301 patients were examined, complete dermatological and allergological examination was performed in all patients. The food allergy was confirmed to peanuts in 62 patients (20%), to egg in 16 patients (5%), to soy in 9 patients (3%), to wheat in 12 patients (4%) and to cow milk in 6 patients (2%). The specificity of SPT, specific IgE and APT is considered as good; the sensitivity of APT is low. The positive results in isolation cannot confirm the food allergy; however, together with other diagnostic methods, such as clinical history and open exposure test, these tests are valuable tool in examination of food allergy. [ABSTRACT FROM AUTHOR]

Background: Pruritus ani (PA) is defined as intense chronic itching affecting perianal skin. Objective: We aimed to determine the efficacy of topical tacrolimus treatment in atopic dermatitis (AD) patients who have PA. Methods: The study included 32 patients with AD who were suffering PA. Patients were randomized into two groups. In total, 16 patients used 0.03% tacrolimus ointment and 16 patients used vaseline as placebo. All groups applied topical treatments to their perianal area twice daily for 4 weeks. The treatments were then reversed for 4 weeks after a 2 weeks wash out period. Results: In total, 32 patients with AD who had refractory anal itching were enrolled in this study. None of the patients had obtained successful results with previous treatments. There was a statistically significant decrease in the recorded EASI, DLQI and itching scores for the tacrolimus group compared to the placebo group at weeks 4 and 6 of treatment ( p < 0.05). Conclusion: Topical tacrolimus treatment was well tolerated and effective in controlling persistent PA in AD patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This randomized, double-blind, multi-centre study compared the long-term safety and tolerability of pimecrolimus cream 1% and topical corticosteroids (TCS) in 658 adults with moderate-severe atopic dermatitis (AD). METHODS: Patients applied either pimecrolimus or TCS (i.e. 0.1% triamcinolone acetonide cream and/or 1% hydrocortisone acetate cream) twice daily to all affected areas until complete clearance or for up to 1 year. The study was approved by the institutional review board or ethics committee at each centre. RESULTS: A majority of patients treated with either pimecrolimus or TCS used the drug on a continuous basis over 1 year. In patients who had >30% of the body surface involved by AD, the incidence rate of all skin infections was significantly lower in the pimecrolimus group than in the TCS group (95% CI of the treatment difference: -25.3% to -3.4%). The most frequent application site reaction was burning (25.9% of patients on pimecrolimus and 10.9% on TCS), which was transient and mild-moderate in most cases. Three TCS-treated patients reported skin striae. There were no treatment-related serious or clinically significant systemic adverse events. Efficacy was better in patients on continuous TCS therapy, although patients completing the study were similarly well-controlled in both groups. About 42% of the pimecrolimus-treated patients were maintained for 1 year without TCS. CONCLUSION: Pimecrolimus demonstrated a favourable safety profile when used to treat adult patients with moderate-severe AD for up to 1 year. A significant proportion of patients could be maintained without TCS for a year. [ABSTRACT FROM AUTHOR]