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Helpful hints for the successful veterinary treatment of canine atopy …

We’re at the height of allergy season here in the Midwest after enduring an extremely high tree pollen and grass pollen season.
Needless to say, people with atopy have been suffering along with our pets. Even if you’re not allergic, the high pollen counts
tend to act as an irritant, bothering both mucous membranes and the respiratory system.

The conventional means of controlling the clinical signs of canine atopy have been discussed in the past (see http://dvm360.com/dermatology). Here I want to offer some small pearls based on new evidence of the pathogenesis of atopy that may make your patients more
comfortable.


Topical measures

Topicals such as shampoos, leave-on anti-itch conditioners and ceramide replacement products seem to have gained new importance
based on the pathogenesis of atopy in dogs. New evidence shows that absorption of the allergen across the skin (percutaneous
absorption) may be the primary mode of getting the allergic response started.1,2 It certainly explains why in dogs with atopy, the face, feet and perineal areas are most often involved (Photos 1 and 2).

Once sensitized, dendritic cells that “patrol” the body are presented with antigen, which starts the immune system going,
switching to T-helper lymphocyte-2 production with consequent cytokines that create inflammation. Ceramide production/destruction,
filaggrin, and other structural elements of the epidermis are compromised, resulting in destruction of the normal skin barrier.1,2 This results in more absorption of the allergen across the skin. Also, the normal resident bacteria of the skin tends to
multiply and produces enzymes that further break down ceramide.1,2

After a while, chronic changes occur that are difficult to reverse and further perpetuate the condition. Frequent bathing
helps to remove the allergen, which can prevent the whole process from starting. It also reduces bacterial colonization. Since
frequent bathing can be helpful in most dogs, choose a shampoo that is mild without ingredients that may cause drying (dry
skin enhances allergy absorption). A hypoallergenic shampoo followed by a topical low-potency, water-based hydrocortisone
such as Resicort (Virbac Animal Health) as a leave-on rinse can help “put the fire out.” Shampoos with phytosphingosines can
be helpful in keeping the epidermal barrier in check.

Wiping off the feet, ventral abdomen, medial pinna and perineal areas (the nonhaired areas of the body) when dogs come in
from outside will reduce the pollen load. Using just a damp cloth or antibacterial wipes such as Preva Medicated Wipes (Bayer
Animal Health) or the bovine nisin wipes (Wipe Out Dairy Wipes—ImmuCell) is inexpensive and helpful. Clothing such as cotton
t-shirts and onesies can act as a barrier to percutaneous absorption of allergens.

Topical skin lipid complexes containing ceramides, botanicals and fatty acids such as Allerderm Spot-on (Virbac Animal Health)
and Dermoscent Essential 6 (Aventix) can help repair stratum corneum lipids.3 This can aid in restoring a normal skin barrier. The topicals are typically used once weekly but can be used more or less
often depending on the patient’s response.

Atopic dermatitis market to reach 132.71 million cases in 2022

The atopic dermatitis market is one of the largest segments of the dermatology disease industry in terms of patient population. However, sales in this market are relatively small, primarily because of generics competition.

Symptomatic treatment of atopic dermatitis relies primarily on the use of topical formulations (corticosteroids and immunosuppressants). Physicians consider current oral treatments to have limited value in the treatment of atopic dermatitis; antihistamines are the primary class of oral agents used.

Atopic dermatitis or atopic eczema is a chronic inflammatory skin disease characterized by itchy skin lesions and rashes. Though the condition affects people of all ages, it is primarily common among infants and children (Bowcock and Cookson, 2004).

Due to its chronic and relapsing nature, atopic dermatitis presents a global public health concern, with reported lifetime prevalence ranging between 10%-20% in children and 1%-3% in adults (Larsen and Hanifin, 2002).

In general, the prevalence of atopic dermatitis is increasing worldwide, with high prevalence in western and developed nations compared with other parts of the world. However, recent trends demonstrate a gradual rise in prevalence in developing countries and plateauing prevalence in developed countries (Asher et al., 2006).

Although atopic dermatitis is not life-threatening, it has a huge impact on economic burden and quality of life of individuals (Carroll et al., 2005).

According to a recent report, ‘EpiCast Report: Atopic Dermatitis – Epidemiology Forecast to 2022,’ prevalent cases within the atopic dermatitis market in the 9MM (US, France, Germany, Italy, Spain, UK, Japan, China, and India) will increase from 132.28 million in 2012 to 132.71 million cases in 2022 at an annual growth rate (AGR) of 0.10%.

Some of the factors associated with an increased risk of atopic dermatitis include small family size, higher socioeconomic and educational levels regardless of ethnicity, movement from rural to urban environment, and increased use of antibiotics.

Research has indicated that there is a predominance of type-2 helper T cells (Th2) in atopic dermatitis. Higher number of cases would involve the increased uptake of therapeutics, thereby increasing the growth of the market.

In 2012, China and India combined contributed 83.04 million cases, comprising more than 60% of the total prevalent cases in the 9MM. (9MM) (US, France, Germany, Italy, Spain, UK, Japan, China, and India).

For more information on the atopic dermatitis market, see the latest research: Atopic Dermatitis Market

Follow us on Twitter @CandMResearch

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1.2m UK study to examine antibiotic effectiveness in treating eczema …

A new £1.2 million UK-wide study to determine the effectiveness of antibiotics to treat atopic eczema — a debilitating skin condition that affects around one in three children — is due to begin in July.

The Children with Eczema Antibiotic Management (CREAM)-study, funded by the National Institute for Health Research (NIHR) and led by scientists at the universities of Bristol, Cardiff and Dundee, is recruiting around 500 children to compare the effectiveness of antibiotic syrup to antibiotic cream and placebos in treating infected eczema.

The two-year project, which will examine the short and long-term effects of these treatments, will help researchers gain an insight into the relationship between clinical features, the presence of bacteria on the skin, and medication cost-effectiveness.

Children taking part in the study will be assessed on their general health status along with the impact the condition has on their quality of life and their families. A questionnaire completed by the child’s parent or carer during the week following treatment will allow the team to find out the extent to which each child is affected by eczema.

The team will also measure the effect of antibiotics on the development of antibiotic resistance by taking swabs (samples) from the child’s skin, mouth and nose. Medication side effects will also be measured.

Dr Matthew Ridd, NIHR Clinical Lecturer at Bristol’s School of Social and Community Medicine, said: “Around 175 children are being recruited to take part in the study from GP practices in Bristol. Findings from the project will help medical practitioners find out the most effective form of treatment for children and to ensure unnecessary antibiotic treatment is avoided.”

Dr Nick Francis, the study’s lead author, at Cardiff School of Medicine, said: “Eczema affects up to a third of young children at some point in their lives, and can cause terrible suffering to children and their families.

“Eczema flares are sometimes thought to be caused by bacterial infections, but we do not know whether antibiotics reduce eczema severity in these children, and if so, whether antibiotic syrup or cream works better.

“Thousands of children receive antibiotic treatment for eczema every year. If these treatments work then we can promote use in those who are most likely to benefit, if not then we can avoid exposing children to the risks of unnecessary antibiotic treatment.”

The study will take place in over 90 general practices in England, Scotland and Wales. Findings from the project will be published around September 2015.

 

Further information:

Atopic eczema

Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can continue into adulthood. Eczema is a condition that causes the skin to become itchy, red, dry and cracked.

Funding

**This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme and will be published in full in Health Technology Assessment. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health.

AACI | Full text | CSACI position statement: safety of topical …

Atopic dermatitis (AD), a chronic and relapsing inflammatory skin condition, is often
the first manifestation of atopy in children [1,2]. Up to 71.3% of children with AD report allergic rhinitis and/or asthma [3]. Managing AD is therefore of utmost importance to the practicing clinical immunologist
and allergist.

The hallmarks of AD include pruritus and ill-defined erythema, with edema and/or vesicles
if acute, and lichenification if chronic. It has a predilection for the flexural creases,
or, in the case of children under 4 years of age, the cheeks, forehead and extensor
surfaces of the limbs [4]. AD is characterized by both structural abnormalities and immune dysregulation, with
evidence of both innate and adaptive dysfunction [5]. Effective management of AD involves measures to avoid exacerbating triggers, maintenance
of skin barrier function and therefore hydration, management of pruritus, and treatment
of inflammation with anti-inflammatory medications.

Low to intermediate-potency topical corticosteroids have long been utilized as first-line
therapy for AD not adequately managed by emollients alone. However, potent fluorinated
corticosteroids are not indicated for use on the face, eyelids, genitalia, intertriginous
areas, or in young infants. Topical calcineurin inhibitors (TCIs), such as tacrolimus
and pimecrolimus, are alternatives to corticosteroids for AD on the face, eyelids
and skin folds that is unresponsive to low potency topical steroids [6].

TCIs exert their anti-inflammatory action by inhibiting calcineurin-dependant T-cell
activation, thus inhibiting the activation of pro-inflammatory cytokines and mediators
of the allergic inflammatory reaction [7]. They have also been demonstrated to exert effects on mast cell activation [8], resulting in relief of pruritus and erythema as early as within three days of initiating
treatment [9]. Topical tacrolimus has also been shown to decrease both the number and co-stimulatory
ability of epidermal dendritic cells [10]. However, it is these anti-inflammatory mechanisms of action which have caused concern
that high or prolonged use may lead to malignancy much like those related to oral
use of these immunosuppressives.

A recent review article by Frankel et al. concluded that tacrolimus 0.1% ointment
has been demonstrated to be as effective as mid to high potency class III-V steroids
in the treatment of AD [10]. Both tacrolimus and pimecrolimus have been associated with an increased frequency
of application-site reactions (namely, localized transient burning), but also with
a decreased risk of skin atrophy as compared to topical corticosteroids [10].

Despite evidence demonstrating efficacy, resistance to using the TCIs in management
of AD is prevalent among clinicians. This anxiety arises in part from the release
of an FDA Black Box warning in 2005, citing concerns that chronic intermittent use
of TCIs could lead to an increased incidence of Hodgkin’s and non-Hodgkin’s lymphoma,
as well as melanoma and non-melanoma skin cancers [11]. Following the release of this warning, many physician groups, including the American
Academy of Allergy, Asthma and Immunology (AAAAI), American College of Allergy, Asthma
and Immunology (ACAAI), and the Canadian Dermatology Association (CDA), released position
statements, promoting the safety of the TCIs, and arguing against the FDA warning
[1214]. In an effort to promote appropriate use of the TCIs in Canadian clinical practice,
the CSACI has developed this position statement.

Importantly, the FDA warning was one of a theoretical risk of increased malignancy with the use of TCIs. This was based primarily on animal
data, case reports and the mechanism of action of the drugs (where tacrolimus, in vitro, has been demonstrated to inhibit spontaneous DNA repair [15]). Of note, however, there has been no strong evidence published that this could represent
a similar risk in humans. In fact, in 2005, the spontaneous reporting system described
fewer cases of malignancy in patients treated with TCIs than would be expected in
the population over the same period of time [13]. More recent data continue to show similar incidence rates [16]. To date, no evidence has been published that concludes a causal relationship between
malignancy in patients with AD, and the use of TCIs [13,14,17]. This includes several nested case–control studies demonstrating no increased risk
of lymphoma in AD patients being treated with TCIs, compared to those without TCI
exposure [18,19]. Preliminary data from long-term safety studies have demonstrated similar safety
profiles, though these studies are ongoing [20]. A recent retrospective cohort observational study did show a possible risk of increased
incidence of T-cell lymphoma in patients with AD treated with TCIs, however, this
was possibly attributed to a bias in its use early in this condition. There was no
increase in other malignancies demonstrated in this study [21]. Notably, the alternatives for patients with AD refractory to low-moderate potency
corticosteroids (i.e. switching to high potency topical steroids and/or leaving AD
untreated) carry an even higher risk profile and/or will lead to ongoing patient suffering.
It is important to note, however, that younger subjects with a higher body surface
area per weight, and subjects with abnormal epidermis (ie. Netherton’s syndrome),
can have significant percutaneous absorption of topically applied calcineurin inhibitors,
which may result in systemic serum concentrations known to cause immunosuppression.
This is why these drugs are not indicated for use in children under 2 years of age,
or patients with severely impaired skin barrier function (ie. patients with Netherton’s
syndrome).

In summary, topical calcineurin inhibitors are effective treatments for atopic dermatitis,
and the benefits of their use in the appropriately selected patient population outweighs
the theoretical risk of increased malignancy.

DermaSilk in long-term treatment of infantile atopic dermatitis …

A recently published paper has reported how DermaSilk may help in the long-term treatment of infantile atopic dermatitis. The double blind, placebo controlled comparative study was carried out with 20 children using either DermaSilk or identically styled cotton underclothes for up to 2 years. Patients wore the garments for an average of 17 months in each group (they were allowed to stop using them during the very hot Italian summer).

A number of interesting points emerged from the study:

  • Of the 22 patients enrolled, only 2 patients were lost to the study.
  • More patients in the DermaSilk group had eczema classified as “severe” compared with the cotton group.
  • Topical steroid therapy averaged 3 tubes in the cotton group compared with 1.2 tubes in the DermaSilk group. This is a reduction of 60% over the period of the study and is directly linked to the reduction in eczema flares suffered by these patients. This is a statistically significant figure (p=0.006) meaning that there is a 6 in 1000 chance of the result happening by chance!!!

ESC_6366_shirt_tights
It is also worth noting that one child in the DermaSilk group did not complete the study as her parents did not come back for more clothes after she grew out of them after 5 months! This demonstrates that the garments do last as long as the manufacturers indicate. What is also worth noting about this little girl is that her steroid usage over the entire 2 year period was similar to the cotton wearers which goes some way towards demonstrating the need for continuous use of DermaSilk.

The authors finish the paper with the following:

“We observed a consistently lower use of topical corticosteroid among children in group A (DermaSilk) compared to group B (cotton) (P=0.006). The subjective evaluation expressed by families (100% DermaSilk group A, group B 45% cotton; P=0.014) was also statistically significant.

Conclusions

In conclusion, this study found a possible role of DermaSilk in reducing relapses of atopic dermatitis. In particular, the use of DermaSilk lead to a reduction of subjective symptoms such as itching, the most important factor responsible for the deterioration of the quality of life of both patients and their families, giving greater benefits than cotton, and without any side effect.”

To read the full paper click here

Treating Eczema with Acupuncture – Yoga






Eczema is a skin condition that falls under the category of atopic dermatitis, indicating that eczema rashes and flare-ups are a result of contact with certain irritants and allergens. In the case of eczema however there could be both internal and external factors.

read more…



































The red patches of itchy skin that develop with eczema could be a response to allergens such as dust mites, foods, medications or cosmetics or as a result of a weak immunity, chronic respiratory condition and digestive problems. There is also a strong possibility that eczema may be hereditary. Today, a disproportionately large amount of children suffer from eczema and carry this affliction well into adulthood.

While there are medications and over-the-counter creams and lotions that are available to help reduce the severity of the rash and symptoms such as inflammation and itchiness, there is no known cure for eczema. Experts are now investigating the efficacy of alternative treatments to prevent flare-ups and control symptoms. A surprisingly effective treatment for eczema is acupuncture. Based on the principles of ancient Chinese medicine, acupuncture uses fine surgical steel needles to stimulate various acupuncture pressure points all over the body. These acupuncture points provide the path to specific nerves and energy meridians and help regulate the immune and endocrine systems. Different acupuncture points have different functions depending on where they are located.

Chinese medicine refers to eczema as ‘skin asthma’. This is an accurate term as a large number of cases of childhood eczema are linked with asthma or some type of respiratory ailment or allergic reaction. Chinese medicine uses acupuncture to treat the body in its entirety. It approaches all skin conditions as a reflection of disharmony in some part of the body. Therefore, according to the principles of acupuncture and Chinese medicine, no amount of external creams or lotions will help cure a skin rash. Only when the internal cause of the problem is addressed will true healing take place. In Chinese medicine, any problems with the skin are the result of an imbalance in the lungs, kidneys or digestive system. A person who suffers from eczema or any skin condition may be unable to convert the nutrition derived from food into the proper energy required to protect the body from inflammations and infections. Weak energy translates into low immunity and a tendency to fall sick more often and suffer from excessive toxins within the system.

Some studies show that acupuncture can treat eczema and prevent flare-ups, especially in children. Treatment usually lasts between a few weeks to three months but can vary from person to person depending on the severity of the symptoms. For skin disorders, acupuncture points are located along the legs, arms and middle region of the body. The needles may be placed for ten minute to an hour at a time and in some severe cases may also use heat or a mild electrical charge to induce healing and recovery.

Although no long-term studies have been conducted to determine the effects on acupuncture in treating eczema and other skin conditions, initial research indicates acupuncture may be able to help treat a variety of skin conditions such as pruritis, herpes zoster, and atopic dermatitis when combined with traditional herbal medication and lifestyle changes.










Food Allergy may be a Factor in Your Child's Dermatitis – NewsFix.ca








Atopic dermatitis is the most common type of eczema. Characterized by itchy, inflamed skin, this chronic skin disorder usually occurs in infants and children, but it may persist into adulthood. About 10 percent of infants and young children are affected by this disorder.

Scientists have speculated that the cause of atopic dermatitis involves a complex interaction between environmental and genetic factors. Research suggests that more than one-third of children with moderate to severe atopic dermatitis may have an unidentified food allergy that is precipitating or worsening this condition. Food allergies affect about three percent of children. The most common culprits are eggs, peanuts, milk, fish, soy products, and wheat. Doctors have long believed that certain foods act as allergens, triggering atopic dermatitis or aggravating its symptoms. This research confirms that there is indeed a link, but whether the dermatitis is caused or worsened by a food allergy remains a mystery.

Experts recommend that children with chronic, difficult to treat atopic dermatitis be screened for potential food allergies. Eliminating offending items has been shown to significantly improve skin symptoms. It is important to remember that identifying food allergens is often difficult and requires medical supervision. Restricted diets may be emotionally or financially difficult to follow. And unless properly monitored, diets with many restrictions could also lead to nutritional deficiencies. With that in mind, consult with your child’s doctor, allergist, or registered dietician to find if your child’s atopic dermatitis could be helped by changes in diet.




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