Update on the Management of Atopic Dermatitis/Eczema

  • Sherrif F Ibrahim
  • Anna De Benedetto
  • Lisa A. Beck
Part of the Allergy Frontiers book series (ALLERGY, volume 5)

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that affects patients of all ages. The etiology is multifactorial, resulting from complex interactions of the immune system, environmental stimuli, and susceptibility genes. The prevalence of AD is increasing in industrialized nations, with as estimates as high as 20% of children and 3% of adults [1]. The financial and psychosocial cost of the disease is substantial [2]. Several studies have shown that AD in children is associated with a reduction in quality of life for patients as well as their families which is beyond that of other chronic diseases of childhood such as asthma, diabetes, and cystic fibrosis [3–5].

The treatment of moderate to severe atopic dermatitis continues to be frustrating because of the lack of efficacy of most therapies and the chronicity of the disease. There are also potential side effects with most therapies — whether topical or systemic – and these risks must be weighed against the therapeutic benefit to the patient. Because the natural history of AD involves periods of waxing and waning severity, treatment plans are often dynamic and must change accordingly to reflect disease activity. Combination therapy is the rule, as the disease itself is the final manifestation of many contributing environmental and host factors. Commonly, trials of several different treatment modalities coupled with environmental measures are necessary before an effective, individualized regiman is achieved.


Atopic Dermatitis Food Allergy Allergy Clin Immunol Topical Steroid Atopic Dermatitis Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Boguniewicz M, Leung DY. Pathophysiologic mechanisms in atopic dermatitis. Semin Cutan Med Surg 2001;20(4):217–25.PubMedCrossRefGoogle Scholar
  2. 2.
    Verboom P, Hakkaart-Van L, Sturkenboom M, De Zeeuw R, Menke H, Rutten F (2002) The cost of atopic dermatitis in the Netherlands: an international comparison. Br J Dermatol 147:716–24PubMedCrossRefGoogle Scholar
  3. 3.
    Emerson RM, Williams HC, Allen BR, Mehta R, Finlay AY (1997) How much. disability does atopic eczema cause compared with other health. problems? Br J Dermatol 137 (S50):19.Google Scholar
  4. 4.
    Beattie PE, Lewis-Jones MS (2006) An audit of the impact of a consultation with a paediatric dermatology team on quality of life in infants with atopic eczema and their families: further validation of the Infants' Dermatitis Quality of Life Index and Dermatitis Family Impact score. Br J Dermatol 155(6):1249–55PubMedCrossRefGoogle Scholar
  5. 5.
    Holm EA, Wulf HC, Stegmann H, Jemec GBE. Life quality assessment among patients with atopic eczema. (2006) Br J Dermatol 154:719–725.PubMedCrossRefGoogle Scholar
  6. 6.
    Paller AS, McAlister RO, Doyle JJ, Jackson A (2002) Perceptions of physicians and pediatric patients about atopic dermatitis, its impact, and its treatment. Clin Pediatr 41(5);323–32CrossRefGoogle Scholar
  7. 7.
    Leung D Y, Hanifin JM, Charlesworth EN, Li JT, et al. Disease management of atopic dermatitis: a practice parameter. Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology. Work Group on Atopic Dermatitis. Ann Allergy Asthma Immunol. 1997;79(3):197–211.PubMedCrossRefGoogle Scholar
  8. 8.
    Williams HC, Burney PG, Pembroke AC, Hay RJ. The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation. Br J Dermatol 1994;131(3):406–16.PubMedCrossRefGoogle Scholar
  9. 9.
    Breuer K, Haussler S, Kapp A, Werfel T (2002) Staphylococcus aureus: colonizing features and influence of an antibacterial treatment in adults with atopic dermatitis. Br J Dermatol 147(1):55–61PubMedCrossRefGoogle Scholar
  10. 10.
    Leung DY, Boguniewicz M, Howell MD, Nomura I, Hamid QA. New insights into atopic dermatitis. J Clin Invest 2004;113(5):651–7.PubMedGoogle Scholar
  11. 11.
    Sampson HA. The evaluation and management of food allergy in atopic dermatitis. Clin Dermatol 2003;21:183–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics 1987;79(5):683–8.PubMedGoogle Scholar
  13. 13.
    Ramesh S. Food Allergy Overview in Children. Clin Rev Allergy Immunol 2007 Nov 8 (Epup ahead of print)Google Scholar
  14. 14.
    Osterballe M, Hansen TK, Mortz CG, Høst A, Bindslev-Jensen C. The prevalence of food hypersensitivity in an unselected population of children and adults. Pediatr Allergy Immunol 2005;16(7):567–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Sicherer SH and Sampson HA (2006) 9. Food allergy. J Allergy Clin Immunol 117(2): S470–S47.PubMedCrossRefGoogle Scholar
  16. 16.
    Sampson HA, Scalon Sm. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr 1989;115:23–27.PubMedCrossRefGoogle Scholar
  17. 17.
    Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in yourng children with atopic eczema and sensitivity to eggs. Pediatr Allergy immunol 1998;9:13–19PubMedCrossRefGoogle Scholar
  18. 18.
    von Berg A, Koletzko S, Grubl A, Filipiak-Pittroff B, Wichmann HE, et al., German Infant Nutritional Intervention Study Group. The effect of hydrolyzed cow's milk formula for allergy prevention in the first year of life: the German Infant Nutritional Intervention Study, a randomized double-blind trial. J Allergy Clin Immunol 2003;111(3):533–40.CrossRefGoogle Scholar
  19. 19.
    Muraro A, Dreborg S, Halken S, Host A, Niggemann B, et al. Dietary prevention of allergic diseases in infants and small children. Part III: Critical review of published peer-reviewed observational and interventional studies and final recommendations. Pediatr Allergy Immunol 2004;15(4):291–307.PubMedCrossRefGoogle Scholar
  20. 20.
    Kagan R, Hayami D, Joseph L, St Pierre Y, Clarke AE. The predictive value of a positive prick skin test to peanut in atopic, peanut-naïve children. Ann Allergy Asthma Immunol 2003;90(6):640–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Fiocchi A, Assa'ad A, Bahna S; Adverse Reactions to Foods Committee; American College of Allergy, Asthma and Immunology. Food allergy and the introduction of solid foods to infants: a consensus document. Ann Allergy Asthma Immunol 2006;97(1):10–20.PubMedGoogle Scholar
  22. 22.
    Werfel T, Ballmer-Weber B, Eigenmann PA, Niggemann B, Rance F, Turjanmaa K, Worm M. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy 2007;62(7):723–8.PubMedGoogle Scholar
  23. 23.
    Larché M, Akdis CA, Valenta R. Immunological mechanisms of allergen-specific immuno-therapy. Nat Rev Immunol 2006;6(10):761–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Bussmann C, Böckenhoff A, Henke H, Werfel T, Novak N. Does allergen-specific immuno-therapy represent a therapeutic option for patients with atopic dermatitis? J Allergy Clin Immunol 2006;118(6):1292–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Novak N. Allergen specific immunotherapy for atopic dermatitis. Curr Opin Allergy Clin Immunol 2007;7(6):542–56.PubMedCrossRefGoogle Scholar
  26. 26.
    Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE. Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis. Br J Dermatol 2001;144(3):523–32.PubMedCrossRefGoogle Scholar
  27. 27.
    el Samahy MH, el-Kerdani T. Value of patch testing in atopic dermatitis. Am J Contact Dermat 1997;8(3):154–7.PubMedCrossRefGoogle Scholar
  28. 28.
    de Groot AC. The frequency of contact allergy in atopic patients with dermatitis. Contact Dermatitis 1990;22(5):273–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Schöpf E, Baumgårtner A. Patch testing in atopic dermatitis. J Am Acad Dermatol 1989;21(4 Pt 2):860–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Imokawa G. Lipid abnormalities in atopic dermatitis. J Am Acad Dermatol 2001;45:S29–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Strid J, Strobel S. Skin barrier dysfunction and systemic sensitization to allergens through the skin. Curr Drug Targets Inflamm Allergy 2005;4(5):531–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Cork MJ, Robinson DA, Vasilopoulos Y, Ferguson A, et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006;118(1):3–21PubMedCrossRefGoogle Scholar
  33. 33.
    Leung DY, Bieber T. Atopic Dermatitis. Lancet 2003;361:151–60.PubMedCrossRefGoogle Scholar
  34. 34.
    Baranda L, González-Amaro R, Torres-Alvarez B, Alvarez C, Ramírez V. Correlation between pH and irritant effect of cleansers marketed for dry skin. Int J Dermatol 2002;41(8):494–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Lucky AW, Leach AD, Laskarzewski P, Wenck H. Use of on an emollient as a steroid sparing agent in the treatment of mild to moderate atopic dermatitis in children. Pediatr Dermatol 1997;14:321–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Chamlin SL, Kao J, Frieden IJ, Sheu MY, Fowler AJ, Fluhr JW, Williams ML, Elias PM. Ceramide-dominant barrier lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol 2002;47(2):198–208PubMedCrossRefGoogle Scholar
  37. 37.
    Abramovits W, Boguniewicz M; Adult Atopiclair Study Group. A multicenter, randomized, vehicle-controlled clinical study to examine the efficacy and safety of MAS063DP (Atopiclair) in the management of mild to moderate atopic dermatitis in adults. J Drugs Dermatol 2006;5(3):236–44.PubMedGoogle Scholar
  38. 38.
    Belloni G, Pinelli S, Veraldi S. A randomised, double-blind, vehicle-controlled study to evaluate the efficacy and safety of MAS063D (Atopiclair) in the treatment of mild to moderate atopic dermatitis. Eur J Dermatol 2005;15(1):31–6.PubMedGoogle Scholar
  39. 39.
    Garcia BD, Goldman MP, Gold MH. Comparison of pre- and/or postphotodynamic therapy and intense pulsed light treatment protocols for the reduction of postprocedure-associated symptoms and enhancement of therapeutic efficacy. J Drugs Dermatol 2007;6(9):924–8.PubMedGoogle Scholar
  40. 40.
    Abramovits W, Perlmutter A. MimyX cream. Skinmed 2006;5(1):29–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Stander S, Reinhardt HW, Luger TA. Topical cannabinoid agonists. An effective new possibility for treating chronic Pruritus. Hautarzt 2006;57(9):801–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Pulvirenti N, Nasca MR, Micali G. Topical adelmidrol 2% emulsion, a novel aliamide, in the treatment of mild atopic dermatitis in pediatric subjects: a pilot study. Acta Dermatovenerol Croat 2007;15(2):80–3.PubMedGoogle Scholar
  43. 43.
    Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet 2006;38(4):441–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Howell MD, Kim BE, Gao P, Grant AV, Boguniewicz M, et al. Cytokine modulation of atopic dermatitis filaggrin skin expression. J Allergy Clin Immunol 2007;120(1):150–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Chamlin SL, Kao J, Frieden IJ, Sheu M Y, Fowler et al. Ceramide-dominant barrier lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol 2002;47(2):198–208.PubMedCrossRefGoogle Scholar
  46. 46.
    Williams HC. Clinical Practice. Atopic Dermatitis. New Engl J Med 2005;352(22):2314–24.PubMedCrossRefGoogle Scholar
  47. 47.
    Boguniewicz M, Leung D Y. Atopic dermatitis. J Allergy Clin Immunol 2006;117(2 Suppl Mini-Primer):S475–80.PubMedCrossRefGoogle Scholar
  48. 48.
    Kiken DA, Silverberg NB. Atopic dermatitis in children, part 2: treatment options. Cutis 2006;78(6):401–6.PubMedGoogle Scholar
  49. 49.
    Callen J, Chamlin S, Eichenfield LF, Ellis C, Girardi M, et al. A systematic review of the safety of topical therapies for atopic dermatitis. Br J Dermatol 2007;156(2):203–21.PubMedCrossRefGoogle Scholar
  50. 50.
    Atherton DJ. Topical corticosteroids in atopic dermatitis. BMJ 2003;327(7421):942–3.PubMedCrossRefGoogle Scholar
  51. 51.
    Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4:1–191PubMedGoogle Scholar
  52. 52.
    Gottlieb AB. Therapeutic options in the treatment of psoriasis and atopic dermatitis. J Am Acad Dermatol 2005;53:S3–16.PubMedCrossRefGoogle Scholar
  53. 53.
    Ellison JA, Patel L, Ray DW, Clayton PE. Hypothalamic-Pituitary-Adrenal Function and Glucocorticoid Sensitivity in Atopic Dermatitis. Pediatrics 2000;105:794–799.PubMedCrossRefGoogle Scholar
  54. 54.
    Wamboldt MZ, Laudenslager M, Wambolt FS, Kelsay K, Hewitt J. Adolescents with atopic disorders have an attenuated cortisol response to laboratory stress. J Allergy Clin Immunol 2003;111:509–14.PubMedCrossRefGoogle Scholar
  55. 55.
    Buske-Kirschbaum A, Geiben A, Höllig H, Morschhäuser E, Hellhammer D. Altered Responsiveness of the Hypothalamus-Pituitary-Adrenal Axis and the Sympathetic Adrenomedullary System to Stress in Patients with Atopic Dermatitis. J Clin Endocrinol Metab 2002;87:4245–4251.PubMedCrossRefGoogle Scholar
  56. 56.
    Friedlander SF, Hebert AA, Allen DB for the Fluticasone Pediatrics Safety Study Group. Safety of fluticasone propionate cream 0.05% for the treatment of severe and extensive atopic dermatitis in children as young as 3 months. J Am Acad Dermatol 2002;46:387–393.PubMedCrossRefGoogle Scholar
  57. 57.
    Bleehen SS, Chu AC, Hamann I, Holden C, Hunter JA, Marks R. Fluticasone propionate 0.05% cream in the treatment of atopic eczema: a multicentre study comparing once-daily treatment and once-daily vehicle cream application versus twice-daily treatment. Br J Dermatol 1995;133(4):592–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Tharp MD. A comparison of twice-daily and once-daily administration of fluticasone propi-onate cream, 0.05%, in the treatment of eczema. Cutis 1996;57(2 Suppl):19–26.PubMedGoogle Scholar
  59. 59.
    Thomas KS, Armstrong S, Avery A, Po AL, et al. Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema. BMJ 2002;324(7340):768.PubMedCrossRefGoogle Scholar
  60. 60.
    Stalder JF, Fleury M, Sourisse M, Rostin M, et al. Local steroid therapy and bacterial skin flora in atopic dermatitis. Br J Dermatol 1994;131(4):536–40.PubMedCrossRefGoogle Scholar
  61. 61.
    Bornhovd E, Burgdorf WH, Wollenberg A. Macrolactam immunomodulators for topical treatment of inflammatory skin diseases. J Am Acad Dermatol 2001;45:736–43PubMedCrossRefGoogle Scholar
  62. 62.
    Eichenfeld LF, Lucky AW, Boguniewicz M, et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol 2002;46:495–504CrossRefGoogle Scholar
  63. 63.
    Paller A, Eichenfield LF, Leung D Y, et al. 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 2001; 44:S47–57PubMedCrossRefGoogle Scholar
  64. 64.
    Novartis and Fujisawa FDA Briefing Statements. Pediatric AdvisoryCommittee Meeting of the US Food Drug Adminstration. Washington, DC, 2005. ac/05/briefing/2005-4089b2.htm
  65. 65.
    Stern RS. Topical calcineurin inhibitors labeling: putting the “box” in perspective. Arch Dermatol 2006;142(9):1233–5.PubMedCrossRefGoogle Scholar
  66. 66.
    Fleischer AB Jr. Black box warning for topical calcineurin inhibitors and the death of common sense. Dermatol Online J 2006;12(6):2.PubMedGoogle Scholar
  67. 67.
    Fonacier L, Charlesworth EN, Spergel JM, Leung D Y. The black box warning for topical calcineu-rin inhibitors: looking outside the box. Ann Allergy Asthma Immunol 2006;97(1):117–20.PubMedCrossRefGoogle Scholar
  68. 68.
    Spergel JM, Leung DY. Safety of topical calcineurin inhibitors in atopic dermatitis: evaluation of the evidence. Curr Allergy Asthma Rep 2006;6(4):270–4.PubMedCrossRefGoogle Scholar
  69. 69.
    Qureshi AA, Fischer MA. Topical calcineurin inhibitors for atopic dermatitis: balancing clinical benefit and possible risks. Arch Dermatol 2006;142(5):633–7PubMedCrossRefGoogle Scholar
  70. 70.
    Arellano FM, Wentworth CE, Arana A, Fernández C, Paul CF. Risk of lymphoma following exposure to calcineurin inhibitors and topical steroids in patients with atopic dermatitis. J Invest Dermatol 2007;127(4):808–16.PubMedCrossRefGoogle Scholar
  71. 71.
    Ashcroft DM, Dimmock P, Garside R, Stein K, Williams HC. Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: meta-analysis of randomised controlled trials. BMJ 2005;330(7490):516.PubMedCrossRefGoogle Scholar
  72. 72.
    Leung DYM. Infection in atopic dermatitis. Curr opin Ped 2003;15:399–404.Google Scholar
  73. 73.
    Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol 2003;112(4):667–74.PubMedCrossRefGoogle Scholar
  74. 74.
    Leung DYM, Harbeck H, Bina P, Reiser RF, Yang E, Norris AD, et al. Presence of IgE antibodies tp Staphylocccal enterotoxins on the skin of patients with Atopic Dermatites: evidence for a new group of allergens. J Clin Invest 1993;92;1374–80.PubMedCrossRefGoogle Scholar
  75. 75.
    Sporik R, Kemp AS. Topical triclosan treatment of atopic dermatitis. J Allergy Clin Immunol 1997;99:8.CrossRefGoogle Scholar
  76. 76.
    Shah M, Mohanraj M. High levels of fusidic acid-resistant Staphylococcus aureus in dermatology patients. Br J Dermatol 2003;148(5):1018–20.PubMedCrossRefGoogle Scholar
  77. 77.
    Lever R, Hadley K, Downey D, Mackie R. Staphylococcal colonization in atopic dermatitis and the effect of topical mupirocin therapy. Br J Dermatol 1988;119(2):189–98.PubMedCrossRefGoogle Scholar
  78. 78.
    Laupland KB, Conly JM. Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: an evidence-based review. Clin Infect Dis 2003;37(7):933–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Hung SH, Lin YT, Chu CY, Lee CC, et al. Staphylococcus colonization in atopic dermatitis treated with fluticasone or tacrolimus with or without antibiotics. Ann Allergy Asthma Immunol 2007;98(1):51–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Spagnola C. Atopic Dermatitis. emedicine.
  81. 81.
    Breneman DL, Hanifin JM, Berge CA, Keswick BH, Neumann PB. The effect of antibacterial soap with 1.5% triclocarban on Staphylococcus aureus in patients with atopic dermatitis. Cutis 2000;66(4):296–300.PubMedGoogle Scholar
  82. 82.
    Gauger A, Mempel M, Schekatz A, Schafer T, Ring J, Abeck D. Silver coated textiles reduce Staphylococcus aureus colonization in patients with atopic eczema. Dermatology 2003;207:15–21.PubMedCrossRefGoogle Scholar
  83. 83.
    Ricci G, Patrizi A, Bendandi B, Menna G, Varotti E, Masi M. Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis. Br Dermatol 2004;150:127–31.CrossRefGoogle Scholar
  84. 84.
    Lubbe J. Secondary infections in patients with atopic dermatitis. Am J Clin Dermatol 2003;4:641–54.PubMedCrossRefGoogle Scholar
  85. 85.
    Diekema DJ, Pfaller MA, Schmitz FJ, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 2001;32(Suppl 2): S114–32.PubMedCrossRefGoogle Scholar
  86. 86.
    Shorr AF. Epidemiology of staphylococcal resistance. Clin Infect Dis 2007;45(Suppl 3): S171–6.PubMedCrossRefGoogle Scholar
  87. 87.
    Blanchard TJ, Alcami A, Andrea P, Smith GL. Modified vaccinia virus Ankara undergoes limited replication in human cells and lacks several immunomodulatory proteins: implications for use as a human vaccine. J Gen Virol 1998;79 (Pt 5):1159–67.PubMedGoogle Scholar
  88. 88.
    Frey SE, Newman FK, Kennedy JS, Sobek V et al. Clinical and immunologic responses to multiple doses of IMVAMUNE((R)) (Modified Vaccinia Ankara) followed by Dryvax((R)) challenge. Vaccine 2007;[Epub ahead of print].Google Scholar
  89. 89.
    Parrino J, McCurdy LH, Larkin BD, Gordon IJ et al. Safety, immunogenicity and efficacy of modified vaccinia Ankara (MVA) against Dryvax challenge in vaccinia-naïve and vaccinia-immune individuals. Vaccine 2007;25(8):1513–25.PubMedCrossRefGoogle Scholar
  90. 90.
    Wollenberg A, Zoch C, Wetzel S, Plewig G, Przybilla B. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases. J Am Acad Dermatol 2003;49(2):198–205.PubMedCrossRefGoogle Scholar
  91. 91.
    Zuckerman RA, Lucchetti A, Whittington WL, Sanchez J, Coombs RW, et al. Herpes Simplex Virus (HSV) Suppression with Valacyclovir Reduces Rectal and Blood Plasma HIV-1 Levels in HIV-1/HSV-2-Seropositive Men: A Randomized, Double-Blind, Placebo-Controlled Crossover Trial. J Infect Dis 2007;196(10):1500–1508PubMedCrossRefGoogle Scholar
  92. 92.
    Patrizi A, Neri I, Bianchi F, Passarini B, Ricci G. Facial eruption of viral warts in a child treated with 0.03% tacrolimus ointment for atopic dermatitis. Pediatr Dermatol 2007;24(4):445–7.PubMedCrossRefGoogle Scholar
  93. 93.
    Lipke MM. An armamentarium of wart treatments. Clin Med Res 2006;4(4):273–93.PubMedCrossRefGoogle Scholar
  94. 94.
    Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database Syst Rev 2006;3:CD001781.PubMedGoogle Scholar
  95. 95.
    Faergemann J. Atopic dermatitis and fungi. Clin Microbiol Rev 2002;15(4):545–63.PubMedCrossRefGoogle Scholar
  96. 96.
    Sugita T, Tajima M, Ito T, Saito M, Tsuboi R, Nishikawa A. Antifungal activities of tacroli-mus and azole agents against the eleven currently accepted Malassezia species. J Clin Microbiol 2005;43(6):2824–9.PubMedCrossRefGoogle Scholar
  97. 97.
    Gallo RL, Hutterner KM. Antimicrobial peptides: an emerging concept in cutaneous biology. J invest Dermatol 1998;111;739–43.PubMedCrossRefGoogle Scholar
  98. 98.
    Howell MD, Boguniewicz M, Pastore S, Novak N, Bieber T, et al. Mechanism of HBD-3 deficiency in atopic dermatitis. Clin Immunol 2006;121(3):332–8.PubMedCrossRefGoogle Scholar
  99. 99.
    Howell MD. The role of human beta defensins and cathelicidins in atopic dermatitis. Curr Opin Allergy Clin Immunol 2007;7(5):413–7.PubMedCrossRefGoogle Scholar
  100. 100.
    Howell MD, Wollenberg A, Gallo RL, Flaig M, et al. Cathelicidin deficiency predisposes to eczema herpeticum. J Allergy Clin Immunol 2006;117(4):836–41.PubMedCrossRefGoogle Scholar
  101. 101.
    Ong PY, Ohtake T, Brandt C, Strickland I, et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med 2002;347(15):1151–60.PubMedCrossRefGoogle Scholar
  102. 102.
    Salmi C, Brunel JM. Therapeutic potential of cationic steroid antibacterials. Expert Opin Investig Drugs 2007;16(8):1143–57.PubMedCrossRefGoogle Scholar
  103. 103.
    Leung DYM, Streib JE, Savage PB, Howell MD, Cationic steroid antibiotics (CSA) exhibit cytotoxic activity against vaccinia virus (VV). J Allergy Clin Immunol 2005;115(2):1083, S272.CrossRefGoogle Scholar
  104. 104.
    Wang TT, Nestel FP, Bourdeau V, Nagai Y, et al. Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol 2004;173(5):2909–12.PubMedGoogle Scholar
  105. 105.
    Heymann WR. Itch. J Am Acad Dermatol 2006;54(4):705–6.PubMedCrossRefGoogle Scholar
  106. 106.
    Ständer S, Luger TA. Antipruritic effects of pimecrolimus and tacrolimus. Hautarzt 2003;54(5):413–7.PubMedGoogle Scholar
  107. 107.
    Drake LA, Millikan LE. The antipruritic effect of 5% doxepin cream in patients with eczematous dermatitis. Doxepin Study Group. Arch Dermatol 1995;131(12):1403–8.Google Scholar
  108. 108.
    Drake LA, Fallon JD, Sober A. Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream The Doxepin Study Group. J Am Acad Dermatol 1994;31(4):613–6.PubMedCrossRefGoogle Scholar
  109. 109.
    Berberian BJ, Breneman DL, Drake LA, Gratton D et al. The addition of topical doxepin to corticosteroid therapy: an improved treatment regimen for atopic dermatitis. Int J Dermatol 1999;38(2):145–8.PubMedCrossRefGoogle Scholar
  110. 110.
    Dimson S, Nanayakkara C. Do oral antihistamines stop the itch of atopic dermatitis? Arch Dis Child 2003;88(9):832–3.PubMedCrossRefGoogle Scholar
  111. 111.
    Imaizumi A, Kawakami T, Murakami F, Soma Y, Mizoguchi M. Effective treatment of pruritus in atopic dermatitis using H1 antihistamines (second-generation antihistamines): changes in blood histamine and tryptase levels. J Dermatol Sci 2003;33(1):23–9.PubMedCrossRefGoogle Scholar
  112. 112.
    Klein PA, Clark RA. An evidence-based review of the efficacy of antihistamines in relieving pruritis in atopic dermatitis. Arch Dermatol 1999; 135:1522–1525PubMedCrossRefGoogle Scholar
  113. 113.
    Fireman P. Therapeutic approaches to allergic rhinitis: treating the child. J Allergy Clin Immunol 2000;105(6 Pt 2):S616–21.PubMedCrossRefGoogle Scholar
  114. 114.
    Chang AB, Peake J, McElrea MS. Anti-histamines for prolonged non-specific cough in children. Cochrane Database Syst Rev 2006;3:CD005604.PubMedGoogle Scholar
  115. 115.
    Meduri NB, Vandergriff T, Rasmussen H, Jacobe H. Phototherapy in the management of atopic dermatitis: a systematic review. Photodermatol Photoimmunol Photomed 2007;23(4):106–12.PubMedCrossRefGoogle Scholar
  116. 116.
    Jekler J. Phototherapy of atopic dermatitis with ultraviolet radiation. Acta Derm Venereol Suppl (Stockh) 1992;171:1–37.Google Scholar
  117. 117.
    Valkova S, Velkova A. UVA/UVB phototherapy for atopic dermatitis revisited. J Dermatolog Treat 2004;15(4):239–44.PubMedCrossRefGoogle Scholar
  118. 118.
    Grundmann-Kollmann M. Phototherapy for atopic eczema with narrow-band UVB. J Am Acad Dermatol 1999;40(6 Pt 1):995–7.PubMedCrossRefGoogle Scholar
  119. 119.
    George SA, Bilsland DJ, Johnson BE, Ferguson J. Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis. Br J Dermatol 1993; 128:48–56.Google Scholar
  120. 120.
    Reynolds NJ, Franklin V, Gray JC, Diffey BL, Farr PM. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet 2001;357:201.CrossRefGoogle Scholar
  121. 121.
    Schade N, Esser C, Krutmann J. Ultraviolet B radiation-induced immunosuppression: molecular mechanisms and cellular alterations. Photochem Photobiol Sci 2005;4(9):699–708.PubMedCrossRefGoogle Scholar
  122. 122.
    Zasloff M. Sunlight, vitamin D, and the innate immune defenses of the human skin. J Invest Dermatol 2005;125(5):xvi–xvii.PubMedCrossRefGoogle Scholar
  123. 123.
    Krueger JG, Wolfe JT, Nabeya RT, Vallat VP, et al. Successful ultraviolet B treatment of psoriasis is accompanied by a reversal of keratinocyte pathology and by selective depletion of intraepidermal T cells. Exp Med 1999;182:2057.Google Scholar
  124. 124.
    Tominaga M, Ogawa H, Takamori K. Possible roles of epidermal opioid systems in pruritus of atopic dermatitis. J Invest Dermatol 2007;127(9):2228–35.PubMedCrossRefGoogle Scholar
  125. 125.
    Bigliardi PL, Stammer H, Jost G, Rufli T, et al. Treatment of pruritus with topically applied opiate receptor antagonist. J Am Acad Dermatol 2007;56(6):979–88.PubMedCrossRefGoogle Scholar
  126. 126.
    Heyer G, Groene D, Martus P. Efficacy of naltrexone on acetylcholine-induced alloknesis in atopic eczema. Exp Dermatol 2002;11(5):448–55.PubMedCrossRefGoogle Scholar
  127. 127.
    Metze D, Reimann S, Beissert S, Luger T. Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases. J Am Acad Dermatol 1999;41(4):533–9.PubMedCrossRefGoogle Scholar
  128. 128.
    Sonkoly E, Muller A, Lauerma AI, Pivarcsi A, et al. IL-31: a new link between T cells and pruritus in atopic skin inflammation. J Allergy Clin Immunol 2006;117(2):411–7.PubMedCrossRefGoogle Scholar
  129. 129.
    Sun YG, Chen ZF. A gastrin-releasing peptide receptor mediates the itch sensation in the spinal cord. Nature 2007;448(7154):700–3.PubMedCrossRefGoogle Scholar
  130. 130.
    Abramovits W. A clinician's paradigm in the treatment of atopic dermatitis. J Am Acad Dermatol 2005;53(1 Suppl 1):S70–7.PubMedCrossRefGoogle Scholar
  131. 131.
    McHenry PM, Williams HC, Bingham EA. Management of atopic eczema. Joint Workshop of the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London. BMJ 1995;310(6983):843–7.PubMedGoogle Scholar
  132. 132.
    Spuls PI, Witkamp L, Bossuyt PM, et al. A systematic review of five systemic treatments for severe psoriasis. Br J Dermatol 1997;137:943–949PubMedCrossRefGoogle Scholar
  133. 133.
    Shaffrali FC, Colver GB, Messenger AG, et al. Experience with low-dose methotrexate for the treatment of eczema in the elderly. J Am Acad Dermatol 2003;48:417–9.PubMedCrossRefGoogle Scholar
  134. 134.
    Weatherhead SC, Wahie S, Reynolds NJ, Meggitt SJ. An open-label, dose-ranging study of methotrexate for moderate-to-severe adult atopic eczema. Br J Dermatol 2007;156(2):346–51.PubMedCrossRefGoogle Scholar
  135. 135.
    Balasubramaniam P, Ilchyshyn A. Successful treatment of severe atopic dermatitis with methotrexate. Clin Exp Dermatol 2005;30(4):436–7.PubMedCrossRefGoogle Scholar
  136. 136.
    Goujon C, Bérard F, Dahel K, Guillot I, Hennino A et al. Methotrexate for the treatment of adult atopic dermatitis. Eur J Dermatol 2006;16(2):155–8.PubMedGoogle Scholar
  137. 137.
    Bateman EA, Ardern-Jones M, Ogg GS. Dose-related reduction in allergen-specific T cells associates with clinical response of atopic dermatitis to methotrexate. Br J Dermatol 2007;156(6):1376–7.PubMedCrossRefGoogle Scholar
  138. 138.
    Morgan SL, Baggott JE, Alarcón GS. Methotrexate in rheumatoid arthritis: folate supplementation should always be given. Bio Drugs 1997;8(3):164–75.Google Scholar
  139. 139.
    Roenigk HH Jr, Auerbach R, Maibach H et al. Methotrexate in psoriasis: Consensus Conference. J Am Acad Dermatol 1998;38:478–85.PubMedCrossRefGoogle Scholar
  140. 140.
    Henning JS, Gruson LM, Strober BE. Reconsidering liver biopsies during methotrexate therapy. J Am Acad Dermatol 2007;56(5):893–4.PubMedCrossRefGoogle Scholar
  141. 141.
    Chédeville G, Scuccimarri R, Duffy CM. Survey on the use of methotrexate by pediatric rheumatologists in Canada. J Rheumatol 2007;34(4):818–22.PubMedGoogle Scholar
  142. 142.
    Sowden JM, Berth-Jones J, Ross JS et al. Double-blind, controlled, crossover study of cyclosporine in adults with severe refractory atopic dermatitis. Lancet 1991;338:137–40.PubMedCrossRefGoogle Scholar
  143. 143.
    Harper JI, Berth-Jones J, Camp RD, Dillon MJ, Finlay AY, Holden CA, O'Sullivan D, Veys PA. Cyclosporin for atopic dermatitis in children. Dermatology 2001;203(1):3–6.PubMedCrossRefGoogle Scholar
  144. 144.
    Harper JI, Ahmed I, Barclay G, Lacour M, et al. Cyclosporin for severe childhood atopic dermatitis: short course versus continuous therapy. Br J Dermatol 2000;142(1):52–8.PubMedCrossRefGoogle Scholar
  145. 145.
    Berth-Jones J, Graham-Brown RA, Marks R, Camp RD, et al. Long-term efficacy and safety of cyclosporin in severe adult atopic dermatitis. Br J Dermatol 1997;136(1):76.PubMedCrossRefGoogle Scholar
  146. 146.
    Berth-Jones J, Finlay AY, Zaki I, Tan B, et al. Cyclosporine in severe childhood atopic dermatitis: a multicenter study. J Am Acad Dermatol 1996;34(6):1016–21.PubMedCrossRefGoogle Scholar
  147. 147.
    Zaki I, Emerson R, Allen BR. Treatment of severe atopic dermatitis in childhood with cyclosporin. Br J Dermatol 1996;135(Suppl 48):21–4.PubMedCrossRefGoogle Scholar
  148. 148.
    Salek MS, Finlay AY, Luscombe DK, Allen BR, et al. Cyclosporin greatly improves the quality of life of adults with severe atopic dermatitis A randomized, double-blind, placebo-controlled trial. Br J Dermatol 1993;129(4):422–30.PubMedCrossRefGoogle Scholar
  149. 149.
    Hijnen DJ, ten Berge O, Timmer-de Mik L, Bruijnzeel-Koomen CA, de Bruin-Weller MS. Efficacy and safety of long-term treatment with cyclosporin A for atopic dermatitis. J Eur Acad Dermatol Venereol 2007;21(1):85–9.PubMedCrossRefGoogle Scholar
  150. 150.
    Schmitt J, Schmitt N, Meurer M. Cyclosporin in the treatment of patients with atopic eczema - a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2007;21(5):606–19.PubMedGoogle Scholar
  151. 151.
    Pedreira CC, King E, Jones G, Moore E, et al. Oral cyclosporin plus topical corticosteroid therapy diminishes bone mass in children with eczema. Pediatr Dermatol 2007;24(6):613–20.PubMedCrossRefGoogle Scholar
  152. 152.
    Zurbriggen B, Wüthrich B, Cachelin AB, Wili PB, et al. Comparison of two formulations of cyclosporin A in the treatment of severe atopic dermatitis. Aa double-blind, single-centre, cross-over pilot study. Dermatology 1999;198(1):56–60.PubMedCrossRefGoogle Scholar
  153. 153.
    Wolff K, Fleming C, Hanifin J et al. Efficacy and tolerability of three different doses of oral pimecrolimus in the treatment of moderate to severe atopic dermatitis: a randomized controlled trial. Br J Dermatol 2005;152:1296–1303.PubMedCrossRefGoogle Scholar
  154. 154.
  155. 155.
    Skaehill PA. Tacrolimus in dermatologic disorders. Ann Pharmacother 2001;35(5):582–8.PubMedCrossRefGoogle Scholar
  156. 156.
    Madan V, Griffiths CE. Systemic ciclosporin and tacrolimus in dermatology. Dermatol Ther 2007;20(4):239–50.PubMedCrossRefGoogle Scholar
  157. 157.
    Schroer B, Lockey R. Oral tacrolimus for severe recalcitrant atopic eczema. J Allergy Clin Immunol 2003;111(6):1409–10.PubMedCrossRefGoogle Scholar
  158. 158.
    Dé Tran QH, Guay E, Chartier S, Tousignant J. Tacrolimus in dermatology. J Cutan Med Surg 2001;5(4):329–35. Epub 2001 May 2.CrossRefGoogle Scholar
  159. 159.
    Hachem RR, Yusen RD, Chakinala MM, Meyers BF et al. A randomized controlled trial of tacrolimus versus cyclosporine after lung transplantation. J Heart Lung Transplant 2007;26(10):1012–8.PubMedCrossRefGoogle Scholar
  160. 160.
    Hernández D, Miquel R, Porrini E, Fernández A et al. Randomized controlled study comparing reduced calcineurin inhibitors exposure versus standard cyclosporine-based immunosup-pression. Transplantation 2007;84(6):706–14.PubMedCrossRefGoogle Scholar
  161. 161.
    Chiang GG, Abraham RT. Targeting the mTOR signaling network in cancer. Trends Mol Med 2007;13(10):433–42.PubMedCrossRefGoogle Scholar
  162. 162.
    Marsland AM, Griffiths CE. The macrolide immunosuppressants in dermatology: mechanisms of action. Eur J Dermatol 2002;12(6):618–22.PubMedGoogle Scholar
  163. 163.
    Reitamo S, Spuls P, Sassolas B, Lahfa M, et al; Sirolimus European Psoriasis Study Group. Efficacy of sirolimus (rapamycin) administered concomitantly with a subtherapeutic dose of cyclosporin in the treatment of severe psoriasis: a randomized controlled trial. Br J Dermatol 2001;145(3):438–45.PubMedCrossRefGoogle Scholar
  164. 164.
    Thervet E. Sirolimus therapy following early cyclosporine withdrawal in transplant patients: mechanisms of action and clinical results. Int J Nanomedicine 2006;1(3):269–81.PubMedGoogle Scholar
  165. 165.
    Reynolds NJ, Al-Daraji WI. Calcineurin inhibitors and sirolimus: mechanisms of action and applications in dermatology. Clin Exp Dermatol 2002;27(7):555–61.PubMedCrossRefGoogle Scholar
  166. 166.
    Duncan JI. Differential inhibition of cutaneous T-cell-mediated reactions and epidermal cell proliferation by cyclosporin A, FK-506, and rapamycin. J Invest Dermatol 1994;102(1):84–8.PubMedCrossRefGoogle Scholar
  167. 167.
    Bissonnette R, Papp K, Poulin Y, Lauzon G, et al; ISA247 Psoriasis Study Group. A randomized, multicenter, double-blind, placebo-controlled phase 2 trial of ISA247 in patients with chronic plaque psoriasis. J Am Acad Dermatol 2006;54(3)Google Scholar
  168. 168.
    Aspeslet L, Freitag D, Trepanier D, et al. ISA(TX)247; a novel calcineurin inhibitor. Transplant Proc 2001;33:1048–51PubMedCrossRefGoogle Scholar
  169. 169.
    Heller M, Shin HT, Orlow SJ, Schaffer J V. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol 2007;157(1):127–32.PubMedCrossRefGoogle Scholar
  170. 170.
    Murray ML, Cohen JB. Mycophenolate mofetil therapy for moderate to severe atopic dermatitis. Clin Exp Dermatol 2007;32(1):23–7.PubMedGoogle Scholar
  171. 171.
    Grundmann-Kollmann M, Kaufmann R, Zollner TM. Treatment of atopic dermatitis with mycophenolate mofetil. Br J Dermatol 2001;145(2):351–2.PubMedCrossRefGoogle Scholar
  172. 172.
    Grundmann-Kollmann M, Podda M, Ochsendorf F, Boehncke WH, et al. Mycophenolate mofetil is effective in the treatment of atopic dermatitis. Arch Dermatol 2001;137(7):870–3.PubMedGoogle Scholar
  173. 173.
    Benez A, Fierlbeck G. Successful long-term treatment of severe atopic dermatitis with myco-phenolate mofetil. Br J Dermatol 2001;144(3):638–9PubMedCrossRefGoogle Scholar
  174. 174.
    Hantash B, Fiorentino D. Liver enzyme abnormalities in patients with atopic dermatitis treated with mycophenolate mofetil. Arch Dermatol 2006;142(1):109–10.PubMedCrossRefGoogle Scholar
  175. 175.
    Jain J, Almquist SJ, Heiser AD et al. Characterization of pharmacological efficacy of VX-148, a new, potent immunosuppressive inosine 5' — monophosphate dehydrogenase inhibitor. J Pharmacol Exp Ther 2002;302:1272–7.PubMedCrossRefGoogle Scholar
  176. 176.
    Berth-Jones J, Takwale A, Tan E, Barclay G, et al. Azathioprine in severe adult atopic dermatitis: a double-blind, placebo-controlled, crossover trial. Br J Dermatol 2002;147(2):324–30.PubMedCrossRefGoogle Scholar
  177. 177.
    Lear JT, English JS, Jones P, Smith AG. Retrospective review of the use of azathioprine in severe atopic dermatitis. J Am Acad Dermatol 1996;35(4):642–3.PubMedCrossRefGoogle Scholar
  178. 178.
    Verma KK, Mittal R. Azathioprine as a therapeutic modality for the treatment of severe adult atopic dermatitis. Indian J Dermatol Venereol Leprol 2001;67(4):189–91.PubMedGoogle Scholar
  179. 179.
    Meggitt SJ, Gray JC, Reynolds NJ. Azathioprine dosed by thiopurine methyltransferase activity for moderate-to-severe atopic eczema: a double-blind, randomised controlled trial. Lancet 2006;367(9513):839–46.PubMedCrossRefGoogle Scholar
  180. 180.
    Evans WE. Pharmacogenetics of thiopurine S-methyltransferase and thiopurine therapy. Ther Drug Monit 2004;26(2):186–91.PubMedCrossRefGoogle Scholar
  181. 181.
    Murphy LA, Atherton DJ. Azathioprine as a treatment for severe atopic eczema in children with a partial thiopurine methyl transferase (TPMT) deficiency. Pediatr Dermatol 2003;20(6):531–4.PubMedCrossRefGoogle Scholar
  182. 182.
    Murphy LA, Atherton DA. retrospective evaluation of azathioprine in severe childhood atopic eczema, using thiopurine methyltransferase levels to exclude patients at high risk of myelosuppression. Br J Dermatol 2002;147(2):308–15.PubMedCrossRefGoogle Scholar
  183. 183.
    Kuanprasert N, Herbert O, Barneston RS. Clinical improvements in and significant reduction of total serum IgE in patients suffering from severe atopic dermatitis treated with oral aza-thioprine. Australas J Dermatol 2002;43:125–7.PubMedCrossRefGoogle Scholar
  184. 184.
    Jang IG, Yang JK, Lee HJ, Yi JY, Kim HO, Kim CW, Kim TY. Clinical improvement and immunohistochemical findings in severe atopic dermatitis treated with interferon gamma. J Am Acad Dermatol 2000;42:1033–40.PubMedCrossRefGoogle Scholar
  185. 185.
    Chang TT, Stevens SR. Atopic dermatitis: the role of recombinant interferon-gamma therapy. Am J Clin Dermatol 2002;3(3):175–83.PubMedCrossRefGoogle Scholar
  186. 186.
    Stevens SR, Hanifin JM, Hamilton T, Tofte SJ, Cooper KD. Long-term effectiveness and safety of recombinant human interferon gamma therapy for atopic dermatitis despite unchanged serum IgE levels. Arch Dermatol 1998;134(7):799–804.PubMedCrossRefGoogle Scholar
  187. 187.
    Hanifin JM, Schneider LC, Leung DY et al. Recombinant interferon gamma therapy for atopic dermatitis. J Am Acad Dermatol 1993;28:189–97.PubMedCrossRefGoogle Scholar
  188. 188.
    Schneider LC, Baz Z, Zarcone C, Zurakowski D. Long-term therapy with recombinant interferon-gamma (rIFN-gamma) for atopic dermatitis. Ann Allergy Asthma Immunol 1998;80(3):263–8. Chang TT, Stevens SR. Am J Clin Dermatol 2002;3(3):175–83.PubMedCrossRefGoogle Scholar
  189. 189.
    Jolles S. A review of high-dose intravenous immunoglobulin treatment for atopic dermatitis. Clin Exp Dermatol 2002;27(1):3–7.PubMedCrossRefGoogle Scholar
  190. 190.
    Bemanian MH, Movahedi M, Farhoudi A, Gharagozlou M, et al. High Doses Intravenous Immunoglobulin versus Oral Cyclosporine in the Treatment of Severe Atopic Dermatitis. Iran J Allergy Asthma Immunol 2005;4(3):139–43.PubMedGoogle Scholar
  191. 191.
    Jolles S, Hughes J. Use of IGIV in the treatment of atopic dermatitis, urticaria, scleromyxe-dema, pyoderma gangrenosum, psoriasis, and pretibial myxedema. Int Immunopharmacol 2006;6(4):579–91.PubMedCrossRefGoogle Scholar
  192. 192.
    Jolles S, Sewell C, Webster D, Ryan A, Heelan B, Waite A, Rustin M. Adjunctive high-dose intravenous immunoglobulin treatment for resistant atopic dermatitis: efficacy and effects on intracellular cytokine levels and CD4 counts. Acta Derm Venereol 2003;83(6):433–7.PubMedCrossRefGoogle Scholar
  193. 193.
    Paul C, Lahfa M, Bachelez H, Chevret S, Dubertret L. A randomized controlled evaluator-blinded trial of intravenous immunoglobulin in adults with severe atopic dermatitis. Br J Dermatol 2002;147(3):518–22.PubMedCrossRefGoogle Scholar
  194. 194.
    Lamb SR, Rademaker M. Intravenous immunoglobulin therapy for the treatment of severe atopic dermatitis. Expert Opin Pharmacother 2001;2(1):67–74.PubMedCrossRefGoogle Scholar
  195. 195.
    Zhang G, Lopez PH, Sheikh KA. Comparison of different brands of IVIg in an in vitro model of immune neuropathy. J Neuroimmunol 2006;173(1–2):200–3.PubMedCrossRefGoogle Scholar
  196. 196.
    Clark B, Cole J Y, Wortley A, Toolan J, et al. Intravenous immunoglobulin-induced panel reactive antibody A reduction: not all preparations are created equal. Transplantation 2003;75(2):242–5.PubMedCrossRefGoogle Scholar
  197. 197.
    Leung D Y, Pober JS, Cotran RS. Expression of endothelial-leukocyte adhesion molecule-1 in elicited late phase allergic reactionset. J Clin Invest 1991;87:1805–1809.PubMedCrossRefGoogle Scholar
  198. 198.
    Laan MP, Koning H, Baert MR, Oranje AP, et al. Levels of soluble intercellular adhesion molecule-1, soluble E-selectin, tumor necrosis factor-alpha, and soluble tumor necrosis factor receptor p55 and p75 in atopic children. Allergy 1998;53(1):51–8.PubMedCrossRefGoogle Scholar
  199. 199.
    Takahashi T, Sasaki Y, Hama K, Furue M, Ishibashi Y. Production of IL-4, IL-2, IFN-gamma, and TNF-alpha by peripheral blood mononuclear cells of patients with atopic dermatitis. J Dermatol Sci 1992;3(3):172–80.PubMedCrossRefGoogle Scholar
  200. 200.
    de Vries IJ, Langeveld-Wildschut EG, van Reijsen FC, Dubois GR. Adhesion molecule expression on skin endothelia in atopic dermatitis: effects of TNF-alpha and IL-4. J Allergy Clin Immunol 1998;102(3):461–8.PubMedCrossRefGoogle Scholar
  201. 201.
    Ackermann L, Harvima IT. Mast cells of psoriatic and atopic dermatitis skin are positive for TNF-alpha and their degranulation is associated with expression of ICAM-1 in the epidermis. Arch Dermatol Res 1998;290(7):353–9.PubMedCrossRefGoogle Scholar
  202. 202.
    Howarth PH, Babu KS, Arshad HS, et al. Tumour necrosis factor (TNFalpha) as a novel therapeutic target in symptomatic corticosteroid dependant asthma. Thorax 2005;60(12):1012–8.PubMedCrossRefGoogle Scholar
  203. 203.
    Berry MA, Hargadon D, Shelley M, et al. Evidence of a role of tumor necrosis factor alpha in refractory asthma. N Engl J Med 2006;354:697–708.PubMedCrossRefGoogle Scholar
  204. 204.
    Conner E, Bochner BS, Brummet M, Beck LA. The Effect of Etanercept on the Human Cutaneous Allergic Response. J Allergy Clin Immunol 2007, in press.Google Scholar
  205. 205.
    Buka RL, Resh B, Roberts B, et al. Etanercept is minimally effective in 2 children with atopic dermatitis. J Am Acad Dermatol 2005;53(2):358–359.PubMedCrossRefGoogle Scholar
  206. 206.
    Jacobi A, Antoni C, Manger B, Schuler G, Hertl M. Infliximab in the treatment of moderate to severe atopic dermatitis. J Am Acad Dermatol 2005;52(3 Pt 1):522–6.PubMedCrossRefGoogle Scholar
  207. 207.
    Leonardi CL. Efalizumab; an overview. J Am Acad Dermatol 2003;49:S98–104.PubMedCrossRefGoogle Scholar
  208. 208.
    Farshidi A, Sadeghi P. Successful treatment of severe refractory atopic dermatitis with efali-zumab. J Drugs Dermatol 2006;5(10):994–8.PubMedGoogle Scholar
  209. 209.
    Hassan AS, Kaelin U, Braathen LR, Yawalkar N. Clinical and immunopathologic findings during treatment of recalcitrant atopic eczema with efalizumab. J Am Acad Dermatol 2007;56(2):217–21.PubMedCrossRefGoogle Scholar
  210. 210.
    Weinberg JM, Siegfried EC. Successful treatment of severe atopic dermatitis in a child and an adult with the T-cell modulator efalizumab. Arch Dermatol 2006;142(5):555–8.PubMedCrossRefGoogle Scholar
  211. 211.
    Takiguchi R, Tofte S, Simpson B, Harper E. Efalizumab for severe atopic dermatitis: a pilot study in adults. J Am Acad Dermatol 2007;56(2):222–7.PubMedCrossRefGoogle Scholar
  212. 212.
    Babu KS, Arshad SH, Holgate ST. Anti-IgE treatment: an update and review of omalizumab and Fc e RI receptor. Allergy 2001;56:1121–1128.PubMedCrossRefGoogle Scholar
  213. 213.
    Beck LA, Marcotte GV, MacGlashan D, Togias A, Saini S. Omalizumab-induced reductions in mast cell Fcepsilon RI expression and function. J Allergy Clin Immunol 2004;114(3):527–30.PubMedCrossRefGoogle Scholar
  214. 214.
    Soresi S, Togias A. Mechanisms of action of anti-immunoglobulin E therapy. Allergy Asthma Proc 2006;27(2 Suppl 1):S15–23.PubMedGoogle Scholar
  215. 215.
    Chang TW, Wu PC, Hsu CL, Hung AF. Anti-IgE antibodies for the treatment of IgE-mediated allergic diseases. Adv Immunol 2007;93:63–119.PubMedCrossRefGoogle Scholar
  216. 216.
    Wuthrich B, Benz A, Skvaril F. IgE and IgG4 levels in children with atopic dermatitis. Dermatologica 1983;166(5):229–35.PubMedCrossRefGoogle Scholar
  217. 217.
    Beck LA, Saini S. Wanted: A study with omalizumab to determine the role of IgE-mediated pathways in atopic dermatitis. J Am Acad Dermatol 2006;55(3):540–1.PubMedCrossRefGoogle Scholar
  218. 218.
    Vigo PG, Girgis KR, Pfuetze BL, Critchlow ME, Fisher J, Hussain I. Efficacy of anti-IgE therapy in patients with atopic dermatitis. J Am Acad Dermatol 2006;55(1):168–70.PubMedCrossRefGoogle Scholar
  219. 219.
    Lane JE, Cheyney JM, Lane TN, Kent DE, Cohen DJ. Treatment of recalcitrant atopic dermatitis with omalizumab. J Am Acad Dermatol 2006;54(1):68–72.PubMedCrossRefGoogle Scholar
  220. 220.
    Krathen RA, Hsu S. Failure of omalizumab for treatment of severe adult atopic dermatitis. J Am Acad Dermatol 2005;53(2):338–40.PubMedCrossRefGoogle Scholar
  221. 221.
    Forman SB, Garrett AB. Success of omalizumab as monotherapy in adult atopic dermatitis: case report and discussion of the high-affinity immunoglobulin E receptor, FcepsilonRI. Cutis 2007;80(1):38–40.PubMedGoogle Scholar
  222. 222.
    Prescott SL, Dunstan JA, Hale J, Breckler L, et al. Clinical effects of probiotics are associated with increased interferon-gamma responses in very young children with atopic dermatitis. Clin Exp Allergy 2005;35(12):1557–64.PubMedCrossRefGoogle Scholar
  223. 223.
    Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child 2005;90(9):892–7.PubMedCrossRefGoogle Scholar
  224. 224.
    Kalliomäki M, Kirjavainen P, Eerola E, Kero P, et al. Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol 2001;107(1):129–34.PubMedCrossRefGoogle Scholar
  225. 225.
    Kalliomaki M, Salminen S, Arvilommi H et al. Probiotics in primary prevention of atopic disease: a randomized placebo-controlled trial. Lancet 2001;357(9262):1076–9PubMedCrossRefGoogle Scholar
  226. 226.
    Madsen K. Probiotics and the immune response. J Clin Gastroenterol 2006;40(3):232–4.PubMedCrossRefGoogle Scholar
  227. 227.
    Williams HC. Two “positive” studies of probiotics for atopic dermatitis: or are they? Arch Dermatol 2006;142(9):1201–3.PubMedCrossRefGoogle Scholar
  228. 228.
    Williams HC. Prevention of atopic eczema: a dream not so far away? Arch Dermatol 2002;138(3):391–2.PubMedCrossRefGoogle Scholar
  229. 229.
    Horrobin DF. Essential fatty acid metabolism and its modification in atopic eczema. Am J Clin Nutr 2000;71(1 Suppl):367S–72S.PubMedGoogle Scholar
  230. 230.
    Ziboh VA, Miller CC. Essential fatty acids and polyunsaturated fatty. acids: significance in cutaneous biology. Annu Rev Nutr 1990;10:433–10.PubMedCrossRefGoogle Scholar
  231. 231.
    Morse NL, Clough PM. A meta-analysis of randomized, placebo-controlled clinical trials of Efamol evening primrose oil in atopic eczema Where do we go from here in light of more recent discoveries. Curr Pharm Biotechnol 2006;7(6):503–24.PubMedCrossRefGoogle Scholar
  232. 232.
    Horne DJ, White AE, Varigos GA. A preliminary study of psychological therapy in the management of atopic eczema. Br J Med Psychol 1989;62(Pt 3):241–8.PubMedGoogle Scholar
  233. 233.
    Sokel B, Kent CA, Lansdown R, Atherton D, Glover M, Knibbs J. A comparison of hypnotherapy and biofeedback in the treatment of childhood atopic eczema. Contemp Hypnosis 1993;10(3).Google Scholar
  234. 234.
    Huang JT, Abrams M, Tlougan B et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics. 2009;123(5):e808–14.PubMedCrossRefGoogle Scholar
  235. 235.
    Warner J, McGirt LY, Beck LA. Biomarkers of Th2 Polarity and Disease Severity are Predictive of Staphylococcal Colonization in Atopic Dermatitis Subjects. Br J Dermatol 2008;160(1):183–5.PubMedCrossRefGoogle Scholar
  236. 236.
    Beck LA, Boguniewicz M, Hata T, Schneider LC, Hanifin J, Gallo R, Paller AS, Lieff S, Reese J, Zaccaro D, Milgrom H, Barnes KC, Leung D Y. Phenotype of atopic dermatitis subjects with a history of eczema herpeticum. J Allergy Clin Immunol 2009; 25. [Epub].Google Scholar
  237. 237.
    Gao P-S, Rafaels NM, Hand T, Murray T, Boguniewicz M, Hata T, Schneider L, Hanifin JM, Gallo RL, Gao L, Beaty TH, Beck LA, Barnes KC, Leung DY. Filaggrin Mutations that Confer Risk of Atopic Dermatitis Confer Greater Risk for Eczema Herpeticum. J Allergy Clin Immunol 2009 (accepted).Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Sherrif F Ibrahim
    • 1
  • Anna De Benedetto
    • 1
  • Lisa A. Beck
    • 2
  1. 1.Department of DermatologyUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Departments of Dermatology and MedicineUniversity of RochesterRochesterUSA

Personalised recommendations