title: Recent Advances in Pharmacotherapeutic Paradigm of Mild to Recalcitrant Atopic Dermatitis.
abstract: Atopic dermatitis (AD) is a common, chronic skin inflammatory disorder characterized by perivascular infiltration of immunoglobulin E (IgE), T lymphocytes, and mast cells. The key factors responsible for the pathophysiology of this disease are immunological disorders and defects in epidermal barrier properties. Pruritus, intense itching, psychological stress, deprived physical and mental performance, and sleep disturbance are the hallmark features of this dermatological disorder. Preventive interventions such as educational programs, avoidance of allergens, and exclusive care toward the skin could play a partial role in suppressing the symptoms. Based on the available clinical evidence, topical corticosteroids (TCs) are among the most commonly prescribed agents; however, these should be selected with care. In cases of steroid phobia, persistent adverse effects or chronic use, topical calcineurin inhibitors can be considered as a promising adjunct to TCs. Recent advances in the pharmacotherapeutic paradigm of atopic diseases exploring the therapeutic dominance of nanocarrier-mediated delivery is also discussed in this evidence-based review with regard to the treatment of AD. The present review summarizes the available clinical evidence, highlighting the current and emerging trends in the treatment of AD and providing evidence-based recommendations for the clinicians and health care professionals. Available evidence for the management of pediatric and adult atopic dermatitis (AD; atopic eczema) of all severities is explored. The management of other types of dermatitis, such as irritant contact dermatitis, seborrheic dermatitis, neurodermatitis, perioral dermatitis, stasis dermatitis, and allergic contact dermatitis are outside the scope of current review article. The presented studies were appraised using a unified system called the "Strength of Recommendation Taxonomy (SORT)", which was developed by the editors of several US family medicine and primary care journals (i.e., American Family Physician, Family Medicine, Journal of Family Practice, and BMJ USA).1 The searched studies were graded using a 3-point scale based on the quality of methodology (e.g., randomized control trial, case control series, clinical cohort studies, case series, etc.) and key emphasis of the trial (i.e., diagnosis, treatment/prevention/ screening, or prognosis) as follows: I. Good-quality patient-oriented evidence (i.e., evidence assessing consequences that matter to patients: mortality, morbidity, improvement in signs and symptom, quality of life, and socioeconomic factors); II. Limited-quality patient-oriented evidence; and III. Other evidence such as consensus guidelines, expert opinion, case control trial, or disease-related information. Recommendations for nonpharmacological and pharmacological approaches were established based on the best available evidence and are graded as follows: A. Recommendations based on consistent and good-quality patient-oriented evidence; B. Recommendations based on inconsistent or limited-quality patient-oriented evidence; and C. Recommendations based on consensus, expert opinion, case control evidence, or disease-related information.
authors.affiliation: Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam 42300, Selangor, Malaysia.
authors.forename: Zahid
authors.initials: Z
authors.lastname: Hussain
authors.affiliation: Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam 42300, Selangor, Malaysia.
authors.forename: Shariza
authors.initials: S
authors.lastname: Sahudin
authors.affiliation: Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Hnin Ei
authors.initials: HE
authors.lastname: Thu
authors.affiliation: Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak 56000 Cheras, Kuala Lumpur, Malaysia.
authors.forename: Ahmad Nazrun
authors.initials: AN
authors.lastname: Shuid
authors.affiliation: Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz 50300, Kuala Lumpur, Malaysia.
authors.forename: Syed Nasir Abbas
authors.initials: SN
authors.lastname: Bukhari
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz 50300, Kuala Lumpur, Malaysia.
authors.forename: Endang
authors.initials: E
authors.lastname: Kumolosasi
mesh_terms: D000279:Administration, Cutaneous; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D004337:Drug Carriers / Q000008:administration & dosage*; D019317:Evidence-Based Medicine; D006801:Humans; D036103:Nanotechnology
chemical_list: D003879:Dermatologic Agents; D004337:Drug Carriers