ATOPIC DERMATITIS – DISEASE ETIOLOGY AND CLINICAL MANAGEMENT Edited by Jorge Esparza-Gordillo and Itaru Dekio Atopic Dermatitis – Disease Etiology and Clinical Management Edited by Jorge Esparza-Gordillo and Itaru Dekio Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Dejan Grgur Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Atopic Dermatitis – Disease Etiology and Clinical Management, Edited by Jorge Esparza-Gordillo and Itaru Dekio p. cm. ISBN 978-953-51-0110-9 Contents Preface IX Part 1 Disease Etiology 1 Chapter 1 Flaky Tail Mouse as a Novel Animal Model of Atopic Dermatitis: Possible Roles of Filaggrin in the Development of Atopic Dermatitis 3 Catharina Sagita Moniaga and Kenji Kabashima Chapter 2 Mouse Models for Atopic Dermatitis Developed in Japan 21 Hiromichi Yonekawa, Toyoyuki Takada, Hiroshi Shitara, Choji Taya, Yoshibumi Matsushima, Kunie Matsuoka and Yoshiaki Kikkawa Chapter 3 The Roles of Th2-Type Cytokines in the Pathogenesis of Atopic Dermatitis 39 Kenji Izuhara, Hiroshi Shiraishi, Shoichiro Ohta, Kazuhiko Arima and Shoichi Suzuki Chapter 4 Epidermal Serine Proteases and Their Inhibitors in Atopic Dermatitis 51 Ulf Meyer-Hoffert Chapter 5 The Role of Prostanoids in Atopic Dermatitis 65 Tetsuya Honda and Kenji Kabashima Chapter 6 Expression and Function of CCL17 in Atopic Dermatitis 81 Susanne Stutte, Nancy Gerbitzki, Natalija Novak and Irmgard Förster Part 2 Microrganisms in Atopic Dermatits 105 Chapter 7 Microorganisms and Atopic Dermatitis 107 Itaru Dekio VI Contents Chapter 8 Atopic Dermatitis and Skin Fungal Microorganisms 123 Takashi Sugita, Enshi Zhang, Takafumi Tanaka, Mami Tajima, Ryoji Tsuboi, Yoshio Ishibashi, Akemi Nishikawa Chapter 9 Fungus as an Exacerbating Factor of Atopic Dermatitis, and Control of Fungi for the Remission of the Disease 141 Takuji Nakashima and Yoshimi Niwano Part 3 Diagnosis and Clinical Management 159 Chapter 10 Atopic Dermatitis: From Pathophysiology to Diagnostic Approach 161 Nicola Fuiano and Cristoforo Incorvaia Chapter 11 Advances in Assessing the Severity of Atopic Dermatitis 169 Zheng-Hong Di, Li Zhang, Ya-Ni Lv, Li-Ping Zhao, Hong-Duo Chen and Xing-Hua Gao Chapter 12 Physical and Chemical Factors that Improve Epidermal Permeability Barrier Homeostasis 197 Mitsuhiro Denda Chapter 13 Trigger Factors, Allergens and Allergy Testing in Atopic Dermatitis 213 Evmorfia Ladoyanni Chapter 14 Food Allergy in Atopic Dermatitis 229 Geunwoong Noh and Jae Ho Lee Chapter 15 Clinical Management of Atopic Dermatitis 251 Soheyla Mahdavian, Patty Ghazvini, Luis Pagan, Angela Singh and Todd Woodard Part 4 New Treatments 267 Chapter 16 Occlusive Therapy in Atopic Dermatitis 269 Misha M. Heller, Eric S. Lee,Faranak Kamangar, Wilson Liao and John Y. M. Koo Chapter 17 Suplatast Tosilate for Prophylaxis of Pediatric Atopy 289 S. Yoshihara, M. Ono, Y. Yamada, H. Fukuda, T. Abe and O. Arisaka Chapter 18 Thinking Atopic Dermatitis Treatment Differently: Specific Immunotherapy as an Option 299 Massimo Milani Contents VII Chapter 19 Improvement of Atopic Dermatitis by Human Sebaceous Fatty Acids and Related Lipids 309 Hiroyuki Araki, Yoshiya Sugai and Hirofumi Takigawa Chapter 20 Probiotics and Atopic Dermatitis 325 Feriel Hacini-Rachinel, Ivana Jankovic, Anurag Singh and Annick Mercenier Chapter 21 The Role of Probiotics in Atopic Dermatitis Prevention and Therapy 353 Öner Özdemir Chapter 22 Food Compounds Inhibit Staphylococcus Aureus Bacteria and the Toxicity of Staphylococcus Enterotoxin A (SEA) Associated with Atopic Dermatitis 387 Reuven Rasooly and Mendel Friedman Preface Atopic Dermatitis is a common disease characterized by inflamed, itching and dry skin. This relapsing allergic disorder has complex etiology and shows a remarkably high clinical heterogeneity which complicates the diagnosis and clinical management. This book is divided into 4 sections. The first section (Disease Etiology) describes some of the physiological mechanisms underlying Atopic Dermatitis, including alterations in the immune system and the skin-barrier function. The important role of host-microorganism interactions on the pathophysiology of Atopic Dermatitis is discussed in the second section (Microorganisms in Atopic Dermatitis). An overview of the clinical diagnostic criteria and the disease management protocols commonly used is given in the third section (Diagnosis and Clinical Management). The last section (New Treatments) describes new therapeutic approaches that are not widely used but are currently being studied due to preliminary evidence showing a clinical benefit for Atopic Dermatitis. As a co-editor, it was my greatest pleasure to work with Dr Jorge Esparza-Gordillo on this book, which handles cutting-edge ideas on atopic dermatitis, provided by ambitious specialists. Every chapter is a real pearl of the subject, and as a clinician- scientist, I was delighted to read the manuscript one by one. I believe clinicians and researchers worldwide will benefit from this book as a unique free online publication. Thanks to Ms. Bojana Zelenika and Mr. Dejan Grgur of InTech - Open Access Publisher, this book is published with a very quick publication process, and will thus reach the reader with the latest information. Last but not least, I thank my wife Shoko for her enormous support during this project. Itaru Dekio, MD, PhD Department of Dermatology, Faculty of Medicine, Shimane University, Izumo, Japan [...]... Moniaga, et al., 2010, Presland, et al., 2000) (Fig.1) 8 Atopic Dermatitis – Disease Etiology and Clinical Management Fig 1 Flgft mouse has a truncated and smaller profilaggin and a lack of filaggrin protein 3.2 Flaky tail mouse and ichtyosis vulgaris Ichthyosis vulgaris (IV) is a heterogeneous autosomal skin disease characterized by dry and scaly skin, mild hyperkeratosis, and a decreased or absent... lesions were observed in the pinnae and scapula of the dorsal area along with congestion and scaly symptoms, and advanced dermatitis was seen in the middle- and right-side photographs in both wild type NC/Nga (upper low) and NCN24 mice (lower low) 26 Atopic Dermatitis – Disease Etiology and Clinical Management Imune cells Table 1 The number of immune cells in wild-type (wt) and NCN24 mice were not occurring... Oyoshi, et al., 2009) with more total cells, 10 Atopic Dermatitis – Disease Etiology and Clinical Management lymphocytes, eosinophils, and mononuclear cells in Flgft mice compared to control mice These data support the diagnosis of AD-like dermatitis in Flgft mice in the steady state under SPF conditions Fig 4 Hematoxyllin and eosin (H&E)-stained sections in 8- and 18-week old mice Scale bar, 100µm Therefore,... permeability barrier abnormality parallels the severity of the 4 Atopic Dermatitis – Disease Etiology and Clinical Management disease phenotype in AD; (2) both the clinically uninvolved skin sites and the skin cleared of inflammation continue to display significant barrier abnormalities; (3) emollient therapy comprises effective ancillary therapy; and (4) specific replacement therapy which targets the prominent... These findings demonstrate that Flgft mice tend to generate allergen-specific IgE and cytokine following cutaneous allergen challenge to the skin even without additional barrier disruption 12 Atopic Dermatitis – Disease Etiology and Clinical Management Fig 6 Amount of FITC in the skin of B6 and Flgft mice (left panel) and fluorescence intensities of FITC of the skin (right panel) after topical application... tail and varitint-waddler-J J Hered, 63, 3, (May-Jun), 135-140 Lee, K H., et al (2011) Filaggrin knockdown and Toll-like receptor 3 (TLR3) stimulation enhanced the production of thymic stromal lymphopoietin (TSLP) from epidermal layers Exp Dermatol, 20, 2, (Feb), 149-151 Leung, D Y &Bieber, T (2003) Atopic dermatitis Lancet, 361, 9352, (Jan 11), 151-160 18 Atopic Dermatitis – Disease Etiology and Clinical. .. 2011) Filaggrins proteolytically degraded into a pool of free amino acids including histidine and glutamine which are further converted to, respectively, urocanic acid (UCA) and 2- 6 Atopic Dermatitis – Disease Etiology and Clinical Management pyrrolidone-5-carboxylic acid (PCA) The concentrations of UCA and PCA in SC in the carriers of FLG mutations were significantly lower than those in healthy donors...Part 1 Disease Etiology 1 Flaky Tail Mouse as a Novel Animal Model of Atopic Dermatitis: Possible Roles of Filaggrin in the Development of Atopic Dermatitis Catharina Sagita Moniaga and Kenji Kabashima Department of Dermatology, Kyoto University Graduate School of Medicine Japan 1 Introduction Understanding of human diseases has been enormously expanded by the use of animal models,... in eczema and asthma: robust risk factors in atopic disease J Allergy Clin Immunol, 123, 6, (Jun), 1361-1370 e1367 Roelandt, T., et al (2008) Proteolytically active allergens cause barrier breakdown J Invest Dermatol, 128, 8, (Aug), 1878-1880 Sandilands, A., et al (2006) Prevalent and rare mutations in the gene encoding filaggrin cause ichthyosis vulgaris and predispose individuals to atopic dermatitis. .. dermatitis N Engl J Med, 358, 14, (Apr 3), 1483-1494 Briot, A., et al (2009) Kallikrein 5 induces atopic dermatitis- like lesions through PAR2mediated thymic stromal lymphopoietin expression in Netherton syndrome J Exp Med, 206, 5, (May 11), 1135-1147 16 Atopic Dermatitis – Disease Etiology and Clinical Management Briot, A., et al (2010) Par2 inactivation inhibits early production of TSLP, but not cutaneous . ATOPIC DERMATITIS – DISEASE ETIOLOGY AND CLINICAL MANAGEMENT Edited by Jorge Esparza-Gordillo and Itaru Dekio Atopic Dermatitis – Disease Etiology and Clinical Management. parallels the severity of the Atopic Dermatitis – Disease Etiology and Clinical Management 4 disease phenotype in AD; (2) both the clinically uninvolved skin sites and the skin cleared of inflammation. Atopic Dermatitis – Disease Etiology and Clinical Management 8 Fig. 1. Flg ft mouse has a truncated and smaller profilaggin and a lack of filaggrin protein. 3.2 Flaky tail mouse and