**8. Complications**

262 Atopic Dermatitis – Disease Etiology and Clinical Management

proliferation. Methotrexate is a folic acid antagonist that inhibits reactions and promotes release of adenosine. It also inhibits lymphocyte proliferation. Adverse effects associated with azathioprine and methotrexate are myelosupression, hepatotoxicity, gastrointestinal disturbances, and increased risk of infection. Monitoring of hematologic and liver function

As discussed, atopic dermatitis is an important skin disorder that leads to significant costs and morbidity to patients, families, and society. Effective therapeutic agents are limited in number, and all have side effects that impede successful long-term use. Consequently, there is a high medical need for better therapies. Bimosiamose, nanocrystalline silver cream,

Bimosiamose is a selectin antagonist that blocks the initial slowing of leukocyte traffic, preventing leukocytes from migrating into the tissue, and may alter cell activation and cellcell signalling pathways. Currently Bimosiamose is in Phase II clinical testing for asthma,

Nanocrystalline Silver Cream completed preliminary studies evaluating its use in atopic dermatitis. Silver has proven for decades to be an effective antimicrobial agent. It has been the active ingredient for the treatment of burns and other wounds. It has also demonstrated anti-inflammatory activity in animal studies. Human studies are currently in Phase II trials evaluating nanocrystalline silver cream applied twice daily using placebo, 0.5% or 1% cream

Phosphodiesterases play a key role in degrading cAMP, which is an important process in virtually all the cell types involved in the pathophysiology of allergic and inflammatory diseases including asthma and chronic obstructive pulmonary disease (COPD), but also skin diseases such as psoriasis and atopic dermatitis. PDE-4 is the major and most abundant in almost all inflammatory and immune cells. PDE-4 suppresses several pro-inflammatory mechanisms like cytokine generation and secretion, IgE production, proliferation, and histamine generation just to name a few. Topical and systemic therapies are being studied. One general problem is the group associated side effect profile with nausea, emesis, and enhanced gastric acid production being the most critical commonly occurring with systemic therapies. Some examples are topical Atizoram and orally Arofylline. The newly FDA approved Roflumilast (Darilesp®) for severe COPD is being investigated for its utility in

Elevated IgE responses and eosinophilia is observed in many patients with atopic dermatitis. This is thought to reflect the increased expression of Th2 cytokines, in particular IL-4, IL-5, and IL-13. Cutaneous infiltration of activated T-cells and their release of cytokines are thought to be key events in the development of atopic dermatitis. There are three ways

phosphodiesterase-4 inhibitors, and IL-4/IL-3 receptor blockers are considered here.

tests is mandatory (Hon et al 2009; Weatherhead et al 2007).

psoriasis, and atopic dermatitis (Revotar Biopharmaceuticals 2011).

**7.3 Emerging therapies** 

**7.3.1 Bimosiamose** 

(ClinicalTrials.gov 2005).

**7.3.2 Nanocrystalline silver cream** 

**7.3.3 Phosphodiesterase-4 Inhibitors** 

atopic dermatitis (Baumer et al 2007).

**7.3.4 Interleukin receptor blockers** 

If AD is not appropriately treated there can be several complications that can arise. It is shown that patients with atopic dermatitis are more susceptible to microorganisms, particularly S. aureus. Untreated lesions can result in bacterial infections, and acute inflammatory responses of the skin. Patients with atopic dermatitis can also present with eyelid dermatitis, nipple dermatitis, and cheilitis of the lips. Eyelid dermatitis and chronic blepharitis can result in visual impairment from corneal scarring. Other ocular complications include atopic keratoconjunctivitis, vernal conjunctivitis, and keratoconus (Leung, et al. 2003). Management of AD is important in the prevention of other conditions.
