The pathogenesis of Atopic dermatitis
- 1. THE PATHOGENESIS OF ATOPIC DERMATITIS By Extern Akechanok Watcharapanjamart
- 2. What is Atopic Dermatitis?
- 3. AD is an important chronic or relapsing inflammatory skin disease AD often precedes asthma and allergic disorders o More than 50% develop asthma o 75% develop AR AD associated with local infiltration of Th 2 that secrete IL-4, IL-5, IL-13, IL-31 Complex interrelationship of genetic, environmental, immunologic, and epidermal factor What is Atopic Dermatitis? Mark Boguniewicz, Donald Leung.Middletons Allergy 7th edition 1 893-1999
- 4. 犢犖犖о犖迦犖犖迦牽犖犖項犖ム牽犖園犖犖迦犖犖犖犖劇犖犖犖項検犖巌犖犢犖犖巌硯犖犖犖園 犖犖巌権犖迦検 犢犖犖犖犖劇犖犖犖項検犖巌犖犢犖犖巌硯犖犖犖園 (atopic dermatitis / atopic eczema) 犢犖犢犖犢犖犖 犖犖巌硯犖犖犖園犖犖園犢犖犖犢犖犖劇犖犖犖園犖犖朽犖犖犢犖犢犖犢犖犖∇犖犖о険犖∇犖犢犖 犖÷元犖ム険犖犖犖犖萎犖迦犖犖ム鹸犖犖巌犖犖朽犖犖迦犖園 犖犖劇賢 犖÷元犖犖迦犖迦牽 犖犖園犖÷顕犖 犖犖巌硯犖犖犖園犢犖犢犖 犖犖園犢犖犖 犢犖ム鍵犖÷元犖犖迦牽犖犖迦犖犖巌犢犖犢犖犖犖萎権犖 犢 犖犖項犖犢犖о権犖犖迦犖÷元犖犖萎犖園 IgE 犢犖犢犖ム厳犖犖犖犖項 犢犖ム鍵犖犢犖о犢犖犖犢犖÷元犖犖犖萎硯犖園犖巌肩犢犖о犖犖園硯犖犖犖劇賢 犖犖犖萎硯犖園犖巌犖犖犖犖犖犖園硯犢犖犢犖犢犖犖犖犖項検犖巌犖犢犢犖犢犖 犢犖犖犖犖劇 (asthma) 犢犖犖犖犖÷弦犖犖犖園犢犖犖犖犖項検犖巌犖犢 (allergic rhinitis) 犢犖犢犖犖犢犖
- 5. Epidemiology Affects 15-30% of children, 2-10% of adult 60% begin during the first yr. 45% begin within the first 6 mo. 85% begin before 5 yrs. Up to 70%: spontaneous remission before adolescence NJEM 2008;358:1483-94
- 6. 犢犖犖о犖迦犖犖迦牽犖犖項犖ム牽犖園犖犖迦犖犖犖犖劇犖犖犖項検犖巌犖犢犖犖巌硯犖犖犖園 : 犖犖伍犖園犖巌犖迦牽犖犢 犢犖犖犖犖朽犖犢犖о犢犖犖犢犖犖犢犖犢犖犢犖犖犖迦権犖伍犢犖迦犖о犖 5 犖犖 犖犖迦犖犖迦牽犖犖謹犖犖迦犖о顕犖÷犖伍 (prevalence) 犖犖犖犢犖犖犖犖劇犖犖犖項検犖巌犖犢犖犖巌硯犖犖犖園犢犖犖犖犖萎犖犖犢犖犖 犖犖犖о犖 o 犢犖犖犖ム幻犢犖÷犖犢犖犖犖迦権犖伍牽犖萎見犖о犖迦 6-7 犖犖 (ISAAC Phase III) 犢犖犖犖犖伍犢犖犖犖÷見犖迦犖犖 犖犖犖犢犖犖∇献犖 16.7 o 犢犖犖犖ム幻犢犖÷犖犢犖犖犖迦権犖 13-14 犖犖 犖犖犖犢犖犖∇献犖 9.6 o 犖犖о顕犖÷犖伍犢犖犖犖項犢犖犖犢犢犖犖∇犖迦牽犖犖謹犖犖迦犖犖犖ム幻犢犖÷犖園犖犖謹犖犖迦検犖犖迦硯犖巌犖∇顕犖ム険犖 犢犖 犖犖犖伍犢犖犖犖÷見犖迦犖犖 犢犖÷厳犢犖犖犖 犖.犖. 2518 犖犖犖犢犖犖∇献犖 15.2 犢犖ム鍵犖犖迦犖犖迦権犖犖迦 犖ム犖迦肩犖伍犢犖犖犖朽.犖.2540-2541 犖犖謹犖犖犖謹犖犖迦犖犖犖ム幻犢犖÷犖園犖犖謹犖犖迦犖犢犖犢犖犖朽権犖о犖園 犖犖 犖犢犖犖∇献犖 9.4
- 7. How to diagnosis Atopic Dermatitis ?
- 8. Hanifin&Rajkas clinical criteria for the atopic dermatitis
- 9. 犢犖犖о犖迦犖犖迦牽犖犖項犖ム牽犖園犖犖迦犖犖犖犖劇犖犖犖項検犖巌犖犢犖犖巌硯犖犖犖園 : 犖犖迦牽犖犖園犖犖犖萎硯犖園犖 犖犖迦牽犖犖園犖犖犖萎硯犖園犖巌賢犖迦犖迦牽犖犖迦犖犖巌硯犖犖犖園 - 犖犖劇犖犢犖犖巌犖÷犖犢犖犢犖÷厳犢犖犢犖 犖犖萎権犖萎犖о献犖迦犖朽犢犖犢犖犖犖劇犖 - 犖犖迦犖犖犢犖犖犖犖犖犖劇犖 - 犖犖迦犖迦牽犖犖園 - 犖犖迦牽犢犖犖巌犖犖劇犖犖犢犖 - 犖犖巌犖犢犖о犖ム犖犖÷犖朽犖犖迦犖÷元犖犢犖о犖犖迦犖犢犢犖犖巌犖犖劇犖 犖犖迦牽犖犖園犖犖犖萎硯犖園犖巌犖ム鍵犖犖犖о犖犢犖迦犖犖迦権犖犖園犖о犖犢犖犖∇献犖萎犖犖朽権犖 犖犖犖萎硯犖園犖巌犖項検犖巌犖犢犖犖犖犖犖犢犖犖 犢犖ム鍵犖犖犖犖犖犖犖園硯 犢犖犢犖 犖犖迦犖迦牽犖犖園犖犖÷弦犖 犖犖迦検 犖犢犖迦検犖項犢犖犖 犖犖犖 犢犖犖犖劇犖犖 犖犖迦権犢犖犖÷元犢犖犖朽権犖犖о元犢犖 犢犖犢犖犖犢犖 犖犖犖萎硯犖園犖巌犖迦牽犢犖犢犖犖迦見犖迦牽 犖犖犖萎硯犖園犖巌犖迦牽犢犖犢犖犖迦牽犖犢犖犖犖項検犖巌犖犢犢犖犖犖迦犖迦絹 (airborne allergen) 犢犖犖犢犖ム鍵犖犖迦硯犖萎賢犖劇犖 犢 犖犖朽犖÷元犖犢犖о犖犖迦犖犢犖犖劇犖犖÷元犖犖о顕犖÷牽犖伍犢犖犖犖÷顕犖犖犖謹犖 犢犖犢犖 犖犖迦牽犖犖巌犢犖犖劇犖犖犖朽犖犖巌硯犖犖犖園
- 10. 犢犖犖о犖迦犖犖迦牽犖犖項犖ム牽犖園犖犖迦犖犖犖犖劇犖犖犖項検犖巌犖犢犖犖巌硯犖犖犖園 : 犖犖迦牽犖犖犖о犖犢犖迦犖犖迦権 犖犖迦牽犖犖犖о犖犢犖迦犖犖迦権 犖犖犖犖犖迦犖犖迦牽犖犖犖о犖犢犖迦犖犖迦権 犖犖園犖о犖犢犖ム犖 犢犖犢犢犖犢犖犖犖迦牽犖犖犖о犖犖劇犖犖犖園犖犖朽 犖犖犖о犖ム険犖犖犖犖萎犖劇犖犢犖犖犖迦鍵犖犖犖犢犖犖 (eczema) 犖犖迦牽犖犖犖萎犖迦権犖犖犖犖犖劇犖 犢犖ム鍵犖犖迦犖迦牽犖犖劇犖 犢犖犖∇犖迦 犖ム鍵犢犖犖朽権犖 犖犖迦犢犖犢犢犖犖犖犢犖犖迦牽犖о鹸犖犖巌犖犖園権犖犖犖 Hanifin (2001) 犖犖犖о犖犖項硯犢犖迦検犖朽犖劇犖犖犖巌硯犖犖犖園犖犖∇犖迦犖犖劇犖犖犖朽犖犖迦犖犖犖犢犖о検 犖犢犖о権 犢犖犢犖 犖犖巌硯犢犖犢犖 (xerosis) 犖犖ム顕犖犖犢犖迦犖 (pityriasis alba) 犢犖犢犖犖犢犖
- 11. Acute Atopic Dermatitis Intensely pruritic, erythematous papule associated with excoriations , vesiculation, and serous exudate
- 12. Chronic Atopic Dermatitis Dry skin Lichenification : Thickening of skin with accentuated surface markings and fibrotic papules
- 14. What is pathogenesis of atopic dermatitis ?
- 15. Genetics Barrier function of the skin Immunopathologic mechanism Environment
- 16. Genetics of Atopic Dermatitis The concordance rate for atopic dermatitis is higher among monozygotic twins (77%) than among dizygotic twins (15%) atopic dermatitisrelated loci on chromosomes 3q21,11 1q21, 16q, 17q25, 20p,12 and 3p26 1q21, which harbors a family of epithelium-related genes called the epidermal differentiation complex NJEM 2008;358:1483-94
- 18. Barrier function of the skin 45%
- 19. Atopic Dermatitis and the Skin Barrier Patients with Atopic Dermatitis have Impaired Barrier Function Transepidermal water loss (A) increase not only in lesional, but also in non-lesional skin of patients normal controls, and hydration (B) is reduced.1 1. Aberg KM, et al. J Invest Dermatol 2008;128;917-925. 2. Jensen JM, et al. J Invest Dermatol 2004;122:1423-1431. 3. Chamlin SL, et al. J Am Acad Dermatol 2002;47:198-208 犖犖朽犖÷顕: http://www.epiceram.ca/physician/ad_skin_barrier.php 10/03/2015
- 20. The skin produces the cathelicidin LL-37; the human 硫-defensins HBD-1, HBD-2, and HBD-3; and dermcidin. The inflammatory micromilieu initiated by interleukin-4, interleukin-13, and interleukin- 10 down-regulates these antimicrobial peptides in the skin of patients with atopic dermatitis. Immunopathologic factors NJEM 2008;358:1483-94
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