Meeting Reports
Atopic Dermatitis – A Disease to “Hit Early and Hit Hard“
LOUISE LÖNNDAHL
Department of Medicine, Section of Dermatology, Karolinska University Hospital, Norrbacka,
Solna, SE-171 76 Stockholm, Sweden. E-mail: louise.lonndahl@ki.se
Louise Lönndahl participated in the 32nd Nordic Congress of Dermato-Venereology.
Read her summary below of one of the sessions.
During this year’s Nordic Congress of Dermato-Venereology
several interesting symposia on various subjects were held
in Tampere, Finland. The subject closest to my own research
area was the symposium about atopic dermatitis (AD). Dr
Sakari Reitamo, from Finland, that so kindly hosted the congress this year, started off by pointing at the importance of
effectively treating the disease early after onset. He and his
collegues had been able to show that treating the eczema in
early childhood affects the further development of atopic
manifestations later in life. Also, maintenance treatment,
in this case a topical steroid twice a week, was shown to
dramatically decrease ?are-ups. This could probably be due
to the lower provocation from the external environment
through a more intact skin barrier. Another good choice for
local treatment is tacrolimus, which has been shown to be
a relatively safe treatment. The speaker ?nished his talk by
using a citation from an earlier published study “Hit early
and hit hard”. This I think we, as clinicians, should bare in
mind when we meet young patients with AD.
The next speaker, Dr Sol-Britt Lonne-Rahm, Stockholm, gave
us a presentation of the psychological aspects of AD. She emphasised that this group of patients and their families have a
reduced quality of life and that we have a high responsibility
in helping these patients also in this matter. The patients may
also have higher anxiety levels and in many patients there is a
pattern of worsening during stress. Dr Lonne-Rahm suggested
psychotherapy as a useful tool in treatment of AD.
The session then went deeper into the pathogenesis of the
disease and ?rst in line was Dr Maria Bradley, Stockholm, who
presented how the skin barrier and ?laggrin gene is thought
to play a role in the development of AD. Filaggrin is a shortening of “?lament-associated protein” which is found in the
epidermis, were it has functions involved in water retention.
There are over 40 different mutations in this gene and they
are common in the population. In Asian and European
populations the mutations are associated with development
of AD. Also healthy people have mutations, 7.5% compared
to 21% in patients with AD. It has been discussed why the
mutations are so common, and in line with the evolutionary
theory there is probably some kind of evolutionary bene?t.
Forum for Nord Derm Ven 2013, Vol. 18, No. 4
One could speculate that a higher penetrance of antigen
through the skin could result in some low-dose vaccine for
certain pathogens. Also, it has been shown that patients
with mutations in the ?laggrin gene had a 10% higher level
of vitamin D in serum.
The level of epidermal ?laggrin could vary depending on mutations but also upon how many repetitions there are on one
allele and the expression may also be up- or down- regulated.
So independent of the reason to why we have low levels of
?laggrin, Dr Bradley believes that in the future there might
be a possibility to treat AD with ?laggrin replacement. Also
one could speculate whether ?laggrin may somehow be used
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