SlideShare ist ein Scribd-Unternehmen logo
IJDVL
Presenter- Deepika Kothari
Moderator - Saroj Purohit Mam
Atopic patch testing
INTRODUCTION
● Atopic dermatitis is a chronic inflammatory skin disorder
characterized by intense itching and a relapsing course
especially in infants and children with a personal or family history
of atopic disorders.
● The atopic patch test is now available for identification of
allergens in aeroallergen-triggered atopic dermatitis.
METHODS
● 75 subjects with atopic dermatitis fitting Hanifin and Rajka’s criteria and
elevated serum IgE were included in the study.
● EXCLUSION -Patients with active disease who had taken drugs like
antihistamines during the last 1week
● corticosteroids , systemically during the last 4 weeks and topically during the
last 1 week or who were on immunomodulators-topical and oral
● beta blockers or tricyclic antidepressants
● who had dermatitis over the test site
● Pregnant
● Patch testing was done using prick test allergens in aluminium patch test
chambers.
● The test site - upper back
● Test material - aqueous allergens supplied by Creative Drug Industries
(Allergology division, Navi Mumbai) containing 50% glycerine as stabilizing
factor and preserved with 0.4% phenol.
● The antigens used were dust mites: Dermatophagoides farinae, D.
pteronyssinus,pollens of Cynodon dactylon and Parthenium hysterophorus,
foods like rice, wheat, milk, egg and dog and cat epithelia.
● The reading was taken after 48 and 72 hours and interpretation and Grading
of APT reaction was done according to the guidelines by European task force
on atopic dermatitis consensus
INTERPRETATIONS OBSERVATION
- Negative
+ Erythema, infilteration
++ Erythema, up to 3 papules
+++ Erythema more than 4 papules
++++ Erythema spreading papules
+++++ Erythema, vesicles
RESULTS
● Out of 75 subjects, 38 were males (51%) and 37 were females (49%) with
mean age of 17.70 (1 to 64) years.
● 70% gave personal or family history
● Commonest site - cubical fossa > popliteal fossa
● 46.66% (35) showed positive reactions
● 50.66% (38) had no reaction and 2.66% (2) manifested angry back syndrome
● Parthenium accounted for 42.8%(15) of all positive reactions followed by
Cynodon 20%(7)
● D. farinae 14%(5), D. pteronyssinus 11%(4), Milk 9%(3) and 6%(2) each to
wheat, egg, dog dander and cat dander and only one subject reacted to rice -
3%.
● among 15 parthenium APT positive subjects, 8 subjects were tested with the
Indian Standard Series (ISS) and of these 6 subjects showed positive
reaction to parthenium in ISS (delayed hypersensitivity).
DISCUSSION
● Dust mites are considered to be the most important triggering agent for atopic
dermatitis.
● Cow milk and hen egg allergy are the most important food allergies ,
avoidance resulted in the clinical improvement.
● Parthenium hysterophorus is the most important antigen in India with both
type I and type IV hypersensitivity.
● Cynodon dactylon, also called Bermuda grass,Pet dander especially cat and
dog dander,having triggering factor for atopic dermatitis
● Presence of at least seven papules after 72 h was the APT skin sign with the
greatest diagnostic accuracy for food allergy in children with atopic dermatitis.
● counselling on avoidance of allergen based on APT can reduce the morbidity
● and can reduce the drug load in atopic dermatitis.
● Advantages of APT over skin prick tests are that: it can be tested at a younger age, risk
of anaphylaxis is low And specificity is high.
● Disadvantages are
● sensitivity is lower than SPT,
● it is time consuming and only a few antigens can be tested at a time.
● To date, no “gold standard” exists for the provocation of reactions in aeroallergen
triggered atopic dermatitis and APT has not been standardised.
● The relevance of allergens for atopic dermatitis flares may be evaluated by APT in
addition to skin prick test.
Phototherapy for atopic
dermatitis
• Management of atopic dermatitis can be
challenging and involves short
‐
term control of acute
symptoms with topical corticosteroids / topical
calcineurin inhibitors, and oral corticosteroids in
severe disease.
• Various types of phototherapy that have been tried
include:
➢ PUVA therapy
➢ UVA1 phototherapy (high
‐
dose [HD], medium
‐
dose [MD],
and low
‐
dose [LD])
➢ UVA/B phototherapy
➢ Narrow
‐
band (NB
‐
UVB) phototherapy
➢ Broad
‐
band UVB (BBUVB) phototherapy.
• Phototherapy is considered a second line
treatment in the management of atopic dermatitis.
• can be tried in patients in whom the disease is not
adequately controlled with emollients and topical
corticosteroids / immunomodulators.
Material & Methods
• A literature search was performed to collect data on
the use of phototherapy in the treatment of atopic
dermatitis.
• Relevant literature published till March 2014 was
obtained from PubMed, EMBASE, and the
Cochrane Library.
Results
➢BBUVB phototherapy
• In the initial study by Jekler and Larko involving, 17
patients with half
‐
side comparison between BBUVB
(0.5–1.0 MED) and visible light, the former was
found to be significantly better.
• Hannuksela et al. utilized Psorilux 9050 emitting
UVB and UVA at 280–315 nm and 315– 400 nm to
treat 107 atopic patients and found both the
treatment modalities to be beneficial in 93% of
cases with a significant corticosteroid
‐
sparing effect.
• In another paired comparison study of 21 patients,
UVA was shown to be significantly better than
BBUVB for the total clinical score.
➢NB-UVB phototherapy
• In a study of 21 adults with severe disease, NB
‐
UVB
photo
‐
therapy given, three times weekly for 12 weeks
• There was 68% reduction in disease severity and an 88%
reduction in topical corticosteroid use
• 15 out of 21 patients continued to show benefit 24weeks
after discontinuing NB
‐
UVB
• In a randomised controlled trial, 73 patients were
randomized to receive either NB
‐
UVB, BBUVA or
visible light phototherapy twice weekly for 12
weeks.
• NB
‐
UVB was demonstrated to be very effective in
moderate
‐
to
‐
severe adult atopic dermatitis with
remission lasting for 3 months.
• BBUVA phototherapy was only moderately
beneficial
• Treatment with oral short
‐
term cyclosporin A for 4 weeks,
followed by a washout phase of 4–6 weeks and
subsequent NB
‐
UVB phototherapy (3 times/week, up to
2 months) has been reported to be effective in the
treatment of severe atopic dermatitis.
• The effect of NB
‐
UVB has been also evaluated in
children.
• In a prospective study done to asses the efficacy of NB
‐
UVB phototherapy in 29 children aged 3–16 years,
• They found 61% reduction in mean SASSAD (Six
Area Six Sign Atopic Dermatitis) score in the NB
‐
UVB cohort compared with an increase of disease
severity in the unexposed cohort.
• The effect of NB
‐
UVB has been also evaluated in children.
• In a prospective study done to asses the efficacy of NB
‐
UVB phototherapy in 29 children aged 3–16 years,
➢UVA/B Phototherapy
• Combination phototherapy of UVA and UVB irradiation
can be applied by using special tubes whose emission
spectrum includes both ranges or by combining UVA and
UVB tubes simultaneously or in a serial manner
• Valkova and Velkova demonstrated that combination
UVA/B and topical corticosteroids was significantly better
than UVA/B alone for the reduction of treatment duration
(P = 0.02)
• Granlund et al. showed that ciclosporin was significantly
better than UVA/B for the rapid reduction of SCORAD, the
days in remission and the improvement in quality of life
during the first 4 weeks of treatment
➢Photochemotherapy
• In a study by Tzaneva et al., 5
‐
methoxypsoralen (MOP)
PUVA was found to be significantly better than medium
dose UVA1 in reducing the disease severity and
increasing the duration of remission .
➢UVA-1 phototherapy
• Krutman et al. compared UVA
‐
1 phototherapy (given in a
single dose of 130J /cm2 for 15 consecutive days) with
UVA/B irradiation (starting doses 30 mJ/cm2 UVB and 7 J/
cm2 UVA, respectively)
• They found that UVA
‐
1, significantly more effective
compared with UVA/B therapy in reducing the clinical
scores and in the downregulation of eosinophilic cationic
protein levels.
Medium dose UVA
‐
1 is as effective as high dose UVA
‐
1 for
the treatment of patients with severe atopic dermatitis
In another study, medium dose UVA
‐
1 cold light (45 J/cm2,
5 times weekly for 4 weeks) showed prolonged therapeutic
improvement in disease activity and quality of life
In another study, 15 irradiation cycles of medium dose UVA
‐
1 phototherapy induced healing of the lesions in chronic
vesicular dyshidrotic hand eczema, in 10 out of 12 patients
with no relapse till 3 months
• NB
‐
UVB and medium dose UVA1 are equally effective in the
treatment of patients with moderate
‐
to
‐
severe atopic dermatitis.
• In a randomized investigator
‐
blinded trial, Majoie et al. evaluated 13
adults (aged 20–56 years) with chronic atopic dermatitis and found
NB
‐
UVB and medium dose UVA1 to be equally effective in reducing
disease severity
• Both therapies were equally effective in significantly decreasing
scores for pruritus and clinical severity .
Adverse effects
➢ MC :
• Xerosis,
• Erythema
• Burning of the skin
➢ Less common:
• Pruritus (UVA1 and full
‐
spectrum light)
• Exacerbations of eczema (UVA, NB
‐
UVB, visible light,
full
‐
spectrum light)
• Folliculitis (UVA1, PUVA)
• Photo
‐
onycholysis (PUVA)
● hyperpigmentation
● HSV reactivation
● Polymorphic light eruption
● Photo ageing
● Photo carcinogenesis
Discussion
• Based on the review of available literature,they concluded that, medium
dose UVA1 and NB
‐
UVB phototherapy are the most effective.
• UVA1 used for controlling acute flares of atopic dermatitis, whereas NB
‐
UVB is the most effective in managing chronic disease.
• High dose UVA1 and medium dose UVA1 has been shown to have
similar efficacy, so UVA1 may be the preferred option as the amount
to heat produced is less leading to better patient acceptability.
• Due to paucity of evidence, full
‐
spectrum UVA, BB
‐
UVB and full
‐
spectrum light should not be recommended for the treatment of
atopic dermatitis.
• Many studies reported the concomitant use of topical corticosteroids, which
confounds the results
• Another important aspect is the limited availability of UV1 phototherapy is, it’s
high cost
• Phototherapy may not be beneficial for all patients as some may not tolerate
the associated heat and sweating and hence, the treatment needs to be
individualized.
• New devices, such as 308 nm monochromatic
excimer light expand the therapeutic options in
patients with localized and therapy
‐
resistant disease,
even though they can treat only limited areas.
THANK YOU

Weitere ähnliche Inhalte

Ähnlich wie APT.pdf

JEADV.pptx
JEADV.pptxJEADV.pptx
JEADV.pptx
MehulChoudhary18
 
Takzema
TakzemaTakzema
Takzema
Biogetica
 
Pembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaPembrolizumab in advanced melanoma
Pembrolizumab in advanced melanoma
Ranjita Pallavi
 
Old vs New Antiseizure drugs.pptx
Old vs New Antiseizure drugs.pptxOld vs New Antiseizure drugs.pptx
Old vs New Antiseizure drugs.pptx
Pramod Krishnan
 
TB updates.pptx
TB updates.pptxTB updates.pptx
TB updates.pptx
Ankit Kumar
 
intradermal tests.pptx
intradermal tests.pptxintradermal tests.pptx
intradermal tests.pptx
VinayakAkki1
 
06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...
06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...
06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...
Arega3
 
Abstracts instylan eng
Abstracts instylan engAbstracts instylan eng
Abstracts instylan eng
Oleksii Denysov
 
Nivolumab vs Docetaxel in Lung SCC
Nivolumab vs Docetaxel in Lung SCCNivolumab vs Docetaxel in Lung SCC
Nivolumab vs Docetaxel in Lung SCC
Abdelrahman Labban
 
Halometasone monohydrate (0
Halometasone monohydrate (0Halometasone monohydrate (0
Halometasone monohydrate (0
DrSatyabrataSahoo
 
managament of drug reactions
managament of drug reactions managament of drug reactions
managament of drug reactions
Harsha Yaramati
 
Efficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasisEfficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasis
Ajeet Kumar
 
18 march what is new in tuberculosis
18 march what is new in tuberculosis18 march what is new in tuberculosis
18 march what is new in tuberculosis
PathKind Labs
 
Allergies to Antimicrobials
Allergies to AntimicrobialsAllergies to Antimicrobials
Allergies to Antimicrobials
Sandro Zorzi
 
UC journal club.pptx
UC journal club.pptxUC journal club.pptx
UC journal club.pptx
KareemSayed17
 
what is new in tuberculosis
what is new in tuberculosiswhat is new in tuberculosis
what is new in tuberculosis
PathKind Labs
 
670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf
670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf
670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf
Amar Prasad
 
Topical Cyclosporine 0.1% In The Treatment Of Vernal Catarrh
Topical Cyclosporine 0.1% In The Treatment Of Vernal CatarrhTopical Cyclosporine 0.1% In The Treatment Of Vernal Catarrh
Topical Cyclosporine 0.1% In The Treatment Of Vernal Catarrh
Dr. Jagannath Boramani
 
Chinmoy tb presentation
Chinmoy tb presentationChinmoy tb presentation
Chinmoy tb presentation
Chinmoy Lath
 
Ijss 05
Ijss 05Ijss 05
Ijss 05
drthtoan
 

Ähnlich wie APT.pdf (20)

JEADV.pptx
JEADV.pptxJEADV.pptx
JEADV.pptx
 
Takzema
TakzemaTakzema
Takzema
 
Pembrolizumab in advanced melanoma
Pembrolizumab in advanced melanomaPembrolizumab in advanced melanoma
Pembrolizumab in advanced melanoma
 
Old vs New Antiseizure drugs.pptx
Old vs New Antiseizure drugs.pptxOld vs New Antiseizure drugs.pptx
Old vs New Antiseizure drugs.pptx
 
TB updates.pptx
TB updates.pptxTB updates.pptx
TB updates.pptx
 
intradermal tests.pptx
intradermal tests.pptxintradermal tests.pptx
intradermal tests.pptx
 
06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...
06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...
06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christ...
 
Abstracts instylan eng
Abstracts instylan engAbstracts instylan eng
Abstracts instylan eng
 
Nivolumab vs Docetaxel in Lung SCC
Nivolumab vs Docetaxel in Lung SCCNivolumab vs Docetaxel in Lung SCC
Nivolumab vs Docetaxel in Lung SCC
 
Halometasone monohydrate (0
Halometasone monohydrate (0Halometasone monohydrate (0
Halometasone monohydrate (0
 
managament of drug reactions
managament of drug reactions managament of drug reactions
managament of drug reactions
 
Efficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasisEfficacy of itraconazole versus fluconazole in vaginal candidiasis
Efficacy of itraconazole versus fluconazole in vaginal candidiasis
 
18 march what is new in tuberculosis
18 march what is new in tuberculosis18 march what is new in tuberculosis
18 march what is new in tuberculosis
 
Allergies to Antimicrobials
Allergies to AntimicrobialsAllergies to Antimicrobials
Allergies to Antimicrobials
 
UC journal club.pptx
UC journal club.pptxUC journal club.pptx
UC journal club.pptx
 
what is new in tuberculosis
what is new in tuberculosiswhat is new in tuberculosis
what is new in tuberculosis
 
670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf
670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf
670f1b6b-3166-472e-b2c7-d290a60f8b75.pdf
 
Topical Cyclosporine 0.1% In The Treatment Of Vernal Catarrh
Topical Cyclosporine 0.1% In The Treatment Of Vernal CatarrhTopical Cyclosporine 0.1% In The Treatment Of Vernal Catarrh
Topical Cyclosporine 0.1% In The Treatment Of Vernal Catarrh
 
Chinmoy tb presentation
Chinmoy tb presentationChinmoy tb presentation
Chinmoy tb presentation
 
Ijss 05
Ijss 05Ijss 05
Ijss 05
 

Mehr von DeepikaKothari9

REGIMES IN LEPROSY.pptx
REGIMES IN LEPROSY.pptxREGIMES IN LEPROSY.pptx
REGIMES IN LEPROSY.pptx
DeepikaKothari9
 
GVHD - tutorial.pptx
GVHD - tutorial.pptxGVHD - tutorial.pptx
GVHD - tutorial.pptx
DeepikaKothari9
 
stains in dermatology.pptx
stains in dermatology.pptxstains in dermatology.pptx
stains in dermatology.pptx
DeepikaKothari9
 
Lepra reactions ketki.pptx
Lepra reactions ketki.pptxLepra reactions ketki.pptx
Lepra reactions ketki.pptx
DeepikaKothari9
 
Prurigo.pdf
Prurigo.pdfPrurigo.pdf
Prurigo.pdf
DeepikaKothari9
 
stains in dermatology.pptx
stains in dermatology.pptxstains in dermatology.pptx
stains in dermatology.pptx
DeepikaKothari9
 
APLA Syndrome.pptx
APLA Syndrome.pptxAPLA Syndrome.pptx
APLA Syndrome.pptx
DeepikaKothari9
 
ATOPIC DERMATITIS RASHI.pptx
ATOPIC DERMATITIS RASHI.pptxATOPIC DERMATITIS RASHI.pptx
ATOPIC DERMATITIS RASHI.pptx
DeepikaKothari9
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptx
DeepikaKothari9
 
acneiform lesions.pptx
acneiform lesions.pptxacneiform lesions.pptx
acneiform lesions.pptx
DeepikaKothari9
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptx
DeepikaKothari9
 
Rosacea tutorial.pptx
Rosacea tutorial.pptxRosacea tutorial.pptx
Rosacea tutorial.pptx
DeepikaKothari9
 
Rosacea tutorial.pptx
Rosacea tutorial.pptxRosacea tutorial.pptx
Rosacea tutorial.pptx
DeepikaKothari9
 
CRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptxCRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptx
DeepikaKothari9
 
CRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptxCRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptx
DeepikaKothari9
 

Mehr von DeepikaKothari9 (15)

REGIMES IN LEPROSY.pptx
REGIMES IN LEPROSY.pptxREGIMES IN LEPROSY.pptx
REGIMES IN LEPROSY.pptx
 
GVHD - tutorial.pptx
GVHD - tutorial.pptxGVHD - tutorial.pptx
GVHD - tutorial.pptx
 
stains in dermatology.pptx
stains in dermatology.pptxstains in dermatology.pptx
stains in dermatology.pptx
 
Lepra reactions ketki.pptx
Lepra reactions ketki.pptxLepra reactions ketki.pptx
Lepra reactions ketki.pptx
 
Prurigo.pdf
Prurigo.pdfPrurigo.pdf
Prurigo.pdf
 
stains in dermatology.pptx
stains in dermatology.pptxstains in dermatology.pptx
stains in dermatology.pptx
 
APLA Syndrome.pptx
APLA Syndrome.pptxAPLA Syndrome.pptx
APLA Syndrome.pptx
 
ATOPIC DERMATITIS RASHI.pptx
ATOPIC DERMATITIS RASHI.pptxATOPIC DERMATITIS RASHI.pptx
ATOPIC DERMATITIS RASHI.pptx
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptx
 
acneiform lesions.pptx
acneiform lesions.pptxacneiform lesions.pptx
acneiform lesions.pptx
 
Immunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptxImmunosuppressives in dermatology tut..pptx
Immunosuppressives in dermatology tut..pptx
 
Rosacea tutorial.pptx
Rosacea tutorial.pptxRosacea tutorial.pptx
Rosacea tutorial.pptx
 
Rosacea tutorial.pptx
Rosacea tutorial.pptxRosacea tutorial.pptx
Rosacea tutorial.pptx
 
CRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptxCRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptx
 
CRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptxCRYOTHERAPY 2.pptx
CRYOTHERAPY 2.pptx
 

Kürzlich hochgeladen

How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17
Celine George
 
C Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdfC Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdf
Scholarhat
 
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Murugan Solaiyappan
 
Kesadaran_Berbangsa_dan_Bernegara_Nasion.pptx
Kesadaran_Berbangsa_dan_Bernegara_Nasion.pptxKesadaran_Berbangsa_dan_Bernegara_Nasion.pptx
Kesadaran_Berbangsa_dan_Bernegara_Nasion.pptx
artenzmartenkai
 
How to Manage Large Scrollbar in Odoo 17 POS
How to Manage Large Scrollbar in Odoo 17 POSHow to Manage Large Scrollbar in Odoo 17 POS
How to Manage Large Scrollbar in Odoo 17 POS
Celine George
 
Principles of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptxPrinciples of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptx
ibtesaam huma
 
Bedok NEWater Photostory - COM322 Assessment (Story 2)
Bedok NEWater Photostory - COM322 Assessment (Story 2)Bedok NEWater Photostory - COM322 Assessment (Story 2)
Bedok NEWater Photostory - COM322 Assessment (Story 2)
Liyana Rozaini
 
Individual Performance Commitment Review Form-Developmental Plan.docx
Individual Performance Commitment Review Form-Developmental Plan.docxIndividual Performance Commitment Review Form-Developmental Plan.docx
Individual Performance Commitment Review Form-Developmental Plan.docx
monicaaringo1
 
(T.L.E.) Agriculture: Essentials of Gardening
(T.L.E.) Agriculture: Essentials of Gardening(T.L.E.) Agriculture: Essentials of Gardening
(T.L.E.) Agriculture: Essentials of Gardening
MJDuyan
 
Bài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.doc
Bài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.docBài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.doc
Bài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.doc
PhngThLmHnh
 
NC Public Schools Involved in NCDPI, Zipline Partnership
NC Public Schools Involved in NCDPI, Zipline PartnershipNC Public Schools Involved in NCDPI, Zipline Partnership
NC Public Schools Involved in NCDPI, Zipline Partnership
Mebane Rash
 
How to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POSHow to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POS
Celine George
 
Odoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On FacebookOdoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On Facebook
Celine George
 
"DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ...
"DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ..."DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ...
"DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ...
thanhluan21
 
New Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 SlidesNew Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 Slides
Celine George
 
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdf
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdfThe Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdf
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdf
JackieSparrow3
 
Howe Writing Center - Orientation Summer 2024
Howe Writing Center - Orientation Summer 2024Howe Writing Center - Orientation Summer 2024
Howe Writing Center - Orientation Summer 2024
Elizabeth Walsh
 
modul ajar kelas x bahasa inggris 2024-2025
modul ajar kelas x bahasa inggris 2024-2025modul ajar kelas x bahasa inggris 2024-2025
modul ajar kelas x bahasa inggris 2024-2025
NurFitriah45
 
Edukasyong Pantahanan at Pangkabuhayan 1: Personal Hygiene
Edukasyong Pantahanan at  Pangkabuhayan 1: Personal HygieneEdukasyong Pantahanan at  Pangkabuhayan 1: Personal Hygiene
Edukasyong Pantahanan at Pangkabuhayan 1: Personal Hygiene
MJDuyan
 
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
thanhluan21
 

Kürzlich hochgeladen (20)

How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17
 
C Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdfC Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdf
 
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
 
Kesadaran_Berbangsa_dan_Bernegara_Nasion.pptx
Kesadaran_Berbangsa_dan_Bernegara_Nasion.pptxKesadaran_Berbangsa_dan_Bernegara_Nasion.pptx
Kesadaran_Berbangsa_dan_Bernegara_Nasion.pptx
 
How to Manage Large Scrollbar in Odoo 17 POS
How to Manage Large Scrollbar in Odoo 17 POSHow to Manage Large Scrollbar in Odoo 17 POS
How to Manage Large Scrollbar in Odoo 17 POS
 
Principles of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptxPrinciples of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptx
 
Bedok NEWater Photostory - COM322 Assessment (Story 2)
Bedok NEWater Photostory - COM322 Assessment (Story 2)Bedok NEWater Photostory - COM322 Assessment (Story 2)
Bedok NEWater Photostory - COM322 Assessment (Story 2)
 
Individual Performance Commitment Review Form-Developmental Plan.docx
Individual Performance Commitment Review Form-Developmental Plan.docxIndividual Performance Commitment Review Form-Developmental Plan.docx
Individual Performance Commitment Review Form-Developmental Plan.docx
 
(T.L.E.) Agriculture: Essentials of Gardening
(T.L.E.) Agriculture: Essentials of Gardening(T.L.E.) Agriculture: Essentials of Gardening
(T.L.E.) Agriculture: Essentials of Gardening
 
Bài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.doc
Bài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.docBài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.doc
Bài tập bộ trợ anh 7 I learn smart world kì 1 năm học 2022 2023 unit 1.doc
 
NC Public Schools Involved in NCDPI, Zipline Partnership
NC Public Schools Involved in NCDPI, Zipline PartnershipNC Public Schools Involved in NCDPI, Zipline Partnership
NC Public Schools Involved in NCDPI, Zipline Partnership
 
How to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POSHow to Manage Early Receipt Printing in Odoo 17 POS
How to Manage Early Receipt Printing in Odoo 17 POS
 
Odoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On FacebookOdoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On Facebook
 
"DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ...
"DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ..."DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ...
"DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY ...
 
New Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 SlidesNew Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 Slides
 
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdf
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdfThe Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdf
The Jewish Trinity : Sabbath,Shekinah and Sanctuary 4.pdf
 
Howe Writing Center - Orientation Summer 2024
Howe Writing Center - Orientation Summer 2024Howe Writing Center - Orientation Summer 2024
Howe Writing Center - Orientation Summer 2024
 
modul ajar kelas x bahasa inggris 2024-2025
modul ajar kelas x bahasa inggris 2024-2025modul ajar kelas x bahasa inggris 2024-2025
modul ajar kelas x bahasa inggris 2024-2025
 
Edukasyong Pantahanan at Pangkabuhayan 1: Personal Hygiene
Edukasyong Pantahanan at  Pangkabuhayan 1: Personal HygieneEdukasyong Pantahanan at  Pangkabuhayan 1: Personal Hygiene
Edukasyong Pantahanan at Pangkabuhayan 1: Personal Hygiene
 
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
 

APT.pdf

  • 3. INTRODUCTION ● Atopic dermatitis is a chronic inflammatory skin disorder characterized by intense itching and a relapsing course especially in infants and children with a personal or family history of atopic disorders. ● The atopic patch test is now available for identification of allergens in aeroallergen-triggered atopic dermatitis.
  • 4. METHODS ● 75 subjects with atopic dermatitis fitting Hanifin and Rajka’s criteria and elevated serum IgE were included in the study. ● EXCLUSION -Patients with active disease who had taken drugs like antihistamines during the last 1week ● corticosteroids , systemically during the last 4 weeks and topically during the last 1 week or who were on immunomodulators-topical and oral ● beta blockers or tricyclic antidepressants ● who had dermatitis over the test site ● Pregnant
  • 5. ● Patch testing was done using prick test allergens in aluminium patch test chambers. ● The test site - upper back ● Test material - aqueous allergens supplied by Creative Drug Industries (Allergology division, Navi Mumbai) containing 50% glycerine as stabilizing factor and preserved with 0.4% phenol. ● The antigens used were dust mites: Dermatophagoides farinae, D. pteronyssinus,pollens of Cynodon dactylon and Parthenium hysterophorus, foods like rice, wheat, milk, egg and dog and cat epithelia.
  • 6. ● The reading was taken after 48 and 72 hours and interpretation and Grading of APT reaction was done according to the guidelines by European task force on atopic dermatitis consensus INTERPRETATIONS OBSERVATION - Negative + Erythema, infilteration ++ Erythema, up to 3 papules +++ Erythema more than 4 papules ++++ Erythema spreading papules +++++ Erythema, vesicles
  • 7. RESULTS ● Out of 75 subjects, 38 were males (51%) and 37 were females (49%) with mean age of 17.70 (1 to 64) years. ● 70% gave personal or family history ● Commonest site - cubical fossa > popliteal fossa ● 46.66% (35) showed positive reactions ● 50.66% (38) had no reaction and 2.66% (2) manifested angry back syndrome
  • 8. ● Parthenium accounted for 42.8%(15) of all positive reactions followed by Cynodon 20%(7) ● D. farinae 14%(5), D. pteronyssinus 11%(4), Milk 9%(3) and 6%(2) each to wheat, egg, dog dander and cat dander and only one subject reacted to rice - 3%. ● among 15 parthenium APT positive subjects, 8 subjects were tested with the Indian Standard Series (ISS) and of these 6 subjects showed positive reaction to parthenium in ISS (delayed hypersensitivity).
  • 9. DISCUSSION ● Dust mites are considered to be the most important triggering agent for atopic dermatitis. ● Cow milk and hen egg allergy are the most important food allergies , avoidance resulted in the clinical improvement.
  • 10. ● Parthenium hysterophorus is the most important antigen in India with both type I and type IV hypersensitivity. ● Cynodon dactylon, also called Bermuda grass,Pet dander especially cat and dog dander,having triggering factor for atopic dermatitis ● Presence of at least seven papules after 72 h was the APT skin sign with the greatest diagnostic accuracy for food allergy in children with atopic dermatitis.
  • 11. ● counselling on avoidance of allergen based on APT can reduce the morbidity ● and can reduce the drug load in atopic dermatitis.
  • 12. ● Advantages of APT over skin prick tests are that: it can be tested at a younger age, risk of anaphylaxis is low And specificity is high. ● Disadvantages are ● sensitivity is lower than SPT, ● it is time consuming and only a few antigens can be tested at a time. ● To date, no “gold standard” exists for the provocation of reactions in aeroallergen triggered atopic dermatitis and APT has not been standardised. ● The relevance of allergens for atopic dermatitis flares may be evaluated by APT in addition to skin prick test.
  • 14. • Management of atopic dermatitis can be challenging and involves short ‐ term control of acute symptoms with topical corticosteroids / topical calcineurin inhibitors, and oral corticosteroids in severe disease. • Various types of phototherapy that have been tried include: ➢ PUVA therapy ➢ UVA1 phototherapy (high ‐ dose [HD], medium ‐ dose [MD], and low ‐ dose [LD]) ➢ UVA/B phototherapy ➢ Narrow ‐ band (NB ‐ UVB) phototherapy ➢ Broad ‐ band UVB (BBUVB) phototherapy.
  • 15. • Phototherapy is considered a second line treatment in the management of atopic dermatitis. • can be tried in patients in whom the disease is not adequately controlled with emollients and topical corticosteroids / immunomodulators.
  • 16. Material & Methods • A literature search was performed to collect data on the use of phototherapy in the treatment of atopic dermatitis. • Relevant literature published till March 2014 was obtained from PubMed, EMBASE, and the Cochrane Library.
  • 17. Results ➢BBUVB phototherapy • In the initial study by Jekler and Larko involving, 17 patients with half ‐ side comparison between BBUVB (0.5–1.0 MED) and visible light, the former was found to be significantly better.
  • 18. • Hannuksela et al. utilized Psorilux 9050 emitting UVB and UVA at 280–315 nm and 315– 400 nm to treat 107 atopic patients and found both the treatment modalities to be beneficial in 93% of cases with a significant corticosteroid ‐ sparing effect. • In another paired comparison study of 21 patients, UVA was shown to be significantly better than BBUVB for the total clinical score.
  • 19. ➢NB-UVB phototherapy • In a study of 21 adults with severe disease, NB ‐ UVB photo ‐ therapy given, three times weekly for 12 weeks • There was 68% reduction in disease severity and an 88% reduction in topical corticosteroid use • 15 out of 21 patients continued to show benefit 24weeks after discontinuing NB ‐ UVB
  • 20. • In a randomised controlled trial, 73 patients were randomized to receive either NB ‐ UVB, BBUVA or visible light phototherapy twice weekly for 12 weeks. • NB ‐ UVB was demonstrated to be very effective in moderate ‐ to ‐ severe adult atopic dermatitis with remission lasting for 3 months. • BBUVA phototherapy was only moderately beneficial
  • 21. • Treatment with oral short ‐ term cyclosporin A for 4 weeks, followed by a washout phase of 4–6 weeks and subsequent NB ‐ UVB phototherapy (3 times/week, up to 2 months) has been reported to be effective in the treatment of severe atopic dermatitis. • The effect of NB ‐ UVB has been also evaluated in children. • In a prospective study done to asses the efficacy of NB ‐ UVB phototherapy in 29 children aged 3–16 years,
  • 22. • They found 61% reduction in mean SASSAD (Six Area Six Sign Atopic Dermatitis) score in the NB ‐ UVB cohort compared with an increase of disease severity in the unexposed cohort. • The effect of NB ‐ UVB has been also evaluated in children. • In a prospective study done to asses the efficacy of NB ‐ UVB phototherapy in 29 children aged 3–16 years,
  • 23. ➢UVA/B Phototherapy • Combination phototherapy of UVA and UVB irradiation can be applied by using special tubes whose emission spectrum includes both ranges or by combining UVA and UVB tubes simultaneously or in a serial manner • Valkova and Velkova demonstrated that combination UVA/B and topical corticosteroids was significantly better than UVA/B alone for the reduction of treatment duration (P = 0.02)
  • 24. • Granlund et al. showed that ciclosporin was significantly better than UVA/B for the rapid reduction of SCORAD, the days in remission and the improvement in quality of life during the first 4 weeks of treatment
  • 25. ➢Photochemotherapy • In a study by Tzaneva et al., 5 ‐ methoxypsoralen (MOP) PUVA was found to be significantly better than medium dose UVA1 in reducing the disease severity and increasing the duration of remission .
  • 26. ➢UVA-1 phototherapy • Krutman et al. compared UVA ‐ 1 phototherapy (given in a single dose of 130J /cm2 for 15 consecutive days) with UVA/B irradiation (starting doses 30 mJ/cm2 UVB and 7 J/ cm2 UVA, respectively) • They found that UVA ‐ 1, significantly more effective compared with UVA/B therapy in reducing the clinical scores and in the downregulation of eosinophilic cationic protein levels.
  • 27. Medium dose UVA ‐ 1 is as effective as high dose UVA ‐ 1 for the treatment of patients with severe atopic dermatitis In another study, medium dose UVA ‐ 1 cold light (45 J/cm2, 5 times weekly for 4 weeks) showed prolonged therapeutic improvement in disease activity and quality of life In another study, 15 irradiation cycles of medium dose UVA ‐ 1 phototherapy induced healing of the lesions in chronic vesicular dyshidrotic hand eczema, in 10 out of 12 patients with no relapse till 3 months
  • 28. • NB ‐ UVB and medium dose UVA1 are equally effective in the treatment of patients with moderate ‐ to ‐ severe atopic dermatitis. • In a randomized investigator ‐ blinded trial, Majoie et al. evaluated 13 adults (aged 20–56 years) with chronic atopic dermatitis and found NB ‐ UVB and medium dose UVA1 to be equally effective in reducing disease severity • Both therapies were equally effective in significantly decreasing scores for pruritus and clinical severity .
  • 29. Adverse effects ➢ MC : • Xerosis, • Erythema • Burning of the skin ➢ Less common: • Pruritus (UVA1 and full ‐ spectrum light) • Exacerbations of eczema (UVA, NB ‐ UVB, visible light, full ‐ spectrum light) • Folliculitis (UVA1, PUVA) • Photo ‐ onycholysis (PUVA)
  • 30. ● hyperpigmentation ● HSV reactivation ● Polymorphic light eruption ● Photo ageing ● Photo carcinogenesis
  • 31. Discussion • Based on the review of available literature,they concluded that, medium dose UVA1 and NB ‐ UVB phototherapy are the most effective. • UVA1 used for controlling acute flares of atopic dermatitis, whereas NB ‐ UVB is the most effective in managing chronic disease.
  • 32. • High dose UVA1 and medium dose UVA1 has been shown to have similar efficacy, so UVA1 may be the preferred option as the amount to heat produced is less leading to better patient acceptability. • Due to paucity of evidence, full ‐ spectrum UVA, BB ‐ UVB and full ‐ spectrum light should not be recommended for the treatment of atopic dermatitis.
  • 33. • Many studies reported the concomitant use of topical corticosteroids, which confounds the results • Another important aspect is the limited availability of UV1 phototherapy is, it’s high cost • Phototherapy may not be beneficial for all patients as some may not tolerate the associated heat and sweating and hence, the treatment needs to be individualized.
  • 34. • New devices, such as 308 nm monochromatic excimer light expand the therapeutic options in patients with localized and therapy ‐ resistant disease, even though they can treat only limited areas.