73 research outputs found

    Pimecrolimus in atopic dermatitis: Consensus on safety and the need to allow use in infants

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    Atopic dermatitis (AD) is a distressing dermatological disease, which is highly prevalent during infancy, can persist into later life and requires long-term management with anti-inflammatory compounds. The introduction of the topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, more than 10 yr ago was a major breakthrough for the topical anti-inflammatory treatment of AD. Pimecrolimus 1% is approved for second-line use in children (≥2 yr old) and adults with mild-to-moderate AD. The age restriction was emphasized in a boxed warning added by the FDA in January 2006, which also highlights the lack of long-term safety data and the theoretical risk of skin malignancy and lymphoma. Since then, pimecrolimus has been extensively investigated in short- and long-term studies including over 4000 infants (<2 yr old). These studies showed that pimecrolimus effectively treats AD in infants, with sustained improvement with long-term intermittent use. Unlike topical corticosteroids, long-term TCI use does not carry the risks of skin atrophy, impaired epidermal barrier function or enhanced percutaneous absorption, and so is suitable for AD treatment especially in sensitive skin areas. Most importantly, the studies of pimecrolimus in infants provided no evidence for systemic immunosuppression, and a comprehensive body of evidence from clinical studies, post-marketing surveillance and epidemiological investigations does not support potential safety concerns. In conclusion, the authors consider that the labelling restrictions regarding the use of pimecrolimus in infants are no longer justified and recommend that the validity of the boxed warning for TCIs should be reconsidered

    When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

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    BackgroundAlthough most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking.ObjectiveTo guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient.MethodsA subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion.ResultsWe recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy.LimitationsOur work is a consensus statement, not a systematic review.ConclusionThe decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies

    Impact of Forest Seral Stage on use of Ant Communities for Rapid Assessment of Terrestrial Ecosystem Health

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    Bioassessment evaluates ecosystem health by using the responses of a community of organisms that integrate all aspects of the ecosystem. A variety of bioassessment methods have been applied to aquatic ecosystems; however, terrestrial methods are less advanced. The objective of this study was to examine baseline differences in ant communities at different seral stages from clear cut to mature pine plantation as a precursor to developing a broader terrestrial bioassessment protocol. Comparative sampling was conducted at nine sites having four seral stages: clearcut, 5 year recovery, 15 year recovery, and mature stands. Soil and vegetation data were also collected at each site. Ants were identified to genus. Analysis of the ant data indicated that ants respond strongly to habitat changes that accompany ecological succession in managed pine forests, and both individual genera and ant community structure can be used as indicators of successional change. Ants exhibited relatively high diversity in both early and mature seral stages. High ant diversity in mature seral stages was likely related to conditions on the forest floor favoring litter dwelling and cold climate specialists. While ants may be very useful in identifying environmental stress in managed pine forests, adjustments must be made for seral stage when comparing impacted and unimpacted forests
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