Complementary, Alternative and Integrative Medicine for Childhood Atopic Dermatitis

Background: Atopic Dermatitis (AD) is a chronic relapsing dermatosis associated with itch, sleep disturbance and poor quality of life. Treatment of AD includes the use of emollients, and topical and systemic immunomodulating agents. Many patients also use complementary and alternative medicine (CAM). Objective: This article reviews the pathophysiology of AD, clinical trials and recent patents involving various modalities of CAM in the treatment of AD. Methods: A Medline/Pubmed search was conducted using Clinical Queries with the key terms “Chinese Medicine OR Complementary and Alternative medicine” AND “Eczema OR Atopic dermatitis”. The search strategy included meta-analyses, Randomized Controlled Trials (RCTs), clinical trials, reviews and pertinent references. Patents were searched using the key term 'atopic dermatitis' from www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. Results: Only a few RCTs evaluated the efficacy of Chinese medicinal herbs in treating AD. There was some evidence for other modalities of CAM. Integrative Medicine (IM) usually refers to the various forms of CAM that combine conventional western medicine and Chinese medicine. Supporting evidence for the efficacy of IM in the treatment of AD is presently lacking. Integration is difficult. Western medicine practitioners are often ignorant about CAM and IM. Parents are concerned about the potential side effects of Western medicine and will tend to be non-compliant with the conventional Western component of IM. Recent patents on CAM and IM are reviewed. Most CAM patents are herbal compositions, evidence on their efficacy is generally lacking. Conclusion: AD is a complex disease. The psychodynamics of the child and his/her family is the reason for the often suboptimal outcomes. Both Western and CAM practitioners should collaborate to create a mutually encouraging environment for the advances of IM. CAM and IM publications and patents are reviewed. Evidence of their efficacy is generally lacking. Further research is needed. Keywords: Alternative medicine, atopic dermatitis, Chinese herbal medicine, complementary medicine, eczema, integrative medicine, pathogenesis

Signal transducer and activator of transcription 3 (STAT3) gene mutations in two patients with hyperimmunoglobulin E syndrome

The autosomal dominant (AD) hyperimmunoglobulin E syndrome (HIES, Job syndrome) is a primary immunodeficiency with multiple systemic involvements. It is characterised by grossly raised serum immunoglobulin E (IgE) level with recurrent cutaneous and pulmonary infections, eczema, pneumatocoeles, dental and musculoskeletal problems. The occurrence of the classic triads, namely recurrent cold abscesses, pneumatocoele formation and raised serum immunoglobulin E should alert the clinicians on the diagnosis of HIES. Mutations in the signal transducer and activator of transcription 3 (STAT3) gene have been identified recently to be the cause of AD HIES. We report 3 patients with HIES, in whom 2 were found to have STAT3 gene mutations.link_to_subscribed_fulltex