Atopic Dermatitis and Treatments in 2023

Atopic dermatitis is the most common form of eczema, affecting greater than 9 million children and about 16.5 million adults in the United States. It is a chronic condition that can have exacerbations for years throughout life. It can overlap with other types of eczema. These include,

Contact dermatitis
Dyshidrotic eczema
Stasis dermatitis
Neurodermatitis
Nummular eczema
Seborrheic dermatitis

In patients with AD, the immune system becomes disorganized and overactive. This triggers inflammation and damages the skin barrier. These dry areas are typically red, inflamed and extremely pruritic. They can have varied discoloration depending on the race of the individual.

Research has shown, people with AD have a mutation of the gene filaggrin. Filaggrin is a protein that helps form a protective barrier in the skin. Without enough filaggrin, moisture can escape, and bacteria and other pathogens can invade leading to chronic skin infections.

Atopic dermatitis typically begins in childhood and can exacerbate into adulthood. It is often associated with asthma and allergies. Itching is the hallmark and 85% of people with this condition experience puritis on a daily basis. This often interferes with normal sleep patterns.

Patients with AD can get rashes anywhere on the body. These can weep, bleed and become infected. They are typically dry, red and inflamed. They can become thickened and hard, a process called lichenification.

In teens and adults, the most common areas for AD include the hands, neck, elbows and knees, the skin around the eyes and the ankles and feet. Common skin features associated with AD include an extra fold of skin under the eye called the Dennie-Morgan fold, darkening under the eye and extra skin creases on the palms and soles of the feet.

Causes of Atopic Dermatitis

Genetics- the chance of developing AD is higher if there is a family history. Research has identified the Filaggrin mutation as described above.
Immune system- The immune system is overactive and causes an inflammatory environment.
Environment- The immune system causes a change in the protective barrier of the skin. This permits exposure to toxic environmental triggers such as tobacco smoke, air pollutants, fragrances, skin products, soaps and detergents.

Treatment

Non- pharmacological interventions such as emollient creams and moisturizers
Corticosteroids
Calcineurin inhibitors
Phototherapy
Oral antihistamines for the itch
Antibiotics under certain circumstances
Monoclonal antibodies
Platelet Rich Plasma
Exosomes

Platelet rich plasma is used in many treatment protocols for dermatologic conditions. It works by releasing bioactive proteins such as cytokines and growth factors. These modulate the inflammatory pathways and induce a tissue healing cascade involving inflammation, proliferation and remodeling thus promoting skin health.

When PRP is injected into the skin, the activated platelets degranulate, releasing the growth factors such as platelet derived, transforming, vascular, epidermal and fibroblast factors. These modulate the cells inducing angiogenesis, cell migration proliferation and differentiation. They also induce changes in the extracellular matrix. These natural healing processes by PRP promotes the healing in atopic dermatitis.

PRP, in atopic dermatitis, was shown to improve the dark circles under the eyes. In one study with repeated use, the symptoms gradually reduced and eventually resolved for extended periods of time. This period extended over two years, which the author concluded was “unprecedented”.

Ghani et al. have reported improved biomarkers after the treatment of atopic eczema with PRP. Clinical examination revealed marked improvement and the patient reported marked control of the itchiness and the disappearance of the rash.

Yosef et al. published encouraging results of their split side study reporting a statistically significant reduction in the scores of the combination of PRP plus ultraviolet light in comparison to light alone.

All studies concluded that PRP was safe and effective in all patients and no adverse events were reported.

Exosomes are nano sized vesicles released by almost all types of cells. The ability of exosomes to travel between cells and deliver their cargo, which includes lipids, proteins, and nucleic acids, makes them an appealing cell free therapy option to treat many diseases including atopic dermatitis. As atopic dermatitis is a multifactorial, heterogenous disease associated with epidermal barrier disruption and intense inflammation, exosomes have been shown to attenuate AD symptoms by reducing multiple inflammatory cytokines. Exosomes also modulate the skin barrier to remarkedly reduce epidermal water loss while enhancing the stratum corneum layer. Deep RNA sequencing analysis of skin lesions treated with exosomes demonstrated the restoration of the expression of genes involved in the skin barrier, lipid metabolism, cell cycle and inflammatory response in the diseased area.

In the first study of its kind, investigating how dermal fibroblast exosomes recover skin function, efficacy was proven in increasing skin epidermal barrier proteins thus increasing the recovery rate of skin damage without significant side effects. ( Yo et al.)

Phototherapy is an important method of dermatological treatments. Ultraviolet therapy is of great importance but there are concerns of its long-term use as it can lead to aging and carcinogenesis. Blue light is a UV free method. The main mediators to blue light are nitric oxide and reactive oxygen species. It has been demonstrated that blue light induces an anti-inflammatory and anti-proliferative effect making it a superior choice in inflammatory dermatosis such as eczema and atopic dermatitis. Studies have shown no long-term side effects.

Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits have been scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.

Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative cascade. This activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.

Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called “the second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory environment and can be used confidently in inflammatory conditions.

Juventix Regenerative Medical also offers Low Laser Light Therapy and our DermaMend device. This gives clinicians options when various spectrums of light are needed for different conditions. LLLT has been proven in many dermatologic conditions such as atopic dermatitis.

Juventix Regenerative Medical is collaborating with Evolutionary Biologics to offer their catalogue of regenerative products. The Evo Elixir contains dermal fibroblast conditioned media that would provide a product that could be used in conjunction with other modalities or stand alone in the treatment of atopic dermatitis.