This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus-based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account. This second part of the guideline covers antimicrobial therapy, systemic treatment, allergen-specific immunotherapy, complementary medicine, psychosomatic counselling and educational interventions, whereas the first part covers methods, patient perspective, general measures and avoidance strategies, basic emollient treatment and bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy. Management of AE must consider the individual clinical variability of the disease. Systemic immunosuppressive treatment with cyclosporine, methotrexate, azathioprine and mycophenolic acid is established option for severe refractory cases, and widely available. Biologicals targeting the T helper 2 pathway such as dupilumab may be a safe and effective, disease-modifying alternative when available. Oral drugs such as JAK inhibitors and histamine 4 receptor antagonists are in development. Microbial colonization and superinfection may cause disease exacerbation and can require additional antimicrobial treatment. Allergen-specific immunotherapy with aeroallergens may be considered in selected cases. Psychosomatic counselling is recommended especially in stress-induced exacerbations. Therapeutic patient education ('Eczema school') is recommended for children and adult patients. General measures, basic emollient treatment, bathing, dietary intervention, topical anti-inflammatory therapy, phototherapy and antipruritic therapy have been addressed in the first part of the guideline.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.14891

Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I.

The rise in the incidence of obesity has led to a major interest in the biology of white adipose tissue. The tissue is a major endocrine and signaling organ, with adipocytes, the characteristic cel...

Hypoxia and Adipose Tissue Function and Dysfunction in Obesity

Implication of free radical mechanisms in ethanol-induced cellular injury

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune-suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen-specific immunotherapy to aeroallergens may be useful in selected cases. Stress-induced exacerbations may make psychosomatic counselling recommendable. 'Eczema school' educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.

https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1468-3083.2012.04635.x

Guidelines for treatment of atopic eczema (atopic dermatitis) part I.

INTRODUCTION .. . . . .. . . . .. . . . . .... . . . . ... . .... . . . . .... . . ...... . . ..... . . . .. . . . .... . . . .. . . . 1 39 DIETARY ANTIOXIDANTS: THEORETICAL ROLES IN CANCER PREVENTION .... . .. . . . . .... . . . ... . . .. . ........ . ... . .. .. .. . . . . . . . . . . . ... . . . . . . . . . . . . . . . . 140 LABORATORY ANIMAL RESEARCH . . . . . .. . . . . . . ...... .. . .. . .. . . .. . . ... . . .... . . . . . .. . . . . . .. . 142 Carotenoids ... . . . . . . . . .. . . . . . . . . . .. . .. . . . . . . . . . ..... ....... . . . .. . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Vitamin C . . ... . . . .. . . . . . . . .. . . . . . . .. . . . . . .. .. . . . . ..... . .... . . . . . . . . . . . . . . . . . .... . . . ... . . .. . . . . .. . . . 144 Vitamin E. . . . . . . . ... . . . ..... . ... . . . .. ..... .. . . . ..... . . ....... . . . . .... . . . . .... . . . . . . . 144 EPIDEMIOLOGIC STUDIES . . . ..... . . . .... . . ...... . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Dietary Assessment . . .. . . .... . . . . .... . .... . . ...... . .. . . . . .. . . . .... . . . ..... . . ... . . . . ... . . . .. . . .. . . . 145 Case-Control and Cohort Diet Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . 145 Studies of Blood Nutrients . . . . .. . . . . .. . . . . . .... . . . . . ... . . . ...... . . ... . . . . . . . . . . . .. .. ...... . . . . . . 1 5 1 Randomized Controlled Trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . ... . 153 CONCLUSIONS AND RECOMMENDATIONS . ... . .. . . .. . . . . .. . . . . . . . . . . . ... . .. . ... . . .. . . .. . 153

Dietary carotenes, vitamin C, and vitamin E as protective antioxidants in human cancers.

Vitamin E is the term used for eight naturally occurring fat-soluble nutrients called tocopherols. alpha-Tocopherol is essential, has the highest biological activity and predominates in many species. In humans vitamin E is the most important lipid soluble antioxidant and deficiency may cause neurological dysfunction, myopathies and diminished erythrocyte life span. alpha-Tocopherol is absorbed via the lymphatic pathway and transported in association with chylomicrons. In plasma, alpha-tocopherol is found in all lipoprotein fractions but mostly is associated with apo B-containing lipoproteins. alpha-Tocopherol is associated with very-low-density lipoprotein when it is secreted from the liver. In the rat, about 90% of total body mass of alpha-tocopherol is recovered in the liver, skeletal muscle and adipose tissue. Most alpha-tocopherol is located in the mitochondrial fractions and in the endoplasmic reticulum, whereas little is found in cytosol and peroxisomes. New clinical evidence from heavy drinkers and from experimental work in rats suggests that alcohol may increase oxidation of alpha-tocopherol. Increased demand for vitamin E has also been observed in premature infants and patients with malabsorption, but there is little evidence that the healthy population requires supplementation of vitamin E to a well-balanced diet.

Absorption, transport and distribution of vitamin E.

The effects of a dietary supplement of n-3 fatty acids in patients with atopic dermatitis were investigated in a 12-week, double-blind study. The experimental group received 10 g of fish oil daily, of which about 1.8 g was eicosapentaenoic acid. This amount of eicosapentaenoic acid can be obtained from a daily intake of fat fish. The controls received an iso-energetic placebo supplement containing olive oil. Compliance was monitored by gas-chromatographic analysis of the fatty acid pattern in serum phospholipids. Results favoured the experimental group with regard to scale (P less than 0.05), itch (P less than 0.05) and overall subjective severity (P less than 0.02) as compared to the controls.

Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis

In a double-blind, block randomized study we investigated the effect of dietary supplementation with eicosapentaenoic acid in patients with psoriasis. The experimental group received 10 g of fish oil daily containing approximately 1.8 g eicosapentaenoic acid, while the controls were given an isoenergetic amount of olive oil. We found no significant change in the clinical manifestations of psoriasis in either group after 8 weeks of treatment. In the experimental group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of trial as compared to pre-treatment values, whereas the level of n-6 fatty acids was decreased.

Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis

Secretion of α-tocopherol from cultured rat hepatocytes

The concentration of alpha-tocopherol was measured in liver biopsy specimens obtained from 83 patients with alcoholic and non-alcoholic liver diseases. The mean hepatic vitamin E content (as alpha-tocopherol) was significantly lower in 23 patients with alcoholic cirrhosis (17.6 +/- 12.1 nmol/mg wet weight liver), compared with 12 patients with normal liver histology (39.2 +/- 29.7 nmol/mg, P less than 0.01). The mean serum concentration of alpha-tocopherol was lower in patients with alcoholic cirrhosis (13.9 +/- 7.0 mumol/l) than in individuals with alcoholic fatty liver (21.3 +/- 9.3 mumol/l, P less than 0.01) and patients with normal liver histology (23.4 +/- 11.6 mumol/l, P less than 0.01). A decreased ratio of serum alpha-tocopherol/total serum lipids was also observed in patients with alcoholic cirrhosis, compared with patients with normal liver histology (P less than 0.05). There was a significant correlation between concentrations of alpha-tocopherol in liver and serum (r = 0.43, P less than 0.001). Furthermore, serum alpha-tocopherol correlated with retinol (r = 0.53, P less than 0.001), selenium (r = 0.45, P less than 0.001), and albumin (r = 0.37, P less than 0.001) in serum. We suggest that the reduced content of hepatic alpha-tocopherol observed in some patients may play a role in ethanol-induced lipid peroxidation.

A. Bjørneboe

Papers

Absorption, transport and distribution of vitamin E.

Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis

Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis

Secretion of α-tocopherol from cultured rat hepatocytes

Reduced concentration of hepatic α-tocopherol in patients with alcoholic liver cirrhosis