doi: 10.1111/1346-8138.12484
Journal of Dermatology 2014; 41: 199
EDITORIAL
Atopic dermatitis
Atopic dermatitis is the second-most common skin disease in Japan. It generally manifests a chronic and intolerant itch and sleep disturbance which deteriorates patients’ quality of life at home, school and work place. The social and individual burden is enormous, resulting in unemployment and absence-ofschool in severe recalcitrant cases. Researches on pruritus are likely to be far behind the levels of those on pain field, however, recent studies rapidly unveil a specific peripheral and central itch-mediating system. Semaphorin 3A/nerve growth factor balance and IL-31 are paid much attention in peripheral itch, whereas gastrin-releasing peptide is emerging candidate in mediating central itch. Based on these findings, new therapies targeting pruritus may appear soon. Recent genom-wide association studies (GWAS) and immunochip analysis of atopic dermatitis have identified a total of 19 associated loci with a genome-wide level of significance (P < 5 9 10 8). The candidate genes identified by GWAS suggest a role for epidermal barrier functions, innate-adaptive immunity, IL-1 family signaling, regulatory T cells, the vitamin D pathway and the NGF pathway in the pathogenesis of atopic dermatitis. Combinations of these genetic factors might influence a wide range of phenotypes of atopic dermatitis among individuals. Filaggrin
© 2014 Japanese Dermatological Association
gene mutation is now widely accepted to be associated with atopic dermatitis, therefore, topical application of emollients is recognized as a fundamental standard therapy together with topical anti-inflammatory agent such as steroids and calcineurin inhibitors. Fear to topical steroids or steroid phobia is still one of the major concern of patients world-wide. Adherence of topical remedies is generally low and the steroid phobia further decrease the adherence to standard topical therapy. In Japan, serum TARC/CCL17 levels are covered by medical insurance. As the TARC levels correlate very well with the disease severity of atopic dermatitis, patients are now able to numerically evaluate their disease condition, sharing the information with their dermatologists. This type of resonance feeling fosters more intimate patient/doctor relationship, contributing to the increased adherence. In this special issue entitled “Atopic Dermatitis”, we focus on the epidemiology, itch investigation, genetic advancement and therapeutic monitoring by serum TARC in our review articles. Masutaka FURUE Department of Dermatology, Kyushu University Editor-in-Chief
199
Journal of Dermatology 2014; 41: 199
EDITORIAL
Atopic dermatitis
Atopic dermatitis is the second-most common skin disease in Japan. It generally manifests a chronic and intolerant itch and sleep disturbance which deteriorates patients’ quality of life at home, school and work place. The social and individual burden is enormous, resulting in unemployment and absence-ofschool in severe recalcitrant cases. Researches on pruritus are likely to be far behind the levels of those on pain field, however, recent studies rapidly unveil a specific peripheral and central itch-mediating system. Semaphorin 3A/nerve growth factor balance and IL-31 are paid much attention in peripheral itch, whereas gastrin-releasing peptide is emerging candidate in mediating central itch. Based on these findings, new therapies targeting pruritus may appear soon. Recent genom-wide association studies (GWAS) and immunochip analysis of atopic dermatitis have identified a total of 19 associated loci with a genome-wide level of significance (P < 5 9 10 8). The candidate genes identified by GWAS suggest a role for epidermal barrier functions, innate-adaptive immunity, IL-1 family signaling, regulatory T cells, the vitamin D pathway and the NGF pathway in the pathogenesis of atopic dermatitis. Combinations of these genetic factors might influence a wide range of phenotypes of atopic dermatitis among individuals. Filaggrin
© 2014 Japanese Dermatological Association
gene mutation is now widely accepted to be associated with atopic dermatitis, therefore, topical application of emollients is recognized as a fundamental standard therapy together with topical anti-inflammatory agent such as steroids and calcineurin inhibitors. Fear to topical steroids or steroid phobia is still one of the major concern of patients world-wide. Adherence of topical remedies is generally low and the steroid phobia further decrease the adherence to standard topical therapy. In Japan, serum TARC/CCL17 levels are covered by medical insurance. As the TARC levels correlate very well with the disease severity of atopic dermatitis, patients are now able to numerically evaluate their disease condition, sharing the information with their dermatologists. This type of resonance feeling fosters more intimate patient/doctor relationship, contributing to the increased adherence. In this special issue entitled “Atopic Dermatitis”, we focus on the epidemiology, itch investigation, genetic advancement and therapeutic monitoring by serum TARC in our review articles. Masutaka FURUE Department of Dermatology, Kyushu University Editor-in-Chief
199
