aprepitant and Dermatitis--Atopic

Patients with atopic dermatitis (AD) suffer from chronic inflammatory dermatitis and antihistamine-resistant itch. The management of intractable pruritus in AD is important, requiring the development of new therapeutic approaches. At present, the standard treatments for AD include topical anti-inflammatory drugs such as calcineurin inhibitors and corticosteroids. Topical emollient treatment is recommended to moisten the skin and to restore and maintain barrier function. Phototherapy is also effective in reducing the number of epidermal nerve fibers, normalizing imbalances in the levels of expression of axon guidance molecules, and inhibiting pruritus. Systemic treatments such as cyclosporine A and aprepitant are used to treat severe and intractable pruritus in AD. Clinical trials of dupilumab and CIM331 have displayed a significant reduction of pruritus in patients with AD. New antipruritic approaches are targeted to the central nervous system such as spinal interneurons and glial cells. This chapter describes therapeutic approaches for attenuating intractable itch in AD.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Aprepitant; Calcineurin Inhibitors; Cyclosporine; Dermatitis, Atopic; Dermatologic Agents; Emollients; Humans; Morpholines; Neurokinin-1 Receptor Antagonists; Phototherapy; Pruritus

Atopic dermatitis (AD) is a chronic, itchy, inflammatory skin disorder that may worsen due to stress and anxiety. Tachykinins have been suggested to be involved in the inflammation in AD, as well as pruritus. Aprepitant is a NK-1 receptor antagonist. This open randomized trial evaluated the effect of aprepitant added to topical treatment in adult patients with moderate-severe AD. The treatment group (n = 19) received 80 mg/day aprepitant for 7 days as a supplement to standardized topical treatment with a moderately strong steroid and a moisturizer. The control group (n = 20) received topical treatment alone. Patients were monitored for the extent of the disease (using SCORing of Atopic Dermatitis; SCORAD), pruritus, and scratching movements. In both the aprepitant-treated and the control groups there was a decrease in SCORAD, pruritus and scratching movements. However, there was no significant additional improvement in any of these parameters in the aprepitant-treated group compared with the control group.

Topics: Administration, Cutaneous; Adult; Antipruritics; Aprepitant; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Morpholines; Neurokinin-1 Receptor Antagonists; Pruritus; Severity of Illness Index; Skin; Substance P; Sweden; Time Factors; Treatment Outcome; Young Adult

Korean red ginseng (KRG, Panax ginseng C.A. Meyer) has traditionally been considered to harbor anti-allergic effects, however its action on atopic dermatitis (AD) is unclear. Therefore, we investigated the effect of KRG on AD using NC/Nga mice as an AD model. In addition, we examined the effect of aprepitant (substance P specific neurokinin receptor antagonist) on AD.. The KRG extract and aprepitant were administered orally to NC/Nga mice. The efficacy of KRG and aprepitant was evaluated by assessing total clinical severity score, ear thickness, serum IgE level and histology. In addition, mRNA and protein expression were measured by real-time RT-PCR and immunohistochemistry, respectively.. The KRG extract significantly reduced the total clinical severity score, ear thickness and the level of serum IgE in AD mouse model, whereas aprepitant reduced only the serum IgE level. KRG not only decreased TNF-α, IFN-γ and substance P but also reduced the infiltration of FOXP3+ regulatory T (Treg) cells and CD1a+ Langerhans cells in the lesions, whereas aprepitant decreased only substance P and the infiltration of Treg cells.. These results suggest that KRG extract may be a potential therapeutic modality for AD and aprepitant could be used as adjunctive agent to control pruritus in AD.

Topics: Animals; Anti-Allergic Agents; Aprepitant; Dermatitis, Atopic; Disease Models, Animal; Down-Regulation; Ethnopharmacology; Female; Forkhead Transcription Factors; Immunoglobulin E; Interferon-gamma; Medicine, Korean Traditional; Mice; Morpholines; Neurokinin-1 Receptor Antagonists; Panax; Phytotherapy; Plant Extracts; Plants, Medicinal; Republic of Korea; RNA, Messenger; Tumor Necrosis Factor-alpha