Types of Eczema. The classification below is based on incidence frequency. Atopic dermatitis of the anterior flexural crease of the elbow

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2 CONTENTS 1. Eczema 2. Types of Eczema 3. How to treat Eczema 4. Atopshield Forte 5. Composition of Atopshield FORTE 6. Mechanism of Action 7. Indications of Atopshield Forte 8. Atopshield forte in Eczema 9. Atopshield forte in Psoriasis

3 3 Eczema (Dermatitis) Eczema (From Greek κζεµα ēkzema, 'to boil over') is a form of dermatitis, [2] or inflammation of the epidermis (the outer layer of the skin). The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Dermatitis and eczema refers to the same medical condition but sometimes dermatitis implies an acute condition and eczema a chronic one Dermatitis comes from the Greek word for skin and both terms refer to exactly the same skin condition. In some languages, dermatitis and eczema are synonymous, while in other languages dermatitis implies an acute condition and "eczema" a chronic one. The two conditions are often classified together. 3

4 4 Types of Eczema The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms used to describe the same condition. A type of eczema may be described by location (e.g., hand eczema), by specific appearance (eczema, craqulureor discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema for the most common type of eczema (atopic dermatitis) interchangeably. The classification below is based on incidence frequency Atopic Eczema Atopic dermatitis is an inflammatory, chronically relapsing, non-contagious and pruritic skin disorder. The skin of a patient with atopic dermatitis reacts abnormally and easily to irritants, food, and environmental allergens and becomes red, flaky and very itchy. It also becomes vulnerable to surface infections caused by bacteria. The skin on the flexural surfaces of the joints (for example inner sides of elbows and knees) is the most commonly affected regions in people. People with contact dermatitis often have asthma or hay fever, too. There is often a family history of allergic conditions such as asthma, hay fever, or eczema. Atopic dermatitis of the anterior flexural crease of the elbow Contact Dermatitis Contact dermatitis is a term for a skin reaction (dermatitis) resulting from exposure to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight. The rash in contact dermatitis takes days to fade away. Even then, contact dermatitis fades only if the skin no longer comes in contact with the allergen or irritant.contact dermatitis results in large, burning, and itchy rashes, and these can take anywhere from several days to weeks to heal. 4

5 5 Seborrheic Eczema Seborrheic Dermatitis is an inflammatory skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin. It particularly affects the sebaceousgland-rich areas of skin. In adolescents and adults, seborrheic dermatitis usually presents as scalp scaling (dandruff) or as mild to marked erythema of the nasolabial fold. Seborrheic dermatitis is thought to be due to a combination of an over production of skin oil and irritation from a yeast called Malassezia. Seborrheic dermatitis appears to run in families. Stress, fatigue, weather extremes, oily skin, infrequent shampoos or skin cleaning, use of lotions that contain alcohol, skin disorders (such as acne), or obesity may increase the risk Acute form of Seborrheic dermatitis on scalp Other less known types of Eczema are also present such as Dyshydrosis Discoid Eczema Venous Eczema Hand Dishyrotic Eczema Discoid Eczema 5

6 6 All types of eczema are caused by a triggering factor that maybe an allergen or an irritant and they share some common symptoms such as Skin rash Redness & inflammation of the skin Blisters with oozing and crusting Itching, dryness & cracking of the skin Lichenification of the skin (thickening of the skin that appears as a leather like areas) that can occur after a long time of itching & scratching Lichenification of the skin occurs after a long time due to continuous scratching of the skin 6

7 Treatment of Eczema 7 There is no known cure for eczema; therefore, treatments aim to control the symptoms by reducing inflammation and relieving itching Medications used for Eczema Corticosteroids Corticosteroids are highly effective in controlling or suppressing symptoms in most cases.for mildmoderate eczema a weak steroid may be used while in more severe cases a higher-potency steroid may be used. In severe cases, oral or injectable corticosteroids may be used. While these usually bring about rapid improvements, they have greater side effects. The best way to overcome eczema is to avoid it from the first place. Avoiding eczema is usually difficult as allergens & irritants are everywhere around us Prolonged use of topical corticosteroids is thought to increase the risk of side effects, the most common of which is the skin becoming thin and fragile (atrophy) Antihistamines antihistamine, may reduce the itch during a flare up of eczema, and the reduced scratching in turn reduces damage and irritation to the skin (the itch cycle).however, in some cases, significant benefit may be due to the sedative side effects of these drugs, rather than their specific antihistamine effect. Thus sedating antihistamines such as promethazine (Phenergan) or diphenhydramine (Benadryl) may be more effective at preventing nighttime scratching than the newer, nonsedating antihistamines. Lower arm of a 47-year-old female showing skin damage due to topical steroid use Moisturizers Eczema can be exacerbated by dryness of the skin. Moisturizing is one of the most important self-care treatments for eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms Medications 7

8 8 Topical Immunosuppressants Topical immunosuppressants like pimecrolimus (and tacrolimus were developed after topical corticosteroids had come into widespread use. These newer agents effectively suppress the immune system in the affected area, and appear to yield better results in some populations. The U.S. Food and Drug Administration has issued a public health advisory about the possible risk of lymph node or skin cancer from use of these products. In addition to cancer risk, there are other potential side effects with this class of drugs. Adverse reactions including severe flushing, headaches, flu-like syndrome, photosensitive reactivity and possible drug interactions with a variety of medications, alcohol and grapefruit. Immunosuppressant drugs are used only when other medications fail. They are relatively expensive and can cause a lot of serious side effects Oral & Parenteral Immunosuppressants When eczema is severe and does not respond to other forms of treatment, immunosuppressant drugs are sometimes prescribed. These dampen the immune system and can result in dramatic improvements to the patient's eczema. However, immunosuppressants can cause side effects on the body. As such, patients must undergo regular blood tests and be closely monitored by a doctor. The most commonly used immunosuppressants for eczema are ciclosporin, azathioprine and methotrexate. These drugs were generally designed for other medical conditions but have been found to be effective against eczema. 8

9 9 Atopshield FORTE is a barrier cream system creating a protective biofilm on the skin and it is containing a novel active principle derived from fresh Plukennetia volubilis in the Colombian Amazon. This is a traditional medicine that has been used for generations by the Andaoque natives to relief itching from the intolerable bites of insects of this tropical forest Atopshield is characterized by an innovative formula for the treatment of allergies of the skin. Its effectiveness comes from a specific action on itchiness, the main symptom in the majority of allergies of the skin. Associated with an anti-inflammatory effect, which can clearly be seen from the first few days, this dual action provides immediate benefits in the commonest allergies of the skin. Itchiness is an uncomfortable sensation, which leads to scratching: in many allergic disorders it becomes so intense as to cause lesions. The discomfort is so strong that it can interfere with intellectual activities, the quality of sleep and social life. It can be triggered off by stimuli that are physical, chemical, of an allergenic nature or simply irritant. From the pathogenetic point of view, itchiness is caused by a complex interaction between inflammatory mediators and nervous stimuli. The sensation of itchiness leads to an uncontrollable drive to scratch: scratching causes lesions and thickening of the skin (lichenization, or an increase in the thickness of the stratum corneum). Lichenized skin in turn causes a stimulus that leads to further scratching, thus causes a vicious circle, which is the basis of ATOPIC DERMATITIS. Plukennetia volubilis Atopshield is the first specific remedy for itchiness and allergies of the skin 9

10 10 COMPOSITION OF ATOPSHIELD FORTE WATER VP/VA COPOLYMER PLUKENNETIA VOLUBILIS FRESH EXTRACT ALKYL BENZOATE CETEARYL ALCOHOL SODIUM HYALURONATE MAGNESIUM SULFATE SODIUM BENZOTE CHLORPHRENESIN TOCOPHERYL ACETATE 10

11 11 Mechanism of Action for Atopshield FORTE Atopshield FORTE is classified by the CE as a medical device class I and that is because Atopshield FORTE exerts its action completely extra cellular Ø Anti-itching effect Atopshield forte contains the fresh extract of Plukennetia Volubilis that contains specific flavonoids that have an action on the TRPM8 and TRPA1 receptors of the C fibers of the nervous system. The activation of these receptors mediate the immediate relief of itchiness and irritation in a way similar to cold sensation Atopshield exerts its actions extra cellular and thus Atopshield is very safe and can be used during pregnancy, lactation and for infants from 1 month of age Ø Barrier like effect Atopshield Forte has a barrier action due to a great concentration of polymers in its constitution. This barrier action forms a shield between the skin and allergens and/or irritant substances that causes the skin to react negatively causing eczema. Ø Prevent skin dehydration The shield covering the skin also helps to maintain a physiological level of hydration that helps the skin to heal and retain back its normal characteristics and functions Atopshield has triple action Ø Direct anti pruritic action Ø Retains the barrier action of the skin Ø Prevent skin dehydration 11

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13 Atopshield use in Atopic Dermatitis Atopshield FORTE has a barrier action, which forms a shield between the skin and the allergens, protecting the epidermis and maintaining a physiological level of hydration. The abnormal sensitivity of the skin to allergens is in part due to the loss of its barrier function. Atopshield Forte by restoring the physiological barrier function of the skin from the first applications rapidly relieves itchiness and irritation Case Study Day 1 13 Atopic dermatitis since the age of 6 months. Allergic rhinitis. Continuous treatment with cortisone. Treatment with cortisone suspended 1 month ago.immediate relapse of the disease.applications of Atopshield every 6 hours directly on the plaques. After two days of treatment with Atopshield : absence of itchiness After 6 days of treatment with Atopshield: absence of itchiness, resolution of acute lesions, lichenification persists Day 8 After 8 days of treatment with Atopshield: absence of itchiness, resolution of lesions from scratching, lichenification persists After 14 days of treatment with Atopshield: absence of itchiness, resolution of lesions from scratching, lichenification coming to an end After 28 days. Complete resolution of all lesions.resolution of lichenification. Day 28 13

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15 15 Advantages of Atopshield FORTE in ECZEMA 1. Immediate relief of itching 2. Four hours long lasting effect 3. Safe for pregnant women and lactating women 4. Safe for infants from 1 month of age 5. Used safely for chronic indications 6. No side effects 7. Can be used safely with other medications 8. Skin refreshing effect 9. Skin rehydrating effect 15

16 Atopshield use in Psoriasis Psoriasis is a chronic inflammation of the skin characterized by papules and erythematous and desquamative plaques. These lesions are more frequent on the elbows, knees, scalp and on the inner side of the arms. The disease has an alternating course. Minor physical traumas, more noticeably sweating or certain physical stimuli can cause the disease to flare up. The acute phases are generally characterized by itchiness, irritation and burning. Thanks to the barrier action, Atopshield FORTE has a protective action on the external triggering stimuli, which can make psoriasis worse. Atopshield FORTE is useful with other common pharmacological treatments of Psoriasis and also Atopshield FORTE can prevent relapse Day 1 16 Case Study A 54 years old woman who suffers from psoriasis since the age of 22, all over the body Continuous treatment with cortisone for 14 years, suspended because it was ineffective. Immunosuppressants suspended after 1 year due to the onset of side effects. Immediate relapse of the disease and gradual expansion. Applications of Atopshield every 6 hours directly on the plaques. After two days of treatment with Atopshield : absence of itchiness Day 8 After 6 days of treatment with Atopshield: absence of itchiness, reduction of desquamation, appearance of lighter areas in the plaques After 8 days of treatment with Atopshield: absence of itchiness, reduction of desquamation, gradual reduction of plaques Day 60 After 30 days of treatment with Atopshield: absence of itchiness, progressive resolution of desquamation, progressive reduction of plaques After 60 days of treatment with Atopshield: progressive disappearance of plaques. 16

17 Advantages of Atopshield FORTE in Psoriasis Immediate relief of itching 2. Immediate improvement in skin hydration 3. Progressive improvement of skin plaques 4. No interactions with other topical and/or systemic therapies 5. Used as prophylactic as it prolongs the durations between relapses 6. Useful in reducing the long term continuous use of topical corticosteroids. 17

18 18 Atopshield FORTE TRAINING MANUAL LOTUS MIDDLE EAST PHARMA CRAB SYNERGY 18