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      Atopic Dermatitis as a Multifactorial Skin Disorder. Can the Analysis of Pathophysiological Targets Represent the Winning Therapeutic Strategy?

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          Abstract

          Atopic dermatitis (AD) is a pathological skin condition with complex aetiological mechanisms that are difficult to fully understand. Scientific evidence suggests that of all the causes, the impairment of the skin barrier and cutaneous dysbiosis together with immunological dysfunction can be considered as the two main factors involved in this pathological skin condition. The loss of the skin barrier function is often linked to dysbiosis and immunological dysfunction, with an imbalance in the ratio between the pathogen Staphylococcus aureus and/or other microorganisms residing in the skin. The bibliographic research was conducted on PubMed, using the following keywords: ‘atopic dermatitis’, ‘bacterial therapy’, ‘drug delivery system’ and ‘alternative therapy’. The main studies concerning microbial therapy, such as the use of bacteria and/or part thereof with microbiota transplantation, and drug delivery systems to recover skin barrier function have been summarized. The studies examined show great potential in the development of effective therapeutic strategies for AD and AD-like symptoms. Despite this promise, however, future investigative efforts should focus both on the replication of some of these studies on a larger scale, with clinical and demographic characteristics that reflect the general AD population, and on the process of standardisation, in order to produce reliable data.

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          Nano based drug delivery systems: recent developments and future prospects

          Nanomedicine and nano delivery systems are a relatively new but rapidly developing science where materials in the nanoscale range are employed to serve as means of diagnostic tools or to deliver therapeutic agents to specific targeted sites in a controlled manner. Nanotechnology offers multiple benefits in treating chronic human diseases by site-specific, and target-oriented delivery of precise medicines. Recently, there are a number of outstanding applications of the nanomedicine (chemotherapeutic agents, biological agents, immunotherapeutic agents etc.) in the treatment of various diseases. The current review, presents an updated summary of recent advances in the field of nanomedicines and nano based drug delivery systems through comprehensive scrutiny of the discovery and application of nanomaterials in improving both the efficacy of novel and old drugs (e.g., natural products) and selective diagnosis through disease marker molecules. The opportunities and challenges of nanomedicines in drug delivery from synthetic/natural sources to their clinical applications are also discussed. In addition, we have included information regarding the trends and perspectives in nanomedicine area.
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            Nanoparticles: Properties, applications and toxicities

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              Atopic dermatitis

              Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a lifetime prevalence of up to 20% and substantial effects on quality of life. AD is characterized by intense itch, recurrent eczematous lesions and a fluctuating course. AD has a strong heritability component and is closely related to and commonly co-occurs with other atopic diseases (such as asthma and allergic rhinitis). Several pathophysiological mechanisms contribute to AD aetiology and clinical manifestations. Impairment of epidermal barrier function, for example, owing to deficiency in the structural protein filaggrin, can promote inflammation and T cell infiltration. The immune response in AD is skewed towards T helper 2 cell-mediated pathways and can in turn favour epidermal barrier disruption. Other contributing factors to AD onset include dysbiosis of the skin microbiota (in particular overgrowth of Staphylococcus aureus), systemic immune responses (including immunoglobulin E (IgE)-mediated sensitization) and neuroinflammation, which is involved in itch. Current treatments for AD include topical moisturizers and anti-inflammatory agents (such as corticosteroids, calcineurin inhibitors and cAMP-specific 3',5'-cyclic phosphodiesterase 4 (PDE4) inhibitors), phototherapy and systemic immunosuppressants. Translational research has fostered the development of targeted small molecules and biologic therapies, especially for moderate-to-severe disease.
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                Author and article information

                Journal
                Pharmaceuticals (Basel)
                Pharmaceuticals (Basel)
                pharmaceuticals
                Pharmaceuticals
                MDPI
                1424-8247
                22 November 2020
                November 2020
                : 13
                : 11
                : 411
                Affiliations
                [1 ]Department of Health and Medical Sciences “V. Tiberio” Università degli Studi del Molise, 8600 Campobasso, Italy; i.magnifico@ 123456studenti.unimol.it (I.M.); n.venditti@ 123456studenti.unimol.it (N.V.); m.cutuli@ 123456studenti.unimol.it (M.A.C.); laura.pietrangelo@ 123456unimol.it (L.P.); roberto.dimarco@ 123456unimol.it (R.D.M.)
                [2 ]Department of Agricultural, Environmental and Food Sciences (DiAAA), Università degli Studi del Molise, 86100 Campobasso, Italy; franca.vergalito@ 123456unimol.it
                [3 ]Department of Biomedical and Biotechnological Sciences, Universitá degli Studi di Catania, 95123 Catania, Italy; kmangano@ 123456unict.it
                [4 ]Department of Biochemistry and Molecular Biology, School of Medicine, Institute of Human Virology, University of Maryland, Baltimore, MD 21201, USA; DZella@ 123456ihv.umaryland.edu
                Author notes
                [* ]Correspondence: giulio.petroniopetronio@ 123456unimol.it ; Tel.: +39-0874-404688
                Author information
                https://orcid.org/0000-0002-5098-7785
                https://orcid.org/0000-0001-5920-4620
                https://orcid.org/0000-0001-5576-5770
                https://orcid.org/0000-0001-5075-4597
                Article
                pharmaceuticals-13-00411
                10.3390/ph13110411
                7700401
                33266440
                a51f9c42-e188-4e68-b570-dd99915c72f3
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 16 October 2020
                : 19 November 2020
                Categories
                Review

                atopic dermatitis,skin barrier,cutaneous dysbiosis,staphylococcus aureus,microbial therapy,drug delivery systems

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