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High Levels of Psychological Distress, Sleep Disturbance, and Alcohol Use Disorder in Adults With Atopic Dermatitis. Dermatitis 2021; 32:S33-S38. [PMID: 33332864 DOI: 10.1097/der.0000000000000687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of illness associated with atopic dermatitis (AD) is significant and multidimensional, especially in those with moderate to severe disease. OBJECTIVE Our objective was to evaluate the disease burden of patients with AD in relation to psychological distress, sleep disturbance, and alcohol misuse. METHODS Patients with AD, attending 2 tertiary referral centers in Dublin, Ireland, were recruited. A series of validated questionnaires were used including the Patient-Oriented Eczema Measure, Dermatology Life Quality Index (DLQI), Center for Epidemiologic Studies-Depression Scale, Quality of Life in Atopic Dermatitis Questionnaire, Alcohol Use Disorders Identification Test, and Pittsburgh Sleep Quality Index. The Eczema Area and Severity Index was calculated contemporaneously with the questionnaire completion. RESULTS One hundred patients completed the questionnaire, of whom 52% were female. Sixty-three percent of patients experienced impaired quality of life as measured by the DLQI. Higher DLQI scores correlated with decreasing age (r = 0.3277, P < 0.0009). Thirty percent were found to be at risk of clinical depression, and higher Center for Epidemiologic Studies-Depression Scale scores correlated with a younger age and eczema severity. Sleep disturbance was greater in those at risk of depression (mean = 10.40 vs 5.79, P < 0.0001). Patients with moderate to severe AD were more likely to score higher on the Alcohol Use Disorders Identification Test, and 25% met the criteria for alcohol use disorder. In relation to sleep, 73% of patients scored higher than 5 on the Pittsburgh Sleep Quality Index, which signifies poor sleep quality. CONCLUSIONS Patients with AD endure a significant burden on health with regard to mental well-being, alcohol use, and sleep quality. Clinicians should consider screening patients for these comorbidities.
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Atopic dermatitis in adults: A cross-sectional study in the department of dermatology, Antananarivo, Madagascar. JAAD Int 2021; 4:28-31. [PMID: 34409387 PMCID: PMC8361904 DOI: 10.1016/j.jdin.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background Although atopic dermatitis (AD) is becoming a pressing public health concern in the world, Madagascar is underrepresented in the AD literature. Objective We aimed to study the demographic and clinical pattern of AD in adult dermatology outpatients. Methods A cross-sectional study was conducted in the Department of Dermatology, University Hospital, Antananarivo, Madagascar. Patients >15 years old with a registered diagnosis of AD, from January 2010 to February 2019, were included. AD was diagnosed by a dermatologist according to Hanifin and Rajka criteria. The severity of AD was assessed using scoring atopic dermatitis (SCORAD). Results Forty-two cases of AD were included. The prevalence was 0.5%. The median patient age was 37 years. The age of onset of AD was before the age of 15 years in 38% of the patients and after the age of 15 years in 61.9% of the patients. There was a female preponderance (female to male ratio, 2:1), but no correlation was found between sex and the severity of AD. People living in urban areas were the most affected. According to SCORAD, 37 cases presented moderate AD and 2 cases presented severe AD. Conclusion The prevalence of AD in adult dermatology outpatients is still low, and moderate AD is the most frequent form, according to SCORAD.
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Fulton RL, Margolis DJ, Sockler PG, Mitra N, Wong XFCC, Common JE. No Association of filaggrin copy number variation and atopic dermatitis risk in White and Black Americans. Exp Dermatol 2021; 31:233-236. [PMID: 34407261 DOI: 10.1111/exd.14449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 01/10/2023]
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin condition with a multifactorial pathophysiology. The filaggrin gene (FLG) has particularly been implicated given loss of function (LoF) mutations in this gene lead to skin barrier dysfunction and such mutations can increase a patient's likelihood of developing AD. FLG has intragenic copy number variation (CNV), which impacts the total amount of filaggrin produced. Previous research reported a dose-dependent effect such that as amount of FLG increases, risk of AD decreases. To gain a better understanding, we evaluated FLG CNV in a large case-control study of Whites and Blacks with and without AD. The goal of our study was to determine whether FLG CNV has a dose-dependent effect on the risk of developing AD and to determine whether FLG CNV varies by race. The frequencies and odds ratios comparing a given CNV by race or race within those with AD did not significantly vary. It had been thought that FLG CNV might vary by race and represent an important association with AD in Black AD subjects. However, our work suggests that while there are racial differences with respect to CNV, these differences do not appear to explain AD risk.
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Affiliation(s)
- Rachel L Fulton
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Patrick G Sockler
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - John E Common
- A⁎STAR, Skin Research Institute of Singapore, Singapore
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Silverberg JI, de Bruin-Weller M, Bieber T, Soong W, Kabashima K, Costanzo A, Rosmarin D, Lynde C, Liu J, Gamelli A, Zeng J, Ladizinski B, Chu AD, Reich K. Upadacitinib plus topical corticosteroids in atopic dermatitis: week-52 AD Up study results. J Allergy Clin Immunol 2021; 149:977-987.e14. [PMID: 34403658 DOI: 10.1016/j.jaci.2021.07.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary (week 16) results from the ongoing phase 3, double-blind AD Up study (NCT03568318) demonstrate a positive benefit-risk profile for upadacitinib+TCS in patients with moderate-to-severe AD. OBJECTIVE Evaluate efficacy and safety of UPA+TCS through 52 weeks. METHODS Patients (12-75y) with chronic AD (≥10% of body surface area affected, EASI ≥16, vIGA-AD™ ≥3, and WP-NRS score ≥4) were randomized 1:1:1 to once-daily upadacitinib 15mg+TCS, upadacitinib 30mg+TCS, or PBO+TCS (re-randomized at week 16 to upadacitinib+TCS). Safety and efficacy, including proportion of patients achieving ≥75% improvement in EASI (EASI-75), vIGA-AD of clear/almost clear with improvement ≥2 grades (vIGA-AD 0/1), and WP-NRS improvement ≥4, were assessed through week 52. Missing data were primarily handled by nonresponder imputation incorporating multiple imputation for missing values due to COVID-19. RESULTS Of 901 patients, 300 were randomized to upadacitinib 15mg+TCS, 297 to upadacitinib 30mg+TCS, and 304 to PBO+TCS. For all endpoints, efficacy for upadacitinib 15mg+TCS and upadacitinib 30mg+TCS at week 16 was maintained through week 52. At week 52, the proportions of patients treated with upadacitinib 15mg+TCS and upadacitinib 30mg+TCS who achieved EASI-75 were 50.8% and 69.0%, respectively; 33.5% and 45.2%, respectively, achieved vIGA-AD 0/1; and 45.3% and 57.5%, respectively, achieved WP-NRS improvement ≥4. upadacitinib+TCS was well tolerated through 52 weeks; no new important safety risks beyond the current label were observed. No deaths were reported; events of MACE and VTE were infrequent (≤0.2/100 PY). CONCLUSION Results through 52 weeks demonstrate long-term maintenance of efficacy and a favorable safety profile of upadacitinib+TCS in patients with moderate-to-severe AD.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - Weily Soong
- Alabama Allergy & Asthma Center and Clinical Research Center of Alabama, Birmingham
| | - Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Antonio Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - David Rosmarin
- Department of Dermatology, Tufts University School of Medicine, Boston, Mass
| | - Charles Lynde
- Lynde Dermatology, Probity Medical Research, Markham and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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55
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Berna R, Margolis DJ, Barbieri JS. Attrition of topical calcineurin inhibitor use over time in patients with atopic dermatitis. J Am Acad Dermatol 2021; 87:242-244. [PMID: 34390782 DOI: 10.1016/j.jaad.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ronald Berna
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - David J Margolis
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Yang M, Deng X, Wang S, Wang K, Niu W, Zhang Z. Risk factors for allergic diseases: a cross-sectional survey of 9,501 Chinese preschool-aged children. Transl Pediatr 2021; 10:1989-2005. [PMID: 34584869 PMCID: PMC8429857 DOI: 10.21037/tp-21-124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Childhood allergic diseases are increasing worldwide with unprecedented complexity and severity, and they cause a major burden on health and healthcare costs. We aimed to identify potential factors, both in isolation and in combination, associated with allergic diseases among preschool-aged children, and to construct a nomogram prediction model based on significant factors. METHODS We cross-sectionally recruited 9,501 preschool-aged children from 30 kindergartens in Beijing and Tangshan. Allergic diseases were ascertained according to the "International Study of Asthma and Allergies in Childhood" questionnaire. Risk for allergic diseases is quantified by odds ratio (OR) with 95% confidence interval (CI). RESULTS Four factors were identified to be independently, consistently, and significantly associated with the risk for allergic diseases overall and by four clinical manifestations separately, including bedtime (per 1 hour late) (taking asthma/wheezing as an example, OR, 95% CI, P: 1.21, 1.08 to 1.35, 0.001), outdoor activities ≤1.5 h per day (1.45, 1.26 to 1.68, 3.77E-07), family history of allergic diseases (2.23, 1.92 to 2.60, 0.00E+00), and antibiotic use during childhood (3.64, 2.44 to 5.42, 1.66E-10). Further analyses revealed that family history of allergic diseases acted with antibiotic use during childhood in an additive manner. For practical reasons, risk prediction nomogram models were constructed for allergic diseases respectively in Beijing and Tangshan based on significant and conventional factors, and the prediction accuracy was good, with the C-index 69% in Tangshan and 68% in Beijing (both P=0.00E+00). CONCLUSIONS Our findings identified four factors in significant association with the risk for allergic diseases, and in particular family history of allergic diseases and antibiotic use during childhood acted additively.
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Affiliation(s)
- Min Yang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Xiangling Deng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Shunan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Kundi Wang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Zhixin Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.,International Medical Services, China-Japan Friendship Hospital, Beijing, China
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Simpson EL, de Bruin-Weller M, Bansal A, Chen Z, Nelson L, Whalley D, Prescilla R, Guillemin I, Delevry D. Definition of Clinically Meaningful Within-Patient Changes in POEM and CDLQI in Children 6 to 11 Years of Age with Severe Atopic Dermatitis. Dermatol Ther (Heidelb) 2021; 11:1415-1422. [PMID: 34046851 PMCID: PMC8322340 DOI: 10.1007/s13555-021-00543-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The Patient-Oriented Eczema Measure (POEM) assesses patient-reported severity of atopic dermatitis (AD) symptoms, whereas the Children's Dermatology Life Quality Index (CDLQI) measures how AD affects health-related quality of life (HRQoL) in children. Although the POEM and CDLQI have established thresholds for clinically meaningful within-patient change in adolescents (aged 12-17 years), there are no defined within-patient responder thresholds for clinically meaningful change in children aged 6-11 years. METHODS Data from the LIBERTY AD PEDS phase 3 randomized, double-blind, placebo-controlled trial of dupilumab in children aged 6-11 years with severe AD were used to define the threshold for within-patient meaningful change in POEM and CDLQI scores. Anchor-based methods were applied to estimate mean change in POEM and CDLQI scores from baseline to week 16, with anchors of a 1-point improvement in the Patient Global Impression of Disease (PGID) scale and an improvement in score of ''A little better'' on the Patient Global Impression of Change (PGIC) scale. The distribution-based methods, a one-half standard deviation (SD) at baseline and a standard error mean (SEM) were also used. RESULTS The mean POEM change scores associated with the anchors were a change of - 8.40 with the PGID anchor and - 6.30 with the PGIC anchor. Distribution-based estimates for POEM were one-half SD at baseline of 2.76, with a SEM of 3.32. Mean CDLQI change scores corresponding to the PGID and PGIC anchors were - 7.30 and - 6.80, respectively, while distribution-based estimates for CDLQI were a one-half SD at baseline of 3.69, with a SEM of 3.52. CONCLUSIONS In children with severe AD, an appropriate minimum threshold of clinically meaningful within-patient change was estimated as 6 points for both the POEM and CDLQI scores. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03345914. What is the clinically meaningful within-person change in Patient-Oriented Eczema Measure and Children's Dermatology Life Quality Index scores in children 6 to 11 years old with severe atopic dermatitis? (MP4 289443 KB).
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
| | | | | | - Zhen Chen
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
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58
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Unraveling heterogeneity in pediatric atopic dermatitis: Identification of serum biomarker based patient clusters. J Allergy Clin Immunol 2021; 149:125-134. [PMID: 34237306 DOI: 10.1016/j.jaci.2021.06.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Increasing evidence shows that pediatric atopic dermatitis (AD) differs from adult AD on a biologic level. Broad biomarker profiling across a wide range of ages of pediatric patients with AD is lacking. OBJECTIVE Our aim was to identify serum biomarker profiles in children with AD aged 0 to 17 years and compare these profiles with those previously found in adults with AD. METHODS Luminex multiplex immunoassays were used to measure 145 biomarkers in serum from 240 children with AD (aged 0-17 years). Principal components analysis followed by unsupervised k-means clustering were performed to identify patient clusters. Patients were stratified into age groups (0-4 years, 5-11 years, and 12-17 years) to assess association between age and cluster membership. RESULTS Children aged 0 to 4 years had the highest levels of TH1 cell-skewing markers and lowest levels of TH17 cell-related markers. TH2 cell-related markers did not differ significantly between age groups. Similar to the pattern in adults, cluster analysis identified 4 distinct pediatric patient clusters (TH2 cell/retinol-dominant, skin-homing-dominant, TH1 cell/TH2 cell/TH17 cell/IL-1-dominant, and TH1 cell/IL-1/eosinophil-inferior clusters). Only the TH1 cell/TH2 cell/TH17 cell/IL-1-dominant cluster resembled 1 of the previously identified adult clusters. Although no association with age or age of onset seemed to be found, disease severity was significantly associated with the skin-homing-dominant cluster. CONCLUSION Four distinct patient clusters based on serum biomarker profiles could be identified in a large cohort of pediatric patients with AD, of which 1 was similar to previously identified adult clusters. The identification of endotypes driven by distinct underlying immunopathologic pathways might be useful to define pediatric patients with AD who are at risk of persistent disease and may necessitate different targeted treatment approaches.
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59
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Genuneit J, Standl M. Epidemiology of Allergy: Natural Course and Risk Factors of Allergic Diseases. Handb Exp Pharmacol 2021; 268:21-27. [PMID: 34165634 DOI: 10.1007/164_2021_507] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The prevalences of allergic diseases, asthma, atopic dermatitis, allergic rhinitis and lately food allergy have been increasing over the last decades. It has been suggested that the prevalence of allergic diseases has reached a plateau in high income countries, while it is still on the rise in low and middle income countries. Generally, allergic diseases more often set on in childhood than in adulthood and affected children contribute more to the rise in allergic disease prevalence than affected adults. Epidemiological evidence suggests that not all atopic dermatitis and asthma cases are attributable to atopic sensitization. Indeed, mainly genetic association studies have prompted the unravelling of barrier dysfunction as a mainstay in the patho-mechanisms leading to atopic dermatitis and to asthma with atopic sensitization secondary to this dysfunction. Epidemiological research on risk and protective factors for allergic disease, acting against the background of genetic susceptibility, has produced an enormous body of evidence. Prominent observations are the 'sibling effect' and the 'farm effect' which gave rise to the 'hygiene hypothesis' and later the 'biodiversity hypothesis'. Future epidemiological research is required to evaluate and refine these hypotheses in light of the paradigm shift from atopic sensitization to barrier dysfunction with ever increasing options for environmental characterization, currently, e.g., 'omics'-techniques in microbiology and metabolism, and with ever increasing options for phenotyping of allergic techniques, including, e.g., high-resolution time series of symptoms using, e.g., sensing technologies.
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Affiliation(s)
- Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Marie Standl
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.
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60
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Gazibara T, Reljic V, Jankovic S, Peric J, Nikolic M, Maksimovic N. Quality of life in children with atopic dermatitis: A one-year prospective cohort study. Indian J Dermatol Venereol Leprol 2021; 88:65-69. [PMID: 34245539 DOI: 10.25259/ijdvl_529_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Literature on the quality of life trends across time in children with atopic dermatitis are scarce. AIMS To assess factors associated with quality of life of children with atopic dermatitis after a one-year follow-up and to examine the factors contributing to greater improvement in the atopic dermatitis-related quality of life over one year. METHODS Our cohort consisted of 98 children who were treated for atopic dermatitis at the clinic of dermatovenereology. Data collection included atopic dermatitis scoring using the SCORing Atopic Dermatitis (SCORAD) index, Children's Dermatology Life Quality Index (CDLQI) for children aged > four years and Infants' Dermatitis Quality of Life Index (IDLQI) for children aged 0-4 years. Categorization of the impairment of quality of life score due to atopic dermatitis was as follows: mild (score from 0 to 6), moderate (score from 7 to 12) and severe (score from 13 to 30). The cohort was followed for one year after which a total of 80 children were reassessed. RESULTS Improvements of both CDLQI and IDLQI were observed in children whose impairment of quality of life due to atopic dermatitis after one year was 'mild'. This was not observed in children whose atopic dermatitis caused either 'moderate' or 'severe impairment' of their quality of life. Adjusted analysis showed that lower initial SCORAD and greater improvement in SCORAD after the one-year follow-up were associated with a better quality of life at follow-up. LIMITATIONS The size of our cohort was relatively small. Study participants were recruited from the largest urban and medical referral center in Serbia. Persons from suburban or rural regions may have had different perceptions of atopic dermatitis-related quality of life. CONCLUSION Children with less severe atopic dermatitis were more likely to improve their atopic dermatitis-related quality of life. Lower SCORAD was associated with both better quality of life initially and greater improvement in quality of life after one year of follow-up.
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Affiliation(s)
- Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Reljic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Slavenka Jankovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Peric
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milos Nikolic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Maksimovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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61
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Fulton RL, Mitra N, Chiesa-Fuxench Z, Sockler PG, Margolis DJ. Untapping the potential of utilizing electronic medical records to identify patients with atopic dermatitis: an algorithm using ICD-10 codes. Arch Dermatol Res 2021; 314:439-444. [PMID: 34081192 DOI: 10.1007/s00403-021-02251-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
Atopic Dermatitis (AD) is a chronic, inflammatory skin condition that imposes an enormous personal and economic burden in the United States. Due to the ubiquity of the use of electronic medical records (EMR) in the United States, utilizing such data is critically important to studying common dermatologic diseases, such as AD. Our goal was to create a simple-to-use algorithm applied to EMR data to accurately identify AD patients thereby making it possible to efficiently use EMR data to ascertain and then study individuals with AD. Our results suggest that the algorithm that is most likely to accurately identify AD patients from the EMR based on PPV utilizes ICD-10 code for L20.89, L20.9, or L20.84 in conjunction with a diagnosis code for asthma or allergic rhinitis, treatment code, and dermatology consult code. This approach yields a PPV of 95.00% in our training cohort and 100.00% in our validation cohort. Therefore, future studies can use this algorithm to better assure that a subject has AD for studies of the pathogenesis and/or potential treatment targets of AD.
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Affiliation(s)
- Rachel L Fulton
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Zelma Chiesa-Fuxench
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Patrick G Sockler
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Bocheva GS, Slominski RM, Slominski AT. Immunological Aspects of Skin Aging in Atopic Dermatitis. Int J Mol Sci 2021; 22:ijms22115729. [PMID: 34072076 PMCID: PMC8198400 DOI: 10.3390/ijms22115729] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
The cutaneous immune response is important for the regulation of skin aging well as for the development of immune-mediated skin diseases. Aging of the human skin undergoes immunosenescence with immunological alterations and can be affected by environmental stressors and internal factors, thus leading to various epidermal barrier abnormalities. The dysfunctional epidermal barrier, immune dysregulation, and skin dysbiosis in the advanced age, together with the genetic factors, facilitate the late onset of atopic dermatitis (AD) in the elderly, whose cases have recently been on the rise. Controversial to the healthy aged skin, where overproduction of many cytokines is found, the levels of Th2/Th22 related cytokines inversely correlated with age in the skin of older AD patients. As opposed to an endogenously aged skin, the expression of the terminal differentiation markers significantly increases with age in AD. Despite the atenuated barrier disturbances in older AD patients, the aged skin carries an impairment associated with the aging process, which reflects the persistence of AD. The chronicity of AD in older patients might not directly affect skin aging but does not allow spontaneous remission. Thus, adult- and elderly subtypes of AD are considered as a lifelong disease.
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Affiliation(s)
- Georgeta St. Bocheva
- Department of Pharmacology and Toxicology, Medical University of Sofia, 1431 Sofia, Bulgaria
- Correspondence: (G.S.B.); (A.T.S.)
| | - Radomir M. Slominski
- Division of Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Andrzej T. Slominski
- Department of Dermatology, Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Veteran Administration Medical Center, Birmingham, AL 35294, USA
- Correspondence: (G.S.B.); (A.T.S.)
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63
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Luger T, Paller AS, Irvine AD, Sidbury R, Eichenfield LF, Werfel T, Bieber T. Topical therapy of atopic dermatitis with a focus on pimecrolimus. J Eur Acad Dermatol Venereol 2021; 35:1505-1518. [PMID: 33834524 DOI: 10.1111/jdv.17272] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis (AD) is a chronic and relapsing, inflammatory skin disease characterized by impaired skin barrier function and immune system dysregulation that results in dryness, skin microbiome dysbiosis and intense pruritus. It is highly heterogeneous, and its management is demanding. Patients with AD are at greater risk of comorbidities such as attention-deficit hyperactivity disorder as well as other atopic diseases. Early-onset AD cases typically improve or resolve in late childhood; however, it is proposed that the prevalence of persistent or adult-onset AD is higher than previously thought. Basic therapy consists of emollient application and trigger avoidance, and when insufficient, topical corticosteroids (TCS) are the first-line treatment. However, corticophobia/steroid aversion and TCS side-effects, particularly on sensitive skin areas, lead to low compliance and insufficient disease control. Several long- and short-term randomized controlled and daily practice studies have demonstrated that topical calcineurin inhibitors, such as pimecrolimus, have similar anti-inflammatory effects to low-to-medium strength TCS, reduce pruritus and improve the quality of life of patients. In addition, pimecrolimus does not cause skin atrophy, is steroid-sparing and has a good safety profile, with no evidence for an increased risk of malignancies or skin infections. In general, pimecrolimus cream is well-accepted and well-tolerated, encouraging patient adherence and leading to its use by many physicians as a preferred therapy for children and sensitive skin areas.
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Affiliation(s)
- T Luger
- Department of Dermatology, University of Münster, Münster, Germany
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A D Irvine
- Pediatric Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - R Sidbury
- University of Washington School of Medicine, Seattle, WA, USA.,Seattle Children's Hospital, Seattle, WA, USA
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, Rady Children's Hospital, San Diego, CA, USA
| | - T Werfel
- Department of Dermatology, MHH, Hannover, Germany
| | - T Bieber
- Department of Dermatology and Allergy, Christine Kühne-Center for Allergy Research and Education, University Hospital, Bonn, Germany
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Margolis DJ, Mitra N, Kim BS, Duke JL, Berna RA, Hoffstad OJ, Wasserman JR, Ferriola DA, Mosbruger TL, Wubbenhorst BS, Nathanson KL, Monos DS. HLA Class I Polymorphisms Influencing Both Peptide Binding and KIR Interactions Are Associated with Remission among Children with Atopic Dermatitis: A Longitudinal Study. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2021; 206:2038-2044. [PMID: 33863792 PMCID: PMC8062288 DOI: 10.4049/jimmunol.2001252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/28/2021] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is a disease of immune dysregulation and skin barrier dysfunction with a relapsing, remitting course and has been associated with several different genetic risk variants. HLA represent a highly variable set of genes that code for cell surface protein molecules involved in the Ag-specific immune response, including the regulation or functioning of T cells, NK cells, and APCs. The purpose of this study was to evaluate associations between HLA class I polymorphisms and the progression of AD over time. We evaluated the associations of AD symptoms and HLA class I polymorphisms based on high-resolution two-field typing in a longitudinal cohort of children with AD (up to 10 y of follow-up). Seven hundred and ninety-two children were evaluated every 6 mo, resulting in 12,752 AD evaluations. Using generalized estimating equations and corrected p values, B*44:02 was found to be associated with AD remission (1.83 [1.35, 2.47]; p = 0.0015). The HLA-B residues at position 116 (d-aspartate) and 80 (T-threonine) were associated with remission (1.42 [1.13, 1.76], p = 0.003; corrected p = 0.028) and (1.45 [1.17, 1.80], p = 0.0008; corrected p = 0.0024), respectively. B80T is a killer-cell Ig-like receptor (KIR) site. Our findings reveal that two axes of immune response (T cell and NK cell) may influence disease progression. Identifying binding pocket changes in addition to other factors (e.g., allergens) that increase the risk or severity of AD can improve our understanding of the immunologic mechanisms associated with AD and may lead to personalized therapies for improving patient care.
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Affiliation(s)
- David J Margolis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA;
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA
| | - Brian S Kim
- Center for the Study of Itch and Sensory Disorders, Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jamie L Duke
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ron A Berna
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ole J Hoffstad
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, Philadelphia, PA
| | - Jenna R Wasserman
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Deborah A Ferriola
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Tim L Mosbruger
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley S Wubbenhorst
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and
| | - Kathrine L Nathanson
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and
| | - Dimitri S Monos
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA;
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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65
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Kwon B, Hong SY, Kim EY, Kim JH, Kim M, Park JH, Sohn Y, Jung HS. Effect of Cone of Pinus densiflora on DNCB-Induced Allergic Contact Dermatitis-Like Skin Lesion in Balb/c Mice. Nutrients 2021; 13:nu13030839. [PMID: 33806628 PMCID: PMC7998145 DOI: 10.3390/nu13030839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 11/25/2022] Open
Abstract
Cone of Pinus densiflora (CP), or Korean red pinecone, is a cluster of Pinus densiflora fruit. CP has also been verified in several studies to have anti-oxidation, anti-fungal, anti-bacterial, and anti-melanogenic effects. However, anti-inflammatory effects have not yet been confirmed in the inflammatory responses of pinecones to allergic contact dermatitis. The purpose of this study is to prove the anti-inflammatory effect of CP on allergic contact dermatitis (ACD) in vitro and in vivo. CP inhibited the expression of TSLP, TARC, MCP-1, TNF-α, and IL-6 in TNF-α/IFN-γ-stimulated HaCaT cells and MCP-1, GM-CSF, TNF-α, IL-6, and IL-8 in PMACI (phorbol-12-myristate-13-acetate plus A23187)-stimulated HMC-1 cells. CP inhibited the phosphorylation of mitogen-activated protein kinase (MAPKs), as well as the translocation of NF-κB on TNF-α/IFN-γ stimulated in HaCaT cells. In vivo, CP decreased major symptoms of ACD, levels of IL-6 in skin lesion, thickening of the epidermis and dermis, infiltration of eosinophils and mast cells, and the infiltration of CD4+ T cells and CD8+ T cells. This result suggests that CP represents a potential alternative medicine to ACD for diseases such as chronic skin inflammation.
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Affiliation(s)
- Boguen Kwon
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, 26, Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Korea; (B.K.); (S.Y.H.); (E.-Y.K.); (J.-H.K.); (M.K.)
| | - Soo Yeon Hong
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, 26, Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Korea; (B.K.); (S.Y.H.); (E.-Y.K.); (J.-H.K.); (M.K.)
| | - Eun-Young Kim
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, 26, Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Korea; (B.K.); (S.Y.H.); (E.-Y.K.); (J.-H.K.); (M.K.)
| | - Jae-Hyun Kim
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, 26, Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Korea; (B.K.); (S.Y.H.); (E.-Y.K.); (J.-H.K.); (M.K.)
| | - Minsun Kim
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, 26, Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Korea; (B.K.); (S.Y.H.); (E.-Y.K.); (J.-H.K.); (M.K.)
| | - Jae Ho Park
- Department of Pharmaceutical Science, Jungwon University, 85, Munmu-ro, Goesan-eup, Goesan-gun, Chungbuk 28024, Korea;
| | - Youngjoo Sohn
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, 26, Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Korea; (B.K.); (S.Y.H.); (E.-Y.K.); (J.-H.K.); (M.K.)
- Correspondence: (Y.S.); (H.-S.J.); Tel.: +82-2-961-0327 (H.-S.J.); Fax: +82-2-961-9449 (H.-S.J.)
| | - Hyuk-Sang Jung
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, 26, Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Korea; (B.K.); (S.Y.H.); (E.-Y.K.); (J.-H.K.); (M.K.)
- Correspondence: (Y.S.); (H.-S.J.); Tel.: +82-2-961-0327 (H.-S.J.); Fax: +82-2-961-9449 (H.-S.J.)
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66
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Ubags ND, Trompette A, Pernot J, Nibbering B, Wong NC, Pattaroni C, Rapin A, Nicod LP, Harris NL, Marsland BJ. Microbiome-induced antigen-presenting cell recruitment coordinates skin and lung allergic inflammation. J Allergy Clin Immunol 2021; 147:1049-1062.e7. [DOI: 10.1016/j.jaci.2020.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
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Tier HL, Balogh EA, Bashyam AM, Fleischer AB, Spergel JM, Masicampo EJ, Kammrath LK, Strowd LC, Feldman SR. Tolerability of and Adherence to Topical Treatments in Atopic Dermatitis: A Narrative Review. Dermatol Ther (Heidelb) 2021; 11:415-431. [PMID: 33599887 PMCID: PMC8019006 DOI: 10.1007/s13555-021-00500-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 02/07/2023] Open
Abstract
Atopic dermatitis (AD) is a common, chronic inflammatory skin disease that oftentimes requires complex therapy. Poor adherence is a major barrier to AD treatment success. An interspecialty, virtual roundtable panel was held, through which clinical dermatologists, allergists, and behavioral and social psychologists discussed AD management and adherence. Relevant literature was reviewed, and the content of this article was organized based on the roundtable discussion. Current guidelines for AD treatment include maintenance and acute therapy for mild-to-severe AD. Therapy is often complex and requires significant patient involvement, which may contribute to poor treatment adherence. Behavioral and social psychology strategies that may help improve adherence include scheduling timely follow-up appointments, using a clearly written eczema action plan (EAP), reducing perceived treatment burden, utilizing anchoring techniques, sharing anecdotes, and rewarding children using positive reinforcement and stickers. There are multiple practical ways by which providers can improve both the management and treatment adherence of patients with AD.
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Affiliation(s)
- Heather L Tier
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
| | - Esther A Balogh
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Arjun M Bashyam
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Alan B Fleischer
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.,Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - E J Masicampo
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Lara K Kammrath
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Lindsay C Strowd
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
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68
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Bruin-Weller MD, Pink AE, Patrizi A, Gimenez-Arnau AM, Agner T, Roquet-Gravy PP, Ferrucci SM, Arenberger P, Svensson A, Schuttelaar MLA, Nosbaum A, Jayawardena S, Rizova E, Ardeleanu M, Eckert L, Ozturk ZE. Disease burden and treatment history among adults with atopic dermatitis receiving systemic therapy: baseline characteristics of participants on the EUROSTAD prospective observational study. J DERMATOL TREAT 2021; 32:164-173. [PMID: 33461356 DOI: 10.1080/09546634.2020.1866741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Insights into the real-world treatment paradigm and long-term burden of atopic dermatitis (AD) are needed to inform clinical and health policy decisions. METHODS The prospective, observational EUROSTAD study enrolled adults with moderate-to-severe AD starting or switching systemic therapy (51 sites in 10 European countries). We report the baseline characteristics, treatment patterns, and outcomes of these patients using descriptive statistics. RESULTS A 12-month enrollment period of EUROSTAD was completed and 308 patients were enrolled: average age 37 years, AD duration 25 years, 43% were female. Most patients reported use of systemic therapy (93%) and ≥1 atopic comorbidity (82%). Mean [standard deviation] disease severity/burden measures were high: Investigator's Global Assessment (3.1 [0.8]), Eczema Area and Severity Index (16.2 [10.9]), Peak Pruritus Numerical Rating Scale (5.5 [2.5]), sleep impairment Visual Analog Scale (49.8 [31.6]) scores, and time lost from work (4.1 [13.7] days/year) or usual activities (16.8 [38.7] days/year). Most patients showed borderline or clinical levels of anxiety (59%) and/or depression (63%) using the Hospital Anxiety and Depression Scale. CONCLUSIONS Adults with moderate-to-severe AD starting/switching systemic treatment enrolled in EUROSTAD have a high burden of longstanding disease despite continuous use of topical drugs, emollients, and systemic therapies.
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Affiliation(s)
- Marjolein de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andrew E Pink
- St. John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Annalisa Patrizi
- Department of Dermatology, IRCCS Policlinico di S. Orsola, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Italy
| | - Ana M Gimenez-Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tove Agner
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Silvia M Ferrucci
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Audrey Nosbaum
- Allergy and Clinical Immunology Department, University of Lyon, Lyon Sud University Hospital, Pierre Benite, France
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69
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Greenwell K, Ghio D, Muller I, Roberts A, McNiven A, Lawton S, Santer M. Taking charge of eczema self-management: a qualitative interview study with young people with eczema. BMJ Open 2021; 11:e044005. [PMID: 33408215 PMCID: PMC7789449 DOI: 10.1136/bmjopen-2020-044005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To explore young people's experiences of eczema self-management and interacting with health professionals. DESIGN Secondary qualitative data analysis of data sets from two semistructured interview studies. Data were analysed using inductive thematic analysis. SETTING Participants were recruited from the UK primary care, dermatology departments and a community-based sample (eg, patient representative groups, social media). PARTICIPANTS Data included 28 interviews with young people with eczema aged 13-25 years (mean age=19.5 years; 20 female). RESULTS Although topical treatments were generally perceived as effective, young people expressed doubts about their long-term effectiveness, and concerns around the safety and an over-reliance on topical corticosteroids. Participants welcomed the opportunity to take an active role in their eczema management, but new roles and responsibilities also came with initial apprehension and challenges, including communicating their treatment concerns and preferences with health professionals, feeling unprepared for transition to an adult clinic and obtaining treatments. Decisions regarding whether to engage in behaviours that would exacerbate their eczema (eg, irritants/triggers, scratching) were influenced by young people's beliefs regarding negative consequences of these behaviours, and perceived control over the behaviour and its negative consequences. CONCLUSIONS Behavioural change interventions must address the treatment concerns of young people and equip them with the knowledge, skills and confidence to take an active role in their own eczema management.
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Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Daniela Ghio
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Psychology, School of Health and Society, University of Salford, Manchester, UK
| | - Ingrid Muller
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Amanda Roberts
- Centre of Evidence-Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Sandra Lawton
- Dermatology Department, The Rotherham NHS Foundation Trust, Rotherham, UK
| | - Miriam Santer
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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70
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Petrova E, Hovnanian A. Advances in understanding of Netherton syndrome and therapeutic implications. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1857724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Evgeniya Petrova
- Laboratory of genetic skin diseases, Université de Paris, Imagine Institute, INSERM UMR1163, Paris, France
| | - Alain Hovnanian
- Laboratory of genetic skin diseases, Université de Paris, Imagine Institute, INSERM UMR1163, Paris, France
- Departement of Genetics, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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71
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Anderson ED, Alishahedani ME, Myles IA. Epithelial-Mesenchymal Transition in Atopy: A Mini-Review. FRONTIERS IN ALLERGY 2020; 1. [PMID: 34308414 PMCID: PMC8301597 DOI: 10.3389/falgy.2020.628381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Atopic diseases, particularly atopic dermatitis (AD), asthma, and allergic rhinitis (AR) share a common pathogenesis of inflammation and barrier dysfunction. Epithelial to mesenchymal transition (EMT) is a process where epithelial cells take on a migratory mesenchymal phenotype and is essential for normal tissue repair and signal through multiple inflammatory pathways. However, while links between EMT and both asthma and AR have been demonstrated, as we outline in this mini-review, the literature investigating AD and EMT is far less well-elucidated. Furthermore, current studies on EMT and atopy are mostly animal models or ex vivo studies on cell cultures or tissue biopsies. The literature covered in this mini-review on EMT-related barrier dysfunction as a contributor to AD as well as the related (perhaps resultant) atopic diseases indicates a potential for therapeutic targeting and carry treatment implications for topical steroid use and environmental exposure assessments. Further research, particularly in vivo studies, may greatly advance the field and translate into benefit for patients and families.
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Affiliation(s)
- Erik D Anderson
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States
| | - Mohammadali E Alishahedani
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States
| | - Ian A Myles
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States
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72
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Aldredge LM. Atopic Dermatitis With a Focus on Moderate to Severe Disease. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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73
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Zhou H, Shi L, Ren Y, Tan X, Liu W, Liu Z. Applications of Human Skin Microbiota in the Cutaneous Disorders for Ecology-Based Therapy. Front Cell Infect Microbiol 2020; 10:570261. [PMID: 33194808 PMCID: PMC7641908 DOI: 10.3389/fcimb.2020.570261] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
The skin represents the exterior interface between the human body with the environment while providing a home to trillions of the commensal microorganisms—collectively referred to as the skin microbiota. These microbes that coexist in an established balance play a pivotal role in the protection of cutaneous health and the orchestration of skin homeostasis. However, the well-controlled but delicate balance can be perturbed by alterations in the skin microbial communities, namely, dysbiosis, often due to commensals defeated by pathogens competing for space and nutrients, which leads to the occurrence of multiple cutaneous disorders. In view of this, the analysis of skin microbiota constituents in skin diseases is crucial for defining the role of commensal microbes and treatment of skin diseases. Emerging evidence shows that the ecology-based therapy of microbial transplantation has been proven as a valid therapeutic strategy for cutaneous disorders caused by skin microbial dysbiosis. Although its mechanism is not well-understood, there are already some applications for ecology-based therapy with the aim of correcting the imbalances on the cutaneous ecosystem. In this review, we summarize the interactions between dysbiosis and the cutaneous disorders, including homeostasis and dysbiosis of skin microbiota, microbial composition in skin diseases, and the mechanisms and applications of reversing or ameliorating the dysbiosis by the targeted manipulation of the skin microbiota, which may contribute to aid development of therapeutic modality for ecology-based therapy.
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Affiliation(s)
- Hong Zhou
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Linlin Shi
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Ren
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Tan
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liu
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China.,National Engineering Research Center for Nanomedicine, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi Liu
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China.,National Engineering Research Center for Nanomedicine, Huazhong University of Science and Technology, Wuhan, China
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74
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Raj KAP, Handa S, Narang T, Sachdeva N, Mahajan R. Correlation of serum vitamin D levels with severity of pediatric atopic dermatitis and the impact of vitamin D supplementation on treatment outcomes. J DERMATOL TREAT 2020; 33:1397-1400. [PMID: 32885699 DOI: 10.1080/09546634.2020.1818677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION There is scarcity of prospective studies assessing the correlation between vitamin D deficiency and atopic dermatitis (AD). MATERIALS AND METHODS We conducted a prospective study where in serum 25-hydroxy-vitamin D levels were measured in 35 AD patients and 35 age and sex-matched controls. AD patients deficient in vitamin D were supplemented with 1000 IU of vitamin D per day for three months. Serum vitamin D levels and SCORAD were again measured at the end of three months in all AD patients. RESULTS The baseline vitamin D levels in patients and controls did not have any statistically significant difference (p = .97). There was a statistically significant (p = .02) inverse relationship between the AD severity and serum vitamin D levels at baseline (r = -0.52). Maximum reduction in SCORAD (41.4 ± 12.7) after 3 months of vitamin D supplementation was seen in severe AD and the minimum (2.4 ± 13.2) in mild AD (p = .0003). CONCLUSIONS We found no difference in the mean serum vitamin D levels between AD patients and controls. An inverse correlation was seen between serum vitamin D levels at baseline and severity of AD. Beneficial effect of vitamin D supplementation was observed maximally in severe AD as observed by a reduction in SCORAD.
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Affiliation(s)
- K A Prithvi Raj
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India
| | - Naresh Sachdeva
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India.,Department of Endocrinology, PGIMER, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology & Leprology, PGIMER, Chandigarh, India
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Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N. Systemic treatments for eczema: a network meta-analysis. Cochrane Database Syst Rev 2020; 9:CD013206. [PMID: 32927498 PMCID: PMC8128359 DOI: 10.1002/14651858.cd013206.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eczema is a common and chronic, relapsing, inflammatory skin disorder. It seriously impacts quality of life and economic outcomes, especially for those with moderate to severe eczema. Various treatments allow sustained control of the disease; however, their relative benefit remains unclear due to the limited number of trials directly comparing treatments. OBJECTIVES To assess the comparative efficacy and safety of different types of systemic immunosuppressive treatments for moderate to severe eczema using NMA and to generate rankings of available systemic immunosuppressive treatments for eczema according to their efficacy and safety. SEARCH METHODS We searched the following databases up to August 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. SELECTION CRITERIA All randomised controlled trials (RCTs) of systemic immunosuppressive agents for moderate to severe atopic eczema when compared against placebo or any other eligible eczema treatment. DATA COLLECTION AND ANALYSIS We synthesised data using pair-wise analysis and NMA to compare treatments and rank them according to their effectiveness. Effectiveness was assessed primarily by determining the proportion of participants who achieved at least 75% improvement in the Eczema Area and Severity Index (EASI75) and improvement in the Patient-Oriented Eczema Measure (POEM). Safety was evaluated primarily by considering the proportion of participants with serious adverse events (SAEs) and infection. We deemed short-term follow-up as ≤ 16 weeks and long-term follow-up as > 16 weeks. We assessed the certainty of the body of evidence from the NMA for these primary outcomes using six domains of CiNEMA grading. MAIN RESULTS We included a total of 74 studies, with 8177 randomised participants. Approximately 55% of participants were male, with average age of 32 years (range 2 to 84 years), although age and gender were unreported for 419 and 902 participants, respectively. Most of the included trials were placebo controlled (65%), 34% were head-to-head studies (15% assessed the effects of different doses of the same drug), and 1% were multi-armed studies with both an active comparator and a placebo. All trials included participants with moderate to severe eczema, but 62% of studies did not separate data by severity; 38% of studies assessed only severe eczema. The total duration of included trials ranged from 2 weeks to 60 months, whereas treatment duration varied from a single dose (CIM331, KPL-716) to 60 months (methotrexate (MTX)). Seventy studies were available for quantitative synthesis; this review assessed 29 immunosuppressive agents from three classes of interventions. These included (1) conventional treatments, with ciclosporin assessed most commonly; (2) small molecule treatments, including phosphodiesterase (PDE)-4 inhibitors, tyrosine kinase inhibitors, and Janus kinase (JAK) inhibitors; and (3) biological treatments, including anti-CD31 receptors, anti-interleukin (IL)-22, anti-IL-31, anti-IL-13, anti-IL-12/23p40, anti-OX40, anti-TSLP, anti-CRTH2, and anti-immunoglobulin E (IgE) monoclonal antibodies, but most commonly dupilumab. Most trials (73) assessed outcomes at a short-term duration ranging from 2 to 16 weeks, whereas 33 trials assessed long-term outcomes, with duration ranging from 5 to 60 months. All participants were from a hospital setting. Fifty-two studies declared a source of funding, and of these, pharmaceutical companies funded 88%. We rated 37 studies as high risk; 21, unclear risk, and 16, low risk of bias, with studies most commonly at high risk of attrition bias. Network meta-analysis suggests that dupilumab ranks first for effectiveness when compared with other biological treatments. Dupilumab is more effective than placebo in achieving EASI75 (risk ratio (RR) 3.04, 95% confidence interval (CI) 2.51 to 3.69) and improvement in POEM score (mean difference 7.30, 95% CI 6.61 to 8.00) at short-term follow-up (high-certainty evidence). Very low-certainty evidence means we are uncertain of the effects of dupilumab when compared with placebo, in terms of the proportion of participants who achieve EASI75 (RR 2.59, 95% CI 1.87 to 3.60) at longer-term follow-up. Low-certainty evidence indicates that tralokinumab may be more effective than placebo in achieving short-term EASI75 (RR 2.54, 95% CI 1.21 to 5.34), but there was no evidence for tralokinumab to allow us to assess short-term follow-up of POEM or long-term follow-up of EASI75. We are uncertain of the effect of ustekinumab compared with placebo in achieving EASI75 (long-term follow-up: RR 1.17, 95% CI 0.40 to 3.45; short-term follow-up: RR 0.91, 95% CI 0.28 to 2.97; both very low certainty). We found no evidence on ustekinumab for the POEM outcome. We are uncertain whether other immunosuppressive agents that targeted our key outcomes influence the achievement of short-term EASI75 compared with placebo due to low- or very low-certainty evidence. Dupilumab and ustekinumab were the only immunosuppressive agents evaluated for longer-term EASI75. Dupilumab was the only agent evaluated for improvement in POEM during short-term follow-up. Low- to moderate-certainty evidence indicates a lower proportion of participants with SAEs after treatment with QAW039 and dupilumab compared to placebo during short-term follow-up, but low- to very low-certainty evidence suggests no difference in SAEs during short-term follow-up of other immunosuppressive agents compared to placebo. Evidence for effects of immunosuppressive agents on risk of any infection during short-term follow-up and SAEs during long-term follow-up compared with placebo was of low or very low certainty but did not indicate a difference. We did not identify differences in other adverse events (AEs), but dupilumab is associated with specific AEs, including eye inflammation and eosinophilia. AUTHORS' CONCLUSIONS Our findings indicate that dupilumab is the most effective biological treatment for eczema. Compared to placebo, dupilumab reduces eczema signs and symptoms in the short term for people with moderate to severe atopic eczema. Short-term safety outcomes from clinical trials did not reveal new safety concerns with dupilumab. Overall, evidence for the efficacy of most other immunosuppressive treatments for moderate to severe atopic eczema is of low or very low certainty. Given the lack of data comparing conventional with newer biological treatments for the primary outcomes, there remains high uncertainty for ranking the efficacy and safety of conventional treatments such as ciclosporin and biological treatments such as dupilumab. Most studies were placebo-controlled and assessed only short-term efficacy of immunosuppressive agents. Further adequately powered head-to-head RCTs should evaluate comparative long-term efficacy and safety of available treatments for moderate to severe eczema.
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Affiliation(s)
- Ratree Sawangjit
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand
| | - Piyameth Dilokthornsakul
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Antonia Lloyd-Lavery
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | | | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
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Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease that has become a global health problem. The pathophysiology of AD includes both skin barrier and immune abnormalities, with type 2 immune deviation central to several clinical phenotypes and underlying endotypes. Recognition of the persistent nature and systemic aspects of AD provides a rationale for treatment with a biologic. Dupilumab has been approved for patients 6 years of age and older with moderate to severe AD. Monoclonal antibodies are in phase 3 trials and may become part of a precision medicine approach to AD.
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MESH Headings
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Biological Products/pharmacology
- Biological Products/therapeutic use
- Clinical Trials as Topic
- Dermatitis, Atopic/diagnosis
- Dermatitis, Atopic/drug therapy
- Dermatitis, Atopic/immunology
- Dermatitis, Atopic/pathology
- Drug Approval
- Humans
- Immunoglobulin E/metabolism
- Interleukin-13/antagonists & inhibitors
- Interleukin-13/metabolism
- Interleukin-4/metabolism
- Interleukin-4 Receptor alpha Subunit/antagonists & inhibitors
- Interleukin-4 Receptor alpha Subunit/metabolism
- Off-Label Use
- Omalizumab/pharmacology
- Omalizumab/therapeutic use
- Receptors, Interleukin/antagonists & inhibitors
- Receptors, Interleukin/metabolism
- Severity of Illness Index
- Signal Transduction/drug effects
- Signal Transduction/immunology
- Skin/drug effects
- Skin/immunology
- Skin/pathology
- Treatment Outcome
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Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, 1400 Jackson Street, J310, Denver, CO 80206, USA.
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Chen Y, Zhu J, Lyu J, Xia Y, Ying Y, Hu Y, Qu J, Tong S, Li S. Association of Maternal Prepregnancy Weight and Gestational Weight Gain With Children's Allergic Diseases. JAMA Netw Open 2020; 3:e2015643. [PMID: 32876683 PMCID: PMC7489810 DOI: 10.1001/jamanetworkopen.2020.15643] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Information on the association between maternal prepregnancy body weight, gestational weight change, and childhood allergies is not consistent. Little is known on whether there is a combined association with comprehensive childhood allergies. OBJECTIVE To examine the association of maternal prepregnancy body mass index and gestational weight gain (GWG) with the risk of childhood allergic diseases including asthma and/or wheezing, allergic rhinitis, eczema, and food and/or drug allergy. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from April 12 to June 1, 2019, using the Shanghai Children Allergy Study (SCAS), a large, population-based survey. A multistage and multistrata sampling approach was applied to conduct the survey in 13 districts across Shanghai, China, with an enrollment of 15 145 mother-child pairs. EXPOSURES Reported maternal weight before pregnancy and at the time of delivery were requested in the survey; GWG was examined in absolute terms and with reference to the Institute of Medicine guideline. MAIN OUTCOMES AND MEASURES The ascertainment of allergic diseases was based on the International Study of Asthma and Allergies in Childhood questionnaire. RESULTS Among 15 145 children aged 3 to 14 years (7911 [52.2%] boys) within the SCAS, 8877 children (58.6%) were screened for allergic diseases. Multivariable log-binomial regression models suggested that excessive GWG was associated with risks of 19% for asthma/wheezing, 11% for allergic rhinitis, and 10% for eczema in the children. Gestational weight gain extremely above the Institute of Medicine guideline in women who were overweight/obese before pregnancy was associated with the highest risk of childhood asthma/wheezing (adjusted prevalence ratio, 1.42; 95% CI, 1.16-1.74; P = .001), allergic rhinitis (adjusted prevalence ratio, 1.32; 95% CI, 1.12-1.56; P = .001), and eczema (adjusted prevalence ratio, 1.24; 95% CI, 1.08-1.41; P = .002). Gestational weight gain below the Institute of Medicine guideline was associated with an attenuated risk of 13% for childhood asthma/wheezing, 11% for allergic rhinitis, 14% for eczema, and 15% food/drug allergy when mothers were of prepregnancy normal weight; similar associations were observed in underweight mothers, but there was no association in overweight mothers. Generally, the associations were similar in the stratified analysis according to children's age group. Moreover, the results were similar in the allergen test subgroup. CONCLUSIONS AND RELEVANCE The findings of this study suggest that excessive GWG may be a risk factor for childhood allergic diseases. Further studies on the long-term effects of the intrauterine environment on children's health may take maternal weight management during pregnancy into consideration since GWG could be a controllable and modifiable risk factor.
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Affiliation(s)
- Yiting Chen
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Jianzhen Zhu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- School of International and Public Affairs, Shanghai Jiao Tong University Shanghai, China
| | - Jiajun Lyu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanqing Xia
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Ying
- School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Yabin Hu
- School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Jiajie Qu
- Shanghai Municipal Education Commission, Shanghai, China
| | - Shilu Tong
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- School of Medicine, Shanghai Jiao Tong University Shanghai, China
- Institute of Environment and Population Health, Anhui Medical University School of Public Health, Hefei, China
- Queensland University of Technology School of Public Health and Social Work, Brisbane, Queensland, Australia
| | - Shenghui Li
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Department of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Ungar B, Pavel AB, Robson PM, Kaufman A, Pruzan A, Brunner P, Kaushik S, Krueger JG, Lebwohl MG, Mani V, Fayad ZA, Guttman-Yassky E. A Preliminary 18F-FDG-PET/MRI Study Shows Increased Vascular Inflammation in Moderate-to-Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3500-3506. [PMID: 32721606 DOI: 10.1016/j.jaip.2020.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/20/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent data suggest that patients with atopic dermatitis (AD) have increased systemic immune activation and cardiovascular risk. However, unlike psoriasis, evaluation of active vascular inflammation using state-of-the-art imaging is lacking in AD. OBJECTIVE To assess aortic and carotid vascular inflammation using 18F-fluorodeoxyglucose-positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) imaging in moderate-to-severe AD versus healthy individuals. METHODS A total of 27 patients with moderate-to-severe AD and 12 healthy controls were imaged using 18F-FDG-PET/MRI. Target-to-background ratio (TBR) values were calculated in multiple segments of the aorta and carotid vessels. RESULTS Patients with AD had elevated aortic max TBR (fold change [FCH] = 1.45, P = .057) versus healthy controls and significantly elevated mean TBR (FCH = 1.20; P < .05) in the right carotid (RC) arteries versus controls. When examining greatest focal inflammation (most diseased segment [MDS] TBR), patients with AD had higher aortic inflammation (FCH = 1.28; P = .052). AD clinical severity significantly correlated with C-reactive protein (ρ = 0.60, P < .01) and with RC mean TBR levels (ρ = 0.60, P = .04). Stratifying patients into moderate-to-severe and very severe AD showed greater RC mean TBR in patients with very severe AD versus controls (FCH = 1.31; P = .02) and versus patients with moderate/severe AD (FCH = 1.23, P = .05). Aortic inflammation was also significantly greater in patients with very severe AD versus controls (max TBR: FCH = 1.6, P = .04; MDS TBR: FCH = 1.73, P = .03). CONCLUSIONS This preliminary study is the first that establishes greater vascular (aorta and carotid) inflammation in moderate-to-severe AD versus healthy controls. Furthermore, very severe AD showed higher inflammation than both moderate/severe patients and healthy controls. Future studies with larger patient cohorts and evaluation before and after treatment are needed to determine the extent to which vascular inflammation in AD is modifiable.
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Affiliation(s)
- Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana B Pavel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Philip M Robson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Audrey Kaufman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alison Pruzan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick Brunner
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Shivani Kaushik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Venkatesh Mani
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zahi A Fayad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY; Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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79
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TSLP and IL-7R Variants Are Associated with Persistent Atopic Dermatitis. J Invest Dermatol 2020; 141:446-450.e2. [PMID: 32712161 DOI: 10.1016/j.jid.2020.05.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/13/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
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80
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Hong MR, Lei D, Yousaf M, Chavda R, Gabriel S, Janmohamed SR, Silverberg JI. A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice. Ann Allergy Asthma Immunol 2020; 125:686-692.e3. [PMID: 32682980 DOI: 10.1016/j.anai.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the longitudinal course of adult atopic dermatitis (AD) lesional severity and extent in clinical practice. OBJECTIVE To determine the longitudinal course of AD in clinical practice. METHODS A prospective, dermatology practice-based study was performed (n = 400). Patients were assessed at baseline and approximately 6, 12, 18, and 24 months by eczema area and severity index (EASI) and objective-scoring atopic dermatitis (objective-SCORAD). Multivariable repeated measures linear regression models were constructed to evaluate AD severity over time. RESULTS Overall, 36.2% and 18.2% of patients had moderate (6.0-22.9) or severe (23.0-72.0) EASI scores at any visit, respectively. Similarly, 29.0% and 26.4% of patients had moderate (24.0-37.9) or severe (38.0-83.0) objective-SCORAD scores at any visit, respectively. Among patients with baseline moderate (6.0-22.9) or severe (23.0-72.0) EASI scores, 25.0% and 18.6% continued to have moderate or severe scores at 1 or more follow-up visits, respectively. Similarly, among patients with baseline moderate (24.0-37.9) or severe (38.0-83.0) objective-SCORAD scores, 22.6% and 24.5% continued to have moderate or severe scores at 1 or more follow-up visits, respectively. In longitudinal regression models, EASI was significantly associated with body surface area (adjusted β [95% confidence interval]: 0.16 [0.09-0.23]) and edema/papulation (2.31 [0.19-4.43]). In addition, objective-SCORAD was significantly associated with body surface area (0.12 [0.04-0.21]), edema/papulation (4.69 [2.05-7.32]), and scratch (3.34 [0.45-6.24]) over time. CONCLUSION AD lesional severity has a heterogeneous longitudinal course. Many patients had fluctuating lesional severity scores over time. A minority of patients had persistently moderate or severe lesions over time. Most patients with moderate-severe disease at baseline were unable to achieve persistent lesional clearance.
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Affiliation(s)
- Mindy R Hong
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald Lei
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Muhammad Yousaf
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rajeev Chavda
- Prescription Strategy and Innovation Group, Galderma SA, La Tour-de-Peilz, Switzerland
| | - Sylvie Gabriel
- Prescription Strategy and Innovation Group, Galderma SA, La Tour-de-Peilz, Switzerland
| | - Sherief R Janmohamed
- Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Jette, Belgium
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Dermatology, the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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81
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Kyung Y, Lee JS, Lee JH, Jo SH, Kim SH. Health-related behaviors and mental health states of South Korean adolescents with atopic dermatitis. J Dermatol 2020; 47:699-706. [PMID: 32452056 DOI: 10.1111/1346-8138.15386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
Atopic dermatitis (AD) is a common chronic skin disease with a negative influence on adolescent mental health state. We aimed to identify the influencing factors for mental health in adolescents with AD. We used data from the 13th Korean Youth Risk Behavior Web-based Survey (KYRBS) conducted in 2017. KYRBS data were obtained from a stratified, multistage, clustered sample. Participants responded to the question "have you ever been diagnosed with AD by a doctor?" and several yes/no questions about stress, depressive symptoms and suicidal ideation. Among 62 276 participants, the proportion of adolescents with AD was 25.0%. Compared with adolescents without AD, those with AD were significantly more likely to experience stress, depressive symptoms and suicidal ideation (P < 0.001) at rates of 59.1%, 27.8% and 13.9%, respectively. In the multivariate logistic regression model, subjective unhappiness was most strongly associated with stress in subjects with AD (adjusted odds ratio [aOR], 7.34; 95% confidence interval [CI], 5.87-9.18), while depression (aOR, 9.83; 95% CI, 7.85-11.32) and suicidal ideation (aOR, 5.70; 95% CI, 5.01-6.48) were reciprocally the most important risk factors in adolescents with AD. AD in adolescents is associated with a higher prevalence of stress, depressive symptoms and suicidal ideation. It is important for pediatricians to watch for these risks and to screen for suicidality in adolescents with AD.
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Affiliation(s)
- Yechan Kyung
- Departments of, Department of, Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ju Suk Lee
- Departments of, Department of, Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Hwa Lee
- Departments of, Department of, Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seon Hui Jo
- Department of, Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sung Hoon Kim
- Departments of, Department of, Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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82
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Rada S, Strohmaier S, Drucker AM, Eliassen AH, Schernhammer ES. Night shift work surrounding pregnancy and offspring risk of atopic disease. PLoS One 2020; 15:e0231784. [PMID: 32298373 PMCID: PMC7161965 DOI: 10.1371/journal.pone.0231784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Night shift work surrounding pregnancy may contribute to the risk of developing atopic diseases in offspring due to alterations in the prenatal environment, from stress. OBJECTIVE To examine the association of maternal night shift work surrounding pregnancy and offspring risk of developing atopic diseases from childhood to adolescence. METHODS We examined the association between night shift work before and during pregnancy among 4,044 mothers in the Nurses' Health Study II (NHSII) and atopic dermatitis, asthma and hay fever risk in 4,813 of their offspring enrolled in the Growing Up Today Study (GUTS). Mothers reported whether GUTS participants had ever been diagnosed with atopic dermatitis, asthma or hay fever in the GUTS Mothers' questionnaire. Generalized estimating equation regression models were used to estimate multivariable adjusted odds ratios (OR) and 95% confidence intervals (CIs). RESULTS There were no significant associations between pre-conception maternal night shift work and risk of atopic dermatitis, asthma or hay fever in their offspring. Among 545 mothers with information on night shift work during pregnancy, shift work also was not associated with atopic dermatitis, asthma or hay fever in the offspring. Stratified analyses by history of parental atopy and maternal chronotype showed some statistically significant findings, but they were inconsistent and no significant interaction was seen with increasing duration of night shift work. CONCLUSION In this study, night shift work before and during pregnancy did not increase offspring risk of developing atopic dermatitis, asthma or hay fever.
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Affiliation(s)
- Samantha Rada
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Strohmaier
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aaron M. Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - A. Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Eva S. Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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83
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Chan AR, Sandhu VK, Drucker AM, Fleming P, Lynde CW. Adult-Onset Atopic Dermatitis: Presentations and Progress. J Cutan Med Surg 2020; 24:267-272. [PMID: 32238071 DOI: 10.1177/1203475420911896] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis (AD) is a chronic skin disease characterized by barrier dysfunction and immune dysregulation that affects approximately 20% of children and 2-5% of adults worldwide. Traditionally, AD has been considered a disease of childhood with many cases resolving before adulthood. However, in recent years, the prevalence of adult AD is increasingly recognized to be substantial, but it is uncertain whether this increase is due to increased childhood-persistent or relapsed AD, or new adult-onset AD. This highlights a need for further investigation into the adult AD population and evaluation of phenotypes in the adult-onset cohort. In this literature review, we examine five studies focused on adult-onset AD phenotype, conducted between 2013 and 2017. The most commonly reported body regions affected in adult-onset AD were the hands, eyelids, neck, and flexural surfaces of the upper limbs. These vary from childhood-onset AD findings, which are less specific to body regions other than flexural areas. These findings have implications for diagnostic accuracy and treatment of AD, including considerations for therapeutic choices and inclusion and exclusion criteria in clinical trials.
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Affiliation(s)
- Airiss R Chan
- 7938 Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vijay K Sandhu
- 7938 Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aaron M Drucker
- 7985 Division of Dermatology, Women's College Hospital and University of Toronto, and Women's College Research Institute, ON, Canada
| | - Patrick Fleming
- Deparment of Medicine, Lynde Institute of Dermatology, Markham, ON, Canada.,Department of Medicine, Division of Dermatology, University of Toronto, ON, Canada
| | - Charles W Lynde
- Deparment of Medicine, Lynde Institute of Dermatology, Markham, ON, Canada.,Department of Medicine, Division of Dermatology, University of Toronto, ON, Canada
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84
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Paller AS, Fölster-Holst R, Chen SC, Diepgen TL, Elmets C, Margolis DJ, Pollock BH. No evidence of increased cancer incidence in children using topical tacrolimus for atopic dermatitis. J Am Acad Dermatol 2020; 83:375-381. [PMID: 32246968 DOI: 10.1016/j.jaad.2020.03.075] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term safety of topical calcineurin inhibitors is not well understood. APPLES (A Prospective Pediatric Longitudinal Evaluation to Assess the Long-Term Safety of Tacrolimus Ointment for the Treatment of Atopic Dermatitis; NCT00475605) examined incidence of lymphoma and other cancers in a pediatric population with atopic dermatitis. OBJECTIVE To quantify incident malignancies during 10 years in children with atopic dermatitis who used topical tacrolimus for ≥6 weeks. METHODS Standardized incidence ratios for cancer events were analyzed relative to sex-, age-, and race-matched control data from national cancer registries. RESULTS There were 7954 eligible patients enrolled at 314 sites in 9 countries. During 44,629 person-years, 6 confirmed incident cancers occurred (standardized incidence ratio, 1.01; 95% confidence interval, 0.37-2.20). No lymphomas occurred. LIMITATIONS Observational prospective cohort study. CONCLUSION The cancer incidence was as expected, given matched background data. This finding provides no support for the hypothesis that topical tacrolimus increases long-term cancer risk in children with atopic dermatitis.
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Affiliation(s)
- Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University School of Medicine, Chicago, Illinois.
| | - Regina Fölster-Holst
- The Department of Dermatology, University Clinics, Schleswig-Holstein Campus, Kiel, Germany
| | - Suephy C Chen
- The Department of Dermatology, Emory University School of Medicine and Regional TeleHealth Service VISN7, Atlanta, Georgia
| | - Thomas L Diepgen
- The Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg at Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Craig Elmets
- The Department of Dermatology and the O'Neal Comprehensive Cancer Center, University of Alabama School of Medicine, Birmingham, Alabama
| | - David J Margolis
- The Departments of Dermatology and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Brad H Pollock
- The Department of Public Health Sciences, School of Medicine, University of California, Davis, California
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85
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Kyung Y, Choi MH, Jeon YJ, Lee JS, Lee JH, Jo SH, Kim SH. Association of atopic dermatitis with suicide risk among 788,411 adolescents: A Korean cross-sectional study. Ann Allergy Asthma Immunol 2020; 125:55-64. [PMID: 32240758 DOI: 10.1016/j.anai.2020.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is known to negatively influence the mental health of patients. However, only a few studies have explored the influencing factors for psychiatric problems among adolescents with AD. OBJECTIVE To assess the association of AD and suicidal behaviors among adolescents by analyzing data from the 3rd through the 13th annual Korean Youth Risk Behavior Web-based Surveys (completed from 2007 to 2017). METHODS Survey data were obtained from a stratified, multistage, clustered sample. Students self-reported AD if they had received a diagnosis of AD by a physician. Influencing factors for suicidal behaviors were tested by logistic regression models. RESULTS A total of 788,411 adolescents completed the survey. The proportion of participants with AD was 22.2%. Those reporting suicide ideation and suicide attempts were 19.0%, and 4.5%, respectively. Compared with adolescents without AD, those with AD were more likely to be female, to skip breakfast less frequently, to exercise less frequently, to drink less alcohol, and to not be current smokers and were statistically significantly more likely to have negative mental health states. In the multivariable model, perceived unhappiness and suicidal ideation were the strongest influencing factors for suicidal ideation (adjusted odds ratio, 4.90; 95% CI, 4.31-5.57) and for suicidal attempts (adjusted odds ratio, 48.01; 95% CI, 42.69-53.09), respectively. CONCLUSION Adolescents with AD had a meaningful prevalence of suicidal behaviors. Although further research is needed to clarify this association, adolescents with AD with influencing factors for negative mental health state may need intervention from practitioners who use a multidisciplinary team approach to prevent suicide.
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Affiliation(s)
- Yechan Kyung
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Min Hwan Choi
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Yoo Jung Jeon
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jun Hwa Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seon Hui Jo
- Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
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86
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Gong JJ, Margolis DJ, Monos DS. Predictive in silico binding algorithms reveal HLA specificities and autoallergen peptides associated with atopic dermatitis. Arch Dermatol Res 2020; 312:647-656. [PMID: 32152724 DOI: 10.1007/s00403-020-02059-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/26/2020] [Indexed: 12/18/2022]
Abstract
Atopic dermatitis (AD) is a skin disease that results from a combination of skin barrier dysfunction and immune dysregulation. The immune dysregulation is often associated with IgE sensitivity. There is also evidence that autoallergens Hom s 1, 2, 3, and 4 play a role in AD; it is possible that patients with specific HLA subtypes are predisposed to autoreactivity due to increased presentation of autoallergen peptides. The goal of our study was to use in silico epitope prediction platforms as an approach to identify HLA subtypes that may preferentially bind autoallergen peptides and are thus candidates for further study. Considering the previously described association of DRB1 alleles with AD and progression of disease, emphasis was placed on DRB1. Certain DRB1 alleles (08:04, 11:01, and 11:04) were identified by both algorithms to bind a significant percent of the generated autoallergen peptides. Conversely, autoallergen core peptide sequences FRQLSHRFH and IRAKLRLQA (Hom s 1), IRKSKNILF (Hom s 2), FKWVPVTDS and MAAIEKVRK (Hom s 3), and FRYFATLKV (Hom s 4) were predicted to bind many DRB1 alleles and, thus, may play a role in the pathogenesis of AD. Our findings provide candidate DRB1 alleles and autoallergen epitopes that will guide future studies exploring the relationship between DRB1 subtype and autoreactivity in AD. A similar approach can be used for any antigen that has been associated with an IgE response and AD.
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Affiliation(s)
- Jan J Gong
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J Margolis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dimitrios S Monos
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
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87
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Eichner B, Michaels LAC, Branca K, Ramsey K, Mitchell J, Morris CD, Fagnan LJ, Dolor RJ, Elder N, Hahn DL, Nease DE, Lapidus J, Cibotti R, Block J, Simpson EL. A Community-based Assessment of Skin Care, Allergies, and Eczema (CASCADE): an atopic dermatitis primary prevention study using emollients-protocol for a randomized controlled trial. Trials 2020; 21:243. [PMID: 32131885 PMCID: PMC7057622 DOI: 10.1186/s13063-020-4150-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/06/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common, chronic skin disorder often beginning in infancy. Skin barrier dysfunction early in life serves as a central event in the pathogenesis of AD. In infants at high risk of developing AD, preventative application of lipid-rich emollients may reduce the risk of developing AD. This study aims to measure the effectiveness of this intervention in a population not selected for risk via a pragmatic, randomized, physician-blinded trial in the primary care setting. METHODS Infant-parent dyads are recruited from a primary care practice participating through one of four practice-based research networks in Oregon, Colorado, Wisconsin, and North Carolina. Eligible dyads are randomized to the intervention (daily use of lipid-rich emollient) or the control (no emollient) group (n = 625 infants in each) and are followed for 24 months. The primary outcome is the cumulative incidence of physician-diagnosed AD and secondary outcomes include caregiver-reported measures of AD and development of other atopic diseases. Data collection occurs via chart review and surveys, with no study visits required. Data will be analyzed utilizing intention-to-treat principles. DISCUSSION AD is a common skin condition in infants that affects quality of life and is associated with the development of other atopic diseases. If a safe intervention, such as application of lipid-rich emollients, in the general population effectively decreases AD prevalence, this could alter the guidance given by providers regarding routine skin care of infants. Because of the pragmatic design, we anticipate that this trial will yield generalizable results. TRIAL REGISTRATION ClinicalTrials.gov: NCT03409367. Registered on 11 February 2018.
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Affiliation(s)
- Brian Eichner
- Duke Primary Care Research Consortium, Duke University, Durham, NC, USA
| | - Le Ann C Michaels
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Kelsey Branca
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Katrina Ramsey
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Julie Mitchell
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Cynthia D Morris
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Lyle J Fagnan
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Rowena J Dolor
- Duke Primary Care Research Consortium, Duke University, Durham, NC, USA
| | - Nancy Elder
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - David L Hahn
- Wisconsin Research & Education Network, University of Wisconsin-Madison, Madison, WI, USA
| | - Donald E Nease
- State Networks of Colorado Ambulatory Partners & Practices, University of Colorado-Denver, Denver, CO, USA
| | - Jodi Lapidus
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Ricardo Cibotti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD, USA
| | - Julie Block
- National Eczema Association, San Rafael, CA, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA.
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA.
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88
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Atopic dermatitis induces anxiety- and depressive-like behaviors with concomitant neuronal adaptations in brain reward circuits in mice. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109818. [PMID: 31743694 DOI: 10.1016/j.pnpbp.2019.109818] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/25/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
Clinically, it has been reported that atopic dermatitis (AD) has been linked with negative emotional problems such as depression and anxiety, thereby reducing the quality of life, but little is known about the molecular mechanism that underlies AD-associated emotional impairments. We sought to determine whether AD could induce anxiety- and depressive-like symptoms in mice and to identify pertinent signaling changes in brain reward circuitry. AD-like lesions were induced by the repeated intradermal application of MC903 into the cheek of the mouse. We assessed dermatitis severity with scratching behavior, histopathological changes, anxiety- and depressive-like behaviors using the elevated plus maze, open field and tail suspension tests, and serum corticosterone levels. In the nucleus accumbens (NAc), dorsal striatum (DS) and ventral tegmental area (VTA), protein levels of dopamine- and plasticity-related signaling molecules were determined by Western immunoblotting assay. Intradermal administration of MC903 into mouse cheek provoked a strong hind limb scratching behavior as well as the robust skin inflammation with epidermal thickening. MC903-treated mice also displayed markedly increased anxiety- and depressive-like behaviors, along with elevated serum corticosterone levels. Under these conditions, enhanced cAMP response element binding protein (CREB) and dopamine and cAMP-regulated phosphoprotein, 32 kDa (DARPP32) phosphorylation, significantly higher brain-derived neurotrophic factor (BDNF) and ΔFosB, but reduced tyrosine hydroxylase (TH) and dopamine D1 receptor (D1R) protein expression were found in the NAc, DS and VTA. Striatal BDNF, phospho-DARPP32 and phospho-CREB levels were significantly associated with the levels of depressive-like behavior in these mice. Taken together, these findings demonstrate that AD-like skin lesion elicits anxiety- and depressive-like phenotypes that are associated with neuroplasticity-related changes in reward circuitry, providing a better understanding of AD-associated emotional impairments.
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89
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Abstract
Atopic dermatitis (AD) in older adults (elderly AD) has recently emerged as a newly defined subgroup of AD. When selecting treatment options, clinical characteristics of elderly AD and age-specific factors of older patients must be considered. As in other age groups, regular application of moisturizers in combination with topical corticosteroids and calcineurin inhibitors, adjunctive administration of oral antihistamines/anti-allergic drugs, and avoidance of exacerbating factors comprise basic treatments for elderly AD. For moderate-to-severe cases and/or in those with a decreased ability to use topical treatments, powerful anti-inflammatory treatments may become necessary as additional treatment options. While low-dose oral corticosteroids may be useful for cases of elderly AD, careful attention should be paid to adverse effects. Oral cyclosporine (ciclosporin) is less commonly used due to the increased risk of malignancy and organ toxicity in older patients with AD. Narrow-band ultraviolet B phototherapy may also be useful for older patients, although the necessity of frequent hospital visits for irradiation therapy may become a burden of disease for such patients. As a biologic, dupilumab therapy markedly improves skin lesions and itch in older patients with AD, with a rapid response and non-serious adverse effects. Nevertheless, injection pain, expensive medical care, and regular follow-up every 2 weeks are disadvantages of dupilumab therapy. Therefore, clinicians must prioritize individualized treatment options that will reduce the burden of disease for cases of elderly AD.
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Affiliation(s)
- Ryoji Tanei
- Department of Dermatology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakaecho, Itabashi, Tokyo, 173-0015, Japan.
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90
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Pezzolo E, Naldi L. Epidemiology of major chronic inflammatory immune-related skin diseases in 2019. Expert Rev Clin Immunol 2020; 16:155-166. [DOI: 10.1080/1744666x.2020.1719833] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Elena Pezzolo
- Study Centre of the Italian Group for the Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Luigi Naldi
- Study Centre of the Italian Group for the Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
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91
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Sendrasoa FA, Ranaivo IM, Razanakoto NH, Andrianarison M, Raharolahy O, Ratovonjanahary VT, Sata M, Rakotoarisaona MF, Ramarozatovo LS, Rapelanoro Rabenja F. Epidemiology and associated factors of atopic dermatitis in Malagasy children. Allergy Asthma Clin Immunol 2020; 16:4. [PMID: 31911806 PMCID: PMC6945509 DOI: 10.1186/s13223-019-0398-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/13/2019] [Indexed: 11/12/2022] Open
Abstract
Background Little is known about the epidemiology and associated factors of childhood AD in the markedly different, low-income, tropical environment like Madagascar. Methods We aim to assess the epidemiology and associated factors of AD in individuals fewer than 15 years of age in Antananarivo Madagascar. It was a retrospective and descriptive study over a period of 7 years (2010 to 2016) in children 6 months to 14 years in the Department of Dermatology, Joseph Raseta Befelatanana Antananarivo Madagascar. The diagnosis of AD was based on clinical data. Results The prevalence of AD was 5.6% in children aged 6 months to 14 years. The details of 151 cases of atopic dermatitis were analyzed. The mean age of patients was 4 years. There was a female preponderance (sex ratio: 0.7). A family history of AD was noted in 56 cases (37%). No association between breast-feeding and AD was found. The age of onset of AD was before the age of 3 months in 7.5% and between 6 months to 5 years in 70%. Children born in March (dry season) had the highest risk of AD. Consultations for AD increased during the winter (from July to October; p = 0.005). However, the prevalence of AD was similar in urban and rural areas. Conclusion Weather may have an impact on the prevalence of atopic dermatitis in Madagascar. No significant correlation was found between the duration of breastfeeding and AD, as well as urbanization.
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Affiliation(s)
- F A Sendrasoa
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - I M Ranaivo
- Department of Dermatology, University Hospital Morafeno, Toamasina, Madagascar
| | - N H Razanakoto
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - M Andrianarison
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - O Raharolahy
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - V T Ratovonjanahary
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - M Sata
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - M F Rakotoarisaona
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - L S Ramarozatovo
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - F Rapelanoro Rabenja
- Department of Dermatology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
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92
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Fishbein AB, Silverberg JI, Wilson EJ, Ong PY. Update on Atopic Dermatitis: Diagnosis, Severity Assessment, and Treatment Selection. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:91-101. [PMID: 31474543 PMCID: PMC7395647 DOI: 10.1016/j.jaip.2019.06.044] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases affecting children and adults. The intense pruritus and rash can be debilitating, significantly impairing quality of life. Until recently, treatment was largely nonspecific and, in severe disease, sometimes ineffective and/or fraught with many side effects. Now, multiple agents targeting specific disease pathways are available or in development. Two new therapies, crisaborole and dupilumab, have become available since 2016, and dupilumab has dramatically improved outcomes for adults with severe AD. This article provides an overview of AD, including strategies for differential diagnosis and assessment of disease severity to guide treatment selection. Key clinical trials for crisaborole and dupilumab are reviewed, and other targeted treatments now in development are summarized. Two cases, representing childhood-onset and adult-onset AD, are discussed to provide clinical context for diagnosis, severity assessment, and treatment selection and outcomes.
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Affiliation(s)
- Anna B Fishbein
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Jonathan I Silverberg
- Northwestern University Feinberg School of Medicine, Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Ill
| | | | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, Calif
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93
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Cho SI, Lee H, Lee DH, Kim KH. Association of frequent intake of fast foods, energy drinks, or convenience food with atopic dermatitis in adolescents. Eur J Nutr 2019; 59:3171-3182. [PMID: 31822988 DOI: 10.1007/s00394-019-02157-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/29/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Specific food consumption, besides food allergy, may aggravate atopic dermatitis (AD). However, previous reports on the association between AD and food intake in adolescents are scarce. The aim of this study was to determine the relationship between AD and specific food consumption frequency in adolescents. METHODS A cross-sectional analysis using data from the Korea Youth Risk Behavior Web-based Survey 2017 was performed. The frequency of food consumption in the recent-diagnosed AD group (AD diagnosed within 12 months) compared to those in the previous-diagnosed AD (AD diagnosed more than 12 months ago) or control group were investigated. RESULTS A total of 53,373 participants were eligible for this study. The weighted prevalence of the recent-diagnosed AD and the previous-diagnosed AD was 7.39% and 18.00%, respectively. When compared with subjects with the previous-diagnosed AD, those with the recent-diagnosed AD were significantly more likely to frequently consume fast foods (odds ratio OR 1.405; 95% CI 1.150-1.717), energy drinks (OR 1.457; 95% CI 1.175-1.807), or convenience food (OR 1.304; 95% CI 1.138-1.495). Patients of the recent-diagnosed AD were significantly more likely to frequently consume fast foods (OR 1.374; 95% CI 1.155-1.634) than the control group. The differences in the frequency of specific food consumption among groups were more pronounced in high school students than in middle school students. CONCLUSIONS Frequent intake of fast foods, energy drinks, and convenience food was related to the recent-diagnosed AD in adolescents. Prospective cohort and interventional studies are needed to identify causal relationships.
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Affiliation(s)
- Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Human-Environment Interface Biology, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hanjae Lee
- Department of Dermatology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Human-Environment Interface Biology, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Institute of Human-Environment Interface Biology, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Kyu-Han Kim
- Department of Dermatology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Institute of Human-Environment Interface Biology, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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94
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Lee A, Lee SY, Lee KS. The Use of Heated Tobacco Products is Associated with Asthma, Allergic Rhinitis, and Atopic Dermatitis in Korean Adolescents. Sci Rep 2019; 9:17699. [PMID: 31776400 PMCID: PMC6881368 DOI: 10.1038/s41598-019-54102-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/08/2019] [Indexed: 01/27/2023] Open
Abstract
The increasing use of new and emerging tobacco products has raised public health concern worldwide. This study aimed to assess the association between tobacco product use and the risk of allergic diseases. We used cross-sectional data of 58,336 students aged 12–18 years from the 2018 Korea Youth Risk Behavior Survey. This study considered three tobacco products, namely cigarettes, electronic cigarettes (e-cigarettes), and heated tobacco products. Descriptive analyses, as well as simple and multinomial logistic regression analyses with a complex sampling design, were performed. Multiple tobacco use had an association with the risk of each allergic disease. Use of each tobacco product was significantly associated with an increased risk of multi-morbidity of asthma, allergic rhinitis, and atopic dermatitis. Furthermore, lifetime use of each tobacco product was associated with the prevalence of atopic dermatitis. This highlights the importance of paying close attention to smoking by adolescents and its association with allergy epidemics. Future research should consider intensity of smoking and/or severity of allergic symptoms.
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Affiliation(s)
- Ahnna Lee
- Department of Public Health, Graduate School, The Catholic University of Korea, Seoul, Korea.,Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kang-Sook Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Orostachys japonicus ethanol extract inhibits 2,4-dinitrochlorobenzene-induced atopic dermatitis-like skin lesions in NC/Nga mice and TNF-α/IFN-γ-induced TARC expression in HaCaT cells. Toxicol Res 2019; 36:99-108. [PMID: 32257921 DOI: 10.1007/s43188-019-00026-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 01/10/2023] Open
Abstract
The risk of atopic dermatitis (AD)-like skin lesions has increased due to the elevated levels of allergens worldwide. Natural-origin agents, which are effective and safe, show promise for the prevention and treatment of inflammatory conditions. Orostachys japonicus (OJ) A. Berger is an ingredient of traditional herbal medicines for fever, gingivitis, and cancer in Korea, China, and Japan. However, the effect of OJ on AD-like skin lesions is unknown. Therefore, we investigated the effect of OJ ethanol extract (OJEE) on AD-like skin symptoms in mice and cells. OJEE reduced the 2,4-dinitrochlorobenzene-induced AD severity, serum levels of IgE and TARC, and mRNA levels of TARC, TNF-α, and IL-4 in NC/Nga mice. Histopathological analysis showed that OJEE reduced the thickness of the epidermis/dermis and dermal infiltration of inflammatory cells in ear tissue. Furthermore, OJEE suppressed the TNF-α/IFN-γ-increased TARC mRNA level by inhibiting NF-κB and STAT1 activation in HaCaT cells. Taken together, our findings show that OJEE reduced the risk of AD-like skin symptoms by decreasing TARC expression via inhibiting NF-κB and STAT1 activation in skin keratinocytes and thus shows promise as an alternative therapy for AD-like skin lesions.
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96
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Margolis DJ, Mitra N, Wubbenhorst B, D'Andrea K, Kraya AA, Hoffstad O, Shah S, Nathanson KL. Association of Filaggrin Loss-of-Function Variants With Race in Children With Atopic Dermatitis. JAMA Dermatol 2019; 155:1269-1276. [PMID: 31365035 DOI: 10.1001/jamadermatol.2019.1946] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Atopic dermatitis (AD) is a common chronic illness that has been associated with variation in the filaggrin gene (FLG). Four variants are most often evaluated. Objectives To comprehensively describe and compare results from targeted sequencing of FLG loss-of-function (LoF) variants in children of African and European ancestry and the association of these variants with onset and persistence of AD. Design, Setting, and Participants This prospective US cohort study assessed the genetic subcohort of the Pediatric Eczema Elective Registry (PEER). Children with mild to moderate AD were included in the analysis. Massively parallel sequencing (MPS) was used to focus on FLG LoF variation in white and African American children. Patients were enrolled from June 2005 through July 2017. Data were analyzed from January 25 through May 10, 2019. Main Outcomes and Measures Associations of FLG LoF variation with white and African American ancestry and with the risk and persistence of AD. Results A total of 741 children were included in the analysis (394 [53.2%] female and 347 [46.8%] male; mean [SD] age at onset, 1.97 [2.72] years); of these, 394 (53.2%) were white, 326 (44.0%) were African American, and 21 (2.8%) were of other ancestries. Using MPS technology, 23 FLG LoF variants were found in children with AD. The prevalence of FLG LoF variants was 177 participants (23.9%) in the full cohort, 124 white participants (31.5%), and 50 African American participants (15.3%). The odds ratio for carrying any FLG LoF variant in a white child compared with an African American child with AD was 2.44 (95% CI, 1.76-3.39). Some FLG LoF variants are only found in children of a specific ancestry (eg, p.S3316* and p.R826* were not seen in white patients). Children with an FLG LoF were more likely to have persistent AD (odds ratio, 0.67; 95% CI, 0.56-0.80). Conclusions and Relevance The FLG LoF variants in a US cohort of children with mild to moderate AD differ significantly by race and their association with the persistence of AD. Conventional testing of the 4 frequently evaluated variants is inadequate. Any planned genetic diagnostic test for AD based on FLG LoF variants must be inclusive and not rely on the most frequently studied variants.
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Affiliation(s)
- David J Margolis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia.,Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
| | - Bradley Wubbenhorst
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Kurt D'Andrea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Adam A Kraya
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Ole Hoffstad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Saloni Shah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Katherine L Nathanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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97
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Irvine A, Mina‐Osorio P. Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide. Br J Dermatol 2019; 181:895-906. [PMID: 30758843 PMCID: PMC6899789 DOI: 10.1111/bjd.17766] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians. METHODS We reviewed recent cohort studies to synthesize and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD. RESULTS Despite the variability in data collection and methods of analysis and their limitations, there are common patterns of early-childhood AD that may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitization and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants and children with AD at potentially higher risk of developing persistent AD and atopic comorbidities. We also present clinical scenarios to illustrate how these data relate to real-life situations. CONCLUSIONS Useful insights are provided for physicians and patients to inform them better about the risk of AD progression and to help guide care pathways for the paediatric population with AD. What's already known about this topic? The complex pathophysiology of atopic dermatitis (AD) translates into a heterogeneous clinical presentation and trajectories of disease progression. Although the consensus is that most paediatric patients with AD will eventually 'outgrow' the disease or follow the longitudinal trajectory known as the 'atopic march', a significant proportion will develop persistent AD and/or other atopic conditions. No known factors conclusively predict the risk of progression or development of comorbidities. What does this study add? Recent analyses of data from large cohorts of paediatric patients with AD have suggested the existence of potentially discrete clusters of patients who present with relatively common AD phenotypes. These studies have shed some light onto the factors associated with risk of progression, which we review in this article. A practitioner's guide with clinical scenarios is provided to help identify patients at high risk of progression to determine whether a patient should be monitored and/or would require specialist referral.
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Affiliation(s)
- A.D. Irvine
- Paediatric DermatologyOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- National Children's Research CentreOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- Clinical MedicineTrinity College DublinDublinIreland
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98
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Czarnowicki T, He H, Canter T, Han J, Lefferdink R, Erickson T, Rangel S, Kameyama N, Kim HJ, Pavel AB, Estrada Y, Krueger JG, Paller AS, Guttman-Yassky E. Evolution of pathologic T-cell subsets in patients with atopic dermatitis from infancy to adulthood. J Allergy Clin Immunol 2019; 145:215-228. [PMID: 31626841 DOI: 10.1016/j.jaci.2019.09.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/23/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The circulating immune phenotype was defined in adults and young children with early atopic dermatitis (AD), but chronologic changes in the blood of infants and children with AD through adolescence have not been explored. OBJECTIVE We sought to compare immune activation and cytokine polarization in the blood of 0- to 5-year-old (n = 39), 6- to 11-year-old (n = 26), 12- to 17-year-old (n = 21) and 18-year-old or older (n = 43) patients with AD versus age-matched control subjects. METHODS Flow cytometry was used to measure IFN-γ, IL-9, IL-13, IL-17, and IL-22 cytokine levels in CD4+/CD8+ T cells, with inducible costimulator molecule and HLA-DR defining midterm and long-term T-cell activation, respectively, within skin-homing/cutaneous lymphocyte antigen (CLA)+ versus systemic/CLA- T cells. Unsupervised clustering differentiated patients based on their blood biomarker frequencies. RESULTS Although CLA+ TH1 frequencies were significantly lower in infants with AD versus all older patients (P < .01), frequencies of CLA+ TH2 T cells were similarly expanded across all AD age groups compared with control subjects (P < .05). After infancy, CLA- TH2 frequencies were increased in patients with AD in all age groups, suggesting systemic immune activation with disease chronicity. IL-22 frequencies serially increased from normal levels in infants to highly significant levels in adolescents and adults compared with levels in respective control subjects (P < .01). Unsupervised clustering aligned the AD profiles along an age-related spectrum from infancy to adulthood (eg, inducible costimulator molecule and IL-22). CONCLUSIONS The adult AD phenotype is achieved only in adulthood. Unique cytokine signatures characterizing individual pediatric endotypes might require age-specific therapies. Future longitudinal studies, comparing the profile of patients with cleared versus persistent pediatric AD, might define age-specific changes that predict AD clearance.
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Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Helen He
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Talia Canter
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Joseph Han
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rachel Lefferdink
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Taylor Erickson
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Stephanie Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Naoya Kameyama
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hyun Je Kim
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana B Pavel
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeriel Estrada
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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99
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He H, Li R, Choi S, Zhou L, Pavel A, Estrada YD, Krueger JG, Guttman-Yassky E. Increased cardiovascular and atherosclerosis markers in blood of older patients with atopic dermatitis. Ann Allergy Asthma Immunol 2019; 124:70-78. [PMID: 31622668 DOI: 10.1016/j.anai.2019.10.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with increased systemic inflammation and cardiovascular risk. Although previous studies have found increased inflammatory proteins in the blood of patients with AD, detailed comparison among patients with AD of different ages is unavailable. OBJECTIVE To characterize the blood proteomic signature of patients with AD as a function of age. METHODS We used the OLINK high-throughput proteomic assay to measure serum inflammatory and cardiovascular risk proteins in 71 patients with moderate to severe AD from 3 age groups (18-40 years old [n = 26], 41-60 years old [n = 24], and >60 years old [n = 21]) compared with 37 age-matched controls. Total and allergen-specific serum IgEs were also measured. RESULTS When we compared patients with AD from 3 different age groups with their respective controls, we identified a total of 172 differentially expressed proteins. TH2 chemokines (CCL13, CCL17) were consistently elevated in patients with AD across all ages (P < .05), whereas TH1 (CXCL10) and TH17 (KYNU, CCL20) markers incrementally increased with age in both patients with AD and healthy subjects. Elderly patients with AD (>60 years old) exhibited striking upregulation of key proinflammatory proteins, including markers of atherosclerosis (CCL4, CCL7, SORT1), cardiovascular risk (GDF15, MPO, ST2), cell adhesion (CDH3), and apoptosis (FAS; all P < .05) compared with younger patients with AD and age-matched controls. We also found that total and allergen-specific serum IgEs decreased significantly with age in patients with AD (P < .05). CONCLUSION Elderly patients with AD had increased levels of systemic inflammatory markers, including those associated with cardiovascular and atherosclerosis risk, which may explain their increased incidence of cardiovascular disease. This finding suggests that older patients with AD may benefit from cardiovascular disease screening and prevention.
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Affiliation(s)
- Helen He
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Randall Li
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Seulah Choi
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lisa Zhou
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ana Pavel
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yeriel D Estrada
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
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100
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Thyssen JP, Corn G, Wohlfahrt J, Melbye M, Bager P. Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study. Clin Exp Allergy 2019; 49:1455-1463. [DOI: 10.1111/cea.13487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jacob P. Thyssen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup Denmark
| | - Giulia Corn
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Jan Wohlfahrt
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Mads Melbye
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
| | - Peter Bager
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
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