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Akan A, Dibek-Mısırlıoğlu E, Civelek E, Vezir E, Kocabaş C. Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria. Allergol Immunopathol (Madr) 2020; 48:175-181. [PMID: 31611041 DOI: 10.1016/j.aller.2019.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/10/2019] [Accepted: 07/26/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age. METHODS Children diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard. RESULTS 200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7-36) months. There was no significant difference in age and sex between groups (p=0.11 and p=0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively). CONCLUSION HRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials.
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Zhang T, Lee TK, Lui H, Dutz J, Dawes M, Lee A, Kalia S. Health insurance claim- and prescription record-based algorithms as a population-based method for eczema ascertainment. J Eur Acad Dermatol Venereol 2020; 34:e466-e468. [PMID: 32103573 DOI: 10.1111/jdv.16315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T Zhang
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - T K Lee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Departments of Cancer Control Research Program and Integrative Oncology - Imaging Unit, BC Cancer, Vancouver, BC, Canada
| | - H Lui
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Departments of Cancer Control Research Program and Integrative Oncology - Imaging Unit, BC Cancer, Vancouver, BC, Canada
| | - J Dutz
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Division of Dermatology, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - M Dawes
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - A Lee
- Cross Roads Clinics, Vancouver, BC, Canada
| | - S Kalia
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Photomedicine Institute, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Departments of Cancer Control Research Program and Integrative Oncology - Imaging Unit, BC Cancer, Vancouver, BC, Canada.,Division of Dermatology, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
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Alexander H, Paller AS, Traidl-Hoffmann C, Beck LA, De Benedetto A, Dhar S, Girolomoni G, Irvine AD, Spuls P, Su J, Thyssen JP, Vestergaard C, Werfel T, Wollenberg A, Deleuran M, Flohr C. The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group. Br J Dermatol 2019; 182:1331-1342. [PMID: 31677162 PMCID: PMC7317931 DOI: 10.1111/bjd.18643] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/27/2022]
Abstract
Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey‐coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD – cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy – overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site‐ and skin‐type‐specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.
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Affiliation(s)
- H Alexander
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - C Traidl-Hoffmann
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany.,CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - L A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - A De Benedetto
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, U.S.A
| | - S Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - A D Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,Dermatology, Children's Health Ireland, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - P Spuls
- Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Su
- Departments of Dermatology and Paediatrics, Murdoch Children's Research Institute, University of Melbourne and Monash University, Eastern Health, Melbourne, VIC, Australia
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - C Vestergaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - T Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - A Wollenberg
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - M Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, U.K
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Liu Y, Cui H, Du R, Zhang L, Yuan H, Zhang X, Zheng S. Acupuncture for patients with atopic dermatitis: A systematic review protocol. Medicine (Baltimore) 2019; 98:e18559. [PMID: 31876756 PMCID: PMC6946324 DOI: 10.1097/md.0000000000018559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The systematic review protocol is aim to evaluate the efficacy and safety of acupuncture in the treatment of atopic dermatitis (AD). METHODS We will search the database on the Cochrane Library, PubMed, Medline, Excerpta Medica Database, Chinese Biomedical Literature Database, PsychINFO, China National Knowledge Infrastructure, Wanfang data, Chinese Scientific Journal Database, including studies and published systematic review in the reference list and grey. And will use Cochrane Collaboration's tools to evaluate the risk of bias of the included randomized controlled trials. The Review Manager 5.3 will be used to synthesize collected data. RESULTS This study will assess the safety and effectiveness based on current evidence of acupuncture for AD, especially scoring atopic dermatitis, eczema area, and severity index, patient-oriented eczema measure, and quality of life. CONCLUSION This study will provide high-quality recently evidence for evaluating the efficacy of acupuncture for patients with AD.PROSPERO registration number: CRD42019135919.
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Andersen YMF, Egeberg A. Comparing apples, oranges and atopic dermatitis. Br J Dermatol 2019; 181:1125-1126. [PMID: 31347145 DOI: 10.1111/bjd.18303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y M F Andersen
- Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
| | - A Egeberg
- Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Denmark
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Lee B, Heo J, Hong S, Kim EY, Sohn YJ, Jung HS. dl-Malic acid as a component of α-hydroxy acids: effect on 2,4-dinitrochlorobenzene-induced inflammation in atopic dermatitis-like skin lesions in vitro and in vivo. Immunopharmacol Immunotoxicol 2019; 41:614-621. [PMID: 31645147 DOI: 10.1080/08923973.2019.1680688] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: dl-Malic acid (dl-M) is used widely in cosmetic formulations as a pH-adjuster or as a preservative. dl-M is used as an exfoliator in the form of α-hydroxy acids. However, the role of dl-M in skin diseases (including atopic dermatitis (AD)) has not been studied deeply. We wished to reveal the effect of dl-M on AD induced by 2,4-dinitrochlorobenzene (DNCB) in Balb/c mice.Methods: The thickness and immune-cell infiltration into the dermis and epidermis were evaluated. Moreover, serum levels of cytokines, as well as expression of mitogen-activated protein kinase (MAPK) and nuclear factor-kappa B (NF-κB) in tissue were measured in AD mice. We also studied the effect of dl-M on inflammatory mediators in a human keratinocyte (HaCaT) cell line. Results: The dl-M (high) group improved skin condition compared with the DNCB-treated group. The dl-M (high) group inhibited phosphorylation of MAPK and NF-κB in skin tissue. dl-M reduced serum levels of interleukin-4 and IgE. Finally, dl-M decreased the expression of thymus and activation-regulated chemokine, monocyte chemoattractant protein-1 and intercellular cell adhesion molecule induced by interferon-gamma/tumor necrosis factor-α in HaCaT cells. Discussion: These results suggest that dl-M can improve the skin conditions of AD mice.
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Affiliation(s)
- Bina Lee
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jun Heo
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - SooYeon Hong
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eun-Young Kim
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young Joo Sohn
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyuk-Sang Jung
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Vlahovic TC. Diagnosis and Treatment Options for Inflammatory Skin Conditions of the Lower Extremity. Clin Podiatr Med Surg 2019; 36:685-694. [PMID: 31466575 DOI: 10.1016/j.cpm.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The lower extremity presents several challenges from a dermatologic standpoint: there are different anatomic areas that not only vary from a stratum corneum thickness and histologic standpoint but are also subject to trauma that is unique (shoe gear, gait cycle). Attention to appropriate diagnosis and management is always warranted but should be especially vigilant to those treating issues of the lower extremity. This article reviews diagnosis and treatment of the most common skin and nail conditions of the foot and ankle.
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Affiliation(s)
- Tracey C Vlahovic
- Department of Podiatric Medicine, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
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58
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Tsai TF, Rajagopalan M, Chu CY, Encarnacion L, Gerber RA, Santos-Estrella P, Llamado LJQ, Tallman AM. Burden of atopic dermatitis in Asia. J Dermatol 2019; 46:825-834. [PMID: 31436343 DOI: 10.1111/1346-8138.15048] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis is a chronic, inflammatory skin disease characterized by intense pruritus and eczematous lesions. It is considered one of the most common chronic conditions, with an estimated global prevalence of nearly 230 million. As in the rest of the world, prevalence of atopic dermatitis has been increasing in Asian countries over the last few decades. This increased prevalence in Asian countries has been attributed to factors such as rapid urbanization, increasingly Westernized lifestyles, and improved standards of living and education. As a result, it is important to understand the increasing burden of disease in Asian countries and the differences between the countries in terms of epidemiology, diagnostic criteria, management, quality of life and economic burden.
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Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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59
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Abuabara K, Ye M, McCulloch CE, Sullivan A, Margolis DJ, Strachan DP, Paternoster L, Yew YW, Williams HC, Langan SM. Clinical onset of atopic eczema: Results from 2 nationally representative British birth cohorts followed through midlife. J Allergy Clin Immunol 2019; 144:710-719. [PMID: 31260715 PMCID: PMC6721832 DOI: 10.1016/j.jaci.2019.05.040] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 12/20/2022]
Abstract
Background Atopic eczema onset is described primarily in early childhood, and the frequency and characteristics of adult-onset disease remain controversial. Objective We sought to determine the proportion of subjects who report atopic eczema symptoms between birth and midadulthood and to examine demographic, immunologic, and genetic factors associated with period of symptom onset. Methods We conducted a longitudinal study using data from 2 nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies 1958 and 1970. Subjects were followed from birth through age 42 to 50 years. The primary outcome was the age period of self-reported atopic eczema symptom onset based on repeated measures of self-reported atopic eczema at each survey wave. Results The annual period prevalence of atopic eczema ranged from 5% to 15% in 2 cohorts of more than 17,000 participants each followed from birth through middle age. There was no clear trend in prevalence by age, and among adults reporting active atopic eczema during a given year, only 38% had symptom onset reported in childhood. When compared with subjects whose eczema started in childhood, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socioeconomic group, smokers in adulthood, and less likely to have a history of asthma. In a subanalysis using data from the 1958 cohort only, genetic mutations previously associated with atopic eczema, including filaggrin-null mutations, and allergen-specific IgE were more common among those with childhood-onset disease. Conclusion Rates of self-reported atopic eczema remain high after childhood, and adult-onset atopic eczema has different risk factor associations than childhood-onset eczema.
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Affiliation(s)
- Katrina Abuabara
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, Calif.
| | - Morgan Ye
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, Calif
| | - Charles E McCulloch
- Division of Biostatistics, University of California, San Francisco School of Medicine, San Francisco, Calif
| | - Alice Sullivan
- UCL Institute of Education, University College, London, United Kingdom
| | - David J Margolis
- Department of Dermatology and Center for Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - David P Strachan
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Lavinia Paternoster
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Hywel C Williams
- Centre of Evidence Based Dermatology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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60
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Nakamura T, Haider S, Colicino S, Murray CS, Holloway J, Simpson A, Cullinan P, Custovic A. Different definitions of atopic dermatitis: impact on prevalence estimates and associated risk factors. Br J Dermatol 2019; 181:1272-1279. [PMID: 30822368 PMCID: PMC6916614 DOI: 10.1111/bjd.17853] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 12/14/2022]
Abstract
Background There is no objective test that can unequivocally confirm the diagnosis of atopic dermatitis (AD), and no uniform clinical definition. Objectives To investigate to what extent operational definitions of AD cause fluctuation in the prevalence estimates and the associated risk factors. Methods We first reviewed the operational definitions of AD used in the literature. We then tested the impact of the choice of the most common definitions of ‘cases’ and ‘controls’ on AD prevalence estimates and associated risk factors (including filaggrin mutations) among children aged 5 years in two population‐based birth cohorts: the Manchester Asthma and Allergy Study (MAAS) and Asthma in Ashford. Model performance was measured by the percentage of children within an area of clinical indecision (defined as having a posterior probability of AD between 25% and 60%). Results We identified 59 different definitions of AD across 45 reviewed studies. Of those, we chose four common ‘case’ definitions and two definitions of ‘controls’. The prevalence estimates using different case definitions ranged between 22% and 33% in MAAS, and between 12% and 22% in Ashford. The area of clinical indecision ranged from 32% to 44% in MAAS and from 9% to 29% in Ashford. Depending on the case definition used, the associations with filaggrin mutations varied, with odds ratios (95% confidence intervals) ranging from 1·8 (1·1–2·9) to 2·2 (1·3–3·7) in MAAS and 1·7 (0·8–3·7) to 2·3 (1·2–4·5) in Ashford. Associations with filaggrin mutations also differed when using the same ‘case’ definition but different definitions of ‘controls’. Conclusions Use of different definitions of AD results in substantial differences in prevalence estimates, the performance of prediction models and association with risk factors. What's already known about this topic? There is no objective test that can unequivocally confirm the diagnosis of atopic dermatitis (AD) and no uniform clinical definition. This results in different definitions utilized in AD studies, raising concerns on the generalizability of the results and comparability across different studies.
What does this study add? This study has shown that different definitions of ‘cases’ and ‘controls’ have major impacts upon prevalence estimates and associations with risk factors, including genetics, in two population‐based birth cohorts. These findings suggest the importance of developing a consensus on AD definitions of both ‘controls’ and ‘cases’ to minimize biases in studies.
https://www.bjdonline.com/article/different-definitions-of-atopic-dermatitis-impact-on-prevalence-estimates-and-associated-risk-factors/ Linked Comment: https://doi.org/10.1111/bjd.18303. https://doi.org/10.1111/bjd.18571 available online
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Affiliation(s)
- T Nakamura
- Department of Paediatrics, Imperial College London, London, U.K
| | - S Haider
- Department of Paediatrics, Imperial College London, London, U.K
| | - S Colicino
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - C S Murray
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, U.K
| | - J Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, U.K
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, U.K
| | - P Cullinan
- National Heart and Lung Institute, Imperial College London, London, U.K
| | - A Custovic
- Department of Paediatrics, Imperial College London, London, U.K
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61
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Vermeulen FM, Gerbens LAA, Bosma AL, Apfelbacher CJ, Irvine AD, Arents BWM, Barbarot S, Deleuran M, Eichenfield LF, Manca A, Schmitt J, Vestergaard C, Wall D, Weidinger S, Middelkamp-Hup MA, Spuls PI, Flohr C. TREatment of ATopic eczema (TREAT) Registry Taskforce: consensus on how and when to measure the core dataset for atopic eczema treatment research registries. Br J Dermatol 2019; 181:492-504. [PMID: 30719709 PMCID: PMC6771812 DOI: 10.1111/bjd.17715] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 01/25/2023]
Abstract
Background Comparative, real‐life and long‐term evidence on the effectiveness and safety of phototherapy and systemic therapy in moderate‐to‐severe atopic eczema (AE) is limited. Such data must come from well‐designed prospective patient registries. Standardization of data collection is needed for direct comparisons and data pooling. Objectives To reach a consensus on how and when to measure the previously defined domain items of the TREatment of ATopic eczema (TREAT) Registry Taskforce core dataset for research registries for paediatric and adult patients with AE. Methods Proposals for the measurement instruments were based on recommendations of the Harmonising Outcome Measures for Eczema (HOME) initiative, the existing AE database of TREATgermany, systematic reviews of the literature and expert opinions. The proposals were discussed at three face‐to‐face consensus meetings, one teleconference and via e‐mail. The frequency of follow‐up visits was determined by an expert survey. Results A total of 16 experts from seven countries participated in the ‘how to measure’ consensus process and 12 external experts were consulted. A consensus was reached for all domain items on how they should be measured by assigning measurement instruments. A minimum follow‐up frequency of initially 4 weeks after commencing treatment, then every 3 months while on treatment and every 6 months while off treatment was defined. Conclusions This core dataset for national AE research registries will aid in the comparability and pooling of data across centres and country borders, and enables international collaboration to assess the long‐term effectiveness and safety of phototherapy and systemic therapy used in patients with AE. What's already known about this topic? Comparable, real‐life and long‐term data on the effectiveness and safety of phototherapy and systemic therapy in patients with atopic eczema (AE) are needed. There is a high diversity of outcomes and instruments used in AE research, which require harmonization to enhance comparability and allow data pooling.
What does this study add? Our taskforce has reached international consensus on how and when to measure core domain items for national AE research registries. This core dataset is now available for use by researchers worldwide and will aid in the collection of unified data.
What are the clinical implications of this work? The data collected through this core dataset will help to gain better insights into the long‐term effectiveness and safety of phototherapy and systemic therapy in AE and will provide important information for clinical practice. Standardization of such data collection at the national level will also allow direct data comparisons and pooling across country borders (e.g. in the analysis of treatment‐related adverse events that require large patient numbers).
Plain language summary available online Respond to this article
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Affiliation(s)
- F M Vermeulen
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - L A A Gerbens
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - A L Bosma
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - A D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - B W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | - M Deleuran
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - L F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, CA, U.S.A
| | - A Manca
- Centre for Health Economics, University of York, York, U.K
| | - J Schmitt
- Centre for Evidence-based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.,University Allergy Centre, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Vestergaard
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - D Wall
- Department of Paediatric Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.,Irish Skin Foundation, Dublin, Ireland
| | - S Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M A Middelkamp-Hup
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - P I Spuls
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands
| | - C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K
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Guo Y, Zhang H, Liu Q, Wei F, Tang J, Li P, Han X, Zou X, Xu G, Xu Z, Zong W, Ran Q, Xiao F, Mu Z, Mao X, Ran N, Cheng R, Li M, Li C, Luo Y, Meng C, Zhang X, Xu H, Li J, Tang P, Xiang J, Shen C, Niu H, Li H, Shen J, Ni C, Zhang J, Wang H, Ma L, Bieber T, Yao Z. Phenotypic analysis of atopic dermatitis in children aged 1-12 months: elaboration of novel diagnostic criteria for infants in China and estimation of prevalence. J Eur Acad Dermatol Venereol 2019; 33:1569-1576. [PMID: 30989708 DOI: 10.1111/jdv.15618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common skin disorder in infancy. However, the diagnosis and definite significance of infantile AD remains a debated issue. OBJECTIVE To analyse the phenotypes of AD in infancy, to establish diagnostic criteria and to estimate the prevalence of this condition in China. METHODS This is a multicentric study, in which 12 locations were chosen from different metropolitan areas of China. Following careful and complete history-taking and skin examination, the definite diagnosis of AD was made and the severity based on the SCORAD index was determined by local experienced dermatologists. Based on the detailed phenotyping, the major and representative clinical features of infantile AD were selected to establish the diagnostic criteria and evaluate their diagnostic efficacy. RESULTS A total of 5967 infants were included in this study. The overall point prevalence of AD was 30.48%. The infantile AD developed as early as at the second month of life, and its incidence peaked in the third month of life at 40.81%. The proportion of mild, moderate and severe AD was 67.40%, 30.57% and 2.03%, respectively. The most commonly seen manifestations in the infantile AD were facial dermatitis (72.07%), xerosis (42.72%) and scalp dermatitis (27.93%). We established the novel diagnostic criteria of infants, which included: (i) onset after 2 weeks of birth; (ii) pruritus and/or irritability and sleeplessness comparable with lesions; and (iii) all two items above with one of the following items can reach a diagnosis of AD: (i) eczematous lesions distributed on cheeks and/or scalp and/or extensor limbs, and (ii) eczematous lesions on any other parts of body accompanied by xerosis. CONCLUSIONS In China, the prevalence of AD in infancy is 30.48% according to clinical diagnosis of dermatologists. The novel Chinese diagnostic criteria for AD in infants show a higher sensitivity and comparable specificity.
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Affiliation(s)
- Y Guo
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - H Zhang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Q Liu
- Department of Dermatology, Shanxi Children's Hospital, Taiyuan, Shanxi, China
| | - F Wei
- Department of Dermatology, Dalian Children's Hospital, Dalian, Liaoning, China
| | - J Tang
- Department of Dermatology, Hunan Children's Hospital, Changsha, Hunan, China
| | - P Li
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - X Han
- Department of Dermatology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - X Zou
- Department of Dermatology, Hubei Maternity and Child Health Hospital, Wuhan, Hubei, China
| | - G Xu
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Z Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - W Zong
- Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, Jiangsu, China
| | - Q Ran
- Department of Dermatology, Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
| | - F Xiao
- Institute of Dermatology and Department of Dermatology, No.1 Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Z Mu
- Department of Dermatology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China
| | - X Mao
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - N Ran
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - R Cheng
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - M Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - C Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Y Luo
- Department of Dermatology, Hunan Children's Hospital, Changsha, Hunan, China
| | - C Meng
- Department of Dermatology, Hubei Maternity and Child Health Hospital, Wuhan, Hubei, China
| | - X Zhang
- Department of Dermatology, Shanxi Children's Hospital, Taiyuan, Shanxi, China
| | - H Xu
- Department of Dermatology, Chengdu Women's and Children's Central Hospital, Chengdu, Sichuan, China
| | - J Li
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - P Tang
- Department of Dermatology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - J Xiang
- Department of Pediatric Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - C Shen
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - H Niu
- Department of Dermatology, Dalian Children's Hospital, Dalian, Liaoning, China
| | - H Li
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - J Shen
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - C Ni
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - J Zhang
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - H Wang
- Department of Pediatric Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - L Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - T Bieber
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - Z Yao
- Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Yu S, Li Y, Zhou Y, Follansbee T, Hwang ST. Immune mediators and therapies for pruritus in atopic dermatitis and psoriasis. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2019. [DOI: 10.1002/cia2.12049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sebastian Yu
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
- Department of Dermatology; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
- Department of Dermatology; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yanxi Li
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
| | - Yan Zhou
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
| | - Taylor Follansbee
- Department of Neurobiology, Physiology and Behavior; University of California Davis; Davis California
| | - Samuel T. Hwang
- Department of Dermatology; University of California Davis School of Medicine; Sacramento California
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Yang G, Han YY, Forno E, Acosta-Pérez E, Colón-Semidey A, Alvarez M, Canino G, Chen W, Celedón JC. Under-diagnosis of atopic dermatitis in Puerto Rican children. World Allergy Organ J 2019; 12:100003. [PMID: 30937128 PMCID: PMC6439410 DOI: 10.1016/j.waojou.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/18/2018] [Accepted: 11/12/2018] [Indexed: 11/27/2022] Open
Abstract
Background Little is known about atopic dermatitis (AD) among children in Puerto Rico. Objective To examine risk factors and identify approaches to better diagnose AD in Puerto Rican children. Methods Case-control study of AD among 540 children aged 6-14 years in San Juan, Puerto Rico. AD was defined as: 1) physician-diagnosed AD, 2) RAST-AD: AD symptoms plus ≥1 positive IgE to allergens, and 3) STR-AD: AD-symptoms and skin test reactivity to ≥1 allergen. Logistic regression was used for the multivariable analysis. We also evaluated the diagnostic performance of various approaches by comparing their sensitivity, specificity, positive predicted value [PPV], negative predictive value [NPV], and area under curve [AUC]). Results Of the 70 children with STR-AD, only 5 (7.1%) had PD-AD. In children without asthma, a positive IgE to Dermatophagoides (D.) pteronyssinus and signs of mold/mildew at home were significantly associated with 3.3 and 5 times increased odds of STR-AD, respectively. Among children with asthma, private/employer-based health insurance and a positive IgE to D. pteronyssinus were each significantly associated with approximately twofold increased odds of STR-AD. A combination of current eczema symptoms and a positive IgE to D. pteronyssinus yielded a sensitivity ≥ 70%, specificity and NPV ≥ 95%, PPV ≥ 88%, and an AUC ≥ 0.85 for STR-AD. Replacing a positive IgE to D. pteronyssinus with a positive IgE to ≥1 allergen slightly increased sensitivity without affecting other parameters. Conclusions AD is markedly under-diagnosed by physicians in Puerto Rico. This could be improved by assessing eczema symptoms and measuring IgEs to common allergens.
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Key Words
- AD, Atopic dermatitis
- AUC, Area under curve
- Atopic dermatitis
- BMI, Body mass index
- Children
- NPV, Negative predictive value
- PD-AD, Physician diagnosed atopic dermatitis
- PPV, Positive predictive value
- Puerto Rico
- RAST, Radioallergosorbent test
- ROC, Receiver operating curve
- STR, Skin test reactivity
- STR-AD, Skin test reactivity atopic dermatitis
- Under-diagnosis
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Affiliation(s)
- Ge Yang
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Neonatology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.,Third Xiangya Hospital, Central South University, Changsha, Hunan, 410083, China
| | - Yueh-Ying Han
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Angel Colón-Semidey
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico.,Department of Pediatrics, University of Puerto Rico, San Juan, Puerto Rico
| | - María Alvarez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico.,Department of Pediatrics, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico.,Department of Pediatrics, University of Puerto Rico, San Juan, Puerto Rico
| | - Wei Chen
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
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Matterne U, Böhmer MM, Weisshaar E, Jupiter A, Carter B, Apfelbacher CJ. Oral H1 antihistamines as 'add-on' therapy to topical treatment for eczema. Cochrane Database Syst Rev 2019; 1:CD012167. [PMID: 30666626 PMCID: PMC6360926 DOI: 10.1002/14651858.cd012167.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The symptoms of eczema can lead to sleeplessness and fatigue and may have a substantial impact on quality of life. Use of oral H1 antihistamines (H1 AH) as adjuvant therapy alongside topical agents is based on the idea that combining the anti-inflammatory effects of topical treatments with the blocking action of histamine on its receptors in the skin by H1 AH (to reduce the principal symptom of itch) might magnify or intensify the effect of treatment. Also, it would be unethical to compare oral H1 AH alone versus no treatment, as topical treatment is the standard management for this condition. OBJECTIVES To assess the effects of oral H1 antihistamines as 'add-on' therapy to topical treatment in adults and children with eczema. SEARCH METHODS We searched the following databases up to May 2018: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and the GREAT database (Global Resource of EczemA Trials; from inception). We searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). We also searched the abstracts of four conference proceedings held between 2000 and 2018. SELECTION CRITERIA We sought RCTs assessing oral H1 AH as 'add-on' therapy to topical treatment for people with eczema compared with topical treatment plus placebo or no additional treatment as add-on therapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Primary outcome measures were 'Mean change in patient-assessed symptoms of eczema' and 'Proportion of participants reporting adverse effects and serious adverse events'. Secondary outcomes were 'Mean change in physician-assessed clinical signs', 'Mean change in quality of life', and 'Number of eczema flares'. MAIN RESULTS We included 25 studies (3285 randomised participants). Seventeen studies included 1344 adults, and eight studies included 1941 children. Most studies failed to report eczema severity at baseline, but they were conducted in secondary care settings, so it is likely that they recruited patients with more severe cases of eczema. Trial duration was between three days and 18 months. Researchers studied 13 different H1 AH treatments. We could not undertake pooling because of the high level of diversity across studies in terms of duration and dose of intervention, concomitant topical therapy, and outcome assessment. Risk of bias was generally unclear, but five studies had high risk of bias in one domain (attrition, selection, or reporting bias). Only one study measured quality of life, but these results were insufficient for statistical analysis.Although this review assessed 17 comparisons, we summarise here the results of three key comparisons in this review.Cetirizine versus placeboOne study compared cetirizine 0.5 mg/kg/d against placebo over 18 months in 795 children. Study authors did not report patient-assessed symptoms of eczema separately for pruritus. Cetirizine is probably associated with fewer adverse events (mainly mild) (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.46 to 1.01) and the need for slightly less additional H1 AH use as an indication of eczema flare rate (P = 0.035; no further numerical data given). Physician-assessed clinical signs (SCORing Atopic Dermatitis index (SCORAD)) were reduced in both groups, but the difference between groups was reported as non-significant (no P value given). Evidence for this comparison was of moderate quality.One study assessed cetirizine 10 mg/d against placebo over four weeks in 84 adults. Results show no evidence of differences between groups in patient-assessed symptoms of eczema (pruritus measured as part of SCORAD; no numerical data given), numbers of adverse events (RR 1.11, 95% CI 0.50 to 2.45; mainly sedation, other skin-related problems, respiratory symptoms, or headache), or physician-assessed changes in clinical signs, amount of local rescue therapy required, or number of applications as an indicator of eczema flares (no numerical data reported). Evidence for this comparison was of low quality.Fexofenadine versus placeboCompared with placebo, fexofenadine 120 mg/d taken in adults over one week (one study) probably leads to a small reduction in patient-assessed symptoms of pruritus on a scale of 0 to 8 (mean difference (MD) -0.25, 95% CI -0.43 to -0.07; n = 400) and a greater reduction in the ratio of physician-assessed pruritus area to whole body surface area (P = 0.007; no further numerical data given); however, these reductions may not be clinically meaningful. Results suggest probably little or no difference in adverse events (mostly somnolence and headache) (RR 1.05, 95% CI 0.74 to 1.50; n = 411) nor in the amount of 0.1% hydrocortisone butyrate used (co-intervention in both groups) as an indicator of eczema flare, but no numerical data were given. Evidence for this comparison was of moderate quality.Loratadine versus placeboA study of 28 adults compared loratadine 10 mg/d taken over 4 weeks versus placebo. Researchers found no evidence of differences between groups in patient-assessed pruritus, measured by a 100-point visual analogue scale (MD -2.30, 95% CI -20.27 to 15.67); reduction in physician-assessed clinical signs (SCORAD) (MD -4.10, 95% CI -13.22 to 5.02); or adverse events. Study authors reported only one side effect (folliculitis with placebo) (RR 0.25, 95% CI 0.01 to 5.76). Evidence for this comparison was of low quality. Number of eczema flares was not measured for this comparison. AUTHORS' CONCLUSIONS Based on the main comparisons, we did not find consistent evidence that H1 AH treatments are effective as 'add-on' therapy for eczema when compared to placebo; evidence for this comparison was of low and moderate quality. However, fexofenadine probably leads to a small improvement in patient-assessed pruritus, with probably no significant difference in the amount of treatment used to prevent eczema flares. Cetirizine was no better than placebo in terms of physician-assessed clinical signs nor patient-assessed symptoms, and we found no evidence that loratadine was more beneficial than placebo, although all interventions seem safe.The quality of evidence was limited because of poor study design and imprecise results. Future researchers should clearly define the condition (course and severity) and clearly report their methods, especially participant selection and randomisation; baseline characteristics; and outcomes (based on the Harmonising Outcome Measures in Eczema initiative).
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Affiliation(s)
- Uwe Matterne
- University of RegensburgMedical Sociology, Institute of Epidemiology and Preventive MedicineRegensburgGermany
| | - Merle Margarete Böhmer
- University of RegensburgMedical Sociology, Institute of Epidemiology and Preventive MedicineRegensburgGermany
| | - Elke Weisshaar
- Heidelberg University HospitalDepartment of Clinical Social MedicineThibautstrasse 3HeidelbergGermany69115
| | - Aldrin Jupiter
- Heidelberg University HospitalDepartment of Clinical Social MedicineThibautstrasse 3HeidelbergGermany69115
| | - Ben Carter
- King's College London; Institute of Psychiatry, Psychology & NeuroscienceBiostatistics and Health InformaticsDenmark HillLondonUK
| | - Christian J Apfelbacher
- University of RegensburgMedical Sociology, Institute of Epidemiology and Preventive MedicineRegensburgGermany
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El-Heis S, Crozier SR, Healy E, Robinson SM, Harvey NC, Cooper C, Inskip HM, Baird J, Godfrey KM. Faltering of prenatal growth precedes the development of atopic eczema in infancy: cohort study. Clin Epidemiol 2018; 10:1851-1864. [PMID: 30588116 PMCID: PMC6296686 DOI: 10.2147/clep.s175878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Infants with atopic eczema have an increased risk of impaired growth, but the origin of this impairment is unclear. The aim of this study was to examine fetal and infant growth in relation to infantile atopic eczema. Methods Within the UK Southampton Women's Survey, 1,759 infants with known maternal menstrual data had anthropometric measurements at 11, 19, and 34 weeks' gestation, birth, and ages 6 and 12 months, enabling derivation of growth velocity SD scores. Infantile atopic eczema at ages 6 and/or 12 months was ascertained using modified UK Working Party diagnostic criteria. Results Expressed per SD increase, higher femur length and abdominal circumference at 34 weeks' gestation were associated with decreased risks of atopic eczema (eczema OR/SD increase 0.81 [95% CI 0.69-0.96], P=0.017 and 0.78 [95% CI 0.65-0.93], P=0.006, respectively), while every SD increase in head to abdominal circumference ratio (indicating disproportionate growth) was associated with an increase in risk of atopic eczema (1.37 [1.15-1.63], P=0.001). Lower velocities of linear growth from 11 weeks' gestation to birth and birth to age 6 months were associated with atopic eczema (atopic eczema OR/SD increase 0.80 [0.65-0.98], P=0.034 and 0.8 [1 0.66-1.00], P=0.051, respectively). Infants with atopic eczema at age 12 months had a larger head circumference in early gestation and faltering of abdominal growth velocity from 19 to 34 weeks' gestation (atopic eczema OR/SD increase 0.67 [0.51-0.88], P=0.003). Conclusion Infants with atopic eczema demonstrate altered patterns of fetal growth, including faltering of linear growth in utero, prior to the clinical onset of atopic eczema. These findings suggest growth falters prior to the start of clinical atopic eczema and its treatment.
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Affiliation(s)
- Sarah El-Heis
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK,
| | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK,
| | - Eugene Healy
- Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sian M Robinson
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, .,NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Hazel M Inskip
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK,
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK, .,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, .,Institute of Developmental Sciences, University of Southampton, Southampton, UK,
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67
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Yew YW, Zheng Q, Kok WL, Ho MSL, Teoh J, Wong YKY, Shi L, Chan ESY. Topical treatments for eczema: a network meta-analysis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Yik Weng Yew
- Department of Dermatology; National Skin Centre; Singapore Singapore
| | - Qishi Zheng
- Department of Epidemiology; Singapore Clinical Research Institute; Singapore Singapore
| | - Wai Leong Kok
- Department of Dermatology; National Skin Centre; Singapore Singapore
| | | | - Jeremy Teoh
- Department of Medicine; National University of Singapore; Singapore Singapore
| | | | - Luming Shi
- Department of Epidemiology; Singapore Clinical Research Institute; Singapore Singapore
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68
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Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Chua S, Lai NM, Dellavalle R, Chaiyakunapruk N. Systemic treatments for eczema: a network meta-analysis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ratree Sawangjit
- Faculty of Pharmacy, Mahasarakham University; Department of Clinical Pharmacy; 41/20 Kham Riang Kantharawichai Mahasarakham Thailand 44150
| | - Piyameth Dilokthornsakul
- Naresuan University; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; 99 Tha Pho Muang Phitsanulok Thailand 65000
| | - Antonia Lloyd-Lavery
- Oxford University Hospitals NHS Foundation Trust; Department of Dermatology; Churchill Hospital Roosevelt Drive Oxford UK OX3 7LE
| | - Sean Chua
- urong East St21 Blk288A #03-358 Singapore Singapore 601288
| | - Nai Ming Lai
- Taylor's University; School of Medicine; Subang Jaya Malaysia
| | - Robert Dellavalle
- University of Colorado School of Medicine; Denver VA Medical Center 1055 Clermont St. #165 Denver Colorado USA 80220
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Prevalence of Atopic Dermatitis and Pattern of Drug Therapy in Malaysian Children. Dermatitis 2018; 29:151-161. [PMID: 29762208 DOI: 10.1097/der.0000000000000376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic relapsing, noncontagious skin inflammation characterized by dry skin and itch. Mutation in filaggrin gene leads to defective skin barrier, allowing entry of allergen and eliciting immunological response. OBJECTIVES The aims of this study were to investigate the prevalence of AD in Malaysian children and to understand the pattern of drug therapy. Such information could be useful to establish the relationship between ethnicity and family history of atopy and the development of associated signs and symptoms. METHODS A cross-sectional survey was conducted among children attending kindergartens and nurseries. Standardized questionnaires were filled out by parents. RESULTS Overall prevalence of AD was 13.4%. Of 384 participants recruited, the highest prevalence was observed in males, Malays, participants younger than 2 years, and those with atopic background such as asthma, hay fever, and family history of atopic diseases. Calamine and white soft paraffin were the preferred choice of nonprescription drugs, whereas topical hydrocortisone seemed to be the preferred choice of prescription drug in the management of AD. CONCLUSIONS The overall prevalence is comparable to that reported in the International Study of Asthma and Allergies in Childhood Phase One. There is an association between ethnicity and AD prevalence. Topical corticosteroids and emollients are the mainstay of AD management among Malaysians.
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Berg AK, Nørgaard K, Thyssen JP, Zachariae C, Hommel E, Rytter K, Svensson J. Skin Problems Associated with Insulin Pumps and Sensors in Adults with Type 1 Diabetes: A Cross-Sectional Study. Diabetes Technol Ther 2018; 20:475-482. [PMID: 29893593 DOI: 10.1089/dia.2018.0088] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND In the future, widespread use of closed-loop infusion (artificial pancreas) systems to treat type 1 diabetes (T1D) may significantly improve glycemic control and enhance treatment flexibility. However, the infusion sets and plasters necessary for these treatments can cause dermatological complications that may hamper the spread of the new technology; few studies have investigated these complications in adults. The aim of this study was to describe the dermatological complications associated with continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in adults. METHODS A total of 118 adult patients from two different diabetes clinics completed a questionnaire concerning the dermatological complications associated with their CSII and/or CGM treatment, other treatment variables, duration of diabetes, allergies, skin care, and other pathologies. RESULTS CGM or CSII use was associated with current eczema, scars, and wounds. In total, 34% of CSII users and 35% of CGM users currently had one or more skin lesions due to the use of these devices. We found no significant association with glycated hemoglobin (HbA1c) levels, a history of atopic dermatitis, or other skin pathologies. However, multivariate analysis revealed associations with a history of atopy and CSII-associated dermatological complications. CONCLUSIONS Dermatological complications were present in one in every three patients and represent a significant challenge to using CSII and CGM to treat adults with T1D. Prospective studies on the causes of these complications will be required to develop preventive strategies and ensure that optimal diabetes treatment approaches that take advantage of the latest technology can be implemented.
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Affiliation(s)
- Anna Korsgaard Berg
- 1 Department of Pediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Copenhagen University Hospital , Herlev and Gentofte, Herlev, Denmark
- 2 Faculty of Health Science, University of Copenhagen , Denmark
| | - Kirsten Nørgaard
- 2 Faculty of Health Science, University of Copenhagen , Denmark
- 3 Department of Endocrinology, Copenhagen University Hospital , Hvidovre, Denmark
| | - Jacob P Thyssen
- 4 Department of Dermatology and Allergy, Copenhagen University Hospital , Herlev and Gentofte, Hellerup, Denmark
| | - Claus Zachariae
- 4 Department of Dermatology and Allergy, Copenhagen University Hospital , Herlev and Gentofte, Hellerup, Denmark
| | - Eva Hommel
- 5 Steno Diabetes Center Copenhagen , Gentofte, Denmark
| | - Karen Rytter
- 5 Steno Diabetes Center Copenhagen , Gentofte, Denmark
| | - Jannet Svensson
- 1 Department of Pediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Copenhagen University Hospital , Herlev and Gentofte, Herlev, Denmark
- 2 Faculty of Health Science, University of Copenhagen , Denmark
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71
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Berg AK, Olsen BS, Thyssen JP, Zachariae C, Simonsen AB, Pilgaard K, Svensson J. High frequencies of dermatological complications in children using insulin pumps or sensors. Pediatr Diabetes 2018; 19:733-740. [PMID: 29484783 DOI: 10.1111/pedi.12652] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dermatological complications in children and adolescents that are related to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) have not been well-characterized. This study examined the prevalence and characteristics of different types of dermatological complications. METHODS Online questionnaires regarding dermatological complications related to CSII and/or CGM were returned from a total of 144 children and adolescents, aged 2 to 20 years. Both previous and current skin problems were reported along with their clinical characteristics. Descriptive statistics, χ2 tests, and multivariate analyses were used to evaluate the data. RESULTS Of 143 patients using CSII, 90% had previous and 63% reported current dermatological complications. Non-specific eczema was most frequently reported and was currently present in 25.7% of the patients. These results were independent of age and current CGM use. Among the 76 patients using CGM, 46% reported current dermatological complications. A history of atopy was associated with dermatological complications in individuals using CSII, but not CGM. The patients rated CGM-related dermal issues as significantly worse than those associated with CSII (P < .05). CONCLUSIONS Dermatological complications can be a serious problem in treating pediatric and adolescent patients of all ages with CSII and/or CGM. Only a few clinical characteristics associated with these complications were identified in this study, highlighting the need for prospective studies that might lead to improvements in the prevention and treatment of dermatological problems.
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Affiliation(s)
- Anna Korsgaard Berg
- Department of Pediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Birthe Susanne Olsen
- Department of Pediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Birgitte Simonsen
- Department of Dermatology and Allergy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Pilgaard
- Pediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - Jannet Svensson
- Department of Pediatrics, Copenhagen Diabetes Research Center (CPH-DIRECT), Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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72
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Gerbens LAA, Hamann SAS, Brouwer MWD, Roekevisch E, Leeflang MMG, Spuls PI. Methotrexate and azathioprine for severe atopic dermatitis: a 5-year follow-up study of a randomized controlled trial. Br J Dermatol 2018; 178:1288-1296. [PMID: 29237228 DOI: 10.1111/bjd.16240] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Systemic treatment is indicated for moderate-to-severe atopic dermatitis (AD) refractory to topical treatment. Long-term evidence, up to 5 years, of off-label prescribed methotrexate (MTX) and azathioprine (AZA) is lacking. OBJECTIVES To investigate long-term effectiveness, safety and drug survival of MTX and AZA. METHODS In an open-label follow-up phase of a clinical trial, patients were seen every 3 months for 5 years. MTX and AZA doses could be increased or decreased concurrent with daily clinical practice. Primary effectiveness outcomes were mean absolute and relative reduction in SCORing Atopic Dermatitis (SCORAD) index and Investigator's Global Assessment (IGA) after 5 years compared with baseline. To assess safety, the type, frequency, severity and relatedness to treatment of adverse events were investigated. Drug survival was analysed by Kaplan-Meier curves. RESULTS Thirty-five of 43 originally included patients participated, of whom 27 completed the follow-up. At year 5, the mean relative reduction in SCORAD index was similar in the MTX and AZA groups: 53% and 54% using descriptive analysis. Twelve serious adverse events occurred in 5 years; for three there was a possible causal relationship. Drug survival demonstrated a longer survival for MTX, but survival in both groups was low after 5 years (MTXn = 5, AZAn = 1). CONCLUSIONS Based on this relatively small pragmatic study, MTX and AZA seem to be effective and safe as maintenance treatments in moderate-to-severe AD up to 5 years. Few patients in both groups survive on their originally allocated drug although some discontinued because of controlled AD.
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Affiliation(s)
- L A A Gerbens
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - S A S Hamann
- Department of Dermatology, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - M W D Brouwer
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - E Roekevisch
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - M M G Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - P I Spuls
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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73
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Andersen YMF, Egeberg A, Hamann CR, Skov L, Gislason GH, Skaaby T, Linneberg A, Thyssen JP. Poor agreement in questionnaire-based diagnostic criteria for adult atopic dermatitis is a challenge when examining cardiovascular comorbidity. Allergy 2018; 73:923-931. [PMID: 29150853 DOI: 10.1111/all.13360] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The association between atopic dermatitis (AD) and cardio-metabolic risk factors is not yet established. Furthermore, no validated questionnaire-based method of identifying adults with AD is currently available. OBJECTIVES To assess the cardio-metabolic risk in adults with a history of AD using 3 different questionnaire-based diagnostic criteria. METHODS We utilized data from a general population study including questionnaire data and objective measurements of 9656 Danish adults. To identify adults with a history of AD, we used a question regarding physician-diagnosed AD and 2 versions of the UK Working Party Diagnostic Criteria. Associations between AD status and cardio-metabolic endpoints were estimated using survey weighted logistic and linear regression analysis. RESULTS We identified 462 (4.8%) adults with self-reported physician-diagnosed AD, whereas 903 (9.4%) and 226 (2.3%) had AD according to the UK Working Party Criteria when at least 2 and 3of 4 minor criteria were fulfilled. The populations were not comparable in terms of occurrence of cardio-metabolic risk factors. For example, the prevalence of obesity was lower in participants with physician-diagnosed AD but overall higher in UK 2/4 and UK 3/4. CONCLUSION Due to the heterogeneity in the captured study populations in terms of the studied outcomes and absence of a gold standard, no conclusions regarding the cardio-metabolic risk in adults with AD in a general population could be made. This study serves as an example of the challenges that are often encountered in questionnaire-based epidemiologic studies and highlights the need of better definitions for this patient group.
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Affiliation(s)
- Y. M. F. Andersen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
- Department of Cardiology, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - A. Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
| | - C. R. Hamann
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
- Department of Cardiology, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - L. Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
| | - G. H. Gislason
- Department of Cardiology, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- The Danish Heart Foundation; Copenhagen Denmark
- The National Institute of Public Health; University of Southern Denmark; Copenhagen Denmark
| | - T. Skaaby
- Research Centre for Prevention and Health; The Capital Region of Denmark; Copenhagen Denmark
| | - A. Linneberg
- Research Centre for Prevention and Health; The Capital Region of Denmark; Copenhagen Denmark
- Department of Clinical Experimental Research; Rigshospitalet Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - J. P. Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS); Herlev and Gentofte Hospital; Hellerup Denmark
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74
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Burden-Teh E, Phillips R, Thomas K, Ratib S, Grindlay D, Murphy R. A systematic review of diagnostic criteria for psoriasis in adults and children: evidence from studies with a primary aim to develop or validate diagnostic criteria. Br J Dermatol 2018; 178:1035-1043. [DOI: 10.1111/bjd.16104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 12/31/2022]
Affiliation(s)
- E. Burden-Teh
- Centre of Evidence Based Dermatology; King's Meadow Campus; University of Nottingham; Nottingham U.K
| | - R.C. Phillips
- Department of Paediatric Dermatology; Nottingham University Hospitals NHS Trust; Nottingham U.K
| | - K.S. Thomas
- Centre of Evidence Based Dermatology; King's Meadow Campus; University of Nottingham; Nottingham U.K
| | - S. Ratib
- Centre of Evidence Based Dermatology; King's Meadow Campus; University of Nottingham; Nottingham U.K
| | - D. Grindlay
- Centre of Evidence Based Dermatology; King's Meadow Campus; University of Nottingham; Nottingham U.K
| | - R. Murphy
- Department of Dermatology; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield U.K
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75
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Abu-Humaidan AH, Elvén M, Sonesson A, Garred P, Sørensen OE. Persistent Intracellular Staphylococcus aureus in Keratinocytes Lead to Activation of the Complement System with Subsequent Reduction in the Intracellular Bacterial Load. Front Immunol 2018; 9:396. [PMID: 29545804 PMCID: PMC5837974 DOI: 10.3389/fimmu.2018.00396] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/13/2018] [Indexed: 01/15/2023] Open
Abstract
The complement system is an ancient part of the innate immune system important for both tissue homeostasis and host defense. However, bacteria like Staphylococcus aureus (SA) possess elaborative mechanisms for evading both the complement system and other parts of the immune system. One of these evasive mechanisms—important in causing chronic and therapy resistant infections—is the intracellular persistence in non-immune cells. The objective of our study was to investigate whether persistent intracellular SA infection of epidermal keratinocytes resulted in complement activation. Using fluorescence microscopy, we found that persistent SA, surviving intracellularly in keratinocytes, caused activation of the complement system with formation of the terminal complement complex (TCC) at the cell surface. Skin samples from atopic dermatitis patients analyzed by bacterial culture and microscopy, demonstrated that SA colonization was associated with the presence of intracellular bacteria and deposition of the TCC in epidermis in vivo. Complement activation on keratinocytes with persistent intracellular bacteria was found with sera deficient/depleted of the complement components C1q, Mannan-binding lectin, or complement factor B, demonstrating involvement of more than one complement activation pathway. Viable bacterial counts showed that complement activation at the cell surface initiated cellular responses that significantly reduced the intracellular bacterial burden. The use of an inhibitor of the extracellular signal-regulated kinase (ERK) abrogated the complement-induced reduction in intracellular bacterial load. These data bridge the roles of the complement system in tissue homeostasis and innate immunity and illustrate a novel mechanism by which the complement system combats persistent intracellular bacteria in epithelial cells.
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Affiliation(s)
- Anas H Abu-Humaidan
- Department of Clinical Sciences Lund, Infection Medicine, Lund University, Lund, Sweden
| | - Malin Elvén
- Skåne University Hospital, Department of Clinical Sciences Lund, Dermatology and Venereology, Lund University, Lund, Sweden
| | - Andreas Sonesson
- Skåne University Hospital, Department of Clinical Sciences Lund, Dermatology and Venereology, Lund University, Lund, Sweden
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ole E Sørensen
- Skåne University Hospital, Department of Clinical Sciences Lund, Dermatology and Venereology, Lund University, Lund, Sweden.,Leo Pharma A/S, Ballerup, Denmark
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76
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Abstract
Inflammatory dermatoses encompass a variety of histologic patterns that affect different portions of the skin. In spongiotic, psoriasiform, lichenoid, pityriasiform, and blistering disorders, there are predominately epidermal and junctional activities with variable superficial dermal inflammation. Hypersensitivity reactions can show either epidermal or mostly dermal changes depending on whether the exposure of the exogenous allergen occurs through an external or internal route, respectively. Exceptions include erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis, where the etiology is often due to infection or ingested medications, but the histologic features are almost exclusively confined to the epidermis and dermoepidermal junction. Autoimmune disorders are unique in that lesions typically incorporate a mixture of epidermal and dermal inflammatory patterns with periadnexal inflammation, while the vast majority of vasculitis/vasculopathy and alopecia have changes limited to only the vessels and hair follicles, respectively. It is critical to recognize that a relatively limited number of histologic patterns are seen in a large array of clinical entities. Therefore, clinicopathologic correlation and careful examination of histologic details are of the utmost importance when evaluating skin biopsies for inflammatory disorders.
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Affiliation(s)
- Andy C Hsi
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Ilana S Rosman
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.,2 Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
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77
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Systematic Review of Diagnostic Criteria Used in Atopic Dermatitis Randomized Controlled Trials. Am J Clin Dermatol 2018. [PMID: 28624959 DOI: 10.1007/s40257-017-0299-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Numerous diagnostic criteria for atopic dermatitis are used in clinical trials, which may limit comparison of results. OBJECTIVE We sought to determine the most commonly used atopic dermatitis diagnostic criteria in randomized controlled trials internationally. METHODS We performed a systematic review of randomized controlled trials with a pharmacological intervention from 2007 to 2016. Cochrane Library, EMBASE, GREAT, LILACS, MEDLINE, and Scopus were searched. Two authors independently performed the study selection and data extraction. RESULTS Two hundred and twelve randomized controlled trials met inclusion/exclusion criteria. Overall, ten different diagnostic criteria were used. The Hanifin and Rajka criteria were most commonly used (41.0%), followed by the UK refinement of the Hanifin and Rajka criteria (9.0%), Japanese Dermatological Association criteria (4.2%), and American Academy of Dermatology criteria (3.8%). No diagnostic criteria were specified in 37.3% of randomized controlled trials. The Hanifin and Rajka criteria were the most commonly used atopic dermatitis diagnostic criteria in clinical trials of topical and systemic interventions, across all years between 2007 and 2016, in pediatric and adult populations, in most countries and regions internationally. CONCLUSIONS The results highlight the lack of uniformity and documentation of atopic dermatitis diagnostic criteria in randomized controlled trials for atopic dermatitis. We recommend harmonizing the diagnostic criteria for atopic dermatitis in future randomized controlled trials.
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78
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Roekevisch E, Schram ME, Leeflang MMG, Brouwer MWD, Gerbens LAA, Bos JD, Spuls PI. Methotrexate versus azathioprine in patients with atopic dermatitis: 2-year follow-up data. J Allergy Clin Immunol 2017; 141:825-827.e10. [PMID: 29111215 DOI: 10.1016/j.jaci.2017.09.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/03/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Evelien Roekevisch
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Mandy Elvira Schram
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mariska Maria Geertruida Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Jan Dositheus Bos
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Phyllis Ira Spuls
- Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands
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79
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Norén P, Hagströmer L, Alimohammadi M, Melin L. The positive effects of habit reversal treatment of scratching in children with atopic dermatitis: a randomized controlled study. Br J Dermatol 2017; 178:665-673. [PMID: 28940213 DOI: 10.1111/bjd.16009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scratching and itch are common clinical signs of atopic dermatitis (AD). Studies of adult patients have shown that a decrease in scratching behaviour results in regression of inflammation and improved healing of the skin. OBJECTIVES To investigate whether a modified habit reversal (HR) treatment protocol could be used for the treatment of scratching in children to improve skin status. METHODS The study is a single-blind, randomized controlled trial of 39 patients who started with registration a week before randomization into one of two groups (intervention or control). The participants in the intervention group received a habit-breaking therapy of their scratching behaviour (i.e. HR) in addition to a potent steroid (mometasone furoate), whereas the patients in the control group received the steroid alone. The patients were assessed by an independent dermatologist after the first week of registration (baseline assessment) and then after 3 and 8 weeks of treatment. The primary efficacy variable was a change in objective Scoring Atopic Dermatitis (SCORAD). RESULTS At the end of the 3-week treatment period, the change in mean objective SCORAD was significantly (P = 0·027) higher in the intervention group (-31·9 ± 9·5) than in the control group (-23·8 ± 10·1). After the 8-week follow-up, the change in mean objective SCORAD was significantly (P = 0·0038) higher in the intervention group (-31·7 ± 10·4) than in the control group (-19·7 ± 9·4). CONCLUSIONS The treatment of scratching with the HR method in combination with a potent steroid was found to improve skin status significantly after 3 and 11 weeks.
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Affiliation(s)
- P Norén
- Department of Medical Sciences, Uppsala University, Laserkliniken in Uppsala, Vaestra Aagatan 16, 753 09, Uppsala, Sweden
| | - L Hagströmer
- Department of Dermatology, Södersjukhuset, Stockholm, Sweden
| | - M Alimohammadi
- Department of Medical Sciences, Uppsala University, Laserkliniken in Uppsala, Vaestra Aagatan 16, 753 09, Uppsala, Sweden
| | - L Melin
- Clinical Psychology, Department of Psychology, Uppsala University, Laserkliniken in Uppsala, Vaestra Aagatan 16, 753 09, Uppsala, Sweden
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80
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Fölster-Holst R, Wollenberg A. Atopic Dermatitis in Infants and Toddlers: a Diagnostic Challenge in Daily Practice. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0195-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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81
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Sonesson A, Przybyszewska K, Eriksson S, Mörgelin M, Kjellström S, Davies J, Potempa J, Schmidtchen A. Identification of bacterial biofilm and the Staphylococcus aureus derived protease, staphopain, on the skin surface of patients with atopic dermatitis. Sci Rep 2017; 7:8689. [PMID: 28821865 PMCID: PMC5562790 DOI: 10.1038/s41598-017-08046-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 07/07/2017] [Indexed: 11/09/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by an impaired epidermal barrier, dysregulation of innate and adaptive immunity, and a high susceptibility to bacterial colonization and infection. In the present study, bacterial biofilm was visualized by electron microscopy at the surface of AD skin. Correspondingly, Staphylococcus aureus (S. aureus) isolates from lesional skin of patients with AD, produced a substantial amount of biofilm in vitro. S. aureus biofilms showed less susceptibility to killing by the antimicrobial peptide LL-37 when compared with results obtained using planktonic cells. Confocal microscopy analysis showed that LL-37 binds to the S. aureus biofilms. Immuno-gold staining of S. aureus biofilm of AD skin detected the S. aureus derived protease staphopain adjacent to the bacteria. In vitro, staphopain B degraded LL-37 into shorter peptide fragments. Further, LL-37 significantly inhibited S. aureus biofilm formation, but no such effects were observed for the degradation products. The data presented here provide novel information on staphopains present in S. aureus biofilms in vivo, and illustrate the complex interplay between biofilm and LL-37 in skin of AD patients, possibly leading to a disturbed host defense, which facilitates bacterial persistence.
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Affiliation(s)
- Andreas Sonesson
- Division of Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, BMC, Tornavägen 10, SE-22184, Lund, Sweden. .,Dermatology and Venereology, Skane University Hospital, Lasarettsgatan 15, SE-22185, Lund, Sweden.
| | - Kornelia Przybyszewska
- Division of Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, BMC, Tornavägen 10, SE-22184, Lund, Sweden.,Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 30-387, Krakow, Poland.,Center for Infection and Immunity, School of Medicine, Dentistry and Bio-medical Sciences Queen's University Belfast, Belfast, UK
| | - Sigrid Eriksson
- Division of Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, BMC, Tornavägen 10, SE-22184, Lund, Sweden.,Dermatology and Venereology, Skane University Hospital, Lasarettsgatan 15, SE-22185, Lund, Sweden
| | - Matthias Mörgelin
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Biomedical Center B14, 221 84, Lund, Sweden
| | - Sven Kjellström
- Department of Biochemistry and Structural Biology, Center for Molecular Protein Science, Lund University, PO Box 124, Lund, SE-22362, Sweden
| | - Julia Davies
- Department of Oral Biology, Faculty of Odontology, Malmö University, 20506, Malmö, Sweden
| | - Jan Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, 30-387, Krakow, Poland.,Malopolska Center of Biotechnology, Jagiellonian University, 30-387, Krakow, Poland.,Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, 40202, USA
| | - Artur Schmidtchen
- Division of Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, BMC, Tornavägen 10, SE-22184, Lund, Sweden.,Dermatology and Venereology, Skane University Hospital, Lasarettsgatan 15, SE-22185, Lund, Sweden.,Dermatology, LKCMedicine, Nanyang Technological University, Singapore, 636921, Singapore
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82
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Abuabara K, Magyari AM, Hoffstad O, Jabbar-Lopez ZK, Smeeth L, Williams HC, Gelfand JM, Margolis DJ, Langan SM. Development and Validation of an Algorithm to Accurately Identify Atopic Eczema Patients in Primary Care Electronic Health Records from the UK. J Invest Dermatol 2017; 137:1655-1662. [PMID: 28428130 PMCID: PMC5883318 DOI: 10.1016/j.jid.2017.03.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/03/2017] [Accepted: 03/21/2017] [Indexed: 12/21/2022]
Abstract
Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging because of its episodic and heterogeneous nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network. We found that at least one of five diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, positive predictive value for a physician-confirmed diagnosis of AE, was 86% (95% confidence interval = 80-91). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% confidence interval = -0.3 to 1.9) and -1.3 years (95% confidence interval = -2.5 to -0.1), respectively. A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from The Health Improvement Network primary care electronic health records in the UK.
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Affiliation(s)
- Katrina Abuabara
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
| | - Alexa M Magyari
- Department of Health Policy & Management, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Ole Hoffstad
- Department of Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zarif K Jabbar-Lopez
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Joel M Gelfand
- Department of Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David J Margolis
- Department of Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sinead M Langan
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
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83
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Wang L, Li LF. Clinical Application of the UK Working Party's Criteria for the Diagnosis of Atopic Dermatitis in the Chinese Population by Age Group. Chin Med J (Engl) 2017; 129:2829-2833. [PMID: 27900997 PMCID: PMC5146791 DOI: 10.4103/0366-6999.194662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory skin disease with an increasingly significant prevalence. The prevalence of AD depends greatly on how its diagnosis is done. The UK Working Party's diagnostic criteria for AD are simple and easy to apply without invasive laboratory tests. This study assessed the clinical utility of these criteria in China. METHODS Data were collected from 6208 patients at 31 tertiary hospitals in 13 Chinese provinces/municipalities from March 2014 to May 2014. . The agreement between the UK diagnostic criteria and the clinical records for AD was assessed by Cohen's kappa. RESULTS The overall agreement between the UK diagnostic criteria and clinical diagnosis was fair (kappa = 0.40). A slightly better agreement was found in patients aged between 4 and 9 years (kappa = 0.48), while fair agreement was found in the group <4 years and the group ≥10 years (kappa = 0.27 and 0.39, respectively). Using the UK party's criteria as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of the clinical diagnosis of AD were 62.3%, 89.2%, 38.0%, and 95.7%, respectively. CONCLUSIONS Our study indicates a modest ability among Chinese dermatologists to apply the UK Working Party's diagnostic criteria for AD, especially in patients aged <4 years and ≥10 years. Since there is no gold standard for AD diagnosis, it is important to determine how AD is identified when evaluating a diagnostic tool.
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Affiliation(s)
- Li Wang
- Department of Dermatology, Allergy and Clinical Immunology Centre, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lin-Feng Li
- Department of Dermatology, Allergy and Clinical Immunology Centre, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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84
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Leitenberger S, Hajar T, Simpson EL, von Kobyletzki L, Hanifin JM. Validation of a Parent-Reported Diagnostic Instrument in a U.S. Referral Population: The Childhood Eczema Questionnaire. Pediatr Dermatol 2017; 34:398-401. [PMID: 28523849 DOI: 10.1111/pde.13139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES There is a paucity of validated tools for diagnosing atopic dermatitis (AD) in very young children that do not rely on clinical evaluation. The Childhood Eczema Questionnaire (CEQ)-a diagnostic tool for AD in children younger than 2 years that a caretaker can complete-was recently validated in Sweden. The objective of this study was to validate the tool in a U.S. POPULATION As a substudy, we added an additional question that was independently assessed. METHODS Children younger than 2 years old were recruited from a dermatology clinic. Their caretakers completed a questionnaire containing the original tool's three questions as well as a fourth question that increased the time frame measured from 1 week to 6 months. Questionnaires with all "yes" answers were considered positive and were compared with a dermatologist diagnosis of AD. RESULTS A total of 283 subjects were recruited. The first three questions (the original CEQ) predicted a positive diagnosis of AD with a sensitivity of 0.72 (95% confidence interval [CI] 0.58, 0.82) and a specificity of 0.93 (95% CI 0.87, 0.95). In a separate analysis we included the first two questions and the fourth question and found that the sensitivity increased to 0.82 (95% CI 0.69, 0.90) with a specificity of 0.89 (95% CI 0.83, 0.93). CONCLUSION This study validates a novel parental questionnaire for the diagnosis of AD in children younger than 2 years in a U.S. clinic population.
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Affiliation(s)
- Sabra Leitenberger
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Tamar Hajar
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Laura von Kobyletzki
- Department of Dermatology, Skane University Hospital, Lund University, Malmo, Sweden
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
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85
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent research regarding the diagnosis of allergic rashes and to suggest future directions for the promotion of accurate diagnosis and endotype specification. RECENT FINDINGS Multiple cohort studies demonstrate that with appropriate clinical evaluation, drug allergy labels can be removed in up to 90% of cases. Genetic tests can predict severe adverse cutaneous drug reactions in some cases and in vitro tests are being sought to identify causative drugs in others. Biomarkers to define endotypes of atopic dermatitis are needed to predict which patients will benefit from evolving targeted therapies. Hyperspectral imaging is a rapidly evolving technology in medical diagnostics; additional research is needed to demonstrate whether this promising technology can be used to distinguish allergic rashes and/or endotypes in atopic dermatitis. SUMMARY Diagnostic tools for the assessment of allergic rashes are primitive in that they frequently rely on challenges to ascertain whether suspected allergens were causative. Validated in vitro tests with high sensitivity and specificity for drug allergies would benefit the field, particularly in delayed type reactions, as would identification of any hyperspectral signatures that could identify endotypes in atopic dermatitis.
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86
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Diagnosis, assessment, and treatment of childhood eczema in primary care: cross-sectional study. BJGP Open 2017; 1:bjgpopen17X1000821. [PMID: 30564671 PMCID: PMC6169955 DOI: 10.3399/bjgpopen17x100821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background The majority of children with eczema in the UK are looked after in primary care yet we know little about their care in this setting. Aim To compare the diagnosis, assessment, and treatment of eczema in primary care with published diagnostic criteria and management guidelines. Design & setting Cross-sectional study using data from a randomised controlled feasibility study. General practices, UK. Method Baseline data from children aged 1 month to 5 years recruited ‘in-consultation’ for the Choice of Moisturiser in Eczema Treatment (COMET) feasibility study was used. These included clinician diagnosis and global severity assessment; the parent-completed Patient Orientated Eczema Measure (POEM); a questionnaire about eczema treatments, including use of topical corticosteroid (TCS); and, the Eczema Area Severity Index (EASI) carried out by trained researchers. Descriptive analyses were undertaken to compare diagnoses with UK diagnostic criteria, severity assessments, and treatment with the National Institute for Health and Care Excellent (NICE) guidance. Results Data were available for 90 participants. Only 46% of participants labelled as having eczema met the UK diagnostic criteria. Agreement between the global severity assessment by a healthcare practitioner with the EASI and POEM measures of eczema severity were 44% and 48% respectively. Emollients and TCSs were underused with 44% of participants not using any emollient and 46% using one or more TCSs. The ‘match’ between eczema severity and TCSs potency was poor. Conclusion Discrepancies were found between the diagnosis, assessment, and treatment of children with eczema in primary care, and UK diagnostic criteria and guidelines. Further investigation to explore the reasons for this discordance, and whether it matters, is needed.
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87
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Erkoçoğlu M, Metin A, Kaya A, Özcan C, Akan A, Civelek E, Çapanoğlu M, Giniş T, Kocabaş CN. Allergic and autoimmune disorders in families with selective IgA deficiency. Turk J Med Sci 2017; 47:592-598. [PMID: 28425252 DOI: 10.3906/sag-1605-50] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/02/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM IgA deficiency is the most common human primary immunodeficiency. The prevalence of allergic disorders and autoimmunity is thought to be increased in selective IgA deficiency (sIgAD). However, it is currently unclear if these disorders coincide within these families. We aimed to evaluate the frequency of allergic and autoimmune disorders in children with sIgAD and their first-degree relatives (FDRs). MATERIALS AND METHODS The study included 81 children diagnosed with sIgAD and 274 of their FDRs. The presence of allergic and autoimmune disorders was evaluated and serum antithyroglobulin and antithyroid peroxidase levels were measured in both patients and their first-degree relatives. RESULTS The mean age of the patients was 9.9 ± 3.9 years. Among the patients with sIgAD, 45.7% of them had at least one allergic disorder and 17.3% of them had at least one autoimmune disorder. The frequencies of asthma, allergic rhinitis, and eczema in the FDRs of sIgAD patients were 10.9%, 9.1%, and 7.7%, respectively. Among their FDRs, 14.6% had autoimmunity, compared to an estimate of 5% in the general population. CONCLUSION Increased frequency of allergic and autoimmune disorders in patients with sIgAD and their FDRs suggests a possible common predisposing genetic component for sIgAD and autoimmunity in these families.
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Affiliation(s)
- Mustafa Erkoçoğlu
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Ayşe Metin
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayşenur Kaya
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Celal Özcan
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Akan
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ersoy Civelek
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Murat Çapanoğlu
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Tayfur Giniş
- Department of Pediatric Allergy and Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Can Naci Kocabaş
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
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Popadić S, Gajić-Veljić M, Prćić S, Mijušković Ž, Jovanović D, Kandolf-Sekulović L, Nikolić M. National Guidelines for the Treatment of Atopic Dermatitis. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2017. [DOI: 10.1515/sjdv-2016-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Svetlana Popadić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mirjana Gajić-Veljić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sonja Prćić
- Institute for Child and Youth Health Care of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia
| | - Željko Mijušković
- Clinic of Skin and Venereal Diseases, Military Medical Academy, Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Jovanović
- Department of Dermatovenereology, Clinic of Skin and Venereal Diseases, Clinical Center Niš, School of Medicine, University of Niš, Niš, Serbia
| | - Lidija Kandolf-Sekulović
- Clinic of Skin and Venereal Diseases, Military Medical Academy, Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology, Clinical Center of Serbia, Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia
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89
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Jiang Y, Ma W. Assessment of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Atopic Dermatitis Patients. Med Sci Monit 2017; 23:1340-1346. [PMID: 28306706 PMCID: PMC5367851 DOI: 10.12659/msm.900212] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To develop new strategies for identifying atopic dermatitis patients, a better understanding of the signs for chronic inflammatory status is needed. This study was designed to investigate whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are related to the severity of atopic dermatitis (AD) assessed by the Scoring Atopic Dermatitis (SCORAD) index. MATERIAL AND METHODS A retrospective study involving 80 AD patients and 45 healthy control subjects was performed. NLR, PLR, and the number of peripheral blood eosinophils were compared between AD patients and healthy controls, and correlations between these indexes and clinical characteristics were analyzed. RESULTS NLR, PLR, and eosinophils in AD patients were all significantly higher than in healthy individuals. Among AD patients, NLR (p<0.001) and PLR (p<0.001), as contrasted with eosinophils (p=0.146), were correlated positively with SCORAD index. Additionally, an NLR level of 1.75 was determined as the predictive cut-off value of severe AD (SCORAD ≥51) (sensitivity 94.7%, specificity 58.6%, the area under the receiver-operating characteristic curve (AUROC) 0.778, p=0.001). For eosinophils, the sensitivity and specificity were 78.9% and 62.1%, respectively, and the AUROC was only 0.685 (p=0.032) in predicting high SCORAD. CONCLUSIONS NLR and PLR reflect inflammatory response and disease severity in AD patients.
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Affiliation(s)
- Ying Jiang
- Department of Dermatology, 1st Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Wencong Ma
- Department of Surgery, 1st Hospital of Jilin University, Changchun, Jilin, China (mainland)
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90
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Liu P, Zhao Y, Mu ZL, Lu QJ, Zhang L, Yao X, Zheng M, Tang YW, Lu XX, Xia XJ, Lin YK, Li YZ, Tu CX, Yao ZR, Xu JH, Li W, Lai W, Yang HM, Xie HF, Han XP, Xie ZQ, Nong X, Guo ZP, Deng DQ, Shi TX, Zhang JZ. Clinical Features of Adult/Adolescent Atopic Dermatitis and Chinese Criteria for Atopic Dermatitis. Chin Med J (Engl) 2017; 129:757-62. [PMID: 26996468 PMCID: PMC4819293 DOI: 10.4103/0366-6999.178960] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Atopic dermatitis (AD) is an inflammatory skin disease characterized by chronic recurrent dermatitis with profound itching. Most patients have personal and/or family history of atopic diseases. Several criteria have been proposed for the diagnosis of AD. Although the clinical features of childhood AD have been widely studied, there has been less large-scale study on adult/adolescent AD. The aim of this study was to investigate the clinical features of adult/adolescent patients with chronic symmetrical eczema/AD and to propose Chinese diagnostic criteria for adult/adolescent AD. Methods: A hospital-based study was performed. Forty-two dermatological centers participated in this study. Adult and adolescent patients (12 years and over) with chronic symmetrical eczema or AD were included in this study. Questionnaires were completed by both patients and investigators. The valid questionnaires were analyzed using EpiData 3.1 and SPSS 17.0 software. Results: A total of 2662 valid questionnaires were collected (1369 male and 1293 female). Of all 2662 patients, 2062 (77.5%) patients had the disease after 12 years old, while only 600 (22.5%) patients had the disease before 12 years old, suggesting late-onset eczema/AD is common. Two thousand one hundred and thirty-nine (80.4%) patients had the disease for more than 6 months. One thousand one hundred and forty-four (43.0%) patients had a personal and/or family history of atopic diseases. One thousand five hundred and forty-eight (58.2%) patients had an elevated total serum IgE and/or eosinophilia and/or positive allergen-specific IgE. Based on these clinical and laboratory features, we proposed Chinese criteria for adult/adolescent AD. Of all 2662 patients, 60.3% were satisfied with our criteria, while only 48.2% satisfied with Hanifin Rajka criteria and 32.7% satisfied with Williams criteria, suggesting a good sensitivity of our criteria in adult/adolescent AD patients. Conclusion: Late-onset of eczema or AD is common. The clinical manifestations of AD are heterogeneous. We have proposed Chinese diagnostic criteria for adolescent and adult AD, which are simple and sensitive for diagnosis of adult/adolescent AD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jian-Zhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing 100044, China
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91
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Reljić V, Gazibara T, Nikolić M, Zarić M, Maksimović N. Parental knowledge, attitude, and behavior toward children with atopic dermatitis. Int J Dermatol 2017; 56:314-323. [DOI: 10.1111/ijd.13529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Vesna Reljić
- Clinic of Dermatovenereology; Clinical Center of Serbia; Belgrade Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology; Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | - Miloš Nikolić
- Clinic of Dermatovenereology; Clinical Center of Serbia; Belgrade Serbia
| | - Milica Zarić
- Institute of Epidemiology; Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | - Nataša Maksimović
- Institute of Epidemiology; Faculty of Medicine; University of Belgrade; Belgrade Serbia
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92
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Laird M, Lo Sicco K. Defining and Measuring the Scope of Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1027:93-104. [DOI: 10.1007/978-3-319-64804-0_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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93
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Thomas KS, Batchelor JM, Bath-Hextall F, Chalmers JR, Clarke T, Crowe S, Delamere FM, Eleftheriadou V, Evans N, Firkins L, Greenlaw N, Lansbury L, Lawton S, Layfield C, Leonardi-Bee J, Mason J, Mitchell E, Nankervis H, Norrie J, Nunn A, Ormerod AD, Patel R, Perkins W, Ravenscroft JC, Schmitt J, Simpson E, Whitton ME, Williams HC. A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundSkin diseases are very common and can have a large impact on the quality of life of patients and caregivers. This programme addressed four diseases: (1) eczema, (2) vitiligo, (3) squamous cell skin cancer (SCC) and (4) pyoderma gangrenosum (PG).ObjectiveTo set priorities and reduce uncertainties for the treatment and prevention of skin disease in our four chosen diseases.DesignMixed methods including eight systematic reviews, three prioritisation exercises, two pilot randomised controlled trials (RCTs), three feasibility studies, two core outcome initiatives, four funding proposals for national RCTs and one completed national RCT.SettingSecondary care, primary care and the general population.ParticipantsPatients (and their caregivers) with eczema, vitiligo, SCC and PG, plus health-care professionals with an interest in skin disease.InterventionsOur three intervention studies included (1) barrier enhancement using emollients from birth to prevent eczema (pilot RCT); (2) handheld narrowband ultraviolet light B therapy for treating vitiligo (pilot RCT); and (3) oral ciclosporin (Neoral®, Novartis Pharmaceuticals) compared with oral prednisolone for managing PG (pragmatic national RCT).ResultsSystematic reviews included two overarching systematic reviews of RCTs of treatments for eczema and vitiligo, an umbrella review of systematic reviews of interventions for the prevention of eczema, two reviews of treatments for SCC (one included RCTs and the second included observational studies), and three reviews of outcome measures and outcome reporting. Three prioritisation partnership exercises identified 26 priority areas for future research in eczema, vitiligo and SCC. Two international consensus initiatives identified four core domains for future eczema trials and seven core domains for vitiligo trials. Two pilot RCTs and three feasibility studies critically informed development of four trial proposals for external funding, three of which are now funded and one is pending consideration by funders. Our pragmatic RCT tested the two commonly used systemic treatments for PG (prednisolone vs. ciclosporin) and found no difference in their clinical effectiveness or cost-effectiveness. Both drugs showed limited benefit. Only half of the participants’ ulcers had healed by 6 months. For those with healed ulcers, recurrence was common (30%). Different side effect profiles were noted for each drug, which can inform clinical decisions on an individual patient basis. Three researchers were trained to PhD level and a dermatology patient panel was established to ensure patient involvement in all aspects of the programme.ConclusionsFindings from this programme of work have already informed clinical guidelines and patient information resources. Feasibility studies have ensured that large national pragmatic trials will now be conducted on important areas of treatment uncertainty that address the needs of patients and the NHS. There is scope for considerable improvement in terms of trial design, conduct and reporting for RCTs of skin disease, which can be improved through wider collaboration, registration of trial protocols and complete reporting and international consensus over core outcome sets. Three national trials have now been funded as a result of this work. Two international initiatives to establish how best to measure the core outcome domains for eczema and vitiligo are ongoing.Trial registrationCurrent Controlled Trials Barrier Enhancement for Eczema Prevention (BEEP) (ISRCTN84854178 and NCT01142999), Study of Treatments fOr Pyoderma GAngrenosum Patients (STOP GAP) (ISRCTN35898459) and Hand Held NB-UVB for Early or Focal Vitiligo at Home (HI-Light Pilot Trial) (NCT01478945).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | | | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Tessa Clarke
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Finola M Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | - Nicholas Evans
- Trust Headquarters, West Hertfordshire Hospital NHS Trust, Hemel Hempstead, UK
| | - Lester Firkins
- Strategy and Development Group, James Lind Alliance, Oxford, UK
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Louise Lansbury
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sandra Lawton
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - James Mason
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Eleanor Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Andrew Nunn
- Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK
| | | | - Ramesh Patel
- Radcliffe-on-Trent Health Centre, Nottingham, UK
| | - William Perkins
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jane C Ravenscroft
- Dermatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jochen Schmitt
- Centre for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, Dresden, Germany
| | - Eric Simpson
- Oregon Health and Science University, Portland, OR, USA
| | - Maxine E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Gaudinski MR, Milner JD. Atopic Dermatitis and Allergic Urticaria: Cutaneous Manifestations of Immunodeficiency. Immunol Allergy Clin North Am 2016; 37:1-10. [PMID: 27886899 DOI: 10.1016/j.iac.2016.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Atopic dermatitis and allergic urticaria are common conditions of the skin that can also be the presenting symptoms of uncommon diseases. Defects leading to immunodeficiency may be associated with atopic dermatitis or allergic urticaria. Unusually severe or otherwise atypical presentations of atopic dermatitis or allergic urticaria may lead to clinical suspicion of an underlying immunodeficiency.
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Affiliation(s)
- Martin Robert Gaudinski
- National Institute of Allergy and Infectious Diseases, Genetics and Pathogenesis of Allergy Section, 10 Center Drive, Building 10 Room 11N240A, Bethesda, MD 20814, USA
| | - Joshua D Milner
- National Institute of Allergy and Infectious Diseases, Genetics and Pathogenesis of Allergy Section, 10 Center Drive, Building 10 Room 11N240A, Bethesda, MD 20814, USA.
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95
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Webb EL, Nampijja M, Kaweesa J, Kizindo R, Namutebi M, Nakazibwe E, Oduru G, Kabubi P, Kabagenyi J, Nkurunungi G, Kizito D, Muhangi L, Akello M, Verweij JJ, Nerima B, Tukahebwa E, Elliott AM, Sanya R, Mirembe B, Okello J, Levin J, Zziwa C, Tumusiime J, Sewankambo M, Nsubuga D, Cose S, Wammes L, Niwagaba E, Kabami G, Abayo E, Muwonge F, Abiriga D, Nannozi V, Kaweesa J. Helminths are positively associated with atopy and wheeze in Ugandan fishing communities: results from a cross-sectional survey. Allergy 2016; 71:1156-69. [PMID: 26918891 PMCID: PMC4949563 DOI: 10.1111/all.12867] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 01/15/2023]
Abstract
Background Parasitic helminths are potent immunomodulators and chronic infections may protect against allergy‐related disease and atopy. We conducted a cross‐sectional survey to test the hypothesis that in heavily helminth‐exposed fishing villages on Lake Victoria, Uganda, helminth infections would be inversely associated with allergy‐related conditions. Methods A household survey was conducted as baseline to an anthelminthic intervention trial. Outcomes were reported wheeze in last year, atopy assessed both by skin prick test (SPT) and by the measurement of allergen‐specific IgE to dust mites and cockroach in plasma. Helminth infections were ascertained by stool, urine and haemoparasitology. Associations were examined using multivariable regression. Results Two thousand three hundred and sixteen individuals were surveyed. Prevalence of reported wheeze was 2% in under‐fives and 5% in participants ≥5 years; 19% had a positive SPT; median Dermatophagoides‐specific IgE and cockroach‐specific IgE were 1440 and 220 ng/ml, respectively. S. mansoni, N. americanus, S. stercoralis, T. trichiura, M. perstans and A. lumbricoides prevalence was estimated as 51%, 22%, 12%, 10%, 2% and 1%, respectively. S. mansoni was positively associated with Dermatophagoides‐specific IgE [adjusted geometric mean ratio (aGMR) (95% confidence interval) 1.64 (1.23, 2.18)]; T. trichiura with SPT [adjusted odds ratio (aOR) 2.08 (1.38, 3.15)]; M. perstans with cockroach‐specific IgE [aGMR 2.37 (1.39, 4.06)], A. lumbricoides with wheeze in participants ≥5 years [aOR 6.36 (1.10, 36.63)] and with Dermatophagoides‐specific IgE [aGMR 2.34 (1.11, 4.95)]. No inverse associations were observed. Conclusions Contrary to our hypothesis, we found little evidence of an inverse relationship between helminths and allergy‐related outcomes, but strong evidence that individuals with certain helminths were more prone to atopy in this setting.
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Affiliation(s)
- E. L. Webb
- London School of Hygiene and Tropical Medicine London UK
| | - M. Nampijja
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. Kaweesa
- Vector Control Division Ministry of Health Kampala Uganda
| | - R. Kizindo
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - M. Namutebi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | | | | | - P. Kabubi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. Kabagenyi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - G. Nkurunungi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - D. Kizito
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - L. Muhangi
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - M. Akello
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - J. J. Verweij
- Laboratory for Medical Microbiology and Immunology St Elisabeth Hospital LC Tilburg the Netherlands
| | - B. Nerima
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
| | - E. Tukahebwa
- Vector Control Division Ministry of Health Kampala Uganda
| | - A. M. Elliott
- London School of Hygiene and Tropical Medicine London UK
- MRC/UVRI Uganda Research Unit on AIDS Entebbe Uganda
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Prevalence of Atopic Dermatitis in Chinese Children aged 1-7 ys. Sci Rep 2016; 6:29751. [PMID: 27432148 PMCID: PMC4949439 DOI: 10.1038/srep29751] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/23/2016] [Indexed: 11/08/2022] Open
Abstract
Prevalence of atopic dermatitis (AD) is increasing worldwide. Up to date, there has been no face-to-face nation-wide study in China. We aim to explore the prevalence of clinical diagnosed AD in children aged 1-7 ys in China. Twelve metropolises were chosen from different areas of China. In each region, we selected 4-10 kindergartens and 2-5 vaccination clinics randomly. A complete history-taking and skin examination were performed by dermatologists. The definite diagnosis of AD and the severity were determined by two or three dermatologists. All criteria concerned in UK diagnosis criteria, characteristic presentation of AD and atypical manifestations were recorded in detail. A total of 13998 children from 84 kindergartens and 40 vaccination clinics were included. The prevalence of AD was 12.94% by clinical diagnosis of dermatologists overall, with 74.6% of mild AD. Comparatively, prevalence of AD based on UK diagnostic criteria was 4.76%. This is the first face-to-face nation-wide study in Chinese children aged 1-7 ys, revealing that the prevalence of AD in children is closer to that of wealthier nations.
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97
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Nankervis H, Thomas KS, Delamere FM, Barbarot S, Rogers NK, Williams HC. Scoping systematic review of treatments for eczema. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04070] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Helen Nankervis
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Finola M Delamere
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sébastien Barbarot
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Natasha K Rogers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Abstract
Atopic dermatitis (also known as atopic eczema) is a chronic inflammatory skin disease that is characterised by intense itching and recurrent eczematous lesions. Although it most often starts in infancy and affects two of ten children, it is also highly prevalent in adults. It is the leading non-fatal health burden attributable to skin diseases, inflicts a substantial psychosocial burden on patients and their relatives, and increases the risk of food allergy, asthma, allergic rhinitis, other immune-mediated inflammatory diseases, and mental health disorders. Originally regarded as a childhood disorder mediated by an imbalance towards a T-helper-2 response and exaggerated IgE responses to allergens, it is now recognised as a lifelong disposition with variable clinical manifestations and expressivity, in which defects of the epidermal barrier are central. Present prevention and treatment focus on restoration of epidermal barrier function, which is best achieved through the use of emollients. Topical corticosteroids are still the first-line therapy for acute flares, but they are also used proactively along with topical calcineurin inhibitors to maintain remission. Non-specific immunosuppressive drugs are used in severe refractory cases, but targeted disease-modifying drugs are being developed. We need to improve understanding of the heterogeneity of the disease and its subtypes, the role of atopy and autoimmunity, the mechanisms behind disease-associated itch, and the comparative effectiveness and safety of therapies.
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Affiliation(s)
- Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Natalija Novak
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
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Lee SC, Bae JM, Lee HJ, Kim HJ, Kim BS, Li K, Cho JW, Park CO, Cho SH, Lee KH, Kim DW, Park CW, Kim KH. Introduction of the Reliable Estimation of Atopic Dermatitis in ChildHood: Novel, Diagnostic Criteria for Childhood Atopic Dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:230-8. [PMID: 26922933 PMCID: PMC4773211 DOI: 10.4168/aair.2016.8.3.230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/08/2015] [Indexed: 11/20/2022]
Abstract
Purpose Questionnaire-based diagnostic criteria for atopic dermatitis (AD) have been proposed to detect the major group of AD with flexural dermatitis. We aimed to develop novel, questionnaire-based diagnostic criteria for childhood AD, which can detect more comprehensive AD including non-flexural type. Methods The draft version of questionnaire to detect childhood AD was prepared to be used for preliminary hospital- (n=1,756) and community-based (n=1,320) surveys. From analysis, the Reliable Estimation of Atopic dermatitis of ChildHood (REACH) was derived and verified in derivation (n=1,129) and validation (n=1,191) sets by community-based surveys. Results The REACH consists of 11 questions including 2 major and 9 minor criteria. AD is diagnosed as the major group of 'eczema on the antecubital or popliteal fossa' to fulfill the 2 major criteria (2M), and the minor group of 'eczema on the non-antecubital or popliteal fossa' to fulfill the 1 major plus 4 or more minor criteria (1M+4m). In the validation set, the overall 1-year AD prevalence by the REACH was estimated as 12.3% (95% CI, 10.5%-14.2%), and the REACH showed a sensitivity of 75.2%, a specificity of 96.1%, and an error rate of 6.4%. The REACH demonstrated better diagnostic performance than the ISAAC in terms of the number of misclassification (10.0%). Conclusions We propose the REACH as new full, questionnaire-based diagnostic criteria for childhood AD in epidemiological surveys. Further studies are warranted to validate the REACH in different populations or countries in the context of large-scale, epidemiological surveys.
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Affiliation(s)
- Seung Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
| | - Jung Min Bae
- Department of Dermatology, The Catholic University of Korea, Seoul, Korea
| | - Ho June Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Jung Kim
- Department of Dermatology, Seoul Medical Center, Seoul, Korea
| | - Byung Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Kapsok Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae We Cho
- Department of Dermatology, Keimyung University School of Medicine, Daegu, Korea
| | - Chang Ook Park
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Cho
- Department of Dermatology, The Catholic University of Korea, Seoul, Korea
| | - Kwang Hoon Lee
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Won Kim
- Department of Dermatology, Kyungpook National University College of Medicine, Daegu, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Kyu Han Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Lee SC. Various diagnostic criteria for atopic dermatitis (AD): A proposal of Reliable Estimation of Atopic Dermatitis in Childhood (REACH) criteria, a novel questionnaire-based diagnostic tool for AD. J Dermatol 2016; 43:376-84. [PMID: 26813749 DOI: 10.1111/1346-8138.13264] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/15/2015] [Indexed: 12/24/2022]
Abstract
Atopic dermatitis (AD) is a heterogeneous disease that manifests with a wide variety of clinical symptoms and signs. Due to the lack of definitive biomarkers for AD, it is very difficult to set up standard diagnostic criteria for AD which cover the entire spectrum of AD patients. Various instruments have been proposed for AD diagnosis, and they can be classified into a hospital setting or a community setting. From the preventive medicine viewpoint, questionnaire-based diagnostic criteria in a community setting are important to detect and manage childhood AD patients properly. In this article, various diagnostic criteria for AD in hospital and community settings will be reviewed. Additionally, the Reliable Estimation of Atopic Dermatitis in Childhood (REACH), a new full questionnaire-based diagnostic tool for childhood AD, will be reviewed.
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Affiliation(s)
- Seung-Chul Lee
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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