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Facheris P, Da Rosa JC, Pagan AD, Angelov M, Del Duca E, Rabinowitz G, Gómez-Arias PJ, Rothenberg-Lausell C, Estrada YD, Bose S, Chowdhury M, Shemer A, Pavel AB, Guttman-Yassky E. Age of onset defines two distinct profiles of atopic dermatitis in adults. Allergy 2023; 78:2202-2214. [PMID: 37032461 DOI: 10.1111/all.15741] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND The incidence of adult-onset atopic dermatitis (AOAD) is increasing. However, the unique characteristics of AOAD compared to pediatric-onset AD persisting into adulthood (POAD) are underexplored, hampering the development of targeted-therapeutics for this growing population. We thus assessed the profile of AOAD in skin and blood compared to that of POAD. METHODS We collected skin biopsies and blood from adults with AOAD, POAD, and healthy controls (n = 15 in each group). Skin samples were analyzed by RNA sequencing, qRT-PCR, and immunohistochemistry, and Olink Proseek multiplex assay was used to identify the serum proteomic profile. RESULTS Compared to healthy controls, both AOAD and POAD showed cutaneous immune and barrier dysregulations with a shared Th2/Th22 hyperactivation. Overall, POAD showed greater inflammation in lesional skin, with more prominent expression of Th2/Th17/Th22 markers (CCL17/22, S100A8/9, IL-36A, PI3/Elafin, DEFB4) in POAD compared to AOAD (p-value < .05). In contrast, higher Th1-(IFN-γ, IL-2, IL-15, CCL5) upregulation and Th1-skewing were seen in AOAD. The epidermal barrier was also more compromised in POAD, with greater epidermal hyperplasia and lower expression of markers related to terminal differentiation, lipids, and cell adhesion. In parallel with increased rates of cardiovascular comorbidities, AOAD demonstrated many more significantly dysregulated proteins in serum (n = 148) compared to POAD (n = 86), including pro-inflammatory and cardiovascular-risk markers. Th1-related products showed significant correlations between their skin and blood expressions only in AOAD subjects. CONCLUSION Age-of-onset delineates two distinct endophenotypes in adult AD potentially suggesting the need for broader (beyond Th2) therapeutic targeting in AOAD.
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Affiliation(s)
- Paola Facheris
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Angel D Pagan
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico
| | - Michael Angelov
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Grace Rabinowitz
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Pedro Jesús Gómez-Arias
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Camille Rothenberg-Lausell
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Yeriel D Estrada
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Swaroop Bose
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Avner Shemer
- Department of Dermatology, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Ana B Pavel
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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2
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Brancaccio R, Murdaca G, Casella R, Loverre T, Bonzano L, Nettis E, Gangemi S. miRNAs' Cross-Involvement in Skin Allergies: A New Horizon for the Pathogenesis, Diagnosis and Therapy of Atopic Dermatitis, Allergic Contact Dermatitis and Chronic Spontaneous Urticaria. Biomedicines 2023; 11:biomedicines11051266. [PMID: 37238937 DOI: 10.3390/biomedicines11051266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Skin inflammation is a common underlying feature of atopic dermatitis, allergic contact dermatitis and chronic spontaneous urticaria. The pathogenetic mechanisms have not been fully elucidated. The purpose of this study was to examine whether miRNA, by regulating inflammatory mechanisms through the modulation of innate and adaptive immune responses, could play a major role in the pathogenesis of these skin conditions. We conducted a narrative review using the Pubmed and Embase scientific databases and search engines to find the most relevant miRNAs related to the pathophysiology, severity and prognosis of skin conditions. The studies show that miRNAs are involved in the pathogenesis and regulation of atopic dermatitis and can reveal an atopic predisposition or indicate disease severity. In chronic spontaneous urticaria, different miRNAs which are over-expressed during urticaria exacerbations not only play a role in the possible response to therapy or remission, but also serve as a marker of chronic autoimmune urticaria and indicate associations with other autoimmune diseases. In allergic contact dermatitis, miRNAs are upregulated in inflammatory lesions and expressed during the sensitization phase of allergic response. Several miRNAs have been identified as potential biomarkers of these chronic skin conditions, but they are also possible therapeutic targets.
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Affiliation(s)
- Raffaele Brancaccio
- Dermatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio nell'Emilia, Italy
| | - Giuseppe Murdaca
- Department of Internal Medicine, University of Genova, 16132 Genova, Italy
- Department of Internal Medicine, Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Rossella Casella
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, 70124 Bari, Italy
| | - Teresa Loverre
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, 70124 Bari, Italy
| | - Laura Bonzano
- Dermatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio nell'Emilia, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Policlinico di Bari, 70124 Bari, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
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3
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Bosma AL, Ascott A, Iskandar R, Farquhar K, Matthewman J, Langendam MW, Mulick A, Abuabara K, Williams HC, Spuls PI, Langan SM, Middelkamp-Hup MA. Classifying atopic dermatitis: a systematic review of phenotypes and associated characteristics. J Eur Acad Dermatol Venereol 2022; 36:807-819. [PMID: 35170821 PMCID: PMC9307020 DOI: 10.1111/jdv.18008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
Atopic dermatitis is a heterogeneous disease, accompanied by a wide variation in disease presentation and the potential to identify many phenotypes that may be relevant for prognosis and treatment. We aimed to systematically review previously reported phenotypes of atopic dermatitis and any characteristics associated with them. Ovid EMBASE, Ovid MEDLINE and Web of Science were searched from inception till the 12th of February 2021 for studies attempting to classify atopic dermatitis. Primary outcomes are atopic dermatitis phenotypes and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. In total, 8,511 records were found. By focusing only on certain clinical phenotypes, 186 studies were eligible for inclusion. The majority of studies were hospital-based (59%, 109/186) and cross-sectional (76%, 141/186). The number of included patients ranged from seven to 526,808. Data-driven approaches to identify phenotypes were only used in a minority of studies (7%, 13/186). Ninety-one studies (49%) investigated a phenotype based on disease severity. A phenotype based on disease trajectory, morphology and eczema herpeticum was investigated in 56 (30%), 22 (12%) and 11 (6%) studies, respectively. Thirty-six studies (19%) investigated morphological characteristics in other phenotypes. Investigated associated characteristics differed between studies. In conclusion, we present an overview of phenotype definitions used in literature for severity, trajectory, morphology and eczema herpeticum, including associated characteristics. There is a lack of uniform and consistent use of atopic dermatitis phenotypes across studies.
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Affiliation(s)
- A L Bosma
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - A Ascott
- Department of Dermatology, University Hospitals Sussex NHS Foundation Trust, Worthing, United Kingdom
| | - R Iskandar
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - J Matthewman
- Department of Non-communicable disease epidemiology, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M W Langendam
- Department of Epidemiology and Data Science, UMC, location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - A Mulick
- Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - K Abuabara
- Department of Dermatology, University of California San Francisco, United States
| | - H C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, United Kingdom
| | - P I Spuls
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - S M Langan
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands.,Faculty of Epidemiology and Population Health, School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M A Middelkamp-Hup
- Department of Dermatology, UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
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AAD Guidelines: awareness of comorbidities associated with atopic dermatitis in adults. J Am Acad Dermatol 2022; 86:1335-1336.e18. [DOI: 10.1016/j.jaad.2022.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
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Raimondo A, Lembo S. Atopic Dermatitis: Epidemiology and Clinical Phenotypes. Dermatol Pract Concept 2021; 11:e2021146. [PMID: 35024238 DOI: 10.5826/dpc.1104a146] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 10/31/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic, lifelong, relapsing condition. The wide spectrum of the possible clinical presentations, depending on patient' s age, age of onset of disease, topography and morphology of dermatitis, limits the epidemiologic information on its prevalence and incidence. A clear definition of the different clinical AD phenotypes and epidemiology is essential for an appropriate patient's treatment and management, in particular for adults. This review summarizes the most recent epidemiologic data from the 21st century, on AD prevalence and incidence rates either in children or adults, with a special focus on their trends in Europe. Moreover, an effort to categorize diverse AD clinical expressions, has been made, aiming to facilitate differential diagnosis and speed up the start of the correct therapy.
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Affiliation(s)
- Annunziata Raimondo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Serena Lembo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
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Patrizi A, Costanzo A, Patruno C, Busà VM, Chiricozzi A, Girolomoni G. Unmet needs in atopic dermatitis management: an expert consensus. J DERMATOL TREAT 2021; 33:2459-2465. [PMID: 34445932 DOI: 10.1080/09546634.2021.1967267] [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: 10/20/2022]
Abstract
INTRODUCTION Atopic dermatitis (AD) has substantial negative impact on patients' quality of life. Although considerable advances have been made in understanding the pathogenesis and its treatment, there is still limited transfer of this knowledge into daily management. Aiming to identify unmet needs in clinical management of patients with AD, we used a Delphi consensus process. METHODS A set of statements regarding diagnosis, management, prognosis, and treatment was identified by five experts (Steering Committee). Then, the Steering Committee and a second group of four clinicians were involved in a Delphi process. Lastly, agreement was assessed in a larger panel of Italian clinicians. RESULTS Overall, 37 clinicians participated to the process. 17 statements reached strong agreement and 2 reached weak agreement. CONCLUSIONS In general, the statements reflected the need for accurate and effective diagnostic criteria to support clinical experience, especially in the atypical forms of AD. Moreover, prognostic criteria are needed to predict the duration of adult-onset AD. The identification of biomarkers was considered to be useful for clinical management of AD at all stages of disease. Lastly, greater emphasis should be placed on patient education and development of effective tools that can aid informing patients about their disease and its treatment.
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Affiliation(s)
- Annalisa Patrizi
- Dermatology, IRCCS S. Orsola-Malpighi Polyclinic, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Antonio Costanzo
- Dermatology, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Cataldo Patruno
- Dermatology Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Andrea Chiricozzi
- Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dermatology, Department of Clinical and Translational Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy
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7
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Yousaf M, Ayasse M, Ahmed A, Gwillim E, Janmohamed SR, Yousaf A, Patel KR, Thyssen JP, Silverberg JI. Association between Atopic Dermatitis and Hypertension: A Systematic Review and Meta-Analysis. Br J Dermatol 2021; 186:227-235. [PMID: 34319589 DOI: 10.1111/bjd.20661] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the association of atopic dermatitis (AD) with hypertension. OBJECTIVES Determine whether AD and AD severity are associated with hypertension. METHODS A systematic review was performed of published studies in MEDLINE, EMBASE, Scopus, Web of Science, and GREAT databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS Fifty-one studies met inclusion criteria; 19 had sufficient data for meta-analysis. AD was associated with higher odds of hypertension compared to healthy controls (increased in 9 of 16 studies; pooled prevalence: 16.4% vs 13.8%; random-effects regression, pooled unadjusted odds ratio [OR][95% confidence interval <CI95>]: 1.16 [1.04-1.30]), but lower odds of hypertension compared to psoriasis (decreased in 5 of 8 studies; 15.4% vs 24.8%; 0.53 [0.37-0.76]). In particular, moderate-severe AD were associated with hypertension compared to healthy controls (increased in 4 of 6 studies; 24.9% vs 14.7%; 2.33 [1.10-4.94]). Hypertension was commonly reported as an adverse-event secondary to AD treatments, particularly systemic cyclosporine A. Limitations include lack of longitudinal studies or individual-level data and potential confounding. CONCLUSIONS AD, particularly moderate-to-severe disease, was associated with increased hypertension compared to healthy controls, but lower odds than psoriasis.
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Affiliation(s)
- M Yousaf
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Ayasse
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - A Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - E Gwillim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - A Yousaf
- Department of Dermatology, West Virginia University School of Medicine, Morgantown
| | - K R Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J P Thyssen
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - J I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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8
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Stingeni L, Belloni Fortina A, Baiardini I, Hansel K, Moretti D, Cipriani F. Atopic Dermatitis and Patient Perspectives: Insights of Bullying at School and Career Discrimination at Work. J Asthma Allergy 2021; 14:919-928. [PMID: 34321892 PMCID: PMC8312319 DOI: 10.2147/jaa.s317009] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by recurrent eczematous lesions and intense pruritus. AD patients are known to face a considerable disease burden, including physical and emotional limitations. There is still limited knowledge about daily implications in education and occupation. We describe disease social stigmatization by measuring bullying and self-isolation in students and professional discrimination in workers. Overall loss of productivity, either at school and at the workplace, was quantified as the sum of absenteeism (number of days AD sick leave) and presenteeism (number of days with decreased focus and functionality). Methods An on-line web survey was sent to 3235 random recipients and 401 met the inclusion criteria (self-reporting AD and ≥12 yo). The survey domains included daily limitations, QoL, feelings and relationships, together with specific questions about bullying, discrimination and loss of productivity. Results AD negatively affected QoL in 51.6% of respondents, whereas 68.8% considered AD as a real limit to daily routine. More in detail, 39.3% of students were victims of bullying and 33.9% of workers felt discriminated because of AD. On average, absenteeism in students was for 17.1 days/year (presenteeism: 19.5 days/year), whereas in workers, the estimate was 10.9 days/year (presenteeism: 13.1 days/year). Absenteeism and presenteeism were more pronounced in bullied/discriminated subjects. Conclusion AD multidimensional implications deeply affect and undermine personal and professional fulfillments. Our results contribute to a better understanding of what living with AD means.
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Affiliation(s)
- Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Anna Belloni Fortina
- Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Ilaria Baiardini
- Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy.,Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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9
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Puluhulawa LE, Joni IM, Mohammed AFA, Arima H, Wathoni N. The Use of Megamolecular Polysaccharide Sacran in Food and Biomedical Applications. Molecules 2021; 26:molecules26113362. [PMID: 34199586 PMCID: PMC8199723 DOI: 10.3390/molecules26113362] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
Natural polymer is a frequently used polymer in various food applications and pharmaceutical formulations due to its benefits and its biocompatibility compared to synthetic polymers. One of the natural polymer groups (i.e., polysaccharide) does not only function as an additive in pharmaceutical preparations, but also as an active ingredient with pharmacological effects. In addition, several natural polymers offer potential distinct applications in gene delivery and genetic engineering. However, some of these polymers have drawbacks, such as their lack of water retention and elasticity. Sacran, one of the high-molecular-weight natural polysaccharides (megamolecular polysaccharides) derived from Aphanothece sacrum (A. sacrum), has good water retention and elasticity. Historically, sacran has been used as a dietary food. Moreover, sacran can be applied in biomedical fields as an active material, excipient, and genetic engineering material. This article discusses the characteristics, extraction, isolation procedures, and the use of sacran in food and biomedical applications.
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Affiliation(s)
- Lisa Efriani Puluhulawa
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjajaran, Sumedang 45363, Indonesia;
| | - I Made Joni
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Padjajaran, Sumedang 45363, Indonesia;
- Functional Nano Powder University Center of Excellence (FiNder U CoE) Padjadajaran Universitas Padjajaran, Sumedang 45363, Indonesia
| | | | | | - Nasrul Wathoni
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjajaran, Sumedang 45363, Indonesia;
- Correspondence: ; Tel.: +62-22-842-888888
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10
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Colucci R, Moretti S. Implication of Human Bacterial Gut Microbiota on Immune-Mediated and Autoimmune Dermatological Diseases and Their Comorbidities: A Narrative Review. Dermatol Ther (Heidelb) 2021; 11:363-384. [PMID: 33507493 PMCID: PMC8018919 DOI: 10.1007/s13555-021-00485-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 12/12/2022] Open
Abstract
During the last decade, the advent of modern sequencing methods (next generation techniques, NGS) has helped describe the composition of the human gut microbiome, enabling us to understand the main characteristics of a healthy gut microbiome and, conversely, the magnitude of its disease-related changes. This new knowledge has revealed that healthy gut microbiota allow the maintenance of several crucial physiological functions, such as the ability to regulate the innate and adaptive immune systems. Increasing evidence has pointed out a condition of dysbiosis in several autoimmune/immune mediated dermatological conditions and specific gut microbial signatures have also been reported to correlate with clinical and prognostic parameters of such diseases. Based on a literature search of relevant published articles, this review debates the current knowledge and the possible pathogenic implications of bacterial gut microbiota composition assessed through NGS techniques in systemic lupus erythematosus, atopic dermatitis, psoriasis, and alopecia areata. Evidence of a potential role of specific gut microbiota signatures in modulating the clinical course of such diseases and their main comorbidities has been also reviewed.
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Affiliation(s)
- Roberta Colucci
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Silvia Moretti
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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11
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Kim JH, Lee SW, Yon DK, Ha EK, Jee HM, Sung M, Sim HJ, Yoon JW, Choi SH, Shin YH, Seo SI, Baek HS, Han MY. Association of serum lipid parameters with the SCORAD index and onset of atopic dermatitis in children. Pediatr Allergy Immunol 2021; 32:322-330. [PMID: 33040380 DOI: 10.1111/pai.13391] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between dyslipidemia and atopic dermatitis in children is unclear. This study investigated the association between dyslipidemia and atopic dermatitis in children by analysis of disease onset, risk factors, and disease severity. METHODS Subset I examined 7-year-old children in elementary school (n = 248), and Subset II was a retrospective long-term follow-up hospital-based study (n = 52 725) conducted from 1986 to 2016 that used propensity score matching. In the Subset I study, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were determined, and the SCORing Atopic Dermatitis (SCORAD) index was determined. In the Subset II study, the time of atopic dermatitis onset was determined for asymptomatic subjects whose TC levels were below or above 170 mg/dL. RESULTS Our Subset I study indicated that children with atopic dermatitis (n = 69, 27.8%) had significantly higher levels of TC and TG, and that the SCORAD index had significant associations with high levels of TC and TG, and a low level of HDL-C. Our Subset II study (1722 with high TC and 6735 with normal TC after propensity score matching) indicated the high TC group had a greater hazard ratio (HR) for the onset of atopic dermatitis (consensus-based HR: 2.47; 95% CI: 1.23, 5.06, P = .012) during 5 years. CONCLUSION An abnormal blood lipid profile in children is associated with the presence of atopic dermatitis and the SCORAD index. The risk of atopic dermatitis onset was significantly greater with high levels of TC.
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Affiliation(s)
- Ju Hee Kim
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea
| | - Dong Keon Yon
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hye Mi Jee
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soon Chun Hyang University Gumi Hospital, Soon Chun Hyang University College of Medicine, Gumi, Korea
| | | | - Jung Won Yoon
- Department of Pediatrics, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Sun-Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seung In Seo
- Department of Internal medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Kandong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Man Yong Han
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Patruno C, Napolitano M, Argenziano G, Peris K, Ortoncelli M, Girolomoni G, Offidani A, Ferrucci SM, Amoruso GF, Rossi M, Stingeni L, Malara G, Grieco T, Foti C, Gattoni M, Loi C, Iannone M, Talamonti M, Stinco G, Rongioletti F, Pigatto PD, Cristaudo A, Nettis E, Corazza M, Guarneri F, Amerio P, Esposito M, Belloni Fortina A, Potenza C, Fabbrocini G. Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real-life study. J Eur Acad Dermatol Venereol 2021; 35:958-964. [PMID: 33332697 DOI: 10.1111/jdv.17094] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment of moderate-to-severe atopic dermatitis (AD) in the elderly may be challenging, due to side-effects of traditional anti-inflammatory drugs and to comorbidities often found in this age group. Furthermore, efficacy and safety of innovative drugs such as dupilumab are not yet well known. OBJECTIVES A multicentre retrospective, observational, real-life study on the efficacy and safety of dupilumab was conducted in a group of patients aged ≥65 years and affected by severe AD. Their main clinical features were also examined. METHODS Data of elderly patients with severe (EASI ≥24) AD treated with dupilumab at label dosage for 16 weeks were retrospectively collected. Treatment outcome was assessed by comparing objective (EASI) and subjective (P-NRS, S-NRS and DLQI) scores at baseline and after 16 weeks of treatment. RESULTS Two hundred and seventy-six patients were enrolled in the study. They represented 11.37% of all patients with severe AD. Flexural eczema was the most frequent clinical phenotype, followed by prurigo nodularis. The coexistence of more than one phenotype was found in 63/276 (22.82%) subjects. Data on the 16-week treatment with dupilumab were available for 253 (91.67%) patients. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores. No statistically significant difference regarding efficacy was found in elderly patients when compared to the group of our AD patients aged 18-64 years, treated with dupilumab over the same period. Furthermore, only 18 (6.52%) patients discontinued the drug due to inefficacy. Sixty-one (22.51%) patients reported adverse events, conjunctivitis and flushing being the most frequent. One (0.36%) patient only discontinued dupilumab due to an adverse event. CONCLUSIONS Therapy with dupilumab led to a significant improvement of AD over a 16-week treatment period, with a good safety profile. Therefore, dupilumab could be considered as an efficacious and safe treatment for AD also in the elderly.
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Affiliation(s)
- C Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - M Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - K Peris
- Dermatology, University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - M Ortoncelli
- Dermatology Clinic, University of Turin, Turin, Italy
| | - G Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - A Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - S M Ferrucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G F Amoruso
- AO Cosenza, UOC Dermatologia, Cosenza, Italy
| | - M Rossi
- UO Dermatologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - L Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - G Malara
- Struttura Complessa di Dermatologia, Grande Ospedale Metropolitano 'Bianchi Melacrino Morelli', Reggio Calabria, Italy
| | - T Grieco
- Dermatology Unit, Sapienza University of Rome, Rome, Italy
| | - C Foti
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - M Gattoni
- Dermatologic Department, S. Andrea Hospital Vercelli, Vercelli, Italy
| | - C Loi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Iannone
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - M Talamonti
- Dermatology Unit, Policlinico Tor Vergata, Department of Systemic Medicine, Tor Vergata University of Rome, Rome, Italy
| | - G Stinco
- Department of Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - P D Pigatto
- Department of Medical, Surgical and Odontoiatric Science, IRCCS Ospedale Ortopedico Galeazzi, Milano, Italy
| | - A Cristaudo
- San Gallicano Dermatologic Institute IRCCS, Rome, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - M Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Guarneri
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - P Amerio
- Dermatologic Clinic, SS. Annunziata Hospital, Chieti, Italy
| | - M Esposito
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Belloni Fortina
- Unit of Dermatology, Department of Medicine DIMED, University of Padua, Padua, Italy
| | - C Potenza
- Dermatology Unit 'Daniele Innocenzi', Department of MEDICO-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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13
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Dudiak GJ, Popyack J, Grimm C, Tyson S, Solic J, Ishmael FT. Prior authorization delays biologic initiation and is associated with a risk of asthma exacerbations. Allergy Asthma Proc 2021; 42:65-71. [PMID: 33404389 DOI: 10.2500/aap.2021.42.200101] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Biologics are effective treatments for patients with severe allergic disease. Impacts of delays in the prior authorization process on clinical outcomes has not been studied. Objective: The objective was to quantify the times for approval and filling of biologics, and whether patients were at risk of exacerbations during this time frame. Methods: The times for insurance approval and pharmacy filling of biologics (omalizumab, benralizumab, mepolizumab, dupilumab) in 80 subjects with severe asthma (n = 60) or urticaria (n = 20) from our clinic were reviewed. We compared the impact of clinical features, insurance, specialty pharmacy on fill times, and quantified exacerbations and prednisone use while awaiting biologic initiation. Results: The mean ± standard deviation (SD) time (days) from submission of a prescription to the first dose available for injection was 44.0 ± 23.2 days. This was composed of the mean ± SD time for insurance approval (21.5 ± 19.6 days) and the mean ± SD time for a specialty pharmacy to fill the medication (22.8 ± 14.1 days). There was no significant difference between the times for diagnosis (asthma versus urticaria), specific biologic, or insurance. The "buy and bill" system was faster than filling via a specialty pharmacy (mean ± SD, 7.3 ± 8.5 days versus 23.3 ± 21.3 days, respectively, p < 0.001). Clinical features of patients with fast versus slow approval times was not significantly different. The subjects with asthma were at high risk of exacerbations and need for prednisone while awaiting initiation of the biologics; 28 of 59 patients (47%) required prednisone, with an mean cumulative dose of 483.2 ± 273.7 mg per person. Conclusion: The prior authorization process for biologics was slow, and the subjects were at high risk of exacerbations during this time. The system needs to be improved to expedite approval and initiation of these medications.
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Affiliation(s)
- Gregor J. Dudiak
- From the Department of Kinesiology, Penn State University, University Park, Pennsylvania; and
| | - Jessica Popyack
- Department of Allergy and Sleep Medicine, Mount Nittany Physician Group, State College, Pennsylvania
| | - Christy Grimm
- Department of Allergy and Sleep Medicine, Mount Nittany Physician Group, State College, Pennsylvania
| | - Sara Tyson
- Department of Allergy and Sleep Medicine, Mount Nittany Physician Group, State College, Pennsylvania
| | - John Solic
- Department of Allergy and Sleep Medicine, Mount Nittany Physician Group, State College, Pennsylvania
| | - Faoud T. Ishmael
- Department of Allergy and Sleep Medicine, Mount Nittany Physician Group, State College, Pennsylvania
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14
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Napolitano M, Monfrecola G, Fabbrocini G, Fattore D, Patrì A, Patruno C. Impact of sun exposure on adult patients affected by atopic dermatitis. Ital J Dermatol Venerol 2020; 156:558-561. [PMID: 32938161 DOI: 10.23736/s2784-8671.20.06582-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Atopic dermatitis management is challenging and usually requires intermittent or continuous, long-term treatment with topical and/or systemic anti-inflammatory agents and appropriate skin care. Most patients affected by atopic dermatitis improve during sun exposure. It has been reported that the change from a subartic/temperate to a subtropical climate for 4 weeks improved significantly skin symptoms and quality of life in children, even for 3 months after return. However, until now the effect of sun exposure on adult patients with atopic dermatitis has never been investigated. METHODS We conducted a retrospective study to assess the short-term effect of sun exposure during summer holidays on skin symptoms of adults affected by AD. RESULTS One hundred and fourteen patients were enrolled in the study (62 males; aged 18-72 years, mean age 35.3±12.6). Seventy-three out of 114 patients (64%) spent their holidays at the seaside, and 41/114 (36%) in the mountains; 38/41 (92.7%) subjects from the latter group reported that during their holidays they frequented outdoor swimming pools or solariums almost every day of their vacation. The sunlight effect was considered beneficial by 68/114 (59.6%) of patients. In particular, 38/114 patients (33.3%%) reported the improvement of AD and 30/114 (26.3%) the complete resolution of the disease during summer holiday. CONCLUSIONS Our data seem to suggest that sun exposure is beneficial in most patients, but not in all patients. In fact, sun exposure does not appear to improve skin symptoms or even aggravate them in about 4 out of 10 patients. This could be particularly important also considering ongoing climate changes that may affect the clinical history of several skin diseases, among which AD.
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Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy -
| | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angela Patrì
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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15
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Napolitano M, Fabbrocini G, Scalvenzi M, Blasio C, Stingeni L, Patruno C. Efficacy and safety of dupilumab in atopic dermatitis in elderly patients: a retrospective study. Clin Exp Dermatol 2020; 45:888-890. [DOI: 10.1111/ced.14260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022]
Affiliation(s)
- M. Napolitano
- Department of Health Sciences Vincenzo Tiberio University of Molise Campobasso Italy
| | - G. Fabbrocini
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - M. Scalvenzi
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - C. Blasio
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - L. Stingeni
- Dermatology Section Department of Medicine University of Perugia Perugia Italy
| | - C. Patruno
- Department of Health Sciences University Magna Graecia of Catanzaro Catanzaro Italy
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16
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Calzavara-Pinton P, Belloni Fortina A, Bonamonte D, Marseglia GL, Miraglia Del Giudice M, Musarra A, Nettis E, Neri I, Patruno C, Stingeni L, Peris K. Diagnosis and management of moderate to severe atopic dermatitis in adolescents. A Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP). Ital J Dermatol Venerol 2020; 156:184-197. [PMID: 32438781 DOI: 10.23736/s2784-8671.20.06654-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with increasing global incidence, which has a multifactorial pathogenesis and a variable expressivity. Clinical features of AD are different in adults compared to children, but it is well recognized the substantial impact of the disease on patients' quality of life at any age. Indeed, little is known about AD in adolescence, a period of life generally associated with high psychological burden and vulnerability to depression. Guidelines for the management of AD are available for both children and adults but specific guidelines for the diagnosis and treatment of AD in adolescents are lacking. Seven Italian scientific societies of dermatologists, allergists, and pediatric allergists joined in a specific meeting to provide practical guidance for the diagnosis and management of moderate-to-severe adolescent AD suitable for the Italian clinical practice. Through a modified Delphi procedure, consensus was reached by 59 Italian experts in the management of AD on 20 statements covering five areas of interest about adolescent AD, including disease complexity, burden and social impact, diagnosis and definition of severity, current treatments, and new biologic therapies. This paper reports recommendations for the diagnosis and management of AD specifically in adolescents, pointing out some peculiar clinical features and focusing on the choice of medications. Dupilumab, the first biologic approved for the treatment of adolescents with AD, represents a useful treatment option due to its efficacy and reassuring safety profile.
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Affiliation(s)
| | | | - Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Gian L Marseglia
- Department of Pediatrics, IRCCS San Matteo Polyclinic Foundation, University of Pavia, Pavia, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman and Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antonino Musarra
- Unit of Allergy, National Healthcare System, Reggio Calabria, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Iria Neri
- Unit of Dermatology, Department of Specialistic, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Cataldo Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Stingeni
- Section of Clinical Allergological Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Ketty Peris
- Unit of Dermatology, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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17
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Wu J, Guttman-Yassky E. Efficacy of biologics in atopic dermatitis. Expert Opin Biol Ther 2020; 20:525-538. [PMID: 32003247 DOI: 10.1080/14712598.2020.1722998] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/25/2020] [Indexed: 12/22/2022]
Abstract
Introduction: Atopic dermatitis (AD) is a heterogeneous disease. Recent advancements in understanding AD pathogenesis resulted in the exponential expansion of its therapeutic pipeline, particularly following the success and FDA-approval of dupilumab. Different phenotypes of AD by age and ethnicity have also recently been described and clinical studies of emerging treatments will further clarify the role of each cytokine pathway in AD.Areas covered: We review the impressive repertoire of biologics for treatment of moderate-to-severe AD, including those targeting Th2, Th22, Th17/IL-23 and IgE. We highlight the scientific rationale behind each approach and provide a discussion of the most recent clinical efficacy and safety data.Expert opinion: AD is a complex disease and recent research has identified numerous endotypes, reinforcing the rationale for developing targeted therapeutics to antagonize these factors. Dupilumab has revolutionized AD treatment and its mechanistic studies also offer crucial insight into AD pathogenesis. Nevertheless, this biologic does not work for everyone, highlighting the need for a more precise approach to address the unique immune fingerprints of each AD subset. Ultimately targeted therapeutics will complement our understanding of the AD molecular map and help push AD management into an era of personalized medicine.
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Affiliation(s)
- Jianni Wu
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, USA
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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18
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Ferrillo M, Patruno C, Villani A, Scalvenzi M, Fabbrocini G, D'Andrea M, Napolitano M. Dermoscopic assessment of long-term systemic therapy with dupilumab in adult atopic dermatitis. J Eur Acad Dermatol Venereol 2020; 34:e701-e703. [PMID: 32239552 DOI: 10.1111/jdv.16409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- M Ferrillo
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - A Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Scalvenzi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M D'Andrea
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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19
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Chan AR, Sandhu VK, Drucker AM, Fleming P, Lynde CW. Adult-Onset Atopic Dermatitis: Presentations and Progress. J Cutan Med Surg 2020; 24:267-272. [PMID: 32238071 DOI: 10.1177/1203475420911896] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis (AD) is a chronic skin disease characterized by barrier dysfunction and immune dysregulation that affects approximately 20% of children and 2-5% of adults worldwide. Traditionally, AD has been considered a disease of childhood with many cases resolving before adulthood. However, in recent years, the prevalence of adult AD is increasingly recognized to be substantial, but it is uncertain whether this increase is due to increased childhood-persistent or relapsed AD, or new adult-onset AD. This highlights a need for further investigation into the adult AD population and evaluation of phenotypes in the adult-onset cohort. In this literature review, we examine five studies focused on adult-onset AD phenotype, conducted between 2013 and 2017. The most commonly reported body regions affected in adult-onset AD were the hands, eyelids, neck, and flexural surfaces of the upper limbs. These vary from childhood-onset AD findings, which are less specific to body regions other than flexural areas. These findings have implications for diagnostic accuracy and treatment of AD, including considerations for therapeutic choices and inclusion and exclusion criteria in clinical trials.
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Affiliation(s)
- Airiss R Chan
- 7938 Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vijay K Sandhu
- 7938 Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aaron M Drucker
- 7985 Division of Dermatology, Women's College Hospital and University of Toronto, and Women's College Research Institute, ON, Canada
| | - Patrick Fleming
- Deparment of Medicine, Lynde Institute of Dermatology, Markham, ON, Canada.,Department of Medicine, Division of Dermatology, University of Toronto, ON, Canada
| | - Charles W Lynde
- Deparment of Medicine, Lynde Institute of Dermatology, Markham, ON, Canada.,Department of Medicine, Division of Dermatology, University of Toronto, ON, Canada
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20
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Patruno C, Fabbrocini G, Napolitano M. Clinical phenotypes of atopic dermatitis of the adult. Ital J Dermatol Venerol 2020; 156:721-722. [PMID: 32129587 DOI: 10.23736/s2784-8671.20.06532-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy -
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maddalena Napolitano
- Vincenzo Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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21
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Patruno C, Stingeni L, Hansel K, Ferrucci SM, Tavecchio S, Fabbrocini G, Nisticò SP, Foti C, De Prezzo S, Napolitano M. Effectiveness of dupilumab for the treatment of nummular eczema phenotype of atopic dermatitis in adults. Dermatol Ther 2020; 33:e13290. [PMID: 32125741 DOI: 10.1111/dth.13290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/28/2020] [Accepted: 02/27/2020] [Indexed: 11/29/2022]
Abstract
Nummular eczema (NE) is currently considered as one of the clinical phenotypes of atopic dermatitis (AD) of the adult. In this multicentre study, 30 adult patients (age ≥ 18 years) affected with nummular-like AD were treated with dupilumab, a monoclonal antibody against the receptor for interleukin(IL)-4 and IL-13. The evaluation of the results after 16 weeks of treatment showed a significant improvement of the disease, as demonstrated by reduction in Eczema Area Severity Score (EASI), visual analogue score (VAS) of pruritus, and Dermatology Life Quality Index (DLQI) scores. Conjunctivitis in one patient was the only side effect. In conclusion, dupilumab seems to be an effective and safe treatment in NE phenotype of AD of the adult.
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Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Section, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Tavecchio
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Steven Paul Nisticò
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - Serena De Prezzo
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - Maddalena Napolitano
- Department of Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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22
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Bertino L, Guarneri F, Cannavò SP, Casciaro M, Pioggia G, Gangemi S. Oxidative Stress and Atopic Dermatitis. Antioxidants (Basel) 2020; 9:E196. [PMID: 32111015 PMCID: PMC7139929 DOI: 10.3390/antiox9030196] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
Atopic dermatitis is a common chronic/chronically relapsing inflammatory skin disease, with increasing worldwide prevalence. Etiopathogenesis is complex and multifactorial, with a mix of genetic, immunological and environmental aspects. Like in other chronic inflammatory diseases, oxidative stress plays an important pathogenetic role. We reviewed in vivo research studies on humans about oxidative stress and atopic dermatitis. Although sometimes contrasting, overall, they suggest that oxidative stress may have a significant role in atopic dermatitis, but our understanding is still incomplete, at least concerning in vivo data, because of limitations of available literature. Research consists of 33 papers published in 28 years, was not always performed on large study populations, represents a limited number of countries and ethnicities-not always in proportion to their size-and is scattered over multiple papers that, in the majority of cases, cannot be pooled and/or compared because many biomarkers were studied, in different tissues and with different methods. Further, larger studies appear warranted and necessary to shed more light on this aspect of atopic dermatitis, which is important not only to improve our understanding of this disease, but also for potential clinical and therapeutic implications.
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Affiliation(s)
- Lucrezia Bertino
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.B.); (S.P.C.)
| | - Fabrizio Guarneri
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.B.); (S.P.C.)
| | - Serafinella Patrizia Cannavò
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (L.B.); (S.P.C.)
| | - Marco Casciaro
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (M.C.); (S.G.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy;
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (M.C.); (S.G.)
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Calzavara-Pinton P, Fabbrocini G, Girolomoni G, Matiucci A, Micali G, Musumeci ML, Patruno C, Pellacani G, Rossi MT, Castello M, Stingeni L. Topical tacrolimus in adult atopic dermatitis: a consensus based on a 15-year experience. GIORN ITAL DERMAT V 2020; 155:8-13. [DOI: 10.23736/s0392-0488.19.06478-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Napolitano M, Fabbrocini G, Cinelli E, Stingeni L, Patruno C. Profile of Baricitinib and Its Potential in the Treatment of Moderate to Severe Atopic Dermatitis: A Short Review on the Emerging Clinical Evidence. J Asthma Allergy 2020; 13:89-94. [PMID: 32099414 PMCID: PMC6999549 DOI: 10.2147/jaa.s206387] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/23/2019] [Indexed: 11/23/2022] Open
Abstract
Atopic dermatitis (AD) is the most common chronic cutaneous inflammatory disease of childhood, affecting up to 25% of children; its prevalence in adulthood is currently unknown, since studies reported that AD may affect 0.3-14.3% of adult population. In the last decade, the advanced understanding of AD molecular pathways along with patient's and physician's demand for more effective therapies, led to the introduction of new therapeutic agents. Baricitinib is an oral JAK inhibitor highly selective for JAK1 and JAK2. Treatment with baricitinib improved the signs and symptoms of moderate-to-severe AD compared to placebo, but it will be essential to better understand the safety profile of this drug.
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Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Eleonora Cinelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Effectiveness of Dupilumab for the Treatment of Generalized Prurigo Nodularis Phenotype of Adult Atopic Dermatitis. Dermatitis 2020; 31:81-84. [DOI: 10.1097/der.0000000000000517] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Patruno C, Amerio P, Chiricozzi A, Costanzo A, Cristaudo A, Cusano F, Foti C, Girolomoni G, Guarneri F, Naldi L, Offidani A, Pigatto P, Prignano F, Stingeni L, Calzavara-Pinton P. Optimizing a clinical guidance for diagnosis of atopic dermatitis in adults: joint recommendations of the Italian Society of Dermatology and Venereology (SIDeMaST), Italian Association of Hospital Dermatologists (ADOI), and Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA). GIORN ITAL DERMAT V 2019; 155:1-7. [PMID: 31840484 DOI: 10.23736/s0392-0488.19.06522-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atopic dermatitis (AD) places significant burden not only on quality of life, but is also associated with considerable costs to healthcare systems. Diagnosis of AD may be challenging when it starts in adolescence or adulthood, and is further complicated as its manifestations are different from those generally seen in children. Accordingly, better definition of diagnostic criteria for adult onset AD is needed to avoid misdiagnosis and undertreatment in adult patients. To provide practical guidance for clinicians to reliably diagnose AD in adult patients, representatives from three Italian dermatology scientific societies (Italian Society of Dermatology and Venereology [SIDeMaST], Italian Association of Hospital Dermatologists [ADOI], Italian Society of Allergological, Occupational and Environmental Dermatology [SIDAPA]) carried out a joint consensus meeting to develop useful indications for improving diagnosis of moderate to severe AD in adult patients in routine clinical practice. The most representative criteria for morphological criteria, localization, clinical history, and differential diagnosis were identified by the experts. The most frequent clinical presentations are those on the flexural areas, hands, face/neck, and trunk, with itch and eczema as key manifestations. The diagnostic path defined herein can form a sort of "check list" for physicians to adopt when evaluating patients with suspected AD, which can help in refining a diagnosis and refer the patient for specialist dermatological care. It is hoped that the practical guidance developed by the consensus group will help to improve outcomes, lower overall costs of care, and ameliorate the patient's quality of life, even though validation in a large cohort of patients is still needed.
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Affiliation(s)
- Cataldo Patruno
- Section of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy -
| | - Paolo Amerio
- Department of Medicine and Aging Sciences, Clinic of Dermatology, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Andrea Chiricozzi
- Institute of Dermatology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Antonio Cristaudo
- Department of Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | | | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Fabrizio Guarneri
- Department of Clinical and Experimental Medicine-Dermatology, University of Messina, Messina, Italy
| | - Luigi Naldi
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Annamaria Offidani
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Paolo Pigatto
- Unit of Dermatology, Department of Biomedical, Surgical and Dental Sciences, Galeazzi Orthopedic Institute IRCCS, University of Milan, Milan, Italy
| | - Francesca Prignano
- Unit of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine, University of Perugia, Perugia, Italy
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27
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Egeberg A, Griffiths C, Williams H, Andersen Y, Thyssen J. Clinical characteristics, symptoms and burden of psoriasis and atopic dermatitis in adults. Br J Dermatol 2019; 183:128-138. [DOI: 10.1111/bjd.18622] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/16/2023]
Affiliation(s)
- A. Egeberg
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegårdsvej 28 2900 Hellerup Denmark
| | - C.E.M. Griffiths
- Dermatology Centre University of Manchester NIHR Manchester Biomedical Research Centre Manchester U.K
| | - H.C. Williams
- Centre of Evidence Based Dermatology University of Nottingham Nottingham U.K
| | - Y.M.F. Andersen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegårdsvej 28 2900 Hellerup Denmark
| | - J.P. Thyssen
- Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Kildegårdsvej 28 2900 Hellerup Denmark
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28
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Damiani G, Calzavara‐Pinton P, Stingeni L, Hansel K, Cusano F, Pigatto PD, Agostinelli D, Albertazzi D, Angelini G, Angerosa F, Arigliano P, Assalve D, Ayala F, Barbagallo T, Belloni‐Fortina A, Berta M, Biale C, Bianchi L, Biasini I, Boccaletti V, Bonamonte D, Borghi A, Bragazzi N, Brambilla L, Bressan M, Brunasso A, Bruni F, Bruni P, Caccavale S, Calogiuri G, Cannavò S, Carugno A, Cataldi I, Chiarelli G, Cirla A, Corazza M, Cossutta M, Cova L, Cristaudo A, Cusano F, Danese P, Dal Canton M, De Pità O, De Salvo P, Donini M, Fantini F, Ferrucci S, Flori M, Fontana E, Foti C, Francalci S, Frasin L, Gallo R, Gasparini G, Gola M, Gravante M, Guarnieri F, Guastaferro D, Ingordo V, Lauriola M, Leghissa P, Lisi P, Lombardi P, Lorenzini M, Malara G, Magrini L, Marone G, Martina E, Mascagni P, Matteini Chiari M, Meligeni L, Melino M, Miccio L, Milanesi N, Molinu A, Monfrecola G, Morelli P, Motolese A, Musumeci M, Naldi L, Napolitano M, Nasca M, Pacifico A, Paganini P, Papini M, Pasolini G, Patruno C, Pellegrino M, Peroni A, Peserico A, Piras V, Pugliese A, Raponi F, Raviolo P, Rebora A, Recchia G, Riva F, Romita P, Rossi M, Ruggieri M, Saggiorato F, Sartorelli P, Schena D, Schettino A, Spanò G, Stinchi C, Tasin L, Tramontana M, Taddei L, Valsecchi R, Russo F, Vascellaro A, Venturini M, Vincenzi C, Virgili A, Zucca M. Italian guidelines for therapy of atopic dermatitis—Adapted from consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis). Dermatol Ther 2019; 32:e13121. [DOI: 10.1111/dth.13121] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni Damiani
- Department of Biomedical, Surgical, and Dental Sciences Unit of DermatologyUniversity of Milan Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
- Young Dermatologists Italian NetworkGISED Bergamo Italy
- Department of DermatologyCase Western Reserve University Cleveland Ohio
| | | | - Luca Stingeni
- Section of Dermatology, Department of MedicineUniversity of Perugia Perugia Italy
| | - Katharina Hansel
- Section of Dermatology, Department of MedicineUniversity of Perugia Perugia Italy
| | | | - Paolo D.M. Pigatto
- Department of Biomedical, Surgical, and Dental Sciences Unit of DermatologyUniversity of Milan Milan Italy
- IRCCS Istituto Ortopedico Galeazzi Milan Italy
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Fargnoli MC, Esposito M, Ferrucci S, Girolomoni G, Offidani A, Patrizi A, Peris K, Costanzo A, Malara G, Pellacani G, Romanelli M, Amerio P, Cristaudo A, Flori ML, Motolese A, Betto P, Patruno C, Pigatto P, Sirna R, Stinco G, Zalaudek I, Bianchi L, Boccaletti V, Cannavò SP, Cusano F, Lembo S, Mozzillo R, Gallo R, Potenza C, Rongioletti F, Tiberio R, Grieco T, Micali G, Persechino S, Pettinato M, Pucci S, Savi E, Stingeni L, Romano A, Argenziano G. Real-life experience on effectiveness and safety of dupilumab in adult patients with moderate-to-severe atopic dermatitis. J DERMATOL TREAT 2019; 32:507-513. [DOI: 10.1080/09546634.2019.1682503] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- M. C. Fargnoli
- Dermatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - M. Esposito
- Dermatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - S. Ferrucci
- Unit of Dermatology, Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - A. Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - A. Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - K. Peris
- Institute of Dermatology, Catholic University, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A. Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Clinical and Research Center, Rozzano, Italy
| | - G. Malara
- Dermatology Department, Grande Ospedale Metropolitano, Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - G. Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - P. Amerio
- Department of Medicine and Aging Science, Dermatologic Clinic, G. D’Annunzio University, Chieti, Italy
| | - A. Cristaudo
- Unit of Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - M. L. Flori
- Dermatology Section, Department of Clinical Medicine and Immunological Science, University of Siena, Hospital S. Maria Alle Scotte, Siena, Italy
| | - A. Motolese
- Department of Dermatology, Macchi Hospital, Varese, Italy
| | - P. Betto
- Department of Dermatology, Ospedale San Bortolo, ULSS8 Berica, Vicenza, Italy
| | - C. Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - P. Pigatto
- Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - R. Sirna
- Unit of Dermatology, Ospedale Della Misericordia, Grosseto, Italy
| | - G. Stinco
- Department of Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - I. Zalaudek
- Dermatology Clinic, Hospital Maggiore of Trieste, Trieste, Italy
| | - L. Bianchi
- Department of Dermatology, University of Tor Vergata, Rome, Italy
| | - V. Boccaletti
- Section of Dermatology, Department of Clinical and Experimental Medicine, University Hospital, Parma
| | - S. P. Cannavò
- Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - F. Cusano
- Dermatology Unit, Gaetano Rummo Hospital Benevento, Benevento, Italy
| | - S. Lembo
- Unit of Dermatology, University Hospital San Giovanni di Dio e Ruggi di Salerno, Hospital Santa Maria Incoronata Dell’Olmo, Cava De’ Tirreni, Salerno, Italy
| | - R. Mozzillo
- Dermatology and Venereology, “San Gennaro” Hospital, Naples, Italy
| | - R. Gallo
- Dermatology Section, Department of Health Science, University of Genoa, Polyclinic Hospital San Martino, Genoa, Italy
| | - C. Potenza
- Dermatology Unit, Department of Medical and Surgical Sciences and Biotechnologies, Daniele Innocenzi, Sapienza University of Rome - Polo Pontino, Rome, Italy
| | - F. Rongioletti
- Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - R. Tiberio
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - T. Grieco
- Dermatology Clinic Umberto I, Sapienza University of Rome, Rome, Italy
| | - G. Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - S. Persechino
- Dermatology Unit, Sant’Andrea Hospital, NESMOS Department, Sapienza University of Rome, Rome, Italy
| | - M. Pettinato
- Unit of Dermatology, University Hospital, Policlinico Vittorio Emanuele, Catania, Italy
| | - S. Pucci
- Allergology, Hospital of Civitanova Marche, Civitanova Marche, Italy
| | - E. Savi
- Unit of Dermatology, Hospital Guglielmo da Saliceto, Piacenza, Italy
| | - L. Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - A. Romano
- Allergology Unit, Columbus Presidium, Catholic University, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G. Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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30
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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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31
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Baum S, Porat S, Lyakhovitsky A, Astman N, Barzilai A. Adult Atopic Dermatitis in Hospitalized Patients: Comparison between Those with Childhood-Onset and Late-Onset Disease. Dermatology 2019; 235:365-371. [PMID: 31230056 DOI: 10.1159/000499708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/18/2019] [Indexed: 12/12/2022] Open
Abstract
Atopic eczema is one of the most prevalent diseases worldwide. It is a common dermatological disorder that affects 17.8 million individuals in the USA, up to 20% of children and up to 3% of adults. Recent data show that the incidence of the disease is still rising, both in children and adults, especially in low-income countries. Atopic dermatitis in adults consists of childhood-onset (COAD) and adult or late-onset types (LOAD). Prior research has described differences in clinical features, laboratory data, and response to treatment between COAD and LOAD. Most studies have been done on an ambulatory population that mostly contains patients with mild to moderate disease. OBJECTIVE The aim of the study was to describe the differences between adults hospitalized with COAD and LOAD. METHODS Data were analyzed from a retrospective cohort of 107 adult AD patients who were hospitalized from 2009 to 2017. Analysis of data included epidemiology, clinical and laboratory characteristics, and response to treatment. RESULTS Of the total sample, 87 (81%) patients were diagnosed with LOAD, and 20 (19%) patients were diagnosed with COAD. The median age was 66 years for all patients, 42 years for COAD patients, and 77 years for LOAD patients. The prevalence of atopy was lower in the LOAD group than in the COAD group (33.8 vs. 68.8% for family history, 35.5 vs. 84.8% for personal history). A higher incidence of head, neck, and flexural involvement was found in COAD patients. LOAD patients had lower immunoglobulin E levels and responded better to phototherapy. CONCLUSIONS Elderly patients with LOAD constitute the majority of adults hospitalized with AD. As in ambulatory AD patients, there are significant differences in medical background, clinical picture, laboratory characteristics, and response to treatment between hospitalized LOAD and COAD patients. There is a need to determine diagnostic criteria and treatment guidelines for these patients.
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Affiliation(s)
- Sharon Baum
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel,
| | - Sharon Porat
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Nadav Astman
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Israel Defense Forces, Medical Corps, Ramat-Gan, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Institute of Pathology, Sheba Medical Center, Ramat-Gan, Israel
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32
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Smeriglio A, Denaro M, Mastracci L, Grillo F, Cornara L, Shirooie S, Nabavi SM, Trombetta D. Safety and efficacy of hydroxytyrosol-based formulation on skin inflammation: in vitro evaluation on reconstructed human epidermis model. Daru 2019; 27:283-293. [PMID: 31129807 PMCID: PMC6593001 DOI: 10.1007/s40199-019-00274-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Atopic dermatitis is a multifactorial immune-mediated skin disorder characterized by an alteration of epidermal barrier function and onset of skin lesions, which range from mild erythema to severe lichenification. Treatment consists in hydration with possible use of topical or immunomodulatory corticosteroids, which, however sometimes showed side effects. Recently, the interest in natural compounds has grown significantly and among these, hydroxytyrosol (HT) plays a pivotal role due to its strong and well-known anti-inflammatory activity. OBJECTIVES The aim of this study was to investigate the safety and efficacy of Fenolia® Eudermal Cream 15 (HT-based formulation) on epidermal barrier impaired as consequence of skin injury. METHODS Whit this purpose, morphologic and structural as well as anti-inflammatory evaluations, after treatment with pro-inflammatory mediators (PBS 1 X and LPS) and HT-based formulation on reconstructed human epidermis (RHE) were carried out by qualitative (hematoxylin/eosin- and immunostaining) and quantitative (MTT assay, IL-1α and IL-8 release by ELISA) techniques. Furthermore, HT absorption through the epidermal barrier was evaluated by RP-LC-DAD analysis. RESULTS A rise in the thickness of the epidermis as well as an appropriate maturation and protein expression (Loricrin, Fillagrin, E-Cadherin and Cytokeratins 5&6) were detected in treated RHE samples. In particular, the HT-based formulation was found to stimulate cell proliferation, as evidenced by the significant increase in Ki67 expression, which suggests the involvement of repair mechanisms, increasing epithelial regeneration and differentiation and improving the epidermal barrier effect. Furthermore, HT-based formulation showed a statistically significant anti-inflammatory activity by reducing both IL-1α and IL-8 release by RHE tissues, greater than the reference drug dexamethasone. Finally, excellent transcutaneous absorption values were found for HT, demonstrating how this new formulation increases the availability of the bioactive compound. CONCLUSIONS In light of these results, Fenolia® Eudermal Cream 15 could be an effective agent to counteract atopic dermatitis. Graphical abstract Safety and efficacy of hydroxytyrosol-based formulation on skin inflammation: in vitro evaluation on reconstructed human epidermis model.
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Affiliation(s)
- Antonella Smeriglio
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Via Ferdinando Stagno d'Alcontres, 31, Viale SS. Annunziata, 98166, Messina, ME, Italy.
- Fondazione Prof. A. Imbesi, University of Messina, Piazza Pugliatti, 1, Messina, ME, Italy.
| | - Marcella Denaro
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Via Ferdinando Stagno d'Alcontres, 31, Viale SS. Annunziata, 98166, Messina, ME, Italy
- Fondazione Prof. A. Imbesi, University of Messina, Piazza Pugliatti, 1, Messina, ME, Italy
| | - Luca Mastracci
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, GE, Italy
| | - Federica Grillo
- Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV, 6, 16132, Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, GE, Italy
| | - Laura Cornara
- Department of Earth, Environment and Life Sciences, University of Genoa, Corso Europa 26, 16132, Genoa, GE, Italy
| | - Samira Shirooie
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Shahid Beheshti Boulevard, Kermanshah, 6715847141, Iran
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Nosrati Alley, Sheikh Bahai South Avenue, Mollasadra St, Vanak Sq, Tehran, 1435916471, Iran
| | - Domenico Trombetta
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Via Ferdinando Stagno d'Alcontres, 31, Viale SS. Annunziata, 98166, Messina, ME, Italy
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Balato A, Raimondo A, Arenberger P, Bruze M, Czarnecka-Operacz M, Johanssen JD, Gonçalo M, Ranki A, Uter W, Wilkinson M, Ayala F, John SM, Giménez-Arnau A, Gollnick H. The role of the dermatologist in the immune-mediated/allergic diseases - position statement of the EADV task force on contact dermatitis, EADV task force on occupational skin diseases, UEMS-EBDV subcommission allergology and European Dermatology Forum. J Eur Acad Dermatol Venereol 2019; 33:1459-1464. [PMID: 31062452 DOI: 10.1111/jdv.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The members of the Task Force on Contact Dermatitis and the Task Force on Occupational Dermatoses of the European Academy of Dermatology and Venereology (EADV), of the European Dermatology Forum (EDF), and the members of the UEMS Section of Dermatology-Venereology (UEMS-EBDV) we want to vindicate the fundamental role that the specialist in Dermatology has in the diagnosis and management of Immuno-mediated /allergic Diseases. OBJECTIVE In disagreement with the blueprint paper of the UEMS section of Allergology (2013), in which dermatologists are excluded from one of their core activities it was decided to write this consensus paper. DISCUSSION The skin occupies a crucial place in the broad spectrum of allergic diseases; there is no other organ with such a multitude of different clinical conditions mediated by so many pathogenetic immune mechanisms. Subsequently, dermatologists play a fundamental role in the management of immune-mediated diseases including among others contact dermatitis, atopic dermatitis, urticaria and angioedema or cutaneous adverse drug, food and arthropod reactions. The essential role of dermatology in the diagnostic, therapeutic and preventive management of immune mediated /allergic diseases which is crucial for patient management is justified from both the academic and professional point of view. CONCLUSION Based on the best care of the patient with cutaneous immune allergic disease a multidisciplinary approach is desirable and the dermatologist has a pivotal role in patient management. Be so good and no one will not ignore you, dermatologist. Ideally Dermatology should be governed according the following Henry Ford statement: "Arriving together is the beginning; keeping together is progress; working together is success."
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Affiliation(s)
- A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - A Raimondo
- Department of Medicine, Surgery and Dentistry, 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - P Arenberger
- Department of Dermatology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - M Czarnecka-Operacz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - J D Johanssen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Ranki
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - W Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - M Wilkinson
- Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Ayala
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - S M John
- Department of Dermatology, Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany
| | - A Giménez-Arnau
- Department of Dermatology, Hospital del Mar. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - H Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke Universität, Magdeburg, Germany
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Ingordo V, Cazzaniga S, Naldi L, Perrucci S, Barbierato M, Crociata F, Cusano F. Atopic dermatitis in young adult Italian males: persistent and adult-onset varieties did not clinically differ, as for allergological variables. GIORN ITAL DERMAT V 2019; 155:724-732. [PMID: 30650956 DOI: 10.23736/s0392-0488.18.06239-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of adult atopic dermatitis (AD) in general population range from 2.6% to 8% according to objective diagnosis in selected groups of people. The adult-onset AD is the clinical form arising de novo in adulthood. The aim of this study was to detect retrospectively the prevalence of AD in Italian general population, examining a sample of young Italian males affected by AD, which was representative of people of same sex and age, and to point out the clinical and allergological differences between the persistent and adult-onset form. METHODS 198,730 potential male conscripts were visited in Italian Navy and Air Force Recruitment's Centers in Taranto to evaluate their fitness to recruitment. All the young men who showed eczema were referred to Italian Navy Hospital. The diagnosis of AD was stated according to Hanifin and Rajka's criteria. All the patients were patch and prick tested. RESULTS One hundred twenty-four cases of AD were diagnosed, with a prevalence of 6.2 cases for 10,000 subjects (95% CI: 5.2-7.4). The subjects with the persistent form were 68 (75.6%; 95% CI: 66.7-84.4) vs. 26 patients with the adult-onset form (21.0%; 95% CI: 13.8-28.1). No statistical difference in clinical and allergological variables was showed between the persistent and adult-onset AD. CONCLUSIONS The prevalence of adult AD in a large sample of young males - representative of the general population of same age and sex - is appreciably lower than the rates previously reported. No clinical feature or allergological variable discriminate between persistent vs. adult-onset varieties.
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Affiliation(s)
- Vito Ingordo
- Centro Studi GISED, Bergamo, Italy - .,Health Local Unit Taranto, District n. 6, Outpatients' Department of Dermatology, Taranto, Italy -
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Luigi Naldi
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, San Bortolo Hospital, AUSL 8 Berica, Vicenza, Italy
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Yew YW, Thyssen JP, Silverberg JI. A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. J Am Acad Dermatol 2018; 80:390-401. [PMID: 30287309 DOI: 10.1016/j.jaad.2018.09.035] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the commonality of different atopic dermatitis (AD) signs and symptoms. OBJECTIVE To determine the prevalences of AD characteristics and differences by region and age. METHODS A systematic review was performed of all published studies in MEDLINE, EMBASE, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii that analyzed the proportion of AD characteristics. Two reviewers performed a review study titles and/or abstracts and data abstraction. RESULTS In all, 101 studies reported proportion of AD features with sufficient data for meta-analysis. The most prevalent AD features were pruritus, lichenification, and xerosis. There were differences in AD characteristics by study region. Flexural involvement was less commonly reported in India, the Americas, and Iran. Studies from East Asian reported more erythroderma and truncal, extensor, scalp, and auricular involvement. Studies from Southeast Asia reported more exudative eczema, truncal involvement, lichenification, and prurigo nodularis. Studies from Iran reported more head, face, and neck involvement; pityriasis alba; and xerosis. Studies from Africa reported more papular lichenoid lesions, palmar hyperlinearity, ichthyosis, and orbital darkening. LIMITATIONS Heterogeneity between studies and limited reporting of certain AD clinical characteristics. CONCLUSIONS AD characteristics are heterogeneous and vary by region and age.
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Affiliation(s)
- Yik Weng Yew
- Institute of Dermatology, National Skin Centre, Singapore
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jonathan I Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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Fabbrocini G, Napolitano M, Megna M, Balato N, Patruno C. Treatment of Atopic Dermatitis with Biologic Drugs. Dermatol Ther (Heidelb) 2018; 8:527-538. [PMID: 30182182 PMCID: PMC6261117 DOI: 10.1007/s13555-018-0258-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 12/20/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease which predominately affects children and usually clears up during infancy or childhood. However, AD may persist with a chronic relapsing course until adulthood or develop at a later age. AD treatment can often be complicated. Treating moderate-to-severe AD can be challenging: only a few therapeutic options are available, with cyclosporine being the only approved and labeled systemic drug. In the last few years, advances in the knowledge of AD pathogenesis have been made that can provide the basis for developing new topical and systemic drugs. Among them, biologic drugs targeting specific cytokines involved in the development of the disease will probably revolutionize AD therapy. Currently, dupilumab, a monoclonal antibody that binds to the shared alpha chain subunit of the receptors for IL-4 and IL-13, is the only biologic drug licensed for the treatment of AD in adults. However, other biologic drugs that selectively target some key cytokines in AD pathogenesis (IL-13, IL-31, and IL-22) are also being studied. In this review, we discuss all of the biologic drugs that have been studied for AD treatment.
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Affiliation(s)
| | - Maddalena Napolitano
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Dermatology, University of Naples Federico II, Naples, Italy.
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Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. J Am Acad Dermatol 2018; 80:1526-1532.e7. [PMID: 29864464 DOI: 10.1016/j.jaad.2018.05.1241] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies found conflicting results about whether atopic dermatitis (AD) begins in adulthood. OBJECTIVE To determine rates, predictors, and phenotypic differences of adult-onset AD. METHODS A systematic review was performed with all published observational studies in Medline, Embase, GREAT (Global Resource of EczemA Trials), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library, and Scopus that analyzed the age of AD onset beyond 10 years of age. At least two reviewers performed study title, abstract review, and data extraction. Pooled meta-analysis of the proportion of adult-onset AD was performed by using random-effects weighting (I2 = 99.3%). RESULTS Overall, 25 studies met inclusion criteria. Seventeen studies reported age of AD onset as after 16 years of age and had sufficient data for meta-analysis. The pooled proportion (95% confidence interval) of adult-onset AD was 26.1% (16.5%-37.2%). Similar results were found in sensitivity analyses by AD diagnostic method, study region, and sex. Phenotypic differences were observed across studies for adult-onset and child-onset AD, including higher rates of foot dermatitis and personal history of atopy but lower rates of flexural lesions and other signs and symptoms. LIMITATIONS Characteristics of adult-onset versus child-onset AD were not commonly reported. CONCLUSION AD is not only a disease of childhood; 1 in 4 adults with AD report adult-onset disease, which has distinct clinical characteristics as compared to child-onset AD.
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Affiliation(s)
- Harrison H Lee
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin R Patel
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vivek Singam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Supriya Rastogi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois.
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Dermatite atopique de l’adulte : présentation clinique, complications et comorbidités. Ann Dermatol Venereol 2017; 144 Suppl 5:VS15-VS22. [DOI: 10.1016/s0151-9638(18)30087-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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