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Hartzell CJ, Szabova A, Collins AB, Morel AN, Mijatovic D, Goldschneider KR. Efficacy of aprepitant for refractory pruritus in patients with epidermolysis bullosa and atopic dermatitis: A retrospective study. Pediatr Dermatol 2024. [PMID: 39049669 DOI: 10.1111/pde.15704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/29/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION At a single-center pediatric hospital, the neurokinin-1 receptor antagonist aprepitant was used to treat refractory pruritus in epidermolysis bullosa (EB) and atopic dermatitis (AD). METHODS Thirty-seven patients were included (24 EB patients, 13 AD patients), ages 10 months to 37 years. RESULTS 58% (14/24) of patients with EB and 85% (11/13) of patients with AD reported aprepitant was effective in decreasing their pruritus, with age-related differences in efficacy observed in EB patients, and access to the medication by insurance denial or availability of the drug as a barrier to use. CONCLUSIONS Aprepitant shows promise in controlling refractory pruritus in pediatric EB and AD patients and deserves further study.
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Affiliation(s)
- Cheryl J Hartzell
- Pain Management Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Alexandra Szabova
- Pain Management Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Andrew B Collins
- Pain Management Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Armand N Morel
- Pain Management Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Desimir Mijatovic
- Pain Management Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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2
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Kelbore AG, Enbiale W, van Wyk JM, Mosam A. Atopic dermatitis in Ethiopian children: a multicenter study of clinical severity, characteristics, and sociodemographic factors. Front Med (Lausanne) 2024; 11:1410310. [PMID: 39076759 PMCID: PMC11285100 DOI: 10.3389/fmed.2024.1410310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/25/2024] [Indexed: 07/31/2024] Open
Abstract
Background Atopic dermatitis (AD) is a chronic relapsing, pruritic, inflammatory skin disease. Assessing the characteristics and risk factors of severe AD is central to healthcare workers' understanding and subsequent education of patients for the most optimal outcomes. The clinical characteristics are known to vary depending on populations and regions. AD has been well-documented in the global North in mainly Caucasian populations, while very few studies have been conducted on African patients residing in Africa. This study assessed the clinical characteristics, severity, and sociodemographic factors of children with AD in Southern Ethiopia. Methods A hospital-based cross-sectional study was conducted among 461 children and their caregivers in four randomly selected hospitals in Southern Ethiopia from October 2022 to September 2023. A systematic sampling technique was used to enroll study participants. Clinical profile and sociodemographic data were collected by trained data collectors. The Scoring Atopic Dermatitis (SCORAD) index tool was used. The descriptive analysis was performed to characterize study participants. Univariate and ordinary logistic regression were used to identify factors associated with the SCORAD index score. The OR with 95% was used to show the strength of association, and a p-value of <0.05 was used to declare the level of significance. Result Out of 461 AD-diagnosed children, 212 (46%) were girls and 249 (54%) were boys. In the sample of pediatric patients, 149 (32.3%) exhibited mild AD, 231 (46.2%) presented with moderate, and 99 (21.5%) showed signs and symptoms of severe AD. All patients had itching. Dryness of skin, excoriation, and erythema, followed by lichenification, were the most observed signs. In the ordinary logistic regression model, age onset of the disease [AOR 95% CI 1.95 (1.3-2.94)], sex of caregiver or family [AOR 95% CI 0.61 (0.41-0.90)], family atopy history [AOR 95% CI 0.64 (0.44-0.93)], mother education status [95% CI 2.45 (1.1-5.47)], and use of herbal medication [AOR 95% CI 0.50 (0.33-0.79)] were significantly associated with the severity of AD. Conclusion In this study, 68% of children were found to have moderate-to-severe AD. Early onset, maternal education, familial atopy history, sex of caregiver, and use of herbal medication were independent predictors of severe AD in children. We recommend further investigation into these variables for their potential to serve as markers to assess the severity of AD and improve the care and management of children with AD in Ethiopia.
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Affiliation(s)
- Abraham Getachew Kelbore
- Department of Dermatology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Wendemagegn Enbiale
- Department of Dermatology, College of Health Sciences and Medicine, Bahir Dar University, Bahir Dar, Ethiopia
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), Location Academic Medical Centre, Amsterdam, Netherlands
| | - Jacqueline M. van Wyk
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Health Sciences Education, University of Cape Town, Cape Town, South Africa
| | - Anisa Mosam
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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3
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Süßmuth K, Magnolo N, Oji V, Koll PO, Striegel A, Tantcheva-Poór I. [Inflammatory dermatoses in children and adolescents : Diagnosis and treatment of atopic dermatitis and psoriasis]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:325-339. [PMID: 38353728 DOI: 10.1007/s00105-023-05257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 03/27/2024]
Abstract
Atopic dermatitis (AD) and psoriasis belong to the most common inflammatory dermatoses that we treat in everyday clinical practice. AD manifests in more than 70% of cases before the age of 5 years. Approximately one-third of psoriasis patients report on onset of disease in the first two decades of life. Here, we are going to review both disorders in the light of pediatric dermatology. We are going to discuss selected subtypes and present clues for further examination with respect to the differential diagnoses and comorbidities. The article provides insight into current therapeutic developments that are relevant for the treatment of children and adolescents.
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Affiliation(s)
- Kira Süßmuth
- Klinik für Dermatologie und Allergologie, Helios Klinikum Berlin-Buch, Campus der Medical School Berlin, Schwanebecker Ch 50, 13125, Berlin, Deutschland.
| | - Nina Magnolo
- Klinik für Hautkrankheiten, Universitätsklinik Münster, Münster, Deutschland
| | - Vinzenz Oji
- Klinik für Hautkrankheiten, Universitätsklinik Münster, Münster, Deutschland
- Praxis am Buddenturm, Münster, Deutschland
| | - Phillipp Otto Koll
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln, Köln, Deutschland
| | - Anne Striegel
- Praxis für Kinder- und Jugendmedizin Delißen und Striegel mit dem Schwerpunkt pädiatrische Pneumologie und Allergologie, Köln, Deutschland
| | - Iliana Tantcheva-Poór
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln, Köln, Deutschland
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4
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Neri I, Galeone C, Pelucchi C, Ronci G, Matruglio P, Pedone MP, Galli E. Atopic Dermatitis in Italian Pre-School Children: Literature Review of Epidemiological Data with a Focus on Disease Prevalence and Severity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1629. [PMID: 37892292 PMCID: PMC10605831 DOI: 10.3390/children10101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Atopic dermatitis (AD) is one of the most common diseases worldwide. Severe AD has a major impact on the quality of life of patients. We performed a systematic literature review on the epidemiology of AD in Italian pre-school children (age 0-5 years) and we assessed the available data on the severity of AD. In August 2022, we performed a bibliographic search using PubMed/Medline and EMBASE. We identified 10 studies with Italian data on the prevalence and/or incidence of AD in pre-school children. The period (12 months) prevalence of AD varied widely across studies, ranging between 4.0% and 42.2%, with median estimates of 14.3% among all studies and 11.8% among studies from 2010 onwards. Applied to the Italian population, this leads to a prevalence of 309,000-375,000 pre-school AD cases. Only one study computed the incidence of AD, reporting rates of 9 cases per 100 person-years in children aged 0-1 year, and 2.5 cases per 100 person-years in children aged 1-4 years. Severity data from Italy were also reviewed, across three identified three studies. A point estimate found 8.4% of cases were considered severe in one study based on the Patient-Oriented Eczema Measure (POEM), with an overall range of 7.8-11% across different Italian studies and according to various severity score types.
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Affiliation(s)
- Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University of Bologna, 40138 Bologna, Italy
| | - Carlotta Galeone
- Department of Statistics, Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, 20126 Milan, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | | | | | | | - Elena Galli
- UOS Immuno-Allergologia dell’Età Evolutive, Ospedale S. Pietro-Fatebenefratelli, 00189 Rome, Italy
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Saeki H, Ohya Y, Nawata H, Arima K, Inukai M, Rossi AB, Bego-Le-Bagousse G. Impact of the Family and Household Environment on Pediatric Atopic Dermatitis in Japan. J Clin Med 2023; 12:jcm12082988. [PMID: 37109324 PMCID: PMC10145633 DOI: 10.3390/jcm12082988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Pediatric atopic dermatitis (AD) can negatively impact the family quality of life (QoL). We report data from the real-world Epidemiology of Children with Atopic Dermatitis Reporting on their Experience (EPI-CARE) study in Japanese pediatric patients, focusing on disease impact on family QoL. Children and adolescents aged 6 months to <18 years completed an online survey between September 2018-December 2019. The impact of disease severity on family QoL and its effect on parents' time were assessed using the dermatitis family impact (DFI) questionnaire. The impact of a family history of allergic conditions, current residency, second-hand smoke exposure, and household pets on AD prevalence and severity was also assessed. Family QoL decreased as AD severity increased, particularly in families with children aged <6 years; but had the greatest impact on sleep and tiredness in families with children aged <12 years. Parents spent at least 4.6 h/week caring for children <6 years, including those with mild symptoms. Most children (>80%) had a family history of allergic conditions; AD prevalence was increased in those exposed to second-hand smoke or household pets. This study demonstrated that pediatric AD in Japanese individuals has negative impacts on family QoL and that family and household environments can influence pediatric AD prevalence.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Setagaya-ku, Tokyo 157-8535, Japan
| | - Hisakatsu Nawata
- Immunology Medical, Sanofi K.K., Shinjuku-ku, Tokyo 163-1488, Japan
| | - Kazuhiko Arima
- Immunology Medical, Sanofi K.K., Shinjuku-ku, Tokyo 163-1488, Japan
| | - Miho Inukai
- Market Access, Sanofi K.K., Shinjuku-ku, Tokyo 163-1488, Japan
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Shi L, Liu C, Xiong H, Shi D. Elevation of IgE in patients with psoriasis: Is it a paradoxical phenomenon? Front Med (Lausanne) 2022; 9:1007892. [PMID: 36314037 PMCID: PMC9606585 DOI: 10.3389/fmed.2022.1007892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin E (IgE) elevation is a hallmark of allergic conditions such as atopic dermatitis (AD). The pathogenesis of AD is typically associated with high levels of IL-4 and IL-13 produced by activated T helper 2 (Th2) cells. Psoriasis, on the other hand, is an inflammatory skin disease mainly driven by Th17 cells and their related cytokines. Although the immunopathologic reactions and clinical manifestations are often easily distinguished in the two skin conditions, patients with psoriasis may sometimes exhibit AD-like manifestations, such as elevated IgE and persistent pruritic lesions. Given the fact that the effective T cells have great plasticity to re-differentiate in response to innate and environmental factors, this unusual skin condition could be a consequence of a cross-reaction between distinct arms of T-cell and humoral immunity. Here we review the literature concerning the roles of IgE in the development of AD and psoriasis, showing that elevated IgE seems to be an important indicator for this non-typical psoriasis.
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Affiliation(s)
- Leyao Shi
- The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China,The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Chen Liu
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Huabao Xiong
- Basic Medical School, Institute of Immunology and Molecular Medicine, Jining Medical University, Jining, China,Huabao Xiong
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China,Department of Dermatology, Jining No.1 People's Hospital, Jining, China,*Correspondence: Dongmei Shi
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Probing the Skin–Brain Axis: New Vistas Using Mouse Models. Int J Mol Sci 2022; 23:ijms23137484. [PMID: 35806489 PMCID: PMC9267936 DOI: 10.3390/ijms23137484] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 12/10/2022] Open
Abstract
Inflammatory diseases of the skin, including atopic dermatitis and psoriasis, have gained increasing attention with rising incidences in developed countries over the past decades. While bodily properties, such as immunological responses of the skin, have been described in some detail, interactions with the brain via different routes are less well studied. The suggested routes of the skin–brain axis comprise the immune system, HPA axis, and the peripheral and central nervous system, including microglia responses and structural changes. They provide starting points to investigate the molecular mechanisms of neuropsychiatric comorbidities in AD and psoriasis. To this end, mouse models exist for AD and psoriasis that could be tested for relevant behavioral entities. In this review, we provide an overview of the current mouse models and assays. By combining an extensive behavioral characterization and state-of-the-art genetic interventions with the investigation of underlying molecular pathways, insights into the mechanisms of the skin–brain axis in inflammatory cutaneous diseases are examined, which will spark further research in humans and drive the development of novel therapeutic strategies.
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8
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Girolomoni G, Busà VM. Flare management in atopic dermatitis: from definition to treatment. Ther Adv Chronic Dis 2022; 13:20406223211066728. [PMID: 35070252 PMCID: PMC8771745 DOI: 10.1177/20406223211066728] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022] Open
Abstract
Atopic dermatitis (AD) is a skin immune-mediated inflammatory disease with a chronic-recurrent course. Acute exacerbations or flares are an integral part of the AD course and are generally defined as disease worsening, requiring escalation/intensification of treatment. Management of flares is crucial since their prevention is a key aim of long-term disease control. Nevertheless, difficulties related to this aspect are several, starting from the definition of flare itself, which is not always satisfactory or unambiguous, and needs clarification. Indeed, this hurdle may reduce clarity on treatment choice and generate difficulties when comparing data between studies. Deepening our knowledge on flares could be highly relevant to both clinicians and patients to provide adequate control of the disease through patient education and appropriate treatment. This review aims to summarize current knowledge on the management of AD flares from definition to treatment, highlighting aspects that are still unclear, and identifying any necessary unmet needs to better manage AD.
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Affiliation(s)
- Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy
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9
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Liu L, Zhou P, Wang Z, Zhai S, Zhou W. Efficacy and Safety of Omalizumab for the Treatment of Severe or Poorly Controlled Allergic Diseases in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:851177. [PMID: 35372142 PMCID: PMC8965060 DOI: 10.3389/fped.2022.851177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of omalizumab in the treatment of severe or uncontrolled allergic diseases in children. METHODS We conducted a systematic search of the PubMed, Embase, CENTRAL, and clinicaltrials.gov databases up to 23rd July 2021, with no language limitations. Randomised controlled trials (RCTs) comparing omalizumab with other treatments or placebo in children with severe or inadequately controlled allergic diseases were considered. The primary outcomes of interest were asthma exacerbation rate, allergic symptom score, desensitisation achievement for food allergy (FA), and incidence of serious adverse events (SAEs). The study selection and data extraction were conducted independently by two researchers. Quality assessments were conducted using the Cochrane risk-of-bias tool, and data were pooled using a random-effects model if I 2 was 50% or greater in the Cochrane Review Manager. RESULTS Overall, 10 RCTs [six on severe asthma, one on atopic dermatitis (AD), one on seasonal allergic rhinitis [SAR], and one on FA] consisting of 2,376 participants met the inclusion criteria. For severe asthma, omalizumab may reduce exacerbations at 12 weeks [risk ratio (RR), 0.52; 95% confidence interval (CI), 0.31-0.89], 24 weeks (RR, 0.69; 95% CI, 0.55-0.85; GRADE: moderate-quality evidence), and 52 weeks (RR, 0.62; 95% CI, 0.40-0.94; GRADE: moderate-quality evidence) and reduce the dose of inhalation corticosteroid compared with placebo. For severe AD, the association between omalizumab and allergic symptom improvement [i.e., SCORing Atopic Dermatitis or Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ)] was not confirmed. For severe SAR, omalizumab showed greater improvement in symptom load scores and saved rescue medication days. For FA, omalizumab demonstrated superiority in desensitisation compared with placebo. To date, no clinically significant drug-related SAEs have been reported. CONCLUSION For severe or uncontrolled asthma, AD, SAR, and FA, omalizumab may be associated with improved allergic symptoms and safety in children. Future studies should focus on the benefits and pharmacoeconomic evaluation of omalizumab in multiple allergic diseases compared with other treatments. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42021271863].
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Affiliation(s)
- Ling Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Pengxiang Zhou
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Zhenhuan Wang
- Department of Pharmacy, First Hospital of Tsinghua University, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Wei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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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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Skin manifestations in pediatric patients with primary immunodeficiency diseases (PIDs) in a tertiary care hospital in Colombia. World Allergy Organ J 2021; 14:100527. [PMID: 33747343 PMCID: PMC7937824 DOI: 10.1016/j.waojou.2021.100527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background The current literature describes the characteristics of some skin manifestations in the context of primary immunodeficiency diseases (PIDs), also known as inborn errors of the immune system. However, there are hardly any data on the epidemiological trends of skin manifestations and PIDs in Latin America (LA). We aimed to describe the characteristics of patients with skin manifestations and the diagnosis of a PID treated at a tertiary hospital in Colombia. Methods This was a retrospective observational study. Data were taken from the institutional database of pediatric PIDs, which includes 306 patients under 18 years of age who attended a tertiary care center in Cali, Colombia for inpatient or outpatient services between December 2013 and December 2018. A trained third-year dermatology resident reviewed the electronic clinical records of all the patients in the database and double-checked patients who presented with cutaneous signs and symptoms. Results A total of 83 patients out of the original 306 patients (27.1%) presented with some type of cutaneous manifestation. Of these patients, 56.6% had atopic dermatitis, 56.6% reported at least one episode of skin infection, and some of the patients had both of these manifestations. Infections were more frequent in the PID group of combined immunodeficiency associated with well-defined syndromes and atopic dermatitis in the group of antibody deficiencies. Conclusions It is important to recognize dermatological clinical characteristics in patients with PIDs. More studies are necessary to establish recommendations regarding the approach of diagnosis and management of these patients.
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12
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Huang AH, Roh YS, Sutaria N, Choi J, Williams KA, Canner JK, Grossberg AL, Kwatra SG. Real-world comorbidities of atopic dermatitis in the pediatric ambulatory population in the United States. J Am Acad Dermatol 2021; 85:893-900. [PMID: 33689777 DOI: 10.1016/j.jaad.2021.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increasing evidence has suggested the systemic nature of atopic dermatitis (AD), a common inflammatory skin condition in children. However, comprehensive analyses of real-world comorbidities in pediatric AD are limited. OBJECTIVE To characterize comorbidity burden in patients with AD aged <18 years old. METHODS The MarketScan commercial claims database was queried from January 1, 2017, to December 31, 2017. Age- and sex-matched analyses were used to compare patients with AD with general population controls. RESULTS A total of 86,969 pediatric patients with AD and 116,564 matched controls were identified. Increased anxiety (odds ratio [OR], 1.20) and attention-deficit hyperactivity disorder (OR, 1.11) were noted in patients with AD. In addition to dermatologic/allergic diseases, AD was also associated with infections, including methicillin-resistant Staphylococcus aureus (OR, 3.76), and autoimmune conditions, including vitiligo (OR, 2.98) and alopecia areata (OR, 4.32). Pediatric patients with AD had higher likelihoods of lymphoid/hematologic malignancies (OR, 1.94), ocular disorders (OR, 1.37-2.02), metabolic syndrome (OR, 1.61), and obesity (OR, 1.81). For all the ORs mentioned above, P was <.001. LIMITATIONS Retrospective analysis of health care claims data. CONCLUSIONS AD in pediatric patients was associated with a wide range of psychologic and systemic comorbidities. Increased awareness can help minimize its negative effects on the quality of life and prevent long-term health consequences in young patients with AD.
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Affiliation(s)
- Amy H Huang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Youkyung Sophie Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna L Grossberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
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Expression of interleukin-31 and interleukin-33 in atopic dermatitis and correlation with clinical features. PEDIATRU.RO 2021. [DOI: 10.26416/pedi.64.4.2021.5782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Paller AS, Siegfried EC, Thaçi D, Wollenberg A, Cork MJ, Arkwright PD, Gooderham M, Beck LA, Boguniewicz M, Sher L, Weisman J, O'Malley JT, Patel N, Hardin M, Graham NM, Ruddy M, Sun X, Davis JD, Kamal MA, Khokhar FA, Weinreich DM, Yancopoulos GD, Beazley B, Bansal A, Shumel B. Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol 2020; 83:1282-1293. [DOI: 10.1016/j.jaad.2020.06.054] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
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15
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Senner S, Seegräber M, Frey S, Kendziora B, Eicher L, Wollenberg A. Dupilumab for the treatment of adolescents with atopic dermatitis. Expert Rev Clin Immunol 2020; 16:641-650. [PMID: 32720530 DOI: 10.1080/1744666x.2020.1801420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Dupilumab is a treatment option newly licensed for adolescents with moderate to severe atopic dermatitis (AD). It reduces type 2 inflammation by blocking the shared receptor subunit for IL-4/-13. Dupilumab affects three disease mechanisms in atopic dermatitis: the skin barrier, the Th2-cell differentiation and the class switch to IgE. This report is based on a systematic literature search of the PubMed Database. AREAS COVERED Dupilumab showed promising results in improving AD signs, symptoms and quality of life in adolescents with moderate to severe AD. The safety profile of dupilumab in adolescents with moderate to severe AD closely resembled the known safety profile of dupilumab in adults with moderate to severe AD. Injection-site reactions and conjunctivitis were the relevant side-effects. Skin infections were less frequently observed compared to placebo. EXPERT COMMENTARY Dupilumab was approved by the Food and Drug Administration in March 2019 and by the European Medicines Agency in August 2019 for the treatment of adolescents with moderate to severe atopic dermatitis whose disease is not adequately controlled with topical therapies or when those therapies are not advisable. Since it is the first licensed drug it will likely become the reference drug for adolescents with moderate to severe AD.
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Affiliation(s)
- Sonja Senner
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilians University , Munich, Germany.,Derma I, München Klinik , Munich, Germany
| | - Marlene Seegräber
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilians University , Munich, Germany.,Derma I, München Klinik , Munich, Germany
| | - Surina Frey
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilians University , Munich, Germany
| | - Benjamin Kendziora
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilians University , Munich, Germany
| | - Laurie Eicher
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilians University , Munich, Germany
| | - Andreas Wollenberg
- Clinic and Polyclinic for Dermatology and Allergology, Ludwig Maximilians University , Munich, Germany.,Derma I, München Klinik , Munich, Germany
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Blake SC, Murrell DF. Monitoring trough levels in cyclosporine for atopic dermatitis: A systematic review. Pediatr Dermatol 2019; 36:843-853. [PMID: 31566785 DOI: 10.1111/pde.13999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cyclosporine is a useful immunosuppressive agent for achieving disease control in moderate to severe atopic dermatitis in children and adults. However, it carries the potential for nephrotoxicity. Monitoring of drug levels is performed in other patient groups, such as transplant recipients, but is not commonplace in the management of atopic dermatitis. OBJECTIVES To investigate levels of nephrotoxicity associated with cyclosporine use in atopic dermatitis and assess potential correlation with trough levels of cyclosporine. METHODS An electronic search was conducted on MEDLINE, EMBASE, and Cochrane databases for randomized controlled trials and cohort studies assessing the safety profile of cyclosporine compared to placebo or other atopic dermatitis treatments, in adult and pediatric atopic dermatitis patients from 1966 to May 2019. Studies that did not assess renal toxicity were excluded from analysis. RESULTS Thirty-eight trials were included for analysis, excluding 11 that did not assess renal toxicity. Descriptive statistical analysis only was performed, due to the high heterogeneity between study methodologies. Significant renal toxicity was seen in 0%-9% of pediatric participants. Monitoring of trough cyclosporine levels was performed in only 10 of the studies, and their correlation to toxicity or disease activity was not explored. CONCLUSION There is limited evidence in atopic dermatitis regarding trough level monitoring of cyclosporine. Currently, the practice is not commonplace, particularly in pediatrics, and this is reflected in trial methodology. Monitoring may be useful in specific pediatric groups, such as those on multiple concurrent medications, patients with hepatic or renal dysfunction and non-responders to therapy.
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Affiliation(s)
- Stephanie C Blake
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Gür Çetinkaya P, Şahiner ÜM. Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turk J Med Sci 2019; 49:963-984. [PMID: 31408293 PMCID: PMC7018348 DOI: 10.3906/sag-1810-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder of childhood. Underlying factors that contribute to AD are impaired epithelial barrier, alterations in the lipid composition of the skin, immunological imbalance including increased Th2/Th1 ratio, proinflammatory cytokines, decreased T regulatory cells, genetic mutations, and epigenetic alterations. Atopic dermatitis is a multifactorial disease with a particularly complicated pathophysiology. Discoveries to date may be considered the tip of the iceberg, and the increasing number of studies in this field indicate that there are many points to be elucidated in AD pathophysiology. In this review, we aimed to illustrate the current understanding of the underlying pathogenic mechanisms in AD, to evaluate available treatment options with a focus on recently discovered therapeutic agents, and to determine the personal, familial, and economic burdens of the disease, which are frequently neglected issues in AD. Currently available therapies only provide transient solutions and cannot fully cure the disease. However, advances in the understanding of the pathogenic mechanisms of the disease have led to the production of new treatment options, while ongoing drug trials also have had promising results.
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Affiliation(s)
- Pınar Gür Çetinkaya
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümit Murat Şahiner
- Division of Pediatric Allergy and Asthma Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Tajima H, Tajiki-Nishino R, Watanabe Y, Fukuyama T. Direct activation of aryl hydrocarbon receptor by benzo[a]pyrene elicits T-helper 2-driven proinflammatory responses in a mouse model of allergic dermatitis. J Appl Toxicol 2019; 39:936-944. [PMID: 30748024 DOI: 10.1002/jat.3782] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/12/2022]
Abstract
The aryl hydrocarbon receptor (AhR) is a ligand-dependent transcription factor that binds to various environmental chemicals and contributes to numerous toxicological effects. However, the direct effects of AhR on the development of allergic diseases are not fully understood. The main aim of this study was to elucidate the action of AhR in the development of cutaneous allergies. Initially, the potential for a direct relationship between AhR and the immune cells was investigated in vitro, using murine bone marrow-derived dendritic cells, human epidermal keratinocytes, and the mixed leukocyte reaction assay. Benzo[a]pyrene (BaP) and 6-formylindolo[3,2-b]carbazole were used as selective ligands for the AhR. Pretreatment with BaP and/or 6-formylindolo[3,2-b]carbazole significantly induced cytokine release by activated keratinocytes and T-cell proliferation, whereas interleukin-12 production in bone marrow-derived dendritic cells was reduced by AhR activation. To confirm the in vitro results, in vivo experiments were also performed in T-helper (Th)2-type hapten toluene-2,4-diisocyanate- and Th1-type hapten dinitrochlorobenzene-induced mouse models of allergic dermatitis. Mice were orally administered BaP at 48, 24 and 4 hours before the final allergen challenge. In the Th2 model, ear-swelling response and scratching behavior were promoted by BaP exposure, which supported the observed significant increases in local cytokine secretion. The infiltration of helper T cells, B cells and dendritic cells into the auricular lymph node was significantly enhanced by BaP administration, although Th1-type immune responses were not influenced by AhR activation. Our findings demonstrate that AhR activation directly activates keratinocytes and T cells, which leads to the exacerbation of Th2-type cutaneous allergy.
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Affiliation(s)
- Hitoshi Tajima
- Toxicology Division, Institute of Environmental Toxicology, 4321, Uchimoriya-machi, Joso-shi, Ibaraki, 303-0043, Japan
| | - Risako Tajiki-Nishino
- Toxicology Division, Institute of Environmental Toxicology, 4321, Uchimoriya-machi, Joso-shi, Ibaraki, 303-0043, Japan
| | - Yuko Watanabe
- Toxicology Division, Institute of Environmental Toxicology, 4321, Uchimoriya-machi, Joso-shi, Ibaraki, 303-0043, Japan
| | - Tomoki Fukuyama
- Toxicology Division, Institute of Environmental Toxicology, 4321, Uchimoriya-machi, Joso-shi, Ibaraki, 303-0043, Japan.,Laboratory of Veterinary Pharmacology, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, 252-5201, Japan
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