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Mercadal-Orfila G, Seguí-Solanes C, Rudi-Sola N, Escriva-Sancho ME, Taberner-Ferrer R. [Translated article] Patient-reported outcome measures for assessing atopic dermatitis in clinical practice. FARMACIA HOSPITALARIA 2024:S1130-6343(24)00139-9. [PMID: 39299870 DOI: 10.1016/j.farma.2024.08.004] [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: 06/26/2023] [Revised: 10/05/2023] [Accepted: 11/01/2023] [Indexed: 09/22/2024] Open
Abstract
Atopic dermatitis is a chronic skin condition that affects up to 20% of children and 10% of adults worldwide. Due to the high burden of dermatological signs and symptoms, atopic dermatitis has a significant impact on the quality of life of patients and their families. In the absence of objective measures to accurately assess severity and symptom burden, patient-reported outcome measures are essential to monitor the impact and progression of the disease, as well as the efficacy of treatments. Although there are currently no standardised guidelines for their use in clinical practice, there are some initiatives, such as the Harmonise Outcome Measures for Eczema and Vivir con Dermatitis Atópica, that can provide guidance. As healthcare systems move toward value-based healthcare models, patient-reported measures are becoming increasingly important for incorporating the patient perspective and improving the quality of healthcare services. The use of these measures can help monitor disease activity and guide treatment decisions. This article discusses the impact of atopic dermatitis and describes the patient-reported outcome measures commonly used in atopic dermatitis and the recommendations of the initiatives that have selected a core set of measures to best assess atopic dermatitis in clinical practice. Considering the recommendations of these initiatives and based on our experience in clinical practice, we propose the use of the Dermatology Life Quality Index to assess the impact of the disease on quality of life, the Patient-Oriented Eczema Measure to assess symptom severity, and the Numerical Rating Scale or the Visual Analogue Scale to measure itch intensity. To systematise the administration of these measures and to integrate them into hospital information systems and medical records, we emphasise the importance of telemedicine platforms that allow the electronic administration of these instruments.
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Affiliation(s)
- Gabriel Mercadal-Orfila
- Servicio de Farmacia, Hospital Mateu Orfila, Mahón, Menorca, Spain; Departamento de Bioquímica y Biología Molecular, Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain.
| | - Carlos Seguí-Solanes
- Servicio de Farmacia, Hospital General de Granollers, Granollers, Barcelona, Spain
| | - Nuria Rudi-Sola
- Servicio de Farmacia, Hospital General de Granollers, Granollers, Barcelona, Spain
| | | | - Rosa Taberner-Ferrer
- Servicio de Dermatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
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Langenbruch A, Andrees V, Scherer M, Augustin M. Healthcare of patients with atopic dermatitis by general practitioners - a nationwide survey in Germany. J Dtsch Dermatol Ges 2024. [PMID: 39226528 DOI: 10.1111/ddg.15529] [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: 09/14/2023] [Accepted: 06/30/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Epidemiological studies on the health care of patients with atopic dermatitis (AD) in dermatological treatment in Germany indicate no improvements within 10 years. In addition to dermatologists, general practitioners (GPs) are particularly involved in AD treatment. This study analyzed the health care situation of adult patients with AD by GPs. PATIENTS AND METHODS The cross-sectional questionnaire survey "PsoADA" was conducted from 2019 to 2021 in general practices throughout Germany and the results were compared with previous data from dermatology care (AtopicHealth2, 2017-19). RESULTS Among 150 patients (mean age: 40 years, 62.2% female), 39.2% received additional treatment by a dermatologist (GP+D). 20.7% of GP+D and 5.7% of patients in GP treatment only (GP only) had severe AD (p < 0.01, AtopicHealth2: 27.6%). Major limitations in quality of life were reported by 31.0% (GP+D) versus 3.4% (GP only) (p < 0.001, AtopicHealth2: 31.6%). Most patients received topicals, mainly glucocorticosteroids. Calcineurin inhibitors were currently administered by 2.7% (PsoADA total). Patient education was reported by 5.7% (PsoADA total). CONCLUSIONS A considerable proportion of patients with AD in GP care shows poor outcomes, as has been observed in dermatological care - possibly due to the lack of use of modern systemic therapy.
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Affiliation(s)
- Anna Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Valerie Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Bradshaw LE, Wyatt LA, Brown SJ, Haines RH, Montgomery AA, Perkin MR, Sach TH, Lawton S, Flohr C, Ridd MJ, Chalmers JR, Brooks J, Swinden R, Mitchell EJ, Tarr S, Jay N, Thomas KS, Allen H, Cork MJ, Kelleher MM, Simpson EL, Lartey ST, Davies-Jones S, Boyle RJ, Williams HC. Emollient application from birth to prevent eczema in high-risk children: the BEEP RCT. Health Technol Assess 2024; 28:1-116. [PMID: 39021147 PMCID: PMC11261424 DOI: 10.3310/rhdn9613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background Atopic eczema is a common childhood skin problem linked with asthma, food allergy and allergic rhinitis that impairs quality of life. Objectives To determine whether advising parents to apply daily emollients in the first year can prevent eczema and/or other atopic diseases in high-risk children. Design A United Kingdom, multicentre, pragmatic, two-arm, parallel-group randomised controlled prevention trial with follow-up to 5 years. Setting Twelve secondary and four primary care centres. Participants Healthy infants (at least 37 weeks' gestation) at high risk of developing eczema, screened and consented during the third trimester or post delivery. Interventions Infants were randomised (1 : 1) within 21 days of birth to apply emollient (Doublebase Gel®; Dermal Laboratories Ltd, Hitchin, UK or Diprobase Cream®) daily to the whole body (excluding scalp) for the first year, plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). Families were not blinded to allocation. Main outcome measures Primary outcome was eczema diagnosis in the last year at age 2 years, as defined by the UK Working Party refinement of the Hanifin and Rajka diagnostic criteria, assessed by research nurses blinded to allocation. Secondary outcomes up to age 2 years included other eczema definitions, time to onset and severity of eczema, allergic rhinitis, wheezing, allergic sensitisation, food allergy, safety (skin infections and slippages) and cost-effectiveness. Results One thousand three hundred and ninety-four newborns were randomised between November 2014 and November 2016; 693 emollient and 701 control. Adherence in the emollient group was 88% (466/532), 82% (427/519) and 74% (375/506) at 3, 6 and 12 months. At 2 years, eczema was present in 139/598 (23%) in the emollient group and 150/612 (25%) in controls (adjusted relative risk 0.95, 95% confidence interval 0.78 to 1.16; p = 0.61 and adjusted risk difference -1.2%, 95% confidence interval -5.9% to 3.6%). Other eczema definitions supported the primary analysis. Food allergy (milk, egg, peanut) was present in 41/547 (7.5%) in the emollient group versus 29/568 (5.1%) in controls (adjusted relative risk 1.47, 95% confidence interval 0.93 to 2.33). Mean number of skin infections per child in the first year was 0.23 (standard deviation 0.68) in the emollient group versus 0.15 (standard deviation 0.46) in controls; adjusted incidence rate ratio 1.55, 95% confidence interval 1.15 to 2.09. The adjusted incremental cost per percentage decrease in risk of eczema at 2 years was £5337 (£7281 unadjusted). No difference between the groups in eczema or other atopic diseases was observed during follow-up to age 5 years via parental questionnaires. Limitations Two emollient types were used which could have had different effects. The median time for starting emollients was 11 days after birth. Some contamination occurred in the control group (< 20%). Participating families were unblinded and reported on some outcomes. Conclusions We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children. Emollient use was associated with a higher risk of skin infections and a possible increase in food allergy. Emollient use is unlikely to be considered cost-effective in this context. Future research To pool similar studies in an individual patient data meta-analysis. Trial registration This trial is registered as ISRCTN21528841. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/67/12) and is published in full in Health Technology Assessment; Vol. 28, No. 29. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Lucy E Bradshaw
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Laura A Wyatt
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sara J Brown
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Dermatology, NHS Lothian, Edinburgh, UK
| | - Rachel H Haines
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael R Perkin
- Population Health Research Institute, St George's, University of London, London, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | | | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joanne Brooks
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard Swinden
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Eleanor J Mitchell
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stella Tarr
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nicola Jay
- Sheffield Children's Hospital, Sheffield, UK
| | - Kim S Thomas
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Hilary Allen
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael J Cork
- Sheffield Dermatology Research, Department of Infection and Immunity, University of Sheffield, Sheffield, UK
| | - Maeve M Kelleher
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Stella T Lartey
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Susan Davies-Jones
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robert J Boyle
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Mercadal-Orfila G, Seguí-Solanes C, Rudi-Sola N, Escriva-Sancho ME, Taberner-Ferrer R. Patient-reported outcome measures for assessing atopic dermatitis in clinical practice. FARMACIA HOSPITALARIA 2024:S1130-6343(23)00927-3. [PMID: 38806365 DOI: 10.1016/j.farma.2023.11.002] [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: 06/26/2023] [Revised: 10/05/2023] [Accepted: 11/01/2023] [Indexed: 05/30/2024] Open
Abstract
Atopic dermatitis is a chronic skin condition that affects up to 20% of children and 10% of adults worldwide. Due to the high burden of dermatological signs and symptoms, atopic dermatitis has a significant impact on the quality of life of patients and their families. In the absence of objective measures to accurately assess severity and symptom burden, patient-reported outcome measures are essential to monitor the impact and progression of the disease, as well as the efficacy of treatments. Although there are currently no standardised guidelines for their use in clinical practice, there are some initiatives, such as the Harmonise Outcome Measures for Eczema and Vivir con Dermatitis Atópica, that can provide guidance. As healthcare systems move towards value-based healthcare models, patient-reported measures are becoming increasingly important for incorporating the patient perspective and improving the quality of healthcare services. The use of these measures can help monitor disease activity and guide treatment decisions. This article discusses the impact of atopic dermatitis and describes the patient-reported outcome measures commonly used in atopic dermatitis and the recommendations of the initiatives that have selected a core set of measures to best assess atopic dermatitis in clinical practice. Considering the recommendations of these initiatives and based on our experience in clinical practice, we propose the use of the Dermatology Life Quality Index to assess the impact of the disease on quality of life, the Patient-Oriented Eczema Measure to assess symptom severity, and the Numerical Rating Scale or the Visual Analogue Scale to measure itch intensity. To systematize the administration of these measures and to integrate them into hospital information systems and medical records, we emphasise the importance of telemedicine platforms that allow the electronic administration of these instruments.
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Affiliation(s)
- Gabriel Mercadal-Orfila
- Servicio de Farmacia, Hospital Mateu Orfila, Mahón, Menorca, España; Departamento de Bioquímica y Biología Molecular, Universitat de les Illes Balears (UIB), Palma de Mallorca, España.
| | - Carlos Seguí-Solanes
- Servicio de Farmacia, Hospital General de Granollers, Granollers, Barcelona, España
| | - Nuria Rudi-Sola
- Servicio de Farmacia, Hospital General de Granollers, Granollers, Barcelona, España
| | | | - Rosa Taberner-Ferrer
- Servicio de Dermatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
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Yew YW, Phuan CZY, Zhao X, Howells L, Apfelbacher CJ. Validation of the Recap of Atopic Eczema (RECAP) Measurement Instrument for Eczema Control in Adult Patients in an Asian Clinical Setting. Acta Derm Venereol 2024; 104:adv32323. [PMID: 38738773 PMCID: PMC11107836 DOI: 10.2340/actadv.v104.32323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/22/2024] [Indexed: 05/14/2024] Open
Abstract
Recap of atopic eczema (RECAP) is a self-reported 7-item questionnaire recommended by the Harmonising Outcome Measures in Eczema initiative to measure eczema control. As RECAP has not been validated in a real-world clinical population in Asia, RECAP was investigated as a measure of eczema control in Singapore. Patients with atopic eczema at the National Skin Centre from July 2019 to January 2020 were included for analysis. Both patient- and physician-reported outcome measures were available for correlation analyses. Correlation analysis was also performed to investigate construct validity, and floor or ceiling effects of RECAP. A total of 260 atopic eczema patients aged between 15 and 87 years were recruited. There were minimal floor and ceiling effects for RECAP scores. There were strong, significant correlations of RECAP with POEM (r = 0.84, p < 0.001) and DLQI (r = 0.81, p < 0.001). Correlation with SCORAD was moderate (r = 0.60, p < 0.001). Correlations remained similar after age, gender, and ethnicity adjustments. Discriminative validity was demonstrated by a significant linear trend of increasing RECAP scores with increasing eczema severity. RECAP demonstrates good discriminative and construct validity evidenced by strong correlations with symptoms and quality of life and moderate correlations with eczema signs. RECAP is useful to measure eczema control in Singapore.
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Affiliation(s)
- Yik Weng Yew
- National Skin Centre, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore.
| | | | | | - Laura Howells
- University of Nottingham Centre for Evidence Based Dermatology, Nottingham, UK
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany; Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore
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Ma L, Tao X, Liu S, Cheng H, Fang R, Zhao Y, Cha A, Encinas GA, Zhou Y, Deng Y, Zhang J. Efficacy and Safety of Crisaborole Ointment 2% in Chinese Patients Aged ≥ 2 Years with Mild to Moderate Atopic Dermatitis. Dermatol Ther (Heidelb) 2024; 14:1229-1243. [PMID: 38748345 PMCID: PMC11116293 DOI: 10.1007/s13555-024-01156-6] [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: 01/12/2024] [Accepted: 04/03/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic immuno-inflammatory skin disease. Crisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor approved for the treatment of mild to moderate AD. This post hoc analysis assesses the efficacy and safety of crisaborole in Chinese patients aged ≥ 2 years with mild to moderate AD. METHODS We evaluated the efficacy and safety of crisaborole in Chinese patients from the vehicle-controlled, phase 3 CrisADe CLEAR study. Patients were randomly assigned 2:1 to receive crisaborole or vehicle twice daily, respectively, for 28 days. The primary endpoint was percent change from baseline in Eczema Area and Severity Index (EASI) total score at day 29. Key secondary endpoints were improvement in Investigator's Static Global Assessment (ISGA), ISGA success, and change from baseline in weekly average Peak Pruritus Numerical Rating Scale (PP-NRS) score. Adverse events were documented. RESULTS Of 391 patients in the overall study, 237 were from China, 157 assigned to crisaborole and 80 assigned to vehicle. A greater reduction in percent change from baseline in EASI total score at day 29 was shown in the crisaborole vs. vehicle group (least squares mean [LSM]: -66.34 [95% (confidence interval) CI -71.55 to -61.12] vs. -50.18 [95% CI -58.02 to -42.34]). Response rates for achievement of ISGA improvement (43.2% [95% CI 35.4-51.1] vs. 33.4% [95% CI 22.5-44.2]) and ISGA success (31.7% [95% CI 24.3-39.0] vs. 21.5% [95% CI 12.1-30.9]) at day 29 were higher in the crisaborole vs. vehicle group. A greater reduction in change from baseline in weekly average PP-NRS score at week 4 was observed in the crisaborole vs. vehicle group (LSM: -1.98 [95% CI -2.34 to -1.62] vs. -1.08 [95% CI -1.63 to -0.53]). No new safety signals were observed. CONCLUSION Crisaborole was effective and well tolerated in Chinese patients aged ≥ 2 years with mild to moderate AD. TRIAL REGISTRATION ClinicalTrials.gov, NCT04360187.
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Affiliation(s)
- Lin Ma
- Department of Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaohua Tao
- Department of Dermatology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Sujun Liu
- Department of Dermatology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China
| | - Hao Cheng
- Department of Dermatology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ruihua Fang
- Department of Dermatology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
| | - Yan Zhao
- Department of Dermatology, Peking University People's Hospital, Beijing, 100044, China
| | - Amy Cha
- Pfizer Inc., New York, NY, USA
| | | | - Yangmei Zhou
- Clinical Development, Pfizer R&D China, Shanghai, China
| | | | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing, 100044, China.
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Artusa S, Mazzuca G, Piacentini G, Castagnoli R, Marseglia GL, Pietrobelli A, Pecoraro L. Paediatric Atopic Dermatitis: The Unexpected Impact on Life with a Specific Look at the Molecular Level. Int J Mol Sci 2024; 25:4778. [PMID: 38731996 PMCID: PMC11083669 DOI: 10.3390/ijms25094778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Atopic dermatitis (AD) is a condition with a multifactorial aetiology that affects the skin. It most often begins at preschool age and involves the skin. The disease's main symptom is intense itching, which occurs especially at night and affects the child's sleep, negatively impacting the quality of life of affected children and, consequently, their families. The difficulty in resting during the night leads to many problems during the day, particularly behavioural disorders and difficulties in paying attention at school, which results in learning impairment. The unexpected symptoms of AD are caused by pathophysiological processes that include many molecular pathways and inflammatory cytokines such as IL-31, IL-1, IL-2, TNF-a, and IL-6. Drawing on a comprehensive review of the literature in PubMed/MedLine, our review offers an in-depth exploration of both the psychosocial impacts of AD and the molecular processes that contribute to this disorder.
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Affiliation(s)
- Silvia Artusa
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Giorgia Mazzuca
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Angelo Pietrobelli
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (S.A.); (G.M.)
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Safiri S, Jaberinezhad M, Mousavi SE, Motlagh Asghari K, Shamekh A, Nejadghaderi SA, Sullman MJM, Houshyar Y, Behrangi E, Kolahi AA. The burden of dermatitis from 1990-2019 in the Middle East and North Africa region. BMC Public Health 2024; 24:399. [PMID: 38326798 PMCID: PMC10848450 DOI: 10.1186/s12889-024-17836-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND There are several types of dermatitis, each capable of causing enduring changes that extend beyond physical discomfort. In severe cases, dermatitis can significantly affect mental health, social interactions, and the overall quality of life. This study reports the burden of dermatitis in the Middle East and North Africa (MENA) region from 1990 to 2019, according to sex, age category, and socio-demographic index (SDI). METHODS Publicly available data regarding the point prevalence, incidence, and years lived with disability (YLDs) were collected from the Global Burden of Disease 2019 study for both the MENA region and its constituent countries. The point prevalence, incidence, and YLDs of dermatitis were represented as counts and age-standardised rates with 95% uncertainty intervals (UIs). RESULTS In 2019, the age-standardised point prevalence of dermatitis was 2744.6 (2517.8-3003.1) per 100,000 population, which was 2.3% lower than in 1990. The YLD rate was 92.3 (55.6-143.4) per 100,000 population, which was 3.1% lower than in 1990. The largest point prevalence rates were observed among those aged 70-74, for both sexes. The 2019 MENA/Global DALY ratio was not above one in any age group for either sex. During the period 1990 to 2019, there was no clear correlation between the burden of dermatitis and the SDI level. CONCLUSION The dermatitis burden in the MENA region remained relatively stable from 1990 to 2019. Future prevention efforts should focus on improving healthcare access, health education, and workplace safety regulations.
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Affiliation(s)
- Saeid Safiri
- Social Determinants of Health Research Center, Department of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehran Jaberinezhad
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kimia Motlagh Asghari
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Shamekh
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Yousef Houshyar
- Department of Dermatology, Özel Çankaya Hospital, Barbaros, Ankara, Turkey
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Giombi F, Pace GM, Pirola F, Cerasuolo M, Ferreli F, Mercante G, Spriano G, Canonica GW, Heffler E, Ferri S, Puggioni F, Paoletti G, Malvezzi L. Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease? Int J Mol Sci 2024; 25:730. [PMID: 38255804 PMCID: PMC10815382 DOI: 10.3390/ijms25020730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.
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Affiliation(s)
- Francesco Giombi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Gian Marco Pace
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Francesca Pirola
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
| | - Michele Cerasuolo
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
| | - Fabio Ferreli
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Giuseppe Mercante
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Giuseppe Spriano
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Sebastian Ferri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Francesca Puggioni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Luca Malvezzi
- Otorhinolaryngology Head & Neck Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.G.); (F.P.); (M.C.); (F.F.); (G.M.); (G.S.); (L.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (G.W.C.); (E.H.); (S.F.); (F.P.); (G.P.)
- Otorhinolaryngology Head & Neck Surgery Unit, Casa di Cura Humanitas San Pio X, Via Francesco Nava 31, 20159 Milan, Italy
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Merkel T, Navarini A, Mueller S. The impact of phototherapy on itch intensity and itch-related quality of life amongst different skin diseases, skin phototypes and genders - A prospective study with 102 patients. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12948. [PMID: 38288769 DOI: 10.1111/phpp.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Phototherapy is a mainstay to treat itchy conditions. However, only little is known about differences in the antipruritic effect of phototherapy amongst different skin conditions, phototypes and genders. METHODS In this prospective, single-center study, we analyzed the effect of phototherapy on itch intensity and itch-related quality of life amongst these subgroups after a treatment duration of 4 weeks, while on-demand treatment with topical corticosteroids, topical calcineurin inhibitors and/or antihistamines was allowed. RESULTS Of 102 patients (age 53.0 ± 18.7, 56 females [54.9%]), 72 (78.3%) reported a significant reduction of itch intensity by Δ -2.76 on a 0-10 Numerical Rating Scale (NRS), p = <.001, 95% CI [2.2; 3.3] paralleled by a significant improvement of itch-related quality of life as measured by the German version of the ItchyQoL by Δ 7.3, p = <.001, 95% CI [4.4; 11.6]. The best improvement of itch intensity and itch-related QoL was reported by patients with pruritus on non-diseased skin (ΔNRS -3.5; Δ 9.7 Ger-ItchyQoL points), followed by patients with atopic dermatitis and psoriasis. We found no statistical differences in the response to phototherapy amongst Fitzpatrick phototypes I-VI. Women had higher itch intensities at baseline but itch-related quality of life impairment at baseline and phototherapy treatment response did not significantly differ between genders. CONCLUSION Phototherapy appears to induce a meaningful itch reduction in various itchy skin conditions, all phototypes and both genders within 4 weeks that directly translates into improvement of itch-related quality of life.
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Affiliation(s)
- Tamara Merkel
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Simon Mueller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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11
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Narla S, Silverberg JI. Which Clinical Measurement Tools for Atopic Dermatitis Severity Make the Most Sense in Clinical Practice? Dermatitis 2024; 35:S13-S23. [PMID: 37040270 DOI: 10.1089/derm.2022.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Assessment of atopic dermatitis (AD) severity is essential for therapeutic decision making and monitoring treatment progress. However, there are a myriad of clinical measurement tools available, some of which are impractical for routine clinical use despite being recommended for clinical trials in AD. For measurement tools to be used in clinical practice, they should be valid, reliable, rapidly completed, and scored, and easily incorporated into existing clinic workflows. This narrative review addresses content, validity, and feasibility, and provides a simplified repertoire of assessments for clinical assessment of AD based on prior evidence and expert opinion. Tools that may be feasible for clinical practice include patient-reported outcomes (eg, dermatology life quality index, patient-oriented eczema measure, numerical rating scales for itch, pain, and sleep disturbance, AD Control Tool, and patient-reported global assessment), and clinician-reported outcomes (eg, body surface area and investigator's global assessment). AD is associated with variable clinical signs, symptoms, extent of lesions, longitudinal course, comorbidities, and impacts. Any single domain is insufficient to holistically characterize AD severity, select therapy, or monitor treatment response. A combination of these tools is recommended to balance completeness and feasibility.
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Affiliation(s)
- Shanthi Narla
- From the Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Russo F, Cioppa V, Cartocci A, De Piano E, Taddeucci P, Lazzeri L, Santi F, Rubegni P. Exploring the Relationship Between Dermatology Life Quality Index, Eczema Area and Severity Index, and Sleep Numerical Rating Scale and Pruritus Numerical Rating Scale in Patients with Atopic Dermatitis Treated with Dupilumab. Dermatitis 2023; 34:440-444. [PMID: 36917539 DOI: 10.1089/derm.2022.0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Patients with atopic dermatitis (AD) experience decreased quality of life (QoL). Here we describe the relationship between severity and QoL-related scores in patients with moderate-to-severe AD treated with dupilumab. Patients and Methods: This was a real-life, retrospective, and observational study involving patients with AD treated with dupilumab. Treatment effectiveness was evaluated based on the changes in the eczema area and severity index (EASI), sleep quality numerical rating scale ,and pruritus numerical rating scale (PNRS), as well as the dermatology life quality index (DLQI). The relationship between each of them was analyzed. After the first data collection at baseline, patients were re-evaluated at 3 subsequent follow-ups (4, 8, and 12 months). Results: A total of 52 patients were enrolled in the study. At 4 months, the change in DLQI is more correlated with PNRSs (r = 0.643, P < 0.001) than the other scores considered. At 8 months, however, the change in DLQIs correlates similarly both with PNRSs (r = 0.644, P < 0.001) and with the change in EASIs (r = 0.633, P < 0.001). At 12 months of treatments, however, the trend reverses and the correlation with EASIs becomes higher (r = 0.735, P < 0.001) than PNRSs (r = 0.0.659, P < 0.001). Conclusions: The results of our study show that the reduction in the impact on QoL for AD patients in the first months of therapy with dupilumab correlates more with the control of pruritus than with the disappearance of skin lesions.
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Affiliation(s)
- Filomena Russo
- From the Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy; and
| | - Vittoria Cioppa
- From the Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy; and
| | | | - Ernesto De Piano
- From the Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy; and
| | - Paolo Taddeucci
- From the Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy; and
| | - Laura Lazzeri
- From the Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy; and
| | - Francesco Santi
- From the Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy; and
| | - Pietro Rubegni
- From the Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy; and
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13
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Choy CT, Siu PLK, Zhou J, Wong CH, Lee YW, Chan HW, Tsui JCC, Lo CJY, Loo SKF, Tsui SKW. Improvements in Gut Microbiome Composition Predict the Clinical Efficacy of a Novel Synbiotics Formula in Children with Mild to Moderate Atopic Dermatitis. Microorganisms 2023; 11:2175. [PMID: 37764019 PMCID: PMC10536305 DOI: 10.3390/microorganisms11092175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a significant association with various type-2 inflammation-related comorbidities. Ongoing research suggests the crucial involvement of gut microbiome, especially in childhood onset AD, and hence, probiotics have emerged as a potential non-steroid-based therapeutics option to complement existing AD management plans. In order to delineate the impact of probiotics in the gut microbiome of pediatric AD patients from southern China, targeted 16S rRNA sequencing and thorough bioinformatic analysis were performed to analyze the gut microbiome profiles of 24 AD children after taking an orally administered novel synbiotics formula with triple prebiotics for 8 weeks. A notable improvement in Eczema Area and Severity Index (EASI) (p = 0.008) was observed after taking an 8-week course of probiotics, with no adverse effects observed. The relative abundances of key microbial drivers including Bacteroides fragilis and Lactobacillus acidophilus were significantly increased at week 8. We also found that the positive responsiveness towards an 8-week course of probiotics was associated with improvements in the gut microbiome profile with a higher relative abundance of probiotic species. Over-represented functional abundance pathways related to vitamin B synthesis and peptidoglycan recycling may imply the underlying mechanism. In summary, our study suggests how the gut microbial landscape shifts upon probiotic supplementation in AD children, and provides preliminary evidence to support targeted probiotic supplementation for the management of childhood AD.
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Affiliation(s)
- Chi Tung Choy
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Pui Ling Kella Siu
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Junwei Zhou
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Chi Ho Wong
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Yuk Wai Lee
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Ho Wang Chan
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | | | - Claudia Jun Yi Lo
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
| | - Steven King Fan Loo
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
- Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Dermatology Centre, CUHK Medical Centre, The Chinese University of Hong Kong, Hong Kong
| | - Stephen Kwok Wing Tsui
- Microbiome Research Centre, BioMed Laboratory Company Limited, Hong Kong
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Centre for Microbial Genomics and Proteomics, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Hong Kong
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Gu C, Yao X, Li W. Burden of Disease; the Current Status of the Diagnosis and Management of Atopic Dermatitis in China. J Clin Med 2023; 12:5370. [PMID: 37629411 PMCID: PMC10456078 DOI: 10.3390/jcm12165370] [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: 04/02/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Atopic dermatitis (AD) is now a global health problem and has been attracting extensive attention from both academic and public society in China. This review aimed to present the current status of the prevalence, disease burden, clinical features, diagnosis, and management of AD in China. The prevalence of AD has been increasing rapidly in China during the past decades, partially due to the increased recognition of the disease; there are still substantial amounts of over-diagnosed eczema and under-diagnosed AD. Chinese dermatologists see many AD patients with atypical manifestation, which poses a challenge to the diagnosis. The Chinese diagnostic criteria for adults and pediatric patients with AD have been proposed respectively and validated with high sensitivity and specificity. International and Chinese guidelines for management of AD have been popularized; however, there are still many practices that need verification through randomized case-control study. Dupilumab and JAK inhibitors have demonstrated favorable efficacy for AD patients in China, and a multidimensional approach is needed for selection of the patients and evaluation of the efficacy and safety. Patient education and long-term management for AD are just beginning in China, and need to be strengthened in the future.
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Affiliation(s)
- Chaoying Gu
- Department of Dermatology, Shanghai Institute of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210042, China
| | - Wei Li
- Department of Dermatology, Shanghai Institute of Dermatology, Huashan Hospital, Fudan University, Shanghai 200040, China
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15
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Isaifan D, Crovella S, Soubra L, Al-Nesf M, Steinhoff M. Fc Epsilon RI-Neuroimmune Interplay in Pruritus Triggered by Particulate Matter in Atopic Dermatitis Patients. Int J Mol Sci 2023; 24:11851. [PMID: 37511610 PMCID: PMC10380572 DOI: 10.3390/ijms241411851] [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: 02/16/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 07/30/2023] Open
Abstract
Atopic dermatitis (AD) is the most common chronic relapsing neuroinflammatory skin disease that is characterized by a complex and multifactorial pathophysiology. It reflects a profound interplay between genetic and environmental factors, and a recently disclosed neuroimmune dysregulation that drives skin barrier disruption, pruritus, and microbial imbalance. In terms of the key external environmental players that impact AD, air quality and itch severity linkage have been thoroughly researched. The impact of ambient air pollutants including particulate matter (PM) and AD pruritic exacerbation has been recorded despite reductions in air pollution levels in in developed countries. The developing countries have, on the contrary, experienced significant urbanization and industrialization with limited environmental protection standards in the past decades. This unprecedented construction, petrochemical industry utilization, and increment in population counts has been paired with consistent exposure to outdoor PM. This may present a key cause of AD pruritic exacerbation supported by the fact that AD prevalence has intensified globally in the past 50 years, indicating that environmental exposure may act as a trigger that could flare up itch in vulnerable persons. At the molecular level, the impact of PM on severe pruritus in AD could be interpreted by the toxic effects on the complex neuroimmune pathways that govern this disease. AD has been recently viewed as a manifestation of the disruption of both the immune and neurological systems. In light of these facts, this current review aims to introduce the basic concepts of itch sensory circuits in the neuroimmune system. In addition, it describes the impact of PM on the potential neuroimmune pathways in AD pathogenesis with a special focus on the Fc Epsilon RI pathway. Finally, the review proposes potential treatment lines that could be targeted to alleviate pruritus based on immune mediators involved in the Fc Epsilon signaling map.
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Affiliation(s)
- Dina Isaifan
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha P.O. Box 2713, Qatar
| | - Sergio Crovella
- Laboratory of Animal Research Center (LARC), Qatar University, Doha P.O. Box 2713, Qatar
| | - Lama Soubra
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha P.O. Box 2713, Qatar
| | - Maryam Al-Nesf
- Allergy and Immunology Division, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Martin Steinhoff
- Department of Dermatology & Venereology, Weill Cornell Medicine, New York, NY 10065, USA
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Lee E, Kim JH, Cha HR, Ha EK, Shin J, Lee WS, Lee SW, Han MY. Association between atopic dermatitis and school readiness in preschool children. Pediatr Allergy Immunol 2023; 34:e13996. [PMID: 37492912 DOI: 10.1111/pai.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Although atopic dermatitis (AD) in children affects diverse stages of life, no studies have reported on the association between school readiness and AD. METHODS This study used Korean National Health Insurance data and the Health Screening Program for Infants and Children. Among all children born between 2008 and 2012 in Korea, those who were assessed for school readiness through questionnaires in a health screening program performed at 54 and 60 months old were enrolled. AD was defined based on the International Classification of Diseases codes, with two or more prescriptions of topical corticosteroids during the first 54-60 months of life. The primary outcome was the association between school readiness and AD. The questionnaire relating to school readiness comprised six items - cognitive skills, social development, activeness, concentration, emotional development, and language skills. Logistic regression analysis was used to identify the associations between school readiness and AD. RESULTS This study included 239,673 children without AD and 38,229 children with AD. The average age at which school readiness was assessed was 4.8 years. AD was associated with vulnerability in activeness (adjusted odds ratio: 1.127; 95% confidence interval: 1.071-1.186) and concentrations (1.170; 1.093-1.254). The impact of AD on concentrations showed consistent results regardless of sex, exposure to systemic corticosteroids and antihistamines, and age at the diagnosis of AD. CONCLUSIONS Children with AD have vulnerability in school readiness in the aspects of activeness and concentration.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sungkyunkwan University, Suwon, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jeewon Shin
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Won Seok Lee
- Department of Pediatrics, CHA Ilsan Medical Center, CHA University, Goyang, Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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17
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Wu PC, Wu CY, Lyu YS, Chang YT, Wu CY. Association between bullous pemphigoid and atopic dermatitis: a population-based case-control study in Taiwan. Arch Dermatol Res 2023; 315:419-427. [PMID: 35834038 DOI: 10.1007/s00403-022-02372-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/30/2022] [Accepted: 07/01/2022] [Indexed: 01/18/2023]
Abstract
Although bullous pemphigoid (BP) and atopic dermatitis (AD) share pathogenic mechanisms, their relationship remains controversial. Therefore, we conducted a population-based case-control study to investigate the association between BP and AD in Taiwan. Based on the Taiwan National Health Insurance Research Database, 9344 patients with BP and 18,688 age- and sex-matched controls were enrolled between 2000 and 2013. Furthermore, the study included 7,196 BP patients and 14,392 controls, matched for age, sex, and propensity score of comorbidities, with a case to controls ratio of 1:2. Logistic regression analysis was performed to examine the association between AD and BP. In the age- and sex-matched cohorts, AD (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.50-1.95) was independently associated with BP. In the age, sex, and comorbidities-matched cohorts, AD (OR 1.76, 95% CI 1.55-2.00) remained a significant risk factor for BP. Other significant risk factors included psoriasis, hypertension, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, neuropsychiatric diseases, and autoimmune connective tissue disease. Limitations of this study include the lack of information on disease severity and phenotypes of BP and misclassification of diseases as potential sources of bias. In conclusion, AD increased the risk of developing BP by 76%, and this association was independent of many BP comorbidities. Further studies are warranted to investigate the clinical and pathophysiological relevance of factors contributing to BP and AD.
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Affiliation(s)
- Po-Chien Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Chun-Ying Wu
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Ying-Syuan Lyu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Dermatology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Yi Wu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.
- Department of Dermatology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Public Health and Department of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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18
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Abstract
INTRODUCTION The relationship between atopic dermatitis and atopic diseases such as food allergies, asthma, and allergic rhinitis in terms of co-occurrence, underlying mechanisms, and therapy is well documented. There is increasing evidence that atopic dermatitis is associated with non-atopic comorbidities such as cardiac, autoimmune, and neuropsychological comorbidities, as well as cutaneous and extracutaneous infections, establishing atopic dermatitis as a systemic disease. AREAS COVERED The authors reviewed evidence on atopic and non-atopic comorbidities of atopic dermatitis. A literature search was conducted in PubMed for peer-reviewed articles published until October 2022. EXPERT OPINION Atopic and non-atopic diseases coexist with atopic dermatitis more often than would be expected by chance. The effect of biologics and small molecules on atopic and non-atopic comorbidities may contribute to a better understanding of the relationship between atopic dermatitis and its comorbidities. Their relationship needs to be explored further to dismantle the underlying mechanism and move toward an atopic dermatitis endotype-based therapeutic approach.
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Affiliation(s)
- Caroline Gewiss
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Ammoury A, Ameen A, El Sayed MH, Al-Khenaizan S, Hassan N, Ghoubar M. Patterns of Clinical Management of Atopic Dermatitis: A Survey of Three Physician Specialties in the Middle East. Dermatol Ther (Heidelb) 2023; 13:769-785. [PMID: 36750545 PMCID: PMC9984640 DOI: 10.1007/s13555-023-00891-6] [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: 10/12/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a complex inflammatory disease of the skin that has a significant impact on the well-being of patients and their families. The prevalence of AD has increased in developing countries and regions, including the Middle East. Despite similarities in the presentation of the disease, there is a lack of consistent management and treatment guidelines for AD. The objective of this survey was to develop further insight into the management patterns of AD from dermatologists, pediatricians, and primary care/family medicine physicians in the Middle Eastern nations of Egypt, Lebanon, the United Arab Emirates, and Saudi Arabia. METHODS The survey was composed of 47 closed-ended, multiple-choice questions. These questions assessed physician and patient characteristics and treatment familiarity and approach. RESULTS A total of 400 physicians, including 200 dermatologists, 100 pediatricians, and 100 primary care physicians, participated in the survey. The findings provide insight into the management of AD by physician specialty within the region. A diverse array of management approaches was observed for both referral patterns and treatments for AD in the Middle East. CONCLUSION The diversity of management tactics highlights the lack of a standard approach for the management of AD throughout the Middle East.
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Affiliation(s)
- Alfred Ammoury
- Division of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Ahmed Ameen
- NMC Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Mahira Hamdy El Sayed
- Department of Venereology and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sultan Al-Khenaizan
- Division of Dermatology, King Abdulaziz Medical City in Riyadh, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Marcelle Ghoubar
- Medical Affairs, Pfizer Gulf FZ LLC, Central Building, 2nd Floor, Sin El Fil, Beirut, Lebanon.
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20
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Cui H, Mu Z. Prenatal Maternal Risk Factors Contributing to Atopic Dermatitis: A Systematic Review and Meta-Analysis of Cohort Studies. Ann Dermatol 2023; 35:11-22. [PMID: 36750454 PMCID: PMC9905861 DOI: 10.5021/ad.21.268] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/06/2022] [Accepted: 10/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The gestational risk factors predispose to the manifestation of early childhood atopic dermatitis (AD). OBJECTIVE We evaluated the association between modifiable and non-modifiable gestational and prenatal risk factors that affect the AD prevalence in children. METHODS We performed the systematic review and meta-analysis of cohort studies (n=27) in PubMed and EMBASE (2000~2021). A meta-analysis was performed using random-effects models to estimate pooled odds ratios (OR) or hazard ratio (HR). We performed a systematic review according to Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines and summarized cohort studies investigating gestational and prenatal risk factor those predispose to AD in off spring. Leading modifiable and non-modifiable were identified through ORs. Meta-analysis using the random effect model was also conducted to provide an overall estimate for several significant factors. RESULTS Among the non-modifiable risk factors gestational diabetes (7.2, 95% confidence interval [CI]: 1.4~34.5), maternal history of allergy (2.14, 95% CI: 1.54~2.97) and prenatal history of eczema (2.46, 95% CI: 1.0~5.8) were found as major determining risk factors in early manifestation of AD in children. Further, maternal exposure to industrial products (1.89, 95% CI: 1.10~3.16), exposure to antibiotics during pregnancy (3.59, 95% CI: 1.19~10.85) and passive smoking during pregnancy (2.60, 95% CI: 1.11~6.1) are leading causes of early AD manifestation. CONCLUSION Conclusively, both genetic and environmental factors play a pivotal role in early manifestation of AD. The better managing the environmental factors during gestational phase to the least can help curtail the prevalence of AD in children.
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Affiliation(s)
- Hong Cui
- Department of Dermatology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
| | - Zhijuan Mu
- Department of Dermatology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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21
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Moreno A, Renert-Yuval Y, Guttman-Yassky E. Shedding light on key pharmacological knowledge and strategies for pediatric atopic dermatitis. Expert Rev Clin Pharmacol 2023; 16:119-131. [PMID: 36705936 PMCID: PMC9947941 DOI: 10.1080/17512433.2023.2173172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Atopic dermatitis (AD) is an inflammatory disease affecting over 20% of the pediatric population, with 85% of cases presenting before the age of five. Recently, therapeutic options in pediatric patients have evolved rapidly, following extensive development in adult treatments. AREAS COVERED This review will encompass relevant molecular drivers, along with an overlook on treatment modalities in pediatric AD, as well as a summary of pipeline treatments in clinical trials for pediatric patients from PubMed, Google Scholar, and Clinicaltrials.gov up to July 2022. Topical corticosteroids are the mainstay for AD flares in adults and children. Topical approved agents in pediatric AD are calcineurin inhibitors, crisaborolecrisaborole, and ruxolitinib. Dupilumab is the only FDA approved biologic for patients with AD from six months of age. A Janus kinase inhibitor, upadacitinib, is a systemic treatment approved for pediatric AD patients (age >12 years). Systemic immunosuppressants used in pediatric AD include methotrexate, azathioprine, cyclosporinecyclosporine, and mycophenolate mofetil. EXPERT OPINION Data regarding disease prevention are conflicting, however, an abundance of research has transpired regarding amelioration of symptoms and induction of disease clearance by targeting numerous pathological mechanisms. Understanding the pediatric AD phenotype will further advance the field and the development of improved therapeutics.
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Affiliation(s)
- Ariana Moreno
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Hedegaard Pliess Larsen H, Vittrup I, Frier Ruge I, Elberling J, Skov L, Ibler K, Borut Ernst Jemec G, Gotthard Mørtz C, Overgaard Bach R, Bindslev-Jensen C, Glud Dalager M, Agner T, Deleuran M, Vestergaard C, Pontoppidan Thyssen J. Severe and ChRonic Atopic dermatitis Treatment CoHort (SCRATCH): A Danish Real-world Evidence Atopic Dermatitis Treatment Registry. Acta Derm Venereol 2022; 102:adv00760. [DOI: 10.2340/actadv.v102.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Data from real-world use of new systemic treatments in atopic dermatitis (AD) is important for assessing safety and efficacy. The aim of this study is to describe the baseline characteristics of adult patients with moderate-to-severe AD enrolled in the Danish nationwide Severe and ChRonic Atopic dermatitis Treatment CoHort (SCRATCH) database, between October 2017 and August 2021. A total of 282 adult patients were included. Most (62%) were men, the median age at baseline was 43 years (interquartile range (IQR) 29–54 years), and median age at onset of AD was 1 year (IQR 0–6 years). The median Eczema Area and Severity Index at treatment initiation was 19.1 (IQR 11.9–25.7); median Patient Oriented Eczema Measure 21.0 (IQR 16.0–25.0); median Dermatology Life Quality Index 13.0 (IQR 7.0–19.0); and median itch and sleep numerical rating scale scores 8.0 (IQR 6.0–9.0) and 6.0 (IQR 4.0–8.0). Differences were found between the sexes. This registry will provide a source for future efficacy and safety studies.
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23
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Umborowati MA, Damayanti D, Anggraeni S, Endaryanto A, Surono IS, Effendy I, Prakoeswa CRS. The role of probiotics in the treatment of adult atopic dermatitis: a meta-analysis of randomized controlled trials. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:37. [PMID: 35978397 PMCID: PMC9386980 DOI: 10.1186/s41043-022-00318-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Atopic dermatitis (AD) is chronic inflammatory skin disease that is relapsing and a serious condition that disrupts the quality of life of affected individuals. Probiotics are an immunomodulator that can enhance the immune control of atopic dermatitis. Methods All randomized controlled trials of probiotics for the treatment of adult AD published before December 2020 were included in this study from the PubMed databases and manual searching. Results Six randomized controlled trials (n = 241) were selected for this meta-analysis study. Probiotics were effective in treating adult patients with AD, indicated by the decrease in Scoring Atopic Dermatitis/SCORAD (Mean Difference (MD) − 7.90, 95% CI − 7.25 to − 6.92; p < 0.00001; I2 = 96%) and improved quality of life (MD − 7.68, 95% CI − 14.08 to − 1.29; p = 0.02; I2 = 47%) which were statistically significant. However, skin severity, itch severity, Dermatology Life Quality Index (DLQI), IL-4, TFN-γ, and IgE showed no significant difference in this meta-analysis study (p > 0.05). Limitations The study found no available data for side effects of probiotics. Strength This meta-analysis analyzed a total of 241 AD patients of Asian and European origin. Conclusion The use of probiotics decreased SCORAD significantly in adult patients with AD. Probiotics can improve the quality of life of patients with AD. Capsule summary The use of probiotics in atopic dermatitis has been widely studied, with controversial results. This meta-analysis suggests that the use of probiotics can improve SCORAD and the quality of life of patients with atopic dermatitis.
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24
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Zhang Y, Heinemann N, Rademacher F, Darvin ME, Raab C, Keck CM, Vollert H, Fluhr JW, Gläser R, Harder J, Meinke MC. Skin Care Product Rich in Antioxidants and Anti-Inflammatory Natural Compounds Reduces Itching and Inflammation in the Skin of Atopic Dermatitis Patients. Antioxidants (Basel) 2022; 11:antiox11061071. [PMID: 35739968 PMCID: PMC9219975 DOI: 10.3390/antiox11061071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 01/29/2023] Open
Abstract
The atopic dermatitis (AD) complex pathogenesis mechanism reveals marked changes of certain signaling factors as well as some morphological alterations in the epidermis. Reduced resilience against environmental factors and oxidative stress often makes the treatment with corticosteroids or tacrolismus ointments indispensable. In view of the correlation between oxidative stress and AD pathological factors, antioxidants can be incorporated into AD management strategies. This study investigates a curly kale, apple and green tea-containing natural extract rich in antioxidants for its effects on signaling inflammatory molecules and skin barrier enhancement in human epidermal keratinocytes- (NHEKs) based cell assays. Furthermore, the skin penetration on porcine ears was measured ex vivo using Raman micro spectroscopy. Finally, in a double-blind half-side, placebo-controlled clinical study, the effects of a formulation containing this extract were analyzed for the influence of lesion severity, epidermal barrier function, and pruritus in mild to moderately AD patients. Summarizing our results: The extract reduces expression of inflammatory cytokines in keratinocytes and increases barrier-related molecules. The verum formulation with a very high antioxidant capacity used in AD patients with mild to moderate lesions reduces itching, local SCORAD, and improves barrier function and the hydration of skin lesions.
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Affiliation(s)
- Yu Zhang
- Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (Y.Z.); (M.E.D.); (C.R.); (J.W.F.)
| | - Nina Heinemann
- Department of Dermatology, Medical Faculty, Christian-Albrecht University Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (N.H.); (F.R.); (R.G.); (J.H.)
| | - Franziska Rademacher
- Department of Dermatology, Medical Faculty, Christian-Albrecht University Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (N.H.); (F.R.); (R.G.); (J.H.)
| | - Maxim E. Darvin
- Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (Y.Z.); (M.E.D.); (C.R.); (J.W.F.)
| | - Christian Raab
- Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (Y.Z.); (M.E.D.); (C.R.); (J.W.F.)
- Department of Pharmaceutics and Biopharmaceutics, Philipps-Universität Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany;
| | - Cornelia M. Keck
- Department of Pharmaceutics and Biopharmaceutics, Philipps-Universität Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany;
| | | | - Joachim W. Fluhr
- Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (Y.Z.); (M.E.D.); (C.R.); (J.W.F.)
- Institute of Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Regine Gläser
- Department of Dermatology, Medical Faculty, Christian-Albrecht University Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (N.H.); (F.R.); (R.G.); (J.H.)
| | - Jürgen Harder
- Department of Dermatology, Medical Faculty, Christian-Albrecht University Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany; (N.H.); (F.R.); (R.G.); (J.H.)
| | - Martina C. Meinke
- Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (Y.Z.); (M.E.D.); (C.R.); (J.W.F.)
- Correspondence: ; Tel.: +49-30-450-518244
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25
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Kalasin S, Sangnuang P, Surareungchai W. Intelligent Wearable Sensors Interconnected with Advanced Wound Dressing Bandages for Contactless Chronic Skin Monitoring: Artificial Intelligence for Predicting Tissue Regeneration. Anal Chem 2022; 94:6842-6852. [PMID: 35467846 DOI: 10.1021/acs.analchem.2c00782] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Toward the adoption of artificial intelligence-enabled wearable sensors interconnected with intelligent medical objects, this contactless multi-intelligent wearable technology provides a solution for healthcare to monitor hard-to-heal wounds and create optimal efficiencies for clinical professionals by minimizing the risk of disease infection. This article addressed a flexible artificial intelligence-guiding (FLEX-AI) wearable sensor that can be operated with a deep artificial neural network (deep ANN) algorithm for chronic wound monitoring via short-range communication toward a seamless, MXENE-attached, radio frequency-tuned, and wound dressing-integrated (SMART-WD) bandage. Based on a supervised training set of on-contact pH-responsive voltage output, the confusion matrix for healing-stage recognition from this deep ANN machine learning revealed an accuracy of 94.6% for the contactless measurement. The core analytical design of these smart bandages integrated wound dressing of poly(vinyl acrylic) gel@PANI/Cu2O NPs for instigating pH-responsive current during the wound healing process. Effectively, a chip-free bandage tag was fabricated with a capacitive Mxene/PTFE electret and adhesive acrylic inductance to match the resonance frequency generated by the intelligent wearable antenna. Under zero-current electrochemical potential, the wound dressing attained a slope of -76 mV/pH. With the higher activation voltage applied toward the wound dressing electrodes, cuprous ions intercalated more into the hybrid PVA gel/PANI shell, resulting in an exponential increase of the two-terminal current response. The healing phase diagram was classified into regimes of fast-curing, slow-curing, and no-curing for skin disease treatment with corticosteroids. Ultimately, the near-field sensing technology offers adequate information for guiding treatment decisions as well as drug effectiveness for wound care.
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Affiliation(s)
- Surachate Kalasin
- Faculty of Science and Nanoscience & Nanotechnology Graduate Program, King Mongkut's University of Technology Thonburi, 10140 Bangkok, Thailand
| | - Pantawan Sangnuang
- Pilot Plant Research and Development Laboratory, King Mongkut's University of Technology Thonburi, 10150 Bangkok, Thailand
| | - Werasak Surareungchai
- Pilot Plant Research and Development Laboratory, King Mongkut's University of Technology Thonburi, 10150 Bangkok, Thailand.,School of Bioresource and Technology, King Mongkut's University of Technology Thonburi, 10150 Bangkok, Thailand
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26
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Golding MA, Batac ALR, Gunnarsson NV, Ahlstedt S, Middelveld R, Protudjer JLP. The burden of food allergy on children and teens: A systematic review. Pediatr Allergy Immunol 2022; 33:e13743. [PMID: 35338731 DOI: 10.1111/pai.13743] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Over the last two decades, researchers have placed increasing attention on understanding how food allergy affects the health-related quality of life (HRQL) and psychosocial well-being of children and teens. In response, a number of reviews have been published that aim at synthesizing the literature. However, many of these papers focus narrowly on HRQL or suffer from methodological limitations. METHOD The current review aims to fill this gap by providing a comprehensive overview of the burden of pediatric food allergy by synthesizing the quantitative and qualitative literature. RESULTS Findings from the present review provide evidence of reduced HRQL among children and teens with food allergy, particularly older children and those with more severe manifestations of the condition. In comparison to HRQL, the link between food allergy and psychosocial functioning is less clear; however, some evidence can be cited linking food allergy to greater levels of psychological distress. Qualitative evidence suggests that the burden of pediatric food allergy largely stems from worries surrounding exposures outside of the home and the social consequences of the condition. The current review also highlights several gaps in the literature, including a paucity of longitudinal research, research focused on predictors of psychological distress among children and teens with food allergy as well as a dearth of studies comparing rates of bullying in food-allergic and non-food-allergic samples. CONCLUSION More emphasis should be placed on not only alleviating the social and psychological consequences of food allergy, but also on identifying and assisting those most acutely burdened by the condition.
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Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ayel L R Batac
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nina V Gunnarsson
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roelinde Middelveld
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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27
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Zhang J, Yang Y, Fu L, Jing D, Sun B, Chen Y, Chen J, Shen S. Short-term exposure of PM 2.5 and PM 10 increases the number of outpatients with eczema in Guangzhou: A time-series study. Front Public Health 2022; 10:930545. [PMID: 36895444 PMCID: PMC9989273 DOI: 10.3389/fpubh.2022.930545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/27/2022] [Indexed: 02/25/2023] Open
Abstract
Background The worldwide prevalence of eczema has continued to rise over the past decades. This has led to the emphasis on the association between air pollution and eczema. This study investigated the relationship between daily exposure to air pollution and the number of eczema outpatient visits in Guangzhou with the overarching goal of providing novel insights on the interventions for eczema aggravation and prevention. Methods Daily air pollution data, meteorological data, and the number of eczema outpatients were obtained from 18 January 2013 to 31 December 2018 in Guangzhou. A generalized additive model with Poisson distribution was used to assess the association between the number of eczema outpatient visits and short-term exposure to PM2.5 and PM10. In addition, the association of PM2.5 and PM10 by age (<65 years, ≥65 years) and gender was evaluated. Results A total of 293,343 eczema outpatient visits were recorded. The obtained results indicated that a 10 μg/m3 increase of the same day/lag 1 day/lag 2 days PM2.5 was associated with increments of 2.33%, 1.81%, and 0.95% in eczema outpatient risk, respectively. On the other hand, a 10 μg/m3 increase of PM10 was associated with eczema outpatients risk increments of 1.97%, 1.65%, and 0.98% respectively. Furthermore, the associations of PM on the increment of eczema were similar in the male and female groups. Results obtained after age stratified analyses indicated that the strongest positive association between PM2.5 exposure and eczema was observed at lag 0 day with the percent changes being 4.72% and 3.34% in <12 years old, ≥12 and <65 years old, and ≥65 years old groups, respectively. Conclusion Short-term exposure to PM2.5 and PM10 increases the number of eczema outpatients, especially among children and the elderly. The relationship between air quality trends and hospital resource arrangement should be paid attention to by hospital managers which may aid in disease prevention and lower the health burden.
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Affiliation(s)
- Ji Zhang
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yicheng Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Fu
- Graduate School of Peking Union Medical Chinese Academy of Medical Sciences Plastic Surgery Hospital, Beijing, China
| | - Dian Jing
- Department of Public Health, Southern Medical University, Guangzhou, China
| | - Bo Sun
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yilin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Junyi Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Shuqun Shen
- Dermatology Hospital, Southern Medical University, Guangzhou, China
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28
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Costanzo A, Amerio P, Asero R, Chiricozzi A, Corazza M, Cristaudo A, Cusano F, Ferrucci SM, Nettis E, Patrizi A, Patruno C, Peris K, Picozza M, Stingeni L, Girolomoni G. Long-term management of moderate-to-severe adult atopic dermatitis: a consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Association of Italian Territorial and Hospital Allergists and Immunologists (AAIITO ), the Italian Association of Hospital Dermatologists (ADOI), the Italian Society of Allergological, Environmental and Occupational Dermatology (SIDAPA), and the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Ital J Dermatol Venerol 2021; 157:1-12. [PMID: 34929995 DOI: 10.23736/s2784-8671.21.07129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atopic dermatitis (AD) is a common chronic-relapsing inflammatory skin disease, burdened by various comorbidities. AD most commonly occurs in children but may persist or present in adulthood becoming a lifelong condition. Therefore, AD requires an effective long-term treatment improving disease signs and symptoms but also of patients' quality of life (QoL). However continuous long-term use of most traditional AD immunosuppressive treatments is not recommended for safety reasons or insufficient efficacy data. Despite the available guidelines, there is still need for knowledge of AD long-term treatment, taking into account new disease measures and recent treatment options. Five Italian scientific societies implemented a joint consensus procedure to define the most appropriate clinical practice for the long-term management of adult moderate-severe AD. Through a modified Delphi procedure, consensus was reached by overall 51 Italian dermatologists and allergists (The Italian AD Study Group) experienced in the management of adult AD on 14 statements covering three AD areas of interest, namely diagnosis, definition of disease severity and clinimetrics, and a treat-to-target approach. This paper reports and discusses the agreed statements, which define disease and patient impact measures, therapeutic approach, and a treatment decision algorithm to support clinicians in the long-term management of adult patients with moderate-to-severe AD in their daily clinical practice.
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Affiliation(s)
- Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Paolo Amerio
- Unit of Dermatology, Department of Medicine and Aging Science, G. D'Annunzio University, Chieti, Chieti-Pescara, Italy
| | - Riccardo Asero
- Department of Allergology, San Carlo Clinic, Paderno Dugnano, Milan, Italy
| | - Andrea Chiricozzi
- Unit of Dermatology, Department of Surgical and Medical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Unit of Dermatology, Department of Medicine and Translational Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonio Cristaudo
- Department of Dermatology, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Francesco Cusano
- Unit of Dermatology, San Pio Hospital - G. Rummo Hospital, Benevento, Italy
| | - Silvia M Ferrucci
- Section of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, Aldo Moro University, Bari, Italy
| | - Annalisa Patrizi
- Dermatology of Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy - .,Unit of Dermatology, IRCCS S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Cataldo Patruno
- Department of Health Sciences, Magna Grecia University, Catanzaro, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Surgical and Medical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Unit of Dermatology, Department of Medicine and Translational Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Mario Picozza
- National Association of Atopic Dermatitis (ANDeA), Prato, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
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A Bibliometric Analysis of Atopic Dermatitis Research over the Past Three Decades and Future Perspectives. Healthcare (Basel) 2021; 9:healthcare9121749. [PMID: 34946474 PMCID: PMC8702046 DOI: 10.3390/healthcare9121749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022] Open
Abstract
Atopic dermatitis (AD) has been increasing in prevalence over the past few decades; however, AD has never been analyzed using a bibliometric approach. We searched for AD studies in the dermatology and allergy category of the Web of Science and SCOPUS databases using the keywords "atopic dermatitis", "eczema", and "atopy". In total, 53,460 documents were retrieved. We analyzed annual publication trends and performed keyword and co-authorship network analyses. The annual number of AD publications has increased over the years. Asthma, food allergies, the skin barrier, IgE, and epidemiology have received extensive attention. The keywords 'allergic rhinitis', 'child(ren)', 'quality of life', and 'probiotics' have become more commonly used in recent years. AD research has been led by only a few countries, such as the USA, Germany, and the UK, and longstanding research topics such as asthma, allergy, and the immune system continue to be important. We suggest that global collaborations, research in developing countries, and research that is more holistic (thus exploring how genes, the immune system, the environment, and the microbiome together impact AD) are necessary.
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Rajagopalan M, Chitkara AJ, Dalwai S, De A, Gulati R, Mukherjee S, Mutalik S, Sharma N, Shenoi S, Vaidya P, Tilak A, Adhav C. Burden of Disease, Unmet Needs in the Diagnosis and Management of Atopic Dermatitis: An Indian Expert Consensus. Clin Cosmet Investig Dermatol 2021; 14:1755-1765. [PMID: 34848986 PMCID: PMC8626844 DOI: 10.2147/ccid.s327593] [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: 07/02/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
Background Atopic dermatitis (AD) is a chronic inflammatory, non-communicable, and relapsing skin disease that affects all age groups. There is a dearth of literature that reports the disease burden, and epidemiology and highlights unmet needs in the diagnosis and management of AD in India. Methods A total of ten specialists including dermatologists, pediatric dermatologists, and pediatricians with more than ten years of experience and practicing in different parts of India served as the expert panel during the virtual meet conducted on January 24, 2021. A questionnaire comprising 32 questions on different aspects of AD management was categorized among different sections: burden of disease (five questions), age of onset and prevalence (five questions), etiology and pathogenesis (six questions), diagnosis and severity of the disease (seven questions), and treatment (nine questions). Consensus was defined when agreement was provided by ≥90% of the experts. Results Considering the profound impact AD has on the quality of life (QoL) of patients, the expert panel recommended patient counseling while moderate to severe cases of AD need a prompt referral to a specialist. The panel did not recommend any specific diagnostic and severity criteria as a standard due to the inherent limitations associated with every criterion. The role of environment and changing lifestyle in addition to genetic and familial risk factors for AD was also considered. The panel unanimously recommended to conduct a countrywide, multicenter survey/study to estimate the true prevalence of AD in India. Further, the experts recommended to follow proper treatment protocols and to perform longitudinal monitoring for understanding corticosteroid treatment associated side effects. Conclusion This guidance focuses on identifying the unmet gaps and provides practical recommendations for improving QoL, diagnosis, prognosis, and overall management of patients with AD in India.
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Affiliation(s)
| | - Amar Jeet Chitkara
- Department of Pediatrics, Max Super Specialty Hospital, Shalimar Bagh, Delhi, India
| | - Samir Dalwai
- New Horizons Child Development Center, Mumbai, Maharashtra, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | | | | | - Sharad Mutalik
- Department of Dermatology, Maharashtra Medical Foundation, Pune, Maharashtra, India
| | | | - Shrutakirthi Shenoi
- Department of Dermatology, Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India
| | - Prakash Vaidya
- Department of Pediatrics and Neonatology, Fortis Hospital, Mulund, Maharashtra, India
| | - Amod Tilak
- Pfizer India Ltd., Pfizer Biopharmaceuticals Group (Emerging Markets), Mumbai, India
| | - Charles Adhav
- Pfizer India Ltd., Pfizer Biopharmaceuticals Group (Emerging Markets), Mumbai, India
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Nagata A, Kazi T, Akter Z, Nody FA, Khan MS, Shahriar ASM, Islam MS, Nakagawa T, Inui S. The Influence of Atopic Dermatitis on Health-Related Quality of Life in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111593. [PMID: 34770105 PMCID: PMC8583474 DOI: 10.3390/ijerph182111593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis (AD) is the foremost non-fatal skin-related disease that affects all age groups. Despite the growing prevalence of AD in low- and middle-income countries, its physiological consequences remain overlooked in countries like Bangladesh. Therefore, we aim to assess and characterize the influence of AD on the health-related quality of life (HRQoL) in Bangladeshi patients. A cross-sectional study comprising 184 eligible adults (83 men and 101 women; mean age, 33.46 ± 15.44 years) was conducted at the dermatology outpatient department of Shaheed Suhrawardy Medical College Hospital (a tertiary hospital in Dhaka, Bangladesh). AD was determined using the UK Working Party criteria. A structured questionnaire, Eczema Area and Severity Index (EASI), and Dermatology Life Quality Index (DLQI) were administered to obtain information on patient characteristics, AD severity, and HRQoL. The mean DLQI score for the entire sample was 11.29 ± 5.27 (range, 1–26), and 51.60% reported the disease greatly affected their lives. Bivariate analysis revealed significant differences in self-rated health measures of DLQI scores in terms of self-reported AD severity, overall health, and the EASI. In multivariable regression models adjusted for patient characteristics, the self-perceived severe AD group reported significantly higher DLQI scores (coefficient = 2.72; 95% confidence interval (CI) = 0.38–5.05; p = 0.022) than the mild group. Concurrently, we observed a substantial increase in the DLQI scores among patients with moderate and severe EASI scores (coefficient = 1.96, 95% CI = 0.08–3.92, p < 0.05 and coefficient = 4.35, 95% CI = 1.98–6.72, p < 0.001, respectively) than in those with mild EASI scores, suggesting that HRQoL was markedly influenced by greater AD severity. These findings highlight the need for a more patient-centric approach to the management of AD in order to alleviate patient suffering and, thereby, improve HRQoL.
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Affiliation(s)
- Abir Nagata
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
- Correspondence: ; Tel.: +81-06-6879-3960
| | - Taheruzzaman Kazi
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
| | - Zubaida Akter
- Department of Dermatology and Venereology, Shaheed Suhrawardy Medical College Hospital, Dhaka 1207, Bangladesh;
| | - Fariha Afrin Nody
- Ibrahim Cardiac Hospital and Research Institute, Dhaka 1000, Bangladesh;
| | - Mohammad Shahriar Khan
- International Platform for Dryland Research and Education, Tottori University, Tottori 680-0001, Japan;
| | | | - Md Sayeedul Islam
- Department of Biological Sciences, Graduate School of Science, Osaka University, Toyonaka 560-0043, Japan;
| | - Takatoshi Nakagawa
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
| | - Shigeki Inui
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan; (T.K.); (T.N.); (S.I.)
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[Quality of care for patients with atopic dermatitis in Germany-no improvements in indicators after ten years]. Hautarzt 2021; 72:1079-1089. [PMID: 34542647 PMCID: PMC8613161 DOI: 10.1007/s00105-021-04885-3] [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] [Accepted: 08/03/2021] [Indexed: 11/12/2022]
Abstract
Hintergrund Mit AtopicHealth1 wurde 2010 die erste nationale Versorgungsstudie zur AD durchgeführt. Damals zeigte etwa ein Drittel der Patienten, die sich in einer Behandlung bei Dermatologen befanden, starke Einschränkungen der Lebensqualität, was auf eine unzureichende Versorgungsqualität hindeutete. Ziel der vorliegenden Studie war die Charakterisierung der aktuellen Versorgung von Patienten mit Neurodermitis in dermatologischer Behandlung im Schweregradvergleich sowie im Vergleich zu 2010 und zu Psoriasis. Methode Die deutschlandweite multizentrische Querschnittstudie „AtopicHealth2“ erfasste klinische Daten, Lebensqualität (DLQI), Therapien, präventives Verhalten und patientendefinierten Behandlungsnutzen (PBI). Patienten mit einer Indikation für Systemtherapie wurden für Subgruppenanalysen als mittelschwer bis schwer, die anderen als leicht betroffen angesehen. Ergebnisse Zwischen 2017 und 2019 wurden 1291 Patienten durch 111 Zentren eingeschlossen, mittleres Alter 41 Jahre, 56,5 % weiblich. Im Vergleich zu 2010 fanden sich keine Verbesserungen hinsichtlich Lebensqualität (jeweils DLQI 8,5), Schweregrad (SCORAD 45,4 vs. 42,3 in 2010) und Therapienutzen (PBI 2,2 vs. 2,4 in 2010). Mittelschwer bis schwer betroffene Patienten zeigten häufiger Lebensqualitätseinbuße (45,4 % vs. 23,6 %) und seltener relevante Therapienutzen (PBI < 1: 21,3 % vs. 13,2 %) als leichter betroffene. Verglichen mit Psoriasis offenbarten die Patienten mit Neurodermitis höhere Lebensqualitätseinschränkungen (DLQI 8,5 vs. 6,1) und einen geringeren Behandlungsnutzen (PBI 2,2 vs. 2,8). Diskussion Im Vergleich zu 2010 zeigt sich keine verbesserte Versorgungsqualität von Neurodermitis in Deutschland. Im Vergleich zur Psoriasis weisen Patienten mit Neurodermitis höhere Belastungen und geringere therapeutische Nutzen auf, was den Bedarf an therapeutischen Innovationen unterstreicht.
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Bruusgaard-Mouritsen MA, Garvey LH, Johansen JD. Facial contact dermatitis caused by cosmetic-relevant allergens. Contact Dermatitis 2021; 85:650-659. [PMID: 34482547 DOI: 10.1111/cod.13966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Facial allergic contact dermatitis caused by cosmetic products is common. New allergens in cosmetics continuously emerge. OBJECTIVES To investigate characteristics of patients with facial dermatitis (FD) between 2010 and 2019 including patch test results from cosmetic-related allergens and a new test series with cosmetic-relevant natural ingredients (CRNIs). METHODS This is a retrospective study analysing demographics, clinical characteristics according to MOAHLFA index (male; occupation; atopic dermatitis; hand; leg; face; age ≥ 40 years), and patch test results to 27 cosmetic-relevant allergens in FD patients. A prospective study evaluating a screening test series with CRNIs in consecutive FD patients for 1 year was also conducted. These patients received a questionnaire for collecting extra characteristics (eg, concerning quality of life). RESULTS Of 8740 tested patients, 2292 (26.2%) had FD. Of these, 30.6% had cosmetic-induced FD. The most common cosmetic-related allergens were fragrances and preservatives. The most common patch test-positive CRNIs were hydroperoxides of limonene and linalool, and propolis. Potato and peanut were rare, but the most common prick test-positive CRNIs, however, without any relation to the use of cosmetic products. FD affected nearly all patients' quality of life and caused limitations to their daily life. CONCLUSIONS Updated management and quick diagnosis of FD is important to avoid negative impact on patients' quality of life.
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Affiliation(s)
- Maria A Bruusgaard-Mouritsen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Hellerup, Denmark
| | - Jeanne D Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Theunis J, Nordon C, Falissard B, Orri M, Mengeaud V, Misery L. Development and preliminary validation of the patient-reported Chronic Itch Burden Scale assessing health-related quality of life in chronic pruritus. Br J Dermatol 2021; 186:86-95. [PMID: 34128535 DOI: 10.1111/bjd.20582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chronic pruritus (CP) significantly affects patients' health-related quality of life (HRQoL). Very few self-reported HRQoL questionnaires exploring CP have been developed according to international guidelines, thus limiting their use in preauthorization trials. OBJECTIVES To develop a self-reported HRQoL questionnaire in patients with CP owing to psoriasis, atopic dermatitis, seborrhoeic dermatitis of the scalp or idiopathic dermatitis, and to explore the preliminary psychometric properties of the questionnaire. METHODS The study was performed in France. A conceptual framework was developed based on a structured literature review and expert insight, and was improved using three focus groups involving 19 participants. A 50-item questionnaire was created and tested with 21 participants using cognitive debriefings; 11 items were removed. A cross-sectional study including 251 participants was performed to explore the preliminary psychometric properties of the 39-item questionnaire. Dimensionality was explored using principal component analysis. Cronbach's alpha and correlation coefficients (interitem, item-total score and item-dimension score) were measured. The number of items was reduced through expert consensus. RESULTS In the 39-item version, three main dimensions were identified (Cronbach's alpha = 0·94) and all correlation coefficients were > 0·34. Upon review, 13 items were deleted owing to poor quality and six items were deleted by the team, generating a 20-item version. The questionnaire's factorial structure was best reflected with a two-dimension solution, i.e. (i) social and emotional repercussions and (ii) relation to others, fear of judgement. CONCLUSIONS The Chronic Itch Burden Scale patient-reported questionnaire explores broad aspects of HRQoL that are relevant for patients with various skin diseases. Its good cross-sectional validity makes it useful for trials and practitioners.
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Affiliation(s)
- J Theunis
- Pierre Fabre Dermo-Cosmetique Skin Research Center, 2 rue Viguerie BP 3071, 31025, Toulouse, Cedex 3, France
| | - C Nordon
- LASER Core, 3 rue de l'Arrivée, 75015, Paris, France
| | - B Falissard
- Inserm unit 1018, University of Paris and Paris-Saclay University, Maison de Solenn 97 boulevard de Port Royal, 75679, Paris, France
| | - M Orri
- Inserm unit 1018, University of Paris and Paris-Saclay University, Maison de Solenn 97 boulevard de Port Royal, 75679, Paris, France
| | - V Mengeaud
- Ducray Pierre Fabre, Les Cauquillous, F-81506, Lavaur Cedex, France
| | - L Misery
- Univ Brest, LIEN and University Hospital of Brest Department of Dermatology, 2 avenue Foch, F-29200, Brest, France
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A Qualitative Analysis of Provider Notes of Atopic Dermatitis-Related Visits Using Natural Language Processing Methods. Dermatol Ther (Heidelb) 2021; 11:1305-1318. [PMID: 34056694 PMCID: PMC8322369 DOI: 10.1007/s13555-021-00553-5] [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: 04/09/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Real-world disease management of atopic dermatitis (AD) is hampered by a lack of consistency between providers that treat AD regarding assessment of severity, disease activity, and quality of life. Variability and inconsistency in documentation makes it difficult to understand the impact of AD. This study summarizes AD-related symptoms and concerns captured in unstructured qualitative provider notes by healthcare providers during visits with patients with AD. Methods Provider notes were obtained for patients with AD (n = 133,025) from a USA-based ambulatory electronic health records system. The sample included both children (n = 69,551) and adults at least 18 years of age (n = 63,474) receiving treatment from a variety of specialties including primary care, dermatology, and allergy/immunology. Key skin-related words were identified from a review of a sample of notes and natural language processing (NLP) was applied to determine the frequency of the keywords and bigram patterns. Results Provider notes largely focused on symptoms (primarily itch) and symptom relief rather than the impact of AD on work or lifestyle. Despite the known relationship between itch and skin pain, neuralgia was not widely documented. Compared to primary care providers, dermatologists’ and allergist/immunologists’ notes had more documentation of symptom-related issues. Personal and work/life burden issues were not widely documented regardless of specialty. Conclusion The topics documented in case notes by healthcare providers about their patients with AD focus largely on symptoms and, to a lesser extent, treatment, but do not reflect the burden of AD on patients’ lives. This finding highlights a potential care gap that warrants further investigation.
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Glabridin attenuates atopic dermatitis progression through downregulating the TLR4/MyD88/NF-κB signaling pathway. Genes Genomics 2021; 43:847-855. [PMID: 34021857 DOI: 10.1007/s13258-021-01081-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/06/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glabridin (GB), a bio-available phytoestrogen, displays various biological properties such as anti-inflammatory, antibacterial, and antiviral. OBJECTIVE To explore the role of GB in the process of atopic dermatitis (AD). METHODS CCK8 was used to detect the therapeutic effect of Glabridin in HaCat and NHEK cell inflammatory models. And evaluated the effect on cell proliferation and cell viability. The expression of TLR4, MyD88, P65 and P50 in HaCat and NHEK cell tissues was detected by qRT-PCR and PCR. At the same time, an AD animal model was constructed, and the cell experiment results were verified by hematoxylin-eosin (HE) and Immunohistochemistry staining (IHC). RESULTS Enzyme-linked immunosorbent assay (ELISA) demonstrated that IL-1β, IL-6, and TNF-α upregulated by lipopolysaccharide (LPS) was decreased by treatment with GB. AD progression was further confirmed to be regulated by GB by inhibiting the TLR4/MyD88/NF-κB signaling pathway through real-time PCR and Western blot analyses. An AD-like mouse model demonstrated that GB considerably alleviated epidermal injury, relieve edema, and reduced inflammatory cell infiltration by H&E staining. Concurrently, IHC staining exhibited GB to reduce AD progression by impeding TLR4 expression. CONCLUSION GB was observed to decrease the AD progression by suppressing the TLR4/MyD88/NF-κB signaling pathway, which may likely serve as a novel therapeutic drug for AD management.
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Butt M, Khesroh E, Simmers J, Rogers AM, Helm MF, Rigby A. Evaluating the need for dermatological care in a postsurgical bariatric sample. Surg Obes Relat Dis 2021; 17:1302-1309. [PMID: 33952428 DOI: 10.1016/j.soard.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bariatric surgery rates are increasing in tandem with obesity in the United States. patients after surgery bariatric can lose up to or more than one-third of their excess weight within the first year. This sudden loss of weight can lead to skin redundancy and increased susceptibility to dermatological issues. There is a paucity of literature addressing the issue of skin redundancy and associated factors following bariatric surgery. OBJECTIVES To evaluate the prevalence and severity of dermatological concerns among postbariatric surgery patients and assess the impact of these issues on patients' quality of life. SETTING Surgical Weight Loss Clinic at an academic medical center in south-central Pennsylvania. METHODS A cross-sectional survey was administered from September 9 to November 30, 2020 to adult postoperative patients. Data were collected via self-report questionnaires with a retest issued approximately 72 hours later. The survey included questions regarding occurrences of skin disturbances and the Dermatology Life Quality Index. All analyses were conducted using SAS version 9.4. RESULTS A total of 575 patients were invited to participate, with 103 participating and 69 completing the retest. The health questionnaire indicated that 69.6% of patients had challenges with skin rashes or irritation due to loose skin; 80.6% were interested in having skin removal surgery; and only 5.8% were referred to a dermatologist for their concerns. CONCLUSION The presence of skin concerns was associated with impaired HRQOL among postbariatric patients. This suggests a need to further educate the bariatric interdisciplinary team to evaluate the impacts of skin pathology on postbariatric patients.
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Affiliation(s)
- Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Eiman Khesroh
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jocelyn Simmers
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ann M Rogers
- Department of Surgery, Division of Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew F Helm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrea Rigby
- Department of Surgery, Division of Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Dai YX, Tai YH, Chang YT, Chen TJ, Chen MH. Bidirectional Association between Psoriasis and Atopic Dermatitis: A Nationwide Population-Based Cohort Study. Dermatology 2021; 237:521-527. [PMID: 33735855 DOI: 10.1159/000514581] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There have been some reports on the coexistence of psoriasis and atopic dermatitis; however, the longitudinal relationship between these two diseases remains unclear. OBJECTIVE This study aimed to investigate the bidirectional association between psoriasis and atopic dermatitis. METHODS This cohort study recruited patients from the National Health Insurance Research Database in Taiwan. We included 8,206 patients with psoriasis and 32,824 matched controls to assess the risk of atopic dermatitis and 25,743 patients with atopic dermatitis and 102,972 matched controls to assess the risk of psoriasis. Cox regression model was used for the analyses. RESULTS After adjusting for potential confounders, patients with psoriasis had a higher risk of atopic dermatitis (adjusted hazard ratio [aHR] 13.01; 95% CI 10.23-16.56) than the controls. Patients with atopic dermatitis had a higher risk of psoriasis (aHR 10.37; 95% CI 6.85-15.69) than the controls. Stratified analyses revealed similar results in both sexes and all age groups. CONCLUSION Our study demonstrated a bidirectional association between psoriasis and atopic dermatitis, suggesting that psoriasis and atopic dermatitis are not mutually exclusive and may share some biological mechanisms.
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Affiliation(s)
- Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, .,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,
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Ogonowska P, Gilaberte Y, Barańska-Rybak W, Nakonieczna J. Colonization With Staphylococcus aureus in Atopic Dermatitis Patients: Attempts to Reveal the Unknown. Front Microbiol 2021; 11:567090. [PMID: 33505363 PMCID: PMC7830525 DOI: 10.3389/fmicb.2020.567090] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
Atopic dermatitis (AD) patients are massively colonized with Staphylococcus aureus (S. aureus) in lesional and non-lesional skin. A skin infection may become systemic if left untreated. Of interest, the incidence of multi-drug resistant S. aureus (MRSA) in AD patients is higher as compared to a healthy population, which makes treatment even more challenging. Information on the specific genetic background of S. aureus accompanying and/or causing AD flares would be of great importance in terms of possible treatment option development. In this review, we summarized the data on the prevalence of S. aureus in general in AD skin, and the prevalence of specific clones that might be associated with flares of eczema. We put our special interest in the presence and role of staphylococcal enterotoxins as important virulence factors in the epidemiology of AD-derived S. aureus. Also, we summarize the present and potentially useful future anti-staphylococcal treatment.
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Affiliation(s)
- Patrycja Ogonowska
- Laboratory of Molecular Diagnostics, Intercollegiate Faculty of Biotechnology University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Yolanda Gilaberte
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Joanna Nakonieczna
- Laboratory of Molecular Diagnostics, Intercollegiate Faculty of Biotechnology University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
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Kannenberg SM, Karabus S, Visser WI, Aboobaker J, Kriel MM, Levin M, Magigaba B, Manjra A, Misra R, Mpofu P, Tshigabe A, Luger T. Paediatric atopic eczema (atopic dermatitis) in South Africa: A practical algorithm for the management of mild-to-moderate disease in daily clinical practice. S Afr Fam Pract (2004) 2020; 62:e1-e9. [PMID: 33314940 PMCID: PMC8377852 DOI: 10.4102/safp.v62i1.5190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background Atopic eczema (AE) is a chronic, highly pruritic, inflammatory skin condition with increasing prevalence worldwide. Atopic eczema mostly affects children, impairing quality of life with poor disease control leading to progression of other atopic disorders. As most patients in South Africa have no access to specialist healthcare, a practical approach is needed for the management of mild-to-moderate AE in paediatric patients for daily clinical practice. Methods A panel of experts in AE convened to develop a practical algorithm for the management of AE for children and adolescents in South Africa. Results Regular moisturising with an oil-based emollient remains the mainstay of AE treatment. Severe AE flares should be managed with topical corticosteroids (TCSs). For mild-to-moderate AE flares in sensitive skin areas, a topical calcineurin inhibitor (TCI) should be applied twice daily from the first signs of AE until complete resolution. Topical corticosteroids may be used when TCIs are unavailable. In non-sensitive skin areas, TCSs should be used for mild-to-moderate AE, but TCIs twice daily may be considered. Proactive maintenance treatment with low-dose TCI or TCS 2–3 times weekly and the liberal use of emollients is recommended for patients with recurrent flares. Conclusions This algorithm aims to simplify treatment of paediatric AE, optimising clinical outcomes and reducing disease burden. This approach excludes treatment of patients with severe AE, who should be referred to specialist care. Emphasis has been given to the importance of general skincare, patient education and the topical anti-inflammatory medications available in South Africa (TCSs and TCIs).
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Affiliation(s)
- Susanna M Kannenberg
- Division of Dermatology, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town.
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Prakoeswa CRS, Bonita L, Karim A, Herwanto N, Umborowati MA, Setyaningrum T, Hidayati AN, Surono IS. Beneficial effect of Lactobacillus plantarum IS-10506 supplementation in adults with atopic dermatitis: a randomized controlled trial. J DERMATOL TREAT 2020; 33:1491-1498. [PMID: 33040631 DOI: 10.1080/09546634.2020.1836310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although the therapeutic effects of probiotics in atopic dermatitis (AD) are known, the limited findings in adults are inconsistent. Lactobacillus plantarum (LP) IS-10506 was found to improve AD symptoms due to its immunomodulatory effects. OBJECTIVE To assess the Scoring Atopic Dermatitis Index (SCORAD), the serum immunoglobulin E (IgE), interleukin (IL)-4, interferon-gamma (IFN-γ), forkhead box P3 (Foxp3+), and IL-17 levels in adults with mild and moderate AD after LP IS-10506 supplementation. METHODS A randomized double-blind placebo-controlled trial comparing the microencapsulated probiotic (2 × 1010 CFU/day) and placebo (skim milk-Avicel) was conducted at an outpatient clinic on 30 adults with mild and moderate AD. The patients were divided into 2 groups with 15 patients each: intervention and control. RESULT The SCORAD score was significantly lower in the probiotic than the placebo group on the 8th week. The IL-4 and IL-17 levels were significantly lower in the probiotic than the placebo group. The IFN-γ and Foxp3+ levels were significantly higher in the probiotic than the placebo group. However, the IgE levels remained significantly unchanged. CONCLUSION The administration of LP IS-10506 is effective for alleviating AD symptoms in adults owing to its immunomodulatory effects.
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Affiliation(s)
- C R S Prakoeswa
- Faculty of Medicine, Department of Dermatology and Venereology, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - L Bonita
- Faculty of Medicine, Department of Dermatology and Venereology, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - A Karim
- Faculty of Medicine, Department of Dermatology and Venereology, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - N Herwanto
- Faculty of Medicine, Department of Dermatology and Venereology, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - M A Umborowati
- Faculty of Medicine, Department of Dermatology and Venereology, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - T Setyaningrum
- Faculty of Medicine, Department of Dermatology and Venereology, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - A N Hidayati
- Faculty of Medicine, Department of Dermatology and Venereology, Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - I S Surono
- Faculty of Engineering, Food Technology Department, Bina Nusantara University, Jakarta, Indonesia
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Ng YT, Chew FT. A systematic review and meta-analysis of risk factors associated with atopic dermatitis in Asia. World Allergy Organ J 2020; 13:100477. [PMID: 33204388 PMCID: PMC7645284 DOI: 10.1016/j.waojou.2020.100477] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/01/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterised by intense itch and eczematous lesions. Rising prevalence of AD has been observed worldwide including in Asia. Understanding the risk factors associated with AD may explain its pathogenicity and identify new preventive strategies and treatments. However, AD-associated risk factors and comorbidities specific to Asia have not been systematically reviewed. Methods We performed a systematic review in accordance with the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines and summarised epidemiological studies investigating personal, family, and environmental factors and comorbidities associated with AD in Asia. Significant factors were assessed if they can be altered through lifestyle practices and further classified into non-modifiable and modifiable factors. Meta-analysis using the random-effect model was also conducted to provide an overall estimate for several significant factors. Results We identified a total of 162 epidemiological studies conducted in Asia. Among non-modifiable factors, a family history of atopic diseases was the most reported, suggesting the involvement of genetics in AD pathogenesis. Among modifiable factors, the results of meta-analyses revealed maternal smoking as the strongest risk factor with a pooled odds ratio (OR) of 2.95 (95% CI, 2.43-3.60), followed by active smoking (pooled OR, 1.91, 95% CI, 1.41-2.59). Conclusion While a family history may aid clinicians in identifying high-risk individuals, literature has long suggested the importance of gene-environment interaction. This review identified several modifiable factors including medical treatments, indoor and outdoor environmental exposure, and personal and family lifestyle specific to Asia. Based on the meta-analyses performed, prevention strategies against AD may start from changing personal and family lifestyle choices, especially smoking habits.
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Key Words
- AD, atopic dermatitis
- Asia
- Atopic dermatitis
- CI, Confidence interval
- Eczema
- FLG, Filaggrin
- HR, Hazard ratio
- I2, Inconsistency index
- ISAAC, International Study of Asthma and Allergies in Childhood
- NO2, nitrogen dioxide
- OR, Odds ratio
- PR, Prevalence ratio
- PRISMA, Preferred Reporting Item for Systematic Review and Meta-Analyses
- PUFAs, polyunsaturated fatty acids
- RR, Relative risk
- Risk factors
- TCM, traditional chinese medicine
- Th, T helper cell
- VOCs, Volatile organic compounds
- p, p-value
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Affiliation(s)
- Yu Ting Ng
- Department of Biological Sciences, National University of Singapore, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, National University of Singapore, Singapore
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Heratizadeh A, Haufe E, Stölzl D, Abraham S, Heinrich L, Kleinheinz A, Wollenberg A, Weisshaar E, Augustin M, Wiemers F, Zink A, von Kiedrowski R, Hilgers M, Worm M, Pawlak M, Sticherling M, Fell I, Handrick C, Schäkel K, Staubach-Renz P, Asmussen A, Schwarz B, Bell M, Effendy I, Bieber T, Homey B, Gerlach B, Tchitcherina E, Stahl M, Schwichtenberg U, Rossbacher J, Buck P, Mempel M, Beissert S, Biedermann T, Weidinger S, Schmitt J, Werfel T. Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD Registry TREATgermany. J Eur Acad Dermatol Venereol 2020; 34:1263-1272. [PMID: 31721316 DOI: 10.1111/jdv.16078] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/17/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the 'real-life' situation of health care for patients with AD. OBJECTIVES Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients. METHODS Patients (≥18 years) with moderate-to-severe AD [objective (o)SCORAD > 20], or with current or previous anti-inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0-72), the oSCORAD (0-83) and the Investigator Global Assessment (IGA; 6-point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six-step Likert scale]. Disease symptoms were assessed by the patient-oriented eczema measure (POEM, 0-28) and numeric rating scales (NRS, 0-10). Health-related quality of life was measured using the dermatological life quality index (DLQI, 0-30). RESULTS A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either 'current' (12.1%) or 'prescribed' (31.4%) at baseline. CONCLUSIONS These 'real-life' data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate-to-severe AD.
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Affiliation(s)
- A Heratizadeh
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - E Haufe
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - D Stölzl
- Department of Dermatology and Allergy, Center for Inflammatory Skin Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S Abraham
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - L Heinrich
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - A Kleinheinz
- Clinics for Dermatology, Elbe Klinikum Buxtehude, Buxtehude, Germany
| | - A Wollenberg
- Clinics and Outpatient Clinics for Dermatology and Allergy, LMU Munich, Munich, Germany
| | - E Weisshaar
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Augustin
- Insitute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Wiemers
- Practice Dr. med. Franca Wiemers, Leipzig, Germany
| | - A Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Munich, Germany
| | - R von Kiedrowski
- CMSS - Company for Medical Study and Service, Selters/Westerwald, Germany
| | - M Hilgers
- Clinics for Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
| | - M Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Pawlak
- Practice Dr. med. Anika Hünermund and Mario Pawlak, Heilbad Heiligenstadt, Germany
| | - M Sticherling
- Department of Dermatology, University Hospital, Friedrich Alexander University Erlangen-Nurnberg, Erlangen, Germany
| | - I Fell
- Hautmedizin Bad Soden, Bad Soden, Germany
| | - C Handrick
- Practice Dr. med. Christiane Handrick, Berlin, Germany
| | - K Schäkel
- Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - P Staubach-Renz
- Department of Dermatology and Allergy, University Medical Center Mainz, Mainz, Germany
| | - A Asmussen
- Practice Dermatologie an der Lesum, Bremen, Germany
| | - B Schwarz
- Practice Dr. med. Beate Schwarz, Langenau, Germany
| | - M Bell
- Practice Dr. Magnus Bell, Thomas Kaiser, Andernach, Germany
| | - I Effendy
- Department of Dermatology, Hospital Rosenhoehe, Bielefeld, Germany
| | - T Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - B Homey
- Department of Dermatology, Heinrich-Heine-University Duesseldorf, Düsseldorf, Germany
| | - B Gerlach
- Practice Dr. med. Beatrice Gerlach, Dresden, Germany
| | - E Tchitcherina
- Practice Dr. med. Ekaterina Tchitcherina, Friedberg/Hessen, Germany
| | - M Stahl
- Practice Dr. med. Maren Stahl, Osterode, Germany
| | | | | | - P Buck
- Goldbek Medical, Hamburg, Germany
| | - M Mempel
- Practice Prof. Dr. med. Martin Mempel, Elmshorn, Germany
| | - S Beissert
- Department of Dermatology, University Allergy Center, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - T Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Munich, Germany
| | - S Weidinger
- Department of Dermatology and Allergy, Center for Inflammatory Skin Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Schmitt
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
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Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Ong PY, Chiesa Fuxench ZC, Simpson EL. Validation and Interpretation of Short Form 12 and Comparison with Dermatology Life Quality Index in Atopic Dermatitis in Adults. J Invest Dermatol 2019; 139:2090-2097.e3. [DOI: 10.1016/j.jid.2019.03.1152] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/07/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
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[Health-related quality of life and its relation to chronic diseases and mental health problems among children and adolescents : Results from KiGGS Wave 2]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1205-1214. [PMID: 31529184 DOI: 10.1007/s00103-019-03006-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is increasingly established as an indicator for the subjective health of children and adolescents. The aim of this study was to describe the current HRQoL among children and adolescents in Germany aged between 11 and 17 years taking into account common chronic diseases (bronchial asthma, atopic dermatitis, obesity, ADHD) and mental health problems. METHODS The analysis is based on information obtained from 6,599 children and adolescents (51.9% girls; 48.1% boys) from KiGGS Wave 2 (2014-2017). HRQoL was measured with the multidimensional KIDSCREEN-27. The chronic diseases and mental health problems under investigation were assessed by several indicators. RESULTS Differences in HRQoL could be found as a function of age and gender. The HRQoL among girls was lower at an older age across all dimensions. These age-related differences are less pronounced among boys. The HRQoL of children and adolescents with chronic diseases and mental health problems was lower compared to their healthy peer groups. The comparison of the investigated chronic diseases and mental health problems revealed significant differences. Particularly, HRQoL was lower for children and adolescents with obesity and mental health problems. DISCUSSION The distinction of several dimensions of HRQoL allows a comprehensive understanding of age- and gender-related effects and provides a detailed assessment of the impact of chronic diseases and mental health problems. The present findings underline the importance of HRQoL as an indicator for the subjective health of children and adolescents.
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The Complexity of Pruritus Requires a Variety of Treatment Strategies. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ring J, Zink A, Arents BWM, Seitz IA, Mensing U, Schielein MC, Wettemann N, de Carlo G, Fink-Wagner A. Atopic eczema: burden of disease and individual suffering - results from a large EU study in adults. J Eur Acad Dermatol Venereol 2019; 33:1331-1340. [PMID: 31002197 DOI: 10.1111/jdv.15634] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atopic eczema (AE, atopic dermatitis) is one of the most common non-communicable inflammatory skin diseases affecting 1-5% of the adult population in Europe with marked impairment in quality of life. In spite of great progress in understanding the pathophysiology of disturbed skin barrier and immune deviation, AE still represents a problem in daily clinical practice. Furthermore, the true impact of AE on individual suffering is often not recognized. OBJECTIVES With a large European study, we wanted to provide insights into the actual suffering and individual burden of disease in adult patients with AE. METHODS A total of 1189 adult patients (18-87 years, 56% female) with moderate to severe AE were recruited in nine European countries by dermatologists or allergists together with the help of patient organizations. A computer-assisted telephone interview was performed by experienced interviewers between October 2017 and March 2018. The following instruments were used to assess severity or measure quality of life: Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS-D) and a newly developed Atopic Eczema Score of Emotional Consequences (AESEC). Patients were also asked to self-assess the severity of their disease. RESULTS Despite current treatment, 45% of participants still had actual moderate to very severe AE in POEM. Due to their skin disease, 57% missed at least 1 day of work in the preceding year. DLQI showed moderate to extremely large impairment in 55%. According to HADS-D, 10% scored on or above the threshold of eight points with signs of depressive symptoms. Assessed with AESEC, 57% were emotionally burdened with feelings such as 'trying to hide the eczema', 'feeling guilty about eczema', having 'problems with intimacy' and more. Of persons actually suffering from severe AE, 88% stated that their AE at least partly compromised their ability to face life. CONCLUSIONS This real-life study shows that adults with a moderate to severe form of AE are suffering more than what would be deemed acceptable. There is a need for increased awareness of this problem among healthcare professionals, policymakers and the general public to support research in the development of new and more effective treatments and provide access to better and affordable health care for affected patients.
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Affiliation(s)
- J Ring
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.,Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - B W M Arents
- European Federation of Allergy and Airway Diseases Patient's Associations, Brussels, Belgium
| | | | | | - M C Schielein
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | | | - G de Carlo
- European Federation of Allergy and Airway Diseases Patient's Associations, Brussels, Belgium
| | - A Fink-Wagner
- European Federation of Allergy and Airway Diseases Patient's Associations, Brussels, Belgium
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Langan TJ, Barczykowski A, Jalal K, Sherwood L, Allewelt H, Kurtzberg J, Carter RL. Survey of quality of life, phenotypic expression, and response to treatment in Krabbe leukodystrophy. JIMD Rep 2019; 47:47-54. [PMID: 31240167 PMCID: PMC6498827 DOI: 10.1002/jmd2.12033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/27/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To develop a quality of life (QOL) survey for Krabbe disease (KD), and to thereby improve understanding of its phenotypic expression and response to treatment. METHODS The survey, the Leukodystrophy Quality of Life Assessment (LQLA) and the Vineland Adaptive Behavior Scales were co-administered to 33 patients or their caretakers. These included the phenotypes of early infantile KD (EIKD; 0-6 months old at onset), late infantile cases (LIKD; 7-12 months old at onset), and cases that emerged after 12 months old, late onset (LOKD). The sample included cases with and without stem cell transplantation (SCT). Reliability and concurrent validity were assessed for overall and subscale scores. Analysis of variance tested differences in QOL between phenotypes and transplant groups (none, pre-, post-symptom). RESULTS Good concurrent validity with the Vineland was shown for total, communication, daily activity, social, and motor scales and good reliability was observed. LOKD cases had better communication skills than either EIKD or LIKD and better overall QOL than EIKD. Analyses of individual items showed that communication items, mostly, contributed significantly to phenotype differences. Presymptomatic SCT significantly improved QOL compared to postsymptomatic SCT or no treatment. Presymptomatically treated patients had near-normal total scores. CONCLUSIONS The LQLA is valid and reliable. Despite small sample size, phenotypic demarcation was determined to be due mainly to differences in communication skills. There was a relative enhancement of QOL in LOKD patients, and in those who had presymptomatic SCT. These results apply to the current controversy about recommendations for newborn screening for this condition.
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Affiliation(s)
- Thomas J. Langan
- Department of Neurology, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew York
| | - Amy Barczykowski
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Kabir Jalal
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Laura Sherwood
- Department of Neurology, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew York
| | - Heather Allewelt
- Department of PediatricsDuke University School of MedicineDurhamNorth Carolina
| | - Joanne Kurtzberg
- Department of PediatricsDuke University School of MedicineDurhamNorth Carolina
| | - Randy L. Carter
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
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Koster ES, Philbert D, Wagelaar KR, Galle S, Bouvy ML. Optimizing pharmaceutical care for pediatric patients with dermatitis: perspectives of parents and pharmacy staff. Int J Clin Pharm 2019; 41:711-718. [PMID: 31020600 PMCID: PMC6554263 DOI: 10.1007/s11096-019-00827-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 04/10/2019] [Indexed: 12/20/2022]
Abstract
Background Atopic dermatitis affects 10–20% of the children worldwide. Unfortunately not all patients who receive treatment have optimal treatment outcomes. Objective To assess the view of parents and pharmacy staff in order to optimize pharmaceutical care for young atopic dermatitis patients. Setting Community pharmacies in the Netherlands. Method We first held an expert panel meeting to determine experts’ views on treatment of atopic dermatitis and their suggestions for areas of improvement. This input was used to develop the interview guide. We conducted telephone interviews with parents of children (aged 0–12 years) with atopic dermatitis and face-to-face interviews with pharmacy staff members. All interviews were audiotaped and transcribed verbatim. Transcripts were coded using qualitative data analysis software. Codes were used to identify themes. Main outcome measure Perspectives of parents of young atopic dermatitis patients and pharmacy staff about treatment. Results We interviewed 29 parents and 18 pharmacy staff members. Many parents mentioned fear of steroid adverse effects, with intentional nonadherence as a consequence, and difficulties with the application of topical treatment. Pharmacy employees also mentioned to encounter these issues. Some employees themselves expressed concerns towards use of steroids. Most parents were satisfied with the information they received; however, they need more practical lifestyle advices, e.g. about bathing or clothing. Both pharmacists and pharmacy technicians mentioned that technicians often lack knowledge to support patients optimally in correct medication use. Conclusion Parents’ perceptions about topical corticosteroids might negatively influence treatment outcomes. Pharmacy staff has an important role to inform parents of children with eczema on the appropriate use of topical corticosteroids and emollients. Counseling should not be influenced by their own prejudices about topical corticosteroids. Close collaboration between primary care providers should ensure that parents receive uniform messages.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands.
| | - Daphne Philbert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Kay R Wagelaar
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Sarah Galle
- Department of Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
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Tolerability and Efficacy of a Medical Device Repairing Emollient Cream in Children and Adults with Mild to Moderate Atopic Dermatitis. Dermatol Ther (Heidelb) 2019; 9:309-319. [PMID: 30968310 PMCID: PMC6522571 DOI: 10.1007/s13555-019-0295-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Indexed: 01/15/2023] Open
Abstract
Introduction Regular emollient application is recommended for managing atopic dermatitis (AD). Although many emollients are available, only AD-tested medical device repairing emollient creams (MDRECs) can be recommended for treating and preventing AD skin lesions. Here, we evaluated the tolerability and benefit of a new MDREC in an open-label study in infants, young children, and adults with mild to moderate AD. Methods Subjects (or their parents or guardians) were instructed to apply the MDREC to AD lesions or areas of dry skin twice daily for 3 weeks. Investigators assessed tolerability and AD severity at days 1, 8, and 22. Subjects assessed AD severity weekly, recorded any adverse events, and reported their satisfaction with the MDREC at day 22. Results Sixty-one subjects (19 infants, 22 children, and 20 adults) were included and 59 completed the study. At inclusion, 49% of the infants and young children and 15% of the adults were experiencing flares of AD. At day 22, the local tolerability of the MDREC was judged by the investigators as excellent in all the children and in 18 of the 20 adult subjects (90%). All adverse events were mild and transient. Investigator- and subject-assessed AD severity progressively decreased at each assessment for each age subgroup. Conclusion This study shows that the MDREC was well tolerated when applied to AD skin lesions in infants, young children, and adults and suggests this product can be used daily to control the signs and symptoms of AD. Funding Laboratoires Dermatologiques Ducray, Pierre Fabre Dermo-Cosmétique.
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