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Maintz L, Bieber T, Simpson HD, Demessant-Flavigny AL. From Skin Barrier Dysfunction to Systemic Impact of Atopic Dermatitis: Implications for a Precision Approach in Dermocosmetics and Medicine. J Pers Med 2022; 12:jpm12060893. [PMID: 35743678 PMCID: PMC9225544 DOI: 10.3390/jpm12060893] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
: Atopic dermatitis (AD) affects up to 20% of children and is considered the starting point of the atopic march with the development of food allergy, asthma, and allergic rhinitis. The heterogeneous phenotype reflects distinct and/or overlapping pathogenetic mechanisms with varying degrees of epidermal barrier disruption, activation of different T cell subsets and dysbiosis of the skin microbiome. Here, we review current evidence suggesting a systemic impact of the cutaneous inflammation in AD together with a higher risk of asthma and other comorbidities, especially in severe and persistent AD. Thus, early therapy of AD to restore the impaired skin barrier, modified microbiome, and target type 2 inflammation, depending on the (endo)phenotype, in a tailored approach is crucial. We discuss what we can learn from the comorbidities and the implications for preventive and therapeutic interventions from precision dermocosmetics to precision medicine. The stratification of AD patients into biomarker-based endotypes for a precision medicine approach offers opportunities for better long-term control of AD with the potential to reduce the systemic impact of a chronic skin inflammation and even prevent or modify the course, not only of AD, but possibly also the comorbidities, depending on the patient’s age and disease stage.
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Affiliation(s)
- Laura Maintz
- Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany;
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), 7265 Davos, Switzerland
- Correspondence: ; Tel.: +49-228-287-16898
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, 53127 Bonn, Germany;
- Christine Kühne Center for Allergy Research and Education Davos (CK-CARE), 7265 Davos, Switzerland
- Davos Biosciences, Herman-Burchard-Str. 9, CH-7265 Davos Wolfgang, Switzerland
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Abeck D. Management der atopischen Dermatitis im Kindes- und Jugendalter. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1664-5400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Abeck F, Booken N, Schneider S. [Inappropriate systemic therapy in severe atopic dermatitis-severe long-term damage]. Hautarzt 2021; 73:638-640. [PMID: 34905073 PMCID: PMC9358965 DOI: 10.1007/s00105-021-04922-1] [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: 11/08/2021] [Indexed: 11/18/2022]
Abstract
Die Therapiemöglichkeiten der schweren atopischen Dermatitis waren bis vor Kurzem sehr begrenzt und haben sich mit der Zulassung des ersten Biologikums Dupilumab Ende 2017 bis heute deutlich verbessert. Aktuell wurden mit dem Biologikum Tralokinumab sowie den Januskinase-Inhibitoren Baricitinib und Upadacitinib weitere neue Systemtherapeutika zugelassen. Dennoch gibt es Fälle, in denen es zur Nichtberücksichtigung moderner Behandlungsmöglichkeiten kommt, wie die Falldarstellung eines 28-jährigen Patienten mit schwerwiegenden Nebenwirkungen einer Langzeitbehandlung mit systemischen Glukokortikosteroiden zeigt. Neben der umfangreichen Abklärung der Folgeschäden, erfolgten die Einleitung einer leitliniengerechten Therapie mit Dupilumab sowie eine interdisziplinäre Zusammenarbeit mit Endokrinologen, Ophthalmologen, Osteologen und Ernährungsmedizinern.
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Affiliation(s)
- F Abeck
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - N Booken
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - S Schneider
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Augustin M, Garbe C, Neitemeier S, Steimle T, Schwarz S, Augustin J, von Kiedrowski R, Hagenström K. [Regional variations in healthcare for patients with psoriasis and atopic dermatitis in Germany]. Hautarzt 2021; 73:27-39. [PMID: 34821976 DOI: 10.1007/s00105-021-04913-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Psoriasis (Pso) and atopic dermatitis (AD) are chronic skin diseases that result in significant physical and psychological impairment, financial burden, and loss of quality of life. According to previous data, there are regional differences in healthcare. OBJECTIVES The aim was to analyse the epidemiology as well as the treatment of insured people with Pso and AD in Germany in a regional comparison. METHODS Data of the insurance company Techniker Krankenkasse for the year 2019 regarding treatment prevalences as well as drug prescriptions on the regional level for all physicians were examined. RESULTS In 2019 the overall prevalence of Pso was 2.5% (about 2 million insured people in Germany) and AD was 4.2% (about 3.6 million insured people). In Pso, new guideline-compliant drugs were frequently utilised, yet systemic glucocorticosteroids (GCS) were still disproportionally prescribed. Regionally, there were pronounced disparities with higher prescription rates of the new drugs in the north and east. Insured people with AD most frequently received topical GCS (approx. 88%), of which most were class III (66%), and significantly less frequently calcineurin inhibitors (< 10%), which also conform to guidelines. Systemically, GCS were by far most commonly used (about 25% of all insured people with drug prescriptions). Dupilumab, the only long-term drug approved in 2019, was very rarely prescribed, accounting for less than 1%. Again, large regional differences similar to Pso were found. CONCLUSION Pso and AD show relevant disparities and gaps in drug care in the regional comparison despite uniform national guidelines and patient needs. The barriers to appropriate modern pharmaceuticals need to be clarified and mitigated.
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Affiliation(s)
- M Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - C Garbe
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | | | - T Steimle
- Techniker Krankenkasse, Hamburg, Deutschland
| | - S Schwarz
- Techniker Krankenkasse, Hamburg, Deutschland
| | - J Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - R von Kiedrowski
- Dermatologische Spezial- und Schwerpunktpraxis Selters, Selters, Deutschland
| | - K Hagenström
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
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5
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Atopic Dermatitis: From Etiology and History to Treatment. ACTA MEDICA BULGARICA 2021. [DOI: 10.2478/amb-2021-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease in patients with atopy. Atopy itself, is defined as a predisposition to develop immune response with overproduction of immunoglobulin E to low doses of allergens. AD is one of the most common skin disorders in the developed world, affecting up to 20% of children and about 3% of adults. The pathogenesis of the disease is complex, with both genetic and environmental factors playing a significant role in it. Clinically, hallmarks of atopic dermatitis include dry, itchy skin and various cutaneous efflorescence, compatible to dermatitis or eczema. Atopic dermatitis subdivides into three morphological variants manifesting during infancy, childhood and adulthood. Various environmental factors and associated diseases may have serious influence on the clinical course or may trigger disease relapses. The aim of this review article is to serve as a comprehensive overview of the etiology, pathogenesis, clinical course and diagnosis, as well as potential challenges facing the successful treatment of atopic dermatitis.
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Knop M, Alelq N, Kubieniec ME, Giehl K. [Palmoplantar dermatoses in children]. Hautarzt 2021; 72:215-224. [PMID: 33580281 DOI: 10.1007/s00105-021-04765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Dermatoses of the hands and feet cover a wide range of skin diseases that can occur in children and adolescents and are a frequent question in dermatological practice. Our synopsis of the most important differential diagnoses and their treatment is intended to provide better orientation for daily practice. A precise and detailed history is essential to establish a diagnosis, followed by clinical examination and specific examination methods. Cutaneous infection should always be excluded, as they occur very frequently. Impetigo, punctate keratolysis, blistering distal dactylitis, tinea manuum and pedum, hand-foot-mouth disease, herpes simplex digitalis and verrucae vulgaris as well as scabies are often found in the palmoplantar area and typically affect children and adolescents. In case of allergic contact dermatitis and dyshidrotic eczema, atopic diathesis in the medical history is of importance. However, we must not miss rare causes. Palmoplantar keratoses, for example, can be due to inflammatory dermatoses like pityriasis rubra pilaris (PRP) or may, as well as blistering diseases, result from hereditary disorders. Specialised centers can perform molecular genetic diagnosis and enhance patient care.
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Affiliation(s)
- M Knop
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München LMU, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - N Alelq
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München LMU, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - M E Kubieniec
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München LMU, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - K Giehl
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München LMU, Frauenlobstr. 9-11, 80337, München, Deutschland.
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7
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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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ARIA guideline 2019: treatment of allergic rhinitis in the German health system. Allergol Select 2019; 3:22-50. [PMID: 32176226 PMCID: PMC7066682 DOI: 10.5414/alx02120e] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background: The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods: ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results: The present ICP (integrated care pathway) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion: A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.
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9
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Sicras-Mainar A, Navarro-Artieda R, Armario-Hita JC. Severe Atopic Dermatitis In Spain: A Real-Life Observational Study. Ther Clin Risk Manag 2019; 15:1393-1401. [PMID: 31819466 PMCID: PMC6897051 DOI: 10.2147/tcrm.s226456] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/03/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine the epidemiology and characterize the treatment prescribed for severe atopic dermatitis (AD) in children/adults in usual clinical practice. METHODS Observational, retrospective study made through review of medical records of Spanish patients aged ≥6 years. Patients diagnosed with severe AD who required care between 2013 and 2017 were included. The study groups were: 6-12 years; 13-18 years; and > 18 years. Patients were followed for 5 years. The main measurements were the prevalence of AD, comorbidity and treatment duration. Statistical significance was established as p <0.05. RESULTS We included 2323 patients with severe AD. The overall prevalence was 0.10% (95% CI: 0.09-0.11%) and was 0.39%, 0.23% and 0.07% in the 6-12 years, 13-18 years and >18 years age groups, respectively (p <0.001), the percentage of males was 58%, 48.6% and 39%, respectively, and general comorbidity was 0.1, 0.2 and 0.9 points, respectively (p <0.001).The most frequent comorbidities were asthma in 49.0%, 44.9% and 20.8%, respectively (p <0.001), and anxiety in 79.7%, 65.8% and 67.3%, respectively (p <0.001). Oral corticosteroids were administered in 97.3%, 90.9% and 81.7%, respectively (concomitant-medication). Cyclosporine (45.3%), azathioprine (15.9%) and methotrexate (9.0%) were the most frequently prescribed drugs; biologic agents were administered in 5.8% of patients (for AD). CONCLUSION In AD the presence of comorbidities was significant, especially in the psychological, immunoallergic and cardiovascular areas. Cyclosporine was the most widely used immunosuppressant. There was a degree of variability in the use and duration of the treatments prescribed.
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Affiliation(s)
| | | | - José C Armario-Hita
- Dermatology Service, Puerto Real University Hospital, Cadiz University, Cádiz, Spain
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10
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ARIA-Leitlinie 2019: Behandlung der allergischen Rhinitis im deutschen Gesundheitssystem. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Wohlrab J, Wollenberg A, Reimann H, Pleyer U, Werfel T. [Interdisciplinary recommendations for action in dupilumab-related inflammatory eye diseases]. Hautarzt 2019; 70:64-67. [PMID: 30478601 DOI: 10.1007/s00105-018-4316-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Johannes Wohlrab
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Deutschland. .,An-Institut für angewandte Dermatopharmazie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland.
| | - Andreas Wollenberg
- Klinik für Dermatologie und Allergologie, Ludwig-Maximilian-Universität München, München, Deutschland
| | - Holger Reimann
- Avoxa - Mediengruppe Deutscher Apotheker GmbH, Eschborn, Deutschland
| | - Uwe Pleyer
- Universitätsmedizin Berlin, Klinik für Augenheilkunde, Charité, Berlin, Deutschland
| | - Thomas Werfel
- Klinik für Dermatologie und Allergologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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12
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Ständer S, Ludwig RJ, Thaçi D. [The skin and rheumatism]. DER ORTHOPADE 2019; 48:905-910. [PMID: 31535157 DOI: 10.1007/s00132-019-03811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The skin is commonly affected in chronic inflammatory disorders and may act as a visual marker for internal or systemic inflammation. Frequent inflammatory skin diseases, like psoriasis and atopic dermatitis (AD), are associated with rheumatic and inflammatory bowel diseases. Metabolic, mental and cardiovascular comorbidity are frequent consequences of chronic inflammation. Further intersections between skin and joints are connective tissue diseases (collagenoses) and can be observed in complex diseases, e.g. systemic lupus erythematosus. Clinically, these diseases range from predominant cutaneous to severe systemic implication of several organs. Localized scleroderma should be clinically distinguished from systemic sclerosis and treated sufficiently to avoid long-term damage and disability. Thus, interdisciplinary disease management is of crucial importance.
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Affiliation(s)
- S Ständer
- Klinik für Dermatologie, Allergologie und Venerologie, UKSH Lübeck, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
| | - R J Ludwig
- Lübecker Institut für experimentelle Dermatologie, Universität zu Lübeck, Lübeck, Deutschland
| | - D Thaçi
- Exzellenzzentrum für Entzündungsmedizin, Universität zu Lübeck, Lübeck, Deutschland
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Lauermann JL, Glitz B, Eter N. [Conservative Treatment Option for Recurrent Bilateral Lower Lid Ectropion]. Klin Monbl Augenheilkd 2019; 238:901-903. [PMID: 31049907 DOI: 10.1055/a-0841-3446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Barbara Glitz
- Klinik für Augenheilkunde, Universitätsklinikum Münster
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster
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14
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Rajagopalan M, De A, Godse K, Krupa Shankar DS, Zawar V, Sharma N, Mukherjee S, Sarda A, Dhar S. Guidelines on Management of Atopic Dermatitis in India: An Evidence-Based Review and an Expert Consensus. Indian J Dermatol 2019; 64:166-181. [PMID: 31148854 PMCID: PMC6537677 DOI: 10.4103/ijd.ijd_683_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common and chronic, pruritic inflammatory skin condition that affects all age groups. There was a dearth of consensus document on AD for Indian practitioners. This article aims to provide an evidence-based consensus statement for the management of AD with a special reference to the Indian context. This guideline includes updated definition, etiological factors, classification, and management of atopic dermatitis. METHODOLOGY The preparation of guidelines was done in multiple phases. Indian Dermatology Expert Board Members (DEBM), recommended by the Skin Allergy Society of India, prepared 26 evidence-based recommendations for AD. An extensive literature search was done in MEDLINE, Google scholar, Cochrane, and other resources. Articles published in the past 10 years were reviewed and recommendations were graded based on the quality of evidence as per GRADE. After forming the initial structure, DEBM met in Mumbai and gave their decisions on an agree and disagree scale with an Indian perspective. Finally, their suggestions were compiled for preparing the article. After DEBM finalized the draft, a treatment algorithm was formulated for the management of AD. RESULTS DEBM suggested a working definition for AD. The panel agreed that moisturizers should be used as mainstay of therapy and should be continued in all lines of therapy and in maintenance phase. Topical corticosteroids and topical calcineurin inhibitors should be considered as the first line of treatment. Among systemic therapies, cyclosporin should be considered first line, followed by azathioprine, methotrexate, and mycophenolate mofetil. Phototherapy can be an effecive alternative. Empirical food restriction was recommended against. CONCLUSION These guidelines should form a reference for the management of patients with AD in an evidence-based manner.
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Affiliation(s)
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Kiran Godse
- Department of Dermatology, D Y Patil Hospital, Navi Mumbai, Maharashtra, India
| | - D S Krupa Shankar
- Department of Dermatology, Mallige Hospital, Bengaluru, Karnataka, India
| | - Vijay Zawar
- Department of Dermatology, Skin Diseases Center, Nashik, Maharashtra, India
| | - Nidhi Sharma
- Department of Dermatology, The Medicity, Medanta Hospital, Gurugram, Haryana, India
| | - Samipa Mukherjee
- Department of Dermatology, Cloud Nine Hospitals, Bengaluru, Karnataka, India
| | - Aarti Sarda
- Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
| | - Sandipan Dhar
- Department of Dermatology, Institute of Child Health, Kolkata, West Bengal, India
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15
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Kamińska E. [The role of emollients in atopic dermatitis in children]. DEVELOPMENTAL PERIOD MEDICINE 2019; 22. [PMID: 30636240 PMCID: PMC8522819 DOI: 10.34763/devperiodmed.20182204.396403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atopic dermatitis is a chronic inflammatory disease characterized by recurrent flares, intense itching, erythema, dry skin resulting from skin barrier defects, and staphylococcal infections. Multiple factors may affect the skin`s normal barrier function, including filaggrin gene mutations, immune dysregulation, altered skin microbiome, altered lipids in stratum corneum, or deficiency of antimicrobial peptides AMPs. The disease mainly affects children, causing a considerable impact on the quality of their life; its first manifestations occur with up to 90% of cases before the age of 5. For years emollients have been known as oily substances used to treat rough, scaling, xerotic conditions to make skin flexible and soft. Recently, we have learned that emollients can also moisten and hydrate dry skin, so the terms "emollient" and "moisturizer" are often used interchangeably. According to current management guidelines on atopic dermatitis prepared by dermatological societies, long-term emollient application direct to the skin and as bath additives are the basic therapy of atopic dermatitis. Emollients may be used in monotherapy or - in the flares - in conjunction with topical corticosteroids or calcineurin inhibitors. Clinical trials proved that regular emollient application moistens and hydrates the skin and helps the skin maintain a defensive barrier effect as well as reduces the amount of topical corticosteroids needed for atopic eczema in infants, children and adult patients. The results of trials and long clinical experience proved that emollients are safe and effective in patients with atopic dermatitis. This paper presents information based on recent knowledge concerning emollients: an overview of emollient components, their properties, mechanism of action, and the role they play in atopic eczema, as well as the results of clinical trials performed in children with atopic dermatitis.
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Affiliation(s)
- Ewa Kamińska
- Zakład Farmakologii, Instytut Matki i Dziecka, Warszawa, Polska,Ewa Kamińska Zakład Farmakologii Instytut Matki i Dziecka ul. Kasprzaka 17A, 01-211 Warszawa tel. (22) 32-77-364
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Allergenspezifische Immuntherapie bei IgE-vermittelten Erkrankungen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-018-0448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Haufe E, Abraham S, Heratizadeh A, Harder I, Zink A, Weisshaar E, Kleinheinz A, von Kiedrowski R, Worm M, Bell M, Wollenberg A, Neubert K, Staubach-Renz P, Hilgers M, Bieber T, Fell I, Homey B, Effendy I, Mempel M, Schäkel K, Beissert S, Weidinger S, Werfel T, Schmitt J. Verminderte berufliche Leistungsfähigkeit und Lebensqualität bei Patienten mit moderater bis schwerer Neurodermitis. Hautarzt 2018; 69:815-824. [DOI: 10.1007/s00105-018-4261-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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Steinke S, Beikert F, Langenbruch A, Fölster-Holst R, Ring J, Schmitt J, Werfel T, Hintzen S, Franzke N, Augustin M. Measurement of healthcare quality in atopic dermatitis - development and application of a set of quality indicators. J Eur Acad Dermatol Venereol 2018; 32:2237-2243. [DOI: 10.1111/jdv.15074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/04/2018] [Indexed: 01/14/2023]
Affiliation(s)
- S. Steinke
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
- Department of Dermatology; University Hospital Münster; Münster Germany
| | - F.C. Beikert
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
- Practice Dres. Büttner/Meewes/Faubel; Neumünster Germany
| | - A. Langenbruch
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - R. Fölster-Holst
- Department of Dermatology; University Medical Center Schleswig-Holstein; Kiel Germany
| | - J. Ring
- Department of Dermatology and Allergy; Technical University Munich; Munich Germany
| | - J. Schmitt
- Center for Evidence-based Healthcare; University Hospital Carl Gustav Carus; Dresden Germany
| | - T. Werfel
- Division of Immunodermatology and Allergy Research; Clinic for Dermatology; Allergology and Venerology; Hannover Medical School; Hannover Germany
| | - S. Hintzen
- Department of Dermatology; Bundeswehrkrankenhaus Berlin; Berlin Germany
| | - N. Franzke
- Hautarztpraxis Braunschweig; Braunschweig Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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19
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de Bruin-Weller M, Thaçi D, Smith C, Reich K, Cork M, Radin A, Zhang Q, Akinlade B, Gadkari A, Eckert L, Hultsch T, Chen Z, Pirozzi G, Graham N, Shumel B. Dupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical t. Br J Dermatol 2018; 178:1083-1101. [DOI: 10.1111/bjd.16156] [Citation(s) in RCA: 279] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | - D. Thaçi
- University of Lübeck; Lübeck Germany
| | - C.H. Smith
- St. John's Institute of Dermatology; London U.K
| | - K. Reich
- Dermatologikum and TFS Research Institute; Hamburg Germany
| | - M.J. Cork
- Sheffield Dermatology Research; The University of Sheffield; Sheffield U.K
| | - A. Radin
- Regeneron Pharmaceuticals, Inc.; Tarrytown NY U.S.A
| | - Q. Zhang
- Regeneron Pharmaceuticals, Inc.; Basking Ridge NJ U.S.A
| | - B. Akinlade
- Regeneron Pharmaceuticals, Inc.; Tarrytown NY U.S.A
| | - A. Gadkari
- Regeneron Pharmaceuticals, Inc.; Tarrytown NY U.S.A
| | | | | | - Z. Chen
- Regeneron Pharmaceuticals, Inc.; Tarrytown NY U.S.A
| | | | | | - B. Shumel
- Regeneron Pharmaceuticals, Inc.; Tarrytown NY U.S.A
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20
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▼Dupilumab for atopic dermatitis. Drug Ther Bull 2018; 56:30-33. [PMID: 29545264 DOI: 10.1136/dtb.2018.3.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
▼Dupilumab (Dupixent - Sanofi-Aventis Groupe), a monoclonal antibody for the treatment of moderate-to-severe atopic dermatitis in adults who require systemic therapy, was licensed by the European Medicines Agency in September 2017. It is the first biological drug approved specifically for this condition. Here, we review the evidence for its efficacy and safety and consider its place in therapy.
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21
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Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study). ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.adengl.2017.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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de María Díaz Granados L, Quijano MA, Ramírez PA, Aguirre N, Sanclemente G. Quality assessment of atopic dermatitis clinical practice guidelines in ≤ 18 years. Arch Dermatol Res 2017; 310:29-37. [PMID: 29127480 DOI: 10.1007/s00403-017-1791-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/13/2017] [Accepted: 11/01/2017] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects the patients' quality of life greatly often from a very young age. Its worldwide incidence in children and adults varies, but it is usually among the first ten causes of dermatological consultation worldwide. There is a wide variety of treatment options for this condition including topical and systemic regimes. The decision to choose a treatment option in dermatological diseases is greatly influenced by the personal experience of each specialist, which increases variability in the selection of available therapies. Clinical practice guidelines (CPGs) not only offer recommendations supported on the available scientific evidence, but also are intended to assist in making appropriate decisions in clinical scenarios. To standardize the way in which CPGs should be developed, an instrument called AGREE II (Appraisal of Guidelines for Research and Evaluation) is used. In this study, ten clinical practice guidelines in ≤ 18 years were evaluated. Six domains (scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence) were assessed for each guideline, by three reviewers. Most of the domains obtained high scores except in the applicability domain. It is suggested that future atopic dermatitis CPGs should emphasize in the facilitating factors and barriers that may influence the application of guideline recommendations.
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Affiliation(s)
- Luz de María Díaz Granados
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - María Adelaida Quijano
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - Paola Andrea Ramírez
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - Natalia Aguirre
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia.,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia
| | - Gloria Sanclemente
- Group of Investigative Dermatology (GRID), Universidad de Antioquia, Carrera 25 A # 1 A Sur 45, Of 2026, Torre Médica El Tesoro, Medellín, Colombia. .,, Carrera Cra. 51d #62-29, Edif. MUA of.303, Medellín, Antioquia, Colombia. .,IPS Universitaria, Universidad de Antioquia, Cra. 51c #62-42, Medellín, Colombia.
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Sicras-Mainar A, Navarro-Artieda R, Carrascosa Carrillo JM. Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study). ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:35-46. [PMID: 29126499 DOI: 10.1016/j.ad.2017.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/01/2017] [Accepted: 09/10/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice. PATIENTS AND METHODS We performed an observational, retrospective study based on a review of registries of patients aged ≥18 years who sought health care in 2013 and 2014 in an area of Catalonia, Spain, with a population of 215,634 persons. We established 3 classes of severity depending on the treatment prescribed. The variables evaluated were total comorbid conditions, concomitant/specific medication, and direct/indirect health care costs. The statistical analysis was based on multiple regression models. Statistical significance was set at P<.05. RESULTS We included 6,186 patients with a diagnosis of atopic dermatitis (mean age, 47.1 years; women, 61.6%). We established 3 groups based on severity, as follows: mild (n=3,445 [55.7%]); moderate (n=2,361 [38.2%]); and severe (n=380 [6.1%]). Severe atopic dermatitis was associated with risk of presenting comorbid conditions (β=0.192), namely, asthma (β=0.138), depression (β=0.099), cardiovascular events (β=0.087), obesity (β=0.085), and smoking (β=0.025); P<.001. Costs reached €9.3 million (health care costs, 75.5%; loss of productivity, 24.5%), with an average unit cost of €1,504 per year. The corrected average unit cost (ANCOVA) was greater in severe atopic dermatitis compared with moderate and mild disease (€3,397 vs. €2,111 vs. €885; P<.001), respectively. CONCLUSIONS Severe atopic dermatitis generates considerable usage of health care resources and high costs for the National Health System. These are in proportion with the severity of the disease. General comorbid conditions and asthma were the factors with the greatest impact on health care costs.
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Affiliation(s)
- A Sicras-Mainar
- Red de Investigación en Servicios Sanitarios (Fundación REDISS), Barcelona, España
| | - R Navarro-Artieda
- Documentación Médica, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - J M Carrascosa Carrillo
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
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Boguniewicz M, Alexis AF, Beck LA, Block J, Eichenfield LF, Fonacier L, Guttman-Yassky E, Paller AS, Pariser D, Silverberg JI, Lebwohl M. Expert Perspectives on Management of Moderate-to-Severe Atopic Dermatitis: A Multidisciplinary Consensus Addressing Current and Emerging Therapies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1519-1531. [PMID: 28970084 DOI: 10.1016/j.jaip.2017.08.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Abstract
Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects children and adults. Until recently, the only Food and Drug Administration-approved systemic treatment option for patients with moderate-to-severe AD was systemic steroids, which are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants, which can have serious adverse effects. A significant number of these patients go untreated. Research on the immunopathogenesis of AD has paved the way for new, targeted, systemic therapies for moderate-to-severe AD. In early 2017, the Food and Drug Administration approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. Although the national guidelines can be very helpful to clinicians, the process for updating them does not allow for timely incorporation of novel therapies. A steering committee of AD experts, including dermatologists, allergists, and a patient advocacy group representative, developed recommendations on the basis of a literature review and expert opinion to help clinicians understand how new therapies fit into the current treatment paradigm and to provide practical recommendations for assessing AD severity, treatment response, and treatment failure.
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Affiliation(s)
- Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo.
| | - Andrew F Alexis
- Department of Dermatology, Skin of Color Center, Mount Sinai St Luke's and Mount Sinai West, New York, NY
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
| | - Julie Block
- National Eczema Association, San Rafael, Calif
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, Calif; Rady Children's Hospital San Diego, San Diego, Calif
| | - Luz Fonacier
- Section of Allergy and Clinical Immunology, Department of Medicine, NYU Winthrop-University Hospital, Mineola, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research, Inc, Norfolk, Va
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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Nomura T, Kabashima K. Advances in atopic dermatitis in 2015. J Allergy Clin Immunol 2017; 138:1548-1555. [PMID: 27931536 DOI: 10.1016/j.jaci.2016.10.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/31/2016] [Accepted: 10/12/2016] [Indexed: 12/15/2022]
Abstract
This review aims to highlight recently published articles on atopic dermatitis (AD). Updated are the insights into epidemiology, pathology, diagnostics, and therapy. Epidemiologic studies have revealed a positive correlation between AD and systemic conditions, such as rheumatoid arthritis, inflammatory bowel disease, and neonatal adiposity. Pathologic findings highlight the involvement of novel barrier factors (desmoplakin and claudin), novel immune cell subsets (pathogenic effector TH2 cells and group 2 innate lymphoid cells), and differential skewing of helper T cells (eg, TH17 dominance in Asians with AD). As diagnostics, noninvasive examinations of the transepidermal water loss of neonates, the density of epidermal Staphylococcus species, and the gut flora might prognosticate the onset of AD. As for therapy, various methods are proposed, including conventional (petrolatum and UV) and molecule-oriented regimens targeting Janus kinase, signal transducer and activator of transcription 3, extracellular signal-regulated kinase, sirtuin 1, or aryl hydrocarbon receptor.
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Affiliation(s)
- Takashi Nomura
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Experimental Therapeutics, Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Japan.
| | - Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Singapore Immunology Network (SIgN) and Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore; PRESTO, Japan Science and Technology Agency, Saitama, Japan
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Systemic Therapy of Atopic Dermatitis: When, How, for How Long? CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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