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Chatrath S, LeBovidge J, Jack C, Abuabara K, Schneider LC, Capozza K, Kelley K, Silverberg JI. Mental health interventions for atopic dermatitis: knowledge gaps, pilot programmes and future directions. Clin Exp Dermatol 2023; 49:9-17. [PMID: 37706273 DOI: 10.1093/ced/llad315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
Atopic dermatitis (AD) is associated with high levels of psychosocial burden, often resulting in poor mental health outcomes. Despite this association, few studies have evaluated the efficacy of mental health interventions within this population. Utilization of multidisciplinary and peer-led support, in addition to equipping patients with psychological tools, may be beneficial in improving mental health outcomes. Future research is needed to determine which interventions and formats are desired by, effective in and accessible to patients and caregivers with AD.
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Affiliation(s)
| | - Jennifer LeBovidge
- Boston Children's Hospital, Boston MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carolyn Jack
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, CA, USA
| | - Keri Kelley
- Global Parents for Eczema Research, Santa Barbara, CA, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Estefan J, Ferreira DDC, Cavalcante FS, dos Santos KRN, Ribeiro M. Investigation of possible relationship between atopic dermatitis and salivary biomarkers, stress, and sleep disorders. World J Clin Cases 2023; 11:3958-3966. [PMID: 37388791 PMCID: PMC10303611 DOI: 10.12998/wjcc.v11.i17.3958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/04/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic, relapsing, multifactorial inflammatory disease with genetic, environmental, and immunological characteristics. The quality of life and sleep of patients and their families are affected by AD, which triggers stress, described as one of the factors that worsens AD. Salivary biomarkers such as cortisol, alpha-amylase, chromogranin A, and melatonin have been associated with stress and sleep disturbances. Therefore, the evaluation of stress and sleep disorders using salivary biomarkers in AD patients is important. This review aims to describe the possible relationship between atopic dermatitis and stress, sleep disorders, and salivary biomarkers, seeking to contribute to better understanding and clinical management of AD. This descriptive study is characterized as a narrative literature review. A literature search was conducted of studies published in English and Portuguese between January 2012 and October 2022 that are available in electronic media from various databases, such as Scientific Electronic Library Online, Latin American and Caribbean Literature on Health Sciences, and PubMed. AD is associated with different degrees of impact on the lives of individuals who present with the disease. Psychological stress may induce changes in saliva composition and worsen AD; at the same time, the severity of the disease may be associated with emotional impact. Further studies are needed to assess and correlate AD severity, stress, and sleep disturbances with salivary biomarkers in order to better understand this association.
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Affiliation(s)
- Juliany Estefan
- Dermatologia Pediátrica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941630, Brazil
| | - Dennis de Carvalho Ferreira
- Faculdade de Enfermagem, Departamento de Fundamentos de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20551030, Brazil
| | - Fernanda Sampaio Cavalcante
- Departamento de Clínica Médica, Instituto de Ciências Médicas, Universidade Federal do Rio de Janeiro, Campus Macaé, Rio de Janeiro 27930-560, Brazil
| | - Kátia Regina Netto dos Santos
- Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941630, Brazil
| | - Marcia Ribeiro
- Genética médica, Instituto de Puericultura e Pediatria Martagão Gesteira/ Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941630, Brazil
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3
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Kong HE, Francois S, Smith S, Lee G, Bradley B, Chen KH, Lawley LP, Spraker M, Roberts JS, Chen SC. Tools to study the severity of itch in 8- to 17-year-old children: Validation of TweenItchyQoL and ItchyQuant. Pediatr Dermatol 2021; 38:1118-1126. [PMID: 34339533 DOI: 10.1111/pde.14662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Validated pruritus-specific quality of life and self-reported severity instruments exist primarily for adults. Clinical trials to develop therapeutics for children with chronic pruritus are hampered by the paucity of appropriate outcome measures. To address this gap, we aimed to develop validated instruments to measure itch-specific quality of life and self-reported severity in children. METHODS We conducted in-depth, open-ended interviews of itchy children and generated concepts to develop TweenItchyQoL. We administered TweenItchyQoL, ItchyQuant, a cartoon-annotated self-reported pruritus severity numeric rating scale (NRS), and a non-cartoon NRS to 175 itchy children aged 8-17 years. We analyzed the data for feasibility, preference, reliability, construct validity, and responsiveness. RESULTS Average completion time was 4.8 minutes for TweenItchyQoL and 33 seconds for ItchyQuant. The majority of patients either preferred ItchyQuant or found no difference between ItchyQuant and the NRS. Cronbach's alpha for TweenItchyQoL total and subscales ranged from 0.84 to 0.95. Test-retest reliability coefficients were ≥0.7 for TweenItchyQoL and 0.4 for ItchyQuant. A 3-dimensional bifactor model was most appropriate (RMSEA = 0.048) on the confirmatory factor analyses. As a function of those reporting worsening, improvement, or no change at their final visit, TweenItchyQoL and ItchyQuant scores in those cohorts changed as expected. CONCLUSIONS This new set of validated and feasible instruments shows promise to quantify itch severity and QoL impact in older children.
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Affiliation(s)
- Ha Eun Kong
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Shelby Smith
- Emory University School of Medicine, Atlanta, GA, USA
| | - Grace Lee
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kuang-Ho Chen
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mary Spraker
- Emory University School of Medicine, Atlanta, GA, USA
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Lauffer F, Baghin V, Standl M, Stark SP, Jargosch M, Wehrle J, Thomas J, Schmidt‐Weber CB, Biedermann T, Eyerich S, Eyerich K, Garzorz‐Stark N. Predicting persistence of atopic dermatitis in children using clinical attributes and serum proteins. Allergy 2021; 76:1158-1172. [PMID: 32794228 DOI: 10.1111/all.14557] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/09/2020] [Accepted: 07/30/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common inflammatory skin disease in children, with 30% of all those diagnosed developing chronic or relapsing disease by adolescence. Such disease persistence cannot yet be predicted. The aim of the present study was to predict the natural course of AD using clinical parameters and serum proteins. METHODS Sera of 144 children with AD (age 0-3 years) were analyzed for IgE and 33 cytokines, chemokines, and growth factors. Patient disease course until the age of 7 years was assessed retrospectively. Unsupervised k-means clustering was performed to define disease endotypes. Identified factors associated with AD persistence at the age of 7 years were validated in children with AD in an independent cohort (LISA Munich; n = 168). Logistic regression and XGBoosting methods followed by cross-validation were applied to predict individual disease outcomes. RESULTS Three distinct endotypes were found in infancy, characterized by a unique inflammatory signature. Factors associated with disease persistence were disease score (SCORAD), involvement of the limbs, flexural lesion distribution at the age of 3 years, allergic comorbidities, and disease exacerbation by the trigger factors stress, pollen exposure, and change in weather. Persistence was predicted with a sensitivity of 81.8% and a specificity of 82.4%. Factors with a high impact on the prediction of persistence were SCORAD at the age of 3 years, trigger factors, and low VEGF serum levels. CONCLUSION Atopic dermatitis in infancy comprises three immunological endotypes. Disease persistence can be predicted using serum cytokines and clinical variables.
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Affiliation(s)
- Felix Lauffer
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - Veronika Baghin
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - Marie Standl
- Institute of Epidemiology Helmholtz Center Munich ‐ German Research Center for Environmental Health Neuherberg Germany
| | - Sebastian P. Stark
- ZAUM ‐ Center of Allergy and Environment Technical University of Munich and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL) Munich Germany
| | - Manja Jargosch
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - Julius Wehrle
- Department of Medicine I Medical Center University of Freiburg Freiburg Germany
- German Cancer Consortium (DKTK) Freiburg Germany
- German Cancer Research Center (DKFZ) Heidelberg Germany
| | - Jenny Thomas
- ZAUM ‐ Center of Allergy and Environment Technical University of Munich and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL) Munich Germany
| | - Carsten B. Schmidt‐Weber
- ZAUM ‐ Center of Allergy and Environment Technical University of Munich and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL) Munich Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - Stefanie Eyerich
- ZAUM ‐ Center of Allergy and Environment Technical University of Munich and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL) Munich Germany
| | - Kilian Eyerich
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
- Division of Dermatology and Venereology Department of Medicine Solna, and Center for molecular medicine Karolinska Institutet Stockholm Sweden
| | - Natalie Garzorz‐Stark
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
- Division of Dermatology and Venereology Department of Medicine Solna, and Center for molecular medicine Karolinska Institutet Stockholm Sweden
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LeBovidge JS, Timmons K, Delano S, Greco KF, DeFreitas F, Chan F, Jeong T, Rosen M, Rea C, Schneider LC. Improving patient education for atopic dermatitis: A randomized controlled trial of a caregiver handbook. Pediatr Dermatol 2021; 38:396-404. [PMID: 33486817 DOI: 10.1111/pde.14519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Patient education is important to families' ability to manage and cope with pediatric atopic dermatitis (AD). We evaluated whether an educational handbook could improve AD symptoms, caregiver confidence in AD management skills, and AD-related quality of life. METHODS Caregivers of children with AD ages 1 month to 16 years were randomly assigned to the intervention arm (handbook in addition to standard AD management) or the control arm (standard management alone). Caregivers completed self-report outcome questionnaires prior to a clinical visit for AD and at 3-month follow-up. RESULTS 175 caregivers completed questionnaires at baseline and follow-up. AD symptoms measured by the Patient-Oriented Eczema Measure (POEM) improved in both the handbook and control arms. However, the decrease in the mean POEM score in the handbook arm (-4.4, 95% CI [-5.8, -3.0]) did not differ from that in the control arm (-3.4, 95% CI [-4.8, -2.03]; P = .343). Change in quality of life did not differ between study arms. Among caregivers attending a new patient visit for AD, mean confidence scores (measured from 0 to 100) increased more in the handbook arm (67 [95% CI {60, 74}] to 83 [95% CI {77, 88}]) relative to the control arm (74 [95% CI {65, 82}] to 75 [95% CI {67, 83}]; P = .012). The majority of caregivers rated the handbook as helpful in managing the child's AD. CONCLUSIONS Despite an adequate sample size, the handbook did not improve AD symptoms more than standard management alone. The handbook improved confidence in management skills for families attending new patient visits for AD.
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Affiliation(s)
- Jennifer S LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Karol Timmons
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Sophia Delano
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | | | - Felice Chan
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Tiffany Jeong
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Corinna Rea
- Harvard Medical School, Boston, MA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Lynda C Schneider
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Kage P, Simon JC, Treudler R. Atopic dermatitis and psychosocial comorbidities. J Dtsch Dermatol Ges 2020; 18:93-102. [PMID: 32026645 DOI: 10.1111/ddg.14029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/03/2019] [Indexed: 01/04/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease that may be associated with a number of comorbidities including psychosocial disorders, which are the primary focus of this article. The data presented is based on a literature search in PubMed and subsequent screening of relevant review articles and guidelines. There is a greater prevalence of depression, anxiety, sleep disorders and suicidal ideation among individuals with AD. The disease negatively impacts patients' quality of life. Children with AD have been shown to more commonly exhibit signs of attention-deficit/hyperactivity disorder. Only little data exists on the association of AD with schizophrenia, eating disorders or obsessive-compulsive disorder. There is a great need for research in the field of AD-related comorbidities, especially with respect to the question as to whether and how novel treatment options may potentially affect these comorbidities.
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Affiliation(s)
- Paula Kage
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
| | - Jan-Christoph Simon
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
| | - Regina Treudler
- Department of Dermatology, Venereology and Allergology, Leipzig Interdisciplinary Center for Allergology - LICA-CAC, University of Leipzig, Germany
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7
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Parisi G, Leonardi S, Ciprandi G, Corsico A, Licari A, Miraglia del Giudice M, Peroni D, Salpietro C, Marseglia G. Antihistamines in children and adolescents: A practical update. Allergol Immunopathol (Madr) 2020; 48:753-762. [PMID: 32448753 DOI: 10.1016/j.aller.2020.02.005] [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] [Received: 12/11/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 01/01/2023]
Abstract
Histamine is a chemical mediator, released predominantly by tissue mast cells, circulating basophils, and neurons, which are activated in response to various immunological and non-immunological stimuli. Histamine has to bind to specific receptors to exert its physiological and pathophysiological functions. Endogenous histamine is the main mediator of the immediate allergic response, which moreover, performs other multiple functions, including regulation of gastric secretion, neurotransmission in the central nervous system, and immunomodulatory activity. The involvement of histamine in various disorders and the importance of receptors in the clinical features have relevant implications in clinical practice. Anti-H1 antihistamines contrast the histamine-dependent effects, mainly concerning nasal symptoms and cutaneous itching and wheal. Antihistamines are among the most prescribed drugs in pediatric care. This review updates the practical use of antihistamines in children and adolescents.
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Cowdell F, Ahmed T, Layfield C. Knowledge mobilisation: a UK co-creation study to devise strategies to amend lay and practitioner atopic eczema mindlines to improve consultation experiences and self-management practices in primary care. BMJ Open 2020; 10:e036520. [PMID: 32988943 PMCID: PMC7523205 DOI: 10.1136/bmjopen-2019-036520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/17/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To devise strategies to amend lay and practitioner atopic eczema mindlines 'collectively reinforced, internalised tacit guidelines', to improve consultation experiences and self-management practices in primary care. DESIGN Co-creation workshops informed by the Co:Create Coproduction Matrix. SETTING Conference centre in central England and via remote communication. PARTICIPANTS Lay people with, and parents of children with, atopic eczema, practitioners, a researcher and a facilitator (n=22). RESULTS Eczema mindline amendment needs to address people and parents of children with the condition, practitioners and wider society in parallel. For lay people trust and 'realness' of amendment activity was vital and practitioners wanted practical, locally relevant, hints and tips, tailored, 'no faff' approaches. To improve consultation experiences and self-management practices, five key, consistent, evidence-based messages need to be instilled into eczema mindlines: (1) eczema is more than just dry skin, (2) eczema does not just go away, (3) moisturisers are for every day, (4) steroid creams are okay when you need them and (5) you know your child's eczema best. CONCLUSION This co-creation study provides original insights into what eczema knowledge should be mobilised, who needs to have this knowledge, how this should be achieved to amend existing mindlines to improve consultation experiences and self-management practices in primary care.The remaining challenge is to refine, implement and evaluate the effectiveness of strategies developed to instil the five core messages and erase outdated or inaccurate information.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Taheeya Ahmed
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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9
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Leung DYM. Allergic skin diseases beyond T H2. Ann Allergy Asthma Immunol 2020; 124:1. [PMID: 31836072 DOI: 10.1016/j.anai.2019.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/07/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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Ražnatović Ðurović M, Janković J, Ćirković A, Sojević Timotijević Z, Rašić J, Vitković L, Tomić Spirić V, Janković S. Impact of atopic dermatitis on the quality of life of children and their families. Ital J Dermatol Venerol 2020; 156:29-35. [PMID: 32041939 DOI: 10.23736/s2784-8671.19.06447-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on the quality of life (QoL). This study aims to evaluate the impact of AD on the QoL of children and their parents and to identify predictors affecting their QoL. METHODS The cross-sectional study was conducted in Montenegro. It included 200 children with AD aged 5-16 years and their parents. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaire. RESULTS The mean CDLQI score of the children affected by AD was 17.11 and the mean DFI score of their parents 19.86. There was a significant correlation between AD severity score assessed by a doctor (TIS) and both CDLQI and DFI scores (r=0.53 and r=0.27, respectively). A moderate positive correlation was observed between the QoL of children with AD and QoL of their parents (r=0.53). According to multiple linear regression, more impaired QoL of affected children was associated with more severe AD, younger parent's age and their lower educational level. Poorer QoL of parents was associated with female sex, younger age of children, more severe AD, lower educational level of parents and absence of a family history of atopic disease. CONCLUSIONS The present study confirmed that AD has a large negative impact on QoL of both patients with AD and their families. More impaired QoL was associated with more severe AD.
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Affiliation(s)
- Milena Ražnatović Ðurović
- Clinic of Dermatology and Venereology, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Anda Ćirković
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Julijana Rašić
- Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | - Leonida Vitković
- Institute of Histology, Faculty of Medicine, University of Priština, Kosovska Mitrovica, Serbia
| | - Vesna Tomić Spirić
- Clinic for Allergology and Immunology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
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Kage P, Simon J, Treudler R. Atopische Dermatitis und psychosoziale Komorbidität. J Dtsch Dermatol Ges 2020; 18:93-102. [DOI: 10.1111/ddg.14029_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Paula Kage
- Klinik für Dermatologie Venerologie und Allergologie Leipziger Interdisziplinäres Centrum für Allergologie – LICA‐CAC Universität Leipzig
| | - Jan‐Christoph Simon
- Klinik für Dermatologie Venerologie und Allergologie Leipziger Interdisziplinäres Centrum für Allergologie – LICA‐CAC Universität Leipzig
| | - Regina Treudler
- Klinik für Dermatologie Venerologie und Allergologie Leipziger Interdisziplinäres Centrum für Allergologie – LICA‐CAC Universität Leipzig
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12
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Saeki H, Baba N, Oshiden K, Abe Y, Tsubouchi H. Phase 2, randomized, double-blind, placebo-controlled, 4-week study to evaluate the safety and efficacy of OPA- 15406 (difamilast), a new topical selective phosphodiesterase type-4 inhibitor, in Japanese pediatric patients aged 2-14 years with atopic dermatitis. J Dermatol 2020; 47:17-24. [PMID: 31713267 PMCID: PMC6972691 DOI: 10.1111/1346-8138.15137] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
The safety and efficacy of OPA-15406 (international non-proprietary name, difamilast; also referred to as MM36), a new topical, selective phosphodiesterase type-4 inhibitor, in Japanese pediatric patients with atopic dermatitis aged 2-14 years were evaluated in a phase 2, randomized, double-blind, vehicle-controlled, 4-week study. Seventy-three patients were randomized 1:1:1 to receive OPA-15406 0.3%, OPA-15406 1% or vehicle ointment twice daily for 4 weeks. The mean age of patients was similar across treatment groups. No deaths or serious treatment-emergent adverse events were reported; all treatment-emergent adverse events were mild or moderate in severity. The incidence of treatment-emergent adverse events leading to treatment discontinuation was 4.2% (1/24) in the OPA-15406 0.3% group, 4.0% (1/25) in the OPA-15406 1% group and 16.7% (4/24) in the vehicle group, all of which were worsening of atopic dermatitis. Both OPA-15406 groups demonstrated a higher incidence of success in the Investigator Global Assessment score compared with the vehicle group over the 4-week study. The OPA-15406 groups also showed greater improvements from baseline compared with the vehicle group in the Investigator Global Assessment score, Eczema Area and Severity Index overall score and subscale (erythema, induration/papulation, excoriation and lichenification) scores, Visual Analog Scale pruritus score, Patient-Oriented Eczema Measure score, and percentage of affected body surface area over the 4-week study. Topical OPA-15406 twice daily for 4 weeks was considered a safe and effective treatment option in this phase 2 study in pediatric patients with atopic dermatitis, and phase 3 development is currently ongoing.
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Affiliation(s)
- Hidehisa Saeki
- Department of DermatologyNippon Medical SchoolTokyoJapan
| | - Naoko Baba
- Kanagawa Children’s Medical CenterKanagawaJapan
| | - Kazuhide Oshiden
- Headquarters of Clinical DevelopmentOtsuka Pharmaceutical Co., Ltd.OsakaJapan
| | - Yuji Abe
- Headquarters of Clinical DevelopmentOtsuka Pharmaceutical Co., Ltd.TokyoJapan
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The Best of 2018 in the Annals of Allergy, Asthma, and Immunology: The Editors' Choices. Ann Allergy Asthma Immunol 2019; 122:127-133. [PMID: 30711033 DOI: 10.1016/j.anai.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/23/2022]
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14
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Leung DYM. The effect of being African American on atopic dermatitis. Ann Allergy Asthma Immunol 2019; 122:1. [PMID: 30579430 DOI: 10.1016/j.anai.2018.09.454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
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15
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Leung DYM. Atopic dermatitis: More than a rash. Ann Allergy Asthma Immunol 2019; 120:555-556. [PMID: 29891118 DOI: 10.1016/j.anai.2018.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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Moving toward a more precise treatment of atopic dermatitis. Ann Allergy Asthma Immunol 2019; 120:3-4. [PMID: 29273126 DOI: 10.1016/j.anai.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 01/16/2023]
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Boguniewicz M, Fonacier L, Guttman-Yassky E, Ong PY, Silverberg J, Farrar JR. Atopic dermatitis yardstick: Practical recommendations for an evolving therapeutic landscape. Ann Allergy Asthma Immunol 2019; 120:10-22.e2. [PMID: 29273118 DOI: 10.1016/j.anai.2017.10.039] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022]
Abstract
The implementation of treatment guidelines for atopic dermatitis is challenging, in part because of different guidance documents being used by different groups of specialists and in part because the language of guidelines often reflects the evidence base rather than the practical "how to." The Atopic Dermatitis Yardstick is part of a series developed in response to the need to proactively address the loss of disease control for atopic illnesses at all levels of severity. It presents a comprehensive update on how to conduct a sustained step-up in therapy for the patient with inadequately controlled or poorly controlled atopic dermatitis. Patient profiles, based on current guidelines and the authors' combined clinical experience, provide a practical and clinically meaningful guide to aid physicians in helping their patients achieve the goal of clear to almost clear. The intent is not to replace guidelines but to complement their recommendations incorporating the latest research and therapies.
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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, Colorado.
| | - Luz Fonacier
- Section of Allergy and Immunology, NYU Winthrop Hospital, Mineola, New York
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at the Mount Sinai Medical Center, New York, New York
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles and Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Jonathan Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Yang EJ, Beck KM, Sekhon S, Bhutani T, Koo J. The impact of pediatric atopic dermatitis on families: A review. Pediatr Dermatol 2019; 36:66-71. [PMID: 30556595 DOI: 10.1111/pde.13727] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is an extremely common childhood disease, with considerable impact on the quality of life of affected children and their families. While pruritus is the hallmark symptom of this disease, AD has been well-documented to impact patients beyond physical symptoms, resulting in behavior problems, mood disorders, and sleep disturbance. OBJECTIVE This literature review outlines how atopic dermatitis impacts the quality of life of families of children affected by AD. METHODS A total of 3436 articles were identified via an online search of the MEDLINE health literature database and were screened for relevance to quality of life impacts on families with children affected by AD. RESULTS Caring for children affected by AD can be an extremely time-consuming task that can impair personal relationships, decrease psychosocial functioning, and cause sleep loss among family members of affected patients. Additionally, AD may result in work absence or decreased work productivity for caregivers. Special diets, irritant and allergen avoidance strategies, and alternative therapies are commonly used by patients to manage their disease and require large amounts of family involvement. CONCLUSIONS Atopic dermatitis can greatly decrease quality of life of families of affected children in various domains, including sleep, finances, and relationships. Early intervention and psychotherapy may be needed in some patients to address these quality of life impairments.
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Affiliation(s)
- Eric J Yang
- Department of Dermatology, University of California San Francisco, San Francisco, California.,Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Kristen M Beck
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Sahil Sekhon
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - John Koo
- Department of Dermatology, University of California San Francisco, San Francisco, California
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Oland AA, Booster GD, Bender BG. Integrated behavioral health care for management of stress in allergic diseases. Ann Allergy Asthma Immunol 2018; 121:31-36. [PMID: 29751088 DOI: 10.1016/j.anai.2018.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This article reviews current findings regarding the management of stress in allergic disease. DATA SOURCES The authors use articles and books published between 1995 and 2017. Approximately 85% of sources used were published in the last 10 years, and 60% were published in the last 5 years. Most of the sources are peer-reviewed articles. STUDY SELECTIONS Articles that focused on allergic diseases such as allergic rhinitis, food allergies, urticaria, and allergic asthma were included. Articles in which whether the underlying disorder was allergic in nature (for example, nonspecified asthma) were not included. Preference was given to articles published within the past five years. RESULTS Patients with allergic diseases, particularly those with chronic or co-occurring allergic diseases, often experience stress and, in turn, this experience of stress can exacerbate disease presentation. High rates of treatment nonadherence in patients with allergic disease also can increase disease burden and stress. Research supports the benefit of behavioral health interventions for patients with allergic disease. Interventions with multidisciplinary teams, which include behavioral health, as well as interventions at the school, workplace, and community level, are recommended. CONCLUSION Medical providers working with patients with allergic disease need to address patients' experience of stress and nonadherence to treatment recommendations. This could be done through routine screening and referrals to behavioral health or, ideally, through incorporation of a behavioral health provider within a multidisciplinary patient team.
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Affiliation(s)
- Alyssa A Oland
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Genery D Booster
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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