Atopic dermatitis in US adults: Epidemiology, association with marital status, and atopy

Potential Aspects of the Use of Cytokines in Atopic Dermatitis

Atopic dermatitis (AD) is an abnormal inflammatory response in the skin to food, environmental IgE, or non-IgE allergens. This disease belongs to a group of inflammatory diseases that affect both children and adults. In highly developed countries, AD is diagnosed twice as often in children than in adults, which may possibly be connected to increased urbanization. The immune system's pathomechanisms of AD involve humoral mechanisms with IgE, cellular T lymphocytes, dendritic cells occurring in the dermis, Langerhans cells occurring in the epidermis, and other cells infiltrating the site of inflammation (eosinophils, macrophages, mast cells, neutrophils, and basophils). Cytokines are small proteins that affect the interaction and communication between cells. This review characterizes cytokines and potential aspects of the treatment of atopic dermatitis, as well as new strategies that are currently being developed, including targeting cytokines and their receptors.

Small-molecule agents for treating skin diseases

Skin diseases are a class of common and frequently occurring diseases that significantly impact daily lives. Currently, the limited effective therapeutic drugs are far from meeting the clinical needs; most drugs typically only provide symptomatic relief rather than a cure. Developing small-molecule drugs with improved efficacy holds paramount importance for treating skin diseases. This review aimed to systematically introduce the pathogenesis of common skin diseases in daily life, list related drugs applied in the clinic, and summarize the clinical research status of candidate drugs and the latest research progress of candidate compounds in the drug discovery stage. Also, it statistically analyzed the number of publications and global attention trends for the involved skin diseases. This review might provide practical information for researchers engaged in dermatological drugs and further increase research attention to this disease area.

Efficacy and safety of abrocitinib in patients with moderate-to-severe atopic dermatitis and comorbid allergies

BACKGROUND

Abrocitinib efficacy by comorbidity status in patients with moderate-to-severe atopic dermatitis (AD) has not been previously assessed. This post hoc analysis evaluated the efficacy and safety of abrocitinib in patients with AD and allergic comorbidities.

METHODS

Data were pooled from patients who received abrocitinib 200 mg, 100 mg, or placebo in phase 2b (NCT02780167) and phase 3 (NCT03349060, NCT03575871) monotherapy trials. Patients with and without allergic comorbidities (allergic asthma, rhinitis, conjunctivitis, or food allergy) were evaluated for Investigator's Global Assessment (IGA) response (clear [0] or almost clear [1]), ≥75% improvement in the Eczema Area and Severity Index (EASI-75), ≥4-point improvement in Peak Pruritus Numerical Rating Scale (PP-NRS4), and Dermatology Life Quality Index (DLQI) response (<2 with baseline score ≥2). Other outcomes were Patient-Oriented Eczema Measure (POEM), SCORing Atopic Dermatitis (SCORAD), Pruritus and Symptoms Assessment for Atopic Dermatitis (PSAAD), and treatment-emergent adverse events (TEAEs).

RESULTS

Of 942 patients, 498 (53%) reported at least one allergic comorbidity (asthma only, 33%; conjunctivitis only or rhinitis only or both, 17%; food allergies only, 15%; >1 allergic comorbidity, 34%). Regardless of comorbidity status, from Week 2 to Week 12, higher percentages of patients treated with either abrocitinib dose achieved IGA 0/1, EASI-75, PP-NRS4, or DLQI 0/1 versus placebo-treated patients. Changes from baseline in POEM, SCORAD, and PSAAD were greater with abrocitinib than with placebo in patients with and without allergic comorbidities. Most TEAEs were mild or moderate.

CONCLUSIONS

Efficacy and safety data support abrocitinib use to manage AD in patients with or without allergic comorbidities.

The efficacy and immunological effects of upadacitinib in the treatment of moderate-to-severe Chinese atopic dermatitis patients

Upadacitinib has received approval for the treatment of atopic dermatitis (AD) with favorable response in clinical trials. However, real-world research on its efficacy remains relatively limited. To bridge this gap, we conducted a prospective cohort study involving 25 Chinese patients with moderate-to-severe AD. These patients received a daily dose of 15 mg of upadacitinib. Our objective was to assess the real-world efficacy of upadacitinib and its impact on the immune system. Clinical assessments were conducted at baseline, 4 weeks, 8 weeks, and 12 weeks following treatment initiation. The findings revealed that upadacitinib treatment significantly improved the clinical scores of the patients. Regarding immunological markers, upadacitinib led to a significant reduction in peripheral blood eosinophils, as well as a decrease in neutrophil count. Furthermore, upadacitinib treatment resulted in an overall decrease in Th1, Th2, and Th17/22-type cytokines, as well as other inflammatory factors. Importantly, for the first time, we observed a notable reduction in both IL-22+CD4+ T cells and serum IL-22 levels in all treated patients, including those with recalcitrant AD who had previously shown inadequate responses to systemic treatments like dupilumab. Currently, international guidelines position upadacitinib as a second-line option following the failure of systemic treatments like dupilumab. Our findings provide valuable insights into the real-world effectiveness and immunological impacts of upadacitinib, which can aid in better understanding and implementation of the drug in clinical practice.

Asthma improvement in patients treated with dupilumab for severe atopic dermatitis

Introduction

Atopic dermatitis (AD) is considered a systemic type 2 immune driven disease, and it is associated to many atopic comorbidities including asthma. The aim of our study was to prospectively evaluate the respiratory outcomes in patients with persistent allergic asthma treated with dupilumab due to severe AD (sAD).

Methods

We enrolled eligible patients with sAD for dupilumab treatment from September 2018 to December 2020. We then selected the subgroup of patients sensitized to perennial allergens. Dupilumab's efficacy and safety on AD and comorbid asthma were assessed at baseline, one month, four months, and then every 4 months up to one year.

Results

A total of 437 patients with sAD were enrolled for dupilumab treatment due to sAD, and 273 reached 48 weeks of therapy. Respiratory outcomes were evaluated in the 85 asthmatic patients with positivity only to perennial allergens. Our patients showed statistically and clinically significant improvement in asthma control (Asthma Control Test and Asthma Control Questionnaire) and airway obstruction parameters (FEV1), in addition to the expected AD-related skin outcomes. Specifically, a significant improvement was achieved at the fourth month of dupilumab therapy, and this trend was maintained up to twelve months, regardless of asthma severity.

Conclusions

Our results showed the overall improvement of the clinical picture that dupilumab offers for patients with severe AD and persistent allergic asthma of any severity, highlighting the importance of a global multidisciplinary approach of type 2 driven disease.

Atopic Dermatitis Across Shades of Skin

Atopic dermatitis (AD) is a chronic, heterogeneous inflammatory skin disease that is associated with immense patient burden globally. There is increasing appreciation of disparities among patients identified as having skin of color (SOC), which often refers to patients of non-White race or non-European ancestry, but can broadly include individuals from a number of different racial, ethnic, ancestral, and skin pigmentation groups based on definition. In this narrative review, we discuss key terminology as it relates to AD across shades of skin, including modern definitions of 'race', 'ethnicity', and 'SOC'. We then synthesize the current literature describing disparities in AD prevalence, disease recognition, and burden alongside current data regarding genetic and immunologic findings across SOC populations. In the context of these findings, we highlight key concomitant social determinants of health, including environmental factors, socioeconomic status, and access to care, for which race often serves as a proxy for true biological and genetic differences. Finally, we discuss future efforts to shift to a more inclusive understanding of AD to encompass all shades of skin, to ensure equitable representation of diverse populations in high impact research, and intensify efforts to address the critical upstream factors driving observed disparities.

Healthcare utilization for atopic dermatitis: An analysis of the 2010-2018 health insurance review and assessment service national patient sample data

This cross-sectional, retrospective, observational study aimed to analyze the distribution and healthcare usage patterns of patients with atopic dermatitis using the 2010-2018 Health Insurance Review and Assessment Service data. Patients diagnosed with atopic dermatitis in Korea between January 2010 and December 2018 and registered in the Health Insurance Review and Assessment national database were identified, and 270,008 patients who used healthcare services at least once during this period were evaluated to ascertain the healthcare usage patterns and treatment methods for atopic dermatitis. The number of patients with atopic dermatitis plateaued during the study period, while the number of claims and total expenses increased by a small margin. Atopic dermatitis prevalence was the highest among patients aged <5 years (31.4%), followed by those aged 5-14 years (23.53%) and 15-24 years (15.33%). However, the prevalence in these age groups showed a decreasing trend over time. The most used Western medicine treatments were injections and oral medications involving topical corticosteroids, antihistamine agents, and oral steroids, while it was acupuncture therapy in Korean medicine. The frequency of the most frequently prescribed medication, topical corticosteroid, showed a decreasing trend over time. The findings in this study will inform healthcare policy makers and clinicians across different countries on the usage trends of Western medicine and Korean medicine treatment.

Factors related to eczema clinical trial participation among adult patients and caregivers

Background

Eczema can be difficult to treat due to its chronic, heterogeneous nature. Effective long-term treatments for adults and children are needed. Little is known about what considerations influence eczema patient and caregiver decision-making regarding clinical trial participation (CTP). This study identifies factors that adult patients and caregivers consider important for CTP and determines if differences exist between these groups.

Methods

A 46-question survey was administered May 1-June 6, 2020, to adults and caregivers of children with eczema. Respondents were asked to rate the importance of a series of factors when considering CTP; adults and caregivers were compared.

Results

Out of 31 total factors queried, eleven factors differed significantly in importance ratings between adults (n = 470) and caregivers (n = 134). The route of therapy (p = 0.030), side effects (p = 0.014), washout period (p = 0.028), receiving a placebo (p = 0.027), rescue therapy option (p = 0.033), access to test drug after trial (p = 0.027), sticking with the clinical trial regimen (p = 0.025), fit with work/school (p = 0.005), impact on overall health (p = 0.008), and satisfaction with current treatment (p = 0.033) were all more likely to be rated as important by caregivers than by adult patients. Only altruism was rated more highly by adult patients than caregivers (p = 0.027).

Conclusions

Caregivers are more likely than adults to attribute high importance to factors that may affect their child's eczema or well-being when considering CTP. Patient-centered CTP education materials and decision aids may support patients and caregivers in CTP decision-making.

Systematic exploration of eczema-associated paediatric diseases in a Chinese population of millions: A retrospective observation study

BACKGROUND

Eczema is the most common form of dermatitis and also the starting point of atopic march. Although many eczema-associated allergic and immunologic disorders have been studied, there remains a gap in the systematic quantitative knowledge regarding the relationships between all childhood disorders and eczema. This study aimed to systematically explore eczema-associated childhood diseases using a real-world, long-term clinical dataset generated from millions of children in China.

METHODS

Data were collected at 8,907,735 outpatient healthcare visits from 2,592,147 children between January 1, 2013, and August 15, 2019, at the largest comprehensive pediatric medical center in Zhejiang Province of China. The period prevalence differences in various pediatric diseases between children with and without eczema were used to test the independence of various pediatric disorders and eczema using Fisher's exact test. Bonferroni correction was used to adjust the p value in multiple testing. Odds ratio >2 with 95% confidence interval not including 1 and adjusted p < 0.05 was used to identify eczema-associated diseases.

RESULTS

Overall, 234 pediatric disorders were identified from more than 6000 different pediatric disorders. An interactive eczema-associated disease map that has related quantitative epidemiological features called ADmap was published at http://pedmap.nbscn.org/admap. Thirty-six of these disease associations have not been reported in previous studies.

CONCLUSION

This systematic exploratory study confirmed the associations of many well-known diseases with eczema in Chinese children and also identified some novel and interesting associations. These results are valuable for the development of a comprehensive approach to the management of eczema in childhood.

Outpatient utilization patterns for atopic dermatitis in the United States

BACKGROUND

The prevalence and demographics of atopic dermatitis (AD) in the United States have changed. Little is known about trends and determinants of outpatient health care utilization.

OBJECTIVE

Determine the trends and determinants of outpatient health care utilization for AD in US adults and children.

METHODS

Data from the 1993-2015 National Ambulatory Medical Care Survey were analyzed, including data on 110,095 pediatric and 642,140 adult outpatient visits.

RESULTS

AD visits were made predominantly to primary care physicians (PCPs) (768,882 mean visits annually), dermatologists (466,529 mean visits annually), and allergists (18,445 mean visits annually). The frequency of AD visits increased overall from 1996-1999 to 2012-2015 (from 867,649 to 1,950,546 annually [Rao-Scott chi-square P = .02]), particularly among PCPs (from 339,889 to 1,025,739 [P = .02]). The frequency of AD visits to dermatologists decreased (from 446,669 to 371,003 [P = .01]). AD visits to PCPs were most common among children aged 0 to 4 years (32.0%). Adults with comorbid allergic rhinitis or food allergies had greater odds of seeing an allergist. AD visits to PCPs were more likely to be visits due to an acute condition (51.5%), whereas AD visits to dermatologists were more likely to be visits due to a chronic condition (41.2%).

LIMITATIONS

AD severity was unavailable.

CONCLUSIONS

Outpatient visits for AD in the United States over time increased overall, but those to dermatologists decreased. Dermatologists are most commonly seeing patients whose visit is due to chronic AD, and they should tailor treatment appropriately.

Longitudinal Course of Sleep Disturbance and Relationship With Itch in Adult Atopic Dermatitis in Clinical Practice

Background: Sleep disturbance (SD) is common in atopic dermatitis (AD). We examined the longitudinal course of SD and relationship with itch in AD patients. Methods: A prospective, dermatology practice-based study was performed (N = 1295) where patients were assessed at baseline and follow-up visits. Results: At baseline, 16.9% of the patients had severe SD based on Patient-Reported Outcomes Information System (PROMIS) SD T scores, 19.1% had difficulty falling asleep, 22.9% had difficulty staying asleep, and 34.2% had SD from AD. A total of 31.4% of the patients with difficulty staying asleep at baseline experienced persistent difficulties (for 3 follow-ups or more). Only 17.7% with baseline difficulty falling asleep had persistent disturbance. Despite significant fluctuation in sleep scores, SD generally improved over time. Of the patients facing baseline SD from AD, 31.5% experienced SD at the first visit, and only 12.3% experienced persistent SD at the second follow-up visit. Predictors of increased PROMIS sleep-related impairment T scores over time included baseline PROMIS sleep-related impairment T scores (0.74 [0.68-0.80]), having 3 to 6 nights of itch (2.22 [0.85-3.59]), and severe/very severe AD (4.40 [2.60-6.20]). Conclusions: A significant proportion of adult AD patients, particularly those with moderate-severe AD and frequent itch, had baseline SD. Although sleep scores generally improved over time, many patients experienced a fluctuating or persistent course.

Associative factors for atopic dermatitis and other atopic diseases in middle-aged adults: A population-based birth cohort study among 5373 subjects

Background and aims

The study aimed to examine parental, longitudinal and current associative factors for atopic dermatitis (AD) and to compare those to other atopic diseases in 46-year-old adults.

Methods

Questionnaire data from the Northern Finland Birth Cohort 1966 study were used. To analyze allergic sensitization, skin prick tests (n = 5373) were performed for birch, timothy, cat, and house dust mite at age 46.

Results

Maternal (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.25-2.59) and paternal allergy (OR 2.54; CI 1.76-3.64), sensitization to any of the four tested aeroallergens (OR 1.56; CI 1.04-2.30) as well as polysensitization (OR 3.04; CI 2.10-4.37) were associated with current AD. Living on a farm in infancy was negatively associated with allergic rhinitis, allergic conjunctivitis, and atopic multimorbidity. Current AD (OR 2.65; CI 1.44-4.60) and all atopic diseases associated with indoor air related symptoms. Current AD associated with other atopic diseases, most strongly with allergic rhinitis (OR 4.92; CI 3.92-6.22).

Conclusion

Current AD in a 46-year-old general population occurred frequently with allergic rhinitis, allergic conjunctivitis, and asthma in the Northern Finland Birth Cohort study 1966. Parental allergy and sensitization to common aeroallergens were found as shared associative factors for AD, allergic rhinitis, allergic conjunctivitis, and asthma. AD and other atopic diseases associated with symptoms related to poor indoor air quality. In daily practice, it is important to take these comorbidities into consideration when treating patients with AD.

Prevalence, Predictors, and Longitudinal Course of Sexual Dysfunction in Adults With Atopic Dermatitis

BACKGROUND

Little is known about the burden of sexual dysfunction (SD) in atopic dermatitis (AD).

OBJECTIVE

The objective of this study is to determine the prevalence and associations of SD in adults with AD.

METHODS

A prospective dermatology practice-based study of adult patients (N = 677) with AD was performed. Sexual dysfunction in the past 7 days was assessed by patient report (4-point Likert scale). Atopic dermatitis severity was assessed using multiple validated clinician-reported and patient-reported outcomes.

RESULTS

At baseline, SD was reported by 19.35% of patients and was associated with being married (adjusted odds ratio [95% confidence interval], 2.252 [1.226-4.136]) and younger age (3.363 [1.768-6.397]) but not race or gender in models controlling for sociodemographics and AD severity. Adult-onset versus childhood-onset AD (2.781 [1.211-6.383]) was associated with significant SD. Sexual dysfunction and SD severity were associated with total and objective scoring AD, Eczema Area and Severity Index, body surface area, Investigator's Global Assessment, and their cross-product, Patient-Oriented Eczema Measure and Patient Global Assessment of AD. Atopic dermatitis lesions on the genitals (3.255 [1.405-7.541]), neck (2.244 [1.066-4.723]), and lower extremities (2.236 [1.265-3.951]) were particularly associated with SD.

CONCLUSIONS

Sexual dysfunction is commonly reported by adults with AD and is associated with marriage, adult-onset AD, AD severity, and lesions on the genitals.

National Saudi Consensus Statement on the Management of Atopic Dermatitis (2021)

Atopic dermatitis (AD) is a chronic inflammatory skin disease with an increasing prevalence regionally and globally. It is characterized by intense itching and recurrent eczematous lesions. With the increase in the availability of treatment options for healthcare practitioner and patients, new challenges arise for treatment selection and approach. The current consensus statement has been developed to provide up-to-date evidence and evidence-based recommendations to guide dermatologists and healthcare professionals managing patients with AD in Saudi Arabia. By an initiative from the Ministry of Health (MOH), a multidisciplinary work group of 11 experts was convened to review and discuss aspects of AD management. Four consensus meetings were held on January 14, February 4, February 25, and March 18 of 2021. All consensus content was voted on by the work group, including diagnostic criteria, AD severity assessment, comorbidities, and therapeutic options for AD. Special consideration for the pediatric population, as well as women during pregnancy and lactation, was also discussed. The present consensus document will be updated as needed to incorporate new data or therapeutic agents.

Comorbidity Identification and Referral in Atopic Dermatitis: a Consensus Document

BACKGROUND

Atopic dermatitis (AD) is associated with different comorbidities.

OBJECTIVE

To develop evidence-based and practical recommendations for comorbidity detection in patients with AD in daily practice.

METHODS

We employed a modified RAND/UCLA methodology, including a systematic literature review (SLR). A group of six experts on AD was established. We conducted a comprehensive search strategy on Medline, Embase, and Cochrane Library up to June 2020. The selection criteria included studies with AD patients with any comorbidity reporting data on comorbidity prevalence, burden, and management. The included studies quality was assessed. The SLR results were discussed in a nominal group meeting, and several recommendations were generated. The recommendation agreement grade was tested on additional experts through a Delphi process.

RESULTS

The recommendations cover the following issues: 1) Which comorbidities should be investigated at the first and subsequent visits; 2) How and when should comorbidities be investigated (screening); 3) How should patients with specific comorbidities be referred to confirm their diagnosis and initiate management; 4) Specific recommendations to ensure an integral care approach for AD patients with any comorbidity.

CONCLUSIONS

These recommendations seek to guide dermatologists, patients, and other stakeholders in regard to early comorbidity identification and AD patient referral to improve decision-making.

The ICER review is in: hope amidst uncertainty

DISCLOSURES: No funding contributed to the writing of this commentary. Smith Begolka, Butler, and Guadalupe are salaried employees of the National Eczema Association, which has received grants and sponsorship awards from a variety of industry partners, including AbbVie, Eli Lilly, Incyte, LEO Pharma, Pfizer, Regeneron, and Sanofi. Smith Begolka has received grant funding from Pfizer and advisory board honoraria from Pfizer and Incyte. Butler and Guadalupe have received advisory board honoraria from Incyte.

Epidemiologic features and burden of atopic dermatitis in adolescent and adult patients: A cross-sectional multicenter study

BACKGROUND

Atopic dermatitis (AD) is considered as one of the most frequent chronic skin conditions. Previous AD epidemiologic studies have been mainly retrospective and/or have been performed through surveys instead of in-person visits. Epidemiological studies concerning AD in Latin American countries are scarce.

OBJECTIVE

To describe sociodemographic and clinical features and the economic burden of AD on children and adult patients in Colombia through in-person visits.

METHODS

This was a cross-sectional study of 212 patients that included sociodemographic and clinimetric data. The diagnostic criteria of Hanifin and Rajka was used and data relating to disease distribution, disease severity (through the BSA: Body surface area; EASI: Eczema Area and Severity Index; SCORAD: Scoring Atopic Dermatitis), Fitzpatrick's skin phototypes, personal and familiar history of allergic diseases, previous treatments, and personal history of comorbidities, was collected.

RESULTS

Patient age range was 12-76, and 52.8% were female. Disease distribution was mainly flexural (19.6%). Early age start, Denni-Morgan fold, and infections tendency were more frequent in adolescents compared to adults. Mean age of diagnosis was 12 years old, AD diagnosis was made mostly by a dermatologist, 48.1% (102 patients) reported alcohol consumption, and 59% of consumers were heavy drinkers. Comorbidities found were: chronic rhinitis (68.9%) food allergy (32.5%), allergic conjunctivitis (29.7%), and asthma (28.8%). Around 81% earned less than $896 US dollars and 59% invested 6-30% of their monthly budget yearly, and 40% had work or school absenteeism. Mean scores of BSA, EASI, and SCORAD involvement were 32.6, 13.7, and 42.4, respectively.

CONCLUSIONS

This study adds well-supported data through an in-depth clinical and economical characterization of Colombian adolescents and adult patients with atopic dermatitis and shows its high impact and burden on patients and their families. It also contributes to understand the burden of AD in Latin America.

Dermatology for the internist: optimal diagnosis and management of atopic dermatitis

Internists are front-line health care providers that commonly provide the first encounter to patients for dermatological conditions, especially atopic dermatitis (AD). Internists need to be comfortable with managing mild-moderate AD in their practices. Criteria and guidelines established in dermatology literature are available to help the general practitioner diagnose and treat AD. AD is a systemic disease associated with multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions. Environmental factors may play a role in the development or worsening of AD; however, there is currently no strong evidence to guide specific population- or clinic-based interventions for their avoidance. While food allergies are common in AD patients, the role of food allergens as an exacerbating factor for AD is controversial. Before starting any dietary modifications, careful evaluation should be performed by an allergist. If the patient is not well-controlled despite adequate topical therapies or is experiencing severe/worsening disease, early referral to dermatology is warranted to rule out confounding diagnoses and/or escalation to systemic therapies. Finally, it is important to recognise the racial disparities present in AD and address these when formulating treatment plans.Key messages:Confounding dermatoses, either instead of or in addition to AD, should be considered in treatment-refractory AD, and the appropriate workup may be initiated while awaiting dermatology referral.AD patients have multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions.

DESCRIBE-AD: A novel classification framework for atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is a chronic, inflammatory skin disease associated with heterogeneous morphology, distribution, symptoms, severity, extent, longitudinal courses, quality of life burden, comorbidities, and treatment responses. This heterogeneity contributes to challenges in diagnosis, the characterization of disease activity, and therapeutic stratification.

OBJECTIVE

To develop a framework to standardize AD assessment.

METHODS

We propose a novel framework to assess AD based on a literature review and clinical experience.

RESULTS

DESCRIBE-AD is a framework that can effectively capture the clinical domains contributing to AD heterogeneity and includes both patient- and clinician-reported perspectives. DESCRIBE-AD includes assessments of Dermatitis morphology and phenotype, Evolution of disease, Symptom severity, Comorbid health disorders, Response to therapy, Intensity of lesions, Burden of disease, and Extent of lesions. Rather than placing the focus on any single, specific aspect of AD, DESCRIBE-AD allows for a comprehensive approach to the assessment and clinical management of AD.

CONCLUSIONS

DESCRIBE-AD is a novel framework that can be used to better describe the heterogeneity of AD and guide treatment decisions.

Structural racism and its pathways to asthma and atopic dermatitis

Black, Latinx, and Indigenous people in the United States experience a disproportionate burden of asthma and atopic dermatitis. The study of these disease disparities has focused on proximal socioenvironmental exposures and on the biomechanistic (including genetic) differences between racial and ethnic groups. Although biomedical research in allergy and immunology stands to benefit from the inclusion of diverse study populations, the narrow focus on biologic mechanisms disregards the complexity of interactions across biologic and structural factors, including the effects of structural racism. Structural racism is the totality of ways in which society fosters discrimination by creating and reinforcing inequitable systems through intentional policies and practices sanctioned by government and institutions. It is embedded across multiple levels, including the economic, educational, health care, and judicial systems, which are manifested in inequity in the physical and social environment. In this review, we present a conceptual framework and pull from the literature to demonstrate how structural racism is a root cause of atopic disease disparities by way of residential segregation, socioeconomic position, and mass incarceration, which may lead to aberrations in the innate and adaptive immune response and the augmentation of physiologic stress responses, contributing to a disproportionate disease burden for racial and ethnic populations.

Financial Burden of Atopic Dermatitis Out-of-Pocket Health Care Expenses in the United States

Background

Atopic dermatitis (AD) is associated with considerable financial cost. However, the full burden of out-of-pocket (OOP) expenses is not well understood.

Objective

We sought to characterize the OOP health care expenses associated with AD management.

Methods

A 25-question voluntary online survey was administered to National Eczema Association members worldwide (n = 113,502). Inclusion criteria (US residents age ≥18 years who either self-reported had AD or were primary caregivers of individuals with AD) were met by 77.3% (1118/1447) of respondents.

Results

Respondents reported OOP expenses in 3 categories: (1) health care providers and prescriptions, including health care provider visit deductibles (68.7% [686]), prescription co-pays (64.3% [635]), and prescriptions not covered by insurance (48.6% [468]); (2) nonprescription health care products, including moisturizers (94.3% [934]), hygiene products (85.0% [824], allergy medications (75.1% [715]), itch relievers (68.25% [647]), dietary supplements (52.2% [491]), and sleep aids (37.0% [336]); and (3) complementary approaches, including cleaning products (74.7% [732]), clothing/bedding (44.8% [430]), alternative medications (19.0% [180]), and adjunctive therapies (15.9% [150]). The median annual AD OOP expense was US $600 (range, US $0–$200,000), with 41.9% (364) reporting expenditures US $1000 or greater.

Conclusions

Out-of-pocket expenses place a significant financial burden on individuals with AD. Additional studies are needed to better understand associations and impact of OOP costs.

Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among black individuals in the United States

Black race is associated with increased atopic dermatitis (AD) severity and healthcare resource utilization. However, the burden of out-of-pocket (OOP) expenses among black individuals with AD is not well understood. We sought to characterize the categories and impact of OOP healthcare expenses associated with AD management among black individuals. A 25-question voluntary online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents age ≥ 18 years; self-report of AD or primary caregivers of individuals with AD) was met by 77.3% (1118/1447) of respondents. Black individuals with AD were younger, had lower household income, Medicaid, urban residence, poor AD control and frequent skin infections (P ≤ 0.02). Blacks vs. non-blacks reported more OOP costs for prescription medications covered (74.2% vs. 63.6%, P = 0.04) and not covered (65.1% vs. 46.5%, P = 0.0004) by insurance, emergency room visits (22.1% vs. 11.8%, P = 0.005), and outpatient laboratory testing (33.3% vs. 21.8%, P = 0.01). Black race was associated with increased household financial impact from OOP expenses (P = 0.0009), and predictors of financial impact included minimally controlled AD (adjusted OR [95% CI] 13.88 [1.63-117.96], P = 0.02), systemic therapy (4.34 [1.63-11.54], 0.003), > $200 monthly OOP expenses (14.28 [3.42-59.60], P = 0.0003), and Medicaid (4.02 [1.15-14.07], P = 0.03). Blacks with Medicaid had higher odds of harmful financial impact (3.32 [1.77-6.24], P = 0.0002) than those of black race (1.81 [1.04-3.15], P = 0.04) or with Medicaid (1.39 [1.02-1.88], P = 0.04) alone. Black race is associated with increased OOP costs for AD and significant household financial impact. Targeted interventions are needed to address financial disparities in AD.

Insights into the Implications of Coexisting Type 2 Inflammatory Diseases

The role of type 2 inflammation in the pathogenesis of certain human diseases is an area of active investigation. Certain asthma, atopic dermatitis, eosinophilic esophagitis, and chronic rhinosinusitis phenotypes are characterized by a Th2 predominant inflammatory pathway and are frequently associated with comorbid conditions in patients. The purpose of this article is to review the evidence behind concurrent Th2-mediated diseases and explore how the presence of these comorbid conditions affect patient and disease outcomes.

JAK inhibitors in the treatment of atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disorder associated with heterogenous presentation and often immense patient burden. Safe, targeted treatment options are currently limited. This focused review of the published literature, including clinical trial results, case reports, and abstracts, as well as presentations from scientific meetings and data from industry press releases, describes the use of topical and systemic Janus kinase (JAK) inhibitors in the treatment of AD. New topical JAK inhibitors include ruxolitinib (JAK1/2) and delgocitinib (pan-JAK). Ruxolitinib cream met all primary and secondary endpoints in phase 3 clinical trials for mild-to-moderate AD with minimal treatment-emergent adverse events. Delgocitinib ointment was recently approved in Japan for pediatric and adult AD. Oral JAK inhibitors include baricitinib (JAK1/2), abrocitinib (JAK1-selective), and upadacitinib (JAK1-selective). All 3 met primary and secondary endpoints across numerous trials for moderate-to-severe AD. Treatment-emergent adverse events were mainly mild to moderate and included acne, nausea, headache, upper respiratory tract infection, and to a lesser degree, herpes infection and selected laboratory abnormalities. JAK inhibitors hold great promise as the next generation of targeted AD therapy. While their outstanding efficacy is balanced by a favorable safety profile in clinical trials, real-world data are needed to better understand long-term safety, durability, and treatment success.

Association between Atopic Dermatitis and Hypertension: A Systematic Review and Meta-Analysis

BACKGROUND

Previous studies found conflicting results about the association of atopic dermatitis (AD) with hypertension.

OBJECTIVES

Determine whether AD and AD severity are associated with hypertension.

METHODS

A systematic review was performed of published studies in MEDLINE, EMBASE, Scopus, Web of Science, and GREAT databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale.

RESULTS

Fifty-one studies met inclusion criteria; 19 had sufficient data for meta-analysis. AD was associated with higher odds of hypertension compared to healthy controls (increased in 9 of 16 studies; pooled prevalence: 16.4% vs 13.8%; random-effects regression, pooled unadjusted odds ratio [OR][95% confidence interval <CI95>]: 1.16 [1.04-1.30]), but lower odds of hypertension compared to psoriasis (decreased in 5 of 8 studies; 15.4% vs 24.8%; 0.53 [0.37-0.76]). In particular, moderate-severe AD were associated with hypertension compared to healthy controls (increased in 4 of 6 studies; 24.9% vs 14.7%; 2.33 [1.10-4.94]). Hypertension was commonly reported as an adverse-event secondary to AD treatments, particularly systemic cyclosporine A. Limitations include lack of longitudinal studies or individual-level data and potential confounding.

CONCLUSIONS

AD, particularly moderate-to-severe disease, was associated with increased hypertension compared to healthy controls, but lower odds than psoriasis.

The Interplay of Atopic Dermatitis and Sexual Health

Atopic dermatitis (AD), a chronic inflammatory skin condition, negatively affects sexual health in various ways including causing physical discomfort and changes in physical appearance that can lead to low self-confidence. The chronic and debilitating nature of this disease can interfere with the sexual well-being of patients and their partners. This review describes the ways that AD affects sexual health. In addition, we review the impact that partnered relationships and physical intimacy can have on AD and provide practical recommendations for optimizing sexual health in AD patients.

Association between atopic dermatitis and headaches throughout childhood and adolescence-A longitudinal birth cohort study

BACKGROUND/OBJECTIVES

Atopic dermatitis (AD) is associated with sleep disturbance, psychosocial distress, anxiety, depression, and atopic comorbidities, which may be associated with increased headaches. Our objective was to understand the association of AD and comorbid asthma, sleep and mental health disturbances with headaches throughout childhood and adolescence.

METHODS

Data were analyzed from The Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of 4898 urban children born in 1998-2000.

RESULTS

AD was associated with headaches at age 5 (adjusted odds ratio [95% confidence interval]: 2.14 [1.27-3.59]), 9 (1.69 [1.27-2.27]) and 15 years (1.71 [1.37-2.14]). AD at age 9 was associated with higher odds of subsequent headaches at age 15 (1.36 [1.05-1.76]). Children with AD at two (1.60 [1.12-2.29]) or all three (1.79 [1.16-2.75]) study-waves had higher odds of headaches at age 15 years. In multivariable repeated measures logistic regression models, significant two-way interactions were found for AD with sleep disturbance (4.59 [3.15-6.69]), attention deficit (hyperactivity) disorder (2.85 [1.87-4.35]), asthma (2.87 [2.18-3.76]), anxiety (2.47 [1.76-3.48]) or depression (2.86 [1.89-4.34]) as predictors of headaches.

CONCLUSION

Children and adolescents with AD, particularly those with sleep disturbances, atopic and mental health comorbidities, had increased headaches. Persistent childhood AD was associated with headaches in adolescence.

Secular trends of atopic dermatitis and its comorbidities in United States children between 1997 and 2018

Previous studies found increased prevalence of childhood atopic dermatitis (AD) in the United States over the past few decades. It is unknown whether the prevalence of AD has plateaued or whether AD comorbidities changed over time. The main objective of this study is to assess the prevalence and secular trends of AD and its comorbidities. We analyzed data on 259,818 children, ages 0 to 17 years, from the National Health Interview Survey, 1997-2018, using logistic regression models. The prevalence (95% confidence interval) of childhood AD steadily increased from 2000 [7.3% (6.8-7.9%)] to 2011 [12.8% (12.1-13.5%)] and remained consistent until 2018 [12.6% (11.6-13.5%)]. In logistic regression models, the odds of AD were significantly increased in all years from 2003 to 2018 compared to 1997. However, the increased odds of AD over time were attenuated when adjusting for socio-demographic factors. AD prevalence increased in most socio-demographic groups, but changed variably by age group, race/ethnicity, and region. There were significant trends of AD comorbidities over time, with increasing prevalence of attention deficit (hyperactivity) disorder, and decreasing prevalence of hay fever and depression/sadness. AD prevalence in US children increased between 1997 and 2011, remaining consistent until 2018 with an overall increase of 59%. Prevalence of comorbid hay fever and sadness/depression decreased, while ADD/ADHD increased. Given divergent trends of AD prevalence by socio-demographic characteristics, future studies are better equipped to identify contributing factors of prevalence change.

Association of Atopic Dermatitis With Bacterial, Fungal, Viral, and Sexually Transmitted Skin Infections

BACKGROUND

Atopic dermatitis (AD) is associated with altered skin barrier, microbiome, and immune dysregulation that may increase risk of skin infections.

OBJECTIVE

The aim of the study was to determine whether AD is associated with skin infections and related outcomes.

METHODS

Data from the 2006 to 2012 National Emergency Department Sample were analyzed, including an approximately 20% sample of all US emergency department (ED) visits (N = 198,102,435 adults or children).

RESULTS

Skin infections were increased in ED visits of adults (7.14% vs 3.76%) and children (5.15% vs 2.48%) with AD. In multivariable logistic regression models, AD was associated with significantly higher odds of skin infection in adults (adjusted odds ratio [95% confidence interval] = 1.93 [1.89-1.97]) and children (2.23 [2.16-2.31]). Pediatric and adult AD were associated with significantly higher odds of carbuncle/furuncles, impetigo, cellulitis, erysipelas, methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections, molluscum contagiosum, cutaneous warts, herpes simplex and zoster viruses, eczema herpeticum, dermatophytosis, and candidiasis of skin/nails and vulva/urogenitals. Adults with AD had significantly higher odds of genital warts (1.51 [1.36-1.52]) and herpes (1.23 [1.11-1.35]). Skin infections were associated with US $19 million excess annual costs of ED care in persons with AD.

CONCLUSIONS

Atopic dermatitis patients had higher odds of multiple bacterial, viral, fungal, and sexually transmitted skin infections.

Psychosocial impact of skin diseases: A population-based study

Background

While it is well established that skin disease places significant psychosocial burden on a patient’s wellbeing, its effects have rarely been examined in Asian populations.

Objective

Evaluate the psychosocial burden of skin disease among community-dwelling adults in Singapore.

Methods

This cross-sectional study included 1510 participants interviewed on their history of thirteen skin diseases. The Patient Health Questionnaire (PHQ-9), Lubben Social Network Scale-6 (LSNS-6), University of California Los Angeles (UCLA) Loneliness Scale, and European Quality of Life-5 Dimensions- 5 Level (EQ-5D-5L) were used as measures for depressive symptoms, social isolation, loneliness and quality of life respectively. Multiple linear regression analysis was used to examine the association of skin diseases with each of the four measured outcomes.

Results

Participants with skin diseases reported significantly higher PHQ-9 and UCLA Loneliness scale scores, and lower LSNS-6 and EQ-5D-5L scores when compared to their healthy counterparts. The presence of skin disease was positively associated with depressive symptoms (B = 0.40, SE = 0.11), and negatively associated with quality of life (B = -0.03, SE = 0.01). As disease severity was not evaluated in this study, we were unable to ascertain the associations between disease severity and measured outcomes.

Conclusion

Participants with skin diseases were more likely to have depressive symptoms, social isolation, loneliness and lower quality of life. Unemployed, single and elderly patients were at higher risk of developing depressive symptoms. More emphasis should be placed on the psychosocial aspect of care to reduce the burden of skin disease. Some considerations include monitoring patients for mood-related changes and implementing early psychosocial interventions.

Efficacy of dupilumab in atopic comorbidities associated with moderate-to-severe adult atopic dermatitis

BACKGROUND

Dupilumab is an anti-IL-4Rα antibody used in the treatment of patients with moderate-to-severe atopic dermatitis (msAD). This study explored the potential benefit of dupilumab in perennial allergic rhinoconjunctivitis (PAR) and perennial allergic asthma (PAA) caused by indoor allergens in adults with msAD.

METHODS

This multicentric, prospective, observational, real-life study included adult patients with msAD who had been treated with dupilumab in 16 Italian care centres. Efficacy outcomes regarding AD, PAR and PAA were collected at baseline and 16 weeks. Safety was also assessed.

RESULTS

We enrolled 123 patients with msAD. Between baseline and 16 weeks of treatment, the following measurements decreased statistically significantly: Eczema Area and Severity Index, SCOring AD, Patient-Oriented Eczema Measure, pruritus score, sleep score, Dermatology Life Quality Index and IgE. Dupilumab treatment in patients with comorbid PAR (n = 41) was associated with significant improvements in PAR disease control (measured using a Rhinitis Control Scoring System) and in PAR Quality of life (QoL) (measured using the Rhinoconjunctivitis QoL Questionnaire scores). In 32 patients with comorbid PAA, dupilumab significantly improved PAA control (measured using the Asthma Control Test and five-item Asthma Control Questionnaire scores) and disease-related QoL (measured using the Asthma QoL Questionnaire scores). Thirty-five patients (28.5%) developed conjunctivitis during the study period.

CONCLUSION

These results support the benefits of dupilumab for adult patients with PAR and/or PAA associated with msAD.

A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice

BACKGROUND

Little is known about the longitudinal course of adult atopic dermatitis (AD) lesional severity and extent in clinical practice.

OBJECTIVE

To determine the longitudinal course of AD in clinical practice.

METHODS

A prospective, dermatology practice-based study was performed (n = 400). Patients were assessed at baseline and approximately 6, 12, 18, and 24 months by eczema area and severity index (EASI) and objective-scoring atopic dermatitis (objective-SCORAD). Multivariable repeated measures linear regression models were constructed to evaluate AD severity over time.

RESULTS

Overall, 36.2% and 18.2% of patients had moderate (6.0-22.9) or severe (23.0-72.0) EASI scores at any visit, respectively. Similarly, 29.0% and 26.4% of patients had moderate (24.0-37.9) or severe (38.0-83.0) objective-SCORAD scores at any visit, respectively. Among patients with baseline moderate (6.0-22.9) or severe (23.0-72.0) EASI scores, 25.0% and 18.6% continued to have moderate or severe scores at 1 or more follow-up visits, respectively. Similarly, among patients with baseline moderate (24.0-37.9) or severe (38.0-83.0) objective-SCORAD scores, 22.6% and 24.5% continued to have moderate or severe scores at 1 or more follow-up visits, respectively. In longitudinal regression models, EASI was significantly associated with body surface area (adjusted β [95% confidence interval]: 0.16 [0.09-0.23]) and edema/papulation (2.31 [0.19-4.43]). In addition, objective-SCORAD was significantly associated with body surface area (0.12 [0.04-0.21]), edema/papulation (4.69 [2.05-7.32]), and scratch (3.34 [0.45-6.24]) over time.

CONCLUSION

AD lesional severity has a heterogeneous longitudinal course. Many patients had fluctuating lesional severity scores over time. A minority of patients had persistently moderate or severe lesions over time. Most patients with moderate-severe disease at baseline were unable to achieve persistent lesional clearance.

Identification of Molecular Signatures in Mild Intrinsic Atopic Dermatitis by Bioinformatics Analysis

Background

Atopic dermatitis (AD) is recognized as a common inflammatory skin disease and frequently occurred in Asian and Black individuals.

Objective

Since the limitation of dataset associated with human severe AD, this study aimed to screen potential novel biomarkers involved in mild AD.

Methods

Expression profile data (GSE75890) were obtained from the database of Gene Expression Omnibus. Using limma package, the differentially expressed genes (DEGs) between samples from AD and healthy control were selected. Furthermore, function analysis was conducted. Meanwhile, the protein-protein interaction (PPI) network and transcription factor (TF)-miRNA-target regulatory network were constructed. And quantitative real-time polymerase chain reaction (qRT-PCR) was used to validate the expressions patterns of key genes.

Results

In total, 285 DEGs including 214 upregulated and 71 downregulated genes were identified between samples from two groups. The upregulated DEGs were mainly involved in nine pathways, such as hematopoietic cell lineage, pertussis, p53 signaling pathway, staphylococcus aureus infection, and cell cycle, while tight junction was the only pathway enriched by the downregulated DEGs. Cyclin B (CCNB)1, CCNB2, cyclin A (CCNA)2, C-X-C motif chemokine ligand (CXCL)10, and CXCL9 were key nodes in PPI network. The TF-miRNA-target gene regulatory network focused on miRNAs such as miR-106b, miR-106a, and miR-17, TFs such as nuclear factor kappa B subunit 1, RELA proto-oncogene, Sp1 transcription factor, and genes such as matrix metallopeptidase 9, peroxisome proliferator activated receptor gamma , and serpin family E member 1. Moreover, the upregulation of these genes, including CCNB1, CCNB2, CCNA2, CXCL10, and CXCL9 were confirmed by qRT-PCR.

Conclusion

CCNB1, CCNB2, CCNA2, and CXCL9 might be novel markers of mild AD. miR-106b and miR-17 may involve in regulation of immune response in AD patients.

Atopic Dermatitis in Adults

Atopic dermatitis (AD) was once thought to be a benign childhood disease that remitted with increasing age. However, recent studies have transformed the understanding of AD, particularly in adult patients. AD is common in adults and can lead to substantial disability by negatively affecting sleep, mental health, and quality of life. There seem to be different genetic, immunologic, and epidemiologic risk factors for AD in adults than in children. This article examines the pathophysiology, epidemiology, heterogeneous clinical presentation, burden, diagnosis, and treatment of adult AD.

Understanding the immune landscape in atopic dermatitis: The era of biologics and emerging therapeutic approaches

Atopic dermatitis (AD) is a chronic, systemic, inflammatory disease that affects the skin and is characterized by persistent itch and marked redness. AD is associated with an increased risk of skin infections and a reduced quality of life. Most AD treatment options to date were not designed to selectively target disease-causing pathways that have been established for this indication. Topical therapies have limited efficacy in moderate-to-severe disease, and systemic agents such as corticosteroids and immunosuppressants present with tolerability issues. Advances in the understanding of AD pathobiology have made possible a new generation of more disease-specific AD therapies. AD is characterized by the inappropriate activation of type 2 T helper (Th2) cells and type 2 innate lymphoid (ILC2) cells, with a predominant increase in type 2 cytokines in the skin, including interleukin (IL)-13 and IL-4. Both cytokines are implicated in tissue inflammation and epidermal barrier dysfunction, and monoclonal antibodies targeting each of these interleukins or their receptors are in clinical development in AD. In March 2017, dupilumab, a human anti-IL-4Rα antibody, became the first biologic to receive approval in the United States for the treatment of moderate-to-severe AD. The anti-IL-13 monoclonal antibodies lebrikizumab and tralokinumab, which bind different IL-13 epitopes with potentially different effects, are currently in advanced-stage trials. Here, we briefly review the underlying pathobiology of AD, the scientific basis for current AD targets, and summarize current clinical studies of these agents, including new research to develop both predictive and response biomarkers to further advance AD therapy in the era of precision medicine.

Dupilumab for atopic dermatitis: evidence to date

INTRODUCTION

Atopic dermatitis (AD) is a common chronic, pruritic inflammatory dermatosis. The inflammatory response is characterized by a T helper 2 (Th2) immune response phenotype.

EVIDENCE ACQUISITION

To assess current available data on dupilumab, the writers of this article did a comprehensive search in different databases, including Medline, EMBASE, SCOPUS, and clinical trial registries. All relevant articles identified were then manually reviewed. Information regarding dupilumab mechanism of action, pharmacokinetics, clinical efficacy, safety, and future trends was then summarized.

EVIDENCE SYNTHESIS

Topical therapy is the main treatment in mild-to-moderate AD, but many cases of moderate-to-severe require systemic treatments. Dupilumab is the first biologic approved for the treatment of adults with moderate-to-severe AD. It inhibits IL-4 and IL-13 signaling pathways and reduces Th2 response. Clinical trials have demonstrated significantly improved clinical and patient-reported outcomes. The addition of application of topical corticosteroids results in a more significant improvement in signs and symptoms of AD than with use of dupilumab in monotherapy. The vast majority of patients improves under dupilumab, and almost 40% of patients achieve clear or nearly clear skin. In addition to its effectiveness, dupilumab also has a favorable safety profile. Frequent adverse events reported in the clinical trials were mostly mild-to-moderate and included nasopharyngitis, upper respiratory tract infection, injection site reactions, and conjunctivitis.

CONCLUSIONS

In general, rates of adverse events occurred with similar frequency between the treatment and placebo groups. Conjunctivitis seems to be a dupilumab-specific side effect and so far has only been observed in atopic dermatitis patients (not in asthma or nasal polyposis). There were no major serious safety concerns identified in phase III clinical trials. Trials in the pediatric population are ongoing and are highly awaited.

Depression and psychological distress in US adults with atopic dermatitis

BACKGROUND

Symptoms of anxiety and depression appear to contribute to the overall burden of atopic dermatitis (AD). However, the burden of mental health symptoms and psychological distress in AD have not been fully elucidated.

OBJECTIVE

To determine the prevalence and predictors of depressive symptoms and psychological distress among US adults with AD and how they compare with psoriasis and other disorders.

METHODS

We analyzed the 2004-2015 Medical Expenditure Panel Surveys, a representative sample of US adults. Patient Health Questionnaire-2 (PHQ-2) and Kessler-6 index (K-6) scores assessed depressive symptoms and psychological distress, respectively.

RESULTS

Atopic dermatitis in adults is associated with increased odds of screening positive for depressive symptoms (PHQ-2 ≥2) (44.3% vs 21.9%; adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.86 [1.14, 7.16]) and severe psychological distress (K-6≥13) (25.9% vs 5.5%; 6.04 [2.28, 15.99]). Adults with vs without AD had increased K6 scores overall (linear regression, P = .04) and severe psychological distress in particular (K-6≥13; logistic regression; adjusted odds ratio [95% CI]: 6.04 [2.28, 15.99]). K-6 scores were associated with lower household income (linear regression; adjusted beta [95% CI]: 6.22 [0.88, 11.56]) and middle income (4.49 [0.39, 8.59]), but inversely associated with black (-7.36 [-11.70, -3.03]) and multiracial/other (-2.85 [-5.67, -0.03]) race/ethnicity.

CONCLUSION

Atopic dermatitis is associated with more depressive symptoms and psychological distress overall, and even worse than many other chronic diseases. These findings highlight the need for clinicians to consider screening for and monitoring mental health symptoms in AD patients. Future studies are needed to develop interventions to reduce psychological distress in AD.

Tripterygium agents for the treatment of atopic eczema: A Bayesian analysis of randomized controlled trials

BACKGROUND

Atopic eczema is a common and recrudescent skin disorder. Tripterygium agents (TA), extracted from Tripterygium wilfordii hook F, a traditional Chinese medicine, have been used as a supplemental therapy for treating eczema empirically in recent years.

PURPOSE

To investigate the efficacy and safety of TA for treating atopic eczema.

STUDY DESIGN

Systematic review and Bayesian analysis.

METHODS

PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Chinese Scientific Journals Database, the Wan Fang Database, and Chinese Biomedicine databases were systematically searched from their respective inception dates to October 2, 2018. Randomized controlled trials (RCTs) related to TA used alone or in combination with other drugs were included. Meta-analysis was conducted by RevMan 5.3 software, and Bayesian analysis was performed in Stata 15.0 and R (V.3.4.0) package gemtc software. The Cochrane risk-of-bias tool and Jadad score were applied to assess the quality of all trials.

RESULTS

Thirteen trials involving 1385 patients were analyzed. Meta-analysis showed that, when treating atopic eczema patients, TA combined with other drugs were strongly synergistic (p < 0.00001). Among all combinations, the efficacy of TA combined with Diyin tablet (DYP) and topical glucocorticoids (TG) (RR: 0.06, 95%CI [0.01, 0.53]), as well as with compound glycyrrhizin (CG) (RR: 0.36, 95%CI [0.14,0.94]) was superior. Among the different combined medications, the best curative effect was achieved with TA combined with DYP and TG (98.2%), followed by TA combined with CG (85.3%), with TG (51.0%), or with Fuyang granule (FG) (49.9%). Reproductive system dysfunction was the main adverse events in patients treated with TA (RR: 6.23, 95%CI [1.12, 34.62]). Immunoglobulin E (IgE) levels were significantly decreased, after treatment with TA (p = 0.04). Subgroup analysis indicated no statistically significant difference in eczema-related cytokines (p = 0.44). Recurrence rates of using TA and other drugs were similar (p = 0.40).

CONCLUSION

TA appear to be effective in some therapies when treating patients with atopic eczema, but with apparent side effects. It cannot be concluded that TA can be generally used for eczema in the clinic, because of the small sample size. Further multi-center studies with large samples, and high-quality RCTs should be conducted to clarify the efficacy and safety of TA for treating eczema.

The prevalence and persistence of atopic dermatitis in urban United States children

BACKGROUND

Previous studies found that childhood atopic dermatitis (AD) and asthma are associated with residence in urban areas. However, little is known about the prevalence and determinants of AD in US urban populations and its impact on quality-of-life (QOL) and asthma.

OBJECTIVE

To determine AD prevalence and persistence, sociodemographic predictors thereof, and association with QOL and atopic comorbidities in US urban children.

METHODS

We analyzed data from The Fragile Families and Child Wellbeing Study, a prospective cohort study of 4898 women and their children born in 20 large US cities between 1998 and 2000. AD prevalence was determined at ages 5, 9, and 15 years, and stratified by sex, race/ethnicity, and household poverty income level.

RESULTS

The prevalences (95% confidence interval [CI]) of childhood AD were 15.0% (11.0%-18.9%), 15.1% (11.5%-18.7%), and 14.5% (10.4%%-18.5%) at ages 5, 9, and 15 years, respectively. Female sex (multivariable repeated measures logistic regression; adjusted odds-ratio [95% CI]: 1.56 [1.02-2.37]) and black race (1.80 [1.07-3.01]) were associated with persistent AD across all 3 ages. Children with AD at ages 5 and 15 (2.63 [1.42-4.86]), 5, 8 and 15 (1.47 [1.02-2.12]) and 9 and 15 years (1.61 [1.00-2.60]) had higher odds of poor/fair/good overall health. Children with AD at ages 5 and 9 years had the highest odds of ever having asthma (adjusted odds ratio [95% confidence interval]: 6.05 [5.88-6.22]), followed by children with AD at ages 5, 9, and 15 years (3.17 [3.07%-3.27]).

CONCLUSION

Atopic dermatitis prevalence and persistence were highest in US urban children who were female or black. Urban children with persistent AD were more likely to have poor QOL and asthma.

Comorbidities and the impact of atopic dermatitis

OBJECTIVE

Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease with substantial patient and population burdens. A number of comorbid health problems occur in patients with AD, aside from the cutaneous signs and symptoms. This review summarizes recent developments in the burden and comorbidities of AD.

DATA SOURCES

Literature review.

STUDY SELECTIONS

Nonsystematic.

RESULTS

Different aspects of AD, such as chronic pruritus, psychosocial distress, and inflammation, can lead to anxiety, depression, or suicidality. Atopic dermatitis is associated with and may predispose to higher risk of other atopic disorders, including asthma, hay fever, food allergy, and eosinophilic esophagitis. Persons with AD appear to be at higher risk for infectious and cardiovascular risk.

CONCLUSION

Atopic dermatitis is associated with substantial burden and comorbidities. Identifying AD comorbidities is essential for proper disease management and improving overall patient outcomes.

Predictors of hospital readmission in US children and adults with atopic dermatitis

BACKGROUND

Decreasing readmissions is a health care priority in the United States. However, little is kanown about the determinants of hospital readmissions for atopic dermatitis (AD).

OBJECTIVE

To determine readmission rates among inpatients hospitalized for AD in the United States.

METHODS

We analyzed the 2012-2014 Nationwide Readmission Database, including a representative, cross-sectional sample of hospital readmissions in the United States.

RESULTS

Overall, 17.0% of inpatients with AD were readmitted within 1 year for all causes, including 12.5% with only a single readmission and 4.6% for AD. In multivariable Cox proportional hazards regression models, hospital readmission for AD was associated with below-median household income, being uninsured, having a prolonged initial hospitalization, but inversely associated with older age and a diagnosis of infection. Inpatients admitted for AD on a weekend, in the summer, or in autumn were more likely to be readmitted for AD. Hospital characteristics associated with readmission for AD included nonmetropolitan hospital location and hospital teaching status.

CONCLUSION

One in 5 inpatients with AD are readmitted within 1 year for all causes. There are socioeconomic and health care disparities in readmission rates for AD.