Tips and Tricks for Controlling Eczema

Electroacupuncture for relieving itching in atopic eczema: study protocol for a multicenter, randomized, sham-controlled trial

Background

Atopic eczema (AE) is a common atopic inflammatory skin disease affecting 2.1-4.9% of the population in different countries. Pruritus, one of the most burdensome symptoms, is often underestimated for the problems it can cause, creating a vicious loop of itching, scratching, and lichenification. Therefore, further research into practical and safe treatments that relieve itchy symptoms and enhance skin protection is key to overcoming AE. Acupuncture, with or without electrical stimulation, is one of the most commonly used therapeutic measures to treat AE. This trial aimed to objectively evaluate the efficacy and safety of the electroacupuncture (EA) antipruritic technique in AE pruritus and obtain high-level clinical evidence for the popularization and application of EA for AE.

Methods and analysis

This multicenter, single-blinded, randomized controlled trial is planned to transpire from April 15, 2023, to June 30, 2025. We will recruit 132 participants with AE (44 per group). Participants will be assigned randomly to three equal-sized groups: EA, sham electroacupuncture, and sham acupuncture. Treatment will be administered three times a week during the 2-week intervention phase. The primary outcome measure is the Visual Analog Scale, with a numeric rating scale to evaluate pruritus. Secondary outcome measures include the Eczema Area and Severity Index and Dermatology Life Quality Index. Other outcome measures include physical examination, serum IgE, and safety evaluation. The number, nature, and severity of adverse events will be carefully recorded.

Trial registration

ClinicalTrials.gov, 22Y11922200. Registered 3 September 2022, https://register.clinicaltrials.gov.

Successful management of a breastfeeding mother with severe eczema of the nipple beginning from puberty: A case report

BACKGROUND

Nipple eczema is the most common presentation of atopic dermatitis of the breast, which seriously influences breastfeeding of mothers. We here present a case of severe nipple eczema that started in puberty and received continuous care and interventions during pregnancy. The patient succeeded in breastfeeding after the interventions.

CASE SUMMARY

A 36-year-old woman at 16 wk of gestation (gestation 1 parturition 0), visited the breastfeeding consultation clinic, complaining of excessive nipple secretion, severe itching, and concerns about breastfeeding. She was diagnosed with severe nipple eczema. Health education, consultation with dermatologists, topical medication, psychological support, and postpartum care were carried out. Through continuous interventions, her nipple eczema significantly improved, lactating confidence enhanced, anxiety symptoms were reduced, and exclusive breastfeeding was achieved.

CONCLUSION

For lactating women with nipple eczema, breastfeeding consultants should play an important role in patient education and provide whole-process and individual guidance.

Low-dose intralesional injection of 5-fluorouracil and triamcinolone reduces tissue resident memory T cells in chronic eczema

BACKGROUND

Tissue resident memory T (T_RM) cells have been reported to play a significant role in the pathogenesis and relapse of chronic eczema.

AIM

To compare the efficacy and safety of the intralesional injection of 5-fluorouracil (5-FU) and triamcinolone (TA) with those associated with TA alone for the treatment of chronic eczema.

METHODS

A total of 168 patients were randomized to 5-FU+TA or TA groups and received a one-time intralesional injection of 5-FU+TA or TA only. Biopsies were collected before and 2 wk after treatment for evaluation of histopathological changes. All patients were followed up monthly for up to 1 year.

RESULTS

No serious adverse event was observed in either group. Although the mean atopic dermatitis severity index scores and effective rates were comparable between the two groups after 2 wk of treatment, the relapse rate was significantly lower in the 5-FU+TA group than in the TA group. Histological examination showed significantly fewer CD8⁺ and CD103⁺ T cells but not CD4⁺ T cells in the 5-FU+TA group.

CONCLUSION

One-time intralesional injection of 5-FU+TA is effective and safe for chronic eczema treatment and can further reduce the retention of T_RM cells in the lesional skin and the relapse rate of chronic eczema.

A convolutional neural network trained with dermoscopic images of psoriasis performed on par with 230 dermatologists

BACKGROUND

Psoriasis is a common chronic inflammatory skin disease that causes physical and psychological burden to patients. A Convolutional Neural Network (CNN) focused on dermoscopic images would substantially aid the classification and increase the accuracy of diagnosis of psoriasis.

OBJECTIVES

This study aimed to train an efficient deep-learning network to recognize dermoscopic images of psoriasis (and other papulosquamous diseases), improving the accuracy of the diagnosis of psoriasis.

METHODS

EfficientNet-B4 architecture was trained with 7033 dermoscopic images from 1166 patients collected from the Department of Dermatology, Peking Union Medical College Hospital (China). We performed a five-fold cross-validation on the training set to compare the classification performance of EfficientNet-B4 over different networks commonly used in previous studies. From the test set, 90 images were used to compare the performance between our four-class model and that of board-certified dermatologists, whose diagnoses and information (e.g., age, titles) were obtained through an online questionnaire.

RESULTS

The mean sensitivity and specificity of EfficientNet-B4 on the training set was 0.927± 0.028 and 0.827 ± 0.043 for the two-class task, and 0.889 ± 0.014 and 0.968 ± 0.004 four-class task. The diagnostic sensitivity and specificity of the 230 dermatologists were 0.688 and 0.903 for psoriasis, 0.677 and 0.838 for eczema, 0.669 and 0.953 for lichen planus, and 0.832 and 0.932 for the "others" group, respectively; the diagnostic sensitivity and specificity of our four-class CNN was 0.929 and 0.952 for psoriasis, 0.773 and 0.926 for eczema, 0.933 and 0.960 for lichen planus, and 0.840 and 0.985 for the "others" group, respectively. Both the 230 dermatologists and CNN achieved at least moderate consistency with the reference standard, and there was no significant difference between them (P > 0.05).

CONCLUSIONS

The two-classification and four-classification models of psoriasis established in our study could accurately classify papulosquamous skin diseases. They showed generally comparable performances to the average level of dermatologists and would provide a strong support for the diagnosis of psoriasis.