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Montero-Vilchez T, Rodriguez-Pozo JA, Cuenca-Barrales C, Sanabria-de-la-Torre R, Torres-de-Pinedo JM, Arias-Santiago S. Stratum Corneum Hydration As a Potential Marker of Response to Dupilumab in Atopic Dermatitis®: A Prospective Observational Study. Dermatitis 2024; 35:250-257. [PMID: 37695812 DOI: 10.1089/derm.2023.0176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background: Dupilumab is an effective treatment for atopic Dermatitis® (AD) and it also restores skin barrier function. Nevertheless, early changes in epidermal barrier parameters related to sustained treatment response or treatment failure are not known. So, the objective of this study is to evaluate whether changes in skin barrier function after 16 weeks dupilumab treatment could predict sustained treatment response or treatment failure. Materials and Methods: A prospective observational study was conducted that included patients with AD starting dupilumab. Clinical scores, patient-reported outcome measures (PROMs), and skin barrier function parameters were assessed at baseline and after 16 weeks treatment. Patients were followed until they failed to dupilumab or until the end of the study period. Participants were divided into 2 groups: patients with treatment failure and those with sustained treatment response. Results: In total, 32 patients with AD were included in the study, with a mean age of 28.03 years (standard deviation 10.65), being 20 (60.6%) females. In total, 22 (66.7%) patients sustained dupilumab response during the study period and only 10 (33.3%) failed to treatment. After 16 weeks treatment, clinical scores were improved in both groups. Patients with sustained treatment response increased stratum corneum hydration (SCH) on noninvolved skin (34.25 arbitrary units [AU] vs 44.90AU, P = 0.001) and on eczematous lesions (20.71 AU vs 40.94 AU, P < 0.001) and also decreased transepidermal water loss (TEWL) on eczematous lesions (28.22 g/[m2·h] vs 14.83 g/[m2·h], P = 0.002). Patients with treatment failure did not change TEWL or SCH. SCH after 16 weeks treatment on noninvolved skin (odds ratio [OR] = 0.83, P = 0.018) and SCH after 16 weeks treatment on eczematous lesions (OR = 0.86, P = 0.028) were related to dupilumab failure. Conclusion: SCH could be used as a predictive biomarker of dupilumab response in patients with AD.
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Affiliation(s)
- Trinidad Montero-Vilchez
- From the Dermatology Department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Carlos Cuenca-Barrales
- From the Dermatology Department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Raquel Sanabria-de-la-Torre
- From the Dermatology Department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Salvador Arias-Santiago
- From the Dermatology Department, Virgen de las Nieves University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Dermatology Department, Faculty of Medicine, University of Granada, Granada, Spain
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Herrera M, Eichenblat S, Campbell E, Shick J, Brown H, Brinkley C, Kester S, Layell J, Passaretti CL, Sampson MM. Beyond the surface: a color-inclusive guide to central line site assessment. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e41. [PMID: 38628376 PMCID: PMC11019580 DOI: 10.1017/ash.2024.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
Significant gaps exist in representation of diverse populations in central-line assessment education and tools. We review some of these gaps and provide some real-world guidance on how to assess central line sites in patients of all skin tones.
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Affiliation(s)
- Meredith Herrera
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | | | - Eileen Campbell
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Julia Shick
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Heather Brown
- Department of Nursing Professional Development, Atrium Health, Charlotte, NC, USA
| | - Chelsea Brinkley
- Department of Nursing Professional Development, Atrium Health, Charlotte, NC, USA
| | - Shelley Kester
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Jessica Layell
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
| | - Catherine L Passaretti
- Department of Infection Prevention, Atrium Health, Charlotte, NC, USA
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mindy M Sampson
- Division of Infectious Diseases & Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
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3
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Alexis AF, Silverberg JI, Rice ZP, Armstrong AW, Desai SR, Fonacier L, Kabashima K, Biswas P, Cella RR, Chan GL, Levenberg M. Abrocitinib efficacy and safety in moderate-to-severe atopic dermatitis by race, ethnicity, and Fitzpatrick skin type. Ann Allergy Asthma Immunol 2024; 132:383-389.e3. [PMID: 37949351 DOI: 10.1016/j.anai.2023.11.002] [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: 07/24/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Response to abrocitinib treatment for moderate-to-severe atopic dermatitis (AD) has not been evaluated across racial and ethnic subpopulations. OBJECTIVE To assess the efficacy and safety of abrocitinib on the basis of patient race, ethnicity, and Fitzpatrick skin type (FST). METHODS Data were pooled post hoc from patients treated with abrocitinib 200 mg, 100 mg, or placebo in 3 monotherapy trials (NCT02780167, NCT03349060, and NCT03575871). Race and ethnicity were self-reported; FST was determined by study investigators. Evaluations through Week 12 include the following: (1) Investigator's Global Assessment of clear or almost-clear skin; (2) greater than or equal to 75% improvement in Eczema Area and Severity Index or SCORing AD; (3) a greater-than-or-equal-to 4-point improvement in Peak Pruritus Numerical Rating Scale score; (4) least squares mean changes in Dermatology Life Quality Index and Patient-Oriented Eczema Measure scores; and (5) treatment-emergent adverse events. RESULTS The sample comprised 628 White, 204 Asian, and 83 Black patients; 37 were Hispanic or Latino; 624 had FST I to III and 320 had FST IV to VI. Treatment with either abrocitinib dose was associated with greater proportions of patients achieving Investigator's Global Assessment of clear or almost-clear skin, ≥ 75% improvement in Eczema Area and Severity Index, ≥ 75% improvement in SCORing AD, and a ≥ 4-point improvement in Peak Pruritus Numerical Rating Scale, or greater score changes from baseline in Dermatology Life Quality Index and Patient-Oriented Eczema Measure vs placebo regardless of race, ethnicity, or FST. Dose-response was most prominent in White patients. In Black patients, the effects of the 2 doses were similar. Treatment-emergent adverse events were more common in White and Black than in Asian patients. CONCLUSION Abrocitinib was more efficacious than placebo across the racial and ethnic groups and ranges of phototypes analyzed. Studies with increased representation of populations of color are warranted to elucidate potential variations in response across diverse populations. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02780167 (phase 2b), NCT03349060 (phase 3 MONO-1), and NCT03575871 (phase 3 MONO-2).
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Affiliation(s)
- Andrew F Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - April W Armstrong
- Department of Dermatology, University of California, Los Angeles, California
| | - Seemal R Desai
- Innovative Dermatology, Plano, Texas; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luz Fonacier
- Department of Medicine, New York University Langone Hospital Long Island, Mineola, New York
| | - Kenji Kabashima
- Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | | | - Ricardo Rojo Cella
- Pfizer Inc, Groton, Connecticut (Affiliation at the time this study was conducted)
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4
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Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol 2024; 132:274-312. [PMID: 38108679 DOI: 10.1016/j.anai.2023.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).
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Affiliation(s)
- Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Mark Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | | | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Joey Huynh
- Sepulveda VA Medical Center, North Hills, California
| | | | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mary Laura Lind
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona
| | - Peter Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Monica O'Brien
- Tufts University School of Medicine, Boston, Massachusetts
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Gordon H Guyatt
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | | | - Alexandro W L Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Irene X Zhao
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Lina Chen
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Paul Oykhman
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Layla Bakaa
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - David Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| | | | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jay Lieberman
- University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee
| | - David Stukus
- Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elissa Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
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5
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Silverberg JI, Horeczko J, Alexis A. Development of an Eczema Area and Severity Index Atlas for Diverse Skin Types. Dermatitis 2024; 35:173-177. [PMID: 37279030 DOI: 10.1089/derm.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background: Current guidance for using Eczema Area and Severity Index (EASI) implementation is limited to lighter skin phototypes. We developed an EASI lesion severity atlas and refined guidance for investigators and clinicians to use across diverse patient populations. Methods: A review was performed of clinical images from internal atopic dermatitis (AD) photorepositories. Representative images of the 4 AD signs included in EASI were selected for different physician-assessed skin phototypes. Images were excluded if they had low resolution, poor focus, or lighting. Discrepancies regarding skin pigmentation and AD severity were resolved by consensus between authors. Results: Over 3000 clinical photographs were reviewed. Final images were selected using an iterative review process and consensus. Two different versions of the atlas were created across 6 physician-assessed phototypes (I-VI) and 3 skin complexions (light, medium, and dark). We propose guidance language for erythema to reflect the range of colors encountered across different skin complexions (shades of red, purple, and brown). Conclusion: We created a photographic atlas and updated guidance language for implementing EASI in diverse populations, including those with higher skin phototypes.
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Affiliation(s)
- Jonathan I Silverberg
- From the Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Joshua Horeczko
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
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6
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Harvey VM, Alexis A, Okeke CAV, McKinley-Grant L, Taylor SC, Desai SR, Jaleel T, Heath CR, Kang S, Vashi N, Lester J, Vasquez R, Rodrigues M, Elbuluk N, Hamzavi I, Kwatra SG, Sundaram H, Cobb C, Brown SG, Kohli I, Callender VD. Integrating skin color assessments into clinical practice and research: A review of current approaches. J Am Acad Dermatol 2024:S0190-9622(24)00215-9. [PMID: 38342247 DOI: 10.1016/j.jaad.2024.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/13/2024]
Abstract
Skin color classification can have importance in skin health, pigmentary disorders, and oncologic condition assessments. It is also critical for evaluating disease course and response to a variety of therapeutic interventions and aids in accurate classification of participants in clinical research studies. A panel of dermatologists conducted a literature review to assess the strengths and limitations of existing classification scales, as well as to compare their preferences and utilities. We identified 17 skin classification systems utilized in dermatologic settings. These systems include a range of parameters such as UV light reactivity, race, ethnicity, and degree of pigmentation. The Fitzpatrick skin type classification is most widely used and validated. However it has numerous limitations including its conflation with race, ethnicity, and skin color. There is a lack of validation data available for the remaining scales. There are significant deficiencies in current skin classification instruments. Consensus-based initiatives to drive the development of validated and reliable tools are critically needed.
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Affiliation(s)
- Valerie M Harvey
- Director, Hampton Roads Center for Dermatology, Newport News, Virginia; President, Skin of Color Society, Newport News, Virginia.
| | - Andrew Alexis
- Clinical Dermatology, Weill Cornell Medical College, New York, New York
| | - Chidubem A V Okeke
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Lynn McKinley-Grant
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seemal R Desai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Dallas, Texas
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Candrice R Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Neelam Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Jenna Lester
- Department of Dermatology, School of Medicine, University of California, San Francisco, California
| | | | - Michelle Rodrigues
- Department of Dermatology, Royal Children's Hospital, Victoria, Australia
| | - Nada Elbuluk
- Department of Dermatology, Keck Medicine, University of Southern California, Los Angeles, California
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hema Sundaram
- Private Practice, Rockville, Maryland; Private Practice, Fairfax, Virginia; Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Caryn Cobb
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stafford G Brown
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Indermeet Kohli
- The Henry W Lim, MD, Division of Photobiology and Photomedicine, Department of Dermatology, Henry Ford Health, Detroit, Michigan; Department of Physics and Astronomy, Wayne State University, Detroit, Michigan
| | - Valerie D Callender
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
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7
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Visitsunthorn K, Atwal S, Lopez E, Ong PY. Solving the health disparity of eczema assessment: A role for skin tape soluble protein? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100180. [PMID: 38026505 PMCID: PMC10652108 DOI: 10.1016/j.jacig.2023.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 12/01/2023]
Abstract
Background The assessment of erythema in patients with atopic dermatitis (AD) is based on clinical examination. The difficulty of perceiving erythema in Black patients with AD has led to underestimation of AD severity in these patients. Objective In this study, we analyzed the concentration of skin tape soluble protein of AD lesions against common AD clinical signs. Method A total of 50 children with AD were included. Skin tape total soluble protein was extracted from AD lesions and analyzed against validated AD clinical signs, including erythema, excoriation, edema, oozing, and lichenification. Results Concentration of skin tape soluble protein is positively correlated with acute signs of AD, especially erythema. Conclusion Determination of concentration of skin tape protein is a potential tool for grading erythema of AD lesions, and it may have an application in improving the health disparity of assessment of eczema severity in Black patients with AD.
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Affiliation(s)
| | - Sanmeet Atwal
- Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, Calif
| | - Elvira Lopez
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, Calif
| | - Peck Y. Ong
- Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, Calif
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, Calif
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8
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Lunjani N, Kerbelker T, Mdletshe FB, Hlela C, O’Mahony L. Phenotypes, endotypes and genotypes of atopic dermatitis and allergy in populations of African ancestry on the continent and diaspora. FRONTIERS IN ALLERGY 2024; 4:1203304. [PMID: 38327736 PMCID: PMC10847302 DOI: 10.3389/falgy.2023.1203304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
Atopic dermatitis is a complex inflammatory condition characterized by synergist interactions between epidermal and immune related genotypes, skin barrier defects and immune dysregulation as well as microbial dysbiosis. Ethnicity-specific variations in clinical presentation, immune endotypes and genetic susceptibility have been described in diverse populations. We summarize available data with specific consideration of AD in populations of African ancestry. Some highlights include the observation of AD lesions on extensor surfaces, lichen planus-like AD, prurigo type AD and follicular AD in African populations. In addition, a consistent absence of dominant filaggrin gene defects has been reported. The detection of normal filaggrin protein content in AD skin implicates the contribution of alternative mechanisms in the pathogenesis of AD in African patients. Markedly high IgE has been described in paediatric and adult African AD. While Th2, Th22 and Th17 activation in African AD skin shares the same direction as with other populations, it has been noted that the magnitude of activation is dissimilar. Reduced Th17 cytokines have been observed in the circulation of moderate to severe paediatric AD.
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Affiliation(s)
- N. Lunjani
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - T. Kerbelker
- Department of Peadiatrics, University of Cape Town, Cape Town, South Africa
| | - F. B. Mdletshe
- Division of Otorhinolaryngology, University of Witwatersrand, Johannesburg, South Africa
| | - C. Hlela
- Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - L. O’Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
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9
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Ragamin A, Schappin R, Tan Nguyen N, Nouwen AE, Hoekstra LF, Schuttelaar ML, Pasmans SG. Remote severity assessment in atopic dermatitis: Validity and reliability of the remote Eczema Area and Severity Index and Self-Administered Eczema Area and Severity Index. JAAD Int 2023; 13:184-191. [PMID: 38025299 PMCID: PMC10630629 DOI: 10.1016/j.jdin.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background Reliable assessment of atopic dermatitis (AD) severity is necessary for clinical practice and research. Valid and reliable remote assessment is essential to facilitate remote care and research. Objectives Assess the validity and reliability of the Eczema Area and Severity Index (EASI) based on images and patient-assessed severity based on the Self-Administered EASI (SA-EASI). Methods Whole-body clinical images were taken during consultation from children with AD. After consultations, caregivers completed the SA-EASI and provided images from home. Four raters assessed all images twice using EASI. Results A total of 1534 clinical images and 425 patient-provided images were collected from 87 and 32 children. Excellent (0.90) validity, good inter (0.77) and intrarater reliability (0.91), and standard error of measurement (4.31) was found for the EASI based on clinical images. Feasibility of patient-provided images showed limitations with missing images (43.8%) and quality issues (23.1%). However, good validity (0.86), inter (0.74) and intrarater reliability (0.94) were found when assessment was possible. Moderate correlation (0.60) between SA-EASI and EASI was found. Limitations Low portion patient-provided images. Conclusion AD severity assessment based on images strongly correlates with in-person AD assessment. Good measurement properties confirm the potential of remote assessment. Moderate correlation between SA-EASI and in-person EASI suggest limited value of self-assessment.
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Affiliation(s)
- Aviël Ragamin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital-Kinderhaven, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Renske Schappin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital-Kinderhaven, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - N. Tan Nguyen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital-Kinderhaven, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Anouk E.M. Nouwen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital-Kinderhaven, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Lisanne F. Hoekstra
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital-Kinderhaven, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marie L.A. Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Suzanne G.M.A. Pasmans
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital-Kinderhaven, Rotterdam, The Netherlands
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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10
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Bissonnette R, Jankicevic J, Saint-Cyr Proulx E, Maari C. Ethnicity, Race and Skin Color: Challenges and Opportunities for Atopic Dermatitis Clinical Trials. J Clin Med 2023; 12:jcm12113805. [PMID: 37297999 DOI: 10.3390/jcm12113805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The number of clinical trials conducted in patients with atopic dermatitis is increasing steadily. These trials are conducted in several countries across all continents and include patients of different ethnicity, race and skin color. This diversity is desired, but it also brings challenges, including the diagnosis and evaluation of disease severity in patients with different skin colors; the influence of ethnicity on the perception of quality of life and patient reported outcomes; the inclusion of ethnicities that are only present in one country or that live far from clinical research sites; and the reporting of drug safety information. There is a need to better train physicians on the evaluation of atopic dermatitis in patients with different skin colors and a need to improve the systematic reporting of ethnicity, race and skin color in clinical trial publications.
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Affiliation(s)
- Robert Bissonnette
- Innovaderm Research Inc., 3530 St-Laurent St, Suite 300, Montreal, QC H2X 2V1, Canada
| | - Jasmina Jankicevic
- Innovaderm Research Inc., 3530 St-Laurent St, Suite 300, Montreal, QC H2X 2V1, Canada
| | | | - Catherine Maari
- Innovaderm Research Inc., 3530 St-Laurent St, Suite 300, Montreal, QC H2X 2V1, Canada
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11
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García-Romero MT, Tollefson M, Pope E, Brandling-Bennett HA, Paller AS, Keimig E, Arkin L, Wanat KA, Humphrey SR, Werth VP, Oza V, Jacobe H, Fett N, Cordoro KM, Medina-Vera I, Chiu YE. Development and Validation of the Morphea Activity Measure in Patients With Pediatric Morphea. JAMA Dermatol 2023; 159:299-307. [PMID: 36753150 PMCID: PMC9909574 DOI: 10.1001/jamadermatol.2022.6365] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 02/09/2023]
Abstract
Importance Morphea is an insidious inflammatory disorder of the skin and deeper tissues. Determining disease activity is challenging yet important to medical decision-making and patient outcomes. Objective To develop and validate a scoring tool, the Morphea Activity Measure (MAM), to evaluate morphea disease activity of any type or severity that is easy to use in clinical and research settings. Design, Setting, and Participants This pilot diagnostic study was conducted from September 9, 2019, to March 6, 2020, in 2 phases: development and validation. During the development phase, 14 morphea experts (dermatologists and pediatric dermatologists) used a Delphi consensus method to determine items that would be included in the MAM. The validation phase included 8 investigators who evaluated the tool in collaboration with 14 patients with pediatric morphea (recruited from a referral center [Medical College of Wisconsin]) during a 1-day in-person meeting on March 6, 2020. Main Outcomes and Measures During the development phase, online survey items were evaluated by experts in morphea using a Likert scale (score range, 0-10, with 0 indicating not important and 10 indicating very important); agreement was defined as a median score of 7.0 or higher, disagreement as a median score of 3.9 or lower, and no consensus as a median score of 4.0 to 6.9. During the validation phase, reliability (interrater and intrarater agreement using intraclass correlation coefficients), validity (using the content validity index and κ statistics as well as correlations with the modified Localized Scleroderma Severity Index and the Physician Global Assessment of Activity using Spearman ρ coefficients), and viability (using qualitative interviews of investigators who used the MAM tool) were evaluated. Descriptive statistics were used for quantitative variables. Data on race and ethnicity categories were collected but not analyzed because skin color was more relevant for the purposes of this study. Results Among 14 survey respondents during the development phase, 9 (64.3%) were pediatric dermatologists and 5 (35.7%) were dermatologists. After 2 rounds, a final tool was developed comprising 10 items that experts agreed were indicative of morphea activity (new lesion in the past 3 months, enlarging lesion in the past 3 months, linear lesion developing progressive atrophy in the past 3 months, erythema, violaceous rim or color, warmth to the touch, induration, white-yellow or waxy appearance, shiny white wrinkling, and body surface area). The validation phase was conducted with 14 patients (median age, 14.5 years [range, 8.0-18.0 years]; 8 [57.1%] female), 2 dermatologists, and 6 pediatric dermatologists. Interrater and intrarater agreement for MAM total scores was good, with intraclass correlation coefficients of 0.844 (95% CI, 0.681-0.942) for interrater agreement and 0.856 (95% CI, 0.791-0.901) for intrarater agreement. Correlations between the MAM and the modified Localized Scleroderma Severity Index (Spearman ρ = 0.747; P < .001) and the MAM and the Physician Global Assessment of Activity (Spearman ρ = 0.729; P < .001) were moderately strong. In qualitative interviews, evaluators agreed that the tool was easy to use, measured morphea disease activity at a single time point, and should be responsive to changes in morphea disease activity over multiple time points. Conclusions and Relevance In this study, the MAM was found to be a reliable, valid, and viable tool to measure pediatric morphea activity. Further testing to assess validity in adults and responsiveness to change is needed.
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Affiliation(s)
| | - Megha Tollefson
- Department of Pediatrics, Mayo Clinic and Mayo Clinic Children’s Center, Rochester, Minnesota
- Department of Dermatology, Mayo Clinic and Mayo Clinic Children’s Center, Rochester, Minnesota
| | - Elena Pope
- Dermatology Section, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Heather A. Brandling-Bennett
- Division of Dermatology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Amy S. Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Northwestern University, Chicago, Illinois
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Lisa Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison, Madison
| | - Karolyn A. Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | | | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Vikash Oza
- Ronald O. Perelman Department of Dermatology, Grossman School of Medicine, New York University, New York
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Nicole Fett
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Kelly M. Cordoro
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco
| | - Isabel Medina-Vera
- Department of Research Methodology, National Institute of Pediatrics, Mexico City
| | - Yvonne E. Chiu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
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12
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Narla S, Heath CR, Alexis A, Silverberg JI. Racial disparities in dermatology. Arch Dermatol Res 2022; 315:1215-1223. [PMID: 36508020 PMCID: PMC9743121 DOI: 10.1007/s00403-022-02507-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Significant racial/ethnic disparities in dermatologic care and their subsequent impact on dermatologic conditions were recently reported. Contributing factors include socioeconomic factors, gaps in educational exposure, and underrepresentation of minority groups in the dermatologic workforce. In 2021, the American Academy of Dermatology (AAD) announced its three-year plan to expand diversity, equity, and inclusion in dermatology. One way to reduce disparities in dermatology is for every dermatologist, regardless of race or ethnicity, to receive adequate education in diseases, treatments, health equity, and tailored approaches to delivering dermatologic care with cultural humility. In addition, a diverse dermatologic workforce-especially at the level of residency program educators and organizational leaders-will contribute to improved cross-cultural understanding, more inclusive research efforts, and improved treatment approaches for conditions that are more prevalent or nuanced in certain racial/ethnic populations. Finally, the dermatology and broader healthcare community needs to acknowledge and educate ourselves on the health impacts of racism.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, St. Luke’s University Health Network, Easton, PA 18045 USA
| | - Candrice R. Heath
- Department of Dermatology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA 19140 USA
| | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medicine, New York, NY 10075 USA
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Suite 2B-430, 2150 Pennsylvania Avenue, Washington, DC 20037 USA
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13
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Kovarik C. Development of High-Quality AI in Dermatology: Guidelines, Pitfalls, and Potential. JID INNOVATIONS 2022; 2:100157. [PMID: 36267807 PMCID: PMC9576984 DOI: 10.1016/j.xjidi.2022.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Carrie Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Correspondence: Carrie Kovarik, Department of Dermatology, University of Pennsylvania, 2 Maloney Building, 3600 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
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14
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Croce EA, Rathouz PJ, Lopes FCPS, Leszczynska M, Diaz LZ, Levy ML, Ruth JS, Varshney P, Rew L, Matsui EC. Validation of remote atopic dermatitis severity assessment with the Eczema Area and Severity Ondex in children using caregiver-provided photos and videos. Pediatr Dermatol 2022; 39:547-552. [PMID: 35522088 PMCID: PMC9420774 DOI: 10.1111/pde.15003] [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: 11/25/2021] [Revised: 02/19/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES We sought to quantify the reliability and validity of remote atopic dermatitis (AD) severity assessment using the Eczema Area and Severity Index (EASI) applied to caregiver-provided photos (p-EASI) and videos (v-EASI). METHODS Children (0-17 years) with a physician diagnosis of AD were recruited. Caregivers took photos and a video of their child's skin. A clinician scored in-person EASI on the same day, then p-EASI and v-EASI for each participant 10 days or more between ratings. Two additional clinicians scored p-EASI and v-EASI. Lin's concordance correlation coefficient (CCC) was employed to assess criterion validity using in-person EASI as the gold standard. Intraclass correlation coefficients (ICCs) were calculated to assess interrater reliability of p-EASI and v-EASI. RESULTS Fifty racially and ethnically diverse children (age [mean ± SD]: 4.3 ± 4.4 years; 42% female) with a range of AD severity (EASI: 6.3 ± 6.4) and Fitzpatrick skin types (1-2: 9%; 3-4: 60%; 5-6: 31%) were enrolled and received in-person EASI assessment. Fifty had p-EASI and 49 had v-EASI by the same in-person rater, and by two additional raters. The CCC and ICC for p-EASI were 0.89, 95% CI [0.83, 0.95] and 0.81, 95% CI [0.71, 0.89], respectively. The CCC and ICC for v-EASI were 0.75, 95% CI [0.63, 0.88] and 0.69, 95% CI [0.51, 0.81], respectively. CONCLUSIONS In this diverse population with a range of skin tones, p-EASI showed good criterion validity and good interrater reliability. v-EASI showed moderate to good criterion validity and moderate interrater reliability. Both may be reliable and valid options for remote AD severity assessment.
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Affiliation(s)
- Emily A Croce
- Dell Children's Medical Group, Ascension Seton, Austin, Texas, USA.,The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Fabiana C P S Lopes
- Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | | | - Lucia Z Diaz
- Dell Children's Medical Group, Ascension Seton, Austin, Texas, USA.,Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Moise L Levy
- Dell Children's Medical Group, Ascension Seton, Austin, Texas, USA.,Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Jennifer S Ruth
- Dell Children's Medical Group, Ascension Seton, Austin, Texas, USA.,Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Pooja Varshney
- Dell Children's Medical Group, Ascension Seton, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Lynn Rew
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Elizabeth C Matsui
- Dell Children's Medical Group, Ascension Seton, Austin, Texas, USA.,Department of Population Health, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.,Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
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15
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Dupilumab Improves Skin Barrier Function in Adults with Atopic Dermatitis: A Prospective Observational Study. J Clin Med 2022; 11:jcm11123341. [PMID: 35743415 PMCID: PMC9225017 DOI: 10.3390/jcm11123341] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
Epidermal barrier dysfunction plays an important role in atopic dermatitis (AD). The difficulty of objectively assessing AD severity and the introduction of new biologicals into clinical practice highlight the need to find parameters to monitor clinical outcomes. The aim of this study is to evaluate the impact of dupilumab on skin barrier function and compare it with other treatments in patients with AD. A prospective observational study was conducted in adults with AD treated with topical corticosteroids (TCS), cyclosporine, or dupilumab. The main outcome measures after 16 weeks of treatment were Eczema Area and Severity (EASI)-50 (50% improvement in EASI), and transepidermal water loss (TEWL)-50 (50% improvement in TEWL). Forty-six patients with AD were included in the study. The proportion of patients who achieved EASI-50 at week 16 was significantly higher in patients receiving dupilumab (81.8% vs. 28.6% vs. 40%, p = 0.004). In eczematous lesions, TEWL decreased in patients receiving dupilumab (31.02 vs. 12.10 g·h−1·m−2, p < 0.001) and TCS (25.30 vs. 14.88 g·h−1·m−2, p = 0.047). The proportion of patients who achieved TEWL-50 at week 16 was higher for dupilumab than for cyclosporine or TCS. Temperature only decreased in the dupilumab group. Stratum corneum hydration increased in eczematous lesions and non-involved skin only in patients with dupilumab. In conclusion, dupilumab improves skin barrier function in patients with AD better than TCS or cyclosporine, both in eczematous lesions and in non-lesioned skin.
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16
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Cole EF, Mustin DE, Feldman RJ. The Effect of Race and Fitzpatrick Skin Type on Bullous Pemphigoid Disease Area Index (BPDAI) Scores. Br J Dermatol 2022; 187:606-607. [PMID: 35531603 DOI: 10.1111/bjd.21648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Emily F Cole
- Emory Department of Dermatology, Atlanta, Georgia, 30322, USA
| | | | - Ron J Feldman
- Emory Department of Dermatology, Atlanta, Georgia, 30322, USA
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17
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Wilson BN, Alexis A, Murase JE. Art of prevention: Atopic dermatitis in women and families of color-prevalence, recognition, and prevention. Int J Womens Dermatol 2022; 8:e014. [PMID: 35620034 PMCID: PMC9112389 DOI: 10.1097/jw9.0000000000000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/01/2021] [Indexed: 12/03/2022] Open
Abstract
Atopic dermatitis (AD) is one of the most common skin conditions encountered by dermatologists. Skin of color (SOC) patients, in particular, are 50% more likely to visit a dermatologist for AD than non-SOC patients. While the misdiagnosis of AD in SOC patients is rare, the misinterpretation of severity or undertreatment of disease experienced by this patient population is a common occurrence. Herein, we present this Art of Prevention piece focused on the epidemiology, presentation, treatment, and management of AD in skin of color patients.
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Affiliation(s)
- Britney N. Wilson
- School of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Andrew Alexis
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Jenny E. Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, California
- Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California
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18
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Kaundinya T, Rakita U, Guraya A, Abboud DM, Croce E, Thyssen JP, Alexis A, Silverberg JI. Differences in Psychometric Properties of Clinician- and Patient-Reported Outcome Measures for Atopic Dermatitis by Race and Skin Tone: A Systematic Review. J Invest Dermatol 2022; 142:364-381. [PMID: 34352262 PMCID: PMC8792149 DOI: 10.1016/j.jid.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023]
Abstract
The psychometric validity and reliability of widely used atopic dermatitis (AD) outcome measures across different races and ethnicities are unclear. We describe the rates of reporting race, ethnicity, and skin tone in studies testing the psychometric properties of AD outcome measures and compare the psychometric analyses across race, ethnicity, and skin tone. We systematically reviewed MEDLINE and EMBASE for studies reporting psychometric properties of clinician-reported or patient-reported outcome measures in AD (International Prospective Register of Systematic Reviews: CRD42021239614). Overall, 16,100 nonduplicate articles were screened; 165 met inclusion criteria. Race and/or ethnicity were reported in 55 (33.3%) studies; of those, race was assessed by self-report in 10 studies (6.1%) or was unspecified in 45 (27.3%). A total of 16 studies (9.7%) evaluated psychometric property differences by race, and only five (4.4%) of those did not recognize it as a limitation. Properties assessed across race, ethnicity, or skin tone were differential item functioning, convergent validity feasibility, inter-rater reliability, intrarater reliability, test‒retest reliability, and known-groups validity. Multiple instruments demonstrated performance differences across ethnoracial groups. This review highlights the paucity of race/ethnicity consideration for psychometric property testing in AD outcome measurement instruments. More AD outcomes instruments should be validated in diverse populations.
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Affiliation(s)
- Trisha Kaundinya
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Uros Rakita
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Armaan Guraya
- Chicago College of Osteopathic Medicine, Midwestern University, Chicago, Illinois, USA
| | | | - Emily Croce
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA; Pediatric and Adolescent Dermatology, Dell Children's Medical Group, Austin, Texas, USA
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Alexis
- Dermatology, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA.
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19
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Gupta M, Doolan B. Pigmentary disorders: paradigms in a multicultural society. PIGMENT INTERNATIONAL 2022. [DOI: 10.4103/pigmentinternational.pigmentinternational_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Ali Z, Joergensen KM, Andersen AD, Chiriac A, Bjerre-Christensen T, Manole I, Dutei AM, Deaconescu I, Suru A, Serban A, Isberg AP, Dahiya P, Thomsen SF, Zibert JR. Remote Rating of Atopic Dermatitis Severity Using Photo-Based Assessments: Proof-of-Concept and Reliability Evaluation. JMIR Form Res 2021; 5:e24766. [PMID: 34032580 PMCID: PMC8188317 DOI: 10.2196/24766] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/08/2020] [Accepted: 04/23/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote decentralized clinical trials are gaining ground. OBJECTIVE We aimed to investigate whether photographs taken by a smartphone are of adequate quality to allow severity assessments to be made and to explore the usefulness of an established atopic dermatitis severity assessment instrument on photograph evaluation. METHODS During scheduled visits in a previously published study, the investigating doctor evaluated the severity of atopic dermatitis using the Scoring AD (SCORAD) index and took photographs of the most representative lesions (target lesions) with both a smartphone and a digital single-lens reflex camera (DSLR). The photographs were then assessed by 5 dermatologists using the intensity items of the SCORAD (iSCORAD), which consists of erythema, oedema/papulation, excoriations, lichenification, oozing/crusts, and dryness (scale 0-3, maximum score 18). The mean iSCORAD of the photographs was calculated and compared with in-person assessments using Pearson correlation and Bland-Altman plots. Intraclass correlation coefficients were used for interrater reliability. RESULTS A total of 942 photographs from 95 patients were assessed. The iSCORAD based on smartphone photographs correlated strongly with the evaluations performed in person (iSCORAD: r=0.78, P<.001; objective SCORAD: r=0.81, P<.001; and total SCORAD: r=0.78, P<.001). For iSCORAD specifically, a Bland-Altman plot showed a difference in mean score of 1.31 for in-person and remote iSCORAD. In addition, the interrater agreement between the 5 rating dermatologists was 0.93 (95% CI 0.911-0.939). A total of 170 lesions were photographed, and the difference in mean scores was 1.32, 1.13, and 1.43 between in-person and remote evaluations based on photographs taken by a DSLR camera, a smartphone without flash, and a smartphone with flash, respectively. CONCLUSIONS In terms of quality, remote atopic dermatitis severity assessments based on photographs are comparable to in-person assessments, and smartphone photos can be used to assess atopic dermatitis severity to a similar degree as photographs from a DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low.
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Affiliation(s)
- Zarqa Ali
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | - Simon Francis Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Hunjan MK, Brockley JR, Buka R, Ramesh R. Treatment of paediatric eczema with narrowband ultraviolet light B therapy. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:105-110. [PMID: 33012054 DOI: 10.1111/phpp.12615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 07/20/2020] [Accepted: 09/27/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Narrowband ultraviolet B phototherapy (nbUVB) is a well-established, well-tolerated and efficacious treatment for eczema. There is a distinct lack of literature surrounding the therapeutic use of nbUVB in eczema in children and especially in children with higher skin phototypes (III to VI). METHODS We undertook a retrospective review of children aged 18 years and under with eczema who had undergone nbUVB in our department between 1 January 2011 and 31 December 2017. Abstracted data included sex, age, skin phototype, severity as graded by a paediatric dermatologist, cumulative dose, response to treatment and subsequent remission. RESULTS In total, 60 children had nbUVB. Of those, 56 had more than 10 nbUVB exposures. Complete or near-complete clearance was achieved in 31 children (52%). Of those, 24 (77%) had a skin phototype of III or greater. Clinical remission rates of these patients were 100%, 87%, 57% and 52% at 0, 3, 6 and 12 months, respectively. Seventeen patients (28%) suffered side effects. Most commonly these were mild side effects such as erythema and xerosis. CONCLUSION We have demonstrated that nbUVB is a safe, well-tolerated and efficacious form of treatment for children with atopic eczema. We have shown it to be effective in those with skin phototypes greater than III and shown that they are a group that may derive greater long-term efficacy. In clinical practice, preference for nbUVB as second-line treatment, over oral systemics, should always be considered.
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Affiliation(s)
- Manrup K Hunjan
- Department of Dermatology, Dudley Group Hospitals NHS Trust, Dudley, UK
| | - Julia R Brockley
- Department of Dermatology, Walsall Manor NHS Hospital, Walsall, UK
| | - Richard Buka
- Institute of Cancer Genomics and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Raakhee Ramesh
- Department of Dermatology, Birmingham Skin Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Department of Dermatology, Birmingham Children's Hospital, Birmingham, UK
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22
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Cugmas B, Viškere D, Štruc E, Olivry T. Evaluation of Erythema Severity in Dermatoscopic Images of Canine Skin: Erythema Index Assessment and Image Sampling Reliability. SENSORS 2021; 21:s21041285. [PMID: 33670225 PMCID: PMC7916917 DOI: 10.3390/s21041285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
The regular monitoring of erythema, one of the most important skin lesions in atopic (allergic) dogs, is essential for successful anti-allergic therapy. The smartphone-based dermatoscopy enables a convenient way to acquire quality images of erythematous skin. However, the image sampling to evaluate erythema severity is still done manually, introducing result variability. In this study, we investigated the correlation between the most popular erythema indices (EIs) and dermatologists’ erythema perception, and we measured intra- and inter-rater variability of the currently-used manual image-sampling methods (ISMs). We showed that the EIBRG, based on all three RGB (red, green, and blue) channels, performed the best with an average Spearman coefficient of 0.75 and a typical absolute disagreement of less than 14% with the erythema assessed by clinicians. On the other hand, two image-sampling methods, based on either selecting specific pixels or small skin areas, performed similarly well. They achieved high intra- and inter-rater reliability with the intraclass correlation coefficient (ICC) and Krippendorff’s alpha well above 0.90. These results indicated that smartphone-based dermatoscopy could be a convenient and precise way to evaluate skin erythema severity. However, better outlined, or even automated ISMs, are likely to improve the intra- and inter-rater reliability in severe erythematous cases.
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Affiliation(s)
- Blaž Cugmas
- Biophotonics laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, 19 Raiņa Blvd., LV-1586 Rīga, Latvia;
- Correspondence: ; Tel.: +371-67-033-848
| | - Daira Viškere
- Biophotonics laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, 19 Raiņa Blvd., LV-1586 Rīga, Latvia;
- Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, 8 Kristapa Helmaņa Str., LV-3004 Jelgava, Latvia
| | - Eva Štruc
- Vetamplify SIA, veterinary services, 57/59-32 Krišjāņa Valdemāra Str., LV-1010 Rīga, Latvia;
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, 1060 William Moore Dr., Raleigh, NC 27607, USA;
- Comparative Medicine Institute, NC State University, Raleigh, NC 27606, USA
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23
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Frew J, Penzi L, Suarez-Farinas M, Garcet S, Brunner PM, Czarnowicki T, Kim J, Bottomley C, Finney R, Cueto I, Fuentes-Duculan J, Ohmatsu H, Lentini T, Yanofsky V, Krueger JG, Guttman-Yassky E, Gareau D. The erythema Q-score, an imaging biomarker for redness in skin inflammation. Exp Dermatol 2020; 30:377-383. [PMID: 33113259 PMCID: PMC8049083 DOI: 10.1111/exd.14224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/15/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022]
Abstract
Physician rating of cutaneous erythema is central to clinical dermatological assessment as well as quantification of outcome measures in clinical trials in a number of dermatologic conditions. However, issues with inter‐rater reliability and variability in the setting of higher Fitzpatrick skin types make visual erythema assessment unreliable. We developed and validated a computer‐assisted image‐processing algorithm (EQscore) to reliably quantify erythema (across a range of skin types) in the dermatology clinical setting. Our image processing algorithm evaluated erythema based upon green light suppression differentials between affected and unaffected skin. A group of four dermatologists used a 4‐point Likert scale as a human evaluation of similar erythematous patch tests. The algorithm and dermatologist scores were compared across 164 positive patch test reactions. The intra‐class correlation coefficient of groups and the correlation coefficient between groups were calculated. The EQscore was validated on and independent image set of psoriasis, minimal erythema dose testing and steroid‐induced blanching images. The reliability of the erythema quantification method produced an intra‐class correlation coefficient of 0.84 for the algorithm and 0.67 for dermatologists. The correlation coefficient between groups was 0.85. The EQscore demonstrated high agreement with clinical scoring and superior reliability compared with clinical scoring, avoiding the pitfalls of erythema underrating in the setting of pigmentation. The EQscore is easily accessible (http://lab.rockefeller.edu/krueger/EQscore), user‐friendly, and may allow dermatologists to more readily and accurately rate the severity of dermatological conditions and the response to therapeutic treatments.
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Affiliation(s)
- John Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Lauren Penzi
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA.,Department of Dermatology, Johns Hopkins Hospital, Columbia, MD, USA
| | - Mayte Suarez-Farinas
- Department of Dermatology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Patrick M Brunner
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Tali Czarnowicki
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Jaehwan Kim
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Claire Bottomley
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Robert Finney
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Inna Cueto
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | | | - Hanako Ohmatsu
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Tim Lentini
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Valerie Yanofsky
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, USA
| | - Daniel Gareau
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
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24
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Berendsen S, van der Paardt JW, Van HL, van Bruggen M, Nusselder H, Jalink M, de Peuter OR, Peen J, van Tricht MJ, de Haan L. Staging and profiling for schizophrenia spectrum disorders: Inter-rater reliability after a short training course. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109856. [PMID: 31931090 DOI: 10.1016/j.pnpbp.2019.109856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Clinical staging and profiling have been proposed as a new approach in order to refine the diagnostic assessment of schizophrenia spectrum disorders. However, only limited evidence is available for the inter-rater reliability of the clinical staging and profiling model. The aim of the present study was therefore to determine the inter-rater reliability of the clinical staging and profiling model for schizophrenia spectrum disorders, and to investigate whether a short course can improve inter-rater reliability. METHODS Consecutively recruited inpatients with schizophrenia spectrum disorders were included between January 2015 and January 2016 (study 1), and between March 2018 and October 2018 (study 2). By contrast with the assessors in study 1, all the assessors in study 2 were trained in clinical staging and profiling. We used the clinical staging model proposed by McGorry and identified profile characteristics. Inter-rater reliability was measured using the Intraclass Correlation Coefficient (ICC). RESULTS The ICC score for clinical staging in study 1 was moderate (0.578). It improved considerably in study 2 (0.757). In general, the ICC scores for the profile characteristics in studies 1 and 2 ranged from poor to sufficient (0.123-0.781). CONCLUSION This study demonstrated that inter-rater reliability in clinical staging was sufficient after training. However, inter-rater reliability for clinical profile characteristics was highly variable. The general implementation of the clinical staging model for schizophrenia spectrum disorders is therefore feasible but clinical profile characteristics should be used with caution.
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Affiliation(s)
- Steven Berendsen
- Arkin Mental Health Care, Amsterdam, The Netherlands; University Medical Center, Academic Medical Center, Department of Psychiatry, Amsterdam, the Netherlands.
| | | | | | | | | | - Margje Jalink
- Arkin Mental Health Care, Amsterdam, The Netherlands
| | | | - Jaap Peen
- Arkin Mental Health Care, Amsterdam, The Netherlands
| | | | - Lieuwe de Haan
- Arkin Mental Health Care, Amsterdam, The Netherlands; University Medical Center, Academic Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
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25
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Drzymalski DM, Ward K, Hernandez JM, Hoot J, Au SC, Yang FSC, Azocar RJ. The effect of Tegaderm™ versus EyeGard® on eyelid erythema during general anesthesia: a randomized-controlled trial. Can J Anaesth 2020; 67:560-567. [DOI: 10.1007/s12630-020-01588-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022] Open
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26
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Lara-Corrales I, Bergman JN, Landells I, Ramien ML, Lansang P. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:3S-11S. [DOI: 10.1177/1203475419882049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pediatric atopic dermatitis (AD) is one of the most common dermatoses encountered by health-care providers treating children. Diagnosis of AD is clinical, with no universally accepted biomarkers or assessment tools. Patient-reported outcomes and subjective assessments of quality of life in both the patient and family are important considerations when treating pediatric AD. Here, we provide an overview of pediatric AD epidemiology, its clinical presentation, burden, diagnosis, and assessment, with a focus on implications for patient counseling in order to optimize care.
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Affiliation(s)
- Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - James N. Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Ian Landells
- Departments of Medicine and Pediatrics, Division of Dermatology, Memorial University, St. John’s, NL, Canada
- Nexus Clinical Research, St. John’s, NL, Canada
| | - Michele L. Ramien
- Department of Medicine, Division of Dermatology, University of Calgary, AB, Canada
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children’s Hospital, Calgary, AB, Canada
| | - Perla Lansang
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
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27
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Siegfried EC, Jaworski JC, Eichenfield LF, Paller A, Hebert AA, Simpson EL, Altman E, Arena C, Blauvelt A, Block J, Boguniewicz M, Chen S, Cordoro K, Hanna D, Horii K, Hultsch T, Lee J, Leung DY, Lio P, Milner J, Omachi T, Schneider C, Schneider L, Sidbury R, Smith T, Sugarman J, Taha S, Tofte S, Tollefson M, Tom WL, West DP, Whitney L, Zane L. Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry. Pediatr Dermatol 2018; 35:303-322. [PMID: 29600515 DOI: 10.1111/pde.13452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis is the most common chronic skin disease, and it primarily affects children. Although atopic dermatitis (AD) has the highest effect on burden of skin disease, no high-level studies have defined optimal therapy for severe disease. Corticosteroids have been used to treat AD since the 1950s and remain the only systemic medication with Food and Drug Administration approval for this indication in children, despite published guidelines of care that recommend against this option. Several clinical trials with level 1 evidence have supported the use of topical treatments for mild to moderate atopic dermatitis in adults and children, but these trials have had little consistency in protocol design. Consensus recommendations will help standardize clinical development and trial design for children. The Food and Drug Administration issues guidance documents for industry as a source for "the Agency's current thinking on a particular subject." Although they are nonbinding, industry considers these documents to be the standard for clinical development and trial design. Our consensus group is the first to specifically address clinical trial design in this population. We developed a draft guidance document for industry, Developing Drugs for Treatment of Atopic Dermatitis in Children (≥3 months to <18 years of age). This draft guidance has been submitted to the Food and Drug Administration based on a provision in the Federal Register (Good Guidance Practices).
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Affiliation(s)
- Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Lawrence F Eichenfield
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Amy Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, TX, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Charles Arena
- Clinical Development & Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Julie Block
- National Eczema Association, San Rafael, CA, USA
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Suephy Chen
- Department of Dermatology, Emory University, and Division of Dermatology, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Kelly Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Diane Hanna
- Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Kimberly Horii
- Division of Dermatology, Children's Mercy and University of Missouri, Kansas City, MO, USA
| | - Thomas Hultsch
- Translational Medicine, Sanofi-Genzyme, Cambridge, MA, USA
| | - James Lee
- Dermavant Sciences, Raleigh-Durham, NC, USA
| | - Donald Y Leung
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua Milner
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Theodore Omachi
- Immunology/Respiratory, Genentech, Inc., San Francisco, CA, USA
| | | | - Lynda Schneider
- Department of Pediatrics, Harvard Medical School and Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Robert Sidbury
- Division of Dermatology, Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Sharif Taha
- National Eczema Association, San Rafael, CA, USA
| | - Susan Tofte
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Wynnis L Tom
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lucinda Whitney
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lee Zane
- Anacor Pharmaceuticals, Palo Alto, CA, USA
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28
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Zhao C, Hao E, Oh D, Daniel B, Martin L, Su J, Rodrigues M, Murrell D. A comparison study of clinician-rated atopic dermatitis outcome measures for intermediate- to dark-skinned patients. Br J Dermatol 2017; 176:985-992. [DOI: 10.1111/bjd.15271] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/28/2023]
Affiliation(s)
- C.Y. Zhao
- St George Hospital; Sydney Australia
- University of New South Wales; Sydney Australia
| | - E.Y. Hao
- University of New South Wales; Sydney Australia
| | - D.D. Oh
- University of New South Wales; Sydney Australia
| | - B.S. Daniel
- University of New South Wales; Sydney Australia
- St Vincent's Hospital; Melbourne Australia
| | - L.K. Martin
- University of New South Wales; Sydney Australia
- Sydney Children's Hospital; Sydney Australia
| | - J.C. Su
- Royal Children's Hospital; Melbourne Australia
- Monash University; Eastern Health; Box Hill Australia
| | - M. Rodrigues
- St Vincent's Hospital; Melbourne Australia
- Royal Children's Hospital; Melbourne Australia
| | - D.F. Murrell
- St George Hospital; Sydney Australia
- University of New South Wales; Sydney Australia
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