1
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Magnolo N, Cameron MC, Shahriari M, Geng B, Calimlim BM, Teixeira H, Hu X, Yang Y, Liu Y, Zhang S, Sancho Sanchez C, Altman K, Langley RG. Rapid and sustained improvements in itch and quality of life with upadacitinib plus topical corticosteroids in adults and adolescents with atopic dermatitis: 52-week outcomes from the phase 3 AD Up study. J DERMATOL TREAT 2024; 35:2344589. [PMID: 38697950 DOI: 10.1080/09546634.2024.2344589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Abstract
Purpose: Atopic dermatitis (AD) adversely impacts quality of life (QoL). We evaluated the effect of upadacitinib, an oral selective Janus kinase inhibitor approved for moderate-to-severe AD, plus topical corticosteroids (+TCS) on patient-reported outcomes (PROs) over 52 weeks. Materials and methods: In the phase 3 AD Up study (NCT03568318), adults and adolescents with moderate-to-severe AD were randomized 1:1:1 to once-daily upadacitinib 15 mg, 30 mg, or placebo + TCS. Itch, skin pain/symptoms, sleep, QoL, daily activities, emotional state, mental health, and patient impressions of disease severity/improvement/treatment satisfaction were assessed. Results: This analysis included 901 patients. Within 1-2 weeks, PRO improvements were greater with both upadacitinib doses than with placebo (p <.05). Improvements increased through weeks 4-8; rates were generally maintained through week 52. At week 52, the proportion of patients with clinically meaningful improvements in itch (Worst Pruritus Numerical Rating Scale improvement ≥4), skin pain (AD Symptom Scale Skin Pain improvement ≥4), sleep (AD Impact Scale [ADerm-IS] Sleep improvement ≥12), daily activities (ADerm-IS Daily Activities improvement ≥14), and emotional state (ADerm-IS Emotional State improvement ≥11) ranged from 62.1%-77.7% with upadacitinib 15 mg + TCS and 71.3%-83.6% with upadacitinib 30 mg + TCS. Conclusions: Upadacitinib + TCS results in rapid, sustained improvements in burdensome AD symptoms and QoL.
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Affiliation(s)
- Nina Magnolo
- Department of Dermatology and Venereology, University Hospital of Münster, Münster, Germany
| | | | - Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Bob Geng
- Division of Allergy and Immunology, University of California San Diego, and Rady Children's Hospital, San Diego, CA, USA
| | | | | | | | | | | | | | | | | | - Richard G Langley
- Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, Canada
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2
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Chong AC, Navarro-Triviño FJ, Su M, Park CO. Fungal Head and Neck Dermatitis: Current Understanding and Management. Clin Rev Allergy Immunol 2024:10.1007/s12016-024-09000-7. [PMID: 39031274 DOI: 10.1007/s12016-024-09000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/22/2024]
Abstract
Head and neck dermatitis (HND) is a form of atopic dermatitis (AD) that affects the seborrheic areas of the body and causes greater quality of life detriments than other types of AD. HND can be challenging to treat since first-line topical therapies may be ineffective or intolerable for long-term use on areas affected by HND while dupilumab may cause dupilumab-associated HND (DAHND). Current evidence implicates fungi, particularly Malassezia spp., in the pathogenesis of HND. Penetration of fungal antigens through the defective AD skin barrier activates the innate and adaptive immune systems to cause cutaneous inflammation via the T helper (Th)17 and/or Th2 axes. Malassezia sensitization may distinguish HND from other forms of AD. Multiple double-blind, placebo-controlled trials have shown antifungals to benefit HND, yet the persistence of symptom relief with sustained use remains unclear. Oral antifungals appear more effective than topical antifungals but may be harmful with long-term use. DAHND may also be fungal-mediated given improvement with antifungals and evidence of an overactive immune response against Malassezia in these patients. Janus kinase inhibitors are effective for HND, including DAHND, but may cause significant side effects when administered systemically. OX40/OX40L inhibitors and tralokinumab may be promising options for HND on the horizon. Demographic and environmental factors influence the host mycobiome and should be considered in future precision-medicine approaches as microbiome composition and diversity are linked to severity of HND.
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Affiliation(s)
- Albert C Chong
- Department of Internal Medicine, Mayo Clinic Arizona, 13400 E Shea Blvd., Scottsdale, AZ, 85259, USA.
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Francisco José Navarro-Triviño
- Department of Contact Eczema and Immunoallergic Diseases, Dermatology Service, Hospital Universitario San Cecilio, Granada, Spain
| | - Malcolm Su
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chang Ook Park
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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3
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Yew YW, Chang BRQ, Mina T, Riboli E, Lee ES, Ngeow J, Elliott P, Chambers JC, Lee J, Loh M. Association of atopic dermatitis with depression and sleep quality in an Asian general population cohort of 8887 participants. J Eur Acad Dermatol Venereol 2024; 38:e622-e624. [PMID: 38372377 DOI: 10.1111/jdv.19836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Yik Weng Yew
- National Skin Centre, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Bill Rong Qin Chang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Theresia Mina
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Elio Riboli
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Clinical Research Unit, National Healthcare Group Polyclinic, Singapore City, Singapore
| | - Joanne Ngeow
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Division of Medical Oncology, National Cancer Centre, Singapore City, Singapore
| | - Paul Elliott
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - John C Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jimmy Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Research Division, Institute of Mental Health, Singapore City, Singapore
| | - Marie Loh
- National Skin Centre, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
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4
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Pereda J, Milde Khatib C, Kezic S, Christensen MO, Yang S, Thyssen JP, Chu CY, Riethmüller C, Liao HS, Akhtar I, Ungar B, Guttman-Yassky E, Hædersdal M, Hwu ET. A Review of Atomic-Force Microscopy in Skin Barrier Function Assessment. J Invest Dermatol 2024:S0022-202X(24)00357-9. [PMID: 38888524 DOI: 10.1016/j.jid.2024.04.005] [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: 05/05/2023] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 06/20/2024]
Abstract
Skin barrier function (SBF) disorders are a class of pathologies that affect a significant portion of the world population. These disorders cause skin lesions with intense itch, impacting patients' physical and psychological well-being as well as their social functioning. It is in the interest of patients that their disorder be monitored closely while under treatment to evaluate the effectiveness of the ongoing therapy and any potential adverse reactions. Symptom-based assessment techniques are widely used by clinicians; however, they carry some limitations. Techniques to assess skin barrier impairment are critical for understanding the nature of the disease and for helping personalize treatment. This review recalls the anatomy of the skin barrier and describes an atomic-force microscopy approach to quantitatively monitor its disorders and their response to treatment. We review a panel of studies that show that this technique is highly relevant for SBF disorder research, and we aim to motivate its adoption into clinical settings.
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Affiliation(s)
- Jorge Pereda
- The Danish National Research Foundation and Villum Foundation's Center for Intelligent Drug Delivery and Sensing Using Microcontainers and Nanomechanics (IDUN), Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Casper Milde Khatib
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sanja Kezic
- Amsterdam UMC, Coronel Institute of Occupational Health, Amsterdam, The Netherlands
| | | | - Sara Yang
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Hsien-Shun Liao
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan
| | - Imtisal Akhtar
- The Danish National Research Foundation and Villum Foundation's Center for Intelligent Drug Delivery and Sensing Using Microcontainers and Nanomechanics (IDUN), Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Benjamin Ungar
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emma Guttman-Yassky
- The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Merete Hædersdal
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - En-Te Hwu
- The Danish National Research Foundation and Villum Foundation's Center for Intelligent Drug Delivery and Sensing Using Microcontainers and Nanomechanics (IDUN), Department of Health Technology, Technical University of Denmark, Lyngby, Denmark.
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5
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Park M, Han MA, Park J, Choi SW. Effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents. J Asthma 2024:1-9. [PMID: 38850521 DOI: 10.1080/02770903.2024.2366525] [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: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE The daily lives of adolescents have changed significantly because of COVID-19 pandemic. We investigated the effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents. METHODS Data from the 2021 Korea Youth Risk Behavior Survey were used. In total, 54,848 survey participants were included in the analysis. Allergic diseases included allergic rhinitis, atopic dermatitis, and asthma. Changes attributed to COVID-19 included family economic difficulties, physical activity, breakfast skipping frequency, alcohol consumption, smoking, and depressive moods. Chi-square tests and multiple logistic regression analyses were conducted to examine the impact of changes in daily life attributed to COVID-19 on allergic diseases. RESULTS Among the Korean adolescents surveyed, 29.8% experienced a deterioration in their economic status due to COVID-19, 49.1% reported decreased physical activity, 2.8% reported increased alcohol consumption, 1.0% reported an increase in their smoking behavior, and 36.9% reported an increase in depressive moods. Those diagnosed with atopic dermatitis, allergic rhinitis, or asthma within the previous 12 months accounted for 17.1%, 6.2%, and 1.0% of the population, respectively. Adolescents who were significantly affected by COVID-19 in their daily lives were frequently diagnosed with allergic diseases within the last 12 months. CONCLUSION Changes in daily life due to COVID-19, including decreased physical activity and increased depressive mood, were common in adolescents and were associated with an increased prevalence of allergic diseases. Since changes in daily life due to the pandemic may increase the burden of allergic disease, additional interventions for disease management should be considered.
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Affiliation(s)
- Miso Park
- Department of Public Health, Graduate School of Health Science, Chosun University, Gwangju, Republic of Korea
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Jong Park
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Seong Woo Choi
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
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6
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Esposito M, Amicucci G, Salfi F, Pellegrini C, De Berardinis A, Chiricozzi A, Peris K, Tempesta D, Ferrara M, Fargnoli MC. Exploring the interplay of atopic dermatitis severity with sleep and mental health: a case-control study in adult patients. Postgrad Med 2024; 136:533-540. [PMID: 38864389 DOI: 10.1080/00325481.2024.2366162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with non-atopic comorbidities. Recently, a severity-dependent relationship between AD and sleep/mental health diseases has been proposed. However, few studies investigated these comorbidities and their association with AD severity through validated questionnaires. This study aimed to use a set of validated instruments to assess the impact of AD on sleep and psychological disorders and estimate the association of itch and AD severity with sleep disorders and psychological symptoms, distinguishing between clinical-oriented and patient-oriented measures. METHODS We conducted a case-control study, recruiting 57 adult AD patients (mean age ± std. dev. 34.28 years ± 13.07; 27 males) matched for age and sex with 57 healthy adults (34.39 years ± 13.09; 27 males). To investigate the differences in sleep quality, insomnia, depression, and anxiety between the two groups, we performed independent sample t-Tests. Moreover, we conducted univariate linear regression analyses to examine the relationship between itch and objective/subjective severity of AD and sleep quality, insomnia, and psychological symptoms. RESULTS AD patients reported lower sleep quality (p = 0.002), more severe insomnia (p = 0.006) and depression (p = 0.013), and higher stress levels than healthy adults (p = 0.049). Itch intensity was linked to sleep disturbances and psychological symptoms (R2range = 0.13-0.19, prange = 0.02-<0.001). Objective and subjective AD severity were similarly associated with worse sleep quality (R2 = 0.26, p < 0.001; R2 = 0.24, p < 0.001; respectively), anxiety (R2 = 0.15, p = 0.04; R2 = 0.17, p = 0.001; respectively), and self-perceived stress (R2 = 0.10, p = 0.02; R2 = 0.07, p = 0.049; respectively). However, subjective AD severity was more strongly associated with insomnia (R2 = 0.31, p < 0.001) and depression (R2 = 0.20, p < 0.001) than clinical-oriented AD severity (R2 = 0.19, p < 0.001; R2 = 0.05, p = 0.098; respectively). CONCLUSIONS The study demonstrated poor sleep quality and high levels of insomnia, depression, and stress in AD patients, with an aggravated psychological status for adults with more severe skin disease. We suggest implementing a multidisciplinary approach to AD management/treatment that considers objective and subjective measures of disease severity.
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Affiliation(s)
- Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
| | - Giulia Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Cristina Pellegrini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea De Berardinis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
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7
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David E, Hawkins K, Shokrian N, Del Duca E, Guttman-Yassky E. Monoclonal antibodies for moderate-to-severe atopic dermatitis: a look at phase III and beyond. Expert Opin Biol Ther 2024; 24:471-489. [PMID: 38888099 DOI: 10.1080/14712598.2024.2368192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The understanding of atopic dermatitis (AD) pathogenesis has rapidly expanded in recent years, catalyzing the development of new targeted monoclonal antibody treatments for AD. AREAS COVERED This review aims to summarize the latest clinical and molecular data about monoclonal antibodies that are in later stages of development for AD, either in Phase 3 trials or in the pharmacopoeia for up to 5 years, highlighting the biologic underpinning of each drug's mechanism of action and the potential modulation of the AD immune profile. EXPERT OPINION The therapeutic pipeline of AD treatments is speedily progressing, introducing the potential for a personalized medical approach in the near future. Understanding how targeting pathogenic players in AD modifies disease progression and symptomatology is key in improving therapeutic choices for patients and identifying ideal patient candidates.
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Affiliation(s)
- Eden David
- Department of Dermatology, Icahn school of Medicine at Mount Sinai, New York, NY, USA
| | - Kelly Hawkins
- Department of Dermatology, Icahn school of Medicine at Mount Sinai, New York, NY, USA
- Department of Dermatology, Albert Einstein College of Medicine, New York, NY, USA
| | - Neda Shokrian
- Department of Dermatology, Icahn school of Medicine at Mount Sinai, New York, NY, USA
- Department of Dermatology, Albert Einstein College of Medicine, New York, NY, USA
| | - Ester Del Duca
- Department of Dermatology, Icahn school of Medicine at Mount Sinai, New York, NY, USA
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn school of Medicine at Mount Sinai, New York, NY, USA
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8
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Silvestre JF, Ruiz-Villaverde R, Pérez-García B, Herranz Pinto P, Domínguez-Cruz JJ, Gentile M, Izu Belloso RM. Real-World Clinical, Psychosocial and Financial Burden of Atopic Dermatitis: Results from the Spanish Cohort of the MEASURE-AD Trial. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00420-4. [PMID: 38777226 DOI: 10.1016/j.ad.2024.04.022] [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: 03/05/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is one of the most prevalent skin diseases, but there are numerous knowledge gaps surrounding the impact this disease has on quality of life (QoL), mental health, and out-of-pocket expenses involved in the management of AD. The available scientific evidence on the multidimensional burden of AD is usually based on studies with measures reported by patients themselves. METHODS In this context, the MEASURE-AD trial was developed as a cross-sectional, multicenter, multinational trial using patient- and physician-reported measures to characterize the multidimensional burden of AD in adults with moderate-to-severe AD. RESULTS This paper presents the results of the Spanish cohort. We found that Spanish adults with moderate-to-severe AD and high EASI score (21.1-72) had a significantly increased disease burden, high severity of symptoms such as itch and sleep disturbances, impaired mental health and QoL, higher use of health care resources, and more out-of-pocket expenses than patients with low EASI scores (0-7 or 7.1-21). CONCLUSIONS This study provides information to better understand disease burden, and identify aspects to be improved in the management of AD.
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Affiliation(s)
- J F Silvestre
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España; Instituto Biosanitario de Granada (ibs.Granada), Granada, España
| | - B Pérez-García
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal Hospital, Madrid, España
| | - P Herranz Pinto
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - J J Domínguez-Cruz
- Unidad de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M Gentile
- Departamento Médico, AbbVie, Madrid, España
| | - R M Izu Belloso
- Servicio de Dermatología, Hospital Universitario de Basurto, Bilbao, España
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9
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Chen GF, Xu S, White MA, Cohen JM. Association between atopic dermatitis and eating disorders: a cross-sectional study in the All of Us Research Program. Br J Dermatol 2024; 190:925-927. [PMID: 38466772 DOI: 10.1093/bjd/ljae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/01/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
We investigated the association between atopic dermatitis (AD) and eating disorders through a cross-sectional study of US adults in the All of Us Research Program, a diverse cohort of over 250 000 participants with a focus on populations traditionally under-represented in biomedical research. Using multivariable analysis, we found that AD was significantly associated with all eating disorders tested, with binge eating disorder having the greatest multivariable odds ratio of 3.58 (95% confidence interval 2.48–5.02, P < 0.001) when adjusted for age, sex, ethnicity and race.
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Affiliation(s)
| | - Suzanne Xu
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Marney A White
- Department of Social and Behavioral Sciences
- Departments of Psychiatry
| | - Jeffrey M Cohen
- Dermatology, Yale School of Medicine, New Haven, CT, USA
- Section of Biomedical Informatics and Data Science, Yale School of Public Health, New Haven, CT
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10
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Scutari M, Kerob D, Salah S. Inferring skin-brain-skin connections from infodemiology data using dynamic Bayesian networks. Sci Rep 2024; 14:10266. [PMID: 38704447 PMCID: PMC11069591 DOI: 10.1038/s41598-024-60937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
The relationship between skin diseases and mental illnesses has been extensively studied using cross-sectional epidemiological data. Typically, such data can only measure association (rather than causation) and include only a subset of the diseases we may be interested in. In this paper, we complement the evidence from such analyses by learning an overarching causal network model over twelve health conditions from the Google Search Trends Symptoms public data set. We learned the causal network model using a dynamic Bayesian network, which can represent both cyclic and acyclic causal relationships, is easy to interpret and accounts for the spatio-temporal trends in the data in a probabilistically rigorous way. The causal network confirms a large number of cyclic relationships between the selected health conditions and the interplay between skin and mental diseases. For acne, we observe a cyclic relationship with anxiety and attention deficit hyperactivity disorder (ADHD) and an indirect relationship with depression through sleep disorders. For dermatitis, we observe directed links to anxiety, depression and sleep disorders and a cyclic relationship with ADHD. We also observe a link between dermatitis and ADHD and a cyclic relationship between acne and ADHD. Furthermore, the network includes several direct connections between sleep disorders and other health conditions, highlighting the impact of the former on the overall health and well-being of the patient. The average R 2 for a condition given the values of all conditions in the previous week is 0.67: in particular, 0.42 for acne, 0.85 for asthma, 0.58 for ADHD, 0.87 for burn, 0.76 for erectile dysfunction, 0.88 for scars, 0.57 for alcohol disorders, 0.57 for anxiety, 0.53 for depression, 0.74 for dermatitis, 0.60 for sleep disorders and 0.66 for obesity. Mapping disease interplay, indirect relationships, and the key role of mediators, such as sleep disorders, will allow healthcare professionals to address disease management holistically and more effectively. Even if we consider all skin and mental diseases jointly, each disease subnetwork is unique, allowing for more targeted interventions.
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Affiliation(s)
- Marco Scutari
- Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Lugano, Switzerland.
| | - Delphine Kerob
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
- Department of Dermatology, AP-HP Saint-Louis Hospital, Paris, France
| | - Samir Salah
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
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11
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Elhage KG, Kranyak A, Jin JQ, Haran K, Spencer RK, Smith PL, Davis MS, Hakimi M, Bhutani T, Liao W. Mendelian Randomization Studies in Atopic Dermatitis: A Systematic Review. J Invest Dermatol 2024; 144:1022-1037. [PMID: 37977498 DOI: 10.1016/j.jid.2023.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
Prior studies have found associations between atopic dermatitis (AD) and comorbidities, including depression, obesity, asthma, and allergic rhinitis. Although observational studies often cannot establish robust causality between potential risk factors and AD, Mendelian randomization minimizes confounding when exploring causality by relying on random allelic assortment at birth. In this study, we systematically reviewed 30 Mendelian randomization studies in AD. Body mass index, gut microbial flora, the IL-18 signaling pathway, and gastroesophageal reflux disease were among the causal factors for AD, whereas AD was causal for several medical conditions, including heart failure, rheumatoid arthritis, and conjunctivitis. These insights may improve preventive counseling in AD.
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Affiliation(s)
- Kareem G Elhage
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Allison Kranyak
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Joy Q Jin
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA; School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kathryn Haran
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Riley K Spencer
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Payton L Smith
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Mitchell S Davis
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA; Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA.
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12
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Morgan AM, Li ZI, Garra S, Bi AS, Gonzalez-Lomas G, Jazrawi LM, Campbell KA. Patient-reported allergies are associated with increased rate of postoperative stiffness after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2024; 33:1050-1057. [PMID: 37839628 DOI: 10.1016/j.jse.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within 2 years after arthroscopic rotator cuff repair (ARCR). METHODS Current Procedural Terminology surgical billing codes were used to retrospectively identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), manipulation under anesthesia (MUA), and AC of the shoulder were further queried within 2 years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC before the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, and hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as the presence of 1, 2, or 3 or more PRAs, with subsequent MUA/LOA or diagnosis of AC within 2 years postoperatively. RESULTS Of 7057 patients identified in the study period, 6583 were eligible for the final analysis. The mean age was 56.6 ± 11.7 years, and the mean body mass index was 29.1 ± 5.6. Overall, 19.3% of patients (n = 1271) reported at least 1 allergy, and 7.1% (n = 469) had >1 PRA. A total of 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within 2 years postoperatively, whereas 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.45-3.92; P < .001), but not MUA/LOA (OR: 1.97, 95% CI: 1.26-3.61; P = .133). Patients with 2 PRAs had greater odds of being diagnosed with AC than patients with 1 PRA (OR: 2.74; 95% CI: 1.14-5.99; P = .012). Although this association was nonsignificant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI: 0.96-8.80; P = .059) demonstrated a similar statistical trend. CONCLUSION PRAs are associated with increased odds of receiving a diagnosis of AC within 2 years after ARCR but were not found to be associated with return to the operating room for postoperative stiffness.
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Affiliation(s)
- Allison M Morgan
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA.
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Andrew S Bi
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | | | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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13
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Simpson EL, Prajapati VH, Leshem YA, Chovatiya R, de Bruin-Weller MS, Ständer S, Pink AE, Calimlim BM, Lee WJ, Teixeira H, Ladizinski B, Hu X, Yang Y, Liu Y, Liu M, Grada A, Platt AM, Silverberg JI. Upadacitinib Rapidly Improves Patient-Reported Outcomes in Atopic Dermatitis: 16-Week Results from Phase 3 Clinical Trials (Measure Up 1 and 2). Dermatol Ther (Heidelb) 2024; 14:1127-1144. [PMID: 38696027 PMCID: PMC11116320 DOI: 10.1007/s13555-024-01157-5] [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: 02/08/2024] [Accepted: 04/03/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is characterized by intense itch and other symptoms that negatively impact quality of life (QoL). This study evaluates the effect of upadacitinib (an oral selective Janus kinase inhibitor) monotherapy on patient-reported outcomes (PROs) among adults and adolescents with moderate-to-severe AD over 16 weeks. METHODS This integrated analysis of the double-blind, placebo-controlled periods of phase 3 monotherapy clinical trials Measure Up 1 (NCT03569293) and Measure Up 2 (NCT03607422) assessed itch (Worst Pruritus Numerical Rating Scale [WP-NRS] and SCORing Atopic Dermatitis [SCORAD]), skin pain and symptom severity (AD Symptom Scale), symptom frequency (Patient-Oriented Eczema Measure), sleep (AD Impact Scale [ADerm-IS] and SCORAD), daily activities and emotional state (ADerm-IS), QoL (Dermatology Life Quality Index [DLQI] and Children's DLQI), mental health (Hospital Anxiety and Depression Scale), and patient impressions (Patient Global Impression of Severity, Patient Global Impression of Change, and Patient Global Impression of Treatment). RESULTS Data from 1683 patients (upadacitinib 15 mg, n = 557; upadacitinib 30 mg, n = 567; placebo, n = 559) were analyzed. A greater proportion of patients receiving upadacitinib versus placebo experienced improvements in itch (≥ 4-point improvement on WP-NRS) by week 1 (upadacitinib 15 mg, 11.2%; upadacitinib 30 mg, 17.7%; placebo, 0.5%; P < 0.001), with response rates sustained through week 16 (upadacitinib 15 mg, 47.1%; upadacitinib 30 mg, 59.8%; placebo, 10.4%; P < 0.001). Improvements were similar for PROs assessing skin pain/symptoms, sleep, daily activities, QoL, emotional state, mental health, and patient impressions of disease severity and treatment. Responses generally improved rapidly (within 1-2 weeks), increased through weeks 4-6, and were maintained through week 16. CONCLUSIONS Once-daily oral upadacitinib monotherapy improved response rates across PROs compared with placebo. Upadacitinib therapy resulted in rapid, sustained improvements in PROs measuring symptom burden and QoL in adults and adolescents with moderate-to-severe AD. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT03569293 and NCT03607422.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, 3303 S. Bond Avenue, Portland, OR, 97239, USA.
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Sections of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - Yael A Leshem
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raj Chovatiya
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Center for Medical Dermatology and Immunology Research, Chicago, IL, USA
| | - Marjolein S de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sonja Ständer
- Center for Chronic Pruritus, Münster University Hospital, Münster, Germany
| | - Andrew E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Meng Liu
- AbbVie Inc, North Chicago, IL, USA
| | | | | | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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14
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Jin T, Seo J, Ye S, Lee S, Park EY, Oh JK, Han C, Kim B. Suicide mortality following the implementation of tobacco packaging and pricing policies in Korea: an interrupted time-series analysis. BMC Med 2024; 22:180. [PMID: 38679738 PMCID: PMC11057188 DOI: 10.1186/s12916-024-03372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND To prevent tobacco use in Korea, the national quitline number was added to tobacco packages in December 2012, tobacco prices were raised by 80% in January 2015, and graphic health warning labels were placed on tobacco packages in December 2016. This study evaluated the association of these tobacco packaging and pricing policies with suicide mortality in Korea. METHODS Monthly mortality from suicide was obtained from Cause-of-Death Statistics in Korea from December 2007 to December 2019. Interrupted time-series analysis was performed using segmented Poisson regression models. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated adjusted for suicide prevention strategies. RESULTS Suicide mortality was 20 per 1,000,000 in December 2007 and showed a downward trend over the study period. After the implementation of tobacco packaging and pricing policies, suicide mortality immediately declined by - 0.09 percent points (95% CI = - 0.19 to 0.01; P > 0.05) for the national quitline number, - 0.22 percent points (95% CI = - 0.35 to - 0.09; P < 0.01) for tobacco prices, and - 0.30 percent points (95% CI = - 0.49 to - 0.11; P < 0.01) for graphic health warning labels. The corresponding RRs for these post-implementation changes compared with the pre-implementation level were 0.91 (95% CI = 0.83 to 1.00), 0.80 (95% CI = 0.70 to 0.91), and 0.74 (95% CI = 0.61 to 0.90), respectively. Significant associations between tobacco control policies and suicide mortality were observed even when stratified by sex and region. CONCLUSIONS The findings of this study provide new evidence for an association between tobacco control policies and deaths by suicide. An array of effective tobacco control policies should be considered for prevention programs targeting suicide.
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Affiliation(s)
- Taiyue Jin
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
| | - Juhee Seo
- Vital Statistics Division, Statistics Korea, Daejeon, South Korea
| | - Shinhee Ye
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, South Korea
| | - Seulbi Lee
- Department of Big Data Strategy, National Health Insurance Service, Wonju, South Korea
| | - Eun Young Park
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jin-Kyoung Oh
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Byungmi Kim
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea.
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
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15
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Zhang H, Li Z, Sun Y, Li W, Sun X, Zhang Y, Liu L, Ma S. Mechanisms of action of Shizhenqing granules for eczema treatment: Network pharmacology analysis and experimental validation. Heliyon 2024; 10:e27603. [PMID: 38496849 PMCID: PMC10944262 DOI: 10.1016/j.heliyon.2024.e27603] [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: 05/04/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Background Jiuwan decoction has been used to treat chronic eczema since the Qing Dynasty. According to clinical experience, Shizhenqing granules (SZQG), derived from the Jiuwan decoction, exert beneficial clinical effects on acute eczema and reduce recurrence. Therefore, we elucidated the underlying mechanisms of SZQG through network pharmacology, molecular docking, and experimental validation. Methods The main chemical components of SZQG were identified by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). And the targets of SZQG against eczema were screened out through online databases. Then, the regulatory network map of the "herbal compound-potential target" and the target protein-protein interaction (PPI) network was constructed. The Gene Ontology (GO) analysis and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted using by R language. Additionally, the interaction between the active compounds and the targets was verified by molecular docking technology. Finally, an experiment in vivo was used to verify the effect and mechanism of SZQG on eczema. Results Using UHPLC-MS/MS, 158 main chemical compounds of SZQG were identified, and 72 compounds were selected according to the criteria for further analysis. All 237 potential targets of SZQG in eczema were explored using multiple online databases. The network with 14 core targets was screened out, including STAT3, RELA, TNF, JUN, MAPK3, IL-6, PIK3CA, STAT1, MAPK14, MAPK1, IL-4, NFKBIA, IL1B, and MYC. KEGG analyses indicated that the therapeutic effects of SZQG on eczema were predominantly associated with cytokine-cytokine receptor interaction, TNF, MAPK, NF-κB, toll-like receptor, T cell receptor, and Th1 and Th2 cell differentiation signaling pathways. Furthermore, the good affinity between the core compounds and core targets was verified by molecular docking technology, particularly for RELA and MAPK. Animal experiments revealed that SZQG downregulated MAPK14, RELA, T-bet, and GATA3 mRNA expression, reduced immunoglobulin E (IgE) and interleukin-4 (IL-4) serum concentrations, and improved eczema-like lesions in model rats. Conclusion This study identified potential targets and signaling pathways of SZQG in the treatment of eczema, whereby RELA and MAPK14 may constitute the main therapeutic targets of SZQG in cytokine regulation and reduction of inflammatory responses.
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Affiliation(s)
- Hairong Zhang
- Department of Integrated Chinese and Western Medicine, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China
| | - Zhenbo Li
- Oregon College of Oriental Medicine, Portland, OR, 97209, USA
| | - Yike Sun
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Wenna Li
- Department of Acupuncture and Minimally Invasive Oncology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, China
| | - Xiao Sun
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Yapeng Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Leilei Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Shuran Ma
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
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16
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Cai XC, Wang SH, Wang CX, Liu L, Wang J, Shen YH, Li X. Epidemiology of mental health comorbidity in patients with atopic dermatitis: An analysis of global trends from 1998 to 2022. J Eur Acad Dermatol Venereol 2024; 38:496-512. [PMID: 38073580 DOI: 10.1111/jdv.19686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/23/2023] [Indexed: 02/24/2024]
Abstract
The prevalence rates of attention deficit hyperactivity disorder (ADHD), depression, anxiety and suicide are increasing in patients with atopic dermatitis (AD), although no research has systematically examined these trends yet. Here, we explore the prevalence of the occurrence of comorbidities, such as ADHD, depression, anxiety and suicide with AD. We searched seven electronic databases from inception to October 2022 to identify relevant studies, and the Agency for Healthcare Research and Quality (AHRQ) and Newcastle-Ottawa Scale (NOS) tools were used to assess the quality of observational studies. Statistical analysis was performed using R software. Publication bias was evaluated using Egger's and Begg's linear tests. The global prevalence rates of ADHD, depression, anxiety and suicidal ideation in patients with AD were 7%, 17%, 21% and 13%, respectively, between 1998 and October 2022. Among children (aged <18 years), North American children with AD had the highest prevalence rates of ADHD (10%), depression (13%) and anxiety (20%). Among the adult (aged ≥18 years) population, patients with AD in Africa had the highest prevalence rates of depression (36%) and anxiety (44%), while Asian adults with AD had the highest prevalence rates of ADHD (7%) and suicidal ideation (20%). These results highlight the high prevalence and comorbidity rates of mental illnesses with AD, which should be brought to the attention of patients with AD and their physicians.
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Affiliation(s)
- Xiao-Ce Cai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Si-Han Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Xiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Hong Shen
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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17
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Wan J, Wang S, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Gelfand JM. Neuropsychiatric disorders in adults with atopic dermatitis: A population-based cohort study. J Eur Acad Dermatol Venereol 2024; 38:543-548. [PMID: 37731131 DOI: 10.1111/jdv.19518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) may be associated with an increased burden of neuropsychiatric outcomes such as anxiety and depression, but longitudinal data on the impact of AD severity is lacking, and a comprehensive assessment of neuropsychiatric disease in adults with AD is needed. OBJECTIVES Determine risk of incident neuropsychiatric disease among adults with AD by severity. METHODS A cohort study using electronic health records data from UK general practices from 1994 to 2015. Adults (≥18 years) with AD were matched on age, practice and index date to patients without AD. AD severity was categorized using treatments and dermatology referrals. Outcomes were incident anxiety, depression, bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder (ADHD), autism, obsessive-compulsive disorder (OCD), suicidality and completed suicide. RESULTS Comparing 625,083 adults with AD to 2,678,888 adults without AD, AD was associated with higher risk of anxiety [HR 1.14 (1.13-1.15)], depression [1.14 (1.13-1.15)] and OCD [1.48 (1.38-1.58)] across all severities. Mild or moderate AD was also associated with higher risk of autism, ADHD, bipolar disorder and suicidality. CONCLUSIONS Atopic dermatitis is associated with a higher risk of multiple neuropsychiatric conditions, but these risks differ by specific condition and AD severity. Clinicians should inquire about mental health in patients with AD.
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Affiliation(s)
- Joy Wan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonia Wang
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Maha N Syed
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Adina R Lemeshow
- Global Medical Epidemiology I&I, Pfizer, Inc, New York, New York, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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18
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Vakirlis E, Gregoriou S, Bakirtzi K, Paschou E, Tsiogka A, Papadimitriou I, Sotiriou E. Insights into Early Systemic Treatment in Atopic Dermatitis: Scientific Facts and Practical Considerations. Dermatol Ther (Heidelb) 2024; 14:563-568. [PMID: 38411895 PMCID: PMC10965849 DOI: 10.1007/s13555-024-01110-6] [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: 11/27/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized clinically by pruritus, and pathophysiologically by immune dysregulation, and compromised skin barrier function. While topical therapies are currently the cornerstone of AD management, especially in mild disease, recent advancements in systemic treatments and a deeper understanding of similar skin diseases, such as psoriasis, have highlighted the importance of early intervention. In this commentary, we explore the potential benefits of early systemic intervention in AD, with pruritus determining such a decision. Building on this concept, we assume that, through the timely systemic treatment that targets the immune dysregulation present in AD, the progression of the disease could be modified, improving overall patient outcomes. Early systemic intervention may minimize systemic inflammation, halting the "atopic march" and disrupting the "itch-scratch" cycle. Managing pruritus at its root could prevent secondary complications and reduce the psychosocial burden of the disease. This paradigm shift fosters a collaborative healthcare approach that empowers patients with long-term disease control strategies. In conclusion, the safety and efficacy of novel systemic treatments offer a compelling scenario for early intervention in atopic dermatitis care.
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Affiliation(s)
- Efstratios Vakirlis
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Stamatios Gregoriou
- 1st Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Katerina Bakirtzi
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Eleni Paschou
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Aikaterini Tsiogka
- 1st Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Ilias Papadimitriou
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
| | - Eleni Sotiriou
- First Department of Dermatology and Venereology, Aristotle University of Thessaloniki, Hospital of Skin and Venereal Diseases, Thessaloniki, Greece
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Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun 2024; 116:286-302. [PMID: 38128623 DOI: 10.1016/j.bbi.2023.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Psychological stress is a crucial factor in the development of many skin diseases, and the stigma caused by skin disorders may further increase the psychological burden, forming a vicious cycle of psychological stress leading to skin diseases. Therefore, understanding the relationship between stress and skin diseases is necessary. The skin, as the vital interface with the external environment, possesses its own complex immune system, and the neuroendocrine system plays a central role in the stress response of the body. Stress-induced alterations in the immune system can also disrupt the delicate balance of immune cells and inflammatory mediators in the skin, leading to immune dysregulation and increased susceptibility to various skin diseases. Stress can also affect the skin barrier function, impair wound healing, and promote the release of pro-inflammatory cytokines, thereby exacerbating existing skin diseases such as psoriasis, atopic dermatitis, acne, and urticaria. In the present review, we explored the intricate relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective. We explored the occurrence and development of skin diseases in the context of stress, the stress models for skin diseases, the impact of stress on skin function and diseases, and relevant epidemiological studies and clinical trials. Understanding the relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective provides a comprehensive framework for targeted interventions and new insights into the diagnosis and treatment of skin diseases.
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Affiliation(s)
- Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Mi Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China; Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xue Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Yujie Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
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20
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Zhao Y, Zhang J, Yang B, Li J, Ding Y, Wu L, Zhang L, Wang J, Zhu X, Zhang F, Tao X, Li Y, Zhang C, Li L, Lu J, Diao Q, Lu Q, Man X, Li F, Xia X, Cheng H, Jia Y, Zhao G, Yan J, Chen B. Efficacy and safety of CM310 in moderate-to-severe atopic dermatitis: A multicenter, randomized, double-blind, placebo-controlled phase 2b trial. Chin Med J (Engl) 2024; 137:200-208. [PMID: 37482623 PMCID: PMC10798785 DOI: 10.1097/cm9.0000000000002747] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Atopic dermatitis (AD) affects approximately 10% of adults worldwide. CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling. This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD. METHODS This multicenter, randomized, double-blind, placebo-controlled, phase 2b trial was conducted in 21 medical institutions in China from February to November 2021. Totally 120 eligible patients were enrolled and randomized (1:1:1) to receive subcutaneous injections of 300 mg CM310, 150 mg CM310, or placebo every 2 weeks for 16 weeks, followed by an 8-week follow-up period. The primary endpoint was the proportion of patients achieving ≥75% improvement in the Eczema Area and Severity Index (EASI-75) score from baseline at week 16. Safety and pharmacodynamics were also studied. RESULTS At week 16, the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups (70% [28/40] for high-dose and 65% [26/40] for low-dose) than that in the placebo group (20%[8/40]). The differences in EASI-75 response rate were 50% (high vs . placebo, 95% CI 31%-69%) and 45% (low vs . placebo, 95% CI 26%-64%), with both P values <0.0001. CM310 at both doses also significantly improved the EASI score, Investigator's Global Assessment score, daily peak pruritus Numerical Rating Scale, AD-affected body surface area, and Dermatology Life Quality Index compared with placebo. CM310 treatment reduced levels of thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase, and blood eosinophils. The incidence of treatment-emergent adverse events (TEAEs) was similar among all three groups, with the most common TEAEs reported being upper respiratory tract infection, atopic dermatitis, hyperlipidemia, and hyperuricemia. No severe adverse events were deemed to be attributed to CM310. CONCLUSION CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.
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Affiliation(s)
- Yan Zhao
- Department of Dermatology, Peking University People's Hospital, Beijing 100044, China
| | - Jianzhong Zhang
- Department of Dermatology, Peking University People's Hospital, Beijing 100044, China
| | - Bin Yang
- Department of Dermatology, Dermatology Hospital, Southern Medical University, Guangzhou, Guangdong 510091, China
| | - Jingyi Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis, Tongji University School of Medicine, Shanghai 200443, China
| | - Liming Wu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China
| | - Litao Zhang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China
| | - Jinyan Wang
- Department of Dermatology, Ningbo No.2 Hospital, Ningbo, Zhejiang 315010, China
| | - Xiaohong Zhu
- Department of Dermatology, The Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Veneorology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250022, China
| | - Xiaohua Tao
- Center for Plastic & Reconstructive Surgery, Department of Dermatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China
| | - Yumei Li
- Department of Dermatology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212001, China
| | - Chunlei Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing 100191, China
| | - Linfeng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jianyun Lu
- Department of Dermatology, The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, China
| | - Qingchun Diao
- Department of Dermatology, Chongqing Traditional Chinese Medicine Hospital, Chongqing 400011, China
| | - Qianjin Lu
- Hunan Key Laboratory of Medical Epigenomics, Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Xiaoyong Man
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Fuqiu Li
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Xiujuan Xia
- Department of Dermatology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong 264000, China
| | - Hao Cheng
- Department of Dermatology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Yingmin Jia
- Clinical Department, Keymed Biosciences (Chengdu) Limited, Chengdu, Sichuan 610219, China
| | - Guoqing Zhao
- Clinical Department, Keymed Biosciences (Chengdu) Limited, Chengdu, Sichuan 610219, China
| | - Jinchun Yan
- Clinical Department, Keymed Biosciences (Chengdu) Limited, Chengdu, Sichuan 610219, China
| | - Bo Chen
- Clinical Department, Keymed Biosciences (Chengdu) Limited, Chengdu, Sichuan 610219, China
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21
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Chong AC, Schwartz A, Lang J, Ong PY, Myles IA, Silverberg JI, Capozza K. Patients' and Caregivers' Preferences for Mental Health Care and Support in Atopic Dermatitis. Dermatitis 2024; 35:S70-S76. [PMID: 37579072 DOI: 10.1089/derm.2023.0111] [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: 08/16/2023]
Abstract
Background: Atopic dermatitis (AD) has large mental health impacts for patients and caregivers, yet their preferences regarding how to relieve these impacts are poorly understood. Objective: To understand patients' and caregivers' preferences for AD-related mental health care and support. Methods: We surveyed 279 adult AD patients and 154 caregivers of children with AD across 26 countries regarding their AD-related mental health burden, preferred strategies for improving AD-related mental health, and experiences with mental health care in AD. Results: Caregivers reported significantly worse overall mental health (P = 0.01) and anxiety (P = 0.03) than adult patients when controlling for AD severity. Among adult patients, 58% selected treating the AD, 51% managing itch, 44% wearing clothing to cover up skin, 43% avoiding social situations, and 41% spending time alone, as strategies they felt would improve their own AD-related mental health. Caregivers selected managing itch and treating the AD most frequently for both their own (76% and 75%, respectively) and their children's (75% and 61%) mental health. Adult patients were less satisfied with mental health care from mental health providers versus nonmental health providers (P < 0.001). Conclusions: Effective AD management is the preferred method for improving mental health among patients as well as caregivers, who may experience the greatest mental health impacts. Self-care strategies should be considered in a shared decision-making approach.
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Affiliation(s)
- Albert C Chong
- From the Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alan Schwartz
- Department of Medical Education and Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jessica Lang
- Global Parents for Eczema Research, Santa Barbara, California, USA
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Ian A Myles
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan I Silverberg
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California, USA
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22
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Kang KM, Han JH, Kim KS, Kim EK, Shin Y, Park JH, Kim H, Kim NY, Kim YG, Kim H, Park H, Kim YM, Kee SJ, Kim SJ, Kim HS, Kim YC. Chlorophyll a and novel synthetic derivatives alleviate atopic dermatitis by suppressing Th2 cell differentiation via IL-4 receptor modulation. Clin Immunol 2024; 258:109852. [PMID: 38029848 DOI: 10.1016/j.clim.2023.109852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/14/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Atopic dermatitis (AD) treatment has largely relied on non-specific broad immunosuppressants despite their long-term toxicities until the approval of dupilumab, which blocks IL-4 signaling to target Th2 cell responses. Here, we report the discovery of compound 4aa, a novel compound derived from the structure of chlorophyll a, and the efficacy of chlorophyll a to alleviate AD symptoms by oral administration in human AD patients. 4aa downregulated GATA3 and IL-4 in differentiating Th2 cells by potently blocking IL-4 receptor dimerization. In the murine model, oral administration of 4aa reduced the clinical severity of symptoms and scratching behavior by 76% and 72%, respectively. Notably, the elevated serum levels of Th2 cytokines reduced to levels similar to those in the normal group after oral administration of 4aa. Additionally, the toxicological studies showed favorable safety profiles and good tolerance. In conclusion, 4aa may be applied for novel therapeutic developments for patients with AD.
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Affiliation(s)
- Koon Mook Kang
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Jung-Hyun Han
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Kyeong Seok Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea
| | - Eun Kyung Kim
- Department of Pharmacy, College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si, Gyeonggi-do 15588, Republic of Korea
| | - Youna Shin
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Jae Hyeon Park
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea
| | - Hyeon Kim
- R&D Center, Huons co. Ltd., 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si, Gyeonggi-do 15588, Republic of Korea
| | - Na Yoon Kim
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31116, Republic of Korea
| | - Yoon Gyoon Kim
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31116, Republic of Korea
| | - Hyunjun Kim
- R&D Center, Huons co. Ltd., 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si, Gyeonggi-do 15588, Republic of Korea
| | - Hyunjin Park
- R&D Center, Huons co. Ltd., 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si, Gyeonggi-do 15588, Republic of Korea
| | - Young-Mi Kim
- Department of Pharmacy, College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan-si, Gyeonggi-do 15588, Republic of Korea
| | - Seung-Jung Kee
- Department of Laboratory Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - Seong-Jin Kim
- Department of Dermatology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea.
| | - Hyung Sik Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do 16419, Republic of Korea.
| | - Yong-Chul Kim
- School of Life Sciences, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju 61005, Republic of Korea.
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23
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Narla S, Silverberg JI. Which Clinical Measurement Tools for Atopic Dermatitis Severity Make the Most Sense in Clinical Practice? Dermatitis 2024; 35:S13-S23. [PMID: 37040270 DOI: 10.1089/derm.2022.0087] [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: 04/12/2023]
Abstract
Assessment of atopic dermatitis (AD) severity is essential for therapeutic decision making and monitoring treatment progress. However, there are a myriad of clinical measurement tools available, some of which are impractical for routine clinical use despite being recommended for clinical trials in AD. For measurement tools to be used in clinical practice, they should be valid, reliable, rapidly completed, and scored, and easily incorporated into existing clinic workflows. This narrative review addresses content, validity, and feasibility, and provides a simplified repertoire of assessments for clinical assessment of AD based on prior evidence and expert opinion. Tools that may be feasible for clinical practice include patient-reported outcomes (eg, dermatology life quality index, patient-oriented eczema measure, numerical rating scales for itch, pain, and sleep disturbance, AD Control Tool, and patient-reported global assessment), and clinician-reported outcomes (eg, body surface area and investigator's global assessment). AD is associated with variable clinical signs, symptoms, extent of lesions, longitudinal course, comorbidities, and impacts. Any single domain is insufficient to holistically characterize AD severity, select therapy, or monitor treatment response. A combination of these tools is recommended to balance completeness and feasibility.
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Affiliation(s)
- Shanthi Narla
- From the Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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24
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Cameron S, Donnelly A, Broderick C, Arichi T, Bartsch U, Dazzan P, Elberling J, Godfrey E, Gringras P, Heathcote LC, Joseph D, Wood TC, Pariante C, Rubia K, Flohr C. Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis. Allergy 2024; 79:26-36. [PMID: 37469218 DOI: 10.1111/all.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/06/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD therefore often has a significant impact on the quality of life of both patients and their families. In this review we discuss recent findings on the putative links between AD, its association with itch, sleep disturbance and neuropsychiatric morbidity, including the role of inflammation in these conditions. Itch was thought to predominantly drive sleep disruption in AD. We now understand changes in sleep influence immune cell distribution and the associated inflammatory cytokines, which suggests a bidirectional relationship between AD and sleep. We also increasingly recognize inflammation as a key driver in psychological symptoms and disorders. The link between cutaneous, systemic and possible brain inflammation could at least in part be driven by the sleep deprivation and itch-driven neuronal proliferation seen in AD.
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Affiliation(s)
- Shona Cameron
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ali Donnelly
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Conor Broderick
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ullrich Bartsch
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jesper Elberling
- Depart of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Emma Godfrey
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Gringras
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Desaline Joseph
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carmine Pariante
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Katya Rubia
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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25
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Jang SY, Seo SR, Kim K, Choi HO, Lee CK. Association Between Atopic Dermatitis and Suicidal Behaviors in North Korean Adolescent Defectors From 2011 to 2019. Psychiatry Investig 2024; 21:52-62. [PMID: 38198830 PMCID: PMC10822740 DOI: 10.30773/pi.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/12/2023] [Accepted: 09/17/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To evaluate the association between atopic dermatitis (AD) and suicidal behaviors in adolescent defectors among residents who escaped from North Korean (adolescent defectors, n=423) and adolescents with South Korean parents (Korean adolescents, n=540,265). METHODS The study used data from the Korea Youth Risk Behavior Survey conducted from 2011 to 2019. Differences in general characteristics, health behaviors, suicidal ideation, suicide plans, suicide attempts, and AD between adolescent defectors and Korean adolescents were examined. Multiple logistic regression analysis was used to determine the association between AD and suicidal behaviors. RESULTS The adolescent defectors group had lower AD (16.3% vs. 24.2%), poorer subjective health (10% vs. 6%), smoked more (47% vs. 18%), drank more (60% vs. 43%), lived with family less frequently (56% vs. 96%), and were more than twice as likely to have depression (42% vs. 27%), suicidal ideation (30% vs. 14%), a suicide plan (23% vs. 5%), or have made a prior suicide attempt (19% vs. 3%) compared with the Korean adolescent group (p<0.001). The adjusted odds ratio for the adolescent defectors group compared to the Korean adolescent group was 1.66 for suicidal ideation, 3.59 for suicide plans, and 4.34 for suicide attempts (p<0.001). AD was found to be associated with suicide plans and attempts in adolescent defectors and associated with suicidal ideation in Korean adolescents. CONCLUSION AD was significantly associated with suicide plans and suicidal attempts among adolescent defectors and suicidal ideation in Korean adolescents, based on a random sample of middle- and high-school students.
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Affiliation(s)
- Shin Yi Jang
- Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Su Ra Seo
- The National Health Insurance Service, Wonju, Republic of Korea
| | - Kyeongsug Kim
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Nursing, Samsung Medical Center, Seoul, Republic of Korea
| | - Hye Ok Choi
- Department of Nursing, Samsung Medical Center, Seoul, Republic of Korea
| | - Chang-Kwan Lee
- Department of Nursing, Gangseo University, Seoul, Republic of Korea
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26
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Renert-Yuval Y, Del Duca E, Arents B, Bissonnette R, Drucker AM, Flohr C, Guttman-Yassky E, Hijnen D, Kabashima K, Leshem YA, Paller AS, Silverberg JI, Simpson EL, Spuls P, Vestergaard C, Wollenberg A, Irvine AD, Thyssen JP. Treat-to-target in dermatology: A scoping review and International Eczema Council survey on the approach in atopic dermatitis. J Eur Acad Dermatol Venereol 2024; 38:42-51. [PMID: 37700595 DOI: 10.1111/jdv.19506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023]
Abstract
Treat-to-target (T2T) is a pragmatic therapeutic strategy being gradually introduced into dermatology after adoption in several other clinical areas. Atopic dermatitis (AD), one of the most common inflammatory skin diseases, may also benefit from this structured and practical therapeutic approach. We aimed to evaluate existing data regarding the T2T approach in dermatology, with a specific focus on AD, as well as the views of International Eczema Council (IEC) members on the potential application of a T2T approach to AD management. To do so, we systematically searched for peer-reviewed publications on the T2T approach for any skin disease in the PubMed and Scopus databases up to February 2022 and conducted a survey among IEC members regarding various components to potentially include in a T2T approach in AD. We identified 21 relevant T2T-related reports in dermatology, of which 14 were related to psoriasis, five to AD, one for juvenile dermatomyositis and one for urticaria. In the IEC member survey, respondents proposed treatable traits (with itch, disease severity and sleep problems getting the highest scores), relevant comorbidities (with asthma being selected most commonly, followed by anxiety and depression in adults), recommended specialists that should define the approach in AD (dermatologists, allergists and primary care physicians were most commonly selected in adults), and applicable assessment tools (both physician- and patient-reported), in both adult and paediatric patients, for potential future utilization of the T2T approach in AD. In conclusion, while the T2T approach may become a useful tool to simplify therapeutic goals and AD management, its foundation in AD is only starting to build. A multidisciplinary approach, including a wide range of stakeholders, including patients, is needed to further define the essential components needed to utilize T2T in AD.
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Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ester Del Duca
- Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | - Bernd Arents
- Dutch Association for People with Atopic Eczema, Nijkerk, The Netherlands
| | | | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto and Women's College Hospital, Toronto, Ontario, Canada
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Emma Guttman-Yassky
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dirkjan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yael A Leshem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Dermatology, Rabin Medical Center, Petach Tikva, Israel
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Phyllis Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
- Department of Dermatology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
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Chiricozzi A, Costanzo A, Levi A, Parretta F, Ravasio R. Costo per NNT di upadacitinib nel trattamento dei pazienti con dermatite atopica da moderata a severa in Italia. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:38-50. [PMID: 38380163 PMCID: PMC10877702 DOI: 10.33393/grhta.2024.2728] [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: 11/17/2023] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
Background: Targeted systemic therapies, including abrocitinib, baricitinib, dupilumab, tralokinumab and upadacitinib, are new treatments for moderate to severe atopic dermatitis (AD). We evaluated the efficacy and the costs of these targeted systemic therapies in the treatment of adult patients with moderate to severe AD. Methods: The clinical efficacy was assessed considering the results of a previous network meta-analysis (NMA). The analysis involved five therapies approved in Italy for the treatment of moderate to severe AD: abrocitinib (ABR), baricitinib (BAR), dupilumab (DUP), tralokinumab (TRA) and upadacitinib (UPA). According to the NMA, the cost of the treatment was based on the number of administrations dispensed at 16 weeks and the clinical efficacy was measured by the number needed to treat (NNT) compared to placebo using the improvement ≥ 75% (EASI-75) or ≥ 90 (EASI-90) from baseline of the eczema area and severity index (EASI). Only the ex-factory price of the targeted systemic therapies was considered. The cost per NNT was adopted as a cost-effectiveness indicator. Results: At 16 weeks, the cost per NNT based on EASI-75 was lower for UPA 15 mg (€ 6,384.00) compared to BAR 4 mg (€ 11,619.73) and 2 mg (€ 14,524.66), ABR 100 mg (€ 16,265.22), DUP 300 mg (€ 16,115.04) and TRA 300 mg (€ 31,710.24). UPA 15 (€ 8,512.00) also showed the lower cost per NNT based on EASI-90 at 16 weeks compared to BAR 4 mg (€ 14,788.75) and 2 mg (€ 20,862.70), ABR 100 mg (€ 25,922.69), DUP 300 mg (€ 25,992.00) and TRA 300 mg (€ 41,067.36). Conclusions: The findings show that upadacitinib is the most cost-effective option (cost per NNT) for the treatment of moderate to severe atopic dermatitis.
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Affiliation(s)
- Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma - Italy
| | - Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Dermatology Unit, Humanitas Research Hospital, Rozzano, Milano - Italy
| | | | | | - Roberto Ravasio
- HEOR and RWE Lead, PharmaLex Italy S.p.A. formerly MA Provider, Milano - Italy
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Braun C, Bourrel-Bouttaz M, Revol O, Verdu V, Montagnon A, Bérard F, Nosbaum A. Atopic Dermatitis and Self-Image Design: A Real-Life Study in Children Using Drawings. Dermatitis 2024; 35:S98-S102. [PMID: 36724458 DOI: 10.1089/derm.2022.0056] [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: 02/03/2023]
Abstract
Background: Atopic dermatitis (AD) induces alterations of external appearance and self-esteem, with impact on the personal development of the children. However, tools for estimating such suffering are lacking. We aimed to assess how children with AD represent themselves through their drawings. Methods: In this retrospective study, we included children (<18 years) suffering from AD who followed the instruction "draw yourself with and without eczema" at the end of a routine follow-up consultation. Drawings were interpreted with the child and then classified in different analysis groups by 5 independent evaluators. Results: A total of 64 children (41 [64.1%] girls and 23 [35.9%] boys, median [range] age 8 [3-7] years) made 64 drawings. Five groups of drawing were identified: "amputee" (n = 8, 12.5%), "identical" (n = 18, 28.1%), "sad" (n = 19, 29.7%), "complex" (n = 11, 17.2%), and "other" (n = 8, 12.5%). Univariate analysis found that age was differently distributed among the different drawing groups (P = 0.0047), as was the predominance of light colors (P = 0.038). The distribution of the other variables (gender, investigator global assessment score, active AD, and duration of activity) was not different among drawing groups. Conclusions: The drawing allows a majority of the AD children to express their self-image with and without eczema, as well as their feelings and their interactions with the environment and with their entourage. The visual tool proposed herein could be used during consultations, to (a) become aware of the need to treat AD, (b) better evaluate the impact of AD burden in childhood, and (c) adjust appropriately AD treatment.
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Affiliation(s)
- Camille Braun
- From the Service de Pédiatrie, Pneumologie, Allergologie et Mucoviscidose, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France
| | - Magali Bourrel-Bouttaz
- Cabinet de Dermatologie, Chambéry, France
- Service D'immunologie Clinique et Allergologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Revol
- Service de Psychopathologie du Développement de L'enfant et de L'adolescent, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Virginie Verdu
- Service D'immunologie Clinique et Allergologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Anaïs Montagnon
- Service D'immunologie Clinique et Allergologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Frédéric Bérard
- Service D'immunologie Clinique et Allergologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Audrey Nosbaum
- Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France
- Service D'immunologie Clinique et Allergologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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Moraes MM, Vaz FPC, Roque RMSDA, Mallozi MDC, Solé D, Wandalsen GF. Behavioral disorders in children and adolescents with atopic dermatitis. J Pediatr (Rio J) 2024; 100:93-99. [PMID: 37783388 PMCID: PMC10751689 DOI: 10.1016/j.jped.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVES To assess the prevalence and pattern of behavioral problems in children and adolescents with atopic dermatitis (AD) and to study their associations with clinical data and severity. METHODS This was a single-center, cross-sectional study of patients (6-17 years) with AD. Assessment of competencies and syndrome scale scores of behavioral problems was performed by applying the Child Behavior Checklist 6-18 (CBCL 6-18) and AD severity using the Eczema Area Severity Index (EASI) score. RESULTS Of the 100 patients with AD, 56% were male, with a mean age of 11±3 years, and 43% had moderate/severe AD. Borderline or abnormal values were found in 75% of the patients for total social competence, 57% for internalization, 27% for externalization, and 18% for aggressive behavior. A higher prevalence of aggressive behavior (27.9% vs. 10.5%; p = 0.02) and sleep disorders (32.6% vs. 15.8%; p = 0.04) was observed in patients with moderate/severe AD than in those with mild AD. Children with current or previous use of immunosuppressants/immunobiological tests had a lower frequency of normal social competence (53% vs. 83%, p = 0.012). Regarding the critical questions, 8% responded affirmatively to suicidal ideation. CONCLUSION A high prevalence of behavioral problems was observed among children and adolescents with AD, with a predominance of internalizing profiles, mainly anxiety and depression. Children with moderate/severe AD have a higher prevalence of aggressive behaviors and sleep disorders. These findings highlight the importance of multidisciplinary teams, including mental health professionals, in caring for patients with AD.
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Affiliation(s)
- Marília Magalhães Moraes
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), Programa de Pós-Graduação em Pediatria e Ciências Aplicadas à Pediatria, São Paulo, SP, Brazil
| | - Fernanda Pires Cecchetti Vaz
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), Programa de Pós-Graduação em Pediatria e Ciências Aplicadas à Pediatria, São Paulo, SP, Brazil
| | | | - Márcia de Carvalho Mallozi
- Faculdade de Medicina do ABC (FMABC), Divisão de Pediatria, São Paulo, SP, Brazil; Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), Divisão de Pediatria, Ambulatório de Alergia e Imunologia do Departamento de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
| | - Dirceu Solé
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), Departamento de Pediatria, Divisão de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
| | - Gustavo Falbo Wandalsen
- Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), Departamento de Pediatria, Divisão de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil.
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30
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Balieva F, Abebe DS, Dalgard FJ, Lien L. Risk of developing psychiatric disease among adult patients with skin disease: A 9-year national register follow-up study in Norway. SKIN HEALTH AND DISEASE 2023; 3:e294. [PMID: 38047256 PMCID: PMC10690693 DOI: 10.1002/ski2.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 12/05/2023]
Abstract
Background The existing association between skin disease and psychiatric comorbidity has gained attention during the last decades. Stress and mental illness can directly or indirectly affect skin disease, while dermatological conditions, known to impair life quality and mental well-being, can promote psychiatric conditions. Objectives The aim of this study was to assess the risk of developing psychiatric disease among adult dermatological patients over a period of time. The secondary objective was to see which psychiatric disorders developed most commonly, and which skin diseases posed the greatest risk for later mental health issues. Methods Adult dermatological patients were followed for 9 years (2008-2016) using the Norwegian Patient Registry, for both outpatient and inpatient specialist healthcare services. Dermatological patients were identified during the first 2 years and were then followed for psychiatric comorbidity prospectively for the next 7 years.Cox regression models were applied to estimate the risks of psychiatric disorders among patients with skin diseases. Estimates were adjusted for age and gender differences. Hazard risk ratios (HR) with 95% CI are reported. Results Dermatological patients developed depressive disorders most frequently (4.1% vs. 2.3% in non-dermatological participants), followed by anxiety disorders (3.3% vs. 1.8%), and adjustment disorders (2.6% vs. 1.5%). Developing depressive disorders showed the highest HR among dermatological patients, HR (95% CI) = 2.5 (2.4-2.5), followed by disorders related to alcohol use, HR (95% CI) = 2.2 (2.1-2.5), and anxiety disorders, HR (95% CI) = 2.1 (2.1-2.2). Papulosquamous disorders were the skin conditions with the highest HR for developing a mental health condition, with depressive disorder having HR (95% CI) = 2.6 (2.5-2.9); anxiety disorders at HR (95% CI) = 2.9 (2.7-3.1); and disorders related to alcohol use at HR (95% CI) = 3.2 (2.8-3.6). Conclusions The study demonstrates that having a skin disease doubles to triples the risk of developing a psychiatric illness within 7 years, especially depression, anxiety, and alcohol use compared with the general population.
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Affiliation(s)
- Flora Balieva
- Department of DermatologyStavanger University HospitalStavangerNorway
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Dawit Shawel Abebe
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersInnlandet Hospital TrustBrumunddalNorway
- Department of Nursing and Health PromotionOslo Metropolitan UniversityOsloNorway
| | - Florence J. Dalgard
- Division of Mental Health and AddictionVestfold Hospital TrustTønsbergNorway
- Department of Dermatology and VenereologySkåne University HospitalUniversity of LundMalmöSweden
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health DisordersInnlandet Hospital TrustBrumunddalNorway
- Faculty of Social and Health SciencesInland Norway University of Applied SciencesElverumNorway
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31
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Ma WR, Zhang LL, Ma JY, Yu F, Hou YQ, Feng XR, Yang L. Mendelian randomization studies of depression: evidence, opportunities, and challenges. Ann Gen Psychiatry 2023; 22:47. [PMID: 37996851 PMCID: PMC10666459 DOI: 10.1186/s12991-023-00479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) poses a significant social and economic burden worldwide. Identifying exposures, risk factors, and biological mechanisms that are causally connected to MDD can help build a scientific basis for disease prevention and development of novel therapeutic approaches. METHODS In this systematic review, we assessed the evidence for causal relationships between putative causal risk factors and MDD from Mendelian randomization (MR) studies, following PRISMA. We assessed methodological quality based on key elements of the MR design: use of a full instrumental variable analysis and validation of the three key MR assumptions. RESULTS We included methodological details and results from 52 articles. A causal link between lifestyle, metabolic, inflammatory biomarkers, particular pathological states and MDD is supported by MR investigations, although results for each category varied substantially. CONCLUSIONS While this review shows how MR can offer useful information for examining prospective treatment targets and better understanding the pathophysiology of MDD, some methodological flaws in the existing literature limit reliability of results and probably underlie their heterogeneity. We highlight perspectives and recommendations for future works on MR in psychiatry.
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Affiliation(s)
- Wang-Ran Ma
- Xian Hospital of Traditional Chinese Medicine, Xi'an, 710021, China
- Shanxi University of Traditional Chinese Medicine, Xianyang, 712046, China
| | - Lei-Lei Zhang
- Xian Hospital of Traditional Chinese Medicine, Xi'an, 710021, China
| | - Jing-Ying Ma
- Shanxi University of Traditional Chinese Medicine, Xianyang, 712046, China
| | - Fang Yu
- Shanxi University of Traditional Chinese Medicine, Xianyang, 712046, China
| | - Ya-Qing Hou
- Shanxi University of Traditional Chinese Medicine, Xianyang, 712046, China
| | - Xiang-Rui Feng
- Shanxi University of Traditional Chinese Medicine, Xianyang, 712046, China
| | - Lin Yang
- Xian Hospital of Traditional Chinese Medicine, Xi'an, 710021, China.
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Pereyra-Rodriguez JJ, Baldrich ES, Ruiz-Villaverde R, Torres EB, De la C Dobao P, Nart IF, Menéndez ÁF, Martin-Santiago A, Miquel JM, Silvestre JF, Armario-Hita JC. Clinical Approach to Patients with Moderate-to-Severe Atopic Dermatitis: A Spanish Delphi Consensus. Acta Derm Venereol 2023; 103:adv12314. [PMID: 37982727 PMCID: PMC10680463 DOI: 10.2340/actadv.v103.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/12/2023] [Indexed: 11/21/2023] Open
Abstract
Despite emerging evidence and advances in the management of atopic dermatitis there a lack of consensus regarding the diagnostic criteria, therapeutic approach, method to assess severity, and patient follow-up for this condition. An expert consensus study was conducted to provide recommendations on the management of patients with moderate-to-severe atopic dermatitis. The study used Delphi-like methodology based on a literature review, a summary of the scientific evidence, and a 2-round survey. The agreement of 60 panellists on 21 statements was evaluated. Consensus was pre-defined as ≥ 80% agreement of all respondents. In the first round 6 statements reached consensus. Unanimous consensus was achieved regarding therapeutic goals and patient satisfaction (maintained in the long term and periodic goals reassessment recommended every 3-6 months). In the second round, half of the statements reached consensus, all related to patient follow-up, treatment goals, and atopic comorbidities. The statements that did not reach consensus were related to diagnosis (biomarkers, allergy, and food testing) and starting patients on conventional systemic treatment rather than advanced treatment. The study assessed expert opinion regarding a variety of topics related to the clinical approach to patients with moderate-to-severe atopic dermatitis, in order to provide guidance on the diagnosis and management of patients with atopic dermatitis.
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Affiliation(s)
| | - Esther S Baldrich
- Department of Dermatology, Santa Creu i Sant Pau Hospital, Barcelona, Spain.
| | | | - Eulalia B Torres
- Department of Dermatology, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Pablo De la C Dobao
- Department of Dermatology, Infanta Leonor University Hospital, Madrid, Spain
| | - Ignasi F Nart
- Department of Dermatology, Bellvitge University Hospital, Barcelona, Spain
| | - Ángeles F Menéndez
- Department of Dermatology, Pontevedra University Hospital, Pontevedra, Spain
| | - Ana Martin-Santiago
- Department of Dermatology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Javier M Miquel
- Department of Dermatology, Arnau de Vilanova Hospital, Valencia, Spain
| | - Juan F Silvestre
- Department of Dermatology, Alicante University General Hospital, Alicante, Spain
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Hagino T, Hamada R, Yoshida M, Fujimoto E, Saeki H, Kanda N. Effectiveness and Safety of Upadacitinib in Combination with Topical Corticosteroids in Adolescent Patients with Moderate-to-Severe Atopic Dermatitis. Clin Cosmet Investig Dermatol 2023; 16:3201-3212. [PMID: 37953857 PMCID: PMC10638939 DOI: 10.2147/ccid.s439053] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023]
Abstract
Purpose To investigate the therapeutic effectiveness and safety of Janus kinase 1 inhibitor upadacitinib in adolescent patients with atopic dermatitis (AD). Patients and Methods This study examined therapeutic effectiveness and safety of upadacitinib for 39 Japanese adolescent patients (aged 12-17 years) diagnosed with moderate-to-severe AD from August 2021 to January 2023. The patients were treated with upadacitinib 15 mg/day plus twice daily topical corticosteroids. Total eczema area and severity index (EASI) or EASI on head and neck, upper limbs, lower limbs, and trunk or for erythema, edema/papulation, excoriation, or lichenification, atopic dermatitis control tool (ADCT), peak pruritus-numerical rating scale (PP-NRS), and laboratory indexes were assessed at weeks 0, 4, and 12 of treatment. Treatment-emergent adverse events were recorded. Results Total EASI or EASI on 4 anatomical sites or for 4 rash types, ADCT, and PP-NRS were significantly reduced at week 4 and 12 compared to week 0. The achievement rates at weeks 4 or 12 were 64.1% or 62.5% for EASI 75, 93.5% or 73.1% for ADCT <7-point, and 80.6% or 60% for PP-NRS ≥4-point improvement, respectively, indicating their peak at week 4 and slight decrease at week 12. The percent reduction of EASI for excoriation was higher than that for lichenification or edema/papulation at week 4 or week 12, respectively. The percent reductions of EASI for erythema and edema/papulation on head and neck were lower than those on lower limbs at week 12. Total eosinophil counts (TEC) and IgE reduced at week 4 compared to week 0 while TARC, IgE, TEC, and LDH increased at week 12 compared to week 4. Conclusion These results suggest therapeutic effectiveness and tolerability of upadacitinib and support its therapeutic usefulness for adolescent AD patients.
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Affiliation(s)
- Teppei Hagino
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Risa Hamada
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Mai Yoshida
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | | | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Naoko Kanda
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
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Abstract
Abrocitinib is an oral small molecule which selectively inhibits JAK1, modulating multiple cytokine pathways involved in atopic dermatitis. Both abrocitinib 200 mg and 100 mg reached efficacy results comparable to dupilumab and superior to placebo. Abrocitinib 200 mg was superior to dupilumab in some trials, consistently providing a faster response and itch relief from week 2 to 26. Continuous abrocitinib 200 mg is the most effective at controlling this disease, but with an induction-maintenance approach with abrocitinib 200 mg followed by 100 mg, over 55% of patients did not flare for 40 weeks. Abrocitinib common adverse effects are nonserious. A self-limited dose-related decrease in platelet counts was consistently observed, without clinical repercussion. Abrocitinib demonstrated high efficacy and a favorable safety profile.
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Affiliation(s)
- Ana Maria Lé
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, 4000-001, Portugal
| | - Melinda Gooderham
- SkiN Centre for Dermatology, Queen's University and Probity Medical Research, Peterborough, ON, K9J 5K2, Canada
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, 4000-001, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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35
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Ofenloch RF. Filling the gap: investigating the interpretability of the Recap of atopic eczema questionnaire. Br J Dermatol 2023; 189:506-507. [PMID: 37643894 DOI: 10.1093/bjd/ljad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/28/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Robert F Ofenloch
- Section of Occupational Dermatology, Department of Dermatology, University Hospital, Ruprecht-Karl University of Heidelberg, Germany
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Birkner T, Siegels D, Heinrich L, Haufe E, Abraham S, Heratizadeh A, Harder I, Bell M, Fell I, Worm M, Handrick C, Effendy I, Asmussen A, Kleinheinz A, Homey B, Sticherling M, Hong-Weldemann SH, Augustin M, Weisshaar E, Schäkel K, Schaefer T, Schwarz B, Wiemers F, Brücher JJ, Quist S, Wollenberg A, Biedermann T, Ertner K, von Kiedrowski R, Werfel T, Weidinger S, Schmitt J. Itch, sleep loss, depressive symptoms, fatigue, and productivity loss in patients with moderate-to-severe atopic dermatitis: Analyses of TREATgermany registry data. J Dtsch Dermatol Ges 2023; 21:1157-1168. [PMID: 37485573 DOI: 10.1111/ddg.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/28/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND TREATgermany is a multicenter registry including patients with moderate-to-severe atopic dermatitis (AD) from currently 74 study centers (university clinics, hospitals and practices) in Germany. As of August 31, 2021, 1,230 adult patients were enrolled. METHODS In TREATgermany, patients and physicians fill in questionnaires pertaining to symptoms, disease severity, quality of life, depressiveness, and fatigue. In particular, limitations in work performance are assessed using the Work Limitations Questionnaire (WLQ). To assess associations between occupational performance/work limitations and symptoms, correlations and regression models were calculated. RESULTS The examined sample of 228 employed patients reported an average of 6% at-work productivity loss within the past two weeks prior to enrolment in the registry. The WLQ productivity loss score was moderately associated with itch (r = 0.32) and sleep loss (r = 0.39) and strongly associated with depressive symptoms (r = 0.68) and fatigue (r = 0.60). CONCLUSIONS The analyses of the registry data show that moderate-to-severe atopic dermatitis has a negative impact on the work productivity of the patients. The analyses further point out the relevant associations between work productivity, depressive symptoms, and fatigue highlighting the disease burden caused by the psychological components of AD.
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Affiliation(s)
- Thomas Birkner
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Doreen Siegels
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Luise Heinrich
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Eva Haufe
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susanne Abraham
- Department of Dermatology, University Allergy Center, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Annice Heratizadeh
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Inken Harder
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Magnus Bell
- Practice Dr. med. Magnus Bell, Andernach, Germany
| | - Isabell Fell
- Hautmedizin Bad Soden Studienzentrum, Bad Soden, Germany
| | - Margitta Worm
- Department of Dermatology, Allergy and Venereology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Isaak Effendy
- Department of Dermatology, OWL University Hospital of Bielefeld University, Campus Clinic Bielefeld, Bielefeld, Germany
| | - Andrea Asmussen
- Practice Dr. med. Andrea Asmussen, Dermatology at Lesum, Bremen, Germany
| | | | - Bernhard Homey
- Department of Dermatology and Allergology, University Hospital Duesseldorf, Düsseldorf, Germany
| | - Michael Sticherling
- Department of Dermatology, University, German Center for Immunotherapy, Erlangen, Germany
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University, Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, University Hospital, Heidelberg, Germany
| | - Thomas Schaefer
- Practice Dr. med. Thomas Schaefer/ Dr. med. Doreen Belz, Derma Koeln, Köln, Germany
| | | | | | - Jens-Joachim Brücher
- Practice Dr. med. Jens-Joachim Brücher, Hautambulatorium Magdeburg, Magdeburg, Germany
| | - Sven Quist
- Dermatology Clinic, Helix Medical Excellence Center Mainz, Mainz, Germany
| | - Andreas Wollenberg
- Clinics and Outpatient Clinics for Dermatology and Allergy, LMU Munich, München, Germany and Vrije Universiteit Brussel, Universitair Ziekenhuis, Department of Dermatology, Brussels, Belgium
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, München, Germany
| | | | - Ralph von Kiedrowski
- Focus Practice for chronic inflammatory dermatoses, skin cancer and allergology and also Study Center CMS3 (Company for Medical Study and Service), Selters/Westerwald, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Stephan Weidinger
- Center for Inflammatory Skin Diseases, Department of Dermatology and Allergy, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jochen Schmitt
- Center of Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Wang J, Wu H, Cong W, Zhu H, Zheng J, Li X, Pan M. Psychological morbidity in patients with pemphigus and its clinicodemographic risk factor: A comparative study. J Dermatol 2023; 50:1237-1245. [PMID: 37381772 DOI: 10.1111/1346-8138.16875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
Due to the long disease duration, impact on appearance, social stigmatization, and numerous side effects of treatment, pemphigus, an autoimmune bullous disease, often has a significant psychological impact on patients. On the other hand, mood disorders may exacerbate the disease by affecting the patient's self-management, forming a vicious circle. To investigate anxiety and depressive disorders in patients with pemphigus, a total of 140 patients with pemphigus were recruited for this cross-sectional retrospective study between March 2020 and January 2022. A control group of 118 patients with psoriasis, a commonly known psychosomatic dermatosis, was established. Patients were evaluated at the visiting day with the Beck Anxiety Inventory and Beck Depression Inventory second edition for mood disorders, the Dermatology Life Quality Index and the EuroQol Five Dimensions Questionnaire for disease-related life quality, and the Visual Analogue Scale for pain and itching symptoms. In our cohort, 30.7% of patients with pemphigus suffered from either anxiety disorder (25%) or depressive disorders (14.3%). Propensity score matching was implemented to create a comparable cohort of pemphigus and psoriasis groups considering the baseline discrepancy. Thirty-four comparable pairs of pemphigus and psoriasis patients were extracted. The prevalence and severity of depressive disorder in pemphigus patients were significantly higher than in psoriasis patients, while anxiety disorder levels appeared to be similar in two groups. Multivariate logistic regression analysis further revealed that disease-related hospitalization history, active mucosal damage, and concomitant thyroid disease are independent risk factors for mood disorders in pemphigus patients. Our results showed that pemphigus patients had a high prevalence and severity of mood disorders. Relevant clinicodemographic indicators may be valuable for prediction and early identification of mood disorders in pemphigus. Better disease education from physicians may be important for these patients to achieve overall disease management.
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Affiliation(s)
- Jingying Wang
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haixi Wu
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiting Cong
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiqin Zhu
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zheng
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Li
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Birkner T, Siegels D, Heinrich L, Haufe E, Abraham S, Heratizadeh A, Harder I, Bell M, Fell I, Worm M, Handrick C, Effendy I, Asmussen A, Kleinheinz A, Homey B, Sticherling M, Hong-Weldemann SH, Augustin M, Weisshaar E, Schäkel K, Schaefer T, Schwarz B, Wiemers F, Brücher JJ, Quist S, Wollenberg A, Biedermann T, Ertner K, von Kiedrowski R, Werfel T, Weidinger S, Schmitt J. Juckreiz, Schlafstörungen, depressive Symptome, Fatigue und Einschränkungen der Arbeitsproduktivität bei Patienten mit moderater bis schwerer atopischer Dermatitis: Daten aus dem TREATgermany-Register. J Dtsch Dermatol Ges 2023; 21:1157-1169. [PMID: 37845075 DOI: 10.1111/ddg.15159_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/28/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungHintergrundTREATgermany ist ein multizentrisches Register, das Patienten mit moderater bis schwerer atopischer Dermatitis (AD) aus derzeit 74 Studienzentren (Universitätskliniken, Krankenhäuser und Praxen) in Deutschland umfasst. Bis zum 31. August 2021 wurden 1.230 erwachsene Patienten eingeschlossen.MethodenIn TREATgermany füllen Patienten und Ärzte Fragebögen zu Symptomen, Krankheitsschwere, Lebensqualität, Depressivität und Fatigue aus. Die Einschränkungen der Arbeitsleistung werden insbesondere mit dem Work Limitations Questionnaire (WLQ) erfasst. Um Assoziationen zwischen beruflicher Leistung/Arbeitseinschränkungen und Symptomen zu bestimmen, wurden Korrelationen und Regressionsmodelle berechnet.ErgebnisseDie untersuchte Stichprobe von 228 berufstätigen Patienten beschrieb einen durchschnittlichen Produktivitätsverlust von 6% bei der Arbeit innerhalb der letzten zwei Wochen vor der Aufnahme in das Register. Der WLQ‐Wert für den Produktivitätsverlust war moderat mit Juckreiz (r = 0,32) und Schlafstörungen (r = 0,39) und stark mit depressiven Symptomen (r = 0,68) und Fatigue (r = 0,60) korreliert.SchlussfolgerungenDie Analysen der Registerdaten zeigen, dass eine moderate bis schwere AD einen negativen Einfluss auf die Arbeitsproduktivität der Patienten hat. Die Analysen weisen außerdem auf die relevanten Zusammenhänge zwischen Arbeitsproduktivität, depressiven Symptomen und Fatigue hin, was die durch die psychologischen Komponenten der AD verursachte Krankheitslast verdeutlicht.
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Affiliation(s)
- Thomas Birkner
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Doreen Siegels
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Luise Heinrich
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Eva Haufe
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Susanne Abraham
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
| | - Annice Heratizadeh
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Inken Harder
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | | | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie am Campus Mitte (CCM), Charité - Universitätsmedizin Berlin
| | | | - Isaak Effendy
- Hautklinik, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld
| | - Andrea Asmussen
- Praxis Dr. med. Andrea Asmussen, Dermatologie an der Lesum, Bremen
| | - Andreas Kleinheinz
- Klinik für Dermatologie, Allergologische Ambulanz, Elbe Klinikum Buxtehude
| | - Bernhard Homey
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf
| | | | | | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Elke Weisshaar
- Berufsdermatologie, Hautklinik, Universitätsklinikum Heidelberg
| | - Knut Schäkel
- Universitäts-Hautklinik, Universitätsklinikum Heidelberg
| | - Thomas Schaefer
- Praxis Dr. med. Thomas Schaefer/ Dr. med. Doreen Belz, Derma Köln
| | - Beate Schwarz
- Praxis Dr. med. Beate Schwarz, Dermatologie und Allergologie, Langenau
| | | | | | - Sven Quist
- Dermatologische Klinik, Helix Medical Excellence Center, Mainz
| | - Andreas Wollenberg
- Klinik und Poliklinik für Dermatologie und Allergologie, LMU München und Hautklinik, Vrije Universiteit Brussel, Universitair Ziekenhuis, Brüssel, Belgien
| | - Tilo Biedermann
- Klinik für Dermatologie und Allergologie, Klinikum rechts der Isar, Technischen Universität München
| | | | - Ralph von Kiedrowski
- Spezialpraxis für chronisch-entzündliche Dermatosen, Hautkrebs und Allergologie/Berufsdermatologie und Studienzentrums CMS3 (Company for Medical Study and Service), Selters/Westerwald
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Stephan Weidinger
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden
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Bernardo D, Bieber T, Torres T. Lebrikizumab for the Treatment of Moderate-to-Severe Atopic Dermatitis. Am J Clin Dermatol 2023; 24:753-764. [PMID: 37266844 PMCID: PMC10460333 DOI: 10.1007/s40257-023-00793-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/03/2023]
Abstract
Atopic dermatitis (AD) is a common, heterogeneous, inflammatory skin disorder characterized by chronic or relapsing eczematous lesions with intense pruritus and discomfort. Affected patients often experience significant impairment in their quality of life, and the treatment of moderate-to-severe AD forms remains challenging. In the past few decades, increasing knowledge on the AD pathogenesis has driven the development of novel targeted therapies. Interleukin (IL)-13 plays a central and pleiotropic role in AD pathogenesis, contributing directly or indirectly to epidermal barrier disfunction, type-2 inflammation, dysbiosis, fibrosis, and itch response. For this reason, agents selectively targeting IL-13, such as lebrikizumab, emerged as a potential therapy for AD. This article reviews the current evidence about lebrikizumab in the management of AD. The phase II and phase III trials seem to corroborate efficacy of lebrikizumab in the treatment of moderate-to-severe AD, as shown by significant improvement of Eczema Area and Severity Index, body surface area, and pruritus scores. Also, lebrikizumab demonstrated favorable safety and tolerability profiles, with the majority of patients experiencing no significant adverse events. Lebrikizumab seems to be a promising emerging targeted biological agent for patients with moderate-to-severe AD. More data on the long-term efficacy and safety, head-to-head comparisons with other agents, and real-world evidence will help to clarify its place in therapy in AD.
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Affiliation(s)
- Diana Bernardo
- Department of Dermatology, Centro Hospitalar Universitário de Sto António, Porto, Portugal
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn Germany and Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário de Sto António, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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Zhao H, Ma X, Song J, Jiang J, Fei X, Luo Y, Ru Y, Luo Y, Gao C, Kuai L, Li B. From gut to skin: exploring the potential of natural products targeting microorganisms for atopic dermatitis treatment. Food Funct 2023; 14:7825-7852. [PMID: 37599562 DOI: 10.1039/d3fo02455e] [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: 08/22/2023]
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. Recent studies have revealed that interactions between pathogenic microorganisms, which have a tendency to parasitize the skin of AD patients, play a significant role in the progression of the disease. Furthermore, specific species of commensal bacteria in the human intestinal tract can have a profound impact on the immune system by promoting inflammation and pruritogenesis in AD, while also regulating adaptive immunity. Natural products (NPs) have emerged as promising agents for the treatment of various diseases. Consequently, there is growing interest in utilizing natural products as a novel therapeutic approach for managing AD, with a focus on modulating both skin and gut microbiota. In this review, we discuss the mechanisms and interplay between the skin and gut microbiota in relation to AD. Additionally, we provide a comprehensive overview of recent clinical and fundamental research on NPs targeting the skin and gut microbiota for AD treatment. We anticipate that our work will contribute to the future development of NPs and facilitate research on microbial mechanisms, based on the efficacy of NPs in treating AD.
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Affiliation(s)
- Hang Zhao
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xin Ma
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Jiankun Song
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Jingsi Jiang
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Xiaoya Fei
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Yue Luo
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Chunjie Gao
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Bin Li
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, 201203, China
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41
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Caffarelli C, Giannetti A, Giannì G, Ricci G. Anti-inflammatory and biologic drugs for atopic dermatitis: a therapeutic approach in children and adolescents. Front Med (Lausanne) 2023; 10:1214963. [PMID: 37654660 PMCID: PMC10466416 DOI: 10.3389/fmed.2023.1214963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease with a heterogeneous pathogenesis correlated with dysregulation of the immune system and a prevalence of the T2-mediated immune pathway. Recent understanding of the pathogenesis of AD has allowed the development of new drugs targeting different mechanisms and cytokines that have changed the treatment approach. The aim of this review is to update knowledge on the standard of care and recent advancements in the control of skin inflammation. In light of recent guidelines, we report on the clinical efficacy of novel treatments, with special attention to situations where biologics and small molecules are involved.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Arianna Giannetti
- Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuliana Giannì
- Clinica Pediatrica, Azienda Ospedaliero-Universitaria, Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Giampaolo Ricci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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42
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Chen S, Tang L, Nie T, Fang M, Cao X. Fructo-oligofructose ameliorates 2,4-dinitrofluorobenzene-induced atopic dermatitis-like skin lesions and psychiatric comorbidities in mice. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2023; 103:5004-5018. [PMID: 36987580 DOI: 10.1002/jsfa.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by pruritus and eczema lesions and psychiatric comorbidities. The gut-brain-skin axis plays a pivotal role during AD development, which might suggest a novel therapeutic strategy for AD. The present study aims to uncover the protective effects and underlying mechanisms of fructo-oligofructose (FOS), a type of prebiotic, on AD-like skin manifestations and comorbid anxiety and depression in AD mice. RESULTS Female Kunming mice were treated topically with 2,4-dinitrofluorobenzene (DNFB) to induce AD-like symptoms and FOS was administered daily for 14 days. The results showed that FOS could alleviate AD-like skin lesions markedly as evidenced by dramatic decreases in severity score, scratching bouts, the levels of immunoglobulin E (IgE) and T helper 1(Th1)/Th2-related cytokines, and the infiltration of inflammatory cells and mast cells to the dermal tissues. The comorbid anxiety and depressive-like behaviors, estimated by the forced swimming test (FST), the tail-suspension test (TST), the open-field test (OFT), and the zero maze test (ZMT) in AD mice, were significantly attenuated by FOS. Fructo-oligofructose significantly upregulated brain neurotransmitters levels of 5-hydroxytryptamine (5-HT) and dopamine (DA). Furthermore, FOS treatment increased the relative abundance of gut microbiota, such as Prevotella and Lactobacillus and the concentrations of short-chain fatty acids (SCFAs), especially acetate and iso-butyrate in the feces of AD mice. The correlation analysis indicated that the reshaped gut microbiome composition and enhanced SCFAs formation are associated with skin inflammation and behavioral alteration. CONCLUSION Collectively, these data identify FOS as a promising microbiota-targeted treatment for AD-like skin inflammation and comorbid anxiety and depressive-like behaviors. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Shaoze Chen
- School of Medicine, Jianghan University, Wuhan, China
| | - Liu Tang
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tingting Nie
- School of Medicine, Jianghan University, Wuhan, China
| | - Mingyu Fang
- School of Medicine, Jianghan University, Wuhan, China
| | - Xiaoqin Cao
- School of Medicine, Jianghan University, Wuhan, China
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Salfi F, Amicucci G, Ferrara M, Tempesta D, De Berardinis A, Chiricozzi A, Peris K, Fargnoli MC, Esposito M. The role of insomnia in the vulnerability to depressive and anxiety symptoms in atopic dermatitis adult patients. Arch Dermatol Res 2023; 315:1577-1582. [PMID: 36749389 PMCID: PMC10338550 DOI: 10.1007/s00403-023-02538-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
Atopic dermatitis (AD) is a common inflammatory chronic skin disease typically associated with atopic comorbidities and other non-atopic conditions such as sleep disturbances, and mood/anxiety disorders. A growing literature proposed a crucial role of sleep disturbances in the development of mental health problems in AD. We tested this assumption by mediation model analyses in adult AD patients.A total of 57 patients (mean age ± std. dev., 34.28 ± 13.07 years; 27 males; range 18-67 years) diagnosed with AD participated in a cross-sectional study. We evaluated self-perceived severity of AD, insomnia, depression, and anxiety symptoms using validated questionnaires: the Patient-Oriented Eczema Measure (POEM), the Insomnia Severity Index (ISI), the Beck Depression Inventory-second edition (BDI-II), and the Generalized Anxiety Disorder-7 scale (GAD-7), respectively. Two mediation models were performed, testing the mediation effect of insomnia symptoms on the relationship between AD severity and depression (model 1) and anxiety (model 2). AD symptoms, as expressed by POEM, were positively associated with insomnia, depression, and anxiety severity. Insomnia fully mediated the effect of AD severity on depression and anxiety. Specifically, insomnia accounted for 81.64% of the relationship between atopic eczema severity and depression, and for 81.84% of the effect of AD severity on anxiety symptoms. The present study proposed a critical role of insomnia in predisposing adult AD patients to experience depression and anxiety. Early interventions focused on treating sleep disturbances could indirectly be beneficial on mental health of patients with AD, counteracting the onset and exacerbation of anxiety and depression disorders.
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Affiliation(s)
- Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Daniela Tempesta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea De Berardinis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
| | - Andrea Chiricozzi
- UOC di DermatologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- UOC di DermatologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy.
| | - Maria Esposito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- UOSD General and Oncologic Dermatology, San Salvatore Hospital, L'Aquila, Italy
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Cortés H, Cariño-Calvo L, Reyes-Hernández OD, Rojas-Márquez M, Magaña JJ, Vizcaino-Dorado PA, Villegas-Vazquez EY, Quintas-Granados LI, Jiménez-Islas E, Cortés-Mollinedo VA, Leyva-Gómez G, González-Del Carmen M. High Levels of Anxiety, Depression, Risk of Suicide, and Implications for Treatment in Patients with Lamellar Ichthyosis. Healthcare (Basel) 2023; 11:2071. [PMID: 37510511 PMCID: PMC10380064 DOI: 10.3390/healthcare11142071] [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: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Lamellar ichthyosis (LI) is a genodermatosis that injures the structure and function of the skin, affecting the appearance and self-esteem of patients, which may seriously impair their mental health and quality of life. In the present study, we determined anxiety, depression, and suicidal risk levels in patients with LI through the Beck anxiety and depression inventories (BAI and DBI-II, respectively) and the SAD PERSONS scale (SPS). We observed that anxiety, depression, and suicidal ideation were strongly associated with the LI (Cramér's V = 0.429, 0.594, and 0.462, respectively). Furthermore, patients with LI showed a significant increase in the scores of anxiety, depression, and suicidal risk (p = 0.011, <0.001, and 0.001, respectively) compared to individuals without the disease. Additionally, the suicide risk increased even more in patients who presented comorbidity of anxiety and depression than in patients who presented only anxiety or depression (p = 0.02). Similarly, the increase in the BAI scores correlated with the score observed on the SPS. Our results indicate that patients with LI have higher levels of anxiety and depression compared to individuals without the disease, which could be associated with suicidal risk. Therefore, the collaborative involvement of skin and mental health professionals is necessary to manage patients with LI appropriately. We believe that psychiatric studies and individual evaluations must be performed in LI patients to determine a treatment that, in addition to reducing skin symptoms, focuses on reducing the levels of depression and anxiety and improving the quality of life to reduce the risk of suicide.
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Affiliation(s)
- Hernán Cortés
- Laboratorio de Medicina Genómica, Departamento de Genómica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | | | - Octavio D Reyes-Hernández
- Laboratorio de Biología Molecular del Cáncer, UMIEZ, FES Zaragoza, Universidad Nacional Autónoma de México, Ciudad de México 09230, Mexico
| | - Martín Rojas-Márquez
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Secretaría de Salud, Ciudad de México 14080, Mexico
| | - Jonathan J Magaña
- Laboratorio de Medicina Genómica, Departamento de Genómica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | - Pablo A Vizcaino-Dorado
- Laboratorio de Medicina Genómica, Departamento de Genómica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | - Edgar Y Villegas-Vazquez
- Laboratorio de Farmacogenética, UMIEZ, FES Zaragoza, Universidad Nacional Autónoma de México, Ciudad de México 09230, Mexico
| | | | - Elizabeth Jiménez-Islas
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | | | - Gerardo Leyva-Gómez
- Departamento de Farmacia, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
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Lugović-Mihić L, Meštrović-Štefekov J, Potočnjak I, Cindrić T, Ilić I, Lovrić I, Skalicki L, Bešlić I, Pondeljak N. Atopic Dermatitis: Disease Features, Therapeutic Options, and a Multidisciplinary Approach. Life (Basel) 2023; 13:1419. [PMID: 37374201 DOI: 10.3390/life13061419] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The latest findings regarding AD pathogenesis point to an impaired function of the epidermal barrier, changed immune response, colonization of the skin by microorganisms, and certain psychological factors among other causes/triggers. The inflammatory response of AD patients is mainly associated with the activation of T cells (Th2 cells predominate), dendritic cells, macrophages, keratinocytes, mast cells, and eosinophils. Therapy usually involves medical evaluations and adequate management including treatment of concomitant diseases (e.g., allergies and infections), patient education and nursing care, psychological support, and nutritional consultations, which are organized through specific programs and structured educational groups. Systemic AD therapy includes conventional systemic treatment (cyclosporine, methotrexate, azathioprine) and new, specific drugs, interleukin inhibitors (e.g., dupilumab) and JAK inhibitors (baricitinib, abrocitinib, upadacitinib, etc.). Since many AD patients are affected by various psychological factors and comorbidities, they should be assessed and managed through a multidisciplinary approach, involving different professions (psychologists, ear-nose-throat specialists, pulmonologists, allergologists, immunologists, nutritionists, pediatricians, gastroenterologists, psychiatrists (when necessary), and others). A multidisciplinary approach provides better coping strategies and improves control over the disease, patient adherence to therapy, and quality of life. It also has a positive influence on family quality of life while at the same time making more efficient use of dermatology healthcare resources, reducing the economic burden on both patients and society.
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Affiliation(s)
- Liborija Lugović-Mihić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Jelena Meštrović-Štefekov
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ines Potočnjak
- Institute for Clinical Medical Research and Education, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Tea Cindrić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Ivana Ilić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ivan Lovrić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Lucija Skalicki
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
| | - Iva Bešlić
- Department of Dermatovenereology, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nives Pondeljak
- School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Dermatology and Venereology, General Hospital Sisak, 44000 Sisak, Croatia
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Wu S, Lei L, Hu Y, Jiang L, Fu C, Zhang Y, Zhu L, Huang J, Chen J, Zeng Q. Machine learning-based prediction models for atopic dermatitis diagnosis and evaluation. FUNDAMENTAL RESEARCH 2023. [DOI: 10.1016/j.fmre.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Proença CC, Mayor SAS, Ragazzo TS, Munhoz SDG, Pires CG. Use of cyclosporine in children and adolescents with moderate to severe atopic dermatitis: clinical experience in a Tertiary Hospital. An Bras Dermatol 2023:S0365-0596(23)00071-5. [PMID: 36973096 DOI: 10.1016/j.abd.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 03/28/2023] Open
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Lauron S, Plasse C, Vaysset M, Pereira B, D’Incan M, Rondepierre F, Jalenques I. Prevalence and Odds of Depressive and Anxiety Disorders and Symptoms in Children and Adults With Alopecia Areata: A Systematic Review and Meta-analysis. JAMA Dermatol 2023; 159:281-288. [PMID: 36696123 PMCID: PMC9878435 DOI: 10.1001/jamadermatol.2022.6085] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/23/2022] [Indexed: 01/26/2023]
Abstract
Importance Two recent meta-analyses reported a high prevalence of both anxiety and depression in patients with alopecia areata (AA), as well as a positive association of AA with anxiety and depression, without distinguishing between disorders and symptoms. Yet, depression and anxiety can manifest either as symptoms identified in questionnaires or as specific diagnoses defined by Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria. Objective To perform a large meta-analysis separating the prevalence of depressive and anxiety disorders from that of depressive and anxiety symptoms in patients with AA. Data Sources PubMed, ScienceDirect, the Cochrane Library, Embase, and PsycINFO databases were searched from inception through August 1, 2020. Study Selection Studies that contained data on the prevalence of depressive or anxiety disorders or symptoms were included. Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were used. Pooled prevalence was calculated with a random effects model meta-analysis that took into account between- and within-study variability. Meta-regressions were used to study the association between variations in prevalence and study characteristics. Main Outcomes and Measures The prevalence of depressive and anxiety disorders and symptoms in patients with AA. Results Thirty-seven articles (29 on depression and 26 on anxiety) that met the inclusion criteria were identified. By distinguishing between disorders and symptoms, the prevalence of both depressive disorders (9%) and unspecified anxiety disorders (13%) in patients with AA was shown to be greater than that in the general population. The prevalence and odds ratio (OR) of depressive disorders (prevalence, 9%; OR, 1.38) and anxiety disorders of which each category had been specifically studied (prevalence, 7%-17%; OR, 1.51-1.69) were markedly lower than that of depressive symptoms (prevalence, 37%; OR, 2.70) and anxiety symptoms (prevalence, 34%; OR, 3.07). Meta-regressions showed that variations in prevalence were mainly associated with methodological differences between studies. Conclusions and Relevance In this systematic review and meta-analysis, the separate analyses showed that 7% to 17% of patients with AA had depressive or anxiety disorders that require psychiatric care, including specific medication. Additionally, more than one-third of patients had symptoms that are warning signs and that need monitoring because they can develop into disorders.
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Affiliation(s)
- Sophie Lauron
- Pascal Institut, Adult Psychiatry and Medical Psychology Department, CNRS, CHU Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
| | - Camille Plasse
- Pascal Institut, Adult Psychiatry and Medical Psychology Department, CNRS, CHU Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
| | - Marion Vaysset
- Pascal Institut, Adult Psychiatry and Medical Psychology Department, CNRS, CHU Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Clinical Research and Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel D’Incan
- Dermatology Department, Clermont Auvergne University, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Adult Psychiatry and Medical Psychology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Jalenques
- Clermont Auvergne INP, Pascal Institut, Adult Psychiatry and Medical Psychology Department, CNRS, CHU Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
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Rondepierre F, Tauveron-Jalenques U, Valette S, Mulliez A, D’Incan M, Lauron S, Jalenques I. Psychiatric symptomatology in skin-restricted lupus patients without axis I psychiatric disorders: A post-hoc analysis. PLoS One 2023; 18:e0282079. [PMID: 36857334 PMCID: PMC9977055 DOI: 10.1371/journal.pone.0282079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Skin-restricted lupus is a chronic inflammatory disease associated with high rates of depression and anxiety disorders. Patients without psychiatric disorders can experience anxiety and depressive symptoms at a subclinical level, which could be risk factors for progression towards psychiatric disorders. It was decided, therefore, to investigate the presence of specific symptoms in skin-restricted lupus patients without axis I psychiatric disorders and their impact on the occurrence of axis I psychiatric disorders during the study follow-up. METHODS Longitudinal data of 38 patients and 76 matched controls without active axis I psychiatric disorders from the LuPsy cohort were used. Depressive, neurovegetative, psychic and somatic anxiety symptom scores were established from the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating scale (HAMA). RESULTS None of the participants had any current active axis I psychiatric disorders but the patients had personality disorders more frequently and had received more past psychotropic treatments than the controls. They also had higher MADRS and HAMA scores than the controls, in particular neurovegetative, psychic anxiety and somatic symptoms scores. No dermatological factor tested was associated with these scores, whereas being a lupus patient was associated with higher neurovegetative and somatic symptoms scores, having a current personality disorder with higher depressive and neurovegetative scores and receiving more past psychotropic treatments with psychic anxiety and somatic symptoms scores. The occurrence of psychiatric disorders during the study follow-up was associated with an elevated psychic anxiety score at baseline and past psychotropic treatment but not with history of psychiatric disorder. LIMITATIONS The LuPsy cohort included a large number of patients with axis I psychiatric disorders, the sample without axis I psychiatric disorders is therefore limited. CONCLUSIONS We observed numerous psychiatric symptoms among the skin-restricted lupus patients. They should therefore receive special attention in the management of their subclinical symptoms before they progress towards full psychiatric disorders.
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Affiliation(s)
- Fabien Rondepierre
- CHU Clermont-Ferrand, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Clermont-Ferrand, France
| | - Urbain Tauveron-Jalenques
- Clermont Auvergne Université, CNRS, CHU Clermont-Ferrand, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Solène Valette
- Clermont Auvergne Université, CNRS, CHU Clermont-Ferrand, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Direction de la Recherche Clinique et de l’Innovation, Clermont-Ferrand, France
| | - Michel D’Incan
- Clermont Auvergne Université, INSERM, CHU Clermont-Ferrand, Service de Dermatologie, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Sophie Lauron
- Clermont Auvergne Université, CNRS, CHU Clermont-Ferrand, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Isabelle Jalenques
- Clermont Auvergne Université, CNRS, CHU Clermont-Ferrand, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France,* E-mail:
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Rønnstad ATM, Bay L, Ruge IF, Halling AS, Fritz BG, Jakaša I, Luiten R, Kezic S, Thomsen SF, Bjarnsholt T, Thyssen JP. Defining the temporal relationship between the skin microbiome, immune response and skin barrier function during flare and resolution of atopic dermatitis: protocol of a Danish intervention study. BMJ Open 2023; 13:e068395. [PMID: 36806068 PMCID: PMC9944644 DOI: 10.1136/bmjopen-2022-068395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Lesional skin of atopic dermatitis (AD) is often colonised by Staphylococcus aureus and the bacterial abundance increases during a flare. However, the role of S. aureus and the skin microbiome in the pathogenesis of AD, including its influence on the dysfunctional skin barrier and immune response, remains to be elucidated. In this study, the temporal relationship between alterations in the skin barrier function, inflammation and microbiome is examined in adults with AD. METHODS AND ANALYSIS This clinical study consists of 81 adult patients with AD, as defined by the Hanifin and Rajka criteria, and 41 age and sex-matched controls. The objectives are to examine alterations in the skin microbiome, skin barrier and immune response during (1) an untreated AD flare, (2) an AD flare treated with topical corticosteroids (TCS), (3) an AD flare treated with systemic dicloxacillin/placebo and TCS or (4) cutaneous exposure to either autologous S. aureus, staphylococcal enterotoxin B or a vehicle. Skin biopsies, tape strips, skin and nasal swabs are collected and analysed using RNA sequencing, multiplex immunoassays, liquid chromatography-mass spectrometry and 16S rDNA. Blood samples are analysed for filaggrin gene mutations and leucocyte gene expression. ETHICS AND DISSEMINATION The scientific Ethical Committee of the Capital Region in Denmark (phases I and II: H-20011047, phases III and IV: H-21079287), the local data protection agency (phases I and II: P-2020-165, phases III and IV: P-2022-250) and the Danish Medicines Agency (phases III and IV: EudraCT 2021-006883-25, ClinicalTrials.gov: NCT05578482) have approved the studies. Participants will give written informed consent prior to study initiation. The study is conducted in accordance with the Helsinki Declaration. Outcomes will be presented at national and international conferences and in international peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05578482, EudraCT 2021-006883-2.
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Affiliation(s)
| | - Lene Bay
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Iben Frier Ruge
- Department of Dermatology and Venerology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Venerology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Blaine Gabriel Fritz
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Ivone Jakaša
- Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Rosalie Luiten
- Laboratory of Experimental Dermatology, Department of Dermatology and Netherlands Institute for Pigment Disorders, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Simon Francis Thomsen
- Department of Dermatology and Venerology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Venerology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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